Therapy After Terror: 9/11, Psychotherapists, and Mental Health.

Trent, September K. ; Sutton, Geoffrey W.

THERAPY AFTER TERROR: 9/11, PSYCHOTHERAPISTS, AND MENTAL HEALTH. Karen M. Seeley. New York: Cambridge University Press. Hardcover. 242 pp. $35.00. ISBN: 978-0-521-88422-8.

"Everybody's trauma was so raw. It didn't matter who you were talking to--relief worker, direct victim, other therapists--you were all the same body in some ways" (p. 152). Seeley peppers her analysis of the effects of 9/11 on psychotherapists and the field of mental health with excerpts from pungent and thoughtful interviews. We glimpse the chaos through the eyes of psychotherapists who lived the trauma in their personal and professional lives. On the morning of September 11, 2001, New York therapists are running to the Red Cross shelters to donate their time, psychologists are treating patients who are eyewitnesses to the worst enemy attack on the American homeland, and counselors, themselves victims who lost everything, are trying to counsel others through trauma-colored lenses. Seeley examines the diagnosis of Post Traumatic Stress Disorder in light of the severe impact of the terrorist attacks and the difficulties mental health professionals had when attempting to formulate a diagnosis. The author, Karen M. Seeley, MSW, Ph.D., is a clinical social worker and cultural psychologist in the Anthropology Department at Columbia University. In addition to her academic qualifications, she provides a highly readable and thoughtful analysis of psychotherapy in the context of terror.

In the first and second chapters, the events of 9/11 are retold in the context of therapists' views of the event and their attempts to donate their skills. Project Liberty, a government funded mental health project, was formed immediately following 9/11 to help its victims deal with their unsteady mental health. Seeley uses personal recounts by psychotherapists as they tried to volunteer their services for Project Liberty and the Red Cross. Many psychotherapists experienced confusion, which they attributed to problems of organization and education about handling a mental health crisis. Most of the professionals did not feel helpful because they were sent to places where no victims arrived. Only later did they learn that no victims arrived because so few survived the twin towers attack.

As readers, we gain insights from Seeley and the psychotherapists that are notably different perspectives on the effects of the terrorist attacks. Because the American mass media focused on the visual assault and the horrific destruction, an in-depth exploration of the psychological sequellae has been missing. Seeley illustrates how the emotional aftermath silently but powerfully impacted a wide swath of people in New York City. In particular, the psychotherapists' stories are heart wrenching. Their narratives take the reader to ground zero, facilities where families are struggling to find lost loved ones, and the private offices of psychologists. Through Seeley's reconstructed timeline of the events and the ineffective efforts to cope with the trauma by some of New York's most experienced therapists, chapters one and two capture the reader's desire to learn the lessons from these untold stories of 9/11.

A few days after 9/11, the Red Cross and Project Liberty identified the problems and places where psychotherapists were needed. Chapters three and four explore a range of psychotherapists' experiences in different facilities. Both the Red Cross and Project Liberty sent psychotherapists to ground zero to talk with fire fighters, police, and construction workers who were searching for survivors. other professionals were sent to Family Assistance Centers or service Centers that were set up by the government to help families find and identify lost loved ones and to obtain monetary support from the government. All of the psychotherapists spoke about the extreme difficulty they experienced in trying to help so many victims and their families. The workers at ground zero did not want to talk about anything; they wanted to keep working because they might find one of their fallen colleagues. For the families of those who were in the twin towers, it was difficult to accept a loss that included no remnants of their dead family members. A poignant example of emotional pain is one psychotherapist's report of a family receiving a container representing the ashes of their loved one from one of Rudy Giuliani's aides. Seeley offers great insight into the emotional vulnerability of many different kinds of victims--both clients and psychotherapists. As clinicians we appreciate the analysis but, as ordinary readers, we are captivated by the stories and yearn to know what happened to these people.

Chapters five and six discuss the toll that helping trauma survivors takes on psychotherapists and the problematic diagnosis of Posttraumatic Stress Disorder. All of the psychotherapists experienced the same emotions that their clients experienced. Many of the psychotherapists lived through the same traumatic events as did their clients. Understandably, psychotherapists found it difficult to hide their own emotions and experiences during psychotherapy so that their clients could fully disclose their feelings and focus on their recovery. How appropriate is it for psychotherapists to treat clients while struggling to manage the same symptoms? Many New York therapists did just that. They felt that they had to help the victims; the victims' mental health was more important than their own. with every new client and every recounting, the psychotherapists were retraumatized. Should psychotherapists endanger themselves under extreme circumstances?

Related to the problem of psychotherapists' perspective on the trauma, is the difficulty they experienced in diagnosing their clients. Many diagnosed their clients with Posttraumatic Stress Disorder (PTSD) without considering the time the client had experienced the symptoms or the related diagnosis of Acute Stress Disorder. Many psychotherapists felt that the Diagnostic and Statistical Manual (DSM) was not useful in the diagnosis of victims from 9/11 because there was no appropriate diagnosis. Complicating the psychotherapists' dilemma were signs listing PTSD symptoms posted throughout New York City. Although PTSD came closest to the expressed symptoms, other nuances could not be accounted for such as the variations in intensity of responses experienced by those walking among human debris versus those experiencing and re-experiencing the visual violence on television and realizing their husband or wife was in that conflagration. She closes chapter six with a thoughtful discussion of emotional contagion as so many trauma victims in close proximity shared their stories and symptoms. Disturbingly, some of these were also psychotherapists, who may have increased rather than alleviated the trauma.

In the last chapters, Seeley summarizes what psychotherapists learned about trauma and how to treat it. Numerous classes and programs are not educating the psychological community because many of the psychotherapists felt incompetent. Many of the psychotherapists questioned the relevance of traditional psychotherapy. They felt that the therapy sessions and all the theories of psychology that they had been taught were not working. The question of theory has stimulated research about the psychological impact of 9/11 and effective treatments for victims of extreme trauma. Seeley identifies spirituality as one dimension that can be helpful to those experiencing trauma. Many psychotherapists found it exceedingly difficult to work with clients who had no spirituality. Psychotherapists will find that these last chapters are very informative because Seeley identifies specific problems and difficulties experienced by victims of terrorist attacks.

We believe readers will benefit from Seeley's informed psychological perspective on the terrorist attacks of 9/11. Although Seeley briefly discusses spirituality, readers of JPC will find that God is mostly absent from the analysis. Given her post-trauma perspective, we can excuse Seeley from a theological discussion of the attack. Yet, we wonder about the spirituality of the psychotherapists and their clients. were people of faith any more compassionate than others? Did any feel empowered by their faith to serve others? Did any have a healthy spirituality that, despite feeling wounded at the time, served as a catalyst to their recovery?

Reviewed by September K. Trent and Geoffrey W. Sutton (Evangel University/Springfield, MO).