Joe Therapist is an intern at a high-stress, nonprofit agency in downtown Any City, U.S.A. A week after the terrorist destruction of the World Trade Center Towers, he sees six or seven clients daily, often after conducting CISDs for government employees. Joe is angered when one of his regular clients, a 27-year-old single female, shows no inclination to share any feelings about the terrorist attack, and instead spends the session talking about her inability to choose between two boyfriends.

Joe is disappointed in himself because he knows very well that his client has displaced her anxiety over the terrorist crisis onto relationship issues that she finds easier to handle. Joe almost wishes he could be one of the heroic firefighters, cops, paramedics he's watched on TV. They seem like society's true heroes, admired by everyone.

Joe, forgive yourself for your anger. What you've really wanted to do the last week is stay in bed and hide under the covers. Only your sense of duty has brought you here to see clients. In this crisis you tell clients that just about anything they're feeling is normal. Why should your feelings be any different?

Remember to value your work and expertise. As a mental health provider, day after day, you are also on the front lines. You deal with men and women who have lost the will to live or who struggle with depression or chemical dependency, couples who are deeply attached but cannot seem to stop hurting each other. This crisis arouses the same fears, feelings of inadequacy, longings for love and recognition, that you work with every day. It's the expertise you gained in your daily work that allows you to deal so capably with traumatized clients.

Accept your own feelings unconditionally and then examine them. Are you angry because your work goes unacknowledged by the world at large, and sometimes individual clients seem far from grateful? Are you perhaps angry because you resent having to take care of others at this time when you'd rather have someone take care of you? Remember that one of the reasons you became a therapist was that one connection when a mentor changed your life forever. If your mentor had that much power over your life, is it so difficult to value what you do for others?

Use your feelings in your work. You don't have to pretend that you've mastered all your own fears and uncertainties. You know the importance of keeping good boundaries and setting firm limits around personal questions your client may ask. But if you model unassailable calm and false security, your clients will suppose they have to behave in the same way. When you remind your clients about some possible reactions to trauma numbing, denial, depression, vulnerability, fear it's useful to indicate by your demeanor that you are no stranger to these human emotions.

Take your own advice. You know how you "should" behave after trauma. Rest, talk, spend some time together, some time alone, eat good food, get some exercise. What you really want to do these days is oversleep, overeat, and stay glued to the TV. Don't criticize yourself for wanting to go splat. And when you recover and resume more regular behavior, don't overdo it. Spend 10 minutes on a slow treadmill instead of 30 minutes on the Stairmaster. Walk in the park and smell the trees instead of attempting your usual 30-minute run while your energy is still depleted. And remember you can hold your head high in the company of other heroes.

References:

Casement, Patrick J. (1991) Learning from the Patient. New York: The Guilford Press

McMahon, Susanna (1992) The Portable Therapist. New York: Dell

09/15/01

Ken Martin, LMFT is a psychotherapist in private practice in San Francisco. His experience of crises includes growing up in Northern Ireland and working on the AIDS wards at San Francisco General in the first years of the epidemic.