Ten years ago this month, terrorists crashed two planes into New York City’s World Trade Center and another plane into the Pentagon just outside of Washington, D.C. A fourth plane crashed in a field in Pennsylvania after passengers fought to regain control of the aircraft, preventing terrorists from reaching their intended target, thought to be the U.S. Capitol building or the White House.

Altogether, nearly 3,000 people died, and an entire nation was affected to its core.

In the aftermath of the tragedy and turmoil, counselors walked alongside individuals affected by the events, attempting to offer assistance during an unprecedented time for which no counselor could have truly prepared. In a multitude of ways both large and small, Sept. 11, 2001, forever changed our nation, and many counselors contend that it forever changed the profession of counseling as well.

Jane Webber, now an associate professor and coordinator of the counseling program at New Jersey City University, was director of guidance at Roxbury High School in New Jersey when the events of 9/11 unfolded. In addition, at the time she was serving as chair of the American Counseling Association Foundation. In that role, she says, it became clear early on that counselors desperately needed information. They needed resources and skills training that could be organized and disseminated quickly, both to help them deal with the massive impact of what had happened and to prepare to effectively assist the millions of people who had been affected, directly or indirectly, by the terrorist attacks.

In the immediate aftermath, Webber volunteered at train stations with others from her community to assist those commuting home from New York City. “Seeing ashen-covered survivors walking from the trains was surrealistic. Checking for cars remaining in the commuter lots was also unnerving. I prayed that the next day, that car would not be there,” says Webber, a major contributor to the first edition of Terrorism, Trauma and Tragedies: A Counselor’s Guide to Preparing and Responding, published by the ACA Foundation in 2002, and coeditor of the second and third editions, the latter of which was published in 2010.

Daniel Weigel, an associate professor of counseling at Southeastern Oklahoma State University, headed to New York about six weeks after the attacks to serve as an American Red Cross disaster mental health volunteer at a service center near Ground Zero. He worked with individuals on an as-needed basis as they applied for Red Cross assistance. “Many had to wait in line for hours, requiring roving intervention as tempers flared,” remembers Weigel, a member of ACA. “Frustrations were high because the building was hot, loud and terribly overcrowded, and the aid recipients were at a point of great vulnerability and fear. Many of the people with whom I worked had lost family and friends [in the attacks or subsequently] lost their jobs and homes. Counseling sessions occurred in makeshift corners, storage closets and even restrooms that were out of service.”

A couple of hours outside Washington in the Shenandoah Valley of Virginia, James Madison University counseling professor Lennis Echterling, along with his colleagues and students, organized a volunteer group to provide outreach services, public education materials and consultation to the campus and local community in the wake of the attacks. Later on, Echterling also served as an American Red Cross disaster mental health volunteer at the Pentagon. He worked with survivors and their families, talking over cups of coffee, sharing meals and listening to their stories.

“One [Pentagon] staff member shared that this incident was far worse than his tours of duty as a Marine in Vietnam,” says Echterling, a member of ACA. “In Vietnam, all his comrades were trained warriors who knew they were going to be in harm’s way. He went on to say that, as horrible as it was, Vietnam was fought in the jungles on the other side of the world. The 9/11 attack was so much worse because it was here in our home and so many of his friends and colleagues, including his secretary, were killed.”

The man told Echterling that his secretary had been working in the office that day, totally unaware she was in the path of the oncoming plane even as he headed to a meeting in another part of the Pentagon. After the plane hit, the man tried to return to his office but was unable to make it through the smoke. “Although he helped many others escape that day, he found himself sometimes feeling a deep sense of shame and guilt about not being able to rescue his secretary, a mother of two young children,” Echterling says.

“At one point later in our conversation, I asked, ‘So, if this is worse than Vietnam, how in the world are you able to come back here and carry on the way that you’re doing?’ He paused, reflected and said that the cards, messages and support that he had already received kept him going. Some children had given [the Pentagon staff members] a banner of the American flag that they had created using red, white and blue handprints. Every time he looked at it, he was reminded that the kids represented our future. He would pass the flag, feeling confident that the U.S. was going to make it through these horrible times. At the end of our conversation, he shook my hand, thanked me and returned to his work.”

Another element of 9/11’s legacy within the profession was that it further established the central role that professional counseling plays in the mental health treatment community, Weigel says. “It has also given the field a greater responsibility with regard to our duty to serve others outside of agencies and hospitals,” he says. “The general skills provided by counselor training programs serve well as the foundation for our work. However, as the social environment changes, so must the continuing education focus of professional counselors and the emphases of training programs.”

Echterling says he has become more strengths-based and resolution-focused with clients since 9/11. “Although the 9/11 survivors were experiencing enormous shock, grief and fear, so many of them also gave voice to their feelings of determination and resolve,” he says. “In the midst of the chaos and turmoil of 9/11, people were stunned and overwhelmed. At the same time, although not as obvious, most survivors were also demonstrating resilience by their initiative and determination. I found myself bearing witness to both their anguish and their strengths — acknowledging their distress, but also reflecting their feelings of hope, compassion and courage.”

Another lesson learned, Webber says, was the need for training geared toward working with children and adolescents and helping parents to support their traumatized children. “Children are not little adults,” she says. “They need play, art, sand tray and expressive tools to share their trauma story, and we need training in these areas to provide developmentally effective trauma tools.”

The events of Sept. 11 also made it apparent that counselors and the counseling profession must continue to evolve and adapt as the needs of clients, their communities and the world evolve, Webber says. “Our sense of security and our encapsulated view that we are safe on American soil were shattered on Sept. 11. We have a heightened awareness of the impact of disasters and traumatic events around the world, and we learn what the people in other communities and countries need from them, not from us. Disaster and trauma counseling must be grounded in the community and the culture.”

During the traumatic events a decade ago, Echterling reminded himself that his goal as a counselor was not to rescue helpless victims but rather to help people create their own survival stories, make meaning of their experiences, manage their emotions and rebuild shattered lives. “The perspective of resilience was vitally important to me as a counselor,” he says. “Like gold miners, my clients and I were panning through the muck and mire of 9/11, finding nuggets of resilience and meaning. Most of the survivors had a powerful need to tell their stories, and the themes that emerged from these stories eventually shaped their own sense of personal identity and family legacy. In other words, the narratives that they created in counseling did much more than organize their life experiences. They affirmed their fundamental beliefs, guided important decisions and offered consolation and solace.”

“On 9/11, the narrative fabric of their lives was shredded,” Echterling continues. “The pieces no longer hung together, and they didn’t make any sense. The process of resilience, on the other hand, involves clients reweaving their shredded lives once again into a meaningful and integrated whole. Like a message written in code, the meaning of their 9/11 experience was not readily apparent. However, clients are compelled to make sense of their traumatic experience, discover its point or purpose, tie together the loose ends and make connections that previously escaped them. As counselors, we joined with survivors as they made that journey.”

A traumatized nation

The 9/11 attacks were so devastating, these counselors say, that people didn’t need to be working at the World Trade Center or the Pentagon that day to be deeply affected by what transpired. Many individuals were affected by vicariously experiencing the events repeatedly on television, says Webber, who is also a member of the ACA Crisis Response Planning Task Force. Students and staff at Webber’s school who had family members who worked in the Twin Towers were unquestionably hit hard, but even those who didn’t have a relative involved expressed fear of another terrorist attack and extreme concern for family members and friends, Webber remembers.

Although many of the physical and emotional wounds opened on that day may no longer be so raw, Weigel says the impact of 9/11 still lingers. “Most clients are at least indirectly affected by 9/11 and the changes it has caused in the lives of Americans, even though 10 years have passed,” he says. “It is one of those unimaginable societal moments that has changed things and continues to change things that Americans had taken for granted the day before the tragedy.”

J. Eric Gentry, a counselor who runs a private practice in Sarasota, Fla., says the terrorist attacks seemingly succeeded in creating a more frightened generation of Americans. “The events of 9/11 and the ensuing secondary traumatic stress resulting from watching and rewatching these events on the television [have] infected our nation,” says Gentry, who assisted in New York after Sept. 11 through the Green Cross, an organization that focused on traumatology. “I believe the events of 9/11 catalyzed and accelerated our nation toward [becoming] a trauma-saturated society of fearful, reactive and symptomatic — i.e., stressed out — citizens.”

Although it isn’t easy to combat fear, Gentry says one antidote is to help clients develop and master their capacity to regulate their bodies and autonomic nervous systems when encountering a perceived threat. “Trauma counselors are beginning to understand this truth and have begun teaching their clients to develop these important skills of self-regulation,” says Gentry, who contributed to the second and third editions of Terrorism, Trauma and Tragedies. “Self-regulation is developing the ability to continuously monitor and soften the tension in the muscles in one’s body while fully engaged in the activities of daily living. Simple. However, most people have never learned this crucial developmental skill. By developing this skill, fear, stress and perceived threat no longer generate distress and symptoms in our lives or the lives of our clients.”

Weigel says he doesn’t necessarily perceive more fear among people in general today, but rather a consistent and heightened level of vigilance. “Peace isn’t the same. War isn’t the same. Safety is no longer taken for granted,” he says. “And because of this, pre-9/11 coping mechanisms are not holding up as well as they once did. Add to that the current economic challenges and the tens of thousands of women and men serving in a brutal combat environment, along with their family members struggling at home, and our nation is left in a very tenuous state.”

In a nation 10 years removed from 9/11, Weigel believes it would be wise for counselors to return to the basics in their efforts to assist clients. “I can’t help but go back to the importance of the generalist model of counselor training and quintessential basic counseling skills that are often brushed over in the fast-paced nature of contemporary mental health care,” he says. “There is no ‘cookbook’ mental health solution to our current societal state of affairs. Rather, I believe it is the foundational counseling skills that will prove most helpful — most importantly, the basic counseling relationship-building skills and the non-agenda-driven focus of the wellness model of counseling. How can counselors help? By listening.”

Trained and ready

Since 9/11, Gentry contends the counseling profession has grown more “trauma-aware” instead of “trauma-phobic,” and he says the field is maturing toward “trauma-competent.”

“Before the events of Sept. 11, there was a tendency to treat trauma only when the clients’ symptoms met the threshold for post-traumatic stress disorder (PTSD),” Gentry says. “Today, I see most competent counselors addressing the effects of trauma as a ubiquitous component of comprehensive mental health care. I am excited and expectant about the positive changes for our field and our clients that this shift foreshadows.”

The events of Sept. 11 created more awareness of the situations that can lead to PTSD, Weigel says, both among counselors and the general public. “Throughout my career, I have seen the expansion of the definition of PTSD move from military combat and direct threats to one’s life, to [the inclusion of] compassion fatigue and vicarious exposure, such as the constant replaying of the terrorist attacks and the buildings collapsing on television after 9/11.”

Today, there is also greater recognition of the possibility for post-traumatic growth after trauma, Webber says. “The majority of survivors and those affected by mass disasters and traumatic events are able to return to their daily lives,” she says. “Because of these events, they often experience post-traumatic growth with a sense of personal change, spirituality, connections with others, increased awareness and insight. They have gone through a unique experience that they share with fellow survivors and responders. This is a deeply humanistic and existential experience that helps people move forward in their lives.”

Another change Webber says the 9/11 tragedy ushered in is that counselors are now being better prepared to respond to traumatic events. She points to the 2009 Council for Accreditation of Counseling and Related Educational Programs Standards, which require that all graduates of CACREP-accredited programs have “achieved standards in disaster, trauma and crisis knowledge and skills,” Webber says. “Post-9/11 counselors have an expanded awareness of and sensitivity to trauma and disaster. Counselors will be prepared to work with clients who experience mass disasters as well as individual trauma and also know when to refer clients. Compassion fatigue and vicarious traumatization in counselors working with traumatized clients is also part of counselor training. Counselors need to have a self-care plan and recognize symptoms.”

Both disaster response and trauma counseling have changed and improved since 2001, according to Webber. “Counselors use distinctive counseling approaches to trauma and disaster that are different from clinical mental health counseling,” she says. “There is a growing body of literature and research on trauma treatment, especially regarding developmentally appropriate trauma techniques with children.”

“Safety and trust are the foundation for trauma counseling,” Webber continues, “and building safety with traumatized clients may take much longer until it is safe enough for the client to begin sharing the trauma narrative. Expressive techniques — play, sand tray, drama, art, music — are more integrated in cognitive behavioral approaches, particularly in building a trusting relationship and in telling the trauma story.”

Judith Herman’s triphasic model of trauma recovery — safety and security, remembrance and mourning, and reintegration — continues to help counselors understand their role with regard to 9/11, Webber says. “Although most individuals return to a normal routine soon, 9/11 shook our bodies and souls, and after 9/11, many felt forever changed,” she says. “This memory, particularly around the anniversary, can be a trigger in a changed worldview that encompasses fear, anxiety and existential anxiety that stays with us each time we witness another disaster — [Hurricane] Katrina, [Hurricane] Rita, Virginia Tech, [the earthquakes in] Haiti and Japan. Hopefully we have filled our counseling tool kit with an array of new skills, including compassionate lurking, psychological first aid and new trauma techniques and skills for psychological recovery.”

While greater emphasis has been placed on crisis and disaster counseling skills since 9/11, Weigel says substance abuse counseling, including the role that alcohol and other drugs play in coping with fear, anxiety and mental health disorders that are exacerbated by tragedy, has also received increased attention. “That being said, I believe the need to establish a genuine working counseling relationship stands unaffected as the bedrock of any counseling intervention,” he says. “Carl Rogers’ core conditions are more important now than they have ever been.”

Disaster counseling is very different from traditional counseling, Weigel points out. Disaster counseling is performed in a high-stress environment that requires flexibility and collegiality among mental health professionals and other volunteers. It also requires good self-care strategies, because crisis counseling is intense and its effects on the helping professional can be long-lasting. “That being said, crisis work is also highly rewarding,” Weigel says. “You can make a huge impact on many lives in a very short period of time. I still have the homemade thank-you cards sent to us by children at a nearby elementary school. I’ll keep them forever.”

Learning from a tragedy

Webber believes the Sept. 11 tragedy left behind a number of lessons from which the counseling profession has learned and grown. “9/11 has shown us the tremendous need for counselors to be trained and prepared not only as ready responders for disaster, trauma and crisis response, but also as professionals who can recognize and address issues our clients bring to us much later,” she says. “We learned that each community and state needs a pool of trained, ready responders who can be called upon quickly. An important lesson is that counselors do not self-deploy or respond without being trained.”

Sept. 11 also taught the profession more about vicarious traumatization and compassion fatigue, Webber says. It served as an example to the profession of how counselors can suffer both vicarious traumatization and contemporaneous traumatization, which, Webber says, occurs when counselors are responding to the trauma of others while also being affected themselves.

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Under suspicion

“I remember Sept. 11, 2001, like it was yesterday,” says Daniel Weigel, an associate professor of counseling at Southeastern Oklahoma State University who spent time near Ground Zero working with the American Red Cross. “One powerful memory is of stepping on an elevator with a man who was a Muslim American. I said good morning to him, and he thanked me. I asked him why he had thanked me, and he said I was the only person who had spoken to him that day.”

“It was at that moment,” Weigel continues, “that I realized many Americans had already put a face on the enemy and wanted to do something to provide ‘justice.’ Some prayed, some put up the American flag, some joined the military and some committed hate crimes against Muslim Americans and their mosques.”

Weigel, a member of ACA, says he saw a level of profiling and stereotyping while working in New York. “I paid extra attention to individuals potentially identifiable as Muslim Americans and sought to make sure that the Red Cross service center at which I worked remained as safe as possible for everyone,” he says.

But a decade after 9/11, Weigel senses that the backlash against Muslim Americans is still being felt. “Some people are profiling the whole due to the actions of a few,” he says. “Therefore, I believe counselors must take a step back from the action-oriented counseling approaches and focus on the core counseling attribute of unconditional positive regard. Again, it goes back to relationship-building being the most important set of skills used by counselors.”

— Lynne Shallcross