Twelve years ago today, terrorists crashed two planes into the World Trade Center in New York City, another plane into the Pentagon and one more into a field in Pennsylvania, leading to nearly 3,000 deaths and a nation suddenly awakened to its own vulnerability.

The anniversary of the 9/11 attacks takes an emotional toll on the entire country, but it is especially difficult for those who witnessed the events firsthand. Counselors have the ability to be a sounding board and support system for clients affected by the tragedy, but they must also keep in mind the impact the event may have had on them personally.

Gail Roaten, an associate professor of psychology at Hardin-Simmons University, recalls the anxiety she felt on the day of the attacks when she didn’t hear from one of her daughters, who worked for an investment firm in New York City and regularly visited the World Trade Center to deliver and pick up documents. Yet Roaten, working as a high school counselor at the time, was tasked with helping her students process their emotions.

“Students began coming into our counseling suite, crying and upset with what they had seen and heard,” she says. “Managing my own anxiety was important in helping students deal with theirs. I met with students for about an hour. … I continued to process feelings with students [and] talk about coping skills, but after about two hours of working with students, I found that I was not really being effective. My own emotions were in turmoil, [and] I could not focus on my clients. I sat in my office and really tried to apply the tools I had discussed with my students on myself.”

Roaten and her husband were greatly relieved upon receiving an email from their daughter around 4 p.m. and learning she was OK.

Eric Gentry, vice president of the International Association of Trauma Professionals, admits he is still haunted by the events.

“Earlier this year, I was walking on Liberty Street in lower Manhattan and couldn’t help thinking about how much change we have all seen since I walked those same streets in late September 2001,” says Gentry, a private practice counselor based in Sarasota, Fla. “While walking, it dawned on me how much those events have become part of my life. I fly over 200,000 miles each year, and I never get on a plane that I am not reminded, unbidden, of the events of Sept. 11. I am never in a multifloored building that I don’t semiconsciously look out the window, halfway expecting to see an airplane hurling itself toward me. That day and the images associated with the events that occurred that day have become part of the collective, nonverbal, implicit memory of a nation.”

“The conscious and unconscious memory of these events have become part of the warp and weft of our worldview,” he says. “We perceive a more dangerous world than we used to, even though we are safer than we have ever been. Because many of us experience an uptick in perceived threat after witnessing trauma, we see our world [being] a little more dangerous than we did before. We find ourselves with a little more [emotional] dysregulation. We find ourselves a little more stressed out. … We are a more anxious people than anytime before now, and much of this is attributable to 9/11.”

Lennis Echterling, a counseling professor at James Madison University, says the anniversary of the attacks is “part of our collective psyche. One only has to mention 9/11 to evoke vivid images and memories of the incidents that took place on that fateful day.”

It is an especially difficult time for those who lived close to the epicenters in New York City, Washington and Pennsylvania. Echterling says counselors can help those individuals to “assess again the impact of those horrific events, and spur reflections on their meaning and place in one’s life.”

Roaten says special care should be taken with children and teenagers who are affected by the event.

“As a counseling team,” she says, “we sent tips home to parents about how to talk to their kids [about the event]. We suggested parents limit TV and news coverage of the event itself and the aftermath. We suggested ways that teachers and parents could help kids process feelings and seek ways to be constructive.”

Clients overcoming trauma have reported to Echterling that, on the anniversary of 9/11, their memories of what happened become “not only more frequent, but also more vivid and clear,” he says. “The original feelings and reactions to the event often reemerge at this time. For some, the anniversary is accompanied by feelings of frustration, hopelessness and disappointment because survivors must acknowledge that many of their life circumstances may be forever changed.”

Jane Webber, a private practice counselor and adjunct professor of counselor education at Kean University, says the anniversary of 9/11, the recent Boston Marathon bombings, the shootings at Sandy Hook Elementary School and other events of mass violence can trigger raw emotions and traumatic reactions. “Individuals can feel a range of responses from vulnerable, uncertain and empty to sad and angry,” she says. “The barrage of media coverage [on] TV, Facebook, Twitter and texting can trigger memories that were forgotten or put aside.”

Roaten agrees that technology can be particularly problematic for survivors, and especially children.

“As I watch TV coverage of crises around our country,” she says, “I continue to advocate for parents trying to control how much of the coverage their kids see and hear. It is important for parents to answer kids’ questions honestly and to talk about their feelings.”

Webber, a member of the ACA Crisis Response Planning Task Force and co-editor of the third edition of Terrorism, Trauma and Tragedies: A Counselor’s Guide to Preparing and Responding, notes that teens who were young children at the time of the 9/11 attacks “may be confused by the barrage of video clips and photos each year that they piece together as a patchwork narrative to help make sense of their loss. Teens may struggle with fulfilling their support role at home or with pending decisions about military or service careers to follow family traditions as firefighters or police.”

She echoes Roaten, saying parents need to “be available to listen and respond to questions with developmentally appropriate answers and lots of love.”

Many survivors feel the need to partake in some sort of commemorative action in honor of the anniversary. Echterling says counselors can help by recommending “that all citizens take some constructive and positive action, such as participating in a memorial event or reaching out to those grieving with supportive messages of support and condolence.”

Around the anniversary, survivors may also be confronted with friends and relatives urging them to put the past behind them and move on from the events.

“As counselors,” Echterling says, “we can give permission to survivors to reflect more on the past at the time of an anniversary. We can encourage everyone to be especially supportive of survivors who lost loved ones. We also can remind survivors that they do not have to carry their burdens alone.”

Webber says counselors should be prepared for clients to feel “distressed, upset and to say they are ‘not OK.’”

“Trauma-informed counseling recognizes that the majority of clients will experience trauma in their lifetime,” she says, “with Sept. 11, 2001, experienced and witnessed by nearly everyone in the country.”

She gives counselors the following recommendations:

• Listen and be fully open to the client’s experience.

• Check for risk-taking or harmful behaviors as well as substance abuse, all of which can increase with triggers related to 9/11.

• Assess for changes in sleeping, eating, work habits and relationships that do not return to normal in a few days.

• Be prepared to hear spontaneous stories of trauma and grief.

• Build on the client’s strengths, resilience and support systems.

• Suggest exercises such as walking, dance and yoga, as well as breathing and relaxation techniques. These activities “focus on emotional and physical regulation,” Webber says.

Roaten reminds counselors that they, too, may need support during this time.

“I always share my own experience with this particular crisis and talk about counselor stress,” she says. “Counselors must be engaged in ongoing reflection, self-care and wellness to be who and what they need to be for their clients.”

Adds Webber, “[Counselors] should be alert to our own signs of vicarious trauma, emotional dysregulation, and concurrent trauma in our shared experience of 9/11. We may need time to reflect, consult with colleagues and supervisors and be mindful of the impact trauma can have on each of us in a changed world.”

The events of 9/11 continue to haunt America’s history and collective memory. But Gentry says the date also marks a significant shift for the counseling profession.

“Since that fateful day, the mental health field has embraced and centralized understanding, diagnosing and treating traumatic stress,” Gentry says. “Over the past decade, trauma has rightly taken its seat at the center of research and development. Research in the area of trauma and PTSD has exponentially proliferated since 2001, causing some evolutional leaps in understanding of and treatment for trauma survivors. As we pass the baton of leadership to the generation that follows 2001, I know of no better way to honor the memory of the victims and indomitability of the survivors than to, in their names, continue to evolve our understanding and treatment of the effects of traumatic stress — primary and secondary — for all survivors of trauma.”

 

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Heather Rudow is a staff writer for Counseling Today.

Letters to the editor: CT@counseling.org