When it really hurts to listen: psychotherapy in the aftermath of September 11.

Abstract

The work of psychotherapy demands that we listen to patients in a very special way. The process requires psychiatrists and other therapists, for a period of time, to step into their patients’ emotional shoes. Then, stepping out of those shoes, informed by feeling the full force of the patient’s emotional state, they are able to make empathic interventions that are responsive to their patient’s internal needs. What happens when these shoes are also our own shoes, and the pain that patients are feeling mirrors our own pain? In the months since September 11, many conferences and presentations have included discussions of the emotional aftereffects of the terrorist attacks. Posttraumatic stress disorder, grief, and loss have been the subjects of scientific panels, roundtable discussions, and Internet dialogues. Poignant presentations by individuals who were involved in immediate outreach have burned tragic images in the minds of those who were more physically distant from the events. In efforts to understand how best to respond, experts have drawn on experiences and information gained during responses to other disasters. We have learned a great deal from the reports made by dedicated volunteers, many of whom have flown long distances to reach out to help survivors of earth quakes, floods, volcanic eruptions, and war. They have provided important insights into how to most effectively address the current crisis. However, the September 11 attacks did not occur in some distant country. The fact that they occurred here in the United States shattered our sense of invulnerabili ty and security. Our patients’ natural reaction is to look to their therapists as experts in dealing with reactions to this kind of distress. They feel the need for a safe harbor and someone to help them contain their anxiety. At the same time, therapists themselves are experiencing many of these same feelings of grief, loss, and vulnerability. A few days after the attacks, Schuster and colleagues (1) conducted a survey of a nationally representative sample of 560 adults in the United States. They found that Americans were experiencing substantial levels of stress: 44 percent reported one or more severe symptoms of stress, and 90 percent reported at least low-level symptoms. These findings show that catastrophes can have a strong effect even on people who are not physically present during a disaster. What kinds of things have patients