Facing Clients' Fears, and Their Own

Sept. 11 Anxiety Makes Hard Job Harder
Again and again, social workers turn to each other.

by John V. O'Neill, MSW, News Staff
September 2002

The practice of social work in New York City was no cakewalk before Sept. 11, 2001. With a highly diverse population, including many immigrants, the needs were great, the resources limited, the economy was sliding toward a recession and the media were unrelenting when there were mistakes in the social services systems.

Then came the devastation of the World Trade Center attacks that traumatized the city's residents to the core, followed by anthrax found in city offices that brought another wave of alarm and dread. Social work practice was made much more difficult and complex when clients lost family members, when everyone in the city was filled with anxiety about their safety, when 100,000 jobs were lost as a result of the WTC attacks, when some agencies were displaced and when the recession and Wall Street declines sharply cut tax revenues at a time of enormous need.

Social workers were faced daily with clients in a state of hyper-vigilance, wondering when they saw police activity or heard a loud noise if it was another act of terrorism and constantly being reminded of Sept. 11 when they saw heavy security presence at bridges, tunnels and transportation hubs. The potential for vicarious trauma to social workers was great from constant exposure to traumatized clients.

What made social work practice especially unusual after Sept. 11 was that social workers shared the same sense of anxiety and loss as their clients. Social workers and their clients together had seen the WTC buildings collapse, had smelled the destruction, had lived through the disruptions and had experienced the same deep feeling of insecurity. They shared their clients' hyper-vigilance when the power went off or there was another bomb scare.

The key to practice has been the ability to set aside personal concerns enough to provide a safe place where clients can articulate their anxieties, experiences, losses and sense of uncertainty in the world. To do this, social workers say that again and again they have turned to each other in formal and informal settings to walk through the anxiety together.

What helps "above all is knowing we can speak with colleagues who can deeply understand the profound impact of doing this work at the same time we are experiencing the direct impact of terrorism, uncertainty and change in terms of safety, security and predictability in the world," said Madelyn Miller, a private practitioner with trauma clients who chairs the NASW New York City Chapter's Disaster Trauma Working Group.

Four pertinent themes repeatedly emerge when talking with social workers about the effects of Sept. 11:

• The terrorist attacks' effects on mental health and economic status are just beginning, not ending.
• Each person responds to the trauma based on individual strengths and history. There is no template.
• Social workers, who operate from a strengths perspective, are ideally educated and trained to assist.
• The terrorist attacks caused people to examine the meaning of their lives and careers.

Reflections on social workers' new reality of life follow, from some of those involved in post-Sept. 11 work. Though most are New Yorkers, their observations would probably be similar to those of practitioners affected by the terrorist acts in Washington, D.C., and Pennsylvania.

Madelyn Miller said the Disaster Trauma Working Group began five weekly trainings on traumatic loss and disaster on Sept. 28, 2001, and began four more in November. The trainings had a dual purpose: to hone skills for working with trauma clients and to offer support to social workers.

The meetings, which often drew 100 social workers from many practice settings, were a lifeline "in terms of a collective sense of community, . . . of finding support in acknowledging a compounded impact of terrorism on social workers and all mental health workers, much like other rescue workers who were impacted themselves from the nature of their work," said Miller. Social workers spoke of sleep disturbance, of alertness to low-flying airplanes, of difficulty in concentrating and being organized, and of turning on television upon awaking — including those who aren't usually television viewers.

"It is important to be respectful of individuals' unique ability to cope and unique resources," Miller said. Among other things, people experience trauma through "their own history of trauma, of loss and other disruptions and their own cultural context, creating a diversity of responses."

"It needs to be said that in the midst of it all, clients and clinicians have been able to summon resourcefulness, resiliency, perseverance and generosity in a way that is quite new and often quite moving," said Miller.

Because the vast majority of New Yorkers will not seek out social services or psychotherapy, Miller said, there is general agreement on the need to interact with the community on a broad scale to "normalize a diversity of experiences after trauma and traumatic loss and put those experiences into a long-term perspective." She spoke of a public health concept to reach the broad community.

"The life span of terrorism is extended and will affect all of us survivors over the years and decades to come, and over generations," she said.

Mary Pender Green, president of the New York City Chapter and chief of the 500-plus social workers at the Jewish Board of Family and Children's Services, said about 80 percent of New Yorkers talk about terrorism "all the time. Not about events that happened any more, but about uncertainty — a feeling of danger lurking."

"Clients and social workers talk about the war in Afghanistan or Israel and the possibility of some retaliation that might hurt them," she said.

"Most social workers came to the profession in the past feeling emotionally generous, yet at this point they need support themselves," she said. "For us, 9-11 is not over."

Tonia Spence, a student intern at the Jewish Board of Family and Children's Services last year, began her orientation on Sept. 10. The Columbia University graduate described her experience as a "wonderful year" despite security upgrades, emergency planning and chaos in the city. The agency held workshops on how to deal with children in the aftermath of Sept. 11, and people began to support one another more than they normally do — "coming together, saying what they need for themselves as well as clients," she said.

"You have to learn how to handle your own feelings and still be present and available for your clients," Spence said. "No matter how tired my mind may have been due to the emotional stress of the situation in New York, I still had to write papers and deal with clients I was given. It was an invaluable experience. On reflection, you realize how much you can do in the midst of adversity."

"I turned to my church family for strength, courage and understanding of how I could get through some of the hard times," she said.

In August, New York City Chapter Executive Director Robert Schachter was at the chapter office at 50 Broadway, some five blocks from what once was the WTC, busy helping plan a city-wide meeting of the profession for Oct. 2, the anniversary of the day last year when more than 600 social workers met to discuss the terrorist attacks.

The meeting, like the one last year, will address the impact on social workers "of having to deal with a year of unprecedented trauma both with their clients and themselves," he said.

New York City has a $4 billion deficit for the budget year that started July 1, putting great strain on traditional human services, causing some agencies to close and creating situation where more needs have to be met with less, said Schachter.

There is no question that the city's long-term response to mental health and psychosocial needs is being led by social workers who hold prominent positions at large public and private agencies, Schachter said. Among others, he mentioned: Elsie Del Campo, deputy commissioner for program services for the Dept. of Mental Hygiene; Megan McLaughlin, executive director of the Federation of Protestant Welfare Agencies; Larry Mandell, executive vice president of the United Way of New York City; Jane Barker, senior vice president of Safe Horizons; Amy Dorin, senior vice president for Federation Employment Guidance Services; and Diane Kane, assistant director of counseling at the New York Fire Department.

Upstate in Albany, New York State Chapter Executive Director Melissa Devine said that like after the Oklahoma City bombing, stresses and problems such as increases in substance abuse will emerge in later years.

Trauma raises awareness of mortality and is reflected in things people decide to do, like go back to school, write a book or start a family, said Devine. "Social workers go through the process personally and help support people they are working with in that process."

Social work is the perfect background for helping others cope with reactions to 9-11 and other terrorism, said social worker John Weaver. The Nazareth, Pa., disaster relief expert was Red Cross coordinator of the family assistance center following the Sept. 11 crash in Pennsylvania and later helped manage the WTC relief operation in New York.

Social workers are oriented more than others toward meeting basic human needs — for food, shelter and safety — before going on to meeting mental health needs, said Weaver. "We tend to work from a strengths perspective rather than a pathology perspective, so we don't automatically assume that trauma will lead to post-traumatic stress. We are keenly aware of how resilient people are," he said.

Weaver, like others, has noticed more attention to the existential since Sept. 11. "There is more emphasis on relationships and spirituality," he said. "For some, that means religion; for others, taking the beauty of life more seriously."

For people who lose loved ones to trauma, it takes two to seven years after the event for people to resolve their loss, said Weaver. "People are not over it, but they rebuild their lives around it. They make other relationships and do what they have to do to survive, thrive and move beyond it."

Likewise, for social workers and their clients, "doing well doesn't mean getting over it." And since terrorism is ongoing, the time needed to restructure lives around it could be prolonged, he said.

"The social work role doesn't end on the first anniversary of Sept. 11," said NASW Executive Director Elizabeth J. Clark. "The social work role will go on for years."

"When you think about who's taking care of people after the initial crisis is over, it is almost always social workers," Clark said.