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Shared Trauma: Group Reflections on the September 11th Disaster

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This article describes the unique collective reflections of M.S.W. students enrolled in the senior author's "Clinical Practice with Groups" course when the September 11th tragedy occurred. The instructor and many of the students, due to the proximity of the school to the disaster site, were first-hand witnesses to the event. The article addresses the student clinicians' initial reactions to the tragedy, as well as their later realizations that their personal and professional lives would be permanently altered by the experience. The unusual opportunity for growth and the implications for clinical practice are also considered in the context of professional literature on the topic of secondary trauma. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Psychoanalytic Social Work
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Shared Trauma
Carol Tosone ab; Martha Lee a; Lisa Bialkin a; Alexandra Martinez a; Marisa Campbell a; Maria Mercedes
Martinez a; Mychelle Charters a; Jennifer Milich a; Kathy Gieri a; Adrienne Riofrio a; Stacey Gross a; Laura
Rosenblatt a; Christine Grounds a; Jennifer Sandler a; Karen Johnson a; Maria Scali a; Denise Kitson a; Miriam
Spiro a; Shane Lanzo a; Aimee Stefan a
a New York University School of Social Work, USA b National Academy of Practice in Social Work,
Online Publication Date: 22 May 2003
To cite this Article Tosone, Carol, Lee, Martha, Bialkin, Lisa, Martinez, Alexandra, Campbell, Marisa, Martinez, Maria Mercedes,
Charters, Mychelle, Milich, Jennifer, Gieri, Kathy, Riofrio, Adrienne, Gross, Stacey, Rosenblatt, Laura, Grounds, Christine, Sandler,
Jennifer, Johnson, Karen, Scali, Maria, Kitson, Denise, Spiro, Miriam, Lanzo, Shane and Stefan, Aimee(2003)'Shared
Trauma',Psychoanalytic Social Work,10:1,57 — 77
To link to this Article: DOI: 10.1300/J032v10n01_06
URL: http://dx.doi.org/10.1300/J032v10n01_06
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Martha Lee
Alexandra Martinez
Maria Mercedes Martinez
Jennifer Milich
Adrienne Riofrio
Laura Rosenblatt
Jennifer Sandler
Maria Scali
Miriam Spiro
Aimee Stefan
Shared Trauma:
Group Reflections
on the September 11th Disaster
ABSTRACT. This article describes the unique collective reflections of
M.S.W. students enrolled in the senior author’s “Clinical Practice with
Groups” course when the September 11th tragedy occurred. The instruc-
tor and many of the students, due to the proximity of the school to the di-
saster site, were first-hand witnesses to the event. The article addresses
the student clinicians’ initial reactions to the tragedy, as well as their later
realizations that their personal and professional lives would be perma-
nently altered by the experience. The unusual opportunity for growth and
Carol Tosone, PhD, is Associate Professor, New York University School of Social
Work and Distinguished Scholar, National Academy of Practice in Social Work. Lisa
Bialkin, Marisa Campbell, Mychelle Charters, Kathy Gieri, Stacey Gross, Christine
Grounds, Karen Johnson, Denise Kitson, Shane Lanzo, Martha Lee, Alexandra Marti-
nez, Maria Mercedes Martinez, Jennifer Milich, Adrienne Riofrio, Laura Rosenblatt,
Jennifer Sandler, Maria Scali, Miriam Spiro, and Aimee Stefan are recent graduates of
New York University School of Social Work.
The authors would like to thank Lisa Bialkin for her expert editorial assistance in
the preparation of this article.
Psychoanalytic Social Work, Vol. 10(1) 2003
http://www.haworthpress.com/store/product.asp?sku=J032
2003 by The Haworth Press, Inc. All rights reserved.
10.1300/J032v10n01_06 57
Carol Tosone
Lisa Bialkin
Marisa Campbell
Mychelle Charters
Kathy Gieri
Stacey Gross
Christine Grounds
Karen Johnson
Denise Kitson
Shane Lanzo
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the implications for clinical practice are also considered in the context of
professional literature on the topic of secondary trauma. [Article copies
available for a fee from The Haworth Document Delivery Service:
1-800-HAWORTH. E-mail address: <docdelivery@haworthpress.com> Website:
<http://www.HaworthPress.com> © 2003 by The Haworth Press, Inc. All rights re-
served.]
KEYWORDS. September 11th, secondary trauma, shared trauma, mass
trauma, disaster
INTRODUCTION
“You can talk or you can cry, but you can’t do both,” reflected one of the
graduate students at New York University’s Ehrenkranz School of Social
Work when asked to discuss her feelings and reactions to the terrorist attacks
on the World Trade Center. The difficulty involved in confronting and ex-
pressing painful personal emotions is but one of the challenges faced by virtu-
ally everyone in New York City as a result of the traumatic events of
September 11th. That challenge is even greater for mental health professionals
in general, and clinical social workers in particular, who face the added com-
plexity of working in a profession that requires them to help others address
whatever personal issues were evoked for them as a result of these events. How
we, as clinical social workers, are able to deal with the unique situation of con-
fronting our own feelings evoked as a result of the tragedy at the same time as
treat patients who are in the midst of experiencing many of the same feelings
and difficulties as their caregivers is the focus of this paper.
The ideas presented here are the collected reflections of the social work stu-
dents, all women, who were scheduled to meet for the first class of Professor
Carol Tosone’s Clinical Work with Groups on the morning of September 11th
at 11 a.m., directly after the attacks. As the members of the class soon discov-
ered, there seemed to be no better way to learn how to do clinical work with
groups than to actually work as a group to process the events that were fore-
most on everyone’s minds. In the first part of this paper, these social work stu-
dents who, in one year, will enter the field as clinicians, give voice to their
initial reactions to the tragic events. The second part of the paper explores the
evolution and development of these initial reactions over the ensuing two
months, as the students attempted to make sense of their feelings and emotions
from the perspective of greater distance, time, and available resources. The fi-
nal part of the paper demonstrates that the ability of clinicians to work with pa-
tients in the highly unusual situation in which caregivers and patients are
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simultaneously confronting many of the same issues relating to trauma de-
pends as much on the clinicians’ abilities to process their own personal reac-
tions to the events as on their dedication to the needs of their patients–in much
the same way that the individual experiences of members in a therapy group
are fundamental to the group process as a whole. In this context, unlike the re-
flection that began this paper, talking and crying are not only able to coexist
but must be seen as inseparable.
GROUP’S EARLY REACTIONS TO A SHARED TRAUMA
The students’ early reactions, within the first month of the disaster, encom-
passed an enormous range of intense personal emotions, including denial,
shock, disbelief, bewilderment, fear, anxiety, hysteria, sadness, sorrow, de-
pression, hopelessness, sleeplessness, confusion, forgetfulness, distractedness,
uncertainty, helplessness, anger, relief, thankfulness, guilt, hope, defiance,
love, liberation, and a renewed desire to find meaning in life. Reactions also
differed with respect to the perceived impact of the terrorist attacks on clinical
practice, ranging from increased desensitization and lack of empathy toward
patients; difficulties in helping others when preoccupied with personal feel-
ings; increased feelings of insecurity, uselessness, and helplessness with re-
spect to clinical abilities, on the one hand, to increased feelings of empathy and
connection to patients, a greater need to feel involved and to communicate, and
a newfound sense of confidence in professional competence on the other. And
if there is a common theme to be drawn from these early reactions, which this
paper will explore, it is that in the context of trauma, and particularly of the
events of September 11th, how a clinical therapist best responds to the needs of
patients in connection with the trauma experienced by all of us is inextricably
interwoven with how these events have been personally interpreted and re-
sponded to, which in turn is dependent on how earlier events have been inter-
nalized and responded to. As stated by Fullerton, McCaughey and Ursano
(1994, p. 5), “[T]he psychological responses of individuals to trauma vary
greatly. The meaning of any traumatic event is a complex interaction of the
event itself and the individual’s past, present, and expected future, as well as
biological givens and social context.”
Some of the students’ most common early personal reactions included ini-
tial shock, numbness, and disbelief, followed by denial and in some cases de-
tachment, often despite the graphic news reports that no one could escape.
“Even with pictures of the burning tower in front of me, I still couldn’t believe
what I saw,” wrote one student. Others described in detail the great lengths to
which they went in order to deny the reality of what happened, including run-
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ning seemingly senseless errands, attending to “more hysterical” friends, and
trying to distance themselves by intellectualizing the events. “Essentially, I
spent the initial hours of the disaster avoiding fear by taking care of the people
around me,” wrote one student.
Many students described initial feelings of bewilderment, confusion, and
helplessness. “I was confused. . . . The carpet was pulled from under me. I be-
came frustrated. . . frustrated with my placement, frustrated with my supervi-
sor and frustrated thinking my life was ruined,” wrote one woman. Still others
described how they were not even sure how to react, often basing their own
feelings on the reactions of those closest to them and the comparisons that they
could then draw. A sense of feeling alone was also prevalent, in particular for
those who were not involved in love relationships at that time. Many students
described a preoccupation with world events and an inability to stay focused
and concentrate on day-to-day matters, both as students and practitioners, as
well as a lack of motivation, distractedness, forgetfulness, and sleeplessness,
often accompanied by nightmares.
Numerous papers described the overwhelming feelings of sadness, sorrow,
grief, and pain that followed these first reactions, alternating with feelings of
loss, of being lost, and a general sense of hopelessness. “Immediately follow-
ing the tragedy, I was overcome by sadness. I felt depressed,” wrote one stu-
dent. Another wrote, “I don’t worry about my personal safety much, only
about the safety of those I love. Mostly I worry about the evil in the world my
children will inherit. In spite of my optimistic nature, it is hard to see a rain-
bow.” For many, depression set in; for some, this feeling has remained.
No less prevalent was anxiety, and in many cases, ongoing and acute fear
revolving around feelings of insecurity about personal safety, as well as an in-
creased need for reassurance from others: “Fear seemed to creep up on me
from every angle, whether it was being startled awake by a plane flying that
seemed too closely overhead, worrying about the packages I saw in the sub-
way, or simply jumping two feet off my chair because a book banged to the
floor from another student’s desk.” Others described more dramatic reactions:
“I did not see that I would ever feel better, and therefore, could not perceive
any other person ever feeling better than I felt every moment since Sept. 11th.”
Wrote another woman, “my initial thoughts the evening of September 11th
were that I would probably die within the week.”
For many the world had suddenly become unbearably unpredictable. “I felt
as though one of my basic needs of feeling secure in New York City, which I
had felt prior to these events, was suddenly gone and replaced by fear,” noted
one student. “I have never experienced a state of anxiousness as constant and
overwhelming within my personal and professional life,” and “I was scared in
a general kind of way” were other reactions. Fears of commuting, and of sub-
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ways in particular, worries about being in large public places, and nightmares
and disturbing images, both real and imagined, were frequently conjured up: “I
cannot stop the scenarios in my head of an explosion leaving me trapped in a
dark tunnel for a week until my final rescue is death,” wrote another student.
The desire to protect loved ones alternated with the desire to be protected. As
the mother of a three-year child wrote, “I felt scared and powerless and was
afraid I wouldn’t be able to protect my daughter in this new world. . . . Since
that day, every day, I often feel I need her more than she needs me.”
Anger, rage, and even hate at the turn of events and the persons who caused
them were also described at great length: “Disbelief soon gave way to anger at
the people who had perpetrated this carnage, sorrow for those who had lost
loved ones, as well as an unfamiliar feeling of pride at being part of a city
whose dwellers were showing such unbelievable courage.” One young
woman’s emotions were raw and palpable. “My rage peaked at the Union
Square rallies,” she wrote. “I could not tolerate peaceniks when all I wanted
was revenge, decapitations, the bloodiest possible vengeance on the perpetra-
tors and their cohorts. Surgical, precise, minimum civilian loss, but no mercy,
no prisoners, certainly not turning the other cheek. My rage and intolerance of
these blind and misguided mounts. My blood is boiling. I want someone liter-
ally to come at me so I could beat them into a pulp. I am also angry at anyone
who continues to believe in God. There is nobody home. Don’t you get it?”
Many students expressed concern that life as they knew it had been irrevo-
cably changed. The following excerpts reflect a common feeling that “nothing
makes sense as before, nothing will be as before,” as well as a desire to try “to
get back to a normal life” in a world where “nothing felt normal”:
Perhaps the most unsettling thought to me is the knowledge that life has
permanently changed. I doubt that I will ever feel the same nonchalance
that I did in the past when boarding a plane, taking a trip abroad, riding
the subway, or opening my mail.
Every so often I think I am getting on with my life and I find I’ve been
caught downward of the burning World Trade Center, miles away, the
acrid smell a visceral reminder of September 11 and of how different our
world is now.
The concept of moving forward seems almost impossible; it is extremely
difficult, for what we once considered normal, will never be again.
This shocking tragedy has forever changed our thoughts and feelings
about safety, freedom, and reality. As a result, our once reasonable and
valid theories apply no longer.
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Spurts of sadness and an attempt at normal alternates in my heart and in
my life. Nothing makes sense as before, nothing will be as before.
Still other personal reactions to the tragic events included relief and thank-
fulness that they and their loved ones were not among the victims, feelings that
were often accompanied by punishing feelings of guilt regarding their own
good fortune, as well as their ability to carry on their lives as usual and in this
way to “forget.” One student wrote, “the second tower is hit and reality weighs
me down. I look back at this day now and think...people were dying, chaos
occurring, and I was snoozing, ignoring.” For some, these intense feelings of
guilt and shame expanded to include the ideas that they themselves should no
longer be allowed to feel good, that they are not deserving of anything “nice”
in their lives as a result of their “privilege,” and that any problems they face
must be viewed as insignificant in the context of what had happened. “I felt we
should do something, but there was nothing to do. I felt like I was bad for not
trying harder to find some way to help,” one woman expressed. “I felt selfish,
self-absorbed, and self-centered,” stated another. “I was alive and nobody I
knew had been injured. Who was I to complain for feeling uncomfortable?”
asked one student who had to move out of her apartment, which was located
near the World Trade Center. “How could I possibly be focusing on my own
issues when so many others are experiencing such real pain?”
Competing with these distressed reactions, however, were a number of
more optimistic ones, including the development of a new sense of perspec-
tive, a forced questioning of themselves, and therefore an unusual opportunity
for growth. Other feelings included an increased desire to look for meaning in
a life that had a new sense of urgency. The need–even compulsion–to “do
something” was overwhelming for many students and had both positive and
negative overtones. “My need to help someone, to get involved, to overcome
my feelings of impotence was very strong, almost selfish,” articulated one stu-
dent. Many discussed their “need to be needed.” As one student observed of
herself, “I needed so badly to feel of use, to feel that at least I had a purpose in a
tragedy that seemed so pointless, so purposeless.” Another reflected, “All I
wanted to do was lose myself in something–anything–to escape my own feel-
ings of powerlessness and uncertainty.”
Some members of the group expressed a new sense of strength, defiance,
and even hope. “I have no answers, only hope,” one student observed. For oth-
ers, this hope was mingled with sadness: “There are moments when I dance to
the rhythm of salsa in my kitchen but sorrow and sadness find their way back to
me.” Existential concerns dominated the thinking of another student: “My per-
spective of my life and the world has taken on new meaning....Mychoices
would have to be different. Life would have to mean more.” Still others went
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even further in describing this new sense of perspective as freeing. “In a sense,
my own personal demons have taken a back seat to reality and I find myself
oddly liberated . . . and more willing to extend myself to others.” Indeed many
viewed the September 11th disaster as a “wake-up call” to remind themselves
that they need to express their love for others more often and more directly.
REACTIVATION OF PREVIOUS TRAUMAS
Although all of the above reactions are compelling and are representative of
the emotional climate that all of us find ourselves in since September 11th,
they are also striking in what they tell us about how people react to trauma, no-
ticeably in the way that recent traumas bring up old feelings–and in particular
losses–for the people who are experiencing them. Freud (1914) first ac-
quainted us with the idea that it is only when buried memories are brought to
the surface and done away with, called up and dismissed, that the self can be
mastered and emancipated from itself; and that it is only by recollecting, re-
constructing, and freeing the self from the ghosts of the past that life can gain
new meaning, complexity, and depth, and a healthy future can result. In much
the same way, as shown in the reactions that follow, it is only by delving into
and understanding our own pasts that we can begin to make sense of the pres-
ent trauma we are experiencing, and be of real help to our patients who are
struggling to do the same. What is unifying in these diverse reactions is the fact
that the majority of the group members seemed to internalize and interpret the
events of September 11th as a continuation of or a reaction to whatever feel-
ings and emotions they were experiencing prior to that time. In other words,
the reactions precipitated by the events of September 11th can be seen less as
new reactions to a horrific world event and more as old ways of looking at the
world superimposed on new losses.
One student described her reaction to the events as a feeling that she was
forced to grieve a recent family death again. “Trauma often brings up other
losses, and I often feel like I am grieving my stepmother’s death all over again.
I get distracted and sad and frustrated that history tends to repeat itself,” she
noted. A more dramatic example is the following scene witnessed by another
member of the class: “One woman abruptly changed her sobs, which originally
were for her brother and his wife, to sobs for herself, when she recounted years
of sexual abuse at the hands of her father when she was a little girl.”
There are many other poignant examples. “Let me start with pre-September
11th because who I am before and despite my reactions to this trauma is crucial
to my understanding.” This particular student described her pre-September
11th emotional state as being overcritical of herself and depressed, and there-
Tosone et al. 63
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fore her reactions to the events as evoking a deep self-hatred. She was not
alone; for many students, this crisis not only served to bring them back to old
feelings of loss, but brought to the surface all the personal issues and feelings
that made them who they are. For some these were old feelings of insecurity,
depression, and lack of control over life; for others they were more positive
feelings of growth and independence. Wherever people found themselves in
their lives prior to September 11th, the events of that day were interpreted
through the particular lens of the person experiencing them. For some, the
events resulted in a setback to the personal growth and development they had
been striving so hard to achieve: “The tragedy of September 11th brought a
number of personal issues to the forefront . . . themes of powerlessness, help-
lessness, and lack of control were woven together throughout my life. I desper-
ately yearned for peace, security, and safety. I wanted to relax. I wanted to just
be.”
For others the events exacerbated longstanding feelings of anxiety. “While
my functioning has remained significantly improved, the impact of these
events in New York and throughout the world has raised my anxiety level and
triggered the return of my habitual feeling of a lack of control over my envi-
ronment,” was one reaction. Others who considered themselves especially
fearful people prior to the events became more so. One woman described the
intense fear she felt following the attacks as an extension of the fears that char-
acterized much of her emotional life prior to that time, including a fear of liv-
ing on her own, of returning to school after a hiatus, and a general fear of
failing in life’s pursuits.
Another woman who described herself as a person who above all “[likes] to
have a sense of control,” acknowledged that the greatest difficulty she was fac-
ing as a result of the attacks was a longstanding fear that the “safety and secu-
rity” that she took for granted would be “stripped away.” She saw herself as a
person who has always felt detached, not particularly in touch with her emo-
tions, and who has “strong feelings but can’t experience them.” She described
her recent anger as directed primarily at newscasters and politicians for in-
creasing her anxiety and for “reminding [her] that there is plenty out there to be
afraid of” and toward her father for even suggesting that she might want to get
a gas mask:
The air was thick and dusty and hurt my lungs and gave me a headache.
But it didn’t feel any more real. It looked like a movie set. I didn’t feel
connected or sad. I am sad that they are gone and for their families, but I
am not feeling any deep personal sadness....Lastly, and mostly, I am an-
gry at myself. I am not normally an anxious person. I am rational. I don’t
jump to conclusions. I am usually good in a crisis. I assess the situation,
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see what needs to be done and do it. I like to be in control. Now it seems
that no one is ...Iamhaving nightmares and I jump at the sound of sirens
and planes. I hate that I feel this way. As I type, I am blinking back tears
again. As much as I consciously want to cry, to get to that point, my sub-
conscious knows better, knows I can’t handle it yet. Maybe I don’t have
to cry but I hope I will.
One student’s rage at the perpetrators of the attacks could be traced back to
her own experiences as the child of a Holocaust survivor, giving her a greater
acceptance of uncertainty than others and making her more angry than afraid:
“Although I have not experienced any form of terror directly, I have never
doubted its existence or its potential impact on my life and the lives of those I
love most,” she wrote. Another member of the class attributed many of her
feelings of insecurity, fear, anger at the injustice, and pride in this country to
her history as an immigrant to the United States. Yet another student admitted
that throughout her life she had always been more afraid of what “has lurked in
[her] imagination,” making her better able to deal with “real crises” than imag-
ined ones.
GROUP’S LATER REACTIONS
Commonalities
At the conclusion of the semester, approximately three months from the
date of the disaster, many students revisited certain of their earlier reactions to
the events. That their perspectives were in some respects different at this time
can be attributed both to the period of time that had elapsed since the tragedy,
and to the fact that the students were now encouraged to make use of available
research and literature relating to trauma, and to consider how certain concepts
pertaining to the therapeutic treatment of members of groups applied to them
as class members in terms of processing these events. It is particularly note-
worthy that whereas three months earlier the students’ reactions varied enor-
mously, as shown above, at this later date, their reactions had become more
similar, at times unified, perhaps in part due to a greater emotional distance
from the events themselves. How psychological reactions to trauma can vary
according to the different meanings that individuals and communities attach to
the traumatic event, and the role that memory plays in this process is also cru-
cial. The “accuracy of memory is affected by the emotional valence of an expe-
rience,” wrote van der Kolk (1996, p. 281). “Meaning is a rich and varied
concept which is not static but results from the interaction of past history, pres-
ent context and physiological state. Thus, the meaning of a traumatic event
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changes over time with the individual’s ever changing psychosocial context”
(McFarlane & van der Kolk, 1986, p. 20).
As a whole, the class took comfort in the fact that many of their initial reac-
tions were similarly documented in the context of other traumatic events in the
available literature on the subject. These reactions included more negative
ones such as the fear of repetition of the stressful events, shame over helpless-
ness, rage at the source of the stress, guilt about shame over aggressive im-
pulses, fear of identification or merger with the victims, and sadness over loss.
More positive reactions included learning that one can handle crisis, becoming
more aware of the importance of family and community, and developing new
priorities, goals, and values (Fullerton et al., 1994). One student seemed partic-
ularly relieved to find evidence in the literature of the occurrence of repeated
nightmares, a type of nocturnal re-experiencing of traumatic events at night
through dreams, whether it is in the form of more symbolic posttraumatic
nightmares or a more actual posttraumatic reenactment of the trauma (Schreuder,
1996). This documented information helped her normalize her own experience
with recurrent nightmares following the disaster.
One of the most common themes to emerge from the student reactions at
this later date was the feeling of relief that ensued as a result of the perceived
universality of their shared experiences and emotions, and the group cohesion
that developed. One student recognized that the concept of universality in a
group allows members to realize that they are not alone and that there are oth-
ers who can understand what they are experiencing because they are experi-
encing the same thing, thereby providing members with a sense of support and
comfort and a way to feel less isolated (Toseland & Rivas, 2001). “As a group
we developed a sense of our individual roles within the class as well as being
one group,” wrote one student. “We taught each other coping and defense
mechanisms necessary to get through midterms, finals, and sometimes, just the
day.” Citing Yalom (1995, p. 6), one student experienced this feeling as the
“disconfirmation of a patient’s feelings of uniqueness. . . [and] a powerful
source of relief,” resulting in a normalizing effect on group members. Others
came to see their reactions as acceptable and normal when they heard class-
mates share their thoughts and emotions. Another student cited Herman
(1992), who addressed the power of group experience in combating the impact
of trauma, stating that where “trauma isolates, the group re-creates a sense of
belonging” (p. 214).
“Although no one was able to come up with a solution for our anxiety re-
garding our feelings of helplessness, it was very comforting for me to know
that others shared my concern,” wrote one student. Another student discussed
feeling a diminished intensity, especially anger, an increase in empathy, and a
sense of group cohesiveness and belonging. A number of the students attrib-
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uted their ability to feel safe in the group to the insight and warmth demon-
strated by their professor, whose “quiet strength, patience, warmth, playfulness
and sense of humor” allowed them to feel safe enough to explore their feelings
by giving them the time and the forum to do so. This in turn led to a sense of
solidarity, a new feeling of confidence, a willingness to listen to others, and a
desire to remain in the group. “Empathy, intimacy, trust, and acceptance were
clearly achieved,” wrote one woman.
Another student related that this feeling of commonality, “the realization
that one is not alone in her experiences” had the strongest impact on her, and
how, instead of feeling “isolated in [her] experiences, unique in [her] prob-
lems, and unable to share with others for fear of horror and rejection,” she felt
“safe to voice these experiences” and in so doing, learned that she was “not
alone” and that her feelings “were common and acceptable to others.” Still oth-
ers felt a common bond even in the absence of words. “Those who did not ver-
balize their experiences still contributed to the sense of universality through
nods, gestures and smiles of understanding,” wrote one student. “No matter
what stage we are in there is the comfort we find in the knowledge that we are
not alone in our suffering, confusion, paranoia and anxiety. We have experi-
enced this comfort in our class group and for that I am grateful,” she said.
“It made me feel better to know I was not the only one, for many reasons,”
said another student.
First, I felt like I was not simply being lazy. Second, I felt like I was not
overreacting. Third, it made me feel like it was ok to have things affect
me, even as a social worker. This feeling, of us all being in the same boat,
made me feel so much better about my reactions to this trauma in these
and other ways. My fears were universalized and normalized. People
who feel they are alone in having disturbing thoughts or feelings, or feel
they are the only ones to face abuse, neglect, or trauma come to find out
that others have dealt with the same feeling they have. This newfound
knowledge creates an environment that makes it safe to explore these is-
sues and process them in a journey toward self-acceptance and psycho-
logical health. I felt less guilty and less disgusted with myself.
The students’ research felt like a universal activity to many class members.
“Another way my colleagues and I found to universalize our feelings during
this disaster was through reading the literature on trauma and coming to a
better understanding of its common effects,” wrote one student.
Our experience with this trauma begins as human beings and New York-
ers first, and then goes on to experiences as a social worker, therapist,
and as a student. Through our class discussions we were able to univer-
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salize our fears of not only the disaster and our safety in New York City
and America, but of not being good enough social workers to handle the
crisis. We were able to identify with each other over our personal symp-
toms and therefore let go of our guilt.
The literature discussed proved that what we were facing was normal and the
effects may last for some time. This also universalized our fears, thoughts, and
feelings, and allowed us to openly discuss our issues throughout the crisis, and
as a group, she wrote.
Another student said, “I was surviving in the group and exploring my theo-
ries by hearing that others were confused about their roles in life, unmotivated
to do their schoolwork or complete their pursuits, and scared to walk on the
streets at times, because I realized I was not the only crazy person pretending I
was leading a normal life.” Although at first she had difficulties expressing her
own emotions, “I realized I had more to gain from the group experience once I
shared a piece of myself,” said another student. Yet another student wrote that
while at first she “felt alone and isolated in that others seemed to be coping
better,” when she discovered that she was not alone she felt “relief from anxi-
ety, more motivated to be part of the group, and not unique in [her] wretched-
ness.” Seeing others cry made some more willing to take the risk of exposing
themselves. “I felt very self-conscious because I don’t easily open myself up to
a group of strangers like that. I remember thinking to myself, if I can’t do this
here, where can I?” asked another woman.
Another student wrote that it was this feeling of not being alone that got her
“through some difficult days. I am and always will be tied to our class, not be-
cause it fit into the parameters of successful group work, but because we all
went through something unthinkable together, and I imagine we will all be
connected to this group in a way that we will never be connected to any other
group again.” Another student wrote, “Slowly, but incredibly, a sense of cohe-
siveness, care, compassion and empathy evolved.” “The process has instilled
in me feelings of empowerment, independence, and confidence. I take with me
the connections with those classmates who assisted me in getting through this
semester, whether they were aware of it or not,” wrote another student.
Some students worried that by delving into the available research on the
subject, they were removing themselves too much from their feelings, and that
this type of intellectualizing and theorizing about these “unique, intense, and
profound experiences we had as a group this semester left [us] feeling some-
what distanced from our experience.” Another student wrote, “Our responses
to the class material became much more intellectualized as we tried to ignore
the elephant in the room.” But perhaps this distance was just illusory, she said,
“maybe those feelings aren’t gone, just covered up by daily survival.”
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Differences
A few students, however, had very different reactions to the almost group-wide
experience of relief at the shared feelings that developed. A few students even
said that they experienced a feeling of increased isolation and aloneness. “On
one level, I connected and felt moved by others’ accounts of what happened;
on another level I felt angry and sad and completely alone,” wrote one woman.
So afraid was she of the “vulnerability of connection,” that she found herself
“intellectualizing” the experience. “My own feelings around this tragedy were
of tremendous isolation,” she wrote. “I remember feeling incredibly alone and
lonely, needing and wanting connection but at the same time not wanting to be
with anyone.” For her, the sense of commonality and universality so sought af-
ter by others was “not the magic that it is portrayed to be.” Nonetheless, she ex-
perienced these feelings as valuable. “Feeling this isolation when I am given
the opportunity of connection has helped me greatly in understanding the ex-
perience of group members. I understand how someone can need to feel close
to others and simultaneously need to feel apart from them,” she wrote.
The limits of universality were also seen in the reactions of the following
student, who did not experience the same relief at the universality that perme-
ated most of the group.
The wildness of my own emotions felt out of place in this group. Perhaps
temperamentally I am more a gut person. Perhaps too, September 11
stirred anew my own past traumas more than I expected: the horror of the
sirens during the war, the roar of planes pregnant with bombs, the run-
ning for shelter faster than little feet can go, the dust after a hit, the terror
of not finding my mother, and the ensuing nightmares. No, I will not be
quiet, no, I will not be peaceful. But how could I explain all this to a class
so polished, so polite, so peaceful, so PC?
This student, whose family fled the Holocaust during World War II, described
herself as searching for another kind of universality, a more spiritual kind, that
of the “great questions,” like the nature of evil and the role of God. “My feeble
attempt to talk about God was promptly dropped. On that day I did not feel ei-
ther understood or included,” she wrote.
In connection with these feelings, certain class members explored their re-
sistance to confronting and discussing their emotions, describing it as
“groupwise resistance to the group task” (Cohen, 1997, p. 451). This grappling
took many forms, including the very way that students defined the concept of
resistance, ranging from the “manifestation of anxiety,” to the integrative
value of coping and the expression of self-assertion and autonomy (Teitelbaum,
1991). One student described the class as “resistant from the first day of class
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due to shock, pain, and the fact that we were virtual strangers to each other.”
Another saw her resistance to participating in the group and her inability to get
involved until late in the semester as characteristic of her behavior in her life as
a whole. “No one wanted to participate and I became the silent student I feared
becoming again. This particular student praised their professor for ”[allowing]
us to resist participating, yet “[checking] in regularly with [our] thoughts,
emotions and feelings. I was faced with, and struck by the resistance from oth-
ers and myself during the classroom session, yet we were unable to steer off
topic,” she wrote.
Another student described the resistance she felt and witnessed in the class-
room as intrapsychic resistance (Cohen, 1997), representing almost innate re-
sponse to avoid pain.
This type of resistance goes straight for the gut and plays on primary
fears in order to achieve its goal of holding back emotions. In essence,
this type of resistance is the one that will take us back to negative memo-
ries of past experiences. I think that the shocking events of 9/11 uncov-
ered our primal fears of death and existential angst and brought them to
the fore. It is very stressful to have our primal fears become so intensely
based in our present reality. We innately fear change because in a basic
way, change implies a death. When this metaphor for change crossed
paths with reality in such a devastating way, it turned everything upside
down. What could only be imagined became reality, what reality had
been, was no more....Ourvagueness and inability to stay in the here and
now is what helped us turn away from the difficult feelings of the mo-
ment.
Another student saw this resistance take the form not only of silence or
“babbling,” but of constricted body language such as sitting “tightly with arms
and legs crossed” and lack of eye contact. One student, she reflected, even
threatened to leave during one of the silences that filled the room. She de-
scribed feeling resistant until she “became engulfed and consumed by the sim-
ilarities in each of us. I felt the need to indirectly give of myself to others, as
they had done for me,” she explained.
Another student described her experience of the resistance in the room as
her unconscious attempt to resist change. “We began our meeting mired in
fear, dread, and immense sadness, ” she said, and as result of the lack of a feel-
ing of safety initially, it was “easier for resistance to sink its teeth into the
class.” According to another student, “Looking back on the dream-like quality
of those first few weeks, I think that perhaps another aspect of not expressing
the emotions in class could be attributed to a resistance to making sense of it all
and therefore making it real. It was the type of experience that made you resist
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connecting to it, because you wanted to deny that it changed you.” As Herman
(1992, p. 1) wrote, this type of “conflict between the will to deny horrible
events, and the will to proclaim them aloud is the central dialectic of psycho-
logical trauma.”
IMPLICATIONS FOR CLINICAL PRACTICE
The varied ways that the events of September 11th were personally experi-
enced accounted in large measure for the impact these events were felt to have
on one’s clinical practice. For some, the high degree of emotion and preoccu-
pation with their own feelings made it almost impossible to reach out to others
in need. Working through their own feelings precluded them from being able
to help others deal with their emotions, whether or not these emotions were di-
rectly related to the trauma. “How could I assuage the very fears I was unable
to comfort in myself?” one young woman asked of herself. “I felt very inse-
cure, and struggled with ethical dilemmas. I wondered whether I was strong
enough to completely be there for others while I experienced weaknesses in
myself.” Many shared her sentiments as helplessness and uselessness in the
face of their own personal anxiety took precedence over the pain and suffering
of others. “I felt scared and unsafe myself, so when patients talked about feel-
ing that way, I had nothing to offer them. They weren’t paranoid, unless I was
too,” noted one young woman.
For some, these feelings resulted in desensitization toward patients, a lack
of empathy, less tolerance of and even anger at patients’ expressions of rage
and anxiety. Some saw their patients as self-absorbed, “babbling about non-
sensical problems and not caring that a few miles away thousands of people lay
dead in piles of rubble.” While also viewing themselves as “less patient and
more vulnerable to overidentifying with clients,” many students expressed
feelings of guilt for not being able to provide better care for their patients. One
woman in particular wondered whether her own desire for retaliation made her
unsuitable as a therapist. “Blow them all off the face of the planet ran through
my head more than once....Should a social worker really be thinking about
the things that were going through my head?” she worried.
These emotions notwithstanding, most students viewed going to placement
and working in a clinical setting with optimism, determination, and in some
cases, even relief. Feeling more, rather than less, connected to patients as a re-
sult of the trauma was a welcome response. One student said that while at first
she did not want to deal with seriously mentally ill patients because they were
not able to look realistically at the events, she later came to realize that they
needed more help due to their fragile mental state and that she was willing and
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able to give that help. Some students saw going to work as a much needed es-
cape, even affording them a welcome sense of perspective. “I find the one
place where I am most focused and most comfortable in the midst of this is my
cancer patient support group. During that time, things are certain, roles are de-
fined,” observed one student. “My clinical work has become one of the few
peaceful things for me,” seconded another.
The desire and the need to communicate with others and to feel involved
and needed were other reactions. Some even saw a certain amount of hope in
being needed. “I thought that after enduring such stress, confusion, and sad-
ness, that I would feel disconnected from my work. At first, I was afraid to re-
turn. But when I did, I found that all my unease about the world faded in the
presence of my patients. Despite all the craziness, all the distrust, all the misun-
derstanding, all the hatred in the world, there I was, in session, being entrusted
with someone’s story and that felt like a gift of hope,” said one woman. Others
described the desire to help others deal with their feelings and emotions as a
way to help them find meaning in their own lives. “If we were needed before,
now we are acknowledged, and the repercussions of this tragedy and war will
continue to provide a need for us,” wrote one student. “I feel like I am doing
something constructive, and still using my emotions, which feels healthy.”
Other students welcomed “being forced to grow up professionally.” One
described a sense of not having time to be a student anymore, leading to a new-
found confidence in her clinical work. Others credited the knowledge they
gained about trauma work as helping them speed up the learning process and
be more confident as social work students and service providers. “None of us
had any education, training, or experience in this. All we had was our instinct
and faith that we would somehow get through this, and get through it together.
I spoke up in a way that normally I wouldn’t have, and people listened.” “It’s
as though life has a new sense of urgency–both in learning to become a thera-
pist and in treating myself by playing more and working less,” wrote another
student.
Some people have been able to find comfort and strength in the fact that
they are experiencing many of the same emotions as their patients and there-
fore feel less alone. One woman realized, “My clients and I are connected in a
way that would never be otherwise.” Said another, “In a way, helping them
process helps me process as well.” This feeling of universality leads some to
experience a new sense of openness and inquisitiveness, bringing them toward
even more self-disclosure to patients as a therapist. “First, hearing others dis-
cuss their emotional reactions to the frightening events in the world helped me
to integrate the fact that I’m not alone. Rather than being unable to act as a con-
tainer for my patients’ anxiety, sadness, and fear, experiencing their feelings
provided me with a sense of universality that was enormously comforting.”
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This feeling of shared trauma has also led some students to feel that everyone’s
emotions and feelings are equally important and deserving of attention.
Perhaps the strongest implication for clinical practice was expressed as the
need for each person to validate and deal with her own feelings first as an indi-
vidual, and then as a therapist, demonstrating that only by taking care of our-
selves can therapists truly be in a position to help others (Catherall, 1995;
Downing & Steed, 1998; Levine, 2001; McCann & Pearlman, 1989; Miller,
1998). “A disaster can engender severe crisis in that it threatens self-images
and identities, life goals and values, and the structure of social systems. It calls
for greatly extended or restricted functioning for which customary coping pat-
terns are, for the most part, inadequate. Both individuals and systems become
disequilibriated and dysfunctional” (Goland quoting Siporin, 1978, p. 126).
Because the role of professionals in a disaster is often ambiguous and marked
with feelings of frustration and helplessness, particularly if the workers are in-
volved in the trauma, professionals are seen as operating in a dual capacity, as
both fellow victims and professional helpers, sometimes leading to a blurring
of their perspective so that they can no longer weigh matters objectively
(Goland). Although providing support during times of stress can be rewarding
to the support provider, the support provider may become overwhelmed if the
demands are experienced as excessive (McFarlane & van der Kolk, 1996). The
following comments are illustrative of these conflicts and the need for self-care:
It has taken me several weeks to allow myself to accept the fact that I can
experience the loss of thousands, not only with the universally felt devas-
tation and sorrow, but in a way that acknowledges and honors the per-
sonal loss reaction that it generates in me.
We must remember that to help our clients, we must also help ourselves
because it is impossible to isolate our personal and professional lives in
light of the tragedy that we have all experienced.
[I have] the need to work things through in every aspect of my life if I
wish to be an effective social worker in the future.
Somehow along the way, social worker has become another word for,
‘Nope, I feel fine–doesn’t affect me at all.’ Speaking about your feeling
regarding the tragedy is a given. To know and to feel that it is okay to not
be there all the time is essential. And to recognize and accept that not
feeling ‘strong’ does not mean you are weak is crucial.
Finally, for some, this crisis has validated the choice of social work as a pro-
fession, especially for those who gave up lucrative careers to pursue it. The
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pleasure taken in feeling needed is enormous. “My sleep is restless and my
nights occupied with wondering. Clearly, my life is different and my thoughts
have changed. Yet what has gotten me through is following my heart. I have
chosen a profession that makes a difference....Myprofession has given me
sanity and hope through this terrible time.”
REPERCUSSIONS OF TRAUMATIC STRESS
In allowing for this type of relational process, one must also take into ac-
count the danger that the patient can in fact be retraumatized by the therapy,
and that the therapist can be vicariously traumatized by the client’s experi-
ences. This susceptibility to secondary traumatic stress or vicarious traumatization
(Figley, 1995, Herman, 1992; McCann & Pearlman, 1989) has been defined as
a change in a helper or therapist’s inner experience that results from empa-
thetic connection or identification with a client’s traumatic material (Pearlman
and Saakvitne, 1995), specifically referring to the negative changes that occur
over a period of time across a variety of patients and have a cumulative effect
(unlike traumatic countertransference which occurs with one client).
Trauma “can actually become contagious,” and “if the therapist shares the
patient’s experiences of helplessness too much, she can become afraid of the
patient and turn away, again retraumatizing the patient” (Berzoff, 1996,
p. 423). This problem takes on even greater significance in the context of the
present scenario where both the patients and the therapists have experienced,
and on some level are still experiencing, the same traumatic events. Indeed, in
an effort to avoid feeling retraumatized some students reported that they were
at times “not present” in sessions and had become somewhat “desensitized.”
Wall (2001) also normalizes this type of therapists reaction by stating that
following a traumatic event “clinicians are understandably psychically pre-oc-
cupied with their own realities” and find it “more difficult or impossible ...to
have the emotional energy available for clients” (p. 142). This kind of disen-
gagement can result in some student therapists feeling guilty that they are not
providing their patients with the quality of care they deserve. Wall understands
this reaction as the therapists’ experience of guilt at abandoning their clients,
therapists having their own needs, or therapists not being omnipotent. Accord-
ing to Hafeez, Hertz, Kefer, and Motta (1999), symptoms of secondary trauma
can include unwanted recollections of the traumatic event, sudden re-experi-
encing of the event, detachment, difficulty concentrating, and sleep distur-
bances. Miller (1998) believes that effective trauma therapists need to have
insight into their own feelings, the capacity for empathy, and the ability to dif-
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ferentiate between the needs of the self and of the patient, and the skill to con-
ceptualize the patient’s dynamics in the present and the past.
CONCLUSION
This paper has attempted to demonstrate, through the personal essays and
group discussions by social work students, the crucial interplay between their
personal reactions to trauma and their ability to treat patients who are experi-
encing many of the same reactions to the events as they are. In order for thera-
pists to be able to help others with their feelings relating to trauma, it is crucial
that they examine and work through their own personal feelings about the
events as they interpret and assimilate these events within their own particular
psychological profiles, and in particular how therapists’ own personal trau-
mas, as well as their beliefs about patients could interact with their patients’
trauma and their regard for such patients (Liebkind & Eranen, 2001).
Mourning is a necessary but painful process for patients and therapists
alike. In many respects the trauma experienced in the aftermath of September
11th was felt primarily as a loss. The process of therapy, much like the act of
mourning, allows both therapist and patient to re-create other unconscious
losses, bring them to the surface, and move on. What is crucial in understand-
ing the unique situation inspired by the events of September 11th is that both
therapist and patient are involved in the process of mourning at the same time
and over the same loss, with the therapist having the added complication
(which some consider a gift) of being the caregiver and the container in this
process as well. In considering loss, one must also include unresolved “ambig-
uous” losses that can be incomplete or uncertain (Boss, 1999). Those persons
presumed to be dead as a result of the attacks but whose bodies have not been
recovered can, in this way, entail a feeling of ambiguous loss. A therapist’s
personal experience of loss is likely to have an impact on how patients deal
with loss (Warshaw, 1996), and how the ongoing work towards the resolution
of related issues will affect the therapist’s evolving beliefs about the treatment
process.
Herman (1992) wrote that in order for group therapy to afford the partici-
pants a feeling of commonality and universality, and thereby restore to them a
feeling of connection to others, a feeling that they are not alone, a renewed
sense of humanity in general, and a reclaimed sense of self, survivors must be
prepared to give up a feeling of specialness and see themselves as part of the
ordinary fabric of the human condition, a “drop of rain in the sea” (Herman
quoting Richard Rhodes, p. 235), small and insignificant. This is particularly
true in cases of traumatic events that “destroy the sustaining bonds between in-
dividual and community” (Herman, p. 214). However, as borne out by the reac-
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tions above, it is equally if not more important for both participant and
therapist to see themselves as large and hugely significant, and to embrace that
same feeling of specialness that will give them the strength and the courage to
battle whatever internal demons rage within them and overcome whatever
trauma an unpredictable world may inflict. In this same way, as most if not all
of the sentiments presented suggest, in order for us as therapists to be success-
ful in caring for others, we must face and continue to evaluate our own feelings
and keep them in mind in the context of helping others, especially in the con-
text of the events that transpired on that fateful day in September.
There are no objective guidelines in this case for establishing where the
therapist as individual ends and the individual as therapist begins. As Yalom
(1985, p. 225) wisely writes:
In the therapy group, freedom becomes possible and constructive only
when it is coupled with responsibility. None of us is free from impulses
or feelings that, if expressed, could be destructive to another. I suggest
that we encourage patients and therapists to speak freely, to shed all in-
ternal censors and filters save one, the filter of responsibility . . . the ther-
apist has a particular type of responsibility, responsibility to patients and
to the task of therapy.
The best we can hope for is that each of us takes this responsibility seriously.
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... To ground this reflection, the authors utilized the concept of shared trauma to better understand the impact of the crisis on our practice as educators and administrators. Shared trauma is defined as an experience in which clinicians are exposed to the same collective trauma as their clients (Baum 2014;Dekel and Baum 2010;Tosone et al. 2003Tosone et al. , 2012). This concept was extraordinarily helpful in examining our practice as educators and administrators during this world-wide health crisis, as we attended to the educational, emotional, and logistical needs of our students. ...
... We observed significant anxiety at all levels of the school community, including within ourselves (the FLCP), the school's leadership, students, field advisors, and agency partners. However, as with most crises, there were also opportunities for growth and a sense of resilience, both individually and as a collective (Nuttman-Shwartz 2015;Straussner and Calnan 2014;Tosone et al. 2003;Tosone 2011;Walsh 2003). This reflection, focused on crisis, anxiety, and shared trauma, illuminates areas of potential change and development in our teaching practice as field educators, and in field education as a whole. ...
... These feelings are similar to those identified by Tosone et al. (2003) reporting on the reactions of student clinicians as they worked with clients after the events of September 11, 2001. In the initial months of the pandemic, students voiced concerns to field advisors, instructors, and also through social media, ranging from disappointment to anger to fear, and from fear to frustration. ...
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The field placement process has become increasingly challenging for schools of social work, particularly for large graduate programs situated in urban centers with competing schools. The unprecedented circumstances created by the COVID-19 public health crisis further strained the placement process, revealing a delicate balance of interdependent systems that schools must address when confronted with an unforeseen disruption of field education. This paper reflectively examines the steps taken by the field faculty and department of one large school of social work to address the impact of the pandemic on field education and its placement process. Utilizing crisis and shared trauma perspectives, the field disruptions, continuity of learning, contingency plans, and the attendant anxiety caused by COVID-19 are discussed, as are the lessons learned. Though COVID-19 has significantly altered the placement process, this reflective frame allows faculty to take the lessons emerging from the crisis and use them to improve services and learning opportunities for students in the future.
... This developmental process agrees with common models of stress and coping (Berger, 2015;Littleton et al. 2007) and supports findings of a similar progression in previous studies. For example, Tosone et al. (2003), similar to the current project, analyzed reflections of MSW students in NYC following the terrorist attack on September 11. The authors described a process in which students moved from a chaotic first stage to attempts to make sense of their feeling and eventually beginning to focus on their professional role. ...
... 252). Similarly, Tosone et al. (2003) reported that students' reactions in the first month included shock, disbelief, bewilderment, loneliness, difficulty to concentrate, fear, anxiety, uncertainty, sorrow, depression, hopelessness, confusion, lack of motivation, helplessness and anger. Interestingly, absent from the report of the instructor was the experience reported elsewhere (e.g. ...
... Wong et al., 2007). Also similar to previous research (Tosone et al., 2003), at least one student shared that the current crisis reactivated in her experiences of struggling with anxiety earlier in her life. ...
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Preliminary results of a qualitative study of the lived experience of teaching and learning during the Covid-19 pandemic are presented. An instructor, a program director and five doctoral students in different stages of their coursework and dissertation proposal development, wrote a reflective journal. Participants varied in their levels of familiarity with technology-assisted education, personal backgrounds and circumstances including work and family responsibilities. Participants’ journals documenting their reactions, struggles and coping since the abrupt move of the university from face to face to online classes were content analyzed. The analysis was co-conducted by five participants to identify themes and generate understanding of the experience. Two main themes emerged from the analysis: a developmental process of participants’ reactions, perceptions and meaning making of the experience and factors that shaped it. Lessons learned are discussed and recommendations for professional education and directions for future research are suggested.
... For example, in the case of the World Trade Center attack, studies examined the coping patterns of social work students in the wake of the outrage (e.g. Matthieu et al., 2007), as well as aspects of secondary trauma amongst social work students who had been closely exposed to the site of the attack (Tosone et al., 2003). In the case of Hurricanes Katrina and Rita in 2005 in the USA, studies have examined resilience factors juxtaposed upon post-traumatic reactions as a coping pattern in the face of exposure to disaster (e.g. ...
... Baum, 2010, pp. 1935-6)-simultaneously managing their own coping with the crisis, and the assistance and support they expected to provide to the service users (Baum, 2004;Nuttman-Shwartz and Dekel, 2007;Tosone et al., 2003). Indeed, responses, such as a sense of helplessness, lack of control over the situation and a heavy sense of responsibility, have all been described in the literature as consistent with the status of social work students and the impact of their lack of experience on mechanisms of adaptation to a STR (Baum, 2004;Nuttman-Shwartz and Dekel, 2007;Tosone et al., 2003). ...
... 1935-6)-simultaneously managing their own coping with the crisis, and the assistance and support they expected to provide to the service users (Baum, 2004;Nuttman-Shwartz and Dekel, 2007;Tosone et al., 2003). Indeed, responses, such as a sense of helplessness, lack of control over the situation and a heavy sense of responsibility, have all been described in the literature as consistent with the status of social work students and the impact of their lack of experience on mechanisms of adaptation to a STR (Baum, 2004;Nuttman-Shwartz and Dekel, 2007;Tosone et al., 2003). ...
Article
The present paper is based on a photovoice study conducted with sixteen undergraduate social work students in their third year of study, examining their real-time lived experience of their fieldwork training in the immediate aftermath of the outbreak of the coronavirus pandemic. The findings of the study, based on an analysis of sixty-six photovoices, indicate four main narratives encapsulating the students’ real-time lived experiences: (i) the challenges of encountering the crisis; (ii) conceptualizing the experience; (iii) coping practices; (iv) perspectives for the future. The findings are discussed in the light of shared traumatic reality theory and transformative learning theory. Following the use of the photovoice methodology, the research conclusions encourage the assimilation of creative and entrepreneurial models of teaching and practice, in order to enable the inclusion of different types of knowledge and life experiences in different learning and research spaces.
... The qualitative data were collected in the late summer/early fall of 2020, before vaccination was available and as clinicians were recognizing that pandemic conditions were not going to be short-lived; in order to continue psychotherapeutic work safely, they would need to adapt to videoconference sessions. These data therefore reflect the thoughts of clinicians about how the therapeutic relationship was changing as they themselves were adapting their practices to teletherapy under the duress, and shared trauma (Tosone et al., 2003(Tosone et al., , 2012, of the pandemic. Our findings coalesce around three central themes: It is a "much more remote experience"; The "connection… remains surprisingly strong"; and It is "energetically taxing." ...
... Beyond the openness of the co-created TF of the shared therapeutic environment, there is also a shared trauma. Tosone et al., (2003Tosone et al., ( , 2012) drew on experiences from September 11, 2001 and of Israeli clinicians to identify the heightened therapeutic intimacy and connectivity that can occur during moments of collective crises, particularly when clinicians are deeply self-reflexive and embrace self-care. Expanding on this concept in an edited volume related to COVID-19, Tosone (2021) was able to document shared resilience as well as shared trauma. ...
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The therapeutic relationship (TR), including its therapeutic frame, is the foundation of the therapeutic endeavor. In response to the COVID-19 pandemic and the rapid transition to videoconferencing for therapeutic encounters, we employed a cross-sectional exploratory survey with 1490 respondents to understand how practitioners adapted to the changes. In this secondary analysis focused on the TR, we analyze the clinicians’ (N = 448) spontaneous narratives about facets of the TR. Temporally, we focused on how these adaptations occurred during the initial part of the pandemic before vaccination was available and while the TR was still adapting to teletherapy videoconferencing under the duress of pandemic crises. We find three broad themes: (1) It is a “much more remote relationship”; (2) The "connection…remains surprisingly strong"; and (3) It is “energetically taxing.” Each reflects clinicians’ views of the TR as altered, but surprisingly resilient. Although grateful for the safety of virtual therapeutic encounters, clinicians mourned the loss of an embodied encounter, experienced depletion of energy beyond Zoom fatigue, and nonetheless recognized their clients’ and their own abilities to adapt.
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In March of 2021, as the world marked the first anniversary since COVID-19 altered our reality, graduate social work students in Dr. Carol Tosone’s Evidence-Based Trauma class at NYU considered the challenges of learning about trauma treatment while simultaneously living through a global trauma. Students reflected on their home lives, school experiences, field placements, mental health challenges, feelings of burnout, and the added complexities of racial disparities and injustices. Students also shared their coping mechanisms and hope for the future. This paper aims to provide insight into their varied experiences while relating their struggles and demonstrating their pathways toward resiliency.
Chapter
This chapter is a first-hand account of one educator’s experience supporting graduating Master of Social Work student-interns as they maneuvered the process of saying goodbye to clients during a time marked by uncertainty, heightened anxiety, and sudden changes. The chapter begins with an exploration of feelings and thoughts related to the pandemic as well as reactions to university decisions surrounding procedural changes to field/internship placements and to the general academic learning environment. This exploration highlights parallel process and shows the value of honoring direct, felt experiences during a crisis or traumatic event, especially at critical and poignant moments such as graduation and the ending of a therapeutic relationship.
Article
COVID-19 has created a less-than-ideal environment for social work education and practice, especially for student interns trying their best to navigate the ups and downs of the forced termination process. Supporting students in meeting this challenge during an era marked by shifting routines, revised learning plans, altered work environments, and increased collective stress is a daunting task for social work supervisors, agencies, faculty, and university administrators. This article offers a literature review on the following concepts: forced termination, parallel process, and shared trauma. These concepts are then used as analytic tools for understanding the potential effects of COVID-19 on the experiences of student interns navigating the forced termination process. A student case example is presented and analyzed, as is the faculty liaison’s response. Insights and considerations for managing forced termination during the pandemic are offered.
Article
The COVID-19 pandemic has impacted individuals across the world and disrupted societal systems, including educational institutions. The aim of the current cross-sectional survey of U.S. social work students was to describe: (1) students’ experiences of COVID-19-related stress, academic stress, and access to supports; (2) changes in academic stress following the onset of the COVID-19 pandemic; and (3) factors that contributed to a change in academic stress following the onset of the COVID-19 pandemic. An independent samples t-test identified an increase in students’ academic stress following the onset of the COVID-19 pandemic and multivariate regression determined factors contributing to levels of student stress, including program support and access to academic resources. Implications for social work programs’ responses to disasters are discussed.
Chapter
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Shared trauma in the wake of a global pandemic has created a unique bond between the clinician and the client. While navigating one’s own fears, anxieties, and losses, the clinician must also serve as an anchor to the client in an unsteady and unpredictable world. The profound impact of collective catastrophic events can create immense hardship for clinicians living and working in traumatogenic environments. Even outside of the pandemic, clinicians who specialize in the treatment of trauma and complex trauma have a distinct susceptibility to vicarious trauma (VT) due to the repeated exposure to the harrowing details of their clients’ traumatic experiences. VT refers to the experience of indirect trauma which can include the clinicians’ continuous emotional engagement with a clients’ traumatic material. This can create cognitive distortions and changes in core belief systems of the clinician, which, in turn, can adversely impact overall functioning and emotional well-being. Many clinicians enter into the profession to compassionately witness, heal, and affirm their clients due to their own lived experiences of trauma. Without adequate use of clinical supervision, professional boundaries, and self-care, repeated exposure to trauma can be precarious to the clinician’s well-being, causing retraumatization or compassion fatigue. Chapter 11 provides a conceptualization of VT before exploring how this may impact upon the clinician and the therapeutic alliance. Secondly, this chapter reviews the impact of countertransference before proposing strategies to effectively manage its adverse effects. Finally, this chapter explores the role of professional supervision and the importance of self-care for the trauma clinician.
Book
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This is the book that started an are of research and practice of compassion fatigue, secondary traumatic stress and stress reactions, vicarious trauma, and most recently compassion fatigue resilience
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It is estimated that 25 to 30 million people are forced to leave their homes because of human rights violations or threats to their lives. Such massive dislocations at the international level result in significant numbers of diverse, persecuted populations seeking asylum in the United States. It is estimated that as many as 400,000 victims of torture now reside in the United States, with many survivors suffering in silence. The challenge for social workers is to discover this often hidden, vulnerable population and to serve them. Among all the populations experiencing the trauma and stress of persecution, most is know about Holocaust survivors. Through examining the long-term effects of massive psychic trauma gleaned from research on Holocaust survivors and their children, this article addresses the skills, techniques, and insights about current refugee populations that can be incorporated into social work practice and training.
Article
This article explores clinical issues related to self-disclosure to clients following a traumatic event in clinicians' lives. In particular, special attention is paid to the role of self-disclosure in clinical work when clinicians are conflicted about whether or not to share personal information or how to communicate it to clients due to the nature of the trauma. Therapeutic implications, both short and long term, associated with such self-disclosure are discussed.