This article is authored by one of my revered colleagues, Lauren Gaspar, LCSW-S, RPT-S who is a child and family therapist in her private practice in Austin, Texas She has significant experience addressing trauma with children ages 3 and up and taught Play Therapy and Treatment of Children and Adolescents while at the University of Texas Graduate School of Social Work for nine years. Her experience in providing services in the wake of the 9/11 tragedy informs the wise guidance she provides those of us now faced with serving the needs of those traumatized by this COVID19 pandemic.
Some of you feel that this time within the mental health arena in our country is unprecedented. But that is not the case for all of us. Some of us have been here before.
For clinicians who treated clients during Hurricane Katrina, after the Oklahoma bombing, and after 9/11 this all feels very familiar. We are finding ourselves in a very similar place once again.
I have been here before.
About two months after two planes from Boston’s Logan airport were flown into the World Trade Centers in 2001, I was asked by the Good Grief Program (GGP) to facilitate a children’s group of 3-5 year olds who each had a parent die on Flights 11 and 175. It was a component of a multi-family grief group we held for these children and their families. Three months later, the GGP offered me a full time position called a “9/11 Therapist” funded by the Victims of Crimes Act. I was to continue leading the 3-5 year old group, and co-facilitate two support groups for widows and widowers, two adult siblings, parents who had had an adult child die, and adult children who had had a parent die.
In addition to my clinical duties I was to serve as a consultant to schools and train their staff on how to talk to students about death and dying. I was only 24 years old, single, and had no children of my own at that time.
What most people don’t realize is that over 250 families in Massachusetts could identify as having had an immediate family die on 9/11, whether on a plane or in one of the towers. That does not include cousins, grandparents, in-laws, aunts, or uncles.
I had already been facilitating volunteer grief groups with GGP for two years, so I thought this should be the same thing, right? Easy peasy. I had all the training, read the right books, and knew what to say. I’d check off the boxes at denial, anger, bargaining, depression, and acceptance and tell them how they were simply moving through the stages. I was confident that I could do this job.
I will tell you that after that first 9/11 family group, we facilitators just stared at each other speechless. We couldn’t even begin to do a proper debrief until our nervous systems quieted down and we didn’t feel like crying.
I was so shocked and traumatized by talking to these children and seeing their newly widowed parents. Although I had been facilitating support groups for widowed parents for GGP for two years before beginning this work, these parents looked different. They wore their trauma and grief like a weighted coat they couldn’t take off.
While previous parents I’d worked with had the chance to bury their loved ones, these parents didn’t have a body that could be identified. Some buried an empty casket.
Post 9/11 grief and this COVID19 pandemic crisis have difference and similarities.
When I think about how this feels similar to working with my current clients during this pandemic, I think about the constant need and flood of information daily. Right now our clients want to discuss the latest updates and strategies about COVID-19 and the dangers it poses. With my 9/11 clients, they wanted to discuss news about Osama Bin Laden on repeat. They tried to piece together any and every detail they could of what took place on the plane or in the towers that their loved one was in so that they could have a sense of what had happened. They watched the news obsessively, much like many of us find ourselves doing now in an attempt to feel more in control through knowledge.
Hearing the same content in all my phone calls and therapy sessions began to wear on me. I discussed the expected pain of grief on repeat like fear, depression, anxiety, and loneliness, but I was also having to tolerate discussions about body parts, DNA testing, the medical examiners office, fights with in-laws, and corporate lawsuits.
Family members would call crying, disclosing new information about body parts of loved ones discovered and I was not prepared for how to respond. They don’t teach this in graduate school.
Even my sweet co-worker who had done grief work for decades would look at me sometimes and say, “I don’t know what to do. I’ve never done anything like this on this scale.” We were just flying by the seat of our pants and there were no boundaries.
I’d talk to parents and clients morning, noon, and night and that was what was expected. The children in my group grew older and as they did their grief became worse because they could understand more of what had happened.
I worried about not knowing enough, not saying the right thing, or being too young myself for parents to trust me.
We were exhausted and pained with their grief but we pushed through it. After all, isn’t that what we’re supposed to do?
I lost 30 pounds in those two years from the stress. I barely slept between coming home at 10 pm after group sessions and getting to work at 9 am to start doing individual sessions.
I never thought about self care.
Our executive director was more concerned about keeping our grants than keeping us healthy. She never asked us how our 12 hour day had gone the night before, just what were we getting done that day. I facilitated groups during a time that was so political that the members broke out in verbal fights and we had to neutralize the anger in order to keep everyone feeling safe in a world that felt unsafe.
The competitive grief was real. There was sadness and bitterness as individual clients and group members tried to justify how their grief was worse based on how old they were, how old their children were, how their loved one died, and how much more devastating their loss felt compared to others. Groups would often become derailed in discussions about whether or not it was worse to die on a plane or burn in a tower. I would walk the tightrope of validating their feelings while gently reminding them, “What difference would it make how your loved ones died? You’re all experiencing the same pain.”
By the summer of 2003 those of us working under the grant in Massachusetts were so over-worked and traumatized ourselves that some of us developed a fear of flying, had daily nightmares, or were burned out and ready to quit.
The fact that we had each other to talk to was an amazing gift, because no one else understood what we were doing nor could we tell them. I remember over-disclosing my secondary-trauma experiences in supervision with a supervisor from an outside agency, and she would just stare at me with wide eyes. I was traumatizing her with my high impact disclosure.
I eventually left my job at the GGP, ironically, because I had became engaged to a man whose father had ALS and needed to help with his care. The irony that I said goodbye to the 9/11 widows I worked with for 2 years because I was moving on to get married and eventually have children is not lost on me. As a parting gift, they gave me a journal where they each wrote the love story of their marriage on a different page with well wishes. I still have it today.
When I think about what I’m experiencing now with clients during this COVID19 pandemic, it’s not much different to that time after 9/11. I find myself feeling scared, anxious, and experiencing secondary trauma with my clients’ grief while I try to bind my own. I’m watching parents try to justify who is working harder, who is balancing more, and who is better at homeschooling on the fly.
The competitive grief is real.
I’m back to working with individuals who are crying all day and don’t know how to manage right now. While the reasons are different than the 9/11 crisis, the amplified helplessness and hopelessness is the same. And it’s overwhelming.
In some ways doing this work feels worse than it did back then. When I met with those family members after 9/11, although they were scared and grieving, it was an event that was in the past and was over. While there was continuous uncertainty around them, the event that created their pain had passed. Now my clients and I are both staring into a screen at each other, not knowing whether we will both get sick or when we will be able to sit in my office together again and laugh.
My child clients are overwhelmingly lonely, bored, and depressed from the on-going sense of fear-induced trauma. They are afraid, and their parents are afraid. Managing my own fear and stress is also different now.
I can’t go to happy hour with my friends to help dispel the heaviness this time. I can’t give or get a hug from a friend when things feel hard. As an attachment therapist, that is the worst. While I’m managing my own emotions, I am stuck within the confines of my home to try and shake the vicarious trauma out of me while my kids ask me what’s for breakfast, lunch, and dinner. I’m making sure homework gets done in between sessions and hoping I can pay my office rent next month. It’s a different ballgame.
But there’s a lot that I can look back on and learn from.
Now that I am 40+ years old I know better and as a result I do better. The trauma and exhaustion of the 9/11 work cut me so deep that I’m simply not willing to go back there again.
While I’m now comforting individuals who are scared all day every day again, I know my limit and I know how to take care of myself. I prioritize myself.
While I was young and single I only had myself to think about and I sacrificed without hesitation. But now I have my husband and my two children and so much more to lose. I know now that I don’t have to prove my worth or knowledge, and I know that what I’m doing is enough.
I know that being a stressed out, overworked clinician doesn’t make me a good clinician.
I’ve learned that the best clinicians are the ones who are humble, loving and compassionate with clients but also know when it’s time to say no. We can not serve the needs of our clients if we are over-extending ourselves.
To prevent burnout or compassion fatigue, here are some helpful ways to ensure prioritizing your own mental health during this time:
- Don’t talk about self-care, enforce it. Force yourself to transition from work to self-care. We are inundated with additional responsibilities right now. The floor will still be able to get mopped and dinner cooked an hour later after you’ve meditated, colored, read, or laughed with your family on a video call. The difference is that the burden of these responsibilities will feel different after you’ve prioritized yourself.
- Move your body. There is enough research out there to justify the need and importance of mobility on our mental health. In addition, walking, running, and various other forms of exercise also provides bi-lateral stimulation that creates grounding and containment. Take that window you’ve been staring at throughout the day in sessions with clients and get on the other side of it.
- Know when to say no. It’s important to know when you need quality and not quantity. This may be the time to do deeper, more emotionally-driven work with your clients that requires having less on your caseload than you normally would. Know your limits and listen to your body that you’re doing too much.
- Get consultation or seek your own therapy. The power of sharing our experiences is not just for clients. It’s ok to need to vent or process sessions right now even while everyone else is talking about getting sick or having financial stress. This too may be a part of your discussion because it impacts our work as therapists. We are currently treating others as many of us are traumatized ourselves. If we are encouraging clients to remain in therapy, then we should be modeling this and doing the work ourselves.
- Breathe and drink (water). This is my #1 advice in grief work, and it applies now to clinicians. Be mindful of your breath and take time in between sessions to breathe deeply and center yourself. Set your timer throughout the day to do breathing exercises before you move onto your next task. Take water with you from room to room and set timers to drink a glass of water. Dehydration is a silent and often forgotten symptom of depression and makes us feel much worse than we realize. Make sure your body is getting the “watering” all living things need.
To reach Lauren Gaspar, LCSW-S, RPT-S for consultation or other questions, e-mail her at lauren@goodourningcounsleing, or visit her website at www.goodmourningcounseling.com.