Feature

For most military psychology interns, training for war takes place in peace. They go to lectures, read papers and practice their skills in calm office settings.

"Although interns may think their supervisors are rough on them, it's typically not a combat zone," says Larry James, PhD, chair of the psychology department at Walter Reed Army Medical Center in Washington, D.C.

The Sept. 11 attack on the Pentagon gave Washington, D.C., area military psychology interns a chance to put their skills to use in a warlike setting. In the weeks after the plane slammed into the building, interns and postdoctoral fellows from the Army, Air Force and Navy helped psychologists assess psychological needs, offer psychological services, teach stress-management skills and train medical personnel.

For James, this training opportunity was the attack's only silver lining. And it's one he hopes future interns won't have.

"I hope that in my professional lifetime this will be the only time that a group of interns has the opportunity to get this type of real-life, go-to-war mission exposure," he says.

Hands-on experience

For two months after the attack, Walter Reed's four interns and a postdoctoral fellow served as part of multidiscip-linary teams working 24 hours a day, seven days a week, at the Pentagon and a nearby family-assistance center. Under the supervision of staff psychologists, they did everything from performing psychological interventions to reminding emergency medical service supervisors that their personnel needed a chance to sleep.

The experience taught them that there's more to being a military psychologist than purely clinical skills, says Stacy A. Williams, PhD, the department's director of residency training and chief of pediatric behavioral health. In a crisis, logistical skills such as setting up communication systems or even just figuring out how to get to the site are also key. At the Pentagon, Williams and some of the interns working the night shift slept in tents at the site.

"When students are in training, it's usually a pristine laboratory with an unrealistic atmosphere," says Williams. "There are always enough doctors, the patients are well-behaved, everything's controlled. Then we send them out on a mental health assignment where they're the only psychologist for 15,000 troops." Making that kind of adjustment can be overwhelming for junior psychologists, she adds, unless they've had the kind of real-life training this year's interns received.

Capt. David J. Beckstead was one of the Walter Reed interns who helped out. In addition to providing psychological interventions, he and his fellow team members went door to door to every office in the Pentagon and asked supervisors how their staff members were holding up. Beckstead, who found himself consoling commanders, was surprised to learn first-hand how emotionally taxing it is to work in a real-life crisis situation.

"Because of our security clearances, we were able to get very close to the spot where the plane impacted the building," he says. "Seeing that--and seeing the amount of suffering that resulted--produces a lot of emotional responses in a person. Learning how to manage those emotions while working with other people was the most valuable lesson I learned."

Interns from the National Naval Medical Center in Bethesda, Md., also helped out in the attack's aftermath. All six of the center's interns answered phones for a crisis hotline set up for military personnel and family members who needed referrals or just someone to talk to. Two of the interns spent time at a Pentagon annex providing interventions to individuals and groups.

"This was a way of applying the psychological principles and everything else they'd been learning in graduate school and their internships in a way that interns rarely get," says Marvin H. Podd, PhD, director of psychology training at the medical center.

Kirsten Betak, an intern at the center at the time of the attack, worked several 3 a.m. shifts on the hotline. That type of work should be part of every intern's training, she says, explaining that the experience offers invaluable practice in helping people in crisis.

As a result of one hotline call, Betak headed to the Office of Naval Intelligence in Suitland, Md. The office had lost about a third of its staff during the Pentagon attack, including its commanding officer. To help the survivors process their grief, guilt and anger, Betak and a psychiatric technician spent a morning with them. In the afternoon, they offered senior officers and civilian managers a seminar on managing stress and recognizing signs of distress in others.

At Malcolm Grow Medical Center at Andrews Air Force Base, interns had just begun their training year when the attacks took place. As a result, they hadn't had enough training yet to help out at the Pentagon itself, but they did get to observe the work of senior staff.

"The Pentagon disaster was an unfortunate training opportunity," says Paul R. Rivest, PhD, assistant director of training. "But having the exposure to a situation like this will help them be more helpful to people down the road."

Rebecca A. Clay is a writer in Washington, D.C.