Karen W. Saakvitne, PhD, usually spends her days listening to other people's traumas. On Sept. 11, she found herself in the unprecedented situation of feeling just as vulnerable and traumatized as her clients.

"With the person I was seeing at 11 a.m. that Tuesday, there was a period when it wasn't as simple as one of us being a therapist and the other a client," remembers Saakvitne, clinical director of the Traumatic Stress Institute in South Windsor, Conn., and Northampton, Mass. "For a while, we were just two humans sitting together in shock and horror and grief."

Whether they were directly affected by the attacks or not, Americans are experiencing high levels of psychological distress, psychologists report. And, they say, practitioners themselves are facing new challenges as they listen to one patient after another recount their experiences and fears.

A nation in distress

In the immediate aftermath of the attacks, a national poll by the Pew Research Center for the People and the Press revealed that seven in 10 Americans have felt de-pressed. Almost half reported having concentration problems. And a third said they had trouble sleeping.

Psychologists don't need a poll to tell them that millions of Americans have been psychologically affected--even if they live far from the attack sites and didn't know any of the victims. Many people are showing signs of acute stress, such as lapses in concentration, flashbacks and obsessive thoughts about the attacks. People are worrying about the safety of loved ones, the possibility of additional attacks and even mundane activities like going to work or sporting events.

Some groups are more vulnerable to distress than others. People whose family and friends work for airlines or the military are obvious examples, says Saakvitne. So are people with disabilities, who may have been traumatized by reports of wheelchair users unable to escape the World Trade Center before the towers collapsed.

People who are already suffering from the stress of experiences like divorce, serious illness or going away to college may face extra emotional challenges. And people with depression, anxiety, post-traumatic stress disorder or related problems may see an exacerbation of their symptoms.

The attacks have been especially difficult for people who have suffered previous traumas, says Saakvitne, whose practice includes clients who have experienced childhood abuse, rape, accidents, combat and even past terrorist attacks.

"These kinds of bridges to the past intensify responses and often bring back very strong and powerful memories and sensations," says Saakvitne.

Children, too, face special risks, says Barry Anton, PhD, a child and adolescent psychologist at Rainier Behavioral Health in Tacoma, Wash. In the weeks following the attacks, the topic came up again and again in his sessions. He also noticed that many of his young clients were suffering from the same irritability, poor concentration and sleep problems as the adults around them. Some of the children had a hard time distinguishing between the real-life attacks and video game versions; others couldn't keep their imaginations in check and thought all of New York had disappeared.

Although the attacks have since receded into the background, Anton worries that they will nonetheless affect his clients--many of whom are children of divorce.

"The attacks exacerbate the feelings of uncertainty that children of divorce struggle with," he says. "The anxiety levels of many of them are even higher now."

Psychologists need to fortify

Psychologists shouldn't consider themselves invulnerable to these kinds of problems, warns Michael O'Connor, chair of APA's Advisory Committee on Colleague Assistance (ACCA) and clinical associate professor of psychology at Stanford University School of Medicine.

Since the attacks, O'Connor has often found himself distracted by his own feelings as clients describe the same images or repeat the same fears over and over again.

The attacks have also intensified psychologists' stress in less obvious ways, adds O'Connor. Demand for services has increased among new and existing clients, and many psychologists are logging in extra hours.

Against this backdrop, O'Connor says that he and his practitioner colleagues need to fortify themselves to help their clients, including those whose emotional needs have increased since Sept. 11.

"We must ensure that our own psychological needs are addressed, so we can continue to help those who require our professional services at this difficult time," O'Connor said.

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