The attacks of Sept. 11 have left an unmistakable psychological imprint on the American psyche. In addition to dealing with trauma, anger and fear in the aftermath of the attacks, many people will take a closer look at what's important to them, said APA President Norine G. Johnson, PhD.

Johnson shared some of her thoughts about the work psychologists have already done, and what may lie ahead, in an interview with the Monitor.

Q: The recent tragedies appear to be prompting more people to seek mental health care. How is psychology responding to an increased demand at this time?

A: The terrorist attacks have affected us all, each in different ways. To cope with the immediate aftermath, psychology has responded to the increased demand in multiple ways:

  • Extending mental health services beyond the treatment room by helping the helpers, such as the police and rescue workers who looked for survivors.

  • Working within established networks such as those set up by state associations and APA's Practice Directorate. The APA Public Education Campaign network has allowed for continuity in school personnel working with children on the aftereffects. Working together with teachers and groups helps extend psychological help. For every teacher you help, you're helping 30 students.

  • Being available to the media. Getting information out about the effects of trauma, PTSD and ways to comfort children.

  • Maintaining up-to-date information on trauma on APA's Web Site.

Other psychologists who have extended their work hours are taking back old clients who need help during this time as well as continuing to work with current clients.

Q: How can psychologists help patients return to "normal" life?

A: I've heard so many people really wondering if what they did before was important and questioning whether or not what they do will have relevance in this new world. We know that one of the guidelines to working with people in trauma is to encourage them to go back to normal. I've been changing that. I say return to a routine. It's important that people go to work, children go to school.

I think people will also be exploring a new way of being, and I think we can help them do that. It's important not to rush to judgment about what is normal. If a family isn't ready to take their children to a ball game, we respect that and find other ways to help them engage in activity as a family. On the other hand, we need to be alert for clients who significantly restrict their lives and devalue their lives and work or those who become agoraphobic. For me, I find cognitive behavioral approaches most helpful at this time, like having people do homework assignments that allow them to put pieces of their routine back in place one at a time. We have to try not to overload them with expectations but to gradually pick up pieces of their lives.

Q: Americans now recognize that terrorism is a real threat to their safety and are more anxious as a result. What implications does this have for clinicians in their practice and training?

A: To me it means that all of us must become specialists in dealing with anxiety. Anxiety is and will be part of what most, if not all, of our clients experience in addition to their other concerns. We need to teach our clients techniques such as deep breathing, muscle relaxation, thought stopping, thought redirection and identification of catastrophic thinking. Several colleagues have commented on how in the weeks following the attack their most disturbed clients came in and began the session just as they had ended the last session; as if nothing had happened in between. When that happens, one needs to think about a disassociative response.

I find that parents are particularly experiencing anxiety. I have noticed a change. In the week after the attack, parents were seeking information on what to tell their children. Now they say children are returning to normal, but they--the parents--aren't. One mom said to me, "How do I handle my fear? I look at my child's smiling face and I think this might be the last time I see her."

I'd like to see APA's continuing education and state associations, agencies and psychology departments put together offerings on anxiety management. We need to beef up training for clinicians already out there and for doctoral students coming along--it needs to be an integral part of doctoral and training programs.

Q: Psychologists are working with many people who are experiencing survivor guilt. What advice are they giving to help people cope?

A: I had a Boston client who was in New York that day. She went into action mode after hearing of the attack....She rented a car and drove eight hours to return to Boston. She feels guilty. She feels she should have gone to look for survivors. She is feeling selfish.

I don't know any formula. I do feel that helping her see the positive part of her actions appears to provide her with relief. I reaffirm that her children did need her and it wasn't selfish to drive eight hours--that those are the actions of a loving mother, not of a bad person.

Q: Some reports have talked about the value of being a good listener. How can psychologists help their clients to be good listeners and foster healing in their communities and families?

A: A few clients are just not able to be good listeners at this time. It's important to let them know that's OK. They will return to being able to be better listeners....How can we facilitate when their responsibilities call for them to be good listeners? First, find out what's blocking the client from listening. For example, one junior high teacher complained that his students wanted to talk about the dance that weekend. He felt like shouting at them, "How can you be so self-centered?" The steps I went through with him have been effective with other clients:

After you listen to what it is that's bothering them, counter that with knowledge. For instance, with the teacher I informed him that this was how early adolescents deal with trauma. They are testing the adult to see if it's safe enough to share what they are feeling.

We need to go back and concretely give our clients steps for listening. Don't assume that they've kept their listening skills. Talk to them about making eye contact, talk about thinking positive thoughts about the other person and about saying something concrete rather than getting into traumatic fantasies. And finally, talk to them about reassuring the person they are listening to, whether it's a friend, a child or a student....For clients who are not having trouble listening to the trauma and want to help their families and communities,...give them basic knowledge about how people experience trauma. Tell them about APA's Web Site.

Q: What can psychology do to help prevent backlash against Arab Americans now?

A: We can move on individual and organizational levels. On the individual level, it's important to share our knowledge about stereotyping and look within ourselves. I've heard several people talk about being aware of their own edginess; not liking it but being aware that it's there. We must look for it in ourselves, bring it up to consciousness, acknowledge it for irrationality and the form of racism that it is, and then let go of it.

On an organizational level, it's important to work through synagogues, churches, mosques, state associations and local clubs. Talk about the phenomenon, talk about the irrationality of it. Remind people of the injustice that has been served through the ages. We don't want to fall back into these ways of behaving. Help people recognize hidden racism, as well as overt racism; help them identify anger, find ways to express it appropriately and direct it where it belongs rather than at other objects. It's important that APA pull together its scientific and public policy information on ethnic and cultural stereotyping and racism.

Q: Self-care is an important issue for anyone after this trauma. What's your advice to psychologists?

A: My recommendations are simple:

  • Debrief daily. Do it personally, by phone or online.

  • Realize your need for new therapeutic tools.

  • Increase your therapy skills in managing anxieties.

  • Try to maintain a stable workload so you won't burn out.

To be an effective helper in this sustained effort, psychologists must have support systems and we must use them regularly. We must also learn new techniques. This isn't something we have been taught. It's the rare psychologist who has had training in ethnopolitical warfare and terrorism.