Practicing psychologists, who are always called upon to balance the demands placed on them in their work with patients and clients against the demands of their own lives, are facing even more compelling challenges in light of the September 11 terrorist attacks and subsequent developments. Psychologist-client relationships are drawing even more intensely on practitioners’ capacity to help and on psychologists’ skills and experience during this time of national trauma.

Health care consumers are responding to unfolding events surrounding the war in Afghanistan and the specter of additional terrorist activity at home with serious concerns and disruptions in daily life. There is a corresponding sense of fear, vulnerability, and feelings of uncertainty about the future.

Providing psychological assistance involves listening to and witnessing clients’ and patients’ emotional, cognitive, and behavioral reactions to these events, their concerns for family and friends who may be directly or indirectly affected, their anxiety about safety and the future, and their existential questions about the meaning of these events. Meeting these demands repeatedly and continuously requires tremendous resilience in the face of these reactions and the psychologist’s own response to these same events.

THE CALL TO HELP A NATION IN DISTRESS
In the midst of this shared crisis, psychologists themselves may experience significant stress from their work, stress that strains practitioners’ capacity to maintain the highest standards in treatment. To succeed in fortifying their resilience, practitioners must ensure that their own psychological needs are appropriately acknowledged and addressed so that as health professionals they may continue to meet the psychological needs of those who require their services.

The effects and consequences of the recent terrorist attacks permeate both the professional and personal realms of the psychologist. Although psychologists are vulnerable to the same emotional and psychological responses as the public, they can, if attentive to the challenge, manage these stresses effectively and maintain exemplary standards of professional performance.

RECOGNIZING PROFESSIONAL CHALLENGES
Some of the professional challenges and practice disruptions facing psychologists as a result of the September 11 tragedy and its aftermath include the following:

• Patient or client regression may be triggered by the recent attacks (particularly among trauma survivors).
• Previously established treatment goals may be eclipsed by outside events, thereby interrupting the treatment process.
• Wide variability of client response and shifts in response over time and as new events unfold require careful professional vigilance in order for psychologists to remain a steady, reliable source of support.
• Psychologists may be called upon to increase hours in order to see new patients or to help those in crisis.
• New professional role and boundary maintenance challenges emerge as psychologists share traumatic national experiences with the client (who, for example, may be particularly interested in the therapist’s personal responses and feelings about the situation).
• Psychologists involved in disaster response may expect to experience increased professional stress and emotionality as a result of their direct exposure to the traumatic injury of survivors.

Psychologists who have been directly affected by the terrorist attacks or their aftermath face a special dilemma in balancing individual needs and professional demands. Some particular challenges for these psychologists may include:

• Maintaining emotional balance and boundaries with clients even while sharing the reality of the circumstances.
• Balancing personal needs and the desire to share concerns with another person with professional role responsibilities when asked about personal experience or the safety of family members.
• Balancing the great need of patients and the psychologist’s desire to provide assistance with the increased personal stress that may result from maintaining the therapist role during a time of personal trauma.

A GREATER NEED FOR SELF-MONITORING
The extraordinary demands on practitioners during this time of crisis and national tragedy intensify the need for self-monitoring with an eye to self-care strategies that can help bolster professional resilience. Psychologists should be attuned to physical and emotional vulnerabilities and attend to preexisting stressors. Ongoing realities of daily personal life and professional practice continue and will intersect with stress caused by traumatic national events. It is important for psychologists to understand that increased professional stress is a natural response to these circumstances and that the first step in managing this stress is careful attention to self-care.

SELF-CARE STRATEGIES
The following self-care strategies may help psychologists cope with additional professional stress in this difficult time:

Take some basic steps

• Assume that you will need more sleep, exercise, and healthy foods -- just as your clients and patients do.
• Notice where you embody stress and attend to your physical needs as much as possible. Take advantage of support such as massage, physical therapy, exercise, meditation, acupuncture, dancing, walking, or whatever adjunctive activities are personally restorative.

• Maintain contact with friends and family, and talk to loved ones about your experience and feelings.
• Shed the therapist role when not working with patients and clients.
• Connect with organizations in your community that are important to you.
• Attend to your spiritual needs, individually or within a spiritual community.

• Pursue hobbies and avocations.
• Even though demands on your schedule may intensify, don’t attempt to do too much. Seek necessary time away from work.
• Write and talk about the events and their effects, recognizing that this may feel difficult to do under unusual circumstances.

PROFESSIONAL STRATEGIES
In addition to self-care, professional resilience can also be strengthened by using various professional support strategies:

Increase interaction with peers
During a period of heightened stress, it may be helpful to increase consultation or supervision. Don’t try to go it alone. Normalizing the difficulty of providing help while managing personal responses can be eased greatly by communicating about your reactions with respected peers or a supervisor.

Consider personal therapy
If the self-care and professional support efforts described in this publication don’t help over time, personal therapy may be a good strategy to aid in managing stress and implementing healthy coping behaviors.

Develop a long-term perspective
It may be helpful to anticipate long-term responses in connection with the crisis and plan ahead for both the demands of work and the need to manage your own experience.

PSYCHOLOGISTS’ COMMITMENT TO AMERICANS IN NEED
Psychologists can and should build their resilience to help patients and clients effectively during this unprecedented period in American history. The effects of the September 11 attacks and their aftermath likely will affect our lives and those of our clients for a long time. Patients and clients across the country will rely on psychologists to help process the personal meaning of the events that already have taken place and will continue to occur.

Practitioners have found it very gratifying to make a valuable contribution by helping others in this time of trauma. Psychologists nationwide will enable themselves to continue providing a much needed service by taking the professional and personal steps necessary to maintain their professional capacity in the months and years ahead.

This publication was developed by members of the APA Board of Professional Affairs’ Advisory Committee on Colleague Assistance including Chair Michael F. O’Connor, Ph.D., Nancy S. Elman, Ph.D., and Karen W. Saakvitne, Ph.D., and by Christopher J. McLaughlin, director of professional development demonstration projects for the APA Practice Directorate.

October 2001