Healing 9/11

Creative Programming by Occupational Therapists

Pat Precin

• Publisher: Routledge
• Year: 2014
• eBook ISBN: 9781317955498
• Topic: Medicine
• Subtopic: Health Care Delivery

Get a first-hand look at the ongoing tragedy of 9/11

Healing 9/11 examines programs and interventions created and implemented by occupational therapists to aid those affected directlyand indirectlyby the 9/11 attacks. Ideal for courses in trauma and recovery, community interventions, disaster recovery, health programs and implementation, and mental health interventions as well as for professionals, this powerful book chronicles the experiences of OTs who worked with firefighters, burn victims, and displaced workers, as well as children, students, and clients suffering long-term symptoms of depression and anxiety. These first-hand accounts offer rare insights into the healing process for victims of terrorism (including OTs themselves), and serve as a guide to developing outreach and counseling services to those touched by future incidents.

Healing 9/11 continues the work of Surviving 9/11: Impact and Experiences of Occupational Therapy Practitioners (Haworth), presenting detailed personal and professional accounts from OTs who provided physical, emotional, and psychosocial relief to thousands of disaster victims. This unique book reveals how OTs provided aggressive manual therapy, wound care, and scar management to the critically injured; how OTs analyzed the job market and found work for people who had lost their livelihoods; how OTs worked with students in classroom settings to relieve their anxieties; and how OTs helped rescue workers at Ground Zero deal with the emotions that threatened to overpower them.

Healing 9/11 examines:

• nontraditional group therapy
  
• non-clinical treatment settings
  
• burn rehabilitation
  
• pediatric occupational therapy
  
• school-based occupational therapy
  
• employment planning
  
• occupational frame of reference
  
• creative arts therapy
  
• post traumatic stress disorder
  
• and much more

Healing 911: Creative Programming by Occupational Therapists is an essential resource for all healthcare professionals who offer relief in times of disaster.

Part I: Programs and Interventions

Counseling Firefighters Post 9/11 An Occupational and Dance Movement Therapists' Interventions and Experiences

Joanne Cordero, OTR/L
Christine Zimbelmann, MS, ADTR, CMA

Introduction

In October of 2001, the Counseling Service Unit of the New York City Fire Department approached the administration of St. Vincent's Hospital, Manhattan, requesting help in providing outreach and counseling services to firefighters. At that time, the Counseling Service Unit or CSU had a staff of 11 full-time employees, consisting of psychiatric nurses, social workers, peer counselors, and firefighters who were retired or on light duty and reassigned to the CSU. With the events of 9/11 and the loss of 343 firefighters, the CSU was overwhelmed and inundated by the needs of the members of the department and the family members of both the survivors and the deceased. Before September 11, the CSU handled about 50 new cases a month; by the middle of December 2001, it has opened more than 1,500 cases, and had visited and provided education to over 8,000 members of the Fire Department of New York (FDNY) workforce. They expect to see over 6,000 clients through private counseling, education, and group events by the end of 2002. Suddenly and without warning that 1 I -member team, which was more accustomed to handling isolated cases of alcoholism and grief was flooded with calls for its services. While the New York City Police Department held mandatory debriefing for all of its members, the FDNY adopted a slightly different approach. The FDNY implemented a more subtle method to address the complex needs of its members. This approach sought to both embrace and side step the insular, decidedly male culture in which firefighters tend to accept help only in the line of duty.

With regard to the department's approach to counseling and to mandatory debriefing, Dr. David J. Prezant, the Fire Department's Deputy Chief Medical Officer, stated in an interview for The New York Times, "If you go to people and say 'mandatory psychological counseling,' that hurts people ... We're not going to do that. We're going to go to every firehouse and go time and time again. Whoever wants to talk to us, there's a counselor downstairs." In a "dominant male force with a lot of macho issues," he said, the challenge is getting across the simple message: "We are there for you" (Barry, 2001).

In terms of St. Vincent's collaboration with the CSU, seven staff members from the Department of Behavioral Health, which consisted of social workers, nurses, occupational therapists and a dance movement therapist, volunteered to participate in Project Liberty counseling services with the FDNY. Initially, teams of two St. Vincent staff were paired with one to two FDNY peer counselors with whom we visited various firehouses in the downtown area. Around the start of the year, a shift occurred and the St. Vincent's counselors "adopted" a house or two houses that they visited on a regular basis without the counselors from the CSU. Some of us from St. Vincent's worked individually and others in pairs.

General Themes and Issues

In counseling firefighters, some general themes and issues presented themselves. Some issues were present from the onset, some themes began to emerge over time, some have faded or resolved, and others have consistently reappeared session after session and continue to be present in the work, Some of the prominent themes and issues will be discussed in this section.

Treatment in the Workplace

Occupational therapists view treatment in the natural environment as enhancing the therapeutic process. It would seem a perfect fit that the therapists were accompanying the CSU peer counselors into the firehouses to provide treatment. However, as the first few sessions would demonstrate, this setup had its pros and cons, and at times it seemed the cons would outnumber the pros.

As each team of therapists would enter the firehouse, the procedure was basically the same. The person at the front desk, or house watch, would call the officer on duty. The officer, either a lieutenant or captain, would come to the front of the house to speak with the peer counselor. After a brief exchange explaining the purpose of the visit, if the men were available, an invitation to proceed to the kitchen would be given. (There was one instance when the session took place in the firefighters' quarters, or the room with beds where the men slept.) An announcement would come over the loudspeaker informing all the men to come to the kitchen. They would enter the kitchen and take their seats, either around the main table, or depending on the configuration of each kitchen, among the various seats available. In the ideal group setting, they would sit in a circle, where all members would be involved.

However, going into the firehouses, this ideal would not be the reality. Most houses had a large wooden table; in addition, many had additional tables and some had couches, chairs, or recliners, the type one would Find in his/her living room. This would serve to be a problem as some would settle into these comfortable niches and engage in other activities such as reading the paper, resting with their eyes closed, or falling asleep. Other aspects of the physical environment not typically seen in a group session would be very much the normative in the firehouse. Attributes such as the physical space, the layout, the lighting, and the group room would vary but common things would be seen. For example, the lighting may not always be ideal. Some men would be hidden from view due to poor lighting.

This being their house, it would not be unusual for a visitor to arrive during sessions. These guests varied from some of the men who were stationed at the house but were passing through on their day off, were on leave and stopping by for a visit, or worked in that house previously but were now stationed elsewhere. This served to be a source of frustration as well as conflict. Could we be professional and ask the person to join in, or set a limit and ask the person to leave? Although we were there for a professional purpose, we were still guests as well, and often learned to work around these intrusions.

As the introductions and purpose of our visit was presented, some would be attentive and listen while others would continue to engage in their own activities, reading the paper, resting, or talking on the phone, This could be interpreted as a rejection of the visits, but another aspect to consider was that we were in their house and the activity did not stop just because we were there to provide group treatment. So the activity quieted down, the television would be turned off, people were attentive for the most part, but the phone would continue to ring, and the alarm, or the signal that they needed to respond, would continue to sound. This was perhaps the most frustrating and most analyzed aspect of this project. How could treatment be provided in this context? How could we ask these men to share their experiences, some very emotional experiences, as they would be expected to leave at the sound of the alarm to respond to a possible fire or other emergency? This is a definite disruption to any sense of a cohesive group process. However, there was no easy solution. There was no other way to reach these men other than to go into their place of employment. The likelihood of a firefighter coming into the counseling center was very slim. This was the only way to reach them and attempt to provide education, resources, and a forum to allow them to share their thoughts, feelings, and experiences.

Resistance

St. Vincent's was initially brought into the firehouses under the auspices of the CSU. The CSU of the FDNY has historically provided counseling services to men for personal, emotional, and mental health issues. When asked by the men, the CSU is commonly known for the treatment provided for persons with addiction issues, namely drugs or alcohol. As stated earlier, after 9/11, the CSU had to shift gears and respond immediately to the needs at hand. Individual treatment was made available. Numerous groups have been developed and offered to meet the various needs of the firefighters, their families and the loved ones of the deceased. There are currently groups for the grieving widows and families, the liaisons who worked with the families, and for survivors. However, the stigma that had been so closely associated with the CSU appears to have remained and may well be a factor in what is at times construed as resistance to the therapeutic process. As outsiders attempting to make our way in to this culture, we very much relied on and benefited from the education and insights of the CSU members when we worked together with them at the onset of this project. We might never have been accepted into the house without them. However, at the same time the stigma attached to the CSU may have contributed to the resistance. Many men have stated their distrust of the CSU. They feel fearful of their supervisors being informed of the fact that they have sought counseling and there is a fear that a change in duty status could possibly result.

During the early stages of being oriented to this project, we were told to anticipate the resistance of the men. As they say of those who help others, they are the ones who are most resistant to helping themselves. This is true of firefighters. During the initial sessions in the firehouses, we often asked the men, "How are you taking care of yourselves during this time?" Many of them would appear surprised by the question. Others would quickly answer, "I am not thinking of that right now"; "I do not know," or even "I am not." In the initial stages after 9/11, many of the men were in what they described as busy mode. They had experienced changes in their work schedules as they were asked to work 12-hour shifts. They were going down to Ground Zero to search for remains. They were attending funerals and memorials on their days off from work. Some attending even four to five memorials and funerals a day. Many houses were busy planning the traditionally elaborate funerals and memorials for their lost brothers. In addition, they were tending to the needs of the widow/families, not to mention their own families. Many men acknowledged that they had not been home, some for days at a time, and that they had little time for their spouses and children. Perhaps in order to maintain such an intense schedule and to keep up the pace they needed to defend against any painful emotions or acknowledgment of any weakness, vulnerability or suffering that they were feeling. We often asked ourselves, "Are they resistant or are they sealing over far the time being in order to get through the day-to-day demands?" Interestingly, many men made statements which indicated that they were concerned about or anticipated their own mental health being affected once all the frenzied activity died down, or "after the holidays," or "when there is no more digging at the site," or "after the last funeral/memorial." Perhaps, what we sometimes misconstrued as resistance was a necessary mechanism at the time.

As we continued to do this work even after the holidays, after the digging was complete, and the frenzied activity quieted a bit, we still encountered resistance to talking about certain feelings or experiences during some of the group sessions. This resistance was often on the heels of a warm polite welcome and the offer of a cup of coffee, and often some sort of baked item. We have spent a fair amount of time thinking about and discussing this among colleagues who are also doing this work. Resistance is common in therapy and most clinicians are familiar with it. We came to understand the resistance as a manifestation of strong cultural norms, long since established within the firehouse culture. The culture is primarily male dominated and many of its members struggled with the process of acknowledging a need or problem and subsequently accepting help. These men are in the business of rescuing others and are invested in maintaining a strong almost impenetrable exterior. As many of the men will tell you, the occurrences of the day within the firehouse along with any fires that may have been responded to, stay within the firehouse. Any discussion about firehouse activity is usually shared in the house as they sit around the kitchen table. We learned early on in this work that it is a common practice not to talk about the challenges or details of their work with loved ones. In fact, there is often a conscious attempt to conceal, guard and protect loved ones, even spouses, from the realities of the job. While this may serve an important purpose, it also perpetuates a dynamic in which there is an investment in not showing weakness, emotion or vulnerability, and in which open sharing and the receiving of support does not occur.

Is this resistance in the classic sense? One could argue that it is a necessary part of the job. With the occurrences of September 11 so widespread and the terror and destruction so readily seen in all forms of media, the spouses, significant others, family members and friends were now exposed to the events they had been protected and shielded from in the past. Naturally, they wanted to speak about what their loved one in the fire department experienced. Many of the men would say that they were not used to discussing details with those outside the job and this presented a conflict and put strain on relationships. The loved ones felt a natural curiosity. In addition they felt concern; and wanted to provide comfort and support. However, the details of what the firefighters had experienced were too gruesome and disturbing to share. So they tended not to talk about them; they shut down, pushed the experiences and memories aside, remained busy and strong, and denied their own vulnerability. As a result, many firefighters held these images and experiences inside.

Often this disinclination to speak about pain or suffering was apparent in our counseling sessions. Many were of the belief "Why talk about it; it does not change anything," or "Nothing we say can undo the situation or bring our brothers back." The idea that acknowledging feelings and giving voice to them may be valuable and help them to feel better was a new idea and was not altogether accepted. In some houses the men were able to talk about the fact that there was a stigma attached to anyone who sought out counseling. With regard to the need for but disinclination toward counseling services, one firefighter was quoted in the December 14, 2001 New York Times article, "Offering First Aid in a Firehouse Culture That Favors Toughness." He commented on what he observed to be "the quiet distress of some colleagues, the hollow look in their faces and stated, 'I don't think they have a clue. They're overwhelmed. And guys are going to tough it out. That's the attitude of firefighters.'"

Anger

Anger was one of the most prominent and palpable emotions displayed in many of the firehouses that we visited. Anger is a typical response to loss and is part of the grieving process. Many authors have suggested that the grieving process takes place in a series of stages. In most of the literature one of the early stages, after ...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• About the Contributors
• Introduction and Acknowledgments
• FROM MY BEDROOM WINDOW: TIME-LAPSE PHOTOGRAPHY BY JOANNE TORRES
• PART I: PROGRAMS AND INTERVENTIONS
• PART II: CREATIVITY
• Index