By JONATHAN D. GLATER
Published on Wednesday, October 10, 2001
See this article in nytimes.com ››

 
Catherine Masterson arrived at the armory on Lexington Avenue and 26th Street in New York at 6 a.m. that first Saturday after the terrorist attacks and spent the next 14 1/2 hours counseling grief-stricken families of the victims. She especially remembers how she coaxed a 9-year-old girl who had lost her father into talking about her feelings by giving her two stuffed kittens, one wrapped in bandages and the other wearing a Red Cross uniform.

All day, a TV screen with the banner ''America Under Attack'' was blaring the news, and at 8:30 p.m., Dr. Masterson, a 46-year-old psychologist who had been volunteering her time, realized it was time to go home. ''I heard the word 'war' one too many times,'' she said. ''I started to cry.''

As she was leaving, her Red Cross supervisor, Lewis Perna, stopped her. ''He said: 'You have to take care of you. What's your plan? How are you going to deal with the feelings that you're carrying around right now?' '' she recalled. ''He made a point of sitting down with everyone going off shift.''

At times, counselors need counseling themselves. Professionals who help people cope with depression, stress and other psychological conditions have long recognized that they are just as vulnerable to emotional stress as any other group, which is why therapists are required to have supervisors until they get their license to practice and why many continue to see therapists afterward. But the strain on the profession in New York since Sept. 11 is without parallel, as large numbers of psychologists struggle to guide people through ordeals that surpass in scale anything they have previously encountered.

''People experience it as something called 'emotional flooding,' '' said Kerry Sulkowicz, a psychoanalyst who spent time talking to survivors and relatives of victims of Cantor Fitzgerald, which lost several hundred employees. ''The flooding has to do with being inundated with so many horrible stories that after a while it just has an overwhelming effect on the listener.''

As a result, Dr. Sulkowicz said, some counselors develop the same physical symptoms, like anxiety or difficulty sleeping, that afflict their patients.

Dr. Masterson acknowledges that she is doubly frazzled -- first by the attacks she witnessed from her 14th Street apartment, second by all the stories she has heard from victims' relatives -- and that she needs help in coping with her anxieties. That help came first from Mr. Perna, her Red Cross supervisor. ''He made you feel like he was in there with you, present emotionally,'' she said.

Back home on that Saturday night, she called family members in New Jersey and spent two hours talking with a neighbor. Then, because she was having trouble sleeping, she took a sleeping pill and went to bed.

Her quest for relief did not end there. She has also looked for succor from her long-time therapist. ''I need somebody for my own stuff,'' she said. ''My need for her is stronger now. I saw the planes crash. I saw the towers come down. We all need to tell our own stories.'' She has cried in those sessions, she says, but her counselor has helped her come to grips with her emotions.

The flood of emotions coming at her ranges from extreme shock to eerie calm. One woman who lost her husband and was waiting for both sets of parents to arrive in New York from Europe wanted to know whether to comfort them or let them comfort her, Dr. Masterson said.

''She was really struggling with this need to be strong,'' she said. ''She was sitting alone, and you could see she was as tight as a knot. She told me that she didn't need any help, so I backed off. Then she started engaging me in a conversation about how the counselors cope with this,'' she continued, and that led to a more open discussion.

What made the woman so memorable was her determination not to cry or seem weak. ''She was so afraid to let anybody in,'' Dr. Masterson said.

The events last month were challenging even to experienced psychiatrists because, as volunteers on the front lines of a mass tragedy, they had to deal with strangers, not familiar longtime patients.

''How do you introduce yourself?'' asked one frustrated psychiatrist, who requested anonymity. ''Do you introduce yourself as a therapist or a psychiatrist or a volunteer? If you introduce yourself as a psychiatrist, it creates the idea that something is seriously wrong,'' which is an idea that someone who may be suffering perfectly normal grief does not need weighing on them, he said.

Rather than turning to any formal debriefing mechanism like that offered by the Red Cross, though, the psychiatrist said he called a colleague that night and discussed ways to meet and work with people.

Residents at New York University's Department of Psychiatry have been meeting in groups once a week to talk about bothwhat they have been doing and how they are doing, said Bella Schanzer, a chief resident.

Initially, the discussions focused on people's sense of frustration that there seemed to be so little they could do to help. ''We were all revved up to be doctors, to really help,'' she said, but in the days after the attack very few patients came to meet with them when they waited at various hospitals, the medical examiner's office or the armory.

As more and more people began to meet with counselors at the family crisis center at Pier 94, conversations have shifted to concerns about how the psychiatrists can protect themselves from all their patients' traumas, Dr. Schanzer said.

It was hardest to keep some sense of distance when she spoke to a middle-age man who escaped from the 89th floor of one of the towers, because he was initially worried about being able to get on an elevator ever again or to go back to work, she said. ''It struck me because it's not the obvious'' tragic loss of friends or loved ones, Dr. Schanzer said. ''I realized this could be any of us. It could be me.''

Identifying with patients is complicated because many therapists were affected by the tragedy themselves, said Carol Bernstein, director of the residency program at New York University.

Even people who knew none of the victims but watched the attack unfold on television have suffered, she said. In a sense, because of the immediacy of the images and the sense of fear, luck, guilt that many people in the city and around the country feel, she said, ''We are all at ground zero.''