The worsening economy and the enduring sadness and anxiety since Sept. 11 are so affecting some people that even their counselors now need help.
"There's something called secondary trauma," said Elsa G. Castillo, program director of Mujeres Latinas en Accion, a domestic violence outreach center in Chicago. "You see people at their worst [and] you yourself can be victimized."
United Way, said Jim Kales, United Way Chicago's communications director. And the agencies are bracing for higher demand.
As social workers tend to anxious clients, they, too, are tense with worry and grasping to make sense of what has happened. Their struggles have sent up red flags to administrators who know heaping problems on troubled people can lead to burnout and ineffectiveness.
Agencies are trying everything from art therapy to the kind of debriefing prescribed for post-traumatic stress victims to puncture the pressure engulfing many counselors.
"They get asked a lot of questions they don't know how to answer--the whys," said Pastor Phil Kwiatkowski, vice president of ministries at the Pacific Garden Mission in Chicago, which provides counseling to homeless men.
"The events of Sept. 11 have changed people's outlook because they have no sense of security. It gave us a sense of our own fragility. [Before Sept. 11] there wasn't as much a sense of urgency about your own life, urgency regarding the events of tomorrow. We were just gonna go on. After the attacks, people started questioning themselves regarding their future, their personal life--Where am I going? Where do I fit in? What does tomorrow hold."
Mary Cotter, 28, a referral specialist at the United Way First Call for Help hot line, said she can't shake her loss of optimism, the feeling that perhaps for many people there is no happy ending.
"I've just felt maybe more sensitive to people suffering. I lived through a trauma. I'm suffering because they're suffering," Cotter said. "We are all human beings and [the terrorist attack victims] didn't deserve that. The way they died and the people in the airplanes--how horrifying. And for what reason? That's what I still struggle with and I can't accept."
Social worker Kathy Sheridan at Metropolitan Family Services worked an international crisis hot line for three days after the Sept. 11 attacks and felt an overwhelming sense of personal grief and involvement that she has felt only a few times before.
"The hardest question of all was, `Is there any hope?'" she said of callers with family members missing in the rubble of the World Trade Center. "At the beginning you wanted people to have hope, that's what I'm trained to do. By the fifth day, you started to realize when they were asking that question--it was like hitting a wall. Do you tell them the truth?"
The tension has persisted as the days have become weeks since the attacks, and it has hit counselors hard because "it doesn't appear that there will be any closure. This is like every day there's a new anxiety," Sheridan said.
Many counselors, like other people, talk and think about the latest headlines, she said.
"The hard part is that we are dealing with clients. We are seeing clients who are harder to work with. If they had an anxiety disorder, this pushes them over the top. If you were making progress, they are a lot more anxious. And it's harder to do your job," Sheridan said.
Castillo knows the signs of counselors in the cauldron of anxiety.
"Anytime somebody has gone through an impactful experience, it stays with you. The way it manifests itself--you may not pay enough attention to what a client is telling you. You are a little on the irritable side. You are not all together there. You are preoccupied with other thoughts on the safety of family and of your children," Castillo said.
Some counselors are overwhelmed by the higher level of desperation they're hearing from clients, while others find comfort and a feeling of gratification that they're helping in some way, agency officials say.
Kwiatkowski oversees about 10 counselors who work with homeless men and he has offered individual help and prayer to those counselors who've asked for it.
Counselors at Mujeres Latinas en Accion, which serves as many as 6,000 women a year, had a two-hour "healing session" where they used art as therapy. Workers used crayons to draw pictures of what they were feeling. They prayed together and lit candles. They also have been encouraged to take stress management classes and get massage therapy if necessary, Castillo said.
"They can't leave it behind--the unsafe feeling. You come to a place like this, there's bruises that need to be photographed, there's a crisis," Castillo said of the center. "You can have a crisis here every day. Then you go home and it's a crisis situation nationally. When do you relax?"
Social workers and counselors at Metropolitan Family Services have had debriefing sessions, said Richard L. Jones, president and CEO.
Such sessions typically focus on specific events, such as a tragedy, and deal with feelings connected to those circumstances.
Dr. William A. Weitz, a retired military psychologist who helped war veterans deal with post-traumatic stress disorder, has recommended that professionals and non-professionals in the Ruth Rales Jewish Family Service agency participate in ongoing, hourlong, once-a-week debriefing sessions.
"Therapy assumes a disorder or illness. [A debriefing] helps people understand normal reactions to abnormal events. They're not sick, it's the situation that's unhealthy," said Weitz, the clinical director of the Rales agency in South Florida.
Like law enforcement officers and soldiers, counselors are not used to asking for help, he said, but he recognized the signs of trouble--denial, sadness, numbness.
Weitz said it's important to remember that what began with Sept. 11 is still happening.
"If they [counselors] don't recognize their own need for processing and healing, it will affect how they deal with the public, and how long they can do their job," he said.
Sheridan said that while dealing with tragedy is a counselor's job, the terrorist attacks have touched therapists and social workers in a way that few cases do. "We are now traumatized people treating traumatized people," she said.