June 1st, 2013

Bombing first responders: seeking counseling more “normative”

A couple of weeks following the Boston Marathon bombing, Amy E. Kahn, Psy.D., coordinator of the Western Mass. Trauma Recovery Network (TRN) in Northampton, joined a team of firefighters from Boston and New York and visited every Boston precinct to administer mental health counseling. In the past, such a scenario was rare, but since 9/11, first responders have realized the importance of post-trauma counseling.

According to Kahn, “Heroes put aside their emotions. They have to be clear thinking in the moment. Later, all the feelings come barreling in. There’s a cost to that.” The group and confidential, one-on-one sessions Kahn and the firefighters conducted aimed to alleviate post-trauma symptoms. “The New York firefighters had responded to the 9/11 attacks so served as role models, having gotten help themselves and are now functioning well,” Kahn says.

Critical incident stress management (CISM) training may account partly for the shift toward acceptance. Kahn indicates that first responders know to apply these techniques in situations like the marathon bombing. She points out that adding eye movement desensitization and reprocessing (EMDR) after CISM helps to fully integrate emotions.

In spite of the recent shift, some first responders are still reluctant to seek psychological help, fearful of the potential impact on their careers. All mental health visits require approval from insurance companies so if word gets to supervisors, the individuals may not get promotions or otherwise advance, says Kahn.

To overcome that barrier, the Boston area TRN is offering three to five pro bono sessions following this traumatic event. “It doesn’t go through insurance so it remains confidential,” Kahn says.

Also, at the request of the Massachusetts Departments of Mental Health (DMH) and Public Health (DPH), the Riverside Trauma Center in Dedham is providing psychological first aid to residents and businesses affected by the Boston Marathon bombings. Larry Berkowitz, Ed.D., director and co-founder of the center, reports that his staff has helped some first responders but notes that most go through their own EAP or peer networks for assistance.

Riverside staff has worked with Boston as it reintroduced owners to their businesses at the bombing site. “We also worked with the city of Cambridge, helping the schools, students and faculty cope with the assault on their community,” he says. One of the alleged bombers lived and attended school in Cambridge.

Currently, Riverside is assembling coping groups to facilitate healing, according to Berkowitz. He says that these groups will benefit some of the medically trained bystanders who unexpectedly had to leap into action on marathon day.

In addition to first responders, hospital personnel who treated the victims may suffer some post-traumatic issues, according to Andrea Stidsen, LICSW and Henrietta Menco, LICSW, certified EAP (Employee Assistance Program) professionals for Partners Healthcare. Hospital departments most directly involved with the aftermath of the bombing, i.e., the emergency room, operating rooms, intensive care and trauma units, have been the ones most seriously affected, says Stidsen.

Sleep difficulties, including nightmares, hyper vigilance and fatigue are the most prevalent presenting symptoms, says Stidsen. Menco adds, “Some people report having visual images they can’t get out of their minds.”

“People feel their reactions are abnormal, but it’s the situation that was abnormal,” says Stidsen. “We try to normalize their feelings.”

Menco says that since 9/11, seeking mental health counseling following a traumatic event has become more normative. “We’re seeing people who might not typically have sought services. People like physicians and security personnel are not ashamed.”

Stidsen attributes this shift in attitude to hospital leadership that encourages and sanctions efforts to get counseling. “Hospitals have done a great job of letting people know what resources are available and what symptoms to look for,” she says. “The media has also helped to reduce the stigma.”

By Phyllis Hanlon

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