Psychothérapie Intégrative Articles

These days when I leave my office each afternoon on the way to the gym, Hector gives me a warm “Hi, Doc. How are you?” He often calls to the other vendors, “Yo, here’s the Doc.” We chat for a few minutes and he catches me up on the street news. He tells me how the street vendors are doing, who is acting “crazy” on the street that day, about the happenings at the World Trade Center site, or about the war in Afghanistan.

Hector is a barrel-chested Puerto Rican who sells socks on Third Avenue between 85th and 86th Street. His neighboring vendors along Third Avenue sell all sorts of seasonal items: umbrellas when it rains, gloves and woolen hats when its cold, NY Jets and Rangers sweatshirts, knock-off Gucci handbags for $25.00 or imitation Rolex watches for $10.00. But, Hector sticks to selling socks because he has loyal customers – he enjoys seeing the same people return over and over for his bargain-priced socks. For years Hector’s favorite customers were the firefighters of Ladder 13 and Pumper 22. The fire station is just around the corner from Hector’s place of business, a folding table piled high with various brands of athletic socks.

Although I had seen Hector many times over the past few years and had even bought socks from him we had never had a conversation. Hector and I met at about midnight on Saturday, September 15th, a few days after the attack on the World Trade Center. Since September 11th, I had been going to the local fire station on East 85th Street to talk to people and do whatever grief or trauma counseling was even possible. Nine of the firemen, including the captain that I had known, died in the collapse of the World Trade Center. The fire station had become a shrine of mourning: Each evening 85th Street was closed to traffic as mourners gathered by the hundreds with candles and bunches of flowers. They prayed silently or sang a few songs like “Amazing Grace” or “America”. Signs of tribute to the dead firemen covered the front and sidewall at the fire station. Amidst our collective grief there was still some hope on that Saturday – the rescue workers had found some people still alive.

The fire station no longer served it’s original function; the two fire trucks were crushed in the rubble of the collapsed buildings. The firemen that had been off duty on Tuesday morning were now pressed into around-the-clock rescue service. Several of the firemen had been called out of retirement to attend the station house and to receive the condolences of the mourners. The retired firefighters were functioning more like chaplains than firemen.

That Saturday night, near midnight, I was inside the fire station talking to one of the retired firemen when Hector began to call out the names of the lost firemen. Hector was drunk. He had been at the station earlier and the fireman-come-chaplain was weary of him. Hector was loud and demanding of people’s attention. His form of grieving was so different than most of the quiet mourners who came with tissues and candles in their hands.

I went to Hector and asked him how he knew the names of the dead firemen. He told me how they all bought socks from him. They were his friends. He kept shouting, “God bless the firemen” and “God bless America”. Together we began to sing God bless America. Hector with his loud Spanish accent bellowed out the song. Tears began to well up in his eyes. As we looked at each other, each with tear-filled eyes, he began to sob. I reached out and put my arms around him. He collapsed into my lap as I sat on the floor of the fire station. I held this large man as he wailed out his grief over the dead firemen and then continued to cry over his buddies who died in Viet Nam. Hector’s pain was intense!

When Hector finally finished crying, one of the retired firemen helped me to my feet and while putting his arm around my shoulder said, “God bless you.” At that moment, I burst into tears. I cried from my whole body. I had not realized how deeply I had been affected by both the traumatic events and the grief of all the people with whom I had been talking. I assumed that this was the end of my traumatic reaction.

The following Wednesday night I took my man’s group to the fire station. Three of the men had been unable to grieve; they were mesmerized by the repeated television scenes. Their disavowal of affect took the form of fascination with how the building collapsed or a loss of reality in the form of “I’ve seen this film before”. Two of the men reported quietly weeping every time they saw a missing person sign on a tree or lamppost. Two others had escaped the fire and collapsed buildings.

We worked as a group in a circle on the floor of the fire station where the destroyed fire trucks once parked. The retired firemen showed us photographs of the dead firemen holding their babies and young children. The reality of the tragedy was right in our faces. The whole group wept. Some expressed their outrage. Perhaps a hundred people stood around and watched our group process as we talked about our feelings and held each other. Hector was again in the crowd of mourners but this time he was sober and no longer boisterous.

On the way back we stopped to look at a car that had been parked in front of my office for a week. The car was covered in white ash and on the front window it bore a firefighter’s parking permit. Someone had written in the white ash with his or her finger, “You gave us your life. You are our Hero.” Piled in the backseat were the uniforms, skates, and hockey sticks of a boy’s team. Some boy’s father and a team’s coach died a hero for all of us!

Every tree and lamppost had signs and photographs that asked, “Have you seen my daddy?” or “Do you recognize my wife? She was last seen leaving the 73rd floor. She must have amnesia.” The reality of this traumatic even continues in all New Yorkers. This was not the end of the grief and trauma therapy for the men’s group. Six months later we are still dealing with traumatic stress reactions. My patient’s dreams are of falling buildings, smoke-filled rooms, or of being paralyzed in the face of danger. A tension still exists when people are going up an elevator in high buildings or when an airplane flies low over the city.

For the past few months, I had been feeling guilty that I had not done more than I did at the time of the World Trade Center attack. I did not work at the bombsite removing rubble, as one of my patients did. I did not work for the Red Cross in their disaster relief shelters as some of our Transactional Analysis colleagues had done. I did however, immediately register to work as a therapist at Lenox Hill Hospital but after the second day there were very few people seeking therapy at the hospital. I was disappointed in my efforts to help so I went and volunteered at the fire station next-door to my office. I wanted to do some serious psychotherapy with the many people who came to the station but there were few openings and no such contract. All I could do was to encourage people to “just talk” and to tell their story: “Where were you when it happened?” “Who do you know that escaped?” “Do you know anyone missing?” “How are you managing?” Inquiry and attunement were the only things that I could provide. I wanted to do more – to be more fully involved as a psychotherapist.

All my life I’ve been a busy, industrious person, particularly if I am interested in the task or it furthers some personal goal. Since the weeks after September 11th, I have been psychologically running in circles, doing multiple tasks at the same time, feeling under pressure, and making many mistakes. I have been what I have always been but I had become more intense, a more exaggerated version of what I used to be. I had a feeling of urgency that would not subside.This past week I finally had the opportunity to be a part of a group of psychologists who were involved in direct services to the families of the victims, the police department and the Red Cross shelters. My lingering sense of guilt began to subside as they revealed their stories of how they were involved in the tragedy.

They all describe how they were not able to do any serious psychotherapy; the people were just not emotionally available. The policemen, firemen, and rescue workers did not want to talk about their feelings. They just wanted to get the rescues completed. The members with missing families wanted information, not therapy. These psychologists described how they passed out tissue, listened to countless stories and got people to tell of their escapes. They did the same thing downtown as I was doing uptown.

One therapist described her past traumatic stress reaction as an attempt to do many things at once. Another described the unending task of consoling the many family members of those who had died. Another pointedly described how inspite of all she had done, that she had a constant sense that she could not do enough. Then I realized that my sense of urgency, multiplicity, and chronicity was my posttraumatic stress reaction. Although I cried with Hector and the other mourners at the fire station – I was carrying the grief of countless numbers of people for whom I did not have the energy or time to be fully involved.

Now I am back to a more natural pace; the urgency has subsided. I am able to be fully contactful with the task at hand and although there are many more people still suffering with posttraumatic stress reactions to September 11th, I can only be involved with one person at any given moment.

On the streets of New York City, Hector and the other vendors appear to be doing business as usual. It is early spring in New York and the vendors now have Yankee and Mets t-shirts and baseball caps, light raincoats and other spring items. Hector has a sale on lightweight socks. On the surface, life seems normal, but I know that internally this tragedy has affected us all. New Yorkers will never be the same; we have shared a tragedy and a profound intimacy. Each one of us is traumatized yet my hope is that we can learn and grow from the experience.

Orginally published in The Script, the newsletter of the ITAA, April 2002, page 3,
Reprinted in Voices, the Journal of the American Academy of Psychotherapists, Fall 2002, pages 16 - 18. .