The Denver Psychoanalytic Society was deeply affected by the horrifying events of the Columbine High School disaster On April 20, 1999, two high school boys opened fire on the students and teachers at Columbine High School. They killed one teacher and twelve students, injuring many others and terrifying all, before killing themselves. The community was stunned, and the school neighborhood turned into SWAT and emergency medical response zones for many hours. The crisis continued days after the disaster as the media broadcast details of the terrible events, which included the fact that the attacking students had set off more than ninety bombs. Shock waves spread.
The Denver society mobilized to help with the aftermath within a day. Much of what we attempted to provide was a balance of education and informed support for a traumatized school of 1,900 students. Like everyone else in the community, we were experiencing chaotic cognitive reactions and feelings of helplessness. Offers of help poured into the Jefferson County school district and the Jefferson County mental health center, neither of which could deal with the proposals in their overwhelmed state. (We were later told by the mental health center that more than 2,000 individual calls offering help had come in that could not be processed at the time.) We realized that our own proposal had to be made in a way that would minimize the stress on a flooded system. We offered pre-screened, licensed, insured responders with backgrounds and training in trauma. The mental health center notified the Denver Society's administrator, Lin Borden, and our liaison people when clinicians were needed for crisis work.
Many other organizations that volunteered help in the immediate crisis were not utilized. However, because of our awareness of the more likely long-term nature of the problem, we remained persistently available and present after the crisis and throughout the next eighteen months.
The school district, newspapers, churches, state legislature, and other groups attempted to seek premature closure and deny that the impact of the tragedy could spread. This was particularly difficult throughout the summer of 1999, when Colorado governor Bill Owens told the state's citizens that the emergency task force assessing mental health needs in the wake of Columbine “needed to have its head examined” and denied adequate funding for treatment. (The task force had found chronic underfunding of the state's mental health needs even before the crisis.)
The problems did not go away, and the Columbine disaster had lasting effects. The most obvious were reported by the media, including suicides, associated shootings, lengthy rehabilitations, and lawsuits. On August 18, 2002, the Denver Post reported that 60 percent of the adults employed at Columbine High School during the shootings had left their jobs, changing careers or retiring.
Mary Ann Levy, M.D., Marguerite Stewart, R.N., Psy.D., and Cathy Krown Buirski, M.S.W., were the primary authors of this article. They were assisted by other members of the Denver Psychoanalytic Society.
In spite of efforts by some to minimize and contain the tragedy through denial and shutting down, members of the Denver Psychoanalytic Society with expertise in trauma supported our community as it struggled to right itself, providing pro bono assistance in many forms. Thirty-three members offered debriefing services immediately after the crisis. We escorted Columbine students when they returned to the school to retrieve their belongings after the shooting. Fifteen members facilitated ongoing groups the following school year for responders who still worked directly with the traumatized school and staff, provided pro bono therapy services, gave educational seminars for the community, and supported anniversary interventions the following year. We were later informed by the mental health center that our relatively small organization (fewer than 100 members) had provided the most volunteers of any professional organization.
Eighteen months after the shootings, a group of our responders began to reflect on the impact of having participated as both community members and analytic therapists. We decided to look at our own responses including countertransference and affective and cognitive disruptions, how we had changed, and the impact on our group process, rather than focusing on the outside community. Robert N. Emde joined the group as a facilitator, which proved to be quite helpful.
By examining ourselves, we developed first-hand appreciation of the disorganizing experiences following traumatic events, inevitable deleterious effects on responders as well as direct victims, and the need to build into a response plan an ongoing way to work through our own experiences during such work. Only one person of our original group of responders felt unchanged!
We wish to encourage other psychoanalytic societies to reach out and respond if their community suffers a traumatic crisis. Psychoanalytic societies can thoughtfully prepare for community involvement before tragedies like Columbine occur.
We have compiled steps for psychoanalytic societies and institutes to ready themselves for community disasters. After the events of September 11, 2001, we realized this readiness is a work in progress; other psychoanalysts, psychotherapists, and societies will have more to add to our recommendations in the future.
Psychoanalysts and psychodynamic psychotherapists have a significant contribution to make in a community crisis. We understand the need for debriefing and short-term therapies in the immediate crisis, but we also know about defenses, resistance, and how symptoms develop later. Our training gives more emphasis to the long-term sequelae and individual differences, which are crucial to many after a disaster.
Like everyone else in the community, we were experiencing chaotic cognitive reactions and feelings of helplessness.
When evil men plot, good men must plan.
From our experience with Columbine, we have come to appreciate that our training and knowledge do not protect us from the vulnerabilities we feel when we encounter a community trauma, nor prevent us from suffering some of the same stress-related problems as any other group. In fact, our special sensitivities to long-term sequelae may make us more vulnerable to a community that may wish to shut things down and thereby deny resources to individuals who continue to suffer. We may feel personally wounded by the tragedy, by our continued involvement in helping, and by our empathic awareness of how much more therapeutic intervention is advisable than the amount most communities will provide.
We offer the following recommendations for psychoanalytic clinicians and mental health groups dealing with community trauma.
Psychoanalytic institutes and societies should be prepared to respond to community traumas. Societies have a tradition of serving the community, while institutes are traditionally invested in training individuals to become psychoanalysts. The educational mission of institutes could be broadened to include training in trauma and community involvement. Here are some steps institutes and societies could take toward this end.
Form groups that study trauma and responses to trauma.
Bring in speakers to talk about these issues.
Teach courses on trauma and loss with case material that makes the study more than an intellectual exercise. Classes on community systems would be most helpful as well.
Encourage members to train in debriefing techniques or obtain ICISF (International Critical Incident Stress Foundation) debriefing training, which leads to a credential for Disaster Respondents. In many crises, one is not permitted to participate in disaster work without such a credential. (See .)
Obtain the latest knowledge on community crisis. Several of the most useful Web sites are those of the International Society for the Study of Traumatic Stress Studies (http://www.istss.org); the American Psychological Association, Practice Directorate (http://www.apa.org/practice/practitionerhelp.html); and the Psychological Association's help center for consumers ().
A preformulated response plan will limit the amount of disorganization during and after a crisis. We were not as effective as we could have been at Columbine because we had to expend energy on mobilizing our resources and formulating plans. There should be a plan already in place to debrief groups of volunteers and offer group support before they must absorb difficult and hard to contain experiences. Volunteers need the opportunity to integrate what they have gone through. Analytic clinicians cannot assume that prior therapy or analysis will handle the stresses entailed in responding to an acute trauma. These suggestions will help provide a better foundation for support:
Select several individual leaders in advance. For example, a pre-designated and prepared Head of Community Crisis Outreach could mobilize efforts quickly. Appoint someone who is not providing direct clinical services to take charge of organizing the overall volunteer effort. Those providing direct services may lose the ability to maintain an overview. They may need the perspective of someone not so intimately immersed in the outreach to the community.
Create a list of people who are willing to
volunteer in the event of a community disaster. Keep updated files of each person's special training and expertise, as well as specifics about what services each is ready to provide and how to contact them quickly by phone, fax, or e-mail.
Designate some people to serve as consultants to analyst volunteers, lining them up in advance to be ready to help process the therapist/analyst/responders' experiences and maintain equilibrium throughout the response.
Develop a file of useful papers and concise handouts for victims, giving psychological information about normal reactions to trauma, listing symptoms that indicate a need for professional help, and listing people and agencies that offer help with such issues as grief and PTSD. Often the first days or weeks after a trauma leave victims too overwhelmed to process information delivered orally at meetings, but they will find printed material helpful later.
Establish relationships with agencies and systems outside the narrower psychoanalytic community. Many community agencies including the Red Cross are reluctant to use “outsiders” once a tragedy occurs. This may be due to jurisdictional requirements for pre-crisis training, or just people's tendency to prefer familiar faces in times of tragedy. Prior connections can be enormously helpful in creating a level of respect and trust so that offers of help from psychoanalysts are more likely to be accepted.
Boundaries between analysts and patients, and between training analysts and candidates, are likely to be blurred in times of crisis. However, concerns about boundary issues should not stifle or paralyze people from being active, so long as the resulting ramifications are approached as part of an analytic or therapeutic process.
If offers of help are turned down, do not take it personally. Hesitancy to accept outside help is an understandable and common response on the part of besieged public agencies. Do not give up. Hang in there.
Bring in nationally recognized specialists on community trauma to provide the community with an overview on disaster. Their experience can provide a roadmap for anticipated developments and their national stature can give needed legitimacy to a long-term perspective.
The aftermath of a community trauma requires complicated involvement for a protracted period of time. Probably the most significant contribution psychoanalysts can make is to continue to be available long-term for responding to community needs. Many society members will not be comfortable with crisis intervention. More important, there are crucial needs for psychodynamically oriented help that are apparent only long after the immediate crisis, triggered by anniversaries and other significant events (graduations, return to school, holidays, etc.). Regardless of the specific details of a community trauma, we recommend that psychoanalytic societies take this approach:
Prepare to offer pro bono groups or individual work for those who experience problems after the immediate crisis.
Deal with the role of traumatic reminders in the community, anniversaries and events for both the community and individuals. Plan for them and educate the community to be aware of the possibility of stress around the time of potentially triggering events.
Anticipate that future disasters affecting a community will add another layer to problems already in existence; personal tragedy increases the risk.
As our group process demonstrated, it is important to consider individual differences in coping with the reactions of psychoanalyst volunteers. Institutes and societies can help their members by being aware of the potential reactions of analysts who volunteer to work in the community.
Many responders may be secondarily traumatized by their work. They will benefit from later “debriefings” or group opportunities to acknowledge and work through their experiences. The calm provided by considerable distance from active involvement may be necessary for responders to fully process their feelings. It may be helpful to bring someone who was not involved in the crisis work but who is trained in group processes to facilitate such debriefings.
Volunteers may experience painful feelings of helplessness and uncertainty (feelings that are often present in people who do not intervene as well) despite their participation. They may also face negative reactions from colleagues, since this treatment modality may even be seen as inappropriate for psychoanalysts, especially when they lack specific crisis training.
Members of the society need support to opt out without guilt. They may be given an option to be farther from the center of the action or to become active as “consultants,” facilitating a working-through of the experiences of those active in the beginning. We need to respect differences in reactions in ourselves and in our colleagues, as we do for our patients and the individuals most traumatized.
Community trauma and analytic response to it can have subtle effects on group functioning. These should be identified and discussed. Analysts with group experience can begin to look at the dynamics and understand the consequences of secondary and tertiary trauma upon professional groups.
While no two disasters are similar, since they occur in different communities with different prior problems, we suggest future psychoanalytic reflection and study directed at understanding more about certain issues. We experienced violence in a suburban school in an upper-middle-class community. The World Trade Center assaults and events of September 11 led to the loss of thousands of lives and the realization that our country was being attacked by unknown terrorists.
Some of the issues that psychoanalysis should study:
The impact on community members who find themselves in the midst of a major crisis—teachers, counselors, parents, those with medical training.
How to deal more effectively with that impact so that such individuals are not lost to the community, as in the case of the teachers and other school staff who left their jobs.
The process of self-selection and self-regulation regarding decisions to offer help in a disaster. We know very little about these choices.
Use of Critical Incident Stress Debriefing. This method is controversial and should be given much greater attention as to benefits, under what circumstances it is appropriate, and what groups are unlikely to benefit.
There is a continuing need for further reflection in our societies and on a national level. We strongly believe the resiliency of individuals who volunteer to help in a disaster can be enhanced by preparation, education, understanding, and continuing group support.