What We Did: Strategies for Therapists in
Communities Struck by Disaster

There was no plan in action about how to deal with something like this, neither in terms of the therapy I was doing with people but also personally. I had no idea what to do.

The long-term psychological legacy of Hurricane Katrina became apparent in New Orleans only about two years after the storm, once the community’s immediate material needs had been met. At that point, recognizing that she and her colleagues were no longer talking about Katrina and its aftermath, but knowing nonetheless that the impact was continuing and profound, Kathryn Nathan, a local psychologist, applied for and received a grant to explore the storm’s effects on mental health professionals, who were expected to help their patients while simultaneously dealing with the effects of the storm.

The grant specifically sought to bring psychoanalytic understanding and help create meaning out of what felt like chaos, to create a community of clinicians who could share their experiences with one another and understand the personal and professional consequences of living in a community that had barely survived a disaster of the proportions of Hurricane Katrina.

The intervention had several components:

  1. Identify and contact a psychoanalytic consultant outside of the affected area who was an expert in the long-term psychological effects of natural and/or man made disasters.

    1 of 2 quotesI really don’t think anyone local could have taken that role. We needed someone outside of the trauma to listen to us.

    2 of 2 quotesThere needs to be an other to validate and help integrate the trauma – we could not trust the perception of each other because we were all traumatized.

  2. Locate local clinicians to volunteer for clinical interviews with the consultant. The goal of these sessions was to describe personal and professional experiences during and after the storm.
    • The New Orleans Birmingham Psychoanalytic Center reached out to analytic and non-analytic colleagues across the city, who in turn contacted others, constituting a broad range of clinical and theoretical disciplines.
    • 40 interviews took place in New Orleans over the course of 20 months. The respondents – psychiatrists, psychologists, social workers, marriage and family therapists, and pastoral counselors – represented a wide range of psychological approaches: psychodynamic therapy and psychoanalysis, family systems, neuropsychology, psychiatry, existential, CBT, DBT, and EMDR.
    • Most interviews were conducted in person, many individually, some in groups, a few by telephone. The interviews were recorded and transcribed for research purposes, but respondents were assured of confidentiality. Initial interviews lasted from an hour to an hour and a half; follow up interviews generally lasted 45 minutes.

      1 of 4It was critical for us to know that these interviews were going to be kept confidential. It created a sense of safety so that we could really open up to someone who wasn’t from here.

      2 of 4Hearing other people’s stories I found out how important it was to talk about what happened. I didn’t think there was space for me to do that. I felt so fortunate that I didn’t lose anyone or my home so I wasn’t aware of the impact of the storm on me. I was aware of the impact it had on clients. They needed me to be quiet and to listen. Then I realized that I needed that too.

      3 of 4Before the interview I got nervous, I thought talking about these things would make me feel worse. It was upsetting, but when I left I felt like a burden had been lifted from me. Someone really understood.

      4 of 4I never took the time to talk about the whole thing from start to finish before. It made me realize how much I had gone through, no wonder I haven’t gotten over it yet.

    • We built a database allowing us to keep local clinicians informed about upcoming events offered by the FAR Fund NOLA
  3. Public lectures by the consultant After the first round of 18 interviews, Dr. Boulanger gave a talk entitled I Don’t Want This Knowledge, placing the experiences of the people she had interviewed in the broader context of communities and individuals struggling with the psychological aftermath of a natural disaster, and particularly focusing on the dilemmas that mental health professionals face under these circumstances. For many of the one hundred plus clinicians who attended this lecture, this was the first opportunity they had had to think about the issue of recovery as it specifically affected them professionally. Having a psychodynamic framework in which to place their internal and external experiences relieved a sense of alienation. That talk is available to be downloaded.

    1 of 3Even today I go back to read that talk. When I feel alone, it’s helpful to remember that other people are feeling the same way. And it’s helpful to see how far I’ve come from our first interview.

    2 of 3Hearing this lecture put into words my thoughts and feelings, it was validation.

    3 of 3That night was the first time I understood that I was part of a larger community. We all went through this. I realized I must find others therapists to talk to.

  4. Workshops A series of workshops for clinicians from diverse backgrounds with different levels of training were offered. The workshops addressed topics of clinical significance, necessary adjustments to therapeutic practice, and countertransferential problems, all of which are inevitable when the therapist and patient have shared a similar trauma, were held.

    1 of 5A great sense of support, encouragement, and empathy for my development as a therapist, and for my interpersonal losses due to Katrina.

    2 of 5Helpful to know that someone outside New Orleans is interested in us.

    2 of 5It brought up concepts that helped communicate my experience.

    4 of 5This clarified my personal reactions to Katrina. They still loom large in my life.

    5 of 5Validated our experiences , personal and professional.

  5. Reading groups Led by members of the Psychoanalytic Center focusing on professional books about trauma, four session reading groups were offered to the therapeutic community at large. These groups were consistently over subscribed.

    1 of 3I’m still trying to make sense of what happened to New Orleans, my family and me.

    2 of 3The readings were helpful in my endeavors.

    3 of 3A wonderful community building experience. A nurturing experience with good, thoughtful content.

  6. Closing conference Just after the fifth anniversary of Katrina, a conference was held in which four local mental health professionals, Linda Floyd, Ph.D., Kathy Nathan, Ph.D., Deborah Poitevant, LCSW, and Elsa Pool, Ph.D., described their post Katrina experiences. Each spoke about her early struggles to maintain a sense of continuity in her ongoing clinical work and to keep it separate from her personal disruptions, only to realize how much the personal is also professional in the aftermath of a disaster of Katrina’s magnitude.

    1 of 5Having to articulate ‘my story’ to my fellow professionals at the conference allowed me to move through the experience and has gone a long way to help me manage my own Katrina wounds. I feel as though I have been given a wonderful gift.

    2 of 5Loved the multiple clinician perspectives. They showed that it was okay to appear vulnerable.

    3 of 5I have not discussed these issues with other therapists. This is an isolating profession and it helped to understand and hear what others were going through.

    4 of 5Validation, respect, and fellowship contributed to my being able to move my trauma from the present to the past.

    5 of 5Hearing others share their sense of responsibility to their patients or clients made me feel part of a community who dealt with similar trauma.

    • In her final lecture, Where have we been and where are we going?, Dr. Boulanger summarized what she had learned from her interviews about therapists working with patients when lives have been disrupted by a massive trauma. Based on her interviews and work in New Orleans over the several years of the grant, she described a psychoanalytic model for understanding the difficult dynamics of shared trauma and suggested ways in which these challenges can be met.

      1 of 4I have a better understanding of vicarious trauma and secondary trauma, useful to hear the integration. Gave me insight on shared trauma.

      2 of 4Valuable for a trauma therapist and wounded healer.

      3 of 4Helped me realize how much I have repressed and over time compartmentalized. Permission given to become aware again and to know I have more work to do.

      4 of 4It was very forgiving. Personally I have struggled for years with this. We have been traumatized and having a meeting to talk about transference and countertransference is tremendous.

    • The four papers by local clinicians together with an introduction and discussion by Ghislaine Boulanger will be published in Psychoanalytic Dialogues in 2012.
  7. What we wish we or others had done In hindsight it would have been beneficial to bring a number of additional outside clinicians to New Orleans on a monthly basis to facilitate small groups and workshops offering the clinicians who attended the earlier lecture and public workshop an opportunity to continue to process their experiences and to build bridges to one another.

    1 of 2The disaster response networks set up by organizations focus on providing help to the public at large. I think that having a network where therapists in affected disaster areas could talk to other therapists on a regular basis even on the telephone would be a great asset in the future.

    2 of 2Immediately after the storm a national professional organization could have volunteered to set up a listserv/bulletin board for mental health professionals to list their contact information for each other. And to make it possible for therapists from other parts of the country to reach out to colleagues in the stricken area.