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Have you ever thought about the effect of those terrorist attacks on mental health clinicians who provided care to the victims of 9/11? 

A new study by Mary Pulido, Ph.D., from the New York Society for the Prevention of Cruelty to Children in the US, provides a sobering account of what it was like for these professionals and reports on the lack of support they received. Her exploratory study, published in Springer's Clinical Social Work Journal, highlights the critical need to develop training and expand support systems for clinicians in order to combat secondary traumatic stress.

"Secondary Traumatic Stress (STS) symptoms experienced by mental health clinicians who treated clients for issues related to the terrorist attacks of 9/11 were intense and unprecedented," the researcher of the study wrote.

STS is the result of exposure to trauma experienced by others, generally within a workplace context. Symptoms of STS are often indistinguishable from those found in individuals as a response to a traumatic event they experienced directly, according to Julie Collin, CWLA's Director of Practice Excellence.

According to Chris Siegfried, Network Liaison at the National Child Traumatic Stress Network-UCLA, symptoms of STS include fatigue or illness, cynicism, irritability, reduced productivity, feelings of hopelessness, anger, despair, sadness, feelings of re-experiencing the event, nightmares, anxiety,avoidance of people and activities, or persistent anger and sadness. 

"First responders from other fields, such as firefighters and emergency response workers, have been shown to experience STS as a result of their work. Such experts as Bride view STS as an occupational hazard of providing direct services to traumatized populations," says Siegfried.

In the case of 9/11, these clinicians were also exposed to the same disaster as those they were helping. Not only are they exposed to the stressors and psychic pains experienced by their clients, they carry the professional burden of being expected to remain open and available to their clients on an emotional level. 

The clinicians' experiences differed based on the type of client: some dealt directly with family members who had lost loved ones, others dealt with people who fled the burning towers, and some worked with individuals considered indirectly exposed, but who were still fearful and symptomatic. Thirty months after the attacks, secondary traumatic stress levels were high among clinicians who provided care to victims of 9/11. The clinicians being interviewed were themselves surprised at the intensity of these stress levels. In addition, they described availability of supervision and agency support as 'weak', but said peer support was helpful.

Dr. Pulido concludes: "For many professionals, these interviews, conducted several years after the attacks, served as the first time they had discussed their 9/11 work and the stresses they encountered. This factor alone speaks volumes for the lack of support that they received while providing such intense clinical support for their clients. These findings need to be integrated into training and practice."