Within hours of the attacks on the World Trade Center on Tuesday, mental health workers at Lenox Hill Hospital in New York had set up a walk-in counseling center. On Wednesday, only a handful of people came through. On Thursday, though, the number had quadrupled.
Dr. Molly Poag, a psychiatrist and the assistant director for education and training in the hospital's department of psychiatry, told The New York Times that she expected the numbers to increase rapidly with each passing day.
"We expected a delay in the emotional reactions of people as the tragedy set in," said Dr. Poag, who counseled a group of emergency rescue workers on Wednesday who had narrowly escaped death. "We have seen people who made it out of the building, those who are missing loved ones, and people who were not directly involved but are part of our traumatized community. And there are other people who simply want to know what to say to a friend who is grieving."
Lenox Hill is one of many hospitals, clinics and community organizations that have established crisis and grief counseling centers and hot lines in the aftermath of the terrorist attack. Therapists have banded together to offer volunteer counseling services by phone, e-mail or in public places.
The New York Psychoanalytic Institute, which set up a crisis and grief center on Thursday, was also sending counselors to Barnes & Noble bookstores in Manhattan to offer help.
"This is a really horrific situation psychologically that has left everyone feeling very vulnerable," said Dr. Ruth Karush, a psychiatrist in private practice in Manhattan who worked as a volunteer at the Psychoanalytic Institute's center this week.
As eager as many mental health organizations are to be of help, several experts warned that not everyone wanted or needed counseling right after a tragedy.
"People vary in the way they cope, and one size does not fit all," said Dr. Richard McNally, a professor of psychology at Harvard University who studies post-traumatic stress disorder.
In some cases, McNally told the Times, counseling may even delay recovery, especially when it is conducted in a single session and does not include instruction for coping with stress.
He said there were conflicting studies of the effectiveness of debriefing - single sessions soon after an event in which trauma survivors are asked to express their feelings and told what psychological symptoms they might experience. Such sessions should never be forced on anyone, he and other experts said.
"The help should be available but not intrusive," he said. If people decide to seek counseling, they should be sure it comes from someone qualified to treat the problems caused by traumatic stress.
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