Five months after 9/11, I sat at the kitchen table of an FDNY firehouse with about thirteen guys, some working their tour (shift), some reporting in for work, and some leaving. Sixty-three firehouses had direct losses from 9/11 and I was one of 62 clinicians who’d been hired and assigned to a specific firehouse. I learned later that someone from the FDNY Services Unit had called all the firehouses and talked whoever answered the phone into accepting a psychologist. In other words, these were not men who’d chosen therapy.

For reasons you can read about in Tuesday’s post, the first day didn’t go well.

Luckily, I’m a baseball fan – instead of starting with the emotions of 9/11 and its aftermath, one of our first reasonably comfortable discussions was about my all time favorite Yankee teams of 1977 and ‘78. The guys were impressed that I could name each position player. And over time just by being there, being present at meals and staying long hours, I started to earn their trust.

There was no blueprint for this work, no literature that was specific to cultivating therapeutic relationships in a very public way in a work setting where the entire population had been so deeply wounded, so profoundly traumatized and had experienced such extensive losses of coworkers who were better described as friends and family.

Instead, sitting in the kitchen that was the main gathering place, I would casually ask whomever was there, “When did you arrive at Ground Zero?” or, “What’s your last of Joe before he died?” As I engaged one man, others would listen and participate. These group talks could last anywhere from five minutes to five hours. As some left the kitchen, others replaced them and kept the discussion going. Through these talks, the men pieced together their individual and group story of that day—they began to weave a cohesive narrative of the events of 9/11.

This version of therapy broke all the rules. For example, when I worked with firemen individually at the firehouse, there was no way to maintain privacy. Everybody knew who was my “patient” and when he was being treated. When the alarm bell sounded, the session ended. Unlike traditional individual therapy, I was a well-known presence in the firehouse to every firefighter and often to his family. At mealtimes they wouldn’t let me pay for my food and they frequently drove me home in the fire truck when I worked late into the night.

Sometimes, a firefighter would request to continue a session at my office that we’d started earlier in the firehouse. But working individually in my office was tricky—you’d have guys run into each other in the waiting room and they were completely mortified to be seen, despite the fact the other guy was there in the same waiting room! Sometimes if I was seeing two FDNY guys back-to-back, I had to make an exit strategy—the first guy would go to the bathroom, then the second guy would come in the office and I’d knock on the bathroom door to let the first guy know it was safe to leave. I rode the rig often, until an order came down from Headquarters telling me not to. I would wait until the job was completed, and on our way back to the firehouse, I would finally get to say to the guy across from me, “So, what’s going on with you?"

The thing is, I’m not sure therapy would’ve worked any other way. As psychologists, we set up the structure of sessions to meet the needs of people who willingly enter our offices looking for help or guidance or a deepened self-understanding. Our patients come to us. But I’m not sure how many guys in the FDNY would have come to therapy on their own—and, as I saw, overtly talking about feelings and their roots as we might have done in a strictly therapeutic setting probably would not have reached these men, even if they’d made it in the door. Therapy as it’s commonly performed wasn’t necessarily designed for these guys.

But the improvised mechanics we started to develop in early 2002 let therapy transform itself to the needs and culture of the FDNY, rather than asking the FDNY to to the culture of therapy. I think this imperfect model allowed the most men the best chance at reaching a "new normal," a way of adjusting to a post-apocalyptic feeling in the FDNY, in New York, and way beyond.

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