The Impact of the September 11 Terrorist Attacks on Psychologists

and Their Clients

The Impact of the September 11 Terrorist Attacks on Psychologists

and Their Clients

Suggested CitationSuggested Citation

American Psychological Association Practice Directorate (2002). The Impact of the September 11 Terrorist Attacks on Practitioners and Their Clients. Unpublished results of the PracticeNet 9/11 survey, October 8-15, 2001, Washington, DC.

AcknowledgementsAcknowledgements

PracticeNet's initial development has been underwritten by the federal Center for Substance Abuse Treatment (CSAT) as part of the agency’s effort to learn more about the ways in which psychologists are encountering and treating problems related to substance use.

What is PracticeNet?What is PracticeNet?

PracticeNet is a “Practitioner Research Network” of professional psychologists within the APA membership All APA members who provide direct health services to clients

at least 5 hours per week are encouraged to enroll

Practice Directorate hopes to enroll several thousand psychologists from diverse areas of practice serving a wide range of populations

Uses a proprietary Internet-based data collection system

What is PracticeNet?What is PracticeNet?

Captures specific moment, or snapshots, of practitioner activity

Over time, snapshots combine to provide a detailed and accurate picture of practice

Brief & “Real-Time” Data Collection Episodes

Data collection tied to recent, specific episodes of care

Data collected at regular, randomly determined times

Objective reporting about a recent event

No "mental averaging”

Observation of many points in time

Significant data analysis opportunities

GoalsGoals

To give members up-to-the-minute information about psychological practice

To serve as a useful practice improvement tool

To inform Practice Directorate initiatives by reversing APA-member flow of information

To influence and provide data base for advocacy efforts on behalf of psychology

Change how government agencies and health care decision makers think about Practice data

Early QuestionsEarly Questions

How are psychologists using their time?

How are health plans’ utilization management practices affecting the provision of care?

What kinds of problems are psychologists seeing more and less often?

What services are psychologists providing?

How have recent events such as natural disasters or a school shooting affected psychology practices?

How Do I Sign Up?How Do I Sign Up?

Complete enrollment on-line:

www.apapracticenet.net

Click “Enroll Now”

PracticeNet 9/11 SurveyPracticeNet 9/11 Survey

Administered October 8-12, 2001

643 email invitations sent to PracticeNet members

Total responses N = 407

Providing direct clinical services within 72 hours of selected date n = 341 (84%)

NY/DC/SW PA n = 126 (31%) Non NY/DC/ SW PA n = 281 (69%)

Client DemographicsClient Demographics

46% Male; 54% Female

Average age 37 (range 5 - 98)

Ethnicity 6% Hispanic or Latino

86% White

8% Black or African American

Education 20% some college

20% college degree

16% graduate degree

16% less than high school

13% high school graduate/GED

Client DemographicsClient Demographics

Employment 39% employed full-time 47% not working

36% students 25% disabled 11% retired

Living arrangements (not mutually exclusive) 33% with a legal spouse 24% with parent(s) 21% with children 20% alone

Clinical Services and SettingsClinical Services and Settings

Individual therapy or counseling 83% Formal assessment or evaluation 19% Providing educational information and/or materials 14%

Independent/private practice - solo 48% Independent/private practice - group 28% Organizational health care setting 18%

44% Mental health services setting 13% Primary health care setting

ResultsResults

During the specified clinical encounter, did this client:

Yes

Bring up the terrorist attacks of September 11? 49.3%

NY/DC/PA 53.3%

Non-NY/DC/PA 47.5%

Bring up any subsequent related events, actual

or feared (e.g. preparations for war, military

build-up and mobilization)? 39.3%

NY/DC/PA 44.8%

Non-NY/DC/PA 36.9%

ResultsResults

During the specified clinical encounter, did this client:

Yes Bring up specific traumatic or anxiety reactions to

environmental stimuli associated with the event? 21.7%

NY/DC/PA 30.5%

Non-NY/DC/PA 17.8%

Discuss a prior traumatic event, memories of which

were triggered or intensified by the events of 9/11

or related subsequent events? 22.6%

NY/DC/PA 24.8%

Non-NY/DC/PA 21.6%

ResultsResults

During the specified clinical encounter, proportion of time spent discussing the terrorist attacks of 9/11, subsequent related events (actual or feared), traumatic or anxiety reactions to associated stimuli, and/or memories of prior traumatic events triggered by the attacks and their aftermath:

0

10

20

30

40

50

None of thetime

Small amount(< 25%)

Moderateamount (26 -

50%)

Large amount(51-75%)

>75% of thetime

Total

NY/DC/PA

NonNY/DC/PA

ResultsResults

Implications of the Events of 9/11 Discussed in Terms of Client’s Identity, Priority, World View and Spiritual Outlook

0

10

20

30

40

% Yes

Identity Priorities Worldview

Spiritualoutlook

Total

NY/DC/PA

Non N/DC/PA

ResultsResults

21.9

23.8

28.6 13.1

30.9

0 10 20 30 40 50 60

Attacks w itnessed f irsthand

Attacks experienced fisthand by loved one(s)

Loved one(s) killed in attack

Loved one(s) injured in attack

Attack sequealae w itnessed firsthand

Witnessed LIVE coverage of attacks

Period of Uncertainty about saftey of love one(s)

Air Travel on 9/11

% NY/DC/PA

Non-NY/DC/PA

Client Proximity to Attacks According to Practitioner Location

ResultsResults

11

11

13.8

29

10.6

15.8

2

0 5 10 15 20 25 30 35

Tearfulness

Irritability

Sleep disturbance

Fear, anxiety or uncertainty about the future

Hypervigilance

Generalized fear

Use of Alcohol or Drugs

%

Client Symptoms that First Appeared or Worsened since September 11

ResultsResults

Practitioner Proximity to Attacks

39.7

52.4

54

62.7

16

53

54.8

0 20 40 60 80 100 120

Attacks w itnessed f irsthand

Attacks experienced f isthand by loved one(s)

Loved one(s) killed in attack

Loved one(s) injured in attack

Attack sequealae w itnessed f irsthand

Witnessed LIVE coverage of attacks

Period of Uncertainty about saftey of love one(s)

Air Travel on 9/11

% NY/DC/PA

Non-NY/DC/PA

ResultsResults

Cumulative Effect of Client’s Discussion of Events on Practitioner

0

5

10

15

20

25

30

35

%

Not at all A little bit Somewhat Quite a bit A great deal

NY/DC/PA

Non NY/DC/PA

ResultsResults

Practitioners’ Strategies for Dealing with Their Own Reactions

11.8

48.2

48.6

65.4

68.6

71.3

92.9

0 10 20 30 40 50 60 70 80 90 100

Personal therapy

Spiritual and/or religious involvement

Volunteering professional services

Taking time for yourself

Balancing activities, e.g., hobbies, exercise

Consultation with colleagues or supervisors

Contact or communication with friends and/or family

%

SummarySummary

Randomly selected sample of clients engaged in sessions with practitioners exhibited an increase in the following symptoms: generalized fear, hypervigilance and fear or uncertainty about the future

Regardless of geographical location, clients’ world view was challenged by 9/11 events

Those in the metro NY/DC area were more likely to discuss the events in personal terms, such as in terms of their priorities, spiritual outlook, or identity

SummarySummary

Impact of these events on practitioners, as assessed by immediacy of exposure, was greater than that of their clients, regardless of the geographical area in which they were practicing

Psychologists reported being significantly affected by their own personal responses, as well as cumulatively affected by the responses of their clients/patients

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