Maintaining Resilience in the Face of War and Terrorism: Suggestions for Professionals

by the Advisory Committee on Colleague Assistance

April 2003 — This document is intended to provide practical guidance to psychologists in maintaining professional resilience and high standards of care in the face of the stressors of war and terrorism now affecting the nation.

Resilience is the process of adapting well in the face of adversity, trauma, tragedy, threats or even significant sources of stress. Psychologists are ordinarily called upon to be resilient in balancing the demands of their work with patients, clients and trainees against the demands of their own lives and personal experience. We face even more compelling challenges in a time of war and terrorism.

Providing psychological assistance involves listening to and witnessing clients' and patients' reactions to these events, their concerns for family and friends, their anxiety about safety and the future, and their existential questions about the meaning of these events. We must also manage our personal response to this difficult time. Meeting these demands repeatedly and continuously can challenge our professional capacities and resilience.

The effects and consequences of war and terrorism permeate both the professional and personal realms of the psychologist. Although psychologists are vulnerable to the same emotional and psychological responses as the public, we can, if attentive to the challenge, manage these stresses effectively and maintain exemplary standards of professional performance.

To succeed in maintaining our resilience, psychologists must ensure that our own psychological needs are appropriately acknowledged and addressed, so that we can continue to meet the psychological needs of those who utilize our services.

Some of the professional challenges and practice disruptions facing psychologists and trainees in the current environment include the following:

• Patient or client regression may be triggered by the current world situation.

• Previously established treatment goals may be eclipsed by outside events, thereby interrupting the treatment process.

• A wide variation of client responses and shifts in response over time will require careful professional vigilance so that psychologists remain a steady, reliable source of support.

• Psychologists may be asked to increase our efforts in order to meet community needs, or to help those in crisis in other ways.

• New professional role and boundary maintenance challenges emerge as psychologists share traumatic national experiences with the client (who, for example, may be particularly interested in the therapist's personal responses and feelings about the situation).

• Psychologists involved in disaster response may experience increased, and possibly chronic professional stress and emotionality, as a result of direct exposure to the distress of those affected.

• Psychologists will need to be alert to the idiosyncratic effects of increased stressors on certain cultural groups, and the resulting demands on our professional skills and functioning.

• Psychologists must attend to the consequences of chronic stress, as it accrues in both our community and our personal lives.

• Psychologists involved in training and supervision will need to attend to similar effects of chronic stress on trainees, as well as the impact of the chronic stress on those they serve.

Psychologists and trainees who have been directly affected by terror or war face a special dilemma in balancing individual needs and professional demands. Some particular challenges for these individuals may include:

• Maintaining emotional balance and boundaries with clients even while sharing the reality of the circumstances.

• Balancing our personal needs and the desire to share concerns with another person with our professional role responsibilities, especially when asked about our personal experience or the safety of family members.

• Balancing the needs of patients and the psychologist's desire to provide assistance, with the increased personal stress that can result from maintaining the therapist role during a time of great personal challenge.

The extraordinary demands on psychologists and trainees during this time intensify the need for self-monitoring, with an emphasis on self-care strategies that can help bolster professional resilience. Psychologists should be attuned to physical and emotional vulnerabilities and should attend to preexisting stressors. Ongoing realities of daily personal life and professional practice continue, and will intersect with stress caused by world and national events. It is important for psychologists to understand that increased stress is a natural response to these circumstances and that the first step in managing this stress is careful attention to self-care.

The following self-care strategies can help psychologists cope with added professional stress in this difficult time:

Take some basic steps

• Assume that you will likely benefit by maintaining sufficient sleep, exercise and healthful eating — just as your clients and patients do.

• Notice how you internalize stress and its effect on your body. Attend to your physical needs as much as possible. Take advantage of personally restorative activities, such as walking or other exercise, massage, meditation, dancing or other adjunctive activities.

Focus on personal relationships

• Maintain contact with friends and family, and talk to loved ones about your experience and feelings.

• Shed the therapist role when not working with patients and clients.

• Connect with organizations in your community that are important to you.

• Attend to your spiritual needs, individually or within a spiritual community.

Engage in activities that balance work and nonwork life

• As much as possible maintain normal routines, which can provide a sense of stability and security.

• Even though demands on your schedule may intensify, don’t attempt to do too much. Seek necessary time away from work.

• Attempt to maintain a proactive and optimistic viewpoint.

• Pursue hobbies and avocations.

• Write and talk about the events and their effects on you, recognizing that this may feel difficult to do under unusual circumstances.

In addition to self-care efforts, professional resilience can also be strengthened by using various professional support strategies.

Increase interaction with peers
During a period of heightened or chronic stress, it may be helpful to increase consultation or supervision. Don't try to go it alone. Normalizing the difficulty of providing help while managing personal responses can be eased greatly by communicating about your reactions with supportive peers or a supervisor.

Develop a long-term perspective
Understand that the impact of these times may last for an extended period, and will necessitate a long-term adaptation.

Consider personal therapy
If the self-care and professional support efforts described in this publication don't help over time, personal therapy may be a good strategy to aid in managing stress and implementing healthy coping behaviors.

Psychologists can and should build our resilience in order to help patients, clients and trainees effectively during this period in American history. The effects of war and terrorism will likely affect all our lives for a long time. People across the country will rely on psychologists to assist in coping, and in processing the personal meaning of the events that have taken place, and those that may yet occur.

Psychologists have found it very gratifying to make a valuable contribution by helping others in times of trauma. In the months and years ahead, psychologists nationwide will enable ourselves to continue providing this much needed service by taking the steps necessary to maintain our optimal professional capacity.

This publication was developed by members of the APA Board of Professional Affairs' Advisory Committee on Colleague Assistance: Michael F. O’Connor, PhD, Nancy S. Elman, PhD, Karen W. Saakvitne, PhD, Patricia R. Todman, PhD, Jeffrey Pincus, PhD, Roberta L. Nutt, PhD, and Lawrence S. Schoenfeld, PhD

For more information regarding this publication, please contact Lynn F. Bufka, PhD, Director, Professional Development Demonstration Projects, APA Practice Directorate.

April 2003