One psychotherapist heard from a client that Saddam Hussein was behind the anthrax.
,A social worker tells of a patient who now hears voices with Middle Eastern accents.
A counselor reports that the prejudice exhibited during some sessions has become overwhelming.
Therapists are expected to listen and guide, but what happens in the unprecedented situation where the caregiver shares the trauma? After listening to the litany of scenarios delivered by an increasing caseload of clients in the aftermath of Sept. 11, more and more therapists are reaching out - to each other.
"I'm certainly not sleeping well and I'm eating more often," Lynne Shine said. "I wouldn't hesitate to see a therapist if I'm not able to follow through with normal activities. I think it's widely accepted. Could it be awkward? Yes. You could run into a former client in the waiting room.
"I've experienced a lot of anxiety," added Shine. "I'm not able to do the things I normally do, like relax and read. I can truly tell you in the last month I've read one chapter because I turn on CNN, which is the opposite of what I'm telling my clients."
Shock, denial, anxiety and depression have pushed many people into first-time counseling sessions, resulting in increased caseloads for many of the mental health workers interviewed for this story. In addition, clients already in therapy may have been pushed into a clinical state by the events and aftermath of Sept. 11.
"The scenarios my clients create in their heads - anthrax is a big one," said Shine. "They are talking about their fears, and as they're talking I'm thinking, too. With this one, you share their anxiety."
Shine, of Audubon Counseling in Amherst, has worked as a therapist for 17 years. As a rule, she said, therapists are accustomed to having current events affect the concerns of their clients, but the recent terrorist turn of events is taking a toll.
"I've never seen this much anxiety," she noted. "With Monica (Lewinsky), the marital concerns would increase, with spouses starting to pay attention to how easy it is to get away with things. The Gulf War increased anxiety of people with older sons. This one is hitting all fronts. Adolescents are old enough to understand, and those who are approaching 18 feel vulnerable for the first time in their lives."
Therapists routinely reach out to each other - with few exceptions, Shine said, pointing to one psychiatrist who was overheard sharing his troubles with a hairdresser.
"Clinicians, social workers, therapists, trauma therapists - they sometimes feel the trauma of their clients, so that they sometimes have the same symptoms," explained Bonnie Collins, who directs the Family Counseling and Wellness Center in Hamburg.
Professionals call it "vicarious traumatization" or "compassion fatigue," when boundaries disappear and the therapist begins to identify with the client. Not to be confused with burnout - prompted by too much work and too little support - vicarious traumatization is characterized by symptoms that include irrational fear about safety, nightmares that the client's story is happening to the therapist and an exaggerated sense of a world gone bad, according to Collins, who wrote about the subject in the current issue of Psychotherapy Networker.
"What makes me not go crazy is connecting with colleagues," Collins said. "We find ourselves connecting more often than we used to. We're all looking for how the terrorist incident affected us. We're talking to each other. The story has to be told."
In Collins' office, a sign reads, "Expect Miracles." She begins each day by lighting a candle that burns throughout the sessions. Fresh flowers and gifts from clients dot an office that is soothed by music.
"Creative techniques help people heal and I'm healing right along with them," said Collins, who also spent five days in Manhattan counseling disaster survivors.
Meanwhile, at Crisis Services of Erie County, phone calls dealing with generalized anxiety have increased 30 percent, making it tough on the telephone counselors, according to Dana Fleischhauer, coordinator of the phone program.
"When you hear the stories, it sometimes changes the way you see the world," explained Steve Osterstrom, coordinator of staff development for Crisis Services. "You start becoming cynical and thinking the world is a bad place. You jump to conclusions, become judgmental, and you get to a place where you are not helpful to your clients."
Carol Conklin is a social worker who specializes in the treatment of sex addictions. Night after night, as she leaves her office shortly after 9, she feels overwhelmed, yet is compelled to watch the news until early morning.
"I don't want to talk when I get home at night," said Conklin, pointing to four friends whose phone calls she needs to return. "I find myself tired and having difficulty teaching. As the weeks went on, I was probably eating more desserts, and evaluating my spending.
"What would make a therapist any different?" Conklin asked. "We're supposed to have black belts in recovery, but we should be more mindful."
Fortunately for Conklin, her best friend is a therapist.
"We kind of talk each other down," she said. "Another thing I did was take Fridays off, and I watch shows that show true-life examples of people with major problems, usually criminal.
"Watching my 1-year-old grandchild is also my therapy," Conklin added. "We talk about Elmo."
One therapist interviewed expressed a feeling of vulnerability during some counseling sessions.
"Being in a listening position, I hear whatever theories they may have about how bad things are, wrinkles on things I hadn't thought of," said Kent Bath, an Amherst clinical psychologist. "It's not like I turn on the news and I voluntarily expose myself. It kind of hits me by surprise."
Bath calls it a manageable strain, one that is brought on not by the increase in client load, but by the intensity of sessions.
"I know the strain is there because at the end of the work day, I am more tired than I can explain from the work itself," said Bath, who relies on a support system that includes his wife and several colleagues.
One Manhattan neuropsychologist, who has worked with families of the victims since Sept. 12, believes the city that never sleeps is now living up to its name.
"I'm very sad," said Joseph Hirsch. "All the tales of woe from a variety of people. How could someone not be affected? But do I need therapy? Not at this juncture.
"It's a matter of putting things into perspective and recognizing the most important thing in your life," Hirsch said. "I've become a better therapist, a better husband, a better father.
"The stigma of going to a therapist is gone."