Advance praise for FDNY Crisis Counseling "This riveting book . . . underscores the need for creativity, modesty, clinical acumen and cultural sensitivity in response to trauma. One ends up in awe both of the lost and surviving firefighters and their courageous families. And the reader emerges with a profound respect for the extraordinary CSU staff who literally came to their rescue." --Paul A. Kurzman, PhD, ACSW, Professor and Chair of Work, Employment, and Rehabilitation Programs at the Hunter College School of Social Work of the City University of New York "This remarkable book comprises a major contribution to the crisis treatment literature. Overall, many will benefit from this careful, well documented explication of an approach to disaster counseling over time." --Katherine Shear, MD, Professor of Psychiatry in Social Work, Columbia University School of Social Work Developing and implementing effective crisis counseling techniques in response to mass trauma Shortly after the September 11th attacks, as the New York City Fire Department (FDNY) started their recovery work in the ruins of the World Trade Center, a large-scale mental health response within the FDNY swung into action, initiated by staff in the department's Counseling Services Unit (CSU). FDNY Crisis Counseling: Innovative Responses to 9/11 Firefighters, Families, and Communities tells the story of this ongoing response from the perspective of those who put it into practice. Using narrative, case studies, and other real-world examples, this unique new resource lays out a roadmap for applying innovative approaches to disaster response and the prevention of Posttraumatic Stress Disorder. The pioneering efforts of the CSU present a model for all mental health professionals working with organizations, communities, individuals, and families. * A brief history of the CSU * FDNY culture and the impact of 9/11 * Shaping services to meet 9/11 needs * Providing help to families, including widows and children * Partnering with other agencies and cargivers to deliver services TABLE OF CONTENTS Preface xiii Acknowledgments xix Chapter 1 Introduction 1 Chapter 2 Coping with Chaos 10 The Counseling Service Unit Pre-9/11 11 The CSU Response to 9/11 16 Assessing the Community 18 Receiving Outside Help 21 CSU Expansion 23 Connecting with the Firefighting Community 23 Connecting with Families 24 Family Liaisons 26 Moving Forward 29 Defining a Timeline for Your Community 30 Chapter 3 Understanding Culture 33 Cultural Identity 35 Applying Cultural Identity to Intervention 37 Firefighting History and Tradition in New York 39 Modern Firefighting in New York City 45 The FDNY as a Paramilitary Organization 47 Everyday Life in the Firehouse 48 Rituals and Rank 50 Common Bonds 54 Family Ties That Bind 56 Heroics, Media, and Politics 60 The Brotherhood and Its Loss 63 Chapter 4 Shaping Services to Meet Emerging Needs 68 Assessment and Planning 69 How the Nature of the Event Shapes the Response 74 Listening and Responding to Emerging Needs 79 Strengthening the CSU Identity 82 Establishing Provider Networks 83 Building a Staff: Both Peer and Professional 87 Care for the Caregivers 90 Keeping the Machinery Going: Funding and Resource Development 95 Thoughts for the Future 96 Chapter 5 Providing Help in the Workplace: The Firehouse Clinician Project 98  The Mindset of FDNY Firefighters 98 The Intervention: Placing Clinicians in Firehouses 100 The Population: Defining Who Needed Services 103 Theoretical Orientation 106 Intervention Goal 107 Selecting and Training Firehouse Clinicians 111 The First Visit to the Firehouse 115 Revamping Professional Boundaries 120 Preparing to Be a Firehouse Clinician 125 Termination Countertransference: The Time to Leave the Firehouse 134 Chapter 6 Modifying Psychotherapy for Individuals 136 Individual Psychotherapy with Firefighters 136 The Parameters of Individual Treatment 140 Choosing Individual Psychotherapy 143 Implications for Psychotherapy Technique 149 Summary 153 Chapter 7 Finding Comfort in Groups 154 Why Group Intervention? 155 Therapy Groups versus Support Groups 156 Trauma Groups 156 On-Site Interventions 159 Office-Based Groups: Middle and Later Phase 162 Importance of Homogeneity in Group Formation 164 Traumatic Bereavement Groups 165 Single-Session Groups 176 A Final Word about Groups 178 Chapter 8 Providing a Home-Based Therapeutic Program for Widows and Children 180 Understanding the Experience for Mothers and Children 181 Developing CSU Services for Bereaved Families 187 Creating a Preliminary Model for the Family Program 189 Preliminary Trauma, Grief, Reconstitution Model 191 Implementing the Family Program 196 Intervention Goals for Children and Adolescents 198 Intervention Goals for Adults 199 Therapeutic Approaches 199 Lessons Learned 207 Chapter 9 Strengthening Connections within the Family at Home 212 The Impact of Trauma on Relationships 215 Reaching Out to Families 217 Developing an Effective Intervention 219 The Couples Connection Weekend 220 Lessons Learned 228 Chapter 10 Assisting Retirees in Transition 231 When the Losses of 9/11 Were Compounded by the Loss of a Job 231 The Retiree Experience 234 The Stay Connected Program 236 Lessons Learned 243 Chapter 11 Conclusion 246 Protracted Time Lines 248 Community of Grievers 249 Crisis Counseling over the Long Haul 250 Public versus Private Mourning 251 The Value of Pre-planning 253 Posttraumatic Growth 255 Postscript 257 References 259 Index 265 ABOUT THE AUTHORS PAUL GREENE, PHD, is Associate Professor and Chair of the Psychology Department at Iona College. He was also a Firehouse Clinician for the Counseling Services Unit of the FDNY. DIANNE KANE, DSW, CGP, is Assistant Director of the FDNY Counseling Services Unit, and an adjunct Associate Professor at Hunter College School of Social Work. GRACE CHRIST, DSW, is Associate Professor at the Columbia University School of Social Work, Director of the Social Work Leadership Development Awards Program of the Project on Death in America, and Director of the FDNY/Columbia University Family Assessment and Guidance Program. SALLIE LYNCH, MA, is a cultural anthropologist, and was the program coordinator of the FDNY/Columbia University Family Assessment and Guidance Program. MALACHY CORRIGAN, MA, RN, has been the Director of the FDNY Counseling Services Unit since 1982.