Beyond the Reach of Ladders Q & A

A Conversation with Dr. Elizabeth Goren, author of
My Story as a Therapist Forging Bonds with
Firefighters in the Aftermath of 9/11

Q: You were in your Greenwich Village office the morning of the attacks on the World Trade Center. After you heard and felt the explosion of the first plane crashing into the World Trade Center, you had a choice: go home to safety as most people would do, or go towards the disaster. What compelled you to get involved?

Dr. Goren: Before 9/11, I had been considering volunteering for an organization like Doctors without Borders, but I couldn't, because the time commitment they required would have disrupted my practice too much. So, doing volunteer work was very much on my mind. When the attacks happened, I was already in my office downtown, and St. Vincent's Hospital was just a short walk away. The way I tend to deal with crisis and stress is by taking action, so I found myself walking to the hospital to see how I could help.

Q: After 9/11, how did you get assigned as a psychologist to the firehouse that is at the heart of your book?

Dr. Goren: In the first few days following 9/11, a good friend and fellow psychoanalyst from NYU came up with the idea to go to firehouses that had been severely affected, to offer our support as mental health professionals. But firehouses around the city became deluged with hordes of well-meaning do-gooders, so the counseling service of the FDNY organized a formal program where they invited a small group of professionals with expertise in trauma, like myself, to go into the firehouses that had lost the most firefighters. The firehouse I write about is within walking distance of my office, so it made it easier for them to come see me when they were off duty.

Q: You write in your book that the FDNY had always prided itself on its ability to take care of its own, but that the scope of the disaster's effects necessitated that they accept outside help for the first time. When you first got to the firehouse to help them work through the trauma of 9/11, what was the initial reaction from the men?

Dr. Goren: Their reaction was quite clear from the look on their faces: "Here comes another do-good civilian who means well but doesn't know a thing about us, or what we need." But the FDNY is a para-military organization, so when the firefighters were told to attend our group sessions, they followed orders. They were present, physically, that is. But between their skepticism if not downright suspiciousness of therapy, their trauma, and their acute grief, they were in a state of confusion and active resistance. To be honest, these are men (and this particular firehouse had no female firefighters) who would have been resistant to counseling and to talking with an outsider even under the best of circumstances. They were used to being the helpers, not the ones being helped. Also, as first responders, they were, understandably, concerned about putting their job at risk by revealing any kind of chink in their armor. I found that, because they followed orders, I could get them to attend Group. But you can't force someone to open up.

Q: To break through their resistance and connect with the men at the firehouse, you judiciously broke some of the rules of psychotherapy. Can you tell us about this?

Dr. Goren: When you're working in the field, you get a different picture of the people you are treating than if you were simply sitting in your office. And they, in turn, have an opportunity to see behind your professional mask, or your "therapist's uniform." You have to be willing and able to think and act outside the box; to be spontaneous and innovative. A firehouse runs like a family—it was as if I were going into someone's home. To adhere strictly to the rules of therapy that applied in my office wasn't going to fly in this setting. My first step was to leave the table where we held our Group sessions and go with them on a run in the fire truck. I also accompanied one of the men with whom I had one-on-one sessions to a conference on terrorism. Most significantly, perhaps, I started talking about myself and sharing details about my own life with the guys in the firehouse, which was crucial in getting them to start opening up.

Q: What was it like to take the therapy process out of your office and into the firehouse? You talk in your book about developing a method of "therapy on the run" in the firehouse. Can you describe how that worked?

Dr. Goren: These men have to be ready to answer a call in 60 seconds, so I learned how to catch a moment and make it meaningful. In Group, the guys were talking about general things, but they weren't going to get into anything personal. But if I chatted with someone while he was cleaning equipment or preparing a meal, the others gave us the privacy we needed and the time to really talk. In these one-on-one situations or the more informal talks that sometimes sprang up organically, the men were more open and would talk more revealingly than in Group.

Q: Once they started expressing their feelings, how were you as a therapist able to help them work through their despair without joining in it?

Dr. Goren: This is the art of being a good psychotherapist—especially when dealing with intense experiences such as trauma. The key is that you have to constantly observe yourself during the process: what do your own responses tell you about what the other person is going through? It's like the ultimate in multi-tasking: you have to be prepared to enter the other person's world fully, and even to lose a little bit of your mind! But at the same time, you always listen to yourself and gauge your own reactions while engaging the other person.

Q: You write in your book that before 9/11, you believed in the term "denial" but that within hours of the attacks on the World Trade Center, that term, along with others you refer to as "psychologically and psychoanalytically facile concepts" went out the window. Can you explain this?

Dr. Goren: "Denial" is a term we all use—mental health professionals and civilians alike—but through my own experience, I saw how complex life really is, including how we understand life and death. I saw those towers go down, and rationally, I knew that all those who had been inside must have died, but I went through my own questioning, especially when talking with family members. How do you declare someone is dead when there's no proof, no body?

We latch onto terms to describe profound phenomena and experiences because they help us deal with something that is so intense and overwhelming. Life at some level is incomprehensible, so we come up with labels as a way of organizing our experience and making something easier to grasp. We also do this when something is so painful, or when we don't have an answer. A label gives us an answer. The more overwhelming something is, the more likely we are to come up with a definition or label. It's comforting, and gives us a way to grasp the ungraspable.

Q: Are you still in touch with any of the men from that firehouse, and if so, how are they doing?

Dr. Goren: : The bonds we form in a crisis are life-long. No matter how long it's been since we've last seen each other when we meet we feel deeply connected. I make a point of periodically dropping by the firehouse, just to see how everyone's doing, and I'm always greeted with hugs or smiles, invited to sit down and eat with them. A lot of the original group have left the firehouse, but we all get together every September 11 for a memorial service and then go for drinks at a local bar.

I'm still in close touch with the three men in particular about whom I write in my book. I recently visited one of them who now lives in Florida, and finally met his family. And one man whom I write about continues to have sessions with me. He's doing well but his daughter, who was just a young child on 9/11, is now an adolescent, and, like many others of her age whose lives were so closely linked to 9/11, she's experiencing some serious problems. Her father and I continue to work together closely.

Q: How are the men in your book experiencing the approach of the 10-year anniversary of 9/11?

Dr. Goren: For firemen, especially those directly involved at the Trade Center, like my guys, each anniversary has been a deeply sad time of year. The Fire Department has a tradition of commemorative rituals which play an important role in their ability to cope with death, which is inherent to what they do. As for the individual men, I think the approaching tenth anniversary brings up the same kind of issues each man struggled with most through 9/11. For some, they're thinking so much more about the friends they lost. Others are remembering specific things that happened that day. One man told me he had nightmares of buildings on fire and collapsing right after Bin Laden was assassinated.

My firehouse holds strongly to its own rituals, and it's planning to hold a memorial service in the church around the corner and have a lunch in a neighborhood bar. I think the tenth anniversary marks a milestone for them as well as for us. One of the guys told me that with guys leaving and new guys coming in, firehouses roll over in about ten years. Perhaps we can all look to this decade marker as the beginning of a new era.

My Story as a Therapist Forging Bonds with Firefighters in the Aftermath of 9/11
Opengate Press
Publication date: September 11, 2011
260 pages, $17.95
ISBN: 978-1871871722

For more information contact Meg A. Parsont, 212-787-5704,