Counseling Today, Features

Counselors without borders

Angela Kennedy June 21, 2006

Answering the need for continued mental health services in the devastated Gulf Coast region, 14 George Mason University graduate students and two counselor educators recently spent a week counseling and consoling Hurricane Katrina victims in Mississippi. The trip was initiated through the university pilot project Counselors Without Borders to provide counseling services by supervised graduate students.

“I was continually hearing about the mental health needs on the Gulf Coast,” said Fred Bemak, a counselor educator at George Mason, located in Fairfax, Va. “I’ve been watching the system that was set up to bring in people, and they required licensure and two-week minimum stays. I was getting increasingly mixed messages that the needs were not being met because they were far greater than the mental health resources being deployed.” Bemak, along with his colleague and wife, Rita Chi-Ying Chung, decided to escort and supervise a group of their own students on a mission to assist those still traumatized by the hurricane.

Bemak asked his students if they would be willing to help those affected by the hurricane. “I told them, ‘I have a license, and I’ll supervise you,’” he said. “It’s no different than supervising a practicum or internship.” He added that he believes counseling graduate students have the resources and ability to help communities affected by Hurricane Katrina in a professional capacity greater than simply handing out food or bottles of water. “We can offer our services to help this underserved population,” he said.

No funding was provided for the trip. Initially, 35 students volunteered, knowing they would have to pay their own expenses. Bemak contacted Walter Frazier, president of the Mississippi Branch of the American Mental Health Counselors Association, a division of the American Counseling Association, to collaborate on the trip’s organization. They decided to limit the trip to seven days, reasoning that a two-week time commitment was too difficult, especially given that the trip was to take place in the middle of the semester and most participants were part-time students with jobs and family obligations.

“Our idea was to do a national pilot to see if this would work and perhaps open the door for other teams from other universities,” Bemak said. “We all wanted to see if this was something that was viable.” Bemak also coordinated with the Mississippi Department of Mental Heath and the local Substance Abuse and Mental Health Services Administration team.

After the dates were finally nailed down, 14 of the 35 students who had originally expressed interest committed to go. Bemak and Chung held an orientation on disaster work to inform the students about what they might encounter. Afterward, they gave the students the option of changing their mind about the trip, given that the work would be both mentally and physically taxing. All 14 students stuck by their commitment. The two supervising faculty members and the students went to the campus computer room and purchased their airline tickets online that day.

“What was very interesting was that the other students in our program, because of our social justice mission, were very willing to support this,” Bemak said, adding that a number contributed money and volunteered to pet or house-sit while their fellow students were away. Several pitched in by driving their peers to the airport in Baltimore or loaning digital cameras and video camcorders to those going on the mission. Bemak and Chung spoke to their fellow faculty members, asking if they would be flexible with deadlines and tests for the students who were volunteering. Again, the response was positive. “We had a whole graduate program community of caring,” he said. “Everyone jumped in to support it. Even a very well-known faculty member in the psychology department offered to buy us T-shirts to show who we were.” The T-shirts helped identify the students among the hundreds of aid and relief workers in the centers and shelters.

Before leaving, team members met again for intense training in disaster relief counseling, using materials from ACA, SAMHSA and the American Red Cross in addition to the experiences of their two supervisors.

The deployment

The Mississippi Department of Health, which hadn’t originally been disposed to accepting nonlicensed volunteers, was on board and supporting the George Mason University team. The director and workers of Project Recovery, a government-funded state mental health program, met team members at the airport upon their arrival in Mississippi and drove them to the coast.

“That, to us, symbolized that there was a great need that they are not able to serve with the resources they have,” Bemak said. “They welcomed this team, even though the students were not licensed. It was a very special moment they created because we were not the traditional, licensed, two-week team.”

Frazier had arranged for the team to stay in tents outside a local church. However, a freak cold snap sent temperatures plunging into the 30s. The SAMHSA team contacted Bemak while en route to say it was working to find an alternate location for the students to stay. When team members arrived, they were told they could stay in the same location as the SAMHSA team — in a secure treatment facility for male adolescents.

“There was barbed wire and several locks and codes we had to go through to get to our area,” Bemak said. “We had a building to ourselves because the facility was not full.” Still, the quarters were far from comfortable. Bemak slept in an isolation room with little more than a mattress on the floor. The students bunked up in pairs, making the best of the situation and trying to prepare for the events to come.

Katrina fatigue

For the next week, the students were split up and scattered along the Mississippi coast at seven shelters and disaster response centers. Frazier arranged for rental cars so students could drive back and forth to the locations. Cell phones were also donated so students could stay in contact with Bemak and Chung.

Most of the people the team members approached welcomed the invitation to talk. At first, Bemak said, the students were a bit hesitant about just going up and talking to those affected by the hurricane. But by the end of the trip, they had seen 591 clients. Chung and Bemak roamed from facility to facility, navigating piles of debris and nameless streets to make sure their students were all right.

“(Team members) worked across ethnicities and races, facilitated dialog among those in different ethnic backgrounds and had mini group sessions — informally — as people and families waited in lines for aid,” Bemak said. “We could have tripled our numbers and still not seen all those who needed help. The stories are profound. The frustration is endless. The mental health issues there are escalating. They call it Katrina fatigue.”

Every night after dinner, the group met for two to three hours to debrief and share their experiences. They discussed victims’ stories that had touched them as well as their own emotions and struggles. The counselor supervisors talked about specific interventions and helpful skills the students could use.

“Every night they cried,” Bemak said. “They were moved and pained by the stories, but they grew significantly as counselors.” Many of the students stated that the experience was different from any of their previous training, he said. According to Bemak, every student said they would have agreed to stay through the Thanksgiving holiday to help if they had known the true level of need that still existed months after the hurricane. “They all said that it was a life-changing experience,” he said.

On to Capitol Hill

Since returning, the team has contacted government officials and is scheduled to meet with members of Congress to further focus attention on the need to provide ongoing mental health services to the hurricane victims. The aim is to create a national program with funding for other schools to send teams of counseling students to the Gulf Coast.

“There is so much devastation and everything is destroyed,” Bemak said. “We weren’t aware of how bad it is and how hopeless and hurt a number of the people are. After the experience, we want to bring that awareness back. The situation warrants a completely different response than what we have been doing. The needs are far greater than the kinds of interventions we are making. We need to make a major shift in how we approach it. One of those shifts can be led by teams from universities going down there with graduate students and supervisors.”

Counselors in progress

Following are the stories of two of the counseling graduate students who volunteered to go to Mississippi:

Kelly Badger

“I was nervous to make the decision to go down to Mississippi due to us not knowing exactly what our role would be, (but) it was something that I just had to do. You come across opportunities in your life that you make a personal connection with and it just feels right. It was one of those situations. The people down there are in need, and I have the ability to go down and try and make a difference in some way.”

Badger was apprehensive about her ability to provide effective trauma and disaster relief counseling, even with her professors on hand to supervise. “I knew that this would not be the same type of counseling that I have been doing as a practicum student in school counseling, but my apprehensions were in not knowing what this type of counseling looked like. We read articles and met with Dr. Bemak to discuss situations we might come across and how to best handle them, but nothing can make you feel fully prepared. You learn to trust your gut and believe that you have the skills as well as the heart to help these people.”

After speaking to individuals affected by Katrina and hearing their stories, her concerns faded and her professional skills and confidence grew. The most challenging part for her was dealing with the emotions involved in this type of work.

“I don’t think you can ever be fully prepared to experience the impact that this devastation has on you, especially when you are working so closely with the individuals that it has impacted. It was crucial that we process what we had experienced together at night back at base camp because we were so busy during the day, I never had a chance to really feel what was impacting me and what effect it would have on me.”

Badger was deeply touched that the individuals she talked to felt comfortable enough to share such private and painful stories with her. “Some individuals would hug you and tell you that you had made a difference to them. With some individuals, you could tell a difference in their demeanor toward the end of our time together. Some I will never know if I made an impact at all, but I am confident that there were people I touched, people that feel reaffirmed and feel heard because of me, and that is the most rewarding gift I have ever received.”

One aspect that Badger said doesn’t get much media coverage is the fact that all the hurricane victims had some sort of personal struggle or issue — no matter how normal or ordinary — before Katrina hit; the storm just exacerbated their pre-existing problems. In addition, she said, life issues that residents dealt with prior to Katrina, such as health care, domestic violence, poverty and discrimination, are still there. People continue to deal with these issues, but they are now combined with a lack of shelter, food, clothing, jobs and overall security.

“They have life events that continue to happen and continue to affect them in addition to the devastation that they are faced with (from the hurricane). One individual that really opened my eyes to this was a man who had found out that he was terminal and that his doctors were no longer going to actively fight the cancer in his body.” He had learned this several days before talking with Badger but hadn’t told his family because he didn’t want to burden them.

“He said he didn’t want to put anything else on their plate. He thanked me for listening and told me how good it felt to get it out and to tell someone. I can’t tell you what a gift it was for him to trust me enough to tell me such a personal story and to feel safe enough in our interaction to do so.”

The experience has changed Badger professionally as well as personally. “I am definitely a different counselor, but even more so a different human being. These people have been such an inspiration for me. They are so strong and so resilient.”

She felt connected to those with whom she spoke and feels a responsibility to do whatever she can to continue providing support. “This is going to take a significant amount of time to heal. These people are in pain, they are frustrated, they are angry, and at the same time they are proud and are full of internal resources that push them through. People I spoke with were so thankful for our presence in their community. There is a true need for continued support from the mental health community.”

Badger encourages other graduate students to establish Counselors Without Borders programs and to volunteer in the Gulf Coast region. “You will not regret a moment of it. It is hard, it is emotional, it is draining. But it is all worth it. We were told that this would be the toughest work we might ever do, and I can say without a doubt it has been, but it has also been the most rewarding experience to date. I would not trade that week of my life for anything.”

Marla Zometsky

With all the discussion surrounding what Gulf Coast residents need and how many of those needs are going unmet, Marla Zometsky thought it was important for her, as a future counselor, to serve in a helping capacity. “Particularly as someone who can listen to their concerns, show that people do care about what is happening to them and try to raise awareness that there is still a great need for assistance in this region, including mental health assistance.” She also wanted to go for the educational opportunity. “Professionally, my reason for pursuing a graduate degree in counseling was an interest in trauma counseling, and this project was a great opportunity to personally help those impacted by the hurricane and to obtain direct crisis counseling experience. I could not have had a better chance to learn while doing.”

She tried to prepare herself for the destruction, but witnessing it in person was surreal, especially when she saw small personal items such as photos or books amid piles of rubble that once were homes. “Knowing that many of those I spoke with were still — three months out from the hurricane — living in their cars, in shelters and in tents, (and) feeling that this was unacceptable and due to a true lack of political will on a grand scale, was personally challenging in that I could not make the system work better for them in that moment. Person after person expressed their frustration, fear and weariness trying to obtain shelter or trying to remain in their current shelter until their trailer or more permanent housing came through.”

She also struggled with the fact that once the GMU team left, no one would be there to continue providing needed mental health services. “On my final day, it was a challenge to leave the DRC (disaster response center) knowing that another mental health worker would not be returning the next day, that they were needed and that further plans for their deployment were still under consideration. As I was leaving on the final day, one of the FEMA (Federal Emergency Management Agency) employees asked if I was returning soon and whether someone else would come the following day. I had to acknowledge that I didn’t know when another mental health worker would come, but we were working on it. That was difficult. While I tried to give them hope, I couldn’t promise anything.”

Zometsky said many of the same people and families returned to the centers daily for assistance and to ensure their information was kept up to date. Their anxiety, sadness and frustration levels were nearing their limits, and the student counselors tried their best to draw on their counseling skills and limited experience to defuse the situations any way they could.

“While I wasn’t able to help them with their immediate goals, such as obtaining shelter, I was able to give them an empathetic ear and help them think through their next steps for that day. I tried to reinforce the personal strengths I heard them express, give them the opportunity to convey their emotions and just simply be there for them in those moments.” She said several FEMA workers, many of whom were from the affected areas and also dealing with loss, relied on the mental health workers and asked them to speak directly with distraught persons.

In one such case, a FEMA worker asked Zometsky to speak with an incredibly anxious and distraught mother and her 14-year-old daughter. “She was in line to learn the status of her travel trailer; her family was currently living in a shelter. I walked up and asked if I could sit next to her. Before I could even finish my sentence asking how she was, she started telling me how worried she was that the shelter they were in would close and that she and her family would literally be living on the street. This wasn’t an unfounded fear, as the previous two shelters they were placed in had closed. This family had lost everything — their home, their belongings and their security. They had no permanent place to live, and she had another child, a son, with Tourette’s syndrome. She was deeply concerned with how a lack of structure and security was affecting her children.”

The women was so upset, she could hardly breathe at times, Zometsky said. “I gently placed my hand on hers and asked her if we could take a deep breath together. She had so many things to take care of and so much to worry about that everything was overwhelming her. So we walked through each step she would take while at the DRC today. I reflected her feelings and summarized the incredible amount of work that she had already accomplished in such a short time.” To the young counselor’s surprise, the woman replied, “You are right! I have gotten a lot done!”

Zometsky said, “Although she was still distressed, by the time it was her turn to meet with the caseworker, she seemed to be thinking more clearly and could present her information in a coherent manner.” As the mother spoke to the FEMA caseworker, Zometsky sat and talked with the daughter. The mother had referred to the daughter as “resilient,” and Zometsky asked the teen what she thought of this.

“The young woman felt it was not true and began to cry. She was still mourning the loss of her father, who died a year ago. She shared with me how she had lost the only things she had that remained of him. Her friends were now scattered across the country. She didn’t know how to contact them. She felt alone and as if no one, including her mother, understood her. We talked about what that was like for her and how she was dealing with all this loss. She told me that she wrote music. I responded that she must be very talented and asked if she wrote about her feelings. She said that she did, but that people did not know they were her feelings. Again, I told her how impressed I was and that she seemed like such a unique and talented young lady.”

Zometsky said that throughout her time with the daughter, she simply reflected the feelings she heard the girl express. That was all the girl needed to continue her story and feel that someone understood what she was going through.

“At one point this young lady asked if I was a counselor. I told her I was a ‘wanna-be’ counselor and that I was in training.” The girl laughed at her joke and told Zometsky she had talked with counselors before but did not like them. However, she liked talking with Zometsky.

“I felt honored that we made a connection, and I shared that with her and thanked her.” Zometsky also gave the daughter a list of hotlines she could call in the future if she wanted to talk to someone. “I was touched by the entire experience with that family. I spoke with this young lady for approximately 45 minutes. During the last 15 minutes, I had noticed that the mother had completed her meeting with the caseworker. However, she sat several rows behind us in order to let her daughter continue talking.” Both the mother and daughter hugged Zometsky and thanked her for listening. Though she made them feel better, Zometsky is under no illusion that the stress and anxiety the mother first expressed are permanently gone. However, for the brief time she spent with the mother, Zometsky was able to help her accomplish her tasks at the DRC in a more productive and calm manner.

“Furthermore, this young lady was able to express her sadness and not pretend that everything was OK. She had been feeling like no one cared about her and that she was alone. For a brief time she met with a stranger who allowed her to share how she felt, empathized with her and thought she was important. As a future counselor, I have a new understanding about what it means to be fully present and work in the moment. I have a new appreciation for the basic counseling skills — reflecting, paraphrasing and attending — and the enormous impact they have on the clients and our relationship.”

Like Badger, Zometsky wants counselors and counseling students to be aware that a great need remains for counseling volunteers in the Gulf Coast. “I would also like disaster relief organizations and mental health associations such as the American Counseling Association to know that graduate counseling students are an untapped resource that should be utilized,” Zometsky said. “The people in the Gulf Coast need our help, and we as counseling trainees should not be excluded when implementing a large-scale mental health crisis-counseling plan. Doing so contributes to a system that has left thousands of the affected without mental health respite. Graduate counseling students can help fill the need. I believe the counseling profession has an obligation to do everything possible to help fill this deficit, and recruiting graduate counseling students is one option. Furthermore, it provides students with the hands-on experience that will make them better counselors and future leaders in the social justice counseling movement.”

Zometsky continued, “We need to fight Katrina fatigue. Do not be fooled into thinking that things are all better. While this may be true for some, and I am grateful for the progress already made, there are thousands and thousands that are still without basic human services and who are fearful for their future. We’ll see the mental health impact of Katrina for years to come.”

For more information on establishing a Counselors Without Borders program with counseling student volunteers, contact Fred Bemak at fbemak@gmu.edu.

To donate to the American Red Cross, go to www.redcross.org. In addition, the American Counseling Association Foundation continues to collect donations for the Counselors Care Fund. For complete details, visit the ACA website at www.counseling.org, or call 800.347.6647 ext. 350 to make a contribution.