Tag Archives: Trauma and Disaster

Trauma and Disaster

Counselors play part in Orlando crisis response

By Bethany Bray July 8, 2016

On June 12, America woke up to the terrible news that dozens of people had been killed and injured in a spree of violence perpetrated by a single shooter at a popular nightclub in Orlando, Florida.

Within 24 hours, local counselors began circulating a spreadsheet, asking practitioners to sign up for shifts to offer therapy and support to victims, their families and community members at several locations around Orlando. The spreadsheet had more than 650 practitioner names on it within a few days, says Kristin Page, a licensed mental health counselor (LMHC) who offered crisis counseling in the days and weeks that have followed the tragedy.

“It was truly a community effort. People were willing to pitch in as needed,” says Page, a faculty member in the Department of Professional Counseling at Webster University in Orlando.

“I wish I could share the beauty of the counseling community in Orlando,” agreed Shainna Ali, president of the Florida Association of Multicultural Counseling and Development, and one of the many who provided crisis counseling in Orlando after the shooting. “Instantly following the [shooting] there was a surge of willing and able counselors ready to meet the needs of the Rainbow heartcommunity. I was able to see our counseling values in action, live in front of my eyes. As hundreds signed up for volunteer shifts, my heart was warmed as I noticed familiar names, peers, colleagues and past students. The counseling community has certainly banded together and is presently championing social justice in Orlando. I never have been more proud to be a counselor in the City Beautiful.”

The June 12 incident at Pulse nightclub in Orlando is being called the deadliest mass shooting in modern U.S. history. Forty-nine people were killed and 53 were wounded.

The first 911 calls came from the packed nightclub just after 2 a.m. After an initial barrage of gunfire, the shooter, 29 year-old Omar Mateen, barricaded himself in a bathroom with other clubgoers. The standoff came to an end just after 5 a.m., when law enforcement breeched the premises and killed Mateen in an exchange of gunfire.

“The community as a whole is grieving. [The shooting] has taken a mental health toll on people here in Orlando in various ways,” says Page. “This really hit home for so many community members – even people who didn’t know anyone who was at Pulse are finding themselves struggling, crying all the time.”

Following the shooting, many who came to counseling “just wanted to sit with someone and talk – be safe, and be heard,” says Page.

“In the initial days and weeks after the attack, we were doing a lot more listening [than structured therapy]. Just letting people express how they’re feeling is important, getting those feelings out there,” says Page.

The ad-hoc group of volunteer practitioners met with people at churches and other community locations, talking with victims, friends and family of victims and community members. They also saw first responders, such as emergency dispatchers, police officers and others who were involved as the shooting unfolded.

Many people expressed feelings of grief, sadness, denial, anger or survivor guilt, says Page, as well as general unease and feeling unsafe.

Through crisis counseling, Page says she focused on the message that feelings of grief and sadness are natural in the wake of trauma, she says.

“So they’re not thinking ‘this is just me’,” she explains. “The intensity of the feelings is very real to them. We [counselors] are letting them know that this is a process, and normal in the wake of something traumatic or the occurrence of a grief event.”

“Overall, the way the community has come together already shows me that we’re going to survive this. We’re going to be OK,” says Page. “The wonderful efforts on local therapists part have just stunned me. I have seen so many people come together. But this has taken a mental health toll on so many in Orlando. We will continue to need services. This is something we’re going to have to build together.”

Grief over the Pulse shooting was felt acutely by both the LGBT community, as Pulse is a popular gay nightclub, and the Latino community, as the violence occurred during a Latin-themed night at the venue.

Counselors should understand that “a safe place for the LGBT community was attacked” on June 12, says Ami Hooper, a LMHC in Tampa and leader in the Florida branch of the Association for Lesbian, Gay, Bisexual and Transgender Issues in Counseling (ALGBTIC). “Our LGBTQ clients need to know they are still safe and [should] be allowed an opportunity to process these events from various perspectives as the realizations come to them. I want counselors to know that like in all times of grief, you don’t have to have the answers. Often, there are no answers. Only that the best approach is to offer a safe space for clients to come as they are, when they desire. Not all of those impacted will seek counseling immediately, but [will] rather wait some time to seek help.”

The Pulse shooting took place during a week when several other traumatic events shook the Orlando community, including an alligator attack that killed a toddler on the Walt Disney World property and a murder-suicide at a rock concert.

Candace Crawford, president and CEO of the Mental Health Association of Central Florida (MHACF), says her organization’s mental health referral service has seen calls increase by roughly 20 to 25 percent since the Pulse shooting.

MHACF, an advocacy and mental health support nonprofit in Orlando, is working on creating a comprehensive plan to offer post-crisis counseling services for at least another 12 months, says Crawford.

“The crisis intervention is great for right now, but there will be many people for whom that is not sufficient,” says Crawford. “What we’re looking at is the delayed onset of trauma. There’s so much to be done for families who are attending to the immediate needs, moment by moment, day by day. There will be a time when they will be impacted, [and] they will all the sudden be unable to get out of bed … We want to be there to provide that safety net for those who have made it through for a time, but are impacted.”

After the Pulse shooting, Orlando city leadership organized a 24-hour response center at the Camping World Stadium, the downtown venue where the Citrus Bowl is played. More than 50 agencies collaborated to provide support services – everything from help with funeral arrangements to finding out-of-town relatives a place to stay.

Crawford said the community-wide response following the shooting has been “remarkable.”

In the week after the shooting, Crawford said she received a group email sent from Orlando’s LGBT community center, asking for help finding an apartment for one of the shooting victims as they were being released from the hospital.

“Within two minutes [someone replied and] they had an apartment for this person. Two minutes. That just shows you the kind of response we’ve been getting from this community,” says Crawford.





The Florida Counseling Association, the American Counseling Association’s branch in the Sunshine State, kicked into high gear on June 12. In the days and weeks that have followed the Pulse shooting, the association has sent out regular communications and social media posts connecting members with resources and information as well as calls for volunteers to join the Orlando-area crisis counseling efforts.

“We are incredibly thankful for our local counselors who quickly came to assist and help those in need, and we are continuing to remain in constant communication with our contacts in Orlando, FCA President Michelle Bradham-Cousar wrote in an email to Counseling Today. “We have sent out various communications to our counselors in order to secure an abundance of counselors for constant rotation and to provide for the needs of the Orlando community.”


In their own words

We asked several counselors from FCA who have been involved in Orlando’s trauma response to share some thoughts on the situation in Orlando.


“Counselors outside of Florida should be mindful about how clients feelings, thoughts and behaviors may be directly or indirectly related to the [Pulse] shooting, although they do not live in Florida. Providing them with the support they need and letting everyone know you stand with Orlando, even in a small way, can make a huge difference to help the nation heal. Counselors can prevent this from happening again by providing education, advocacy and clinical services to and on behalf of marginalized groups to reduce the effects of mental health issues and inequality from contributing to future incidents.

… When people worldwide go back to their regular lives and the media moves on to other stories, people all over will still be suffering from the shooting massacre just like the victims, families and community members of similar [past] tragedies are still suffering or were re-traumatized by this event. [They] will still be grieving, and trauma symptoms will emerge or continue for victims, their families and first responders, including professional counselors.”

— Letitia Browne-James, a LMHC who provided crisis counseling in Orlando


“As counselors, it is essential that we remember to be kind to others and most importantly, to be kind to ourselves. Tragedy can occur at any point in time and our ability to heal and process difficult emotions arising from a difficult event is easier to endure with supportive individuals at our side. Enhancing safety for the LGBT community and educating the public regarding awareness on mental illness — more specifically anxiety and depression, among others — will be the first step in helping our communities prepare for future tragedies … Although individuals around the globe have not directly experienced the calamitous event in Orlando, they are still impacted and are in need of comfort and support from caring individuals. Counselors worldwide are subject to compassion fatigue and may also be indirectly impacted by this senseless tragedy.”

— Courtney Martensen of Jacksonville, president-elect of the Florida Association for Child and Adolescent Counseling


“At the present time, there is heightened energy and willingness to assist. However, individuals are still in shock and absorbing the news. It is important to remember that when considering traumatic events, self-awareness to mental health needs often occurs much later than the actual event. Thus, it is important to consider that realization and subsequent need for counseling may likely occur in waves following the Pulse tragedy.

… The traumatic influence of this tragedy influences individuals within and beyond Orlando. Counselors should be well aware of the pervasive impact of this event. Beyond clients, individuals who may be affected yet not enrolled in counseling services may seek solace in a counselor who may be a family member, friend or acquaintance. Counselors should be prepared to provide these individuals with the gift of presence and be prepared to provide clinical resources and referrals.

To do your part in standing against such acts of violence, counselors should take a moment to consider what their counseling identity means to them. Beyond specialty and training, counselors should consider what advocacy means to them and how this looks for them. Counselors should be propelled to action to stand upon their values and tenets of counselor identity.”

— Shainna Ali, president of the Florida Association of Multicultural Counseling Development, who provided crisis counseling in Orlando





Find more information and resources by visiting:


The Florida Counseling Association at flacounseling.org

The Mental Health Association of Central Florida at mhacf.org

ACA’s page on disaster mental health: counseling.org/knowledge-center/trauma-disaster

The American School Counselor Association page on helping kids during a crisis: bit.ly/29A8Nr0

The Substance Abuse and Mental Health Services Administration (SAMHSA) page on mass violence: bit.ly/1M4yJBi


From Counseling Today:

Counselor addresses self-care, guilt in the wake of Orlando shooting

After Orlando: Helping others, helping ourselves

When tragedy hits close to home





Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org


Follow Counseling Today on Twitter @ACA_CTonline and on Facebook at facebook.com/CounselingToday.

Counselor addresses self-care, guilt in the wake of Orlando shooting

By Samuel Sanabria July 5, 2016

“When I was a boy and I would see scary things in the news, my mother would say to me, ‘Look for the helpers. You will always find people who are helping.’” — Fred Rogers


It was 9:53 a.m. on Sunday, June 12, when I received a text from my husband regarding the mass shooting at Pulse, an Orlando, Florida, nightclub catering mainly to lesbian, gay, bisexual and transgender (LGBT) individuals.

I was wrapping up the week at a sex education and counseling conference in San Juan, Puerto Rico, where I was sitting in our closing plenary session. It had been a week of personal empowerment. I had been absorbed by the many workshops on sexual inclusivity, especially regarding the LGBT community. I was surrounded by like-minded professionals who were advocating for change in our society’s attitudes toward sexual minorities. My evenings were spent enjoying time with my husband and 7-year-old daughter, who had come with me to Puerto Rico to enjoy the beach and pool at the conference hotel. It was a nice way to kick off the summer with my family.

As I sat in the final session, I looked down at the text and read the headline of the link my husband had sent me, “Orlando Shooting: 50 People Killed.” Reading further, I learned the shooting had taken place at Pulse, which is just a few miles from our home. I had enjoyed visiting the nightclub with my husband and friends on numerous occasions.

After reading the article again, my thoughts quickly turned to my immediate friends who might have been at Pulse when the shooting occurred. I began to worry. I could no longer focus on the session and stepped outside to begin texting friends to see if they were OK. Thankfully, my friends were safe, but they were as distraught as I was and were anxiously going through their own lists of friends. Social media was filled with news of the shooting. Some posts provided reassurances of loved ones’ safety. But, heart-wrenchingly, other posts were from people seeking information about family and friends who were still missing.

As we traveled back home the next day and as the names and faces of the victims were gradually released in the media, I was struck by how many young people of color were killed on what was “Latin Night” at the nightclub. As a gay Latino man who had visited Pulse, I felt a strong connection to the victims and their families. I didn’t talk much during our flight back to Orlando. I spent the time turned inward, trying to make sense of what had happened and thinking about what my city was going through. I was distressed by my roiling emotions and felt trapped by the logistics of travel. I couldn’t wait to do something to help the victims and their families.

After arriving home, I visited The Center, Orlando’s LGBT community center, to volunteer crisis counseling and Spanish translation services. The common area of The Center was a beehive of activity as volunteers welcomed visitors, organized donations, worked crisis phone lines and did their best to help people affected by the shooting. Local individuals, organizations and

Lucia Lassiter-Sanabria, the author's 7 year-old daughter, at a memorial site set up recently at the Dr. Phillips Center for the Performing Arts in downtown Orlando. "I had been talking to Lucia about the [Pulse] shooting and wanted to show the enormous amount of love and support that was given.  It was a tender moment watching her walk around and look at the pictures of the victims and reading some of the signs of love," says Sanabria.

Lucia Lassiter-Sanabria, the author’s 7 year-old daughter, at a memorial site set up recently at the Dr. Phillips Center for the Performing Arts in downtown Orlando. “I had been talking to Lucia about the [Pulse] shooting and wanted to show the enormous amount of love and support that was given. It was a tender moment watching her walk around, look at the pictures of the victims and read some of the signs of love,” says Sanabria.

businesses had donated food, water, services and gifts, while others were providing safe spaces for anyone who needed support. People from all over the country and the world were donating money to support the survivors and victims’ families. And, of course, professional counselors from around the state had stepped up to provide grief and crisis counseling.

Witnessing all of this activity and the many people who were traumatized or retraumatized by the news and stories of the shooting, I felt the magnitude of what this tragedy had done, not only to the victims at Pulse but to our entire community. It was at this point, standing there witnessing the outpouring of grief and anger, that I felt anxious, insignificant and powerless. I immediately felt an internal pressure to do as much as I could to help.

Throughout the week, I met with and provided support for survivors of the shooting; debriefed with my students in each of my summer classes; took my daughter and a couple of her friends to the LGBT center with sympathy cards I had helped them create; attended vigils; donated money; and locked arms with other LGBT activists and allies to block the well-known hate group, Westboro Baptist Church, from disrupting the funeral of one of the victims.

Despite this involvement, I still felt anxious, insignificant and powerless. These feelings stubbornly remained in the face of so much need. As my anxiety grew, I began losing sleep, had difficulty concentrating and was irritable. The worst part was my need to reenact, in my imagination, some of the stories I had heard on the news and from the survivors I had spoken with. These feelings were exacerbated by the litany of anti-gay and pro-gun political messages being expressed by the talking heads on various media outlets.

I realized I was experiencing burnout as a result of vicarious trauma and needed to make some immediate changes, starting with recognizing the importance of self-care.


Counselor self-care

Most counselors are familiar with the importance of self-care. Many of us spend hours each day listening to difficult stories, and for those who work in crisis care, these stories can be exceedingly tragic. Providing empathy for our clients is the hallmark of our profession, but it is also a main contributor to compassion fatigue. Counselors often become so involved in their work that they do not take adequate time to check in with how that work is affecting them physically and emotionally.

It is important that counselors remain alert to the warning signs of compassion fatigue. Physiological symptoms may include physical exhaustion, headaches, insomnia and increased susceptibility to illness. Emotional symptoms include anger, irritability, gradual disassociation, depression and difficulty concentrating. Ignoring these warning signs can lead to counselor impairment, which puts clients at risk for harm.

Red sky with rainbowIt is a counselor’s ethical and professional responsibility to work toward reducing compassion fatigue. This does not mean fighting against these feelings, but rather working through them, both before and after meeting with clients. Giving oneself permission to break for self-care can also help reduce compassion fatigue. This can be as simple as pausing for a deep breath and identifying one’s physical and emotional responses throughout the day. It can also be vital to create some mental space between oneself and the work, perhaps by spending quality time with family and close friends.

Taking these steps may be challenging for some, especially when working with a community impacted by a tragic event. Luckily, my close friend and colleague has a background in crisis work and, knowing the importance of self-care, reached out to me daily with reminders to take breaks and meditate on my physiological and emotional responses.

Once I recognized the symptoms of compassion fatigue within myself, I made sure to spend quality time with my family and to show appreciation for them. These were meaningful experiences that helped me re-center myself.

Also, at my friend’s suggestion, and for the first time in my professional life, I attended a support group for counselors. I appreciated being able to share how this tragedy had affected me in a room of supportive individuals who were going through the same experience. This group outlet was important and I noticed a reduction in my level of anxiety. However, there was still something that kept me from moving forward. It wasn’t until I heard another counselor share her experience with guilt for not doing enough that something clicked inside me.


Recognizing and addressing guilt

Another common experience among crisis counselors is the feeling of empathy guilt and survivor’s guilt.

Empathy guilt is a reaction to someone’s pain or distress that leads to the belief that one should try to work toward relieving those feelings. This can also lead to the feeling that one is not doing enough to help others relieve their pain. Survivor’s guilt can occur with someone who has survived a traumatic event or, in the case of counselors, works directly with victims impacted by a traumatic event. The symptoms of empathy guilt and survivor’s guilt include feeling regret, isolation, helplessness and, in serious cases, suicidal ideation.

One of the best ways to work through guilt is to share the experience with others and to recognize that this is a common emotion that, if properly managed, can be used to further empathize with the experiences of our clients. During the counselor support group, I was able to share my feelings of guilt and begin the acceptance process. I realized that it was not necessary to fully rid myself of these feelings of guilt; instead, I could use them to gain better insight into my internal emotional processes.

I came to understand that there was no amount of hours I could volunteer, marches I could walk, sympathy cards I could help my daughter create or money I could donate that would change what had happened to the victims of the shooting. I realized that “never enough” was good enough. This realization became a central part of my self-forgiveness and healing.


Conclusion: Never enough is good enough

This tragedy has shattered lives. It will take years to understand why this happened, if we ever can. The greater Orlando community has been galvanized, and I can feel a sense of unity and compassion that is heartening.

Personally, I have come to grasp one of the most important lessons of being a counselor, advocate, ally and humanitarian: Despite our best efforts and whatever time we put in, we will never achieve “enough.” Once I understood this, I felt a profound sense of peace and self-forgiveness. As I write this, the need for caring and supportive counselors in Orlando continues. Fortunately, I am able to volunteer service in a way that doesn’t deplete me or put those seeking my help at risk of harm.

It still breaks my heart to think about the bright lives taken from our community. As I sat with the other crisis workers in our support group, I realized that we had all been affected by this senseless tragedy and that we needed support just like everybody else. We laughed, cried and hugged each other; we respected our own emotional struggles; and we sat in silence to honor the lost lives. Most important, we helped strengthen one another so that we can go back out there and do work that will never be enough.





Samuel Sanabria is a licensed mental health counselor in the state of Florida with more than 15 years of clinical experience. He is an associate professor in the graduate counseling program at Rollins College in Winter Park, Florida. Contact him at ssanabria@rollins.edu.

After Orlando: Helping others, helping ourselves

By Laura R. Shannonhouse June 22, 2016

In the wake of the recent shooting disaster in Orlando, we find ourselves faced with the difficult task of moving forward with purpose and hope, both as individuals and as a people.  While we may not have been directly touched by this event, or we may have been personally immune to such tragedies in our own past, disasters like this one may feel omnipresent and inescapable in today’s media rich culture. This is especially true now, since the nature of this photo-1463797987952-208b34e8e887particular event was incited by hate towards a specific group, the lesbian, gay, bisexual and transgender (LGBT) community, which has been under a perennial struggle for acceptance.


There are many ways to directly help the victims and their families, but from my perspective as a counselor educator who researches crisis, disasters and cultural issues, I would like to share three thoughts as to how all of us can intentionally focus on the future: helping others, helping ourselves and ensuring that them and me are instead us.


I am so heartened by the outpouring of love for those who were affected and the political resolve for doing what we can to ensure that such tragedies become far more rare. In terms of the literature on disaster response, I would say that we are in the “honeymoon” phase of disaster, characterized by community cohesion and shared resolve. Unfortunately, research shows that this period is only temporary, usually lasting a few weeks, and is followed by disillusionment. Eventually, survivors will realize that there are limits to the assistance available. Those that were injured or lost loved ones will have to go on with rebuilding their lives. The universal calls to action and justice may be met with the reality that institutions often change slowly, if at all. A painful reminder of this can be seen in the heartfelt essay from the mother of one of the Sandy Hook victims, “Orlando, I Am Sorry Our Tragedy Wasn’t Enough to Save Your Loved Ones” (written by Nelba Márquez-Greene, a licensed marriage and family therapist and mother of a child who died in the 2012 shooting at Sandy Hook Elementary school in Newtown, Connecticut). So, for my first thought, I challenge you to maintain your resolve and support through the impending disillusionment.


In the months and years to come, those affected will face anniversaries of the tragedy and trigger events such as missed birthdays. The strongest protection against disillusionment is resilience. If you are in the position to help a survivor or someone affected, challenge yourself to be a point of resilience for that person for as long as you can. That being said, resist the urge to parachute in, and if you feel compelled to respond to someone that you don’t personally know, be sure to do it as part of an organized response effort. Also remember to act within your own scope of care as a friend, counselor or human. For a good article on how to respond, I would suggest Jamie Aten’s recent piece in the Washington Post, “Tips for helping a loved one after a tragedy, from a Christian disaster expert.” And, if you are now calling for political change, don’t stop until that change is realized.


As a helping professional that has worked with trauma survivors and responders, I have seen many times how those not personally affected by crisis may yet still be touched. The literature is full of terms such as vicarious traumatization, secondary traumatic stress (STS), compassion fatigue and burnout. All of these constructs describe how bystanders and responders to disaster can themselves have real physical and emotional reactions. STS can result from witnessing (directly or indirectly) a traumatic event, whereas burnout results from repeated and prolonged exposure to stress. The media will be full of vivid descriptions of the event, and it’s likely [that] continuous coverage will keep us on alert. Daniel Antonius condensed much of the recent literature on this phenomenon after the 2015 San Bernardino shooting in his article, “How the media-related ‘contagion effect’ after terror attacks impacts our mental health.” Consequently, my second thought is to protect yourself from the vicarious traumatization that you may experience from our 24 hour news cycle and practice self-care.


If you are more closely connected to the Orlando event, either because of some prior life experience with trauma or because you closely identify with the targeted group, then I would urge you to be on guard for common stress reactions. The list of possible symptoms is long and includes changes in emotional, cognitive, behavioral, physical and spiritual domains. If several of those listed symptoms look like they apply to you, then do the following:

  • Unplug – turn off the TV and social media
  • Do what normally helps you feel better (e.g. exercise, listen to music, be creative or routine, spend time with friends, etc.). For a longer list, check out the Department of Health and Human Services’ self-help guide, “Dealing with the Effects of Trauma.”
  • Consider pursuing mental health care. As a licensed counselor and trainer of new counselors, I definitely believe in my profession’s power to help those that are struggling.  There is no shame in asking for help, and there are often low-cost resources available in your community.


Since this shooting was, effectively, a hate crime, my final thought is one regarding empathy: live the African concept of ubuntu, or “I am because we are.” The construct of empathy is core to professional counseling (for a three minute visual summary, consider watching Brené Brown on Empathy). In my counseling skills classes, we often talk about “getting in the well” and genuinely connecting with others. Those are good clinical skills, but for those of us that aren’t in Orlando and aren’t directly interacting with someone personally affected by the shooting, it isn’t possible to truly show our empathy. Instead, we can ensure that we hold empathy close as a personal virtue in how we relate to others, especially those different from ourselves in beliefs or worldview. In my travels to Southern Africa on research projects and clinical outreaches, I’ve found that the Bantu word ubuntu truly captures this internalized empathy. In the words of Archbishop Desmond Tutu, “My humanity is caught up, and inextricably bound up, in yours … A person is a person through other persons …  A person with ubuntu is open and available to others, affirming of others [and] does not feel threatened that others are able and good, for he or she has a proper self-assurance that comes from knowing that he or she belongs in a greater whole and is diminished when others are humiliated or diminished, when others are tortured or oppressed, or treated as if they were less than who they are.”


In the wake of the recent horrific events in Orlando, I pray that we may all show love for each other, take care of ourselves and remember that I am because we are.




If you are in need of immediate crisis counseling, contact the Substance Abuse and Mental Health Services Administration (SAMHSA)’s Disaster Distress Helpline: Call 1-800-985-5990 or text TalkWithUs to 66746 to connect with a trained crisis counselor.




Laura R. Shannonhouse

Laura R. Shannonhouse

Laura R. Shannonhouse is a licensed professional counselor (LPC), American Counseling Association member and assistant professor in the Department of Counseling and Psychological Services at Georgia State University in Atlanta. Contact her at lshannonhouse@gsu.edu


When tragedy hits close to home

By Lynne Shallcross July 24, 2015

Aurora, Colorado. Fort Hood, Texas. Virginia Tech. The Washington Navy Yard. And, most recently, Charleston, South Carolina. Each of these places transitioned from being a name on a map to an instant reminder of the devastating aftermath of mass violence. Another is Sandy Hook, the TragedyNewtown, Connecticut, elementary school where shooter Adam Lanza killed 26 people, including 20 children, in December 2012.

In a report published last year, the FBI found that mass shootings in the United States have risen dramatically in recent years. In a study of 160 active shooter incidents between 2000 and 2013, the agency stated that an average of 6.4 incidents happened each year between 2000 and 2006. Between 2007 and 2013, that average rose to 16.4 incidents each year.

Deb Del Vecchio-Scully is the clinical recovery leader of the Newtown Recovery and Resiliency Team, formed out of a $7.1 million grant from the U.S. Department of Justice (DOJ) to bolster the Connecticut town’s mental health recovery and community resiliency in the wake of the shooting. According to Del Vecchio-Scully, this is the first time that a DOJ grant has been awarded specifically to provide mental health services following school-based violence.

When the grant was being written, Del Vecchio-Scully says, it was nearly impossible to gauge what Newtown’s needs would be in the months and years ahead. “There’s no road map,” she says, adding that the tragedy was unique because of the age of the children who were murdered and the impact the event had worldwide.

“What I’ve really come to understand about trauma is that in the aftermath of tragedy, regardless of how it happened — if it’s natural tragedy, if it’s violence — the reactions are extraordinarily complicated,” says Del Vecchio-Scully, a member of the American Counseling Association and the executive director of the Connecticut Counseling Association, a branch of ACA.

Since 9/11, psychological first aid has become the preferred modality suggested by the Federal Emergency Management Agency for use in the immediate aftermath of a disaster such as a mass shooting, says J. Barry Mascari, an associate professor and chair of the Counselor Education Department at Kean University in New Jersey. He explains that three core actions are involved in psychological first aid: protect, direct and connect. Protect survivors from further vulnerability, direct them to other services and connect them with their families and communities.

Counselors should think about that concept in terms of Maslow’s hierarchy of needs, Del Vecchio-Scully says. People’s basic needs must be met first, and the type of event will determine what those needs are — financial, social, psychological, emotional or practical.

Traditional counseling treatment and interventions are not part of psychological first aid. The goal of counseling is often to help people change, Mascari points out, but the goal in the immediate aftermath of a disaster is to help people get back to normal, which is the objective of psychological first aid. “You don’t want to start bringing in your other bag of tricks because [psychological first aid is] not treatment,” says Mascari, a member of ACA who is a co-editor with Jane Webber of the forthcoming book Disaster Mental Health Counseling: A Guide to Preparing and Responding, due to be published by the ACA Foundation next year.

Psychological first aid is also based on the recognition that individuals involved in a mass tragedy are experiencing normal reactions to an abnormal event, and the majority of people will return to normal in time, Mascari says.

Wait until called

After the events of 9/11, the United States learned one lesson in particular, Mascari says, “and that was that we weren’t prepared as a country to respond to these kinds of events.”

In the years since, individual states and the federal government have developed better-organized plans for responding to various types of disasters, including events of mass violence, Mascari says. Today, the response includes a hierarchy of those in charge and standards for survivor care.

Yet something that can still complicate the response to a tragic event is the influx of what Mascari calls “SUVs,” or spontaneous uninvited volunteers. “It was very clear both after the hurricane [Katrina] in New Orleans and after 9/11 that mental health professionals showed up expecting to do therapy with people and, in many cases, could have done more harm than good,” he says.

Del Vecchio-Scully also witnessed this after the school shootings in Newtown. “Communities can be overwhelmed by well-meaning helpers in the aftermath of a mass violence event, just as they are after a natural disaster,” she says. “Out of the goodness of people’s hearts, they want to help, and communities get flooded by individuals who may not have the training. Newtown was flooded by many whose hearts were in the right places but [who] did not really have the expertise to be doing what they were attempting to do.”

“You never want to be an SUV,” Mascari advises his colleagues in the counseling profession. “If you’re not deployed through an organization, you shouldn’t be there, because what happens is that you contribute to the disaster rather than help mitigate it.”

Counselors who are interested in assisting after a tragedy should start by seeking training beforehand to become an American Red Cross disaster mental health volunteer, Del Vecchio-Scully says. Among other places, the training is offered each year at the ACA Conference & Expo.

Mascari agrees that counselors should first get trained as disaster mental health volunteers and never self-deploy. He advises connecting with one of the responding organizations, such as the respective state mental health organization or the American Red Cross, to help in the aftermath of a disaster.

According to Mascari, New Jersey was the first state — about a decade ago — to develop a disaster response crisis counselor program. It uses a formal certification process for the state’s disaster crisis response workforce. Other states have since followed suit, using New Jersey’s model to create similar programs, he says.

Finding a new normal

People are often resilient in the face of disaster, says Daniel Linnenberg, an assistant professor of counseling in the Warner School of Education at the University of Rochester. “However, it takes a long time for them to go from being a victim of an event to a survivor of an event to a ‘thriver’ of an event,” adds Linnenberg, an ACA member who teaches a course on crisis counseling and disaster mental health and is also a disaster mental health volunteer with the American Red Cross and in his home county in New York.

“There will always be that ‘hole’ of that event within them,” he continues. “But, generally, people go beyond that and sort of come to what they refer to as a new normal.” Still, Linnenberg says it’s important to “remember that the event may only take seconds, but the recovery time takes years.”

That process of building resilience can be aided by various factors, the most important of which is social support, Linnenberg says. For example, when people have loved ones around them to lean on, that can foster resilience. Possessing a sense of optimism, having meaning and purpose in life, and accepting that we don’t have control over the world can also foster resilience, he says.

One way that counselors can assist survivors in building social support is through peer groups, such as the one Linnenberg helped establish in the wake of a tragedy in Webster, New York. Linnenberg had been providing counseling in the aftermath of an ambush shooting of firefighters that took place in the Rochester suburb in December 2012. The peer group was set up for loved ones of the firefighter community because they didn’t naturally have a group of people to connect with who could understand what they were going through.

Although resiliency will look different for everyone in the aftermath of an event of mass violence, Del Vecchio-Scully says that counselors can foster resilience among clients by engaging in ego-strengthening exercises — namely, recognizing and honoring when they take a step forward in some way. Remind clients that simply getting up in the morning and completing a task such as attending a counseling appointment or going to work is evidence of resilience, she says.

Del Vecchio-Scully cautions, however, that when the immediate aftermath of an event of mass violence has passed, it will not be a “neat transition” from the psychological first aid stage to what survivors will need next. Counselors should be on the lookout for people who are struggling and might need mental health treatment, she says.

Trauma affects people on a number of different levels in a tragedy such as a mass shooting. The base level is personal trauma, or what the individual’s own experience in the tragedy was, Del Vecchio-Scully says. There is also vicarious trauma, which usually affects helpers who are repeatedly exposed to the traumatic stories of others, she says. Secondary trauma is experienced only where primary trauma has occurred and results from being exposed to others who have been traumatized by the same event, she explains. Shared trauma affects people at the community level — for example, a teacher who works at a different school in Newtown, she says.

Complicated reactions to events of mass violence and other disasters, including posttraumatic stress disorder (PTSD), complicated PTSD and traumatic grief, are sometimes missed or misdiagnosed, Del Vecchio-Scully says. Counselors working with people in the aftermath of disaster or violent tragedy need to understand that trauma is a neurobiological injury to the brain, she says. A traumatic event such as a mass shooting can affect the brain in such a way that fearful memories get stored and the fight-or-flight response gets frozen. A cascade of neurochemicals then leads to triggering, emotional flooding, avoidance and hypervigilant reactions, she says.

“The long-term impact of trauma on children is particularly concerning within the Sandy Hook community [because] the brains of those directly impacted are in their most formative stages, ages 5 to 18,” Del Vecchio-Scully says. “The dysregulation of the brain due to trauma may impact brain size, brain hemisphere integration — which is important for emotional regulation — and an ability to determine cause and effect. [There is also] the impact on academic learning and performance.”

Del Vecchio-Scully suggests that counselors work from a trauma-informed model, which “requires advanced training in the neuroscience of trauma and trauma-informed treatments that focus on whole-brain treatment.” She says the treatments include eye-movement desensitization and reprocessing therapy, brainspotting, the emotional freedom technique, trauma-focused cognitive behavior therapy, somatic experiencing and trauma-informed art therapy.

“Counselors must have a basic understanding of the brain’s reaction to trauma, avoid assessment/treatment that requires a client to ‘retell their story,’ utilize calming and soothing techniques to regulate the brain and then initiate a trauma-informed treatment approach,” Del Vecchio-Scully says.

Caring for the caregivers

Most recently in Newtown, Del Vecchio-Scully has been working to provide support for the mental health clinicians in the community. She says that two and a half years after the shootings, community members affected by the tragedy are still coming to see these clinicians for the first time, which means the impact hasn’t really lessened for these mental health professionals.

On top of that, the community’s mental health clinicians are likely navigating multiple layers of exposure to the tragedy. For example, a counselor might be hearing clients’ stories of trauma while simultaneously feeling personally connected to the trauma because their children go to school in Newtown.

Del Vecchio-Scully’s team has been working to create peer support groups for the mental health clinicians working in the community. The helping professionals, who are from in and around the Newtown area, have a deep commitment to helping their community, Del Vecchio-Scully says. But clinicians in these kinds of situations can struggle to identify when they become impaired.

“If you enter into this work with an open heart, it isn’t a matter of if you’ll be impacted by the work but when this will occur,” she says. “Self-care when responding following a mass violence or natural disaster tragedy requires the basics of adequate rest; food and drink; time off and away from the situation; good, solid support from others; [and] methods of decompressing from what has been witnessed, including supervision, which for licensed people often lapses.”

In her role in Newtown, Del Vecchio-Scully participates in two peer supervision groups. It is an experience that she terms “invaluable.”

“Our team has worked with nearly 400 Newtown residents since its inception in July 2014,” she says. “I have worked very closely with a group of families whose children survived the shooting and were in the classrooms where the shooting took place. Bob [Schmidt, a fellow leader in the Connecticut Counseling Association] and I run a monthly group with these parents, and I have worked individually with some of the parents and kids. I have also worked in the Sandy Hook School providing support to the staff.”

Linnenberg emphasizes that supervision or peer support is a must for counselors who provide services in the aftermath of mass tragedy, no matter their level of experience. Self-care is also about knowing when to take a break, he says. “It’s more than drinking water. It’s more than getting exercise,” he asserts. “All those things are important, but it is really … forcing yourself to take time off even though you know you’re needed.”

Prevention on campus

One of Meggen Sixbey’s roles as a counselor is to try to prevent instances of violence before they happen. As the associate director for crisis and emergency resources at the University of Florida’s counseling and wellness center, Sixbey serves as a member of the university’s multidisciplinary threat assessment team.

Multidisciplinary threat assessment teams, which can be convened in a variety of communities, such as college campuses, typically bring together representatives from that community to address individuals who have raised a level of concern. On a college campus, the team might include representatives from the university administration, law enforcement, the campus counseling center and other sectors of the campus, says Sixbey, a member of ACA.

At the University of Florida, Sixbey says the team is called a behavioral consultation team, and its purpose is to bring a holistic perspective to individuals of concern. That individual might be someone who is threatening harm to others, Sixbey says, but it’s also possible that the person is a victim in some way, such as someone who survived a car accident or is being stalked.

All students, faculty and staff at the university have access to a phone number and email address that allow them to report a person of concern, Sixbey says. That information first goes to the office of the dean of students, which vets the reports and forwards the situations that need to be addressed to the multidisciplinary threat assessment team.

A counselor’s role on teams such as these is to act as a consultant and assess the situation with others on the team, Sixbey says. Although other team members might want a counselor to predict the likelihood of violence or pathologize behaviors, Sixbey says her role is to help cultivate a holistic perspective by looking at the whole of the person and the whole of the systems around the person. She often finds herself asking questions about what else could be done or what else is in play in the situation to help move the team forward in its assessment. “I don’t really come in with a diagnostic lens,” she says.

The ethical considerations surrounding a counselor’s participation on teams such as these can be complex. For example, Sixbey says if she is currently working with or has previously worked with a client at the university counseling center who subsequently comes up as a person of concern, she doesn’t typically consult with the team on that assessment because it would be a conflict of interest. But each situation must be considered on a case-by-case basis, she says. For instance, it may not be helpful to the person of concern if Sixbey recuses herself because that action may confirm to the rest of the team that the person is seeking counseling services or has sought them in the past.

In other situations, Sixbey might possess confidential knowledge about the person of concern that she can’t share with the team even though she is participating in the assessment. For example, during the course of the team’s assessment, a student could be asked to meet with Sixbey. That student could confidentially share with Sixbey that she is willfully stalking a faculty member, despite claiming publicly that it was a cultural misunderstanding. “A lot of that ethical piece is having this firsthandish knowledge that we can’t share,” Sixbey says.

In such situations, Sixbey has to consider how she can consult with the team in a helpful way while still honoring the legal and ethical guidelines of confidentiality. In this example, she might suggest to the team that if the student is to see the faculty member in person, a third person should be present. That way, Sixbey could protect the confidentiality of the student but also protect the safety of the faculty member.

The most helpful thing counselors can do to navigate ethical dilemmas associated with participation on multidisciplinary threat assessment teams is to consult with other mental health professionals, Sixbey says. “Consultation is key, and if we don’t do that, we’re doing ourselves a disservice.”

Some counselors might worry that a multidisciplinary threat assessment team is essentially a “profiling team,” Sixbey says. “That’s far from what these sorts of teams do if they’re doing it right.” In fact, teams such as the one Sixbey serves on focus mainly on ways they can help a person of concern be successful — “as opposed,” she says, “to cleaning up something that happens later because we didn’t do any kind of prevention.”

“I’d like to think our team is preventing crimes and homicides and suicides and depression, just frankly, on a daily basis,” Sixbey says. The hard part is that the team members will rarely know just how effective their intervention and prevention efforts have been at heading off crises. “We know when a school shooting happens, for example, but we don’t know when a school shooting has been prevented,” she says.

Since the mass shootings at Virginia Tech in 2007 and Northern Illinois University in 2008, more college campuses have initiated multidisciplinary threat assessment teams, Sixbey says. In addition to defusing potential situations of mass violence, she says these teams allow counselors to feel they are part of a larger, more collaborative effort to help people.

“If it’s just us with that person behind closed doors, we’re going to have a really limited view,” Sixbey says. “We may have a tenth of the pie, and there’s 90 percent more that we just don’t know.”

Sixbey offers an example. Perhaps getting a family member involved in a situation might help a person of concern — and perhaps the dean’s office would be better positioned than the counseling office to get that family member involved. “Counselors [can] get caught in a role of [thinking], ‘It’s just me trying to help this person,’” Sixbey says, “and that can feel really daunting.”

‘It can happen here’

Although a community may be flooded with outside resources and supports in the immediate aftermath of a tragedy, many of those supports, such as the American Red Cross, will eventually leave. At that point, Linnenberg says, the community itself needs to be prepared to take over.

For that to happen, Linnenberg contends that the community must be ready before a tragedy takes place. That includes mental health counselors and school counselors in the community preparing ahead of time for what they would need to do should an event of mass violence affect their community, he says. It also means counselors should prepare others in the community as well. For example, school counselors might help students understand what actions they should take if an event of mass violence were to happen at their school.

Counselors should also get more involved in public policy, Mascari says. “We tend not to think that we should be active in public policy, but public policy drives almost everything we do,” he says. Mascari tells his students to listen to what is being said in the public arena and then respond so that fewer public policy decisions will be made based on fear and misinformation.

The supposed connection between mass violence and mental illness is a perfect example, Mascari says. “There is a constant tagline in the media about mentally ill people performing violent acts,” he says. But Mascari points to a New York Times article written by Richard A. Friedman in the wake of the Newtown, Connecticut, shooting that said “only about 4 percent of violence in the United States can be attributed to people with mental illness.”

“While it is true that policy should consider closer screening of people with violent histories or mental illness who want to obtain guns, people should not stigmatize the majority of [individuals who are] mentally ill as violent, because they are not,” Mascari says.

Regardless of who the perpetrators of mass violence are or where these traumatic events take place, counselors need to be ready to respond, Del Vecchio-Scully says. “Following mass trauma, the community looks to counselors for support,” she says. “Therefore, counselors must have a minimum, base knowledge of trauma assessment and crisis intervention to assist immediately following the event before referring to a colleague with the advanced skills needed to engage in treatment,” which could mean another counselor or a different clinician with appropriate training.

“Nobody expects these things to happen, but they are happening with an ever-increasing amount of frequency,” Linnenberg says. “You hear about them almost every day. … We cannot necessarily prevent them from happening,” he says, “but we need to be prepared for them happening.”

Even in the class he teaches on crisis counseling and disaster mental health, Linnenberg says he has students who don’t understand why the door to the classroom should be locked.

“We do not have that mindset that this could happen to us at any time,” Linnenberg says. “The likelihood is very, very, very extremely low. But there is always that possibility. And, in a sense, as a counselor, you never want to be the one thinking, ‘I didn’t think it could have happened here.’ Yes, it can happen here.”




To contact the individuals interviewed for this article, email:




Harm to Others

Earlier this year, the American Counseling Association published Harm to Others: The Assessment and Treatment of Dangerousness by Brian Van Brunt. The book offers students and clinicians an effective way to increase their knowledge of and training in violence risk and threat assessment, and it also provides a comprehensive examination of current treatment approaches. Van Brunt offers numerous examples from recent mass shootings and rampage violence to help explain the motivations and risk factors of those who make threats.


See Counseling Today‘s Q+A with Van Brunt here: ct.counseling.org/2015/06/behind-the-book-harm-to-others-the-assessment-and-treatment-of-dangerousness/


For more information on the book, visit ACA’s Online Bookstore at counseling.org/bookstore or call 800.422.2648 ext. 222.



Lynne Shallcross is a contributing writer to Counseling Today. She recently graduated with a master’s degree in journalism from the University of California, Berkeley. Contact her at lshallcross@berkeley.edu.

Letters to the editor: ct@counseling.org


Dispatches from Nepal: A drop in the bucket

By Bethany Bray May 27, 2015

The 10 days that Jeffrey Kottler spent in earthquake-ravaged Nepal this month were exhausting and painful but also some of the most worthwhile work of his career, he says.

Kottler served in a medical team with Empower Nepali Girls (ENG), the nonprofit he founded 15

Jeffrey Kottler plays with some Nepali youngsters near an Empower Nepali Girls medical tent.

Jeffrey Kottler plays with some Nepali youngsters moments before a 7.3-magnitude quake hit on May 12. (Click on photos to see full size)

years ago. The help the team members provided, including treating both physical and mental wounds and distributing donated supplies such as tents, is just a “drop in the bucket” toward what is needed, says Kottler, an American Counseling Association member and professor of counseling at California State University Fullerton.

Over the course of 10 days, the ENG team treated more than 500 people, including some in the hardest-hit areas of the country that had yet to see international aid. A 7.8-magnitude quake left much of Nepal in ruins on April 25; the destruction was made worse by a 7.3-magnitude quake on May 12.

Kottler is CEO of ENG, a nonprofit that develops mentoring and supportive relationships with children at greatest risk of being forced into early marriage or sex slavery.

Kottler and an ENG translator wait for their next patient in the "counseling corner" of a makeshift ENG medical center setup in a school.

Kottler and an ENG translator have their counseling tools ready as they wait for the next patient in an ENG medical center setup in a school.


Counseling Today has posted a series of online articles about the conditions in Nepal via Kottler’s travel journals. This journal entry from May 19 is the final installment.

Find more photos and information in earlier articles here and here.


Jeffrey Kottler’s travel journal: May 19

Mount Everest area


I had already seen four families in a row without a break, and my energy was faltering. Many cases are similar: One or more of the children has a headache or stomachache or sleep problem, and the parents are worried; or an adult is hypervigilant and overreactive to any noise or movement, unable to sleep or eat; or some preexisting medical condition like hypertension or heart problems are now far more serious. With such a long line of people waiting to be seen, most of our sessions are 20

Kottler and one of his students (far left) in the middle of a counseling session with a Nepali family.

Kottler and one of his students (far left) in the middle of a counseling session with a Nepali family.

minutes. During that time my team of students and I have to figure out what’s going on and attempt some form of reassurance or intervention. I’ve been teaching deep breathing, a simplified form of self-talk, but mostly explaining and normalizing their reactions as typical of trauma symptoms and chronic, unrelenting fear.

One mother brought in her boy after seeing our doctor because of an eating disorder. She had taken him to hospitals trying to figure out why he wouldn’t eat and complained of stomachaches when he did eat. The doctors recommended giving him vitamins and energy drinks to maintain his nutrition. But the mother was beside herself with worry and didn’t know what to do, especially since the earthquakes, when the boy had become even more unwilling to eat at the family meals.

I asked the social work students to do an assessment while I worked with an older girl, one of our [ENG] scholarship students who wanted to attend medical school next year but whose father thought that it was time for her to be married now that she was 18. He insisted girls didn’t belong in school and tried to sabotage her studies as much as he could. What should she do? Can she disobey her father and pursue her studies? Or should she follow her dreams and risk being disowned? I had spoken to her a few months earlier when I was in Nepal with several of my counseling students and had told her that the choice was hers and promised her that if she wanted to continue medical training, we would provide alternative housing and support her. I had directed my counseling students (after only one semester) to talk to her, and one student, Karla, shared her own story of immigrating from Mexico when she was 12, unable to speak English, leaving everything behind, and also showing resolve to be the first in her family to ever attend university, much less graduate school. This seemed to strongly impact the girl, and now I was following up with her.

I returned to our therapy room to find the social work students still trying to engage the boy who would not speak and deferred all questions to his mother. Yes, in other ways he is normal and happy, although since the earthquakes his eating problems have worsened. Yes, the family is intact and they are all healthy. Yes, their home had been damaged and they were living outside, but they planned to move back inside if there were no further quakes in the next few days. The students looked at me and shrugged, unsure what to do next. They are smart and capable and awesome, but this was really confusing, and I was also puzzled. Time was running short, and we had barricaded the door against the crowd fighting to get their turn.

I told the boy I had a test for him and wondered if he would pass. He looked intrigued, so I told him that I bet I could find something that he would eat. He barely looked at me, but I could see the beginning of a smile. I pulled out a Snickers bar and handed it to him. Out of pure obstinacy, he

Two Empower Nepali Girls scholarship children stand in front of their damaged house near Lukla in the Mount Everest region of Nepal.

Two Empower Nepali Girls scholarship children stand in front of their damaged house near Lukla in the Mount Everest region of Nepal.

shrugged and passed it to his mother, pretending he wasn’t interested. He looked back at me defiantly, the glimpse of a smile now gone.

“What DO you like to eat?” I asked him. “Smoothies?”

He nodded his head affirmative, or rather waggled it back and forth in that characteristic Nepali way.


Another nod.


Again, a nod.

“So, what don’t you like to eat?”

He whispered something I couldn’t hear. “Say that again,” I asked him.

“Dahl baht.”

“I see.” And now I did see. Most Nepalis eat rice and lentils for both meals of the day, every day, even when they are given other choices. It is perhaps the single most nutritious meal that the human body can metabolize and provides a cheap and efficient source of protein and energy. It turned out he really didn’t have an eating disorder; he just didn’t like dahl baht. But he LOVED fast food.

My head hurt with concentration. I desperately needed a break and to use the restroom. Before I could get out of my chair, a tiny girl was carried into the room by a man, accompanied by what I assumed was the girl’s mother. They were followed by the principal of the school we were using as our clinic, and Pasang Sherpa, the president of our (ENG) foundation in Nepal.

Because confusion was my usual state of mind, I just sat and waited for the drama to unfold. I wondered what could possibly surprise me next.

“This is Pramisa,” Pasang said to me, pointing to this absolutely adorable girl who was looking around the room, studying all of us carefully. “She is 3 years old.”

I nodded, waiting. Pasang and the principal explained to me that these were her aunt and uncle.

“Where are her parents?” I asked.

Everyone looked at one another after the translation. Her mother was at the hospital. “She is dressed in white,” the uncle said.

“She is dressed in white?” I repeated, now completely confused.

“Yes,” Pasang agreed. “Her husband, the girl’s father, died yesterday. He was hit on the head during the last earthquake. He was in the hospital and he died. The mother is with the body, dressed in white as she is [culturally] required. This girl, she doesn’t have a father, and we haven’t told her yet.”

I looked at this little girl, Pramisa, and she was smiling and playing with a stuffed animal I had just given her. My heart just broke. I could feel myself losing control, tears running down my cheeks, and so excused myself for a moment and walked out of the room to regain my composure. Were we now going to tell this 3-year-old that her father was never coming home? I had already seen and done so much, but this I could not do. But I knew I had to go back in the room.

Once I was back in my chair, Pasang asked if we might offer this girl a scholarship, support her now that she had lost her father and her home. They had no money, no place to live, no way to earn an income. The mother would spend a year in mourning, and that would be her job.

I thought to myself how fate had put me in this place, at this moment in time. My chest hurt. I felt so flooded with emotion from all the accumulated stress, all the stories I had heard and all the people I

had seen. I had felt so helpless at times, so inadequate to provide the help and support that everyone needed. And now I was given this gift: I could save this child — literally save her life and give her a future — by agreeing to provide her with a scholarship so she could have an education and a future.

I could barely speak, but I nodded my head, once, twice, then up and down so vigorously that everyone looked at me curiously. “Yes, of course,” I finally spoke aloud. I looked at the aunt and uncle and told them that although this was a terrible tragedy, I would do everything in my power to make certain that Pramisa was provided an education, to go as far as she could in life, maybe even to become a doctor or an engineer, professions that were rarely possible for girls in Nepal.

Then I fled the room, went into the restroom, shut the door and started sobbing. In fact, I am crying now as I try to tell this story.

Kottler (upper right) with his ENG medical team composed of a doctor, nurse, medical assistants, mental health assistant, administrator and local volunteers.

Kottler (upper right) with his ENG medical team.

We are now heading home after 10 days of exhausting, overwhelming work. During this time, we have treated more than 500 patients, as well as distributed and prescribed $30,000 worth of medications and medical supplies that have been donated by doctors and hospitals in the U.S. We reached areas that have still not received any government help or assistance by any nongovernmental organization three weeks after the first earthquake.

It has been among the most painful and yet the most interesting experiences of my professional life. I have known many of our ENG scholarship girls for over 10 years, some for almost 15 years. During that time I have spent time with their families, shared tea in their homes, visited with them at school and walked on the trails, listened to the stories of their lives and the daily challenges they face. Now many of their homes are destroyed. Their schools are gone and their teachers have disappeared.

My heart still hurts. I can barely sleep. I’ve probably lost 10 pounds in the last week. I can’t tighten my belt any farther. I know this is the result of compassion fatigue or vicarious trauma, as well as primary trauma of surviving two major earthquakes and dozens of smaller ones. I know it is the result of working insane hours and seeing so many people compressed in a day. I know it is the result of seeing so much devastation and despair, so much sickness.

I know that what we have done is just a drop in the bucket compared to the millions of people who still need help, need tents and food and water, need support. But after a life devoted to service, a life dedicated to teaching and helping others, I am certain that everything I have ever done, everything I have ever prepared for, was to be here now.

Kottler walks along a trail in the Mount Everest region with a nurse, Pema. They took the walk to take a break and talk about the trauma and flashbacks they had been experiencing themselves. "Pema is a nurse who was at ground zero after the first earthquake. She saw headless bodies, saw hundreds of corpses crushed and listened to the wails of desperate mothers begging her to save their injured children. We talked about secondary trauma and how so many health professionals will experience problems once they fully metabolize everything they’ve witnessed," Kottler says.

Jeffrey Kottler walks along a trail in the Mount Everest region with a nurse, Pema. They took the walk to take a break and talk about the trauma and flashbacks they had been experiencing themselves. “Pema is a nurse who was at ground zero after the first earthquake. She saw headless bodies, saw hundreds of corpses crushed and listened to the wails of desperate mothers begging her to save their injured children. We talked about secondary trauma and how so many health professionals will experience problems once they fully metabolize everything they’ve witnessed,” Kottler says.





For more information on Empower Nepali Girls, see empowernepaligirls.org

See recent photos and updates from Nepal at ENG’s Facebook page




Bethany Bray is a staff writer for Counseling Today. Contact her at bbray@counseling.org


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