Psychotherapy Theory, Research, Practice, Training

2010, Vol. 47, No. 2, 249 259

2010 American Psychological Association

0033-3204/10/$12.00
DOI: 10.1037/a0019784

SHARED TRAUMATIC REALITY IN COMMUNAL

DISASTERS: TOWARD A CONCEPTUALIZATION
NEHAMI BAUM

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Bar Ilan University

The phenomenon variously termed

shared reality, shared trauma, or
shared traumatic reality refers to situations in which helper and helpee, psychotherapist and client, are exposed to
the same communal disaster. This article
has two aims. One, pursued in the first
part of the article, is to trace the development of the concept; analyze the conditions under which it was acknowledged,
articulated, and labeled; and review the
changes in the term over time. The other,
pursued in the second part, is to offer a
conceptualization of the phenomenon
based on analysis of the literature. Here,
the article shows that the phenomenon is
characterized by two distinct dynamics,
one pertaining to professionals providing
help in the emergency phase, the other to
professionals conducting ongoing psychotherapy; to offer a preliminary definition
of the phenomenon which covers the
shared features of the two dynamics; and
to present the distinct features of each.

The concept of shared reality, shared

trauma, or shared traumatic reality has attracted increasing attention in the professional
literature since the terror attacks of September 11,
2001. Practitioners and scholars alike use these
terms to refer to situations in which client and
psychotherapist or survivor and helper are exposed to the same collective disaster, such as war,
terror attack, or natural disaster (e.g., hurricane,
earthquake).1 However they term it, if they do at
all, most writers up through 9/11 have presented
the concepts as new. A thorough review of the
literature that covers virtually all the publications
in English found on the subject, however, shows
that the phenomenon has been known, but little
acknowledged, for some time. This article has
two aims: one is to trace the development of the
concept; analyze the conditions under which it
was acknowledged, articulated, and labeled; and
review the changes in the term over time. The
other, based on analysis of the literature, is to
show that the phenomenon is characterized by
two distinct dynamics, to offer a preliminary definition of the phenomenon that covers the shared
features of the two dynamics, and then to present
the distinct features of each and offer recommendations for practice and research.

Keywords: shared trauma, shared traumatic reality, helping professionals,

communal disaster, blurring boundaries

The first-known references to the impact of

communal disasters on professionals can be
found in two studies published in the mid-20th
century. The first is in Schmidebergs (1942)
lengthy article published in the International

Nehami Baum, Louis and Gabi Weisfeld School of Social

Work, Bar Ilan University.
This paper was written when the author was a visiting
scholar at the School of Social Welfare, University of California, Berkeley, CA.
Correspondence regarding this article should be addressed
to Nehami Baum, PhD, Louis and Gabi Weisfeld School of
Social Work, Bar Ilan University, Ramat Gan, Israel 52900.
E-mail: nehami@hotmail.com

1
The term helper in this article refers to all helping
professionals providing emergency assistance in the immediate wake of a communal disaster, and the term helpee, to
persons receiving the assistance. The helper can be any
helping professional, whether nurse, doctor, social worker, or
psychologist. The term is used to make generalizations regarding professionals performing emergency duties, while
specific professional designations are used when discussing
studies on specific professional groups.

Historical Development

249

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Baum
Journal of Psychoanalysis on the impact of the
London blitz, with its repeated bombings, on the
civilian population. A small part of the article is
devoted to a brief discussion of the impact that
exposure to the same ongoing threat of injury and
death had on Schmideberg as a psychoanalyst
and on her patients. The second is the article by
the sociologist Killian (1952) in the American
Journal of Sociology on the responses of the
population to different communal disasters (e.g.,
explosion, tornado). Among other things, this article dealt with the responses of persons in positions of responsibility to disasters in their home
community. Killian claimed that in such critical
times individuals must cope with crosspressures exerted by different groups of affiliation (e.g., the family, the profession). Although
rarely cited, these articles presaged two separate
currents in the literature on the impact of communal disasters on professionals. Whereas
Schmideberg as a psychoanalyst discussed
mainly the impact of the communal disaster on
her relationships with her patients in the course of
ongoing psychotherapy, Killian as a sociologist
looked at the dilemmas of service providers, both
as individuals and professionals, as they navigated the acute phase of the disaster. Schmideberg focused on the joint exposure of client and
psychotherapist to the same disaster, Killian on
the professionals double exposure, as a professional and individual.
Neither gave the shared or double exposure a
name. Nor did the next author, Beverley Raphael,
who wrote about the situation only some 40 years
later, in her book When Disaster Strikes (1986).
In a chapter titled Victims and Helpers,
Raphael shows how psychotherapists who belong
to a community hit by a large-scale disaster become victims as well. She shows the impacts of
the disaster on them as individuals and professionals and on the victim helper relationship, as
well as how they cope with the pressures that the
dual roleas psychotherapist and victim
creates for them. Like Schmidebergs (1942) and
Killians (1952) shorter discussions, her detailed
treatment of the issue was also forgotten.
The next time the matter appeared in the scholarly literature was in the wake of the 1991 Gulf
War, in which the Israeli population was exposed
to repeated Iraqi bombing and to the threat of
chemical warfare. In contrast to earlier disasters,
the Gulf War generated a fair number of
studiesall by Israeli writers who had experi-

250

enced it. The studies divide into those which, like

Killians (1952), deal with emergency intervention and those that, like Schmidebergs (1942),
deal with ongoing psychotherapy. Thus, Loewenberg (1992) explored the conflict between professional commitments and loyalty to family faced
by social workers who provided emergency assistance to civilian victims. Like Killian (1952),
he focused on the helpers inner conflict in dealing with the emergency situation. Kretsch, Benyakar, Baruch, and Roth (1997), psychologists
who provided emergency mental health services
to persons whose homes were bombed, also
wrote about emergency assistance, but emphasized the helper helpee relationship. In contrast,
several studies by psychoanalysts (Gampel, 1992;
Keinan-Kon, 1998; Kogan, 2004; MillerFlorsheim, 2002) focused on the impact of the
shared situation on both the ongoing therapeutic
process and psychotherapist client relationship
and on themselves, as professionals and as individual members of the threatened community. It
is also in connection with the Gulf War that the
phenomenon was named. Kretsch et al. (1997)
called it a shared reality, Keinan-Kon (1998)
termed it a shared traumatic reality. The use of
the word reality is of note. Although one author
wrote about emergency assistance and the other
about ongoing psychotherapy, as psychologists
both attributed great importance to the meeting of
outer and inner realities.
At about the same time, however, an early
report on professionals who provided emergency
services following the 1995 bombing of the Federal Building in Oklahoma downplays the implications of the professionals personal exposure to
the disaster. In their brief descriptive report,
Krug, Nixon, and Vincent (1996) observe that the
disaster was shared by victims and psychotherapists alike, but deny that it affected the professionals as individuals: The pressure of work is
so constant and immediate that you forget you are
part of this community and its bereavement as
much as you are its clinician . . . (p. 103). It was
only after 9/11 that researchers Wee and Myers
(2002) reported findings showing that professionals
who provided assistance after the bombing suffered
very high levels of distress and, moreover, that the
major predictor of their distress was the intense
worry about their families that they experienced as
members of the stricken community.
The 9/11 disaster constitutes a turning point in
the consideration of situations in which psycho-

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Shared Traumatic Reality

therapists and their clients are exposed to the
same traumatic event. The change was anchored
not only in the unexpectedness and extremity of
the attack, but also in the extensive work carried
out in the 1990s on the intense stress experienced
by clinicians who treated traumatized clients. The
notions of compassion fatigue (Figley, 1995),
secondary traumatic stress (Figley, 1999), and
vicarious traumatization (McCann & Pearlman,
1990) suffered by psychotherapists of trauma victims created fertile ground for recognition of the
concept of shared trauma. As with previous disasters, most of the scholars who wrote about the
impact of 9/11 on mental health professionals
treated it as an unprecedented situation for them
(e.g., Batten & Orsillo, 2002). With this, the 9/11
attacks ushered in a change in both the quantity and
approach of the scholarship. From that point on, the
subject, which had hitherto been dealt with in only
a few article, has been investigated and discussed in
a growing collection of articles and chapters, and
the clinicians who had hitherto been the main writers on the subject were joined by a variety of
researchers carrying out empirical studies.
In terms of approach, the phenomenon underwent a name change. To the knowledge of the
author, all the psychotherapists and psychoanalysts who wrote about the impact of 9/11 on
themselves and their clients called the phenomenon a shared trauma. The new term was
adopted in the wake of the extensive trauma
studies in the previous decade (e.g., Figley, 1995,
1999; Herman, 1992; McCann & Pearlman,
1990; Pearlman & Saakvitne, 1995). It reflects
the shift in the conceptualization of the phenomenon, now viewed from the perspective of trauma
theory, as well as the feelings of the writers who
underwent the experience. The new term was
used, however, only in papers relating the clinicians professional experiences, but not in empirical studies. Cabaniss, Forand, and Roose (2003)
retained the term shared reality. Eidelson,
DAlessio, and Eidelson (2003) used the term
shared tragedy. Most researchers didnt give
the phenomenon a name at all (e.g., Adams,
Figley, & Boscarino, 2008; Seeley, 2003).
Another change was that clinicians who published in psychoanalytical journals now dealt
with both the clinical and personal implications
of the disaster. Gensler et al. (2002) presented the
voices of six psychoanalysts who gathered to
support each other a week after the assault and
share their impressions of how the events were

affecting their patients and themselves (p. 77).

Frawley-ODea (2003) observed that 9/11 differs from the personal traumas written about
thus far in that analysts have been coping with
the same traumatic events impinging on patients, and we have been attempting to do it
right alongside them (p. 69). Altman and
Davies (2002) described the shared trauma experienced by psychotherapists and clients. Tosone
and Bialkin (2003) discussed the impact of
shared trauma on both the therapeutic process
and the psychotherapist client relationship, on
the one hand, and the blurring of boundaries
between the psychotherapists personal and professional worlds, on the other. In a later article,
Tosone (2006) further elaborated on these aspects
of the phenomenon. Saakvitne (2002) similarly
emphasized that shared trauma subjects professionals to several possible levels of injury: as
threatened individuals; as persons whose relatives or close friends are exposed to potential
injury; and as clinicians concerned for their clients and influenced by the materials the clients,
bring to psychotherapy.
Furthermore, from that point on, researchers
focusing on emergency work expanded their research to different types of communal disasters
and to different groups of professionals. Somer,
Buchbinder, Peled-Avram, and Ben-Yizhack
(2004) examined the effect of multiple terror
attacks on hospital social workers. Shamai (2005)
tried to determine whether and to what extent the
functioning of social workers was affected differently by war and terror attacks. Lev-Wiesel,
Goldblatt, Eisikovits, and Admi (2009) examined
the positive as well as negative implications of
the Second Lebanon War on social workers and
nurses. Two studies examined the functioning of
social work students: Tosone et al. (2003) after
9/11, Baum (2004) during a period of terror attacks in Israel. One studied the impact of the
forced evacuation of the Gaza settlements on
students who provided assistance to the evacuees
(Nuttman-Shwartz & Dekel, 2007). Clinicians
expanded their discussion to the large scale natural disasters hurricanes Katrina and Rita (e.g.,
Faust, Black, Abrahams, Warner, & Bellando,
2008; Matthews, 2007).
Despite the substantial amount of work that
has been done on the impact of communal disasters on professionals, however, there is still no
published conceptualization of the phenomenon.
Every writer on the subject speaks of the psycho-

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therapist and client or helper and helpee having
been exposed to the same disaster. However,
there is no single definition of the phenomenon
that is both clear and distinctive. Every writer
defines the phenomenon in terms of the single
disaster being written about. Even where the
writer names the disaster a shared reality,
shared trauma, shared traumatic reality, or
something else, the definition offered applies to
the single disaster, not to the class of communal
or collective disasters. Moreover, most definitions encompass only one component of the phenomenon: the exposure of client and psychotherapist to the same event. Only a few encompass
the second component: the psychotherapists or
helpers exposure both as a professional and as an
individual member of the stricken community
(Tosone & Bialkin, 2003; Saakvitne, 2002). Nor
has a clear organizing framework been proposed.
The remainder of this article proposes a definition
and organizing framework, based on a close reading and synthesis of the relevant literature to date.
Toward a Definition and Organizing
Framework
The brief review of the literature points to two
distinct bodies of knowledge, both provided
mainly by writers who were members of the
community in which the disaster they wrote
about occurred. One focuses on professionals
who provide assistance in the immediate wake of
the disaster. Their interventions are generally crisis focused and, aside from a few exceptions
(e.g., Adams et al., 2008; Pulido, 2007; Wee &
Myers, 2002), very short term. The available
knowledge on professionals in this situation rests
on a combination of quantitative and qualitative
studies, with relatively few personal reports. The
other body of knowledge focuses mainly on clinicians (including psychotherapists and psychoanalysts) in the midst of ongoing psychotherapy
that started before the disaster and continues during and after it (e.g., Frawley-ODea, 2003;
Keinan-Kon, 1998; Kogan, 2004; Saakvitne,
2002; Tosone, 2006;). The available knowledge
here is based mainly on psychotherapists descriptions and analyses of their own experiences
as professionals and private individuals.
From both bodies of knowledge, we can formulate a definition of shared traumatic reality.
I choose this term to encompass both the relevant
elements of the disaster (e.g., the external reality)

252

and its implications, sometimes traumatic, for the

professionals exposed to it. The definition entails
four features. (1) The disaster is a collective
trauma, that is, a traumatogenic event that can
potentially traumatize the entire community. (2)
The communal disaster is a current one, not one
in the distant past. (3) Both the client and psychotherapist or survivor and helper belong to that
community, even if they have been there only for
a short time. (4) The helping professional suffers
double exposure both as an individual member of
the stricken community and as a professional
providing services and care to persons who are
themselves adversely affected by the disaster. For
a situation to be defined as a shared traumatic
reality, all four features must be present.
Although this definition applies to both situations described in the literature, the same communal disasteras will be shown below gives
rise to distinct dynamics in the emergency stage
and in ongoing therapeutic relationships. Both
dynamics are characterized by blurred boundaries
in two spheres: within the professional realm and
between the personal and professional realms.
Boundaries can be physical, behavioral, verbal,
and/or emotional. They can be between client and
professional, as well as within the professionals
themselves. The boundaries between client and
professional define personal space and are essential in the helping professions to create a safe,
reliable, and useful platform for the work to take
place (e.g., Davis & Davis, 1981). The boundaries within the professional enable him or her to
provide assistance in an optimal manner with
maximum orientation toward the client (Gelso,
Latts, Gomez, & Fassinger, 2002). In both emergency work and ongoing psychotherapy, the blurring of boundaries is a source of distress to the
professional, although the sources and manifestations of the blurring differ in the two situations.
The Emergency Stage
A communal disaster requires professionals to
provide mental help assistance in the emergency
phase during and shortly after disaster, under
conditions that differ greatly from those in which
they usually work. In the professional realm, the
changes often lead to the blurring of the boundaries provided by a fixed workplace and clear role
definition. The boundaries between the professional and personal realms may be blurred by
both the intrusion of the personal world into the

Shared Traumatic Reality

professional work and the intrusion of the professional work into the personal world.

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Blurred Boundaries in the Professional Realm

Change of workplace. Professional work in
the aftermath of a collective disaster often requires intervention at the site of the event or at
sites to which the victims have been evacuated.
Often there is no organized intimate space for
meeting with victims and/or their families. The
literature describes sessions with war evacuees in
the lobby of the hotel where they were staying
and on benches on the hotel grounds (Kretsch et
al., 1997), and with the survivors of hurricanes
Katrina and Rita in the shelters to which they had
been evacuated (Rosser, 2008). It describes sessions with terror victims at the site of the terror
attack (Gibson & Iwaniec, 2003) and with victims families in a morgue (Shamai, 2005).
On the whole, the writers regard their presence
at the terror site or evacuation point at the extremely difficult point in time as vital to their
ability to help and to the formation of a therapeutic relationship after the disaster. With this, two
studies reveal that changing the usual work setting to provide the emergency assistance may
cause the professional considerable distress.
McCammon, Durham, Allison, and Williamson
(1988), who investigated the impacts of an apartment building explosion and a devastating tornado in the same city, found that professionals
who provided mental health assistance outside
their regular workplace suffered greater distress
than those who provided the assistance in the
hospitals where they were employed. Lev-Wiesel
et al. (2009) found that social workers who provided help at shelters and other places in the
community during the second Lebanon War,
when many persons in the north of Israel sought
safety outside their homes, reported high levels of
emotional distress.
The distress that resulted from the change in
work place probably stemmed from two main
sources. One was the loss of the familiar work
setting and the sense of safety it provided at a
time when both the helpers and helpees anxiety
and stress ran very high. The other was the unsuitability and uncomfortableness of most of the
alternative settings, which had no containing
walls (park bench, hotel lobby) or were eerie
(e.g., the morgue). Several writers tell of the vast
amount of mental energy they invested in finding

a place where sessions could be held in privacy

(e.g., Kretsch et al., 1997; Rosser, 2008; Shamai,
2005).
Change of role boundaries. Emergency work
in the wake of collective disasters often requires
mental health professions to perform tasks that
are not part of their regular job and to handle new
and unfamiliar situations. For example, Gibson
and Iwaniec (2003) describe how social workers
performed not only professional tasks (e.g.,
speaking with the victims) after a terror attack,
but also distributed food to them. Somer et al.
(2004) report hospital social workers telling that
victims relatives asked them to take care to remember everything they heard about the victims
in case it turned out that they had to mourn them.
These role expansions blurred the familiar
boundaries of the professionals job. That the
blurred boundaries stemming from role expansion can be a source of stress is recognized by
Lev-Wiesel et al. (2009). In their study of the
impact of working in the shared traumatic reality
of war affected different professionals, these authors suggest that hospital nurses reported a
lower level of distress than social workers because the nurses role boundaries remained the
same while the social workers changed.
Blurred boundary between the personal and
professional realms. Boundaries between the
personal and professional realms are blurred in
emergency work because the helper experiences
the collective disaster both as a professional and
as an individual member of the stricken community. The blurring occurs through the penetration
of the world of work into the professionals personal space and the penetration of his or her
personal world into the professional space.
Penetration of the world of work into the professionals personal space. The way in which
the world of work penetrates the emergency
workers personal space is well conveyed by Shamai and Rons (2009) study of Israeli social
workers who were called upon to provide assistance immediately after a terror attack. According
to the workers interviewed for the study, calls
would come at any time of day, including ordinary family moments like dinnertime and special
events like family weddings and holiday eves,
when the extended family is usually together, and
they would be asked to leave their spouses and
children to attend to the victims.
The many and weighty demands of work in the
emergency phase of a collective disaster often

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result in concrete, practical role conflicts, where
professionals are torn between their professional
commitments and their loyalty and commitment
to their families, which are also part of the
stricken community. Loewenberg (1992) reported the difficult dilemma and emotional conflict faced by Israeli social workers during the
Gulf War, when after each of the many Iraqi
missile attacks to which Israel was subjected,
they had to decide whether or not to leave their
children to provide emergency assistance to families that had to be evacuated. Similar dilemmas
are reported by Saakvitne (2002) after September
11 and by Shamai after terror attacks in Israel
(Shamai, 2005; Shamai & Ron, 2009).
Fulfilling the professional role is especially
difficult in the immediate wake of a collective
disaster. One source of difficulty is that it is often
not immediately known who has been hurt. In
such situations, the professionals, like many others, are uncertain regarding the situation of their
loved ones (e.g., Marmar, Weiss, Metzler, Ronfeldt, & Foreman, 1996; McCammon et al.,
1988). Research indicates this uncertainty makes
it very difficult for them to do their jobs, and that
only after their uncertainty is cleared up can they
make themselves available to fulfill their professional roles (Shamai, 2005; Somer et al., 2004).
In their study of social workers called upon to
provide help after terror attacks, Somer and colleagues (2004) present numerous examples of
this. One is an interviewee who stated: What I
remember is everybody in hysteria. I was on the
ward, and I felt my own panic . . . . First, I had to
look for my children . . . Then I ran to [my post
at] the hospital information center (p. 1083). In
similar vein, Rosser (2008), who analyzed his
involvement in assisting residents of New Orleans after Hurricane Katrina, reports that he was
able to fulfill his duty as a psychologist only after
he made sure his family was capable of coping
with the situation.
Penetration of professional demands into the
personal world. Communal disasters, by their
nature, often affect the professionals social
world: their friends, neighbors, acquaintances,
and others, who not infrequently ask them for
their professional attention. Ostodic (1999), who
documented her work in war zones in Bosnia,
told of the added tasks and responsibility imposed on mental health workers when people
around them asked for their help in relieving their
emotional distress. Eidelson et al. (2003) reported

254

requests for professional help from family,

friends, and close acquaintances after the events
of September 11th, and found that such requests
added substantially to the professionals emotional burden. Made outside the time and place
usually allotted to professional work, the requests
intrude on the professionals personal space and
blur the boundaries between professional relations and social relations. Giving professional
help to persons one knows raises the dilemma of
how to provide emotional succor as a caring
human being without inappropriately assuming a
professional role.
In both the professional and personal realms, the
clinicians ordinary routines are upset by the penetration of demands from the other realm. This penetration causes what Figley (1995), writing of psychotherapists compassion fatigue, terms life
disruptions, defined as the unexpected changes in
schedule and routine stemming from the need to
manage life responsibilities that demand attention,
such as illness or changes in lifestyle, social status,
or professional or personal responsibilities.
Ongoing Psychotherapy
Both the boundaries between the clinician and
patient and those within the clinicians self are
blurred when the communal disaster strikes in the
course of ongoing psychotherapy.
Blurred boundaries in the therapeutic dyad.
A communal disaster may affect the ongoing relations between psychotherapist and client in several
ways. First of all, psychotherapist and client may
find themselves responding to and working through
the disaster at much the same time, so that clients
references to the disaster may arouse strong countertransference in the psychotherapist. Moreover,
many psychotherapists who experience the same
communal disaster as their clients have a feeling of
being in the same boat with them (Tosone &
Bialkin, 2003)an awareness that creates new dynamics both in the therapeutic relationship and in
the psychotherapists self.
The more or less simultaneous response to the
same disaster may change the psychotherapist
client dynamic in two ways. One is that it disrupts
the asymmetry that is typical of most therapeutic
relationships, and which enables clients to receive help without the burden of reciprocity and
concern for the other person (Keinan-Kon, 1998;
Schmideberg, 1942; Tosone, 2006). The psychotherapist may be more stressed, preoccupied, and

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Shared Traumatic Reality

defensive than under ordinary circumstances. The
client, perceiving the change, may lose confidence in the psychotherapists ability to help and
contain. Keinan-Kon (1998), discussing four psychoanalyses she was conducting when the Gulf
War was launched, wonders about the possibility
of ever restoring the asymmetry: when analyst
and patient alike are threatened by the same traumatizing reality, the question truly becomes: Is it
possible to bring back into the common symmetrical, factual reality, the asymmetry necessary for
the therapeutic space? (p. 439).
The other way in which the simultaneous response may change the psychotherapist client
relationship is through changes in the real relationship (Gelso, 2002), beyond the professional
relationship. As early as the Second World War,
Schmideberg (1942) reported that her clients
called to inquire about her welfare after bombings. Gampel (1992) described similar experiences, when her clients asked about her and her
family during the Gulf War. Frawley-ODea
(2003) reports that after September 11, many
psychoanalysts she knew phoned patients they
believed might be directly involved in the crisis,
allowed patients to use their phones during sessions, waived fees for canceled sessions, hugged
and were hugged by patients, expressed their own
feelings about the attacks, and shared information
about the fate of their own family members and
friends. Cabaniss et al. (2003) draw a similar
picture based on quantitative findings among psychoanalysts. Almost 90% of the analysts who
responded to Cabaniss et al.s questionnaire reported that analysands asked about their analysts
family; 70% reported that they answered their
questions; and some two thirds reported that they
themselves asked about their analysands families. According to these researchers, most of the
psychoanalysts they queried regarded asking
about their analysands families and answering
analysands questions about their own family after a tragedy of the magnitude of 9/11 as critical
to maintaining the psychotherapists humanness in the eyes of the client and thus to preserving the working alliance. At the same time, as
Tosone (2006) points out, the breach of the usual
psychotherapist client distance blurs the
boundary between the psychotherapists professional and personal space. In a more contemplative vein, Keinan-Kon (1998) observes: While
contemporary psychoanalysts differ widely as to
what degree this type of distance or neutrality is

valuable and even conceivable, all would need to

readjust their perspectives in the face of war
reality . . . and other social catastrophes . . . (p.
439).
The inner dialogue: The personal self and the
professional self. Within the psychotherapists
self, the shared trauma may affect the ongoing
inner dialogue that psychotherapists generally
hold during and after their sessions, as they monitor and review their professional and personal
responses. According to the reports of clinicians
who practiced when a communal disaster struck,
personal thoughts, feelings, and concerns related
to the disaster tended to intrude into their sessions
with much greater frequency and intensity than at
other times. The usual inner dialogue thus demanded substantially more effort than previously.
For example, Kogan (2004), writing of the Gulf
War in Israel, describes how difficult it was for
her to differentiate between her personal and professional self when a client expressed thoughts of
leaving Israel to a safer place. As Kogan relates,
the clients thoughts made her think that she
should perhaps encourage her daughter to leave.
The inner dialogue required after such intrusions
can be so draining that some scholars indicate its
detrimental impact on their professional functioning. For example, Saakvitne (2002) and Tosone
(2006), each in her own way, describe how their
ability to be empathetic in certain moments diminished as a result of their preoccupation with
the inner dialogue during psychotherapy sessions.
In summary, it seems that shared traumas generate changes and blurring of boundaries in different ways in accord with the situation. In both
emergency work and ongoing psychotherapy,
boundaries are blurred in the professional realm
and in the gray area where the professional and
the personal selves overlap. Among emergency
workers, the boundaries that are blurred are practical and concrete. Among psychotherapists
whose therapeutic relationships continue in tandem with the disaster, the boundaries that are
blurred are between themselves and their clients
and within themselves.
Heightened Sense of the Existential Threat
Large-scale disasters generally intensify the
sense of personal vulnerability and existential
threat of those who are exposed to them. This is
what makes them so traumatic. Such intensification may occur even when the disaster does not

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entail many actual deaths, but only the threat of
death, such as was the case in Israel during the
Gulf War. The intensification has different
sources and implications, however, among the
professionals in the two situations described in
this paper. Among emergency workers, the intensification stems from their direct exposure to the
dead, the injured, and the displaced, as well as to
the rubble, debris, and physical destruction
wreaked by the disaster (e.g., Gibson & Iwaniec,
2003; Raphael, 1986). Psychotherapists in ongoing practice are usually spared such direct exposure; the existential threat they experience is intensified by their patients reports of their own
exposure and anxieties (Keinan-Kon, 1998;
Kogan, 2004).
In both situations, professionals mobilize
their defense mechanisms to enable them to
cope with their heightened sense of vulnerability. However, while their defense mechanisms
may help emergency workers to carry out their
tasks (e.g., McCammon et al., 1988; Sloan,
Rozensky, Kaplan & Saunders, 1994), they may
impair the interventions of clinicians doing ongoing psychotherapy by reducing their emotional
availability to their clients and their ability to
contain their clients anxieties (Keinan-Kon,
1998; Saakvitne, 2002).

Summary and Conclusions

Research and writing on shared trauma burgeoned in the wake of two events, 10 years apart:
the First Gulf War in Israel in 1991 and the Twin
Tower attack of September 11, 2001, in the
United States. Both events affected entire communities and exposed large populations to the
same threat of injury and death. To most professionals who found themselves sharing the same
traumatic experience as their helpees or clients, it
apparently seemed that no one had ever encountered this phenomenon before. They documented
and analyzed their experiences as if no theoretical, clinical, or practical knowledge had ever
been gleaned or published. The review in the first
part of this paper indicates that situations of
shared reality in which helpers and helpees and
psychotherapists and clients were exposed to the
same collective disaster were written about as
early as the 1940s and 1950s. It would be several
more decades, though, before the phenomenon
was fully recognized.

256

Why is it that the concept of shared reality

gained the recognition it did during the Gulf
War? One reason, given by Kretsch et al. (1997),
was that psychotherapists found themselves in
the same sealed room with their clients, gas
masks on their faces, both of them sheltering
from the threat of a chemical attack. That is, the
shared reality became salient enough for it to
be acknowledged and named.
Another possibility is the convergence of two
somewhat contrary factors. One was that the Gulf
War in Israel exposed most of the population,
especially those in the crowed center of the country, to a succession of Iraqi bombings, which
destroyed several buildings and, beyond this, sent
large numbers of people fleeing in fear. On the
other hand, most of the bombs missed, the
dreaded chemical weapons were not used, and, as
a result, relatively little rescue work was actually
required. This combination seems to have left
professionals the time and energy to consider the
impact of the shared reality, as they called it.
Yet another explanation lies in changes in professionals views of the proper relation between
their psychotherapeutic work and the real world
context in which it was carried out. The London
Blitz was a much more destructive communal
disaster, with many more dead, injured, and displaced. There too, psychotherapists and clients
were exposed to the same bombings. However,
only one psychoanalyst wrote about the impact of
the shared exposure on herself (Schmideberg,
1942). The general consensus was that it was
essential to totally separate the psychotherapy
from the events of the world outside and that the
psychotherapists personal world and feelings
had no place in the intervention. The recognition
and acceptance of the fact that both events in the
psychotherapists life (e.g., Gerson, 1996) and
the psychotherapists feelings (e.g., Gelso et al.,
2002) can affect the psychotherapists professional functioning has apparently enabled not
only psychoanalysts, but scholars as well, to consider the impact of the shared reality on the
psychotherapist-client relationship and the psychotherapist him- or herself.
The phenomenon was rediscovered and given
much wider recognition in the United States with
the attacks of September 11, 2001. At this point,
too, the accepted term of the phenomenon was
changed from shared reality to shared
trauma. The change in name reflected a change
in perspective. During the Gulf War, the phenom-

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Shared Traumatic Reality

enon was considered from the perspective of
stress theory, with the communal disaster viewed
as an external stressor. Those who wrote after
September 11 considered the phenomenon from
the perspective of trauma theory, with the communal disaster viewed as a traumatic event.
When the first papers that referred to shared reality were written, the emerging trauma literature
focused almost exclusively on the victims and
their families. It was only in the 1990s that scholars began to examine the impact of treating
trauma victims on psychotherapists and other
helpers (Figley, 1995, 1999; McCann & Pearlman, 1990). The growing awareness that treating
trauma victims may cause psychotherapists and
other helpers to develop secondary or vicarious
traumatization even though they had not undergone
the traumatic event themselves seems to have been
a cornerstone of the conceptual shift.
Whether it is termed shared reality, shared
trauma, or (my preference) shared traumatic reality, the phenomenon emerged from and gained
recognition on account of a blurring of boundaries.
During the London Blitz, the Gulf War, and the
9/11 attacks, the traditional distinction between battlefield and home front was blurred. No longer was
there a clear separation between those exposed to
injury fighting on the front and civilian populations
exposed to injury at home.
More importantly, blurred boundaries are central to the phenomenon. Whether in the emergency phase or ongoing psychotherapy, victim
and professional helper were exposed to the same
disaster and experience much the same threat. In
emergency work, the containing boundaries of
the profession are undermined as the work setting
and professional role both change. The demands
of the helpers personal world intrude into the
professional realm, and demands associated with
the professional realm penetrate the helpers family and social life. In ongoing psychotherapy, the
asymmetry and distance between clinician and
client are reduced. The inner boundaries between
the clinicians personal and professional selves
are blurred. We have only begun to understand
the implications of the blurring of these inter- and
intrapersonal boundaries.
Clinical Implications
The earlier discussed implications of shared
traumatic reality underscore the need to help professionals to deal with the challenges and dilem-

mas that arise for them in large scale communal

disasters. Some organizations that send out emergency workers instruct them to check that their
families are safe and their needs taken care of
before beginning their emergency tasks (Shamai
& Ron, 2009), and most send out emergency
workers in teams to reduce the pressures they
come under (Bleich, Kutz, Klien, Rubinshtein, &
Shriber, 2005). Based on evidence of their efficacy, these practices should be made routine.
Other practices not in current use should be
adopted. To ensure that essential services are
provided without delay, workers with less family
responsibility should be sent out first. If possible,
tents or other quick, temporary shelters should be
set up to provide a measure of privacy and quiet
and an emotionally safe place set off from the
surroundings for professionals meetings with
survivors and their families.
In supervision and debriefings, emergency
workers should be encouraged to discuss not only
their emergency tasks, but also their own emotions and the difficulties created for them by the
blurred boundaries. Where a close relative or
friend of an emergency worker is hurt, the organization should check to see whether the worker
wants to continue to work or would like some
respite. An eye should be kept on workers so that
they dont pass the exhaustion point where continuing to work where doing so isnt essential,
which often occurs in communal disasters.
Psychotherapists and psychoanalysts in ongoing practice when a communal disaster strikes
must, first, recognize that external and internal
boundaries are often blurred in such situations
and, then, consider ways of dealing with the
various manifestations and consequences of the
blurring. In view of the psychotherapists and
clients simultaneous experience of and response
to the common disaster, therapists should try to
be especially alert to their countertransference
responses in matters related to the disaster. They
should be alert to the disruption of the asymmetry
in the therapeutic relationship and work to create
a new asymmetry, which would incorporate the
shared experience. Along similar lines, while recognizing the legitimacy of the much heightened
presence of the real relationship in the therapeutic setting in the wake of communal disasters,
they should take care not to allow it to undermine
the therapeutic relationship. To prevent the intensification of the inner dialogue in the wake of
communal disasters from drawing their attention

257

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Baum
away from their clients, psychotherapists should
make space for their disaster related thoughts,
feelings, and concerns outside their therapy sessions. Finally, psychotherapists should not reproach themselves for the blurring of boundaries
or for the momentary lapses in attention and
empathy that may ensue from the blurring.
Rather, where possible, they should seek to enlist
the blurring to further the therapeutic process, for
example by discussing its impact with their clients.
These are difficult undertakings, especially on
ones own. Professionals practicing in the wake
of a communal disaster would be advised to seek
professional or peer supervision. Such supervision is not without its problems in a shared traumatic reality, where the available supervisors are
part of the same community of sufferers (Fritz,
1996) as the psychotherapists seeking their assistance and do not bring an outside perspective.
Nonetheless, the shared experience of the disaster
may also carry the potential for assistance, by
providing a forum for discussing and working
through the issues, as well as by enhancing the
sense of connectedness and belonging that are so
essential to coping with disasters (Fraidlin &
Rabin, 2006).
Research Implications
Despite progress in recognizing the existence
of shared traumatic reality and defining some of
its characteristics, many questions remain unanswered. Does it occur only in large-scale events,
or does it also occur in smaller traumatic events
known as minidisasters (Alexander, 1990),
such as school shooting incidents (Sloan et al.,
1994)? Do manmade traumatic events shape the
characteristics of the phenomenon differently
than natural disasters? Is shared traumatic reality
restricted to mental health professionals or does it
occur among other professionals who assist victims of communal disasters, such as doctors,
nurses, teachers, police officers, fire fighters, and
nonprofessional volunteers? Addressing these
and other questions should help us to better understand the differential impacts of different
types of shared traumatic realities on different
types of helpers and in different phases.
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