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After 9/11: Building Healthy Relationships -- April Naturale

The opinions expressed in this transcript are those of the guest and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome to WebMD Live. Our guest today is April Naturale, statewide director for Project Liberty. Welcome back to WebMD Live, April.

Naturale: It's very good to be here a year after the World Trade Center attacks. People are in a little bit of a different place and this is a good time to talk about building healthy relationships. In order to nurture and build relationships after life-changing events there are a number of things to remember and I'd like to talk a little bit about those:

  • Stay connected. We know that after a significant trauma, certainly one as large as the World Trade Center attacks, one that affected the entire country, it is most important to make sure you do not isolate yourself. When you're under stress you know how hard it is to reach out. Maintain contact with people who are important to you, especially those able to nurture and support you as well as those who are able to accept the same from you. Remember, relationships should be reciprocal.

  • Be aware of how you interact with others who are important in your life. Listen well, reflect on your conversations and how you feel about them -- the interactions, the content. Be cognizant of your own language. How do you speak to those you care about? Do they know how much you care about them? They won't if you don't tell them. Be honest.

  • Maintain your individuality. The healthiest thing to do in relationships is to keep your sense of self-identity. Know what is important to you, how you like to spend your leisure time, how you interact with others in your community. A key to a good relationship is maintaining those important aspects of your self and either accepting what may be different in others in your family, your social sphere, and intimate relationships, or recognizing what is not acceptable to you and making a conscious decision about that. Again, be honest.

Moderator: Looking at your first point about maintaining connections: Do you have any tips for making that easier?

Naturale: Staying connected can be hard when you're stressed. So you want to try to use all types of communication that you can. Some things work at certain times better than others and by communicating I mean either making a social date or talking on the phone and doing things that we often did before email, which was to drop someone a note or even just a postcard to let them know you're thinking about them. Very often when you feel you cannot talk, it's acceptable to do something indirect like leaving a message on voicemail or jotting a note to let people know you're thinking about them. And maybe also that it's a difficult time for you to be socializing in person. Leave the door open for future contact and thank them for being patient with what may seem to them like you're pulling away.

Member: I have a hard time communicating with family and friends outside of NYC. They don't quite understand what I've been through.

Naturale: I've heard that a lot. I think the key to communicating with others who have not had your same experience -- in any circumstance but certainly in this experience -- is to be very clear as to where you are at this time. And you can say things calmly, even if they may be difficult things like, "I really need you just to listen right now," or, "I get upset when it seems that you're really not paying attention to my concerns," or, "It's very difficult for me to try and explain to you what this feels like for me."

Something that may also be helpful is to acknowledge where the other person is. For example, "I am really glad that you are doing OK and haven't been affected by this," or, "That's not been my experience."

When someone invalidates the intensity of this event it's called appropriate assertiveness. It's often helpful when someone is complaining or saying something negative about a mutual friend or an experience and you do not want to join in that negativity. It doesn't invalidate how they feel, but it makes clear that you feel different. It sounds to me that you have a need to talk to people who have shared your experience around the disaster.

It might be helpful for you to join a group where you have an opportunity to connect with others who understand what you're going through. You can call 1-800-LIFE-NET if you are in the New York City area and would like to join such a group.

Know also that some people are still in denial about the enormity of this disaster and the implications that it has had not only for New York, but also for the nation. Sometimes by just talking about your own experience and your feelings by using "I" statements, people may feel a little bit more comfortable in starting to share how they have been affected. That's not going to be the case with everyone. So I certainly would choose to speak to those people who provide you the support that you need around your distress responses.

Member: My mother wants me to leave the city. She is very fearful for me since 9/11. I love living here. This has become a huge cloud over every conversation we have. What can I do to convince her that I'm OK staying here? It's getting to the point where we can't talk. I'm dreading going home for the holidays because it will just be one long argument about my safety.

Naturale: It sounds to me like you are not going to be able to convince her to feel different than she does. The shift will really depend on you and your comfort level in saying what you would really like to without breaking down your relationship with your mother. It would be best to be clear with her that you plan on remaining in the city and that you're very comfortable there, that it is your preference not to leave, and while you can respect her concerns, you're not going to make such a major change in your life when you don't want to.

It may be helpful for you to talk to the real issue, which is her anxiety about losing you. So, for example, a good response to her may be, "Mom, I love you and I know that you love me. My staying in or moving out of New York City is not going to change that. So why don't we talk about what we can do to stay in touch so that we both feel connected as much as possible."

Moderator: Can lasting relationships be built under extreme circumstances? So many people shared extraordinary moments on 9/11. Movies like Speed romanticize quickly formed intense relationships. Can a romance like the one between the characters played by Sandra Bullock and Keanu Reeves really last? Or does the magic go away as you move away from the trauma? Is it different if the relationship is not a romantic one?

Naturale: Instant intimacy. That is very common under extreme circumstances and can often lead to intense relationships. This happens because during trauma, one's defenses are down. People are often stripped of their everyday, healthy defenses and therefore connect in ways they wouldn't under normal circumstances. Very often people who have had the same experience in a trauma will bond. Whether they are able to maintain that relationship or not will usually depend on all the same circumstances that affect relationships outside the trauma.

For example, if a couple gets together after having met in the middle of a disaster and a year after living together find that have nothing in common except the disaster experience, the likelihood of the relationship remaining healthy is minimal. This can lead to another problem where a couple may be so afraid of losing the relationship that they hold onto the disaster experience and never quite heal.

Some people who get together under traumatic experiences may be fortunate enough to find that the person they connected with during the disaster is someone who shares many common characteristics like sense of family and community, religion, and desire to have children. If they're really lucky, they may even enjoy the same leisure activities and be able to maintain a relationship that started in a trauma but has many qualities and characteristics that allow it to remain healthy.

Instant intimacy between friends who have experienced similar feelings during an event may be much more likely to last a lifetime, as friends can continue to have contact over long periods of time from different parts of the country. Because they don't have to live together in a day-to-day situation, they can maintain a relationship around the shared experience forever. They may never have a need to expand their relationship in any other area.

Moderator: You said we should have an awareness of how we interact with others. What should we be aware of in our interactions? What should we be looking for?

Naturale: I think the best thing to do is to try and monitor what kinds of responses you have on an emotional and an intellectual level when you're interacting with others:

  • Does someone say something that offends you? Do you address it or avoid it?
  • Does the person you're interacting with listen while your speak, or do they constantly interrupt?
  • Do you make eye contact and receive eye contact when you're having a conversation?
  • Do you feel that the person you're talking to is responding to what you say or does it seem like they're just waiting for you to finish your sentence so they can talk about what they've wanted to say all along?

A very significant indicator in a relationship is how someone responds when you indicate distress over the quality of the interactions between you, and how you respond to their reaction.

  • Again, do they try and listen so they might understand your point of view?
  • Do they immediately become defensive?
  • Or do they just automatically go into denial and invalidate what you're saying?
  • Do you also go into denial and avoid addressing important issues?
  • Do you expect that the other person should have mental telepathy, which we all know does not exist?

Unfortunately, we are all exposed to many television shows and movies where a scriptwriter has very neatly, clearly, and concisely instructed all the actors to say exactly what they feel at the exact right moment. And of course, they always get the response they want. This is just not the real world. We must be very thoughtful about how we communicate, how our communications are received, and make conscious decisions about what we want to do. This requires much thought, processing, and often difficult confrontations.

When you verbalize what you're thinking and feeling in a calm, appropriate way, you deserve to expect a thoughtful and respectful response. If you don't get that, look closely at the person you're interacting with and think about why you choose to continue in such a relationship if this is the routine exchange. Relationships are hard work but we are social creatures who are really meant to be together so it's worth it to try and communicate in healthy, honest ways.

Member: I live in Maryland and everything feels uncertain to me right now: The plane in the Pentagon, the anthrax scare, and now the sniper. My relationships are suffering because I'm suffering. What to do?

Naturale: It would be very important to talk with those close to you about how you're feeling and make sure you have opportunities to connect with those you care about. The anxiety in Maryland is high and rightfully so. Again, isolation is probably the worst thing that can happen when one is distressed. There are individuals and groups available throughout the Washington area for those who have been experiencing difficulty with the Pentagon attack and the anthrax scare. You can go on the Project Liberty website,, and there is a link to the Maryland project. They will continue to be available to address the concerns of those who are experiencing distress symptoms due to these events. Their services are free and confidential, just like Project Liberty Services.

Member: I moved to NYC after 9/11. It seems to be a huge gap between me and the people I am meeting. How can I form new relationships when I haven't been through the same things others have?

Naturale: Over the next 12 months, Project Liberty will be working with the New York City community and the surrounding counties to help move forward in the healing process. There will be many community-based activities that will focus on building healthy community relationships.

I think that you will see a shift in the community as we work toward resilience. Right now is still a bit of a difficult time since we are recently past the one-year anniversary and approaching the holidays. So I would suggest using the best communication skills you have to be supportive while people go through this transition. Be a good listener, validate their feelings, and try and be as supportive as possible. The mood will certainly shift. And if someone you know is experiencing continued distress, you might refer them to Project Liberty at 1-800-LIFE-NET or for free, confidential support. We will continue to be available through the next nine to 12 months. Sounds to me like you are very perceptive; my best to you.

Moderator: April, we are almost out of time. Do you have any final comments for us today?

Naturale: I guess the last thing that people need to know is that everyone is experiencing this disaster differently. Many people are in different phases of either denial, acceptance, coping, or healing. We need to be patient with each other and to not let the hopeful spirit and the good will that got us through the first year of this disaster fade. We need it to continue. We need each other.

Moderator: Thanks for joining us, members, and thanks to April Naturale for being our guest. April Naturale will be back with us on Nov. 11 to discuss coping with loss during the holidays. For more information please call Project Liberty at 800-LIFE-NET, (800-543-3638).

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