By Lindsey Phillips
June 2019
Patience Carter took a bullet in the leg during the 2016 mass shooting at Pulse nightclub in Orlando, Florida 鈥 the second deadliest mass shooting in the United States 鈥 and survived. In a while recovering, Carter captured the devastating effects of survivor guilt: 鈥淭he guilt of feeling lucky to be alive is heavy. It鈥檚 like the weight of the ocean鈥檚 walls crushing, uncontrolled by levees.鈥
Some people are able to grasp and admit that they are suffering from survivor guilt. Others, however, don鈥檛 necessarily realize they are wrestling with it, or they struggle to acknowledge carrying a sense of guilt. Luna Medina-Wolf, president of Professionals United 4 Parkland, was part of the mental health response team after the 2018 shooting at Marjory Stoneman Douglas High School in Parkland, Florida. She says many of the teachers sought help for their trauma after the shooting and, through therapy, also found they were dealing with survivor guilt for not being able to protect all of their students or for living when a child died.
Thus, Medina-Wolf, a licensed mental health counselor and the owner of Helping Moon Counseling, advises other clinicians to pay close attention to subtle comments clients make that may indicate they are struggling with survivor guilt. Rather than directly stating 鈥淚 shouldn鈥檛 have survived,鈥 a client may say, 鈥淗ow is it that my friend died?鈥 This question infers the thought 鈥淎nd I didn鈥檛 die,鈥 explains Medina-Wolf, a member of the 乐博传媒. Counselors must sharpen their listening skills and not be afraid to ask questions and dig deeper, she adds.
鈥淓ven when people are admitting [their guilt], when the words are coming out, they鈥檙e not realizing what it is that they鈥檙e admitting,鈥 says Melissa Glaser, an 乐博传媒member in private practice in Connecticut. 鈥淭hey don鈥檛 know as they鈥檙e saying it that this is survivor鈥檚 guilt and that they鈥檙e stuck in a place that they can鈥檛 navigate out of.鈥
Glaser, a community response and recovery leader, served as director of the Newtown Recovery and Resiliency Team following the mass shooting at Sandy Hook Elementary School in 2012. She says counselors can listen for telltale comments that clients are struggling with survivor guilt. For example:
Glaser is a consultant, a public speaker on trauma and relevant clinical applications, and a licensed professional counselor (LPC) who specializes in trauma and posttraumatic stress disorder (PTSD). She says survivor guilt typically manifests when someone feels a sense of responsibility for a loss or traumatic experience or when someone is grappling with questions of why and how (e.g., Why did this happen? Why did I react that way? How can I enjoy life when others can鈥檛?). This is especially true if they think they could have done something differently to prevent or change the outcome.
鈥淚t鈥檚 really important for clinicians to help individuals get to a place where they are able to understand that they鈥檒l never have the answers [and] that they can鈥檛 stay rooted on the why. 鈥 You have to find a way to project those whys into or onto something else,鈥 Glaser says. 鈥淥therwise, it can consume you, and it can become such a part of your identity.鈥
Glaser often suggests that clients picture themselves throwing their why questions into the air and they don鈥檛 come back down. If clients value spirituality, they can imagine that God is going to deal with the questions for a while, she adds.
鈥淪urvivor guilt is complicated. 鈥 [A] lot of the time, people will not even seek counseling because 鈥 they feel they don鈥檛 deserve to feel better or they鈥檙e not worthy of getting relief,鈥 Medina-Wolf says.
She had a client who was diagnosed with cancer at the same time a friend was diagnosed. When the client survived and the friend didn鈥檛, the client said, 鈥淢y friend was such a good person. I鈥檓 not a good person like her. She volunteered and was kind to everybody. I鈥檓 not kind to people. Why did she die?鈥
is also often intertwined with survivor guilt, adds Courtney Armstrong, an 乐博传媒member with a private practice, Real World Therapy, in Tennessee. 鈥淲hen there鈥檚 an element of survivor鈥檚 guilt on top of [grief], they feel ashamed or guilty for having any joy 鈥 because that鈥檚 disrespectful to this other person,鈥 she explains. For example, when a child dies, parents may not want to change the child鈥檚 room because they feel guilty about moving forward and seemingly 鈥渄ismissing鈥 their child.
Other clients have told Armstrong, 鈥淚 can鈥檛 be happy if [my loved one] isn鈥檛 here. 鈥 I feel bad for enjoying my life when they鈥檙e not here.鈥
Survivor guilt can set in immediately, or it can make its presence known months or even years later. This past March, roughly one year after the Stoneman Douglas High School shooting in Parkland, two survivors 鈥 Sydney Aiello and Calvin Desir 鈥 took their own lives. Aiello鈥檚 family reported that she suffered from survivor guilt. A few days later, Jeremy Richman, who lost his daughter in the 2012 Sandy Hook shooting and who later served as one of the , also died by suicide.
Richman, along with his wife, had created a foundation to prevent violence and build compassion through brain health research. Up until his death, Richman was actively working with Parkland families. Glaser says Richman was the last person most people would have expected to take his own life, but she stresses the importance of being aware that everybody is in a different place. Counselors 鈥渉ave to be well-versed in [the] signs and symptoms [of PTSD and survivor guilt] and never hesitate to reach out, never hesitate to ask questions,鈥 she adds.
John Super, coordinator of the Community Counseling and Research Center and a lecturer of counselor education at the University of Central Florida, has observed that a person鈥檚 proximity to the traumatic event may affect how quickly he or she feels survivor guilt. After the Pulse nightclub shooting, Super, along with two other colleagues, helped organize a grassroots collaborative plan to offer supportive counseling services to those affected.
Super compares trauma and the potential for experiencing resulting survivor guilt with throwing a pebble into a lake: 鈥淚t ripples out. Those [who] are the closest feel it the quickest and the strongest, but that doesn鈥檛 mean that people on the outside don鈥檛 feel it.鈥
Working closely with media reporters after the Pulse shooting, Super witnessed how they also experienced a sense of guilt. 鈥淕enerally, reporters tend to see themselves as hardened 鈥 鈥榃e鈥檝e seen and heard the worst of life so, obviously, we can鈥檛 have any guilt or emotional response to this,鈥欌 Super says. 鈥淎nd they would be the ones who buried it the deepest.鈥 Some reporters felt guilt almost instantly because they knew they were prying into people鈥檚 lives or pushing people to comment who weren鈥檛 ready. Super noticed the guilt appeared later for other reporters, such as when they were writing their stories, editing a video or doing a follow-up special.
Jeffrey A. Lieberman, who chairs Columbia University鈥檚 psychiatry department, adolescents are particularly susceptible to the after-effects of trauma, including survivor guilt, because they are already dealing with massive changes as they move toward adulthood.
One way that counselors can help survivors is to normalize the guilt they may be feeling after a loss or traumatic event. Glaser, author of Healing a Community: Lessons for Recovery After a Large-Scale Trauma and co-author of the chapter 鈥淒isaster Recovery in Newtown: The Intermediate Phase鈥 in the fourth edition of ACA鈥檚 Disaster Mental Health Counseling: A Guide to Preparing and Responding, points out that part of the recovery process is simply understanding what is involved. After the Sandy Hook shooting, she noticed a sense of relief when she told clients about common physical and emotional responses to trauma. The clients would look at her and say, 鈥淥h my God! That鈥檚 why I feel the way I do. That鈥檚 why I can鈥檛 do that [activity] anymore.鈥
During the first session, or when clients are otherwise ready to absorb information, Medina-Wolf will show them a 鈥渨indow of tolerance鈥 infographic created by the National Institute for the Clinical Application of Behavioral Medicine (see ). The infographic helps clients understand that what they are experiencing is a normal reaction to a traumatic event.
A person鈥檚 window of tolerance is the ideal place for coping with stressors and triggers, Medina-Wolf explains. Hyperarousal (e.g., hypervigilance, anxiety, panic, fear, racing thoughts) sits at one end of the window of tolerance, whereas hypoarousal (e.g., feelings of numbness, emptiness) sits on the other. The infographic illustrates how a traumatic experience can narrow a person鈥檚 window of tolerance, causing the person to feel dysregulated. Although most people commonly associate trauma symptoms with hyperarousal, many of the symptoms of survivor guilt 鈥 such as feeling helpless, unmotivated, immobilized, numb or disconnected 鈥 are components of hypoarousal, Medina-Wolf adds.
Medina-Wolf says she has had clients cry upon viewing the window of tolerance infographic because they realize they are not going crazy. 鈥淎 lot of what people need in the beginning is just that reassurance that what they鈥檙e going through is symptoms of trauma,鈥 she says.
In addition, recovery from survivor guilt and trauma isn鈥檛 a linear process. The guilt and grief of the loss comes in waves, not stages, says Armstrong, author of Rethinking Trauma Treatment: Attachment, Memory Reconsolidation and Resilience and Transforming Traumatic Grief. The reality is that people who are grieving typically move back and forth between loss-orientated waves, in which they feel emotionally and physically drained, and restorative waves, in which they become more task-oriented and don鈥檛 dwell on the pain, she explains. Counselors should reassure clients that experiencing grief and guilt in waves is a normal part of the recovery process, Armstrong says. Otherwise, clients who have been feeling better may wonder what is happening when they suddenly find themselves back in a loss-oriented wave.
Of course, as both Armstrong and Medina-Wolf point out, when clients start feeling better and moving through their grief, this can actually cause their survivor guilt to flare more intensely because they don鈥檛 think they should be 鈥渙ver it鈥 this quickly or because they feel guilty about being happy again.
Medina-Wolf, who is certified in eye movement desensitization and reprocessing (EMDR), uses recent traumatic episode protocol (R-TEP) for early EMDR intervention with clients. If clients don鈥檛 have any underlying issues, this protocol often helps them feel better in as little as three to five sessions lasting 90 minutes apiece. This sometimes prompts them to ask, 鈥淗ow can I feel so good so quickly?鈥 she says.
Of course, some clients may feel that they have their survivor guilt and grief under control, only to turn on the news and be faced with the reality of another traumatic event transpiring. This can throw survivors back into a sense of guilt, distrust and questioning why, Glaser says.
鈥淚t isn鈥檛 that [trauma] is going to be erased,鈥 she says. 鈥淚t isn鈥檛 that they are going to recover and never be triggered again or never have a day or moment where they鈥檙e feeling that extreme sadness, or they鈥檙e feeling dysregulated again, or they鈥檙e feeling things are foggy. They will experience times like that for the rest of their lives. Hopefully, it鈥檚 fewer and further between as they work through this.鈥
Glaser is trained in cognitive behavior therapy (CBT), but when it comes to collective community trauma, she has found that CBT may not be the most effective approach 鈥 or not effective at all 鈥 until the client is grounded.
Medina-Wolf agrees: 鈥淐ommunal trauma requires specific brain-based therapeutic techniques to really be able to break some of the negative schemas that were created due to the trauma. Just doing talk therapy would really take a long time until you would be able to heal. 鈥 [A] lot of times, it doesn鈥檛 take care of it all. You just learn to cope with it, but the damage is done. And if you don鈥檛 make sure to really work on the underlying schemas, then [they] may stay with [you] for the rest of your life.鈥
With survivor guilt, clients experience a disconnect between what they feel and what they know, Medina-Wolf explains. They may realize on a cognitive level there was nothing they could have done to prevent someone鈥檚 death, but they still feel differently.
Medina-Wolf uses a metaphor to explain to clients how trauma shapes the way they see the world and themselves in it. If they were to put on red-tinted sunglasses, she tells them, then everything would seem reddish; once they removed the sunglasses, they would realize it was just the glasses making things appear red. Similarly, being in a state of hyperarousal or hypoarousal makes it difficult to think rationally and process one鈥檚 thoughts and emotions, which may alter a person鈥檚 perceptions, Medina-Wolf says. Thus, bottom-up approaches such as EMDR, neurofeedback and brainspotting, which allow emotions to be processed at an unconscious level, work better to treat survivor guilt and other trauma-related symptoms than does a top-down approach such as CBT, which assumes that changing thoughts will change behavior and feelings, she explains.
With EMDR, the client and counselor first identify the negative self-belief (e.g., 鈥淚 could have done something more to save the person鈥檚 life鈥). The client then thinks about this distressing feeling while the counselor uses bilateral simulation such as eye movement, tappers or bilateral music. This technique allows clients to open a door between their conscious and subconscious minds so that they are able to figure out what happened and rewire the way they understand it, Medina-Wolf explains. By identifying the negative self-belief and reprocessing and desensitizing what happened, clients can come to terms with what occurred in a more rational way and are more in control of their emotions when they are triggered, she continues.
For example, Medina-Wolf used EMDR R-TEP with a Parkland student who felt guilty for not saving another student鈥檚 life. First, they identified the client鈥檚 negative self-belief (鈥淚 should have done something more to save the student鈥) and the positive self-belief she wanted to work toward (鈥淚 did the best I could鈥). Medina-Wolf used tappers to administer bilateral simulation, and after three sessions, the client was able to reach that goal. Her thought process was more rational, she believed she had done the best she could, and she no longer felt guilty for the person鈥檚 death.
Individuals who experience survivor guilt, complicated grief or extreme trauma reactions may not be able to organize their thoughts to tell counselors what they need, Glaser says. For that reason, she also recommends using mind-body techniques such as meditation and music therapy to regulate and ground clients. This helps them to process their story and recover the vocabulary to talk about their experience. In many instances, clinicians may need to take a layered approach 鈥 for example, doing CBT in conjunction with tapping, art therapy or brainspotting.
Glaser often reverts to something rhythmic to help ground clients. For example, she may have them tap the side of a chair or their leg in a rhythmic way or take them on a walk outside (if they feel safe doing that). This simple rhythmic work helps get clients through the initial acute stage so they can begin to hear the counselor and produce the language they need to tell the counselor what they are feeling, Glaser explains.
In session, Medina-Wolf uses aromatherapy, meditation, breathing techniques and a box filled with fidget toys, pencils and squishy toys that clients can grab and play with while they are processing the event. She also encourages clients to supplement therapy with activities such as running, swimming or cycling that encourage bilateral simulation.
The attachment system often confuses what is imagined and what is real after a traumatic loss or event, points out Armstrong, founder of the Institute for Trauma Informed Hypnotherapy. Thus, she finds the imaginal conversation technique helpful for calming clients鈥 attachment systems and rewriting the negative thoughts connected to guilt.
With this technique, Armstrong has clients close their eyes and imagine what the person who died would say to them now from a place of enlightened awareness. Would the person want them to be tormented? Would this person tell them they don鈥檛 deserve to be alive? Imagining these conversations often helps clients obtain resolution, she says.
Armstrong allows clients to take the lead on these conversations. If they struggle, however, she might say, 鈥淚鈥檓 imagining they understand that you feel regret and they appreciate how much you care, but they think that being stuck in this depression and guilt isn鈥檛 the solution. It isn鈥檛 the best way to honor them.鈥
Armstrong had one client whose mother died by suicide and blamed the client in the suicide note. Because the client had a complicated relationship with her mother, she had a hard time being able to think with a clear, stable mind about her mother. Armstrong told the client she could instead imagine the way she would have liked her mother to be. With clients who are spiritual, counselors can have them imagine a conversation with God and God telling them everything is OK and they are not responsible for what happened, she adds.
Armstrong also has clients write letters to the deceased about their feelings. Then she has clients write an imagined response from the deceased (using their nondominant hand so they are less likely to edit it with their intellectual mind).
Counselors may also need to help clients address another common symptom of survivor guilt: recurring nightmares. Armstrong finds imagery rescripting helpful here. The technique involves rewriting or changing the ending of the nightmare. Clients first describe the nightmare to Armstrong, and then she asks how they would want to change it.
Armstrong had a client whose son died by suicide. The mother felt guilty for not somehow preventing his death 鈥 which she feared had caused him to go to hell 鈥 and for cremating him when she wasn鈥檛 sure he would have wanted that. This guilt culminated in a nightmare in which her son was asking for help as he was being rolled into a furnace, but she was unable to move her body to help him.
Armstrong asked the client, 鈥淲hat do you wish you could do in the dream?鈥 The client responded that she wanted to move and go to her son. Armstrong then asked her to close her eyes and imagine a new ending 鈥 one in which her feet could move, she possessed the superpower to leave her body and go to her son, or her son was able to walk to her. The mother closed her eyes and reimagined the nightmare: The son got off the gurney and met her halfway. Then he embraced her and said, 鈥淚 love you, Mom. I鈥檓 sorry I didn鈥檛 get to say goodbye. I鈥檓 going to be OK.鈥 This revision brought an end to the client鈥檚 nightmares.
Counselors should have clients imagine their dreams and the new endings as vividly as possible, Armstrong advises. It typically requires going over this new ending several times in session and having clients imagine it again before bed. 鈥淚f you just talk about the ending without imagining it as best you can, it won鈥檛 work because your emotional brain needs that imaginal experience,鈥 Armstrong explains. The emotional brain learns through experiences, not reasoning, she says, so counselors must have clients create an experience that will allow them to heal.
According to Glaser, survivor guilt is rooted in pain. She advises counselors to help clients realize that 鈥済uilt in any of its forms is not really productive鈥 鈥 either for clients, for those around them or for those who are gone.
Medina-Wolf says clients often acknowledge being angry, depressed or anxious, even when guilt is the underlying cause of their problems, because it is more difficult to admit feeling guilty. 鈥淭hey feel like if they say it out loud, then maybe they are guilty,鈥 she observes. 鈥淭he guilt is so deep and they鈥檙e so [ashamed] of it because they鈥檙e so confident ... in that negative distortion that it鈥檚 literally killing them from the inside.鈥
It matters where that guilt is coming from, Medina-Wolf continues. Do they think they didn鈥檛 do enough? Do they feel they are a bad person who shouldn鈥檛 have survived? Counselors can help clients process exactly what they are experiencing and identify the underlying cause of the guilt, she says.
Often, the guilt is based on a fear of not knowing how to go back into a world they no longer trust, Glaser says. So, instead, they hold on to the guilt and the awful feeling of responsibility. 鈥淲hen we understand that, we can start to make some inroads,鈥 she continues. 鈥淲e can help the client know where it鈥檚 coming from.鈥
Armstrong points out that pain is also a way for some clients to maintain a bond with their loved one, especially if they experienced the death of a child or someone鈥檚 death by suicide. Clients may assume that living without the pain would suggest their loved one鈥檚 life wasn鈥檛 important, she explains.
She encourages clients to honor their loved ones by letting their importance stay alive in a positive way. Armstrong provides a personal example: Her husband enjoyed watching Atlanta Braves baseball games with his mother, so after she died, he and Armstrong continued to go to games to honor her.
One of Armstrong鈥檚 clients had a son who died of an overdose. The client鈥檚 happiest memory was of camping in the Grand Canyon with his son, but after his son鈥檚 death, the father鈥檚 sadness and guilt stripped him of his motivation to hike and camp. Armstrong asked the client to imagine whether his son would want his father to stop hiking to prove his love for him or whether he might prefer that his father do something that served as a positive reminder of their time together. After the father鈥檚 perspective was changed through this imagined conversation, he took a small step forward by going hiking. Eventually, the father and his wife planned a trip to the Grand Canyon in their son鈥檚 honor and spread some of his ashes there.
Armstrong also recommends using the making living stories technique, in which she invites clients to bring in photos or share stories about the deceased. However, she has found that if she asks clients to tell her a story about the person, their minds often go blank. So, instead, Armstrong will ask about the deceased loved one鈥檚 favorite music or food, about a trip the client took with the person, or even what annoyed the client about the person. These silly or trivial questions often end up producing the best stories, she says.
Armstrong also prefaces this technique with the phrase 鈥渨hen you are ready鈥 to ensure that discussing the loved one won鈥檛 create additional pain for the client. Counselors can put the invitation out there, and when clients are ready, they can work together to find ways to remember the loved one, she says.
There are times when the attempt to turn pain into something positive can result in others feeling even more guilt. For example, survivors or those who have perished in mass shootings for their bravery, such as in the case of Kendrick Castillo, a student who died trying to subdue an active shooter in his school in Colorado this past May. Glaser acknowledges the desire to honor those who perform heroic acts, but she also notes this action can create something of an expectation among adolescents that it is their responsibility to react bravely and save others during a school shooting. It can also exacerbate survivor guilt among those who followed safety protocols and hid behind their desks.
Armstrong is impressed when survivors take a horrible situation and become empowered, such as with the Parkland students鈥 gun violence advocacy work. However, she also acknowledges that survivors sometimes need to work on healing themselves first.
One of Armstrong鈥檚 clients had a daughter who died of a childhood cancer. Soon after her daughter died, the hospital and cancer community approached the mother about having a fun run in honor of her daughter and to raise money to battle the specific type of cancer. Her daughter鈥檚 death was too fresh though, and the mother ended up experiencing survivor guilt for not wanting to help create a fun run in her daughter鈥檚 honor.
To help the client, Armstrong had the mother imagine what her daughter would say about the situation. Armstrong knew a little bit about the daughter鈥檚 personality, so she mentioned the daughter would probably say that even she didn鈥檛 have time for a fun run because she was still learning to navigate the afterlife. This helped the client put her guilt into perspective and focus her energy on healing herself.
鈥淵ou don鈥檛 have to be a hero,鈥 Armstrong often reminds clients. 鈥淚f you decide to do something later, then that鈥檚 awesome. But [honoring a person鈥檚 life] may just be in little simple ways 鈥 I鈥檓 just going to take more time to appreciate a sunny day, be kinder to people or not take things for granted.鈥
Often, it鈥檚 easier to offer compassion to others rather than to oneself. This may be especially true for counselors. Super, an 乐博传媒member who presented 鈥淭he Shared Trauma of School Shootings and Their Impact on Counseling and Education鈥 at the 乐博传媒2019 Conference in New Orleans, admits he wasn鈥檛 good at self-care during the recovery after the Pulse shooting. As one of the coordinators of the grassroots recovery effort in Orlando, Super spent the majority of his time at different counseling centers helping survivors and supervising counselors, and at the end of the day, he often had nothing left in him to tend to his own self-care.
Months later, as he was researching and presenting on his personal experience with this large-scale traumatic event, he realized how it had affected him. 鈥淭hose thoughts [of 鈥榠t could have been me鈥橾 start coming to you, that guilt of 鈥榯his young person 鈥 just lost their life and I didn鈥檛.鈥 I think that is probably a quiet voice that sat in the back of my mind through the entire process.鈥
Super also witnessed counselors who experienced guilt over not feeling prepared enough or not knowing enough about trauma and the LGBTQ+ community. Other counselors felt guilty that they didn鈥檛 help with the recovery efforts because life got in the way or because they simply weren鈥檛 ready and needed to take care of themselves first, he adds.
Super would pay close attention to how counselors were responding 鈥 for example, if they didn鈥檛 want to meet with clients or walked off by themselves 鈥 and check in with them. He and the other two organizers weren鈥檛 able to be in contact with all of the mental health providers offering assistance, so they also trained counselors to be aware of colleagues鈥 behavior and check in with them as needed.
People don鈥檛 often think about the need for counseling supervision during a collective trauma, Super points out. 鈥淏ut if you have counselors out there, you really need to have supervisors who are debriefing or helping process emotions for those who are providing services in the moment,鈥 he says. He advises counselors and supervisors to make time for self-care. Talking about their feelings with another counselor, a supervisor or someone they trust will help counseling professionals recharge, and it will minimize the residual effects down the road, he notes.
Compassion also helps clients reframe their own guilt. Armstrong stresses the importance of providing psychological first aid 鈥 which includes making the person feel supported and safe 鈥 immediately after a traumatic experience. Armstrong has had sessions in which a client cried the entire time, and she felt guilty for not doing enough 鈥 only to discover that the client thought the session was extremely helpful. Outside of the counseling space, clients typically have to hold it together, she points out, so they often appreciate having a space where they can break down and not worry about others.
Armstrong who dealt with survivor guilt after the 2012 mass shooting in a movie theater in Aurora, Colorado. The client had been watching a movie next door and, on her way out, almost tripped over a woman who had been shot. She didn鈥檛 know how to help the woman, so she simply held her hand and called the woman鈥檚 mother. Discussing this with Armstrong, the client said, 鈥淎ll I could think to do for the gunshot victim in the parking lot was to sit there and hold her hand. I am in the health care field, and I felt completely incompetent.鈥
Armstrong reassured the client that she had done something valuable by offering the shooting victim compassion and psychological first aid, but the client still felt guilty for not doing more. While the client described the event again, Armstrong held her hand, which created an experience to demonstrate the power of compassion. When the client finished her story this time, she noted how the simple act of Armstrong holding her hand had helped her get through the story and made it seem less scary.
A few months later, the client ran into the woman she had helped after the shooting. The woman told her that the kindness of a stranger holding her hand was what replayed in her mind 鈥 not the horror of the event.
Armstrong acknowledges that counselors frequently worry about not doing enough, not knowing what to say to clients and not being able to rid them of all their pain. 鈥淎t the end of the day,鈥 she says, 鈥渋t鈥檚 just us being able to sit with [clients] through all of the confusion and the heartache that heals them.鈥
For many survivors, the weight of survivor guilt is heavy. But counselors can operate as levees to prevent the weight of this guilt from crushing those who survive.