The terrorist attacks of September 11, 2001 traum atized the nation and produced serious mental health issues for many residents in New York City. Unprecedented in nature and scope, this disaster produced trauma PTS symptoms both in individuals “directly” exposed, and in those “indirectly” exposed, whose needs often go unrealized. The main goal of this study was to broaden the concept of “exposure” used in the disaster trauma field. A mixed methodological approach, using qualitative techniques as the primary information gathering method, was utilized. Interviews were conducted with 26 mental health professionals who were “indirectly” exposed. Their physical, psychological and relational exposure to the attacks, prior trauma history, secondary traumatic stress (STS) issues and coping strategies were explored. The Impact of Events Scale-Revised (IES-R) was also utilized to capture current PTS symptoms, in addition to the respondents' self-report. This study offers support for the Etiological Hypothesis Model proposed by Foy et al (1992). Its findings indicate that indirect exposure to a terrorist disaster is particularly relevant and related to PTS symptoms in this sample. Respondents' exposure to the disaster through vision, both in person and through the media, olfactory sensation and through hearing the sounds associated with 9/11, produced tremendous upset and PTS symptoms. Striking was that almost half of the respondents still scored “moderate” to “extreme” on the IES-R, 30 months after the attacks. Levels of Secondary Traumatic Stress were also high among those clinicians who worked with clients with 9/11 related issues. Personal coping strategies such as the support of friends, family, and colleagues, use of religion, faith in one's self, and immersion in clinical work, were reported as reducing stress levels.

Results call for a new conceptualization of exposure level to terrorist trauma, in order to ensure that those at high risk for PTS symptoms are identified and receive trauma recovery support. A model with questions for an initial assessment to determine exposure risk following a disaster was suggested. Implications of the findings are included for social work clinical practice, disaster mental health administration, funding sources and policy. Recommendations for future research were identified. They are needed, as the trauma of 9/11 has not subsided in many.