Tag Archives: First Responders

Putting first responders’ mental health on the front lines

By Lindsey Phillips July 6, 2020

A firefighter/emergency medical technician (EMT) in Maine answers an emergency call. He grabs his gear and performs a job he knows well. The next day, he discovers that the person he helped has tested positive for COVID-19. He immediately starts worrying not just about himself but about his wife and young child, who have respiratory issues.

Amy Davenport Dakin, a licensed clinical professional counselor in Maine and a licensed clinical mental health counselor in New Hampshire, has been working with this firefighter/EMT for several years now. Before this incident, he had struggled with anxiety, depression, suicidality and posttraumatic stress disorder (PTSD), but with Dakin’s help, had successfully worked through many of these issues. This latest experience of being exposed to the virus that causes COVID-19 adds another layer of stress and anxiety that could negate his previous progress, Dakin says.

As the name implies, first responders such as EMTs, police officers, firefighters, paramedics, dispatchers and others are trained professionals who are the first to respond in emergency situations. Unless people happen to be facing an emergency themselves, this service often gets taken for granted, and little thought is generally paid to the accumulating toll on first responders’ mental health.

That calls for a reality check. “Our worst day is first responders’ every day,” points out Drew Prochniak, a licensed professional counselor (LPC) and licensed mental health counselor (LMHC) in private practice in Portland, Oregon. “Their days are filled with accidents, pain, grief, loss and trauma.”

According to a 2018 supplemental research bulletin from the Substance Abuse and Mental Health Services Administration’s Disaster Technical Assistance Center, depression and PTSD affect approximately 30% of first responders. In addition, 37% of fire and emergency medical services professionals have contemplated suicide, which is nearly 10 times the rate of American adults in general. In fact, in the United States, more firefighters die from suicide than from fires, Dakin notes.

It is easy to surmise that this population could benefit from therapeutic interventions, yet its members are often the last to ask for help. By getting to know the first responder community and tailoring approaches to match this population, counselors can break down some of the barriers that prevent these heroes from prioritizing their mental health.

 

Getting to know the culture

Dakin, a member of the American Counseling Association, acknowledges that it can be difficult for counselors who do not have previous experience with first responders to get a foot in the door with the community. Someone initially referred a firefighter to Dakin for counseling services, and the experience piqued her interest in working more with first responders. But first she had to earn their trust.

For approximately seven years, she attended labor union meetings, conducted trainings and presentations, rode along with first responders on calls, and hung out at their stations. This exposure allowed her to build relationships and trust within the first responder community and helped her determine that it was a population with which she wanted to work full time. Today she owns New Perceptions Inc. in Kingston, New Hampshire, a private practice that focuses on trauma and mental help treatment for first responders.

Prochniak, a former search and rescue professional and author of the book Addiction & Recovery for First Responders, agrees that establishing a relationship with a first responder department or agency is an important step toward overcoming community members’ belief that clinicians don’t understand their culture. “There’s this mystique about clinicians that we only want to talk about emotions and get in people’s heads,” Prochniak says. Building relationships with first responders outside of counseling sessions will show them that therapists are just regular people too, he says.

Prochniak, who specializes in the education, training and treatment of first responders, says there is a personality type that goes along with being a clinician who works with this population. Counselors must be able to handle hearing about grotesque experiences and communicate respect for the work that first responders do, he explains. With clients in law enforcement, this often means that counselors must be comfortable with clients having guns in session, he adds.

Prochniak cautions counselors against asking first responders about the worst thing they have seen, what type of gun they carry or whether they have ever shot someone. Instead, counselors should be curious about them as people: How long have they done this work? What led them to get into this line of work? How does their work affect their family? What kind of social network do they have? Do they hang out only with people from the first responder community? What else do they do outside of work?

Counselors will also need to be able to tolerate a dark, almost morbid, sense of humor because first responders often use that as a coping mechanism. “One of the ways we cope with trauma is with humor. And it can be really upsetting for people who don’t experience [what first responders do],” notes Carrie Whittaker, an LPC and LMHC in New York and Connecticut.

Prochniak points out that counselors must also be savvy about managing dual relationships. In addition to being a clinician in private practice, he is also a trainer and educator. At the start of every new client relationship with a first responder, he prepares them for the possibility of also bumping into him at trainings, briefings, meetings or ride-alongs. He makes it clear to these clients that he will not initiate acknowledgment of them in such circumstances out of respect for their confidentiality. “One wrong slip in acknowledging that you see someone [in counseling] or that you know someone else could cost you a client,” he explains.

In addition, counselors have to be flexible when working with first responders because they have irregular schedules, Dakin says. This might mean needing to conduct telehealth sessions or meeting with these clients outside of the typical 9-to-5 workday. There will also be last-minute cancellations, she points out. Dakin typically has a 24-hour cancellation fee, but she waives it for first responders who are stuck at work or otherwise have a good reason for not making their appointments.

In many ways, counselors may need to be on call themselves when working with first responders, Dakin says. When there is an emergency such as a line-of-duty death or an explosion, Dakin has to be prepared to drop everything, including her current caseload for that day, to respond. And if a client who is a first responder has a bad call on a Sunday, then she is also working that Sunday. Although it has happened infrequently, she has even had the labor union or clients call her as late as 10 p.m. because of an emergency.

Prochniak and Dakin both emphasize the importance of being humble when working with this population. “Although you are the professional in mental health, you’re not the professional in their field,” Prochniak explains. “Just because you know trauma or just because you know stress doesn’t mean you know this population. It shows up very differently … because this is a unique culture. So, get to know the culture. Spend time with them.”

No shame in needing help

The biggest barrier to first responders seeking help is the attached stigma — a false belief that if they need counseling, it means they are weak or unfit to do the job, Dakin says.

People often assume that because first responders signed up for the job, it means they are prepared to handle the associated trauma. But that’s not how the brain works, Dakin stresses. “The brain can only handle so much exposure to traumatic images before it’s on overload,” she says.

Joel Smith, an LPC in private practice in Denver, concurs that as a society, we do relatively little to acknowledge vicarious trauma among first responders. Although these professionals do generally possess an enhanced skill set to cope with trauma, they are still vulnerable to burnout, he says. Smith tries to normalize this reality for clients who are first responders by asking, “Has your stress been building up for a while? Is it exploding? How are you handling your stress?”

Whittaker, an ACA member who has a private practice in Manhattan and Westchester, New York, puts this idea of “being tough enough to handle it” into context for her first responder clients. She explains that being tough doesn’t mean that they never get upset or that nothing bothers them. It means processing those feelings to help themselves do their job better.

“It’s important for counselors to remind them that being tough enough to handle it doesn’t have to mean being hardened to it. It doesn’t mean that you don’t break down and cry sometimes,” she says.

First responders also have a tendency to not want to burden others with what they have experienced. Some of Dakin’s clients have said to her, “It’s a really bad call, and I don’t know if I want to put those thoughts in your head.”

Clinicians have to reassure these clients that counseling is a safe space for them to talk about their issues and experiences. When hearing difficult stories, Dakin says, counselors should refrain from sounding alarmed and making statements such as, “I can’t believe that happened! That must have been horrible.”

“While [that statement] is validating and has the best of intentions, that’s not what these people want to hear,” Dakin says. “They basically want to talk. They want to tell their story.” Counselors can validate that the client’s experience was tough without being too reactionary, she says, and that largely involves listening carefully.

Counselors should also remain aware of their facial expressions, Whittaker adds. If counselors look shocked or terrified, these clients will notice and be more likely to shut down.   

Smith, a therapist at Jefferson Center (a community-focused mental health care and substance use services provider in Colorado) and an associate at Look Inside Counseling, finds motivational interviewing an effective technique when first responders are hesitant to accept help from others. For example, Smith says, counselors can ask these clients, “How can you receive help yourself?” or “How can you model receiving help?” The technique allows first responders to develop some healthy discomfort with the fact that they are simultaneously heroes who help others and people who need help with their own problems, Smith explains.

“One of the best ways they can help themselves is to feel like they have a role in helping someone else,” Smith continues. That’s one of the reasons he encourages first responders who have benefited from counseling to tell colleagues about how it has helped them.

These clients could share an effective coping skill they learned in counseling with the rest of their team, or they could model self-care at work. “If you see someone struggle, that’s one thing. But if you see them struggle and overcome it, it builds the idea that it’s possible [for you too],” Smith notes.

Tailoring counseling to fit first responders

Prochniak, the mental health professional for American Medical Response in the Portland/Vancouver metro areas, finds that mindfulness, focused breathing and meditation techniques all work well to reduce first responders’ anxiety and stress levels and build their stress resilience. Sometimes, however, these clients can be hesitant to try such techniques, either because they perceive some stigma attached to the techniques or because of the way that counselors present them.

One approach that can help break through this hesitation is finding concrete ways of translating clinical speech into first responders’ everyday language, Prochniak says. For example, if he’s working with a paramedic, he will discuss how mindfulness techniques strengthen the parasympathetic nervous system. If he’s working with a client in law enforcement, he will reference combat breathing, which is how these professionals already describe the use of deep breaths to calm down or reduce stress.

Dakin frequently convinces first responders to give mindfulness and yoga a try by explaining the science behind the exercises. She often compares how the brain processes trauma with what happens with diabetes: Just as elevated levels of glucose in the body worsen when the pancreas does not work correctly, experiencing too much trauma causes an overload of chemicals to be dumped into the brain. Then the brain responds by releasing cortisol. Breathing and mindfulness exercises help reduce that response and regulate chemical levels.

Similarly, the traditional way of presenting and explaining yoga doesn’t match with the culture of first responders, Dakin notes. When she first encourages these clients to try yoga, the response is typically along the lines of, “I’m not going into a studio wearing spandex and meditating.”

To counter this negative perception, Dakin recommends a yoga program designed specifically for first responders (yogaforfirstresponders.org). The program gears its language to fit the culture, she says. For example, it renames child’s pose as a warrior’s pose, which is a more strength-based term. Dakin now knows some first responders who practice yoga on the job to regulate their breathing and avoid going into fight-or-flight mode as quickly.

Smith has discovered that some of his clients find it helpful to conceptualize grounding techniques as a workout. They have a “grounding buddy,” and together they work on their awareness, he says.

Dakin also uses familiar language to help first responders get more comfortable with mindfulness. For example, rather than having firefighters use a numerical scale to describe how upset they are, she uses the fire danger warning scale, which estimates the existing and expected fire risk for an area. The scale is color-coded, moving from red (extreme danger) to green (low danger).

If a client says they are in the red, then Dakin has them breathe deeply while imagining their arrow moving into a safer level. She explains how each breath is calming their nervous system. This skill has become a special language that she shares with her clients. A client may start a session by saying, “I was in the red a couple of times this week, but I breathed and at least got myself into the yellow.”

Dakin also explains to clients that mindfulness doesn’t have to be limited to sitting still and taking deep breaths. It can take the form of something they normally enjoy doing, such as fishing, taking a walk, kayaking or hiking, as long as they are doing it mindfully.

Managing anxiety

First responders often get anxious anticipating what their day might hold. “Schedule and routine are the enemy of anxiety,” says Smith, who specializes in trauma, mood management, addiction, and LGBTQ-specific needs. First responders can incorporate comforting activities such as walking their dog or calling a family member at certain times throughout the day. “Having that kind of expectation in life leaves less room for anxiety to happen,” he explains.

He encourages his clients to make grounding a part of their daily routine. They can ground themselves when they wake up, when they shower or when they go to bed. They can also ground themselves on the way to work, Smith points out, taking a few minutes when they are at a red light and noticing what’s happening around them: “I’m stuck in traffic. A kid is riding a bike beside me. It’s raining. A song I like is playing on the radio.”

Smith advises clients to set phone reminders to ground themselves. Even if they can’t check their phones that minute, they will be reminded later. Then they can take two minutes before going back to work to breathe and be aware of the way their body feels, their surroundings and their emotions.

Grounding can also be a preventive measure, Smith adds. “If you walk into an emergency and you’re already grounded, then you’ll be better off on the back end of that emergency,” he says.

As clients progress with their grounding skills, Smith asks them to visualize grounding themselves during an emergency on the job. This involves visualizing the person in front of them who is having the emergency, as well as all the chaos and turmoil unfolding around them, while also being aware of their body and their role in the situation.

“It sounds counterintuitive to have them visualize chaos, but first responders are going to experience that during their day, and then they can ground themselves in the midst of this chaos,” Smith says. This is an advanced grounding skill and not appropriate for first responders who have just started therapy, he points out.

Processing the trauma

Trauma is no stranger to first responders. They see people die and watch people suffer, all while working long hours. And they often feel unable or powerless to help, Smith says.

Some first responders also wrestle with guilt over choices they made during an emergency. “When you have to make a decision in a split second, that’s something that can be really haunting. It might mean saving your life or saving someone else’s life but sacrificing something or someone else,” says Whittaker, who specializes in working with trauma.

“Trauma makes us think horrible things about ourselves and our own abilities,” Smith says. For example, a highly skilled emergency room nurse may suddenly doubt their skills if multiple people die during their shift one week. The nurse may suddenly feel out of control or useless.

Smith finds trauma-processing therapies such as eye movement desensitization and reprocessing (EMDR) and trauma-focused cognitive behavior therapy effective with the first responder population. These therapies help clients process their feelings about the trauma while learning to separate themselves from unhealthy thinking.

Because emergency situations are filled with chaos and unpredictability, it is often difficult for first responders to slow down and think about what they can realistically control, Smith says. He often has clients journal about what they can and can’t control.

“They can have control over their own beliefs about themselves and what their own purpose is. And that can be enormously helpful in a trauma environment,” Smith says. With EMDR, clients are able to look at a task that gives them anxiety, reduce that anxiety, and feel more confident to perform that task, he adds.

Behavior patterns can be telling

Dakin often detects PTSD and emotional problems by looking for behavioral shifts or irregular behavior patterns with first responders. For example, a first responder who has been working in the department for 20 years without any issues may suddenly start yelling at the fire chief and refusing to follow rules. When this happens, the labor union often asks Dakin to perform an evaluation to figure out what might be going on.

Counselors should also be aware of behavior patterns around substance use. “There’s a huge co-occurrence of substance abuse and trauma,” Smith says. “So, if you work in an environment where you’re going to see and experience trauma, then … you’re more likely to develop a substance abuse problem.”

First responders might not necessarily be battling a long-term addiction or engaging in binge drinking, Prochniak says. They might just be spending their days off work each week casually drinking because they find their home life less exciting than their work life, he observes.

Both Prochniak and Smith encourage counselors working with first responders to ask about their substance use, including amount, frequency and any changes over time. “If that problem exists, then it’s usually helpful to manage substance abuse habits before working on trauma,” Smith advises.

Prochniak also encourages clients to notice when they experience the itch to have a drink or use drugs and to think about what that itch (the substance use) is trying to scratch. Are they anxious, bored, unsettled? Together, they then figure out a plan to address the underlying issue. “Breaking it down into this smaller view of what’s behind the drinking [or substance use] can be helpful,” he notes.

Developing transition plans

All the stress and trauma of the job can spill into first responders’ personal relationships. “People who are going through trauma can be emotionally up and down, so a first responder may be angry or irritable, if not explosive, sometimes,” Smith says. “Maybe they will cry a lot or be super anxious and not be able to really be in a room with [family or friends] because they have pent-up energy.”

First responders often need help learning how to transition from work to home, where the rules may be different, Prochniak says. For example, if a firefighter works a 24-hour shift (followed by 48 hours off), their partner is in charge of the house for those 24 hours. When the firefighter returns home, they may be upset because they expect the house to be clean and organized like it is at work.

Prochniak and Smith help these clients develop transition plans to better manage the boundaries between work and home. Smith encourages his clients to perform self-checks before heading home from work. They can ask themselves, “Where am I right now? How am I feeling (angry, sad, anxious)? What do I need before I go home?” His clients often discover they need to take 30 minutes for themselves. They may go for a run, sit in the car and listen to music, read a book or grab a bite to eat before they are ready to take on the demands at home.

Prochniak recommends that first responders use the following transition strategies:

  • If they’ve had a rough day at work, text or call their partner to provide a heads-up.
  • Take 30 minutes to exercise either at a gym or on equipment they keep in their garage to process the cortisol and neurotransmitters that have accumulated over the course of their shift.
  • Change their clothes at work so that they don’t wear their uniform home. Prochniak often advises clients to look at the shoes they’re wearing. If they are wearing their duty or work boots, then they are at work. If not, then they are at home. This serves as a reminder of the role they are in and what their expectations should be.

Helping first responders support themselves

First responders operate in a close-knit community. “They protect each other, but they also don’t know what to do [to help one another],” Dakin says. She recalls a client who found his co-worker’s behavior troubling, but he wasn’t sure how to provide assistance because he didn’t want to get his friend in trouble or for his friend to get mad at him.

One of the best things counselors can do to support this population is to educate them on healthy ways to help one another. Dakin works with a program (offered by the International Association of Firefighters and the Professional Firefighters of Maine) that trains firefighters to look for warning signs that a co-worker may be struggling and to intervene before it turns into a mental health crisis.

According to Whittaker, peer support often works better than group therapy for this population. Group therapy places people who have been taught to swallow their feelings and just “deal with it” in a setting where they may fear what a therapist will push them to say and how their peers will react, she explains.

Peer support, on the other hand, “takes the therapist out of the room,” Whittaker says. “It is led by people who have been through it and people who can find that common ground. It feels less like therapy and more like people just hanging out and talking, which is a much safer experience for them.”

Dakin recently helped some firefighters/EMTs launch a peer support recovery group. Even if she is present in the group, she lets the first responders lead. She is there not as a counselor but as moral support, she says. If the group asks for her clinical advice, she provides a quick blurb on how the brain works or offers tips such as how to get better sleep. She then fades into the background and lets the group take control again. The goal, she says, is for the first responders to support one another.

Responding during COVID-19

The “invisible threat” of COVID-19 currently looms over first responders, Prochniak says. When they pull up on scene or respond to a call, they no longer know what to expect. They have to assume that everyone is sick or symptomatic, so they wear protective gear and practice physical distancing as best they can while still performing their jobs.

Clients have told Prochniak that although the number of emergency calls has decreased, the overall intensity of those calls has increased. More calls have been made related to suicide and domestic violence.

Most first responders are anxious about what the future holds, Dakin says. They worry about the health of their families and co-workers and their own health. They are concerned about people in the community who often rely on their services and who aren’t calling right now. And they are anxious about the types of calls they will receive once call volumes return to normal.

Prochniak is helping his first responder clients manage their anxiety over the COVID-19 pandemic by having them focus on what is in their control. They may not be able to reduce their threat of being exposed to the virus, but they can develop a plan for what they would do should they be exposed. Would they live in the garage, in a tent in the backyard, in a hotel? How would they handle child care?

Whittaker admits that listening to first responders’ experiences can be difficult, but she also appreciates that they are willing to share something so personal with her. She makes a point of ending each session on an uplifting note. They might talk about how the client demonstrated bravery, how much the client has improved at using a particular counseling skill or how an experience worked out better than the client expected.

“When you see change in somebody’s life,” Whittaker says, “it’s easier to hear these difficult stories because you have a role in making it a little better for them.”

 

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Why do cops avoid counseling? Eight myths about law enforcement officers and mental health treatment

By Jessika Redman January 23, 2018

Most clinicians who work with law enforcement officers will tell you that the experience can be a little different. Sometimes, it seems to incorporate elements of a spy thriller. First, the call from the unknown number. Then, the interrogation from the unidentified caller, asking about your experience with cops, your ability to keep secrets and if you are in any way affiliated with the department. James Bond must be on the other end of the phone.

Let’s start by exploring the impacts that a career in law enforcement can have on officers. Law enforcement officers are a special population (like military and paramilitary personnel and other first responders) who experience coexisting medical and behavioral health issues with links to job-related stressors. According to a landmark study published by researcher John Violanti with the University at Buffalo in 2012, various factors contribute to the very serious physical and mental health concerns experienced by many law enforcement officers. These factors include:

  • Shift work
  • Long hours
  • Unpredictable schedules
  • Exposure to critical incidents
  • Being the frequent focus of public attention and criticism
  • Various physical demands
  • High rates of on-the-job injuries

The major concerns identified in Violanti’s study are high blood pressure, insomnia, heart disease, diabetes, posttraumatic stress disorder, obesity, depression, anxiety, cancer, substance abuse, relational distress and suicide. This special population often presents with higher rates of depression, substance abuse and suicide than does the general public.

In the October 2010 Issue of the FBI Law Enforcement Bulletin, Daniel Mattos, a law enforcement veteran for more than 30 years, described the psychological impact of police work: “By the very nature of what we do as police officers, we are unavoidably exposed to a host of toxic elements that can be likened to grains of emotional sand that ever so gradually are placed on our psychological backs. As time goes on, the sand increases in volume. Without the proper tools to remove it, the weight can become unbearable. In fact, in some cases, the sand becomes so heavy that it can collapse officers. The result of the sand’s weight takes a heavy toll on us; substance abuse, anxiety, depression, failed marriages, and other emotional and physical ailments that rise well above societal averages plague our profession.”

In an international meta-analytic study completed in 2012, researchers Claudia Morales-Manrique and Juan Valderrama-Zurian identified strong links between the high-demand/low-control nature of police work and the high stress levels that negatively impact the physical and mental health of police officers. In high-demand/low-control careers, individuals are required to be at constant peak performance levels, stemming from the unpredictability and wide range of scenarios that can be presented to them.

Research suggests that officer rates of completed suicides are three times higher than in the general population. In January 2014, Perry Mason, a retired Canadian constable (police officer), publicly described in an interview with The Hamilton Spectator his suicidal thoughts and a very near suicide attempt during his career. During 34 years of service, Mason also recounted that seven of his fellow officers had died from suicide. Mason admitted that he sought help, but also kept it highly secret because of his fears of possible repercussions to his career. He never disclosed his suicidal thoughts until after he retired.

 

Dilemmas and challenges complicating treatment

The high rates of physical and mental health conditions among law enforcement officers reflect the need for medical and behavioral support and treatment. However, treatment resistance is often a significant barrier.

In 2002, the American Psychological Association recognized the need to take a closer look at law enforcement as a special population and to define guidelines for forensic psychology. Ensuring public safety requires that officers are mentally, emotionally and physically stable and deemed “fit for duty” to perform effectively.

Law enforcement personnel often struggle to manage the challenges associated with competing demands. Very intense and difficult circumstances must be addressed while simultaneously mitigating the impact those demands have on personal health and well-being. Seeking and adhering to needed medical and behavioral treatments can present specific dilemmas and challenges.

Law enforcement officers are legally and ethically mandated to maintain good physical and mental health. However, the stressors these individuals face, ranging from inconsistent shift work to frequent and unpredictable threats to life, result in both physical and emotional challenges for the majority of officers during an average career. Law enforcement employers are legally obligated to verify and monitor officers to ensure physical, mental and emotional stability, as well as job performance capability. As a result, any signs of behavior that are in question, either on or off duty, are subject to scrutiny by the officer’s department or chain of command.

Every single law enforcement officer undergoes fit-for-duty evaluations that entail a combination of psychological testing and interviewing. In the book Practical Police Psychology: Stress Management and Crisis Intervention for Law Enforcement (2006), Laurence Miller writes that failure of the evaluation may result in job loss or suspension. An unintended consequence is that the majority of officers are hesitant to seek help with mental, emotional, relational or even physical issues because it could result in their inability to work.

According to retired police officer and psychologist Joel Fay in the April 2012 issue of the POA Journal, officers presenting with medical or mental health concerns often struggle taking medications as prescribed to address symptoms. Officers are restricted from having certain types of medications in their systems. For the safety of the public and the officers, police departments have policies against the use of certain classifications of medications such as strong painkillers and benzodiazepines. An officer-involved accident or shooting is often subject to a review of the incident that includes blood tests to determine the possible presence of chemicals or medications that may have played a role in the incident. Officers recognize that doctors may be unaware of these restrictions. Unable to fully understand the classifications of medications, officers may consequently resist taking prescribed medications.

So, what can we do as clinicians to help reduce the stigma and minimize the fear that going to counseling has for many law enforcement officers? The first step is to help officers understand their rights to privacy. I asked the legal experts at Bruno, Colin & Lowe P.C., with more than 60 years’ combined experience in protecting the rights of law enforcement officers in Colorado, and Mariya Dvoskina, a police and public safety psychologist with Nicoletti-Flater Associates, experts in the evaluation and critical incident response for law enforcement officers, to give me “just the facts.”

Collectively, we identified eight myths that keep many law enforcement officers from seeking support through counseling. Because each state may have some independent legislation in this regard, it is important for clinicians to verify the legal standards in the individual states in which they practice.

 

The myths

Myth #1

Departments/agencies have the right to obtain information about officers that seek help from licensed mental health professionals.

False! Licensed mental health professionals are legally and ethically bound to protect client privacy. If an officer reaches out to a therapist on his or her own — in other words, if the officer wasn’t ordered to see a therapist by a court or the officer’s department — then the employer doesn’t even have the right to know that the officer is attending therapy. Nothing that is said in counseling can be released to anyone without the officer’s written consent. The U.S. Supreme court has ruled that the confidential relationship between a psychotherapist and an officer is privileged. To learn more, see http://www.apa.org/about/offices/ogc/amicus/jaffee.aspx

The only times confidentiality can be broken are for the reasons below, which apply to every client/patient.

  • A suspected incident of child abuse or neglect must be reported.
  • A threat of imminent physical harm by a patient must be reported to law enforcement and to the person(s) threatened.
  • A mental health evaluation must be initiated for a patient who is imminently dangerous to self or to others, or who is gravely disabled, as a result of a mental disorder.
  • A suspected threat to national security must be reported to federal officials.
  • Suspected abuse of a senior adult (70 years of age or older), including institutional neglect, physical injury, financial exploitation or unreasonable restraint, must be reported.

 

Myth #2

Rights to privacy change if you use your insurance or employee assistance program (EAP).

False! Treatment by a licensed mental health professional that is paid for by your insurance company or your EAP is protected by HIPAA (the Health Insurance Portability and Accountability Act), and the same rules apply.

Sometimes patients choose not to use insurance benefits so that their outpatient treatment remains separate from their medical record.

 

Myth #3

There is no reason to see a licensed professional because the rules are exactly the same with a peer support team.

False! Limits to confidentiality vary by department and the standards may be different than those that licensed professionals have. The peer support member must disclose these limitations in the first meeting. In addition to the exceptions to confidentiality listed in Myth #1, most peer support teams are also expected to report crimes and sometimes policy violations. Outside of those limitations, conversations between a peer support member and an officer are confidential.

 

Myth #4

The department or agency automatically has a right to know if an officer receives a mental health diagnosis or takes medication.

False! HIPAA protects both diagnosis and medication or other treatment methods because they are part of the clinical record and therefore confidential. If an officer would like the department to know this information, he or she must sign a release of information. Otherwise, the professional treatment provider cannot disclose anything related to the client/patient to the department or anyone else.

 

Myth #5

If an officer seeks help from a hospital or a rehabilitation facility voluntarily, the department automatically has the right to this information.

False! The department can only access information that an officer has granted it permission to have, as is the case with any other medical condition.

 

Myth #6

If an officer is placed on an M-1 hold, he or she automatically loses their right to carry and possess a firearm.

False! When there is a court-approved certification for an involuntary mental health hold, restrictions to weapons are limited while the certification is active. If the provider that requested the certification acknowledges that the client/patient is no longer a danger to themselves or anyone else, then the restriction can and should be released as well.

 

Myth #7

If an officer seeks the support of a licensed mental health professional, that automatically means that the officer is not fit for duty.

False! Seeking counseling voluntarily would NEVER automatically mean that an officer is unfit for duty.

 

Myth #8

Counseling is the same as a fit-for-duty evaluation.

False! The most important question to ask is “Who is the client?” If the officer is seeking support on his or her own, all of the rights stated above belong to the officer. If the department is the client, as is the case in a pre-employment evaluation or a fitness-for-duty evaluation, then the information most often belongs to the department.

 

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Jessika Redman is a licensed professional counselor, a national certified counselor and the founder of Well Relate LLC (http://www.wellrelate.com) in Castle Rock, Colorado. Contact her at jessika@wellrelate.com.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Bridging the divide between police and the public

By Kylen Farrell December 8, 2016

In a 2012 Counseling Today article titled “Counselors: Support local police by sharing your skills,” counselor educator Diana Hulse and retired police Capt. Peter J. McDermott advocated for counselors and counselor educators to serve their communities by training local police in interpersonal skills. They made the case that interpersonal skills are not inherent, but that they can be learned when taught according to counselor education best practices. They also emphasized the need to integrate interpersonal skills training in police academy curricula nationwide.

This past spring, Fairfield University’s Counselor Education Department and the Center for Applied Ethics sponsored a pilot interpersonal skills training program designed by Hulse for local police. As a current school counseling graduate student, I was invited to participate as an interpersonal skills coach. Through this experience, my eyes were opened to the immense potential for interpersonal skills training to change the culture of law enforcement and improve relations between police and the public.

The pilot program

Four sergeants and three officers from five police departments in the state of Connecticut participated in the pilot training program. After meeting the participants and speaking with them about their jobs, I came to realize that police work involves high-stakes interpersonal demands. I found myself contemplating the complexity of the interpersonal tasks that police personnel routinely carry out, including delivering death notifications and intervening in domestic violence situations.

I was astounded to hear that police personnel typically negotiate these challenges without first undergoing specific training courses for interpersonal skills. In response to this gap in police training, the pilot interpersonal skills training program designed by Hulse, chair of the Fairfield University Counselor Education Department, models the type of instruction that needs to be implemented into police academy curricula. A key objective of the pilot program is to help police-smallpolice personnel develop an awareness that using effective interpersonal skills can create and foster positive relationships within the communities in which they work.

Hulse and McDermott operated as lead instructors with help from 13 volunteers — a mix of faculty, licensed counselors, practicum supervisors, alumni and current students who served as skills coaches. The training was organized around three categories: setting the stage for effective interactions, gathering information and evidence, and summarizing and confirming information and evidence. Skills for these categories were taught and evaluated according to standard interpersonal skills instruction carried out by counselor educators. Verbal and nonverbal attending skills, door openers and minimal encouragers were covered first. Focusing, paraphrasing, reflecting feelings and confronting were reviewed next. Clarifying and summarizing were examined last.

Each training session commenced by introducing skills in a slideshow format. The significance of the skills and their utility in the field for police personnel were then discussed through lecture and rounds. Groups of two to three participants and one to two coaches broke off into separate rooms to practice the skills until the participants demonstrated them successfully. Finally, the coaches delivered verbal and written feedback to the participants. Between sessions, participants completed reflection forms on their learning and their ideas for future improvement.

At the program’s conclusion, participants were asked to complete an evaluation form about the training. In support of the original mission of Hulse and McDermott, participants unanimously agreed that interpersonal skills training would improve the curricula of police academies.

As one participant stated, “This training needs to be introduced ASAP. As the divide between the police and the public grows, we need to start developing the skills that will bridge this unfortunate gap. The skills learned in this class would produce a more well-rounded officer, who is able to interact with the public on a much higher level.”

Personal reflections

Leading up to this training, I was slightly intimidated by the thought of working with a group of police personnel, partially because of the stereotyped image of them being tough, stern individuals with guns strapped to them. My confidence wavered as I questioned whether I was qualified to coach these individuals, some of whom possessed up to 20 years of professional experience in their field. Furthermore, I wondered whether the participants would be open to learning skills that might seem “touchy-feely.”

My uncertainties were resolved quickly as I discovered that the participants were extremely open to learning material that was outside the norm for them. They continually expressed appreciation for the efforts of the instructors and coaches. This increased my confidence and helped me realize that over the course of my own training, I had developed many skills and insights that I could share with participants to improve the effectiveness of their interpersonal interactions.

At the start of each new session, I listened to the participants excitedly share stories about using their new skills on the job. Their execution of the skills demonstrated to me that interpersonal skills can, in fact, be taught, learned and applied to various fields. In addition to mastering specific skills, the participants reported being more aware of the perspectives of others, and more empathetic in general in their daily lives. These stories confirmed for me the positive impact the program had on these participants.

I learned valuable lessons while working with the participating police personnel that will enrich the remainder of my studies and my future career in counseling. In observing how eagerly the participants awaited feedback on their interpersonal skills, I was inspired to adopt greater openness toward the feedback that I receive as I prepare for my practicum and internship.

I also witnessed the effectiveness of learning in relationship with others. The participants shared that it was stimulating to interact with their fellow learners in such a dynamic way. Watching them grow closer as a group each session and gain appreciation for perspectives that were different from their own has encouraged me to focus on relationship building in groups as a future school counselor.

In light of the success of the pilot training program, I urge other counselors and counselor educators to support their local communities by offering interpersonal skills training to police personnel and departments. These programs not only would result in more effective interpersonal skills being practiced in the field of law enforcement, but also would increase the visibility of the counseling profession and enrich the academic experiences of counseling students. These results align directly with the mission of the American Counseling Association “to enhance the quality of life in society by promoting the development of professional counselors, advancing the counseling profession and using the profession and practice of counseling to promote and respect human dignity and diversity.”

My experience confirms the various benefits of providing interpersonal skills training to law enforcement personnel. Embarking on this journey offers counseling students and professionals the chance to work with a unique population, serve their communities, share their knowledge and practice their interpersonal skills and feedback delivery. I am grateful that I was presented with the opportunity to take part in this groundbreaking program during my studies, and I strongly encourage other counselors and counselor educators to sustain the effort to provide interpersonal skills training to police.

 

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To follow the latest news and developments in the initiatives of Diana Hulse and Peter J. McDermott, visit their website, talktrumpstechnology.com.

 

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Kylen Farrell is a graduate student in the school counseling program and a graduate assistant in the Counselor Education Department at Fairfield University. She is a member of the American Counseling Association and the American School Counselor Association, and is co-president of the Gamma Lambda Chi Chapter of Chi Sigma Iota. She recently received the Connecticut School Counselor Association Graduate Student of the Year Award and was inducted into Alpha Sigma Nu, the Jesuit honor society. She will be starting her school internship in the spring. Contact her at Kylen_farrell@sbcglobal.net.

Letters to the editor: ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for getting your article accepted for publication, go to ct.counseling.org/feedback.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

First to respond, last to seek help

By Lynne Shallcross August 1, 2013

helmetFive years ago, Matthew Carlson responded to the call of a house fire. It was a relatively routine part of his job. A certified firefighter and medical first responder, Carlson was no stranger to trauma, but the tragedy he witnessed that day would stand out from all the others.

As Carlson was providing CPR to one of the victims, he glanced around the lawn to see several children lying near him unconscious. The fire would claim the lives of four children and a woman who was pregnant. Carlson calls the experience the straw that broke the camel’s back and an event that eventually led to a call of another kind — becoming a counselor.

Soon after the fire, Carlson started noticing signs of posttraumatic stress disorder (PTSD). He decided to take a step that many other first responders hesitate to take and sought counseling. “I had lost who I was and felt I had to reach out or I was going to self-destruct,” he says.

“I purposely sought out a faith-based counselor because I wanted to work with someone who held the same worldview,” Carlson says. “He first took inventory of all the traumatic events that had been particularly bothersome over the years. This was good because many of these events I had not talked about or to the extent necessary to provide insight. He used a faith-based form of guided imagery where I imagined the incident. He helped me discover core beliefs I held about the incident. We concluded each incident by praying and asking God, ‘What would Christ say in this moment? About this scene? What would he say to you?’”

Carlson was affected so deeply by the counseling he received and by how it helped him overcome his PTSD that he decided to seek a degree in counseling and focus his research on firefighters. After earning his master’s degree, he also started Resilience Consulting, through which he offers training and education on psychological resilience to first responders.

Carlson describes working with one firefighter client who was struggling with PTSD, just as Carlson had in the past. The client and his partner had fallen through the floor during a house fire and almost died. “Before we could get to the heart of [the client’s] PTSD, I spent hours and hours listening to his war stories and letting him unload years and years of the trauma he saw but never talked about,” says Carlson, a member of the American Counseling Association. “You see, he was taught to ‘suck it up,’ and he was a pro. He refused to say the word feelings, which I then dubbed the ‘F-word.’ As he described how he fell through the floor, became disoriented, injured and separated from his partner, he cried for the first time in 10 years. He briefly looked at me and saw tears rolling down my face. It was at that moment that he knew I understood and it was OK to ‘F.’ We spent our remaining sessions using a combination of guided imagery and systematic desensitization to bring about incredible healing and growth.”

Carlson was a limited licensed professional counselor in Michigan, where he was also still working as a firefighter, before relocating to Colorado. He is now employed by an area mental health center while working toward licensure in his new state and pursuing his doctorate in advanced human behavior from Capella University. “I am dedicating myself to emergency service counseling full time and have decided not to pursue firefighting again until after I finish my doctorate,” he says. “However, it is unlikely that I will work full time as a firefighter [again]. I will most likely volunteer in my local community, wherever that may be.”

Not a pro-counseling culture

Matthew Carlson and his wife, Rebecca, attending a fellow firefighter's wedding in 2007.

Matthew Carlson and his wife, Rebecca, attending a fellow firefighter’s wedding in 2007.

Carlson says his motivation is to break down the barriers between first responders — such as firefighters, police officers and EMTs — and mental health treatment. He says first responder culture is characteristically resistant to discussing mental health or seeking treatment for it. “There’s an understanding that, ‘Hey, we don’t talk about this,’” Carlson says.

According to Carlson, when traumatic experiences are encountered on the job, first responders historically have been encouraged to get over them quickly because they have duties they need to continue performing. “It’s a sign of weakness to bring anything up,” he says.

It’s little surprise then that first responders fear “losing face” and may avoid counseling, Carlson says. “There needs to be a way to get help without fear of reprisal,” he adds.

Brian Chopko, an associate professor in the Department of Sociology at Kent State University at Stark, is a former police officer who began conducting research on police officer mental health while earning his master’s and doctorate in counseling. The stigma surrounding mental health treatment is prevalent within police culture, Chopko asserts. He points out that officers worry they might be skipped over for promotion if word gets out they have sought counseling.

There is an element of secrecy and insulation to the police culture that also serves as a barrier to seeking outside help, says Chopko, who also works as a reserve deputy sheriff and is an instructor with his county’s crisis intervention team. Part of that insulation stems from the distrust that sometimes seems to exist between police officers, the public and the media, he says. Chopko explains that police officers often find themselves in “damned if you do, damned if you don’t” situations in which they anticipate facing public criticism or other negative consequences regardless of their actions.

For instance, Chopko says, if a police officer encounters someone with a gun and doesn’t react quickly enough, the officer risks being killed. But if the officer shoots too quickly, the media might portray the police as being unnecessarily brutal. It makes sense then that police officers sometimes maintain an insular mindset and believe that the rest of society, including counselors, don’t truly understand what they go through, says Chopko, a member of ACA.

That said, Chopko and Carlson think the tide is slowly turning and more light is being focused on the importance of mental health care within first responder culture. Part of that is attributable to the growing awareness and discussion of mental health in the media and society at large, Carlson says, and part is due to first responders waking up to tragic happenings such as firefighter suicides within their own culture. In fact, Jeff Dill, a licensed professional counselor and professional firefighter, has been working since 2010 to collect firefighter suicide statistics (read a Counseling Today online exclusive article about Dill here).

Within police culture, Chopko says, there is a push to pay more attention to mental health issues among officers because administrators have come to see that neglecting mental health care ends up being more costly in the long run. “Officers missing work and being off on sick leave costs the department,” Chopko says. “Also, the department spends a lot of money training officers over many years. So, if the officer retires early or quits due to mental health issues, the agency has to spend more money to train new officers.” Chopko adds that the growing awareness may also come from the officers themselves, who tend to be better educated than in past years, including on the topic of mental health.

Chopko believes the focus on mental health care among first responders will continue to expand in the future because researchers and mental health professionals are showing a growing interest in the community. Chopko says this may be partly influenced by the increased attention being given to the effects of stress among military veterans.

Making a connection

Brian Chopko, in 1995, after he began working as a reserve deputy sheriff in Ohio.

Brian Chopko, in 1995, after he began working as a reserve deputy sheriff in Ohio.

A significant element of reducing stigma within first responder cultures, Chopko says, is to educate this population early on about how people experience stress and emphasize that what they are feeling, or may one day feel, is completely normal. In Chopko’s experience, it is rare for police officers to share their feelings and symptoms of stress with one another. So, when officers do feel stressed or overwhelmed, they may regard it as an indication that they are weak or unable to do their job. “Other officers go through similar things, but [they] don’t talk about it,” he says.

For counselors interested in working with first responders as clients, offering trainings at a police station or firehouse, with the administration’s approval, can be a win-win. Trainings offer the counselor an inroad to finding potential clients, while providing first responders an opportunity to learn about mental health symptoms and issues without initially having to go against their culture and seek out counseling.

Chopko conducts police officer trainings on PTSD through his county’s crisis intervention team, which offers another access point for reaching first responders. Chopko says each time he does a training, officers pull him aside and ask questions about how to deal with the stress they are under. Counselors can find out about working with crisis intervention teams in their area by contacting their local police department or sheriff’s office, local board of mental health or local chapter of the National Alliance on Mental Illness, all of which may know about or be directly involved with the teams, Chopko says.

Working as an employee assistance program provider for a firehouse or police station is another option for connecting with first responders, he adds.

Because first responders typically won’t show up at a counselor’s office without having heard about the counselor ahead of time, Carlson emphasizes that counselors must be proactive and intentional about building their reputation within this particular client population. “Meet them where they are,” he says. “Visit the local firehouses, police stations and ambulance bays. Request to ride along to get a feel for the culture. Immerse yourself in their world for an afternoon once a month and let them know you just want to understand what they go through.”

Ride-along programs are fairly common in public safety departments, Carlson says. “I suggest calling the station and inquiring directly by asking if they have a ride-along program,” he says. “Don’t be alarmed if they’re a little skeptical about you doing ride-alongs. It’s nothing personal. It takes time to establish trust, and that’s your mission. Tell them you would like to find out what their job is like. That’s what a ride-along program is all about. You won’t need to overemphasize that you’re a counselor. The point of riding along is to take that first step and [allow] the first responders to check you out and see that you’re a safe person, while you observe firsthand how they operate.”

As a next step, consider offering resilience training or educational sessions on stress, adrenaline and psychological performance enhancement, Carlson advises. “If your intent is to offer training with a dual goal of making yourself available for counseling, be up-front about it. Don’t secretly hope they will come see you. Tell them what your motives are.”

Carlson also emphasizes that counselors shouldn’t overlook volunteer-based departments, which he says make up more than 75 percent of fire and emergency medical services departments nationwide. “I would … make the case that the volunteers need more intervention, especially if they serve in a rural area, due to the low call volume and underexposure to traumatic incidents,” he says. “They don’t run enough calls to become resilient. They need our help. It has been my experience that the lower the call volume, the more receptive the department is to openly addressing mental health issues.”

Thinking ahead

If first responders do begin seeing a counselor, they may be afraid of their colleagues finding out. Counselors can take steps to make the process more comfortable for these clients, Carlson says. For instance, he recommends having a separate entrance and exit. That way, when first responder clients leave the counselor’s office, possibly in uniform, they won’t have to go back through a lobby where other clients might be waiting.

Also worth thinking about, Carlson says, is where these clients can park if they are driving a first responder vehicle. A parking lot around the back of a building might be preferable to parking on the street, where others are likely to notice an emergency or police vehicle. The point, Carlson says, is to make it as easy and comfortable as possible for first responder clients to enter and leave the counselor’s office unnoticed.

For that matter, he says, “If your practice allows it, be willing to go mobile for sessions. For many first responders, the thought of being seen at a mental health clinic is enough to keep them from coming.”

Unfortunately, Carlson says, even when first responders take the bold step of seeking help, they too often encounter mental health professionals who don’t understand what these clients do for a living or grasp the day-to-day challenges they face. “This requires the client to first explain the job and then explain the problem,” he says. “This has to change.”

“Don’t think you have to be a first responder to help a first responder, but do take the time to understand the culture,” Carlson says. Among the elements he says are common to the culture of first responders is a high level of cohesion and trust within their respective departments, a requirement to perform in extreme circumstances and take calculated risks, a belief in the power of personal sacrifice and a connection to the local community. Counselors can seek training to learn more about what it means to be a first responder and how to work with them, Carlson says. One such training he recommends is offered through Helping Heroes at helping-heroes.org.

Chopko also suggests that counselors read the revised 2006 edition of Ellen Kirschman’s book, I Love a Cop, published by Guilford Press. Although the book was written for families and loved ones of police officers, Chopko says counselors can learn about police culture by reading it.

Relationship first

When counselors work with first responders as clients, Carlson suggests putting treatment planning aside in the beginning in favor of a focus on building rapport. Building rapport will go a long way toward establishing trust in the therapeutic relationship. This is key, Carlson says, because based on the work culture in which they were groomed, first responders may initially be less trusting of the counselor’s services than the average client.

Chopko echoes Carlson. “Trust is a very important thing,” he says. “If someone feels they’re going to go to you and someone else might find out, that will prevent them from coming back.”

Once trust and rapport are established, Chopko and Carlson say counselors can move forward to address whatever issues are at hand. Given the nature of what first responders spend their lives doing, signs and symptoms of PTSD may be a common issue.

Carlson is no stranger to it, having experienced PTSD himself. It is a significant issue for first responders, he says, because although many are at risk of experiencing it, a substantial number don’t understand it.

Carlson says when he begins talking about the signs and symptoms of PTSD in trainings, firefighters often nod their heads in recognition. “It’s giving it a name,” he says. “It’s like, ‘OK, now I know what I’m dealing with.’”

Chopko points out that police officers are exposed not only to a greater frequency of traumas but also to a greater variety of trauma types than is the general public. They not only experience situations in which they are at personal risk of death or physical harm but also regularly find themselves in situations where they witness others being killed or seriously harmed. Additionally, Chopko explains, firefighters don’t normally experience intentional violence that is directed at them, whereas police officers often do. In his research, Chopko has explored posttraumatic stress among police officers who have been seriously injured during an assault versus during an accident. He says the rates of posttraumatic stress tend to be higher if the injury was incurred during an intentional assault.

Being exposed to those traumas, regardless of their nature, can lead to PTSD among police officers, but developing PTSD should not be regarded as a given, he cautions. When thinking about PTSD, mental health providers need to realize that people react to the same situations in different ways, he says. So, some police officers may be deeply affected by what they see and experience, while the impact will be less disturbing for others.

Chopko points out that the common cluster of symptoms for PTSD in the Diagnostic and Statistical Manual of Mental Disorders includes reexperiencing, hyperarousal and avoidance. On the basis of the research he has conducted, Chopko adds guilt and shame as symptoms that may be related to potential PTSD.

Giving the ‘warrior’ a way forward

Working on resilience training with clients who are experiencing trauma or PTSD can be helpful, Carlson says. First responders can’t leave their jobs, so the stimuli will continue. Therefore, the
only option is teaching them how to bounce back and be resilient after each traumatic situation. Having a purpose larger than one’s job, building self-reliance and developing a support system are all elements to increasing resilience, Carlson says.

In his research, Chopko is looking at the effectiveness of mindfulness-based treatments with police officers who are dealing with PTSD. “In theory, [mindfulness] could be helpful because avoidance is such a big part of PTSD,” he says. “[If] you were involved in a traumatic experience, when you think about it, talk about it or see people who were there, it makes the symptoms go up. So, you avoid talking about it or thinking about it. That doesn’t work in the long run. It actually intensifies the symptoms.”

If avoidance intensifies PTSD symptoms, Chopko’s thinking is that mindfulness might have the potential to decrease symptoms. Mindfulness is the ability to accept without judgment, he says, and is thus the opposite of avoidance.

Chopko adds that counselors who are going to treat first responders or any other clients for PTSD should be specially trained and be using empirically validated treatments such as cognitive processing therapy and prolonged exposure therapy.

Because stressful situations are an inevitable part of a first responder’s life, teaching these clients relaxation techniques, such as breathing techniques for stress reduction and progressive muscle relaxation, can be helpful, Chopko says. “To account for some officers viewing this as ‘wimpy’ and not taking it seriously, counselors can present breathing relaxation techniques as something commonly practiced by kung fu warriors,” he suggests. “Also, breathing exercises are taught to our military special forces to handle the stress of going into life-threatening combat. They are taught this as ‘combat breathing.’ So, counselors can present breathing exercises as something that elite warriors do so it does not distract from the tough exterior mindset common among officers.”

Chopko also introduces the idea of elite warriors in another way — by incorporating a “compassionate warrior” concept in his work with police officers. He originally created the concept for use in training officers through his local crisis intervention team. It combines the ideas of serving a larger purpose, treating those who are vulnerable with compassion and empathy, and yet still remaining tough in “battle.”

“My hope is that facilitating a sense of purpose in life — [the idea] that being an officer is more than a job, it is a calling — will help officers better cope with, or act as a buffer against, occupational stress as well as physical harm,” Chopko says. “Officers often receive more negative than positive sentiment from the people they come into contact with on a daily basis as well as the larger community. So, to emphasize that they are part of a proud warrior tradition and highly valued may be important.”

 

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When the ‘protector’ is gone

First responders’ roles and responsibilities aren’t tough only on first responders themselves. They’re also tough on first responders’ loved ones. Lisa Jackson-Cherry, professor and chair of the Department of Counseling at Marymount University in Arlington, Va., serves as a counselor during National Police Week, which occurs each May in Washington. She grew up with close family members in law enforcement, her husband is a police officer, and the first master’s degree Jackson-Cherry earned was in criminal justice.

Jackson-Cherry, a member of the American Counseling Association, first got involved with National Police Week seven years ago. During the week, she and her colleagues provide two days of group counseling to children and adolescents whose parents have died in the line of duty as police officers. Jackson-Cherry is the lead counselor for the “returning survivors” groups, which are composed of children and adolescents who have been to National Police Week at least once before.

When a family loses a parent who was a police officer, Jackson-Cherry says, there is sometimes a simultaneous loss of identity because the family no longer feels as much a part of the greater “police family.” Negative stereotypes concerning police officers can also complicate a family’s grief. Some of the kids with whom Jackson-Cherry has worked have told her their peers have expressed less sympathy for them, saying things such as, “Well, your father shouldn’t have pulled that person over.”

Many police officers work long shifts or even extra shifts, and that can lead children who have lost a parent in the line of duty to feel some anger, Jackson-Cherry says. Children might harbor thoughts that their parent should have been safe at home instead of working long hours and getting caught in a situation that claimed the parent’s life.

Children may also feel like they have lost a “protector” after a parent who was a police officer dies, Jackson-Cherry says. “Children of police officers often grow up thinking their mother or father is a good person — the one who protects good people from bad people,” she says. “When a police officer parent dies, they may think, although it may be exaggerated due to the profession of the parent, ‘Who is going to protect me from bad people since my protector is no longer here and was killed protecting [other] people?’ Often, these children have intense fears of losing the other parent,” especially in cases in which both parents are on the police force.

Because Jackson-Cherry’s time with the children during National Police Week is short, she says her goal is “planting the seed that counseling is OK.” She tries to normalize the grief process and the children’s feelings, raise awareness to the likelihood that they may reexperience some of those feelings in the future and suggest support options, such as visiting a school counselor, should they need them in the future. Jackson-Cherry and her colleagues also remain on the lookout for any child or adolescent who needs immediate and more significant help and work to ensure that help is in place after National Police Week.

To contact Lisa Jackson-Cherry, email LJackson@marymount.edu.

— Lynne Shallcross

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To contact the individuals interviewed for this article, email:

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Letters to the editor: ct@counseling.org

After the smoke clears: Counselor raises awareness of mental health challenges faced by firefighters

Heather Rudow June 17, 2013

DSCF2369When running into burning buildings is part of your job description, it’s understandable that your profession might have a substantial impact on your emotional and mental well-being.

But for reasons Jeff Dill can’t explain, inadequate focus has been placed on the mental health care of professional and volunteer firefighters. “In the fire service, we can teach you how to use ropes and ladders, we can teach you search-and-rescue [techniques], we can even teach you how to exit out of a window head first,” he says. “But there has not been a lot of training on [the fact that] you may also see some depression or PTSD or suicidal ideation.” Dill would know. He is both a licensed professional counselor and a professional firefighter.

In fact, Dill has taken it upon himself to bridge the gap between counselors and firefighters by creating Counseling Services for Firefighters (CSFF) and the nonprofit Firefighter Behavioral Health Alliance (FBHA).

CSFF, which Dill founded in 2009 after receiving his master’s in counseling, offers behavioral health support to firefighters and provides workshops to educate counselors on the emotional challenges and culture of firefighters. The following year, Dill founded FBHA, an organization focused on educating firefighters about suicide prevention and awareness.

Dill, a member of the American Counseling Association and the Illinois Counseling Association, has been a career firefighter since 1995. He is currently a captain at the Palatine Rural Fire Protection District in Inverness, Ill. But it was Hurricane Katrina in 2005 that made him realize he wanted to do something tangible to help his fellow firefighters.

Katrina, one of the five deadliest hurricanes in U.S. history, was blamed for the deaths of more than 1,800 people. It also left a lasting mark on rescue personnel who tried to help in the aftermath of the storm.

“I spoke to a lot of firefighters who went down there to help, and they had to do a lot of horrific things, like pulling dead bodies out of water,” Dill says. “They really wanted someone to talk to about what they went though.”

Unfortunately, he says, many of the firefighters who returned felt a disconnect between themselves and the mental health professionals they turned to for help. Many firefighters didn’t think the therapists truly recognized what they had experienced or understood their culture, so they stopped seeking the help they needed.

So, Dill began to consider becoming a counselor, thinking it was a way to give back to the profession he loved.

Firefighters are faced with emotional needs unique to their occupation, Dill says. The percentage of firefighters struggling with career-related stress is marked as “very high.” A 1995 study revealed that 16.5 percent of firefighters had diagnosable PTSD, which was approximately 1 percent higher than PTSD rates among Vietnam veterans. In comparison, the rate was 1 to 3 percent in the general population.

Research from the nonprofit Sweeney Alliance reports that many firefighters don’t feel their families understand the magnitude of their duties or the emotional toll their job takes on a daily basis. This can result in higher rates of divorce, addiction to alcohol, drugs or gambling, and suicide.

“There are a lot of counselors who don’t understand our culture,” Dill explains. “And because of our culture, things are internalized, [so firefighters] may not have had anywhere to turn. There is the mindset of, ‘Let’s not ask for help. I don’t want anyone on my company to know I have these signs of weakness because I don’t want my company to think I can’t handle these things.’”

“When I was in school getting my master’s degree,” Dill continues, “I realized my professors and [fellow] students had no idea what I was talking about, when I thought I was speaking about Firefighter 101.”

It was on the basis of that experience that Dill decided to create CSFF, with the goal of helping to foster communication about the mental health needs of firefighters. Since that time, he has traveled all over the country holding workshops to educate both firefighters and counselors about suicide prevention and the mental health needs of firefighters.

Not long after CSFF began gaining traction, Dill started getting phone calls from people all over the world asking whether he had statistics on firefighter suicides. “I didn’t know we had a problem [obtaining] them” until that point, Dill recalls.

Dill began collecting reports through a confidential reporting system in late 2010. “After much research and effort, I realized this was a much larger issue than I had originally thought,” he says.

That is when Dill decided to expand his reach and founded FBHA, through which he now collects this data. He has been tracking firefighter suicide data internationally since the beginning of the year.

Dill says FBHA is the only organization he knows that collects data on firefighter suicides nationally as well as globally. The most up-to-date numbers can be found on the organization’s website at ffbha.org. As of June 17, there have been 348 documented in the United States, with the earliest dating back to 1880. The numbers include both active and retired firefighters who died by suicide. Dill has been actively requesting that fire departments across the United States report suicides from their department’s history to the present. No names are used unless families give permission.

This year, FBHA has also launched a scholarship program that will provide higher education financial assistance to surviving children and spouses of firefighters who died by suicide.

The five scholarships, ranging from $500-$1,000, will be determined by the amount of funding donated to the program. The scholarships are named after U.S. firefighters who took their own lives and whose families Dill has met.

“We’re very excited that we can offer something back to the children and families of firefighter suicide,” he says. “I think it’s important that we don’t forget about the family members because after a suicide, there’s not much to offer them.”

Dill notes that when a firefighter dies by suicide, there is no state or federal compensation for his or her family.

“When a firefighter dies in what we call a line of duty death, there is both state and federal compensation to the family,” he explains. “Yet, the issue is for those firefighters who took their lives, how many suffered due to the horrific calls they have experienced in their career? At this point, there is no state or federal compensation.”

In the future, Dill would like FBHA to sponsor a weekend retreat for spouses and children of firefighters who have died by suicide. He wants them to meet so “they can learn that they’re not alone out there in the world.”

Although Dill thinks there is a long way to go in terms of society recognizing the mental health needs of firefighters, he says “the tide is definitely turning.” He notes he has also witnessed more of a vested interest within the counseling community to help this unique client population.

He recommends that counselors who are interested in taking on firefighters as clients adopt a proactive approach. “Take some time to go up and introduce yourself to the department. Go out for rides.” Dill says local fire departments are an important resource for counselors and can help counselors better understand the culture.

It is also important that counselors receive specialized training to learn about firefighter culture and how best to help, Dill says.

For information about workshops that are available for continuing education credit through Dill’s organization, or for information about applying for the scholarships, visit ffbha.org and csff.info.

 

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Heather Rudow is a staff writer for Counseling Today.

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