Tag Archives: First Responders

A mental wellness program for law enforcement

By Margaret Taylor August 14, 2023

A headshot of a white male police officer.

Fractal Pictures/Shutterstock.com

For more than 16 years, I have had the privilege of working closely with law enforcement. I spent the first nine years of my career as a mental health counselor working alongside law enforcement in the investigation process as a forensic interviewer and counselor for victims of abuse. This relationship allowed me to better understand the unique culture and needs of law enforcement, and I realized officers had unmet mental health concerns.

After leaving that position, I opened a private practice, where I had the opportunity to develop a relationship with Jay Turner, the chief of police for Alexander City, Alabama. As a mental health advocate, he also saw the growing need for mental wellness in his department. To address this need, I collaborated with Turner and developed a mental wellness program for law enforcement. I have implemented this program in three different police departments, and it has been successful in helping improve the mental wellness of law enforcement officers. In this article, I discuss the components of this mental wellness program and share my experience using it.

Barriers to seeking help

Several barriers prevent law enforcement officers from seeking help for mental health concerns. In a study published in JAMA Network Open in 2020, Katelyn Jetelina and colleagues found that officers did not pursue mental health treatment for four reasons:

  • They did not know they were experiencing a mental health issue.
  • They were concerned about confidentiality.
  • They feared being misunderstood by the counselor.
  • They worried they would be found unfit for duty because of the stigma around mental health.

Silence in police departments also serves as a significant barrier to officers seeking mental health treatment. In a USA Today article on the Capitol riots published in 2021, Nicholas Wu and Courtney Subramanian discussed how the culture of silence at some police organizations minimizes the experiences of trauma and stress related to the job. Officers are trained to be in control of everything around them, so if they feel they are not in control, they become confused and unsure how to cope. When this happens, they often remain silent rather than ask for help. This mentality contributes to isolation, relationship problems and ultimately the perpetuation of mental health issues.

Counselors working with law enforcement can ensure they are taking steps to remove these barriers by adopting a mental health program designed for law enforcement. This program policy should stress the importance of confidentiality and assure clients that privacy will only be breached when an officer is found to be a danger to oneself or others. Officers and counselors can emphasize that the wellness program is not a fitness-for-duty examination. In my experience, approaching this immediately often leads to the officer relaxing and trusting the process more.

Police departments should also seek a counselor who is sensitive and educated on the culture of law enforcement, which will decrease the likelihood that officers feel misunderstood or judged. It is also crucial counselors encourage law enforcement leadership to promote mental wellness in their departments and reduce the stigma that prevents officers from seeking assistance.

Components of the mental wellness program

Officer wellness should be a priority for every police department, so they can better protect their officers and community members. Counselors can work with police organizations to develop a mental wellness program that contains the following four components, which I have found to be effective in my own work: a formal mental health policy, supportive department leadership, trained and culturally aware mental health professionals and a mental wellness framework.

Create a mental health policy. The Law Enforcement Mental Health and Wellness Act of 2017 calls on federal and local law enforcement departments to adopt mental health practices, including regular mental health checks. Central to a mental wellness program is the development of a formal departmental policy. Captain Brian Nanavaty with the Indianapolis Metropolitan Police Department reported in a 2015 article in the FBI Law Enforcement Bulletin that mental health counselors and law enforcement must work together to create organizational policy on mental health for it to be effective. Agencies can dispel fears of repercussions for seeking mental health by creating a policy that requires or mandates mental health treatment for all officers, not just those who have experienced traumatic incidents. I have found that requiring all officers to attend one therapy session a year decreases mental health stigma within the department and increases the likelihood that officers will seek help on their own.

After five years of using this program in three local police departments, I have found that stigma has decreased significantly, and individuals now talk openly and without shame about making counseling appointments. In addition, those in leadership such as sergeants and lieutenants now recommend officers attend counseling when they openly discuss their struggles.

Work with administrative leadership. For a mental health program to be successful, the leadership in the police department must be supportive and educated about mental health. In a 2016 article published in Police 1, Alethea Olson and Mike Wasilewski modified the National Alliance on Mental Illness’ nine suggested ways to fight mental health stigma to meet the needs of law enforcement. I have found the following three suggestions from that list are crucial for law enforcement leadership to follow:

    • Leadership speaks openly about mental health. When leaders promote mental wellness, officers feel safer to seek mental health assistance.
    • Leadership educates themselves on mental health. Counselors can provide evidence-based research on the benefits of mental health to leadership so they can help educate their officers about the benefits.
    • Leadership displays empathy for those struggling with a mental illness. The police department should align themselves with a counselor in the community who is trained to work with law enforcement. Then, leadership can refer individual officers to this counselor when they need assistance.

I was fortunate enough to work with a police chief who followed these guidelines, but if this does not exist in your community, consider encouraging or discussing these suggestions within leadership in the police department.

Be trained to work with law enforcement. The third piece to designing a mental wellness program for law enforcement is making sure mental health professionals have been trained to work specifically with law enforcement and understand the culture within law enforcement.

Counselors must communicate that counseling is a secure place for police to talk about their experiences and express their needs. It is essential counselors do not immediately address traumatic experiences. Trauma-informed care stresses the importance of establishing coping strategies before processing trauma. For the safety of the officer, you must assess current adaptive and maladaptive coping strategies before discussing potential trauma as well as establish trust with the officer. Trust is foundational to any therapeutic relationship, but even more so with law enforcement.

I have found that during initial counseling sessions, officers may be angry for being told they must come to therapy, nervous about what to expect and hesitant to trust someone outside the police department. Thus, it is essential counselors attend to these feelings, create a safe space and make sure the officer (who is trained to be in control) still feels they have a sense of control in session. To give officers some control in session, you can tell the officer you are not going to force them to talk or stay. If they don’t want to talk, they are free to leave. You can also give them control by allowing them to choose what they want to talk about. I have found this helps ease tension and makes the client more receptive to counseling.

The success of this mental wellness program also depends on the counselor’s familiarity with the culture of law enforcement. I strongly advise counselors to develop working relationships with local law enforcement leaders, which will increase the counselors’ understanding of police culture. You can accomplish this in a variety of ways. You could schedule meetings with law enforcement leadership and ask them to tell you about policing and their department. You can also see if it’s possible to have a meet-and-greet with the officers; I found this approach helpful because officers were able to meet me before their appointment, which helped reduce their anxiety about the process. And do your own research to learn more about the culture. I have found the website police1.com to be a helpful resource to better understand the culture.

Counselors must also be prepared to handle the unique circumstances of law enforcement. This includes being comfortable with officers who may attend session in full uniform and be armed and listening to graphic details of events experienced while on duty, such as car accidents, homicides, suicides and sexual assaults. Giving the officer a safe and trauma-informed space to discuss these graphic details is important, but as the counselor, you need to be prepared to hear these details and mitigate the potential for your own vicarious trauma.

Counselors must also be able to tolerate a morbid sense of humor, which is a common coping strategy for officers during traumatic events and a way of bonding with each other while on duty. Officers are often hesitant to admit they have a morbid sense of humor for fear of being judged, so it is important counselors normalize this experience for officers and avoid passing judgment for this coping and bonding strategy.

Use a mental wellness program framework. This wellness model is a simple guiding framework that can be modified according to the counselor’s approach and the needs of the officer. Counselors can use the Indivisible Self model as a guide for the wellness program. This model includes five factors: the essential self (the spirituality of the person, their cultural identity and self-care practices), the creative self (a person’s emotions, control, humor and thought patterns), the coping self (a person’s stress management, self-worth and leisure activities), the social self (a person’s friendships and ability to love) and the physical self (a person’s exercise habits, sleep patterns and nutrition).

I often find the Indivisible Self model to be a safe and noninvasive starting point for the officer to evaluate their current wellness because the officer is in control of how much they share about themselves. Here is a process counselors can follow when using the Indivisible Self model with law enforcement:

  1. The counselor provides psychoeducation on the Indivisible Self model.
  2. The counselor reviews the benefits of living a healthy lifestyle.
  3. The counselor asks the officer to evaluate each individual area of wellness within the model. This process helps the officer gain self-awareness and an awareness of both their strengths and areas of change.
  4. The counselor helps the officer create goals for improvement in some wellness areas. The goals should be realistic for the officer and the demands of their career.
  5. The counselor provides psychoeducation on the symptoms of posttraumatic stress disorder (PTSD) so they can recognize them in themselves or their fellow officers. Moreover, counselors should educate officers on how to practice self-care and prevent the development of PTSD, burnout and other mental health concerns.

The discussion of the Indivisible Self model, in my experience, often increases the chance that the officer wants to return to counseling. You have created a trusting relationship and given the officer control, and now they feel safe enough to make changes in their lives.

It is also important that counselors offer interventions that are practical, easily understood and approachable. Counselors who have worked with law enforcement have found mindfulness techniques, deep breathing and meditation to be effective in decreasing anxiety and stress, and ultimately increasing resilience.

In the Counseling Today article “Putting first responders’ mental health on the front lines,” Lindsey Phillips discusses how law enforcement and other first responders often find the transition from home to work challenging. I have also found this to be true in my work with law enforcement. If officers are not able to transition from work to home successfully, then they may experience relationship problems. Counselors should help officers make a plan that will help them effectively transition home.

Conclusion

Having a mental wellness program and mandating that law enforcement attend one wellness session with a mental health professional opens the door for counselors to encourage officers to be self-aware and prioritize self-care. Some officers may want to continue counseling, and then clinicians can use practices that will address the officer’s specific mental health concern. The department will not be informed if the officer returns for additional sessions, as long as they are not at risk of harming themselves or others.

To summarize, here are some things counselors need to keep in mind when implementing a mental wellness program for law enforcement:

  • Learn about the culture of law enforcement.
  • Develop relationships with leadership within the police department.
  • Teach administration about mental health and the benefits of mental wellness.
  • Work with leadership to develop a formal policy for the mental wellness program.
  • Take time to meet officers before implementing the program.
  • Do not force officers to talk or stay in their initial session.
  • Do not judge the officer for a morbid sense of humor.
  • Avoid discussing traumatic experiences in the initial session.

Traditionally, law enforcement is a helping profession, one that involves placing the needs of others above oneself. In doing so, officers often neglect their own physical, mental and emotional health. Therefore, officer wellness must be a priority for every department to protect their officers and community members. Counselors can use the steps discussed in this article to implement a mental wellness program in their community and help law enforcement begin to prioritize their mental health moving forward.

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Editor’s Note: Parts of this article were included in “Building resilience in law enforcement through a mental wellness program” published in the Journal of Police and Criminal Psychology (2022). This article has been revised to include original content for Counseling Today.

 


headshot of the author, Margaret Taylor

Margaret Taylor is a professor of practice and coordinator of the clinical mental health program at Auburn University. She is also a licensed professional counselor supervisor and owns a private practice in Alexander City, Alabama, where she specializes in treating first responders and trauma. Contact her at barnema@auburn.edu.

 

Counseling Today reviews unsolicited articles written by American Counseling Association members. Learn more about our writing guidelines and submission process at ct.counseling.org/author-guidelines.


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.

Don’t forget school counselors on the list of first responders 

By Jetaun Bailey, Cheryl Allen, and Morgan Alford August 4, 2023

School counselor sitting in a classroom with a pen and clipboard. Talking to a teenage student.

VH-studio/Shutterstock.com

The American School Counselor Association states that school counselors assist students with concentrating on their academic, professional and social/emotional growth so these students can succeed in school and be ready to lead fulfilling lives as contributing members of society. Based on our experience, however, there is a significant role related to mental health — which falls under the heading of social and emotional growth — that is often disregarded. School counselors are first responders to mental health concerns. 

Who are first responders? 

The U.S. Homeland Security Presidential Directive 8 defines “first responders” as “those individuals who in the early stages of an incident are responsible for the protection and preservation of life, property, evidence and the environment, including emergency response providers …, emergency management, public health, clinical care, public works and other skilled support personnel … that provide immediate support services during prevention, response and recovery operations.” 

The national Mental Health First Aid program has broadened the first responder role to include people who, through specialized training, can identify, understand and respond to signs of mental illness and substance use problems. This cutting-edge public education training enables individuals to approach someone who may be experiencing a crisis or developing a mental health or drug use problem and provide that person with the early support and treatment they require. The National Council for Mental Wellbeing and the Missouri Department of Mental Health manage and operate Mental Health First Aid, a training course to help people identify, understand and respond to signs of mental illness and substance use disorder. 

Unfortunately, it seems that many people don’t naturally associate school counselors with the role of mental health first responder, even though it is imperative to their work (and the same holds true for teachers). In fact, school counselors may naturally take on the role of mental health first responder without even realizing it.  

The school counselor’s role in responding to mental health crises extends beyond simply making the proper referrals to the right people. School counselors must maintain control and defuse situations before making these referrals, which might happen right away or may take days. School counselors engage with students who are having suicidal thoughts or emotional breakdowns caused by loss or personal trauma. Other common scenarios include students struggling with anxiety or depression after receiving a poor grade, a failure to live up to parental expectations causing issues at home, and inferiority complexes that feed into low self-esteem and a desire to quit school. The school counselor must be prepared to handle these mental health crises as a first responder even though the crises may occur at any time throughout any given day in the school building. 

School districts are increasingly offering in-house mental health services coordinated in conjunction with outside providers. However, this does not diminish the responsibility that the school counselor has at any given time to respond quickly and convey concerns to the mental health coordinator at the school. For instance, during the time that we (Jetaun and Cheryl) worked together as a school counselor and school counselor intern in Alabama, Hurricane Katrina caused a surge in the number of children transferring from schools in Louisiana. We suddenly found ourselves trying to help an influx of new students with issues such as missing grades, ongoing academic preparation, worry and anxiety about adapting to a new environment, and the depression that could arise from it all. In response, we had to collaborate to develop programs and resources and think quickly as new scenarios arose. We carefully surveyed each student’s situation and assessed their needs, just like any first responder would, to prevent problems from being exacerbated. This is an example of what school counselors can experience, even if their district offers additional mental health services. 

A 3-step approach to helping students  

Counselor and young adults sitting in a support circle. All clapping hands after one kid shares their story.

SeventyFour/Shutterstock.com

We believe that school systems should invest in their school counselors (and teachers and other school professionals) by providing additional mental health first aid training. School systems could also consider other measures to aid school counselors in further developing their overlooked role as mental health first responders.  

We propose that the path to resolving many of the mental health issues that today’s students face can be broken down into three components: 

  • Awareness
  • Commonality
  • Communication

Morgan Alford, who recently graduated from high school, helped us with this three-step idea during her senior year (with the approval of her parents). Her insights were based on her firsthand experience of problems as a high school student and the multiple testimonies she heard of how students struggle in high school settings. We therefore thought it appropriate to include these components and elaborate on what Morgan believes can aid school counselors in their sometimes-unwitting capacity as first responders to mental health issues. 

Awareness 

In Morgan’s experience, high school students do not generally understand common problems such as anxiety and depression. Absent additional context or complexity, these concepts can hold a wide array of meanings for high school students. We believe it would be helpful if mental health was included in the curriculum to teach students quick lessons, facilitate group conversations and provide a general mental health vocabulary check. 

Educating students about anxiety and depression concerns might decrease the amount of time school counselors and other professionals spend assessing emergencies. With this understanding, students might be able to describe what they are feeling much more clearly, as opposed to not knowing how to articulate what they are experiencing. This pre-planning would enable the school counselor to offer the student the best assistance and recommendations. This situational awareness also clarifies the challenges that school counselors confront every day and improves their understanding of how to react swiftly and effectively to circumstances.  

Commonality 

Teenagers are often unaware of how prevalent some of their internal conflicts are. From their perspective, maintaining the status quo might seem simpler than acknowledging the inner fears or struggles they think they are handling alone. The definitions and words acquired through the “awareness” component can be made more personal for teenagers by offering statistics — exactly how many of their friends are experiencing some type of mental or emotional struggle — and advancing the discussion about why these numbers are rising.  

Morgan told us that rather than merely acknowledging their own issues with mental health, individuals need to understand that improving student mental health as a whole is a goal to work toward.

Communication  

Communication is the third, and arguably most important, component. Once teens are aware of what constitutes mental health, understand how common issues are and can recognize struggles within themselves, a safe environment has to be established for them to feel comfortable talking to an adult or counselor about something so personal. The people best equipped for these situations are school counselors, but according to Morgan, many high school students aren’t aware of the role of their school counselors or where they are located. It is important to announce and establish these connections with students while also making it crystal clear that confiding in these counselors about anything at any time is acceptable. 

Additionally, when counselors and authority figures develop one-on-one relationships with students, this better fosters an open and positive mental health culture in schools. For example, students could respond to questionnaires or Google Forms that counselors use to initiate small, but meaningful, conversations. Just one-minute, individual meetings between a student and a counselor can open a gateway to alleviating a teen’s inner turmoil. 

Even under ideal conditions, there are always outliers — students who are more private, more reserved or more volatile than others. The key to reaching all students is meeting them where they are comfortable rather than imposing on their boundaries. Students want to feel like individuals and young adults rather than patients waiting for treatment. Practicing empathy, understanding that baring one’s soul to another is terrifying and knowing how to comfortably move past that will yield results. Vulnerability is a gradual process, but toeing the line between peer and authority figure can go a long way.  

As this article demonstrates, school counselors can unwittingly serve as first responders in the field of mental health. There are steps that can be taken, or simply reinforced, to improve awareness, shared experiences and communication that will ostensibly aid in assessing mental health crises when they occur. 

Bringing the components to the school counselor 

Many school counselors perform the unrecognized task of being a first responder to mental health crises. According to research, the demands placed on first responders — including their repeated exposure to crisis situations — can cause stress that exacerbates depression and anxiety. Given that school counselors must deal with resolving daily crises that may increase their stress levels, especially in more challenging school environments, we may speculate that this is an underlying factor in school counselor burnout. This is similar to what is observed with first responders such as firefighters, police and others.  

School counselors may frequently work in isolation, depending on the size of the school. As a result, crises may interfere with their regular schedules or duties, adding a great deal of unnoticed stress to their lives. We believe school counselors could use components such as awareness, commonality and communication to ease some of their stressors. These efforts could be carried out through their local school districts or among their own colleagues.  

Awareness involves raising school counselors’ recognition of what they might be experiencing if they are not taking breaks or if they are taking work home to catch up. This can help school counselors become more mindful that work is extending beyond the workday and into their personal time.  

Because some school counselors work alone, districts should put in place budgets that fund attendance at state or national conferences so that individuals can share experiences (commonality) and gain additional resources as their positions as school counselors are becoming more complex and demanding.  

Finally, as it relates to communication, districts should host monthly or bimonthly meetings for school counselors to discuss pressing issues that they may be facing within themselves or as a result of workload responsibilities and what those workload responsibilities look like for each individual.  

First responders routinely meet situations head-on and provide the appropriate services or resources thereafter. In the case of school counselors and teachers, this service isn’t always recognized or applauded. Once we properly understand the load that comes with repeatedly handling crises, more resources should be provided to help alleviate the emotional heaviness that occurs for these professionals day to day. The recognition of a job well done should be more commonplace in the lives of first responders — including school counselors. 

 


Jetaun Bailey holds a doctorate in professional counseling and supervision. Jetaun is a college professor, a professional licensed counselor, an evaluator and a certified school counselor. Contact Jetaun at jetaunbailey@gmail.com. 

Cheryl Allen is an educational specialist in school counseling, holds instructional leadership certification and is a certified school counselor. Cheryl is an assistant principal at Montevallo High School. Contact Cheryl at Allen1908@yahoo.com. 

Morgan Alford is a recent graduate of Mount Juliet High School. Her professional aspirations are to be a writer and media producer. Morgan will enroll at Tennessee State University this coming fall, where she received a scholarship for her academic achievement. Contact Morgan at mealford05@yahoo.com.  


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.

Developing competence to address undue police violence

By Darius Green May 10, 2022

In the summer of 2020, many of us were reminded about the tense relationship between law enforcement and those who are Black, Indigenous and people of color (BIPOC), particularly Black Americans. Just a few months prior to the breaking news of the murder of George Floyd, the killing of Breonna Taylor and several others whose deaths came to the national spotlight, I had successfully defended my dissertation that investigated undue police violence and counselor preparation. In the recently published article from my dissertation, “Undue police violence toward African Americans: An analysis of professional counselors’ training and perceptions” (October 2021 Journal of Counseling & Development), I defined undue police violence as the unwarranted and excessive uses of law enforcement officers’ (LEO) inherently violent force that results in physical, emotional and psychological harm to those who directly or vicariously experience it.

While I am hopeful that the spotlight on racism and undue police violence has conjured lasting motivation and action toward change among some counselors, I find myself skeptical about the enduring nature of many of the anti-racist commitments and promises for change from within our profession. My skepticism is rooted in the following. 

  1. Undue police violence is not a new phenomenon. It has occurred throughout the history of the United States in the form of slave patrols, during the Civil Rights movement and in modern institutions of law enforcement (e.g., local, state, federal and immigration officers). 
  2. Racism tends to be adapted and perpetuated even as the status quo is challenged. We see this in the social and political rhetoric of disinformation toward critical race theory and approaches that work against racism. 
  3. Findings from my dissertation suggest that there is considerable room for growth in competence among professional counselors regarding undue police violence. For example, despite 68.2% of the 112 participants indicating having worked with clients who experienced undue police violence, only 17% had clinical training in identifying its impact and only 22.5% had training in advocating against it. 

I am writing this article to build off findings from my study by offering reflective points and practical suggestions for professional counselors seeking to enhance their competence regarding the topic of undue police violence. These reflective points and practical suggestions are grounded in the Multicultural and Social Justice Counseling Competencies (MSJCC) framework.

Reshaping our attitudes

According to the MSJCC, we can start developing and enhancing our competency to address undue police violence by examining and altering our current attitudes and beliefs regarding law enforcement, criminality and racially marginalized populations. Many of us may hold positive beliefs towards LEOs, informed by personal experiences, media representation and the attitudes of those we trust. For example, we may believe that LEOs promote security in society through their roles as first responders and that their use of force toward those deemed to be “bad people” and “criminals” is typically legitimate. Alternatively, when individuals such as Derek Chauvin are highlighted in national media for negligent and violent policing, we may be inclined to believe that the harm they have inflicted is the result of individual bad behavior. When we unquestioningly hold on to these adopted beliefs, we may be hindered from critically reflecting upon and acknowledging the ways in which law enforcement systems perpetuate harm. 

A deconstruction of our belief systems entails a critical questioning and analysis of our current beliefs, the beliefs of others and how these beliefs have been shaped and developed within our social context. While LEOs can certainly function in ways that appear to promote security for some populations, we need to critically analyze instances when our attitudes and beliefs are not held up to be true. We might begin by asking ourselves: What are the purposes and functions of law enforcement? What has influenced my beliefs about LEOs across my life span? What differing beliefs do people hold toward LEOs and why? What impact have LEOs had on me and others in my community? Which members of my community have had experiences that diverge from my own regarding LEOs? What alternatives to policing exist to foster safety and security? 

Deconstruction of our current beliefs is an essential step because many populations do not live in a world in which LEOs are experienced as safe, protective and trustworthy. In fact, my fellow Black Americans and I often feel that we are seen as threatening and criminalizable by LEOs. Native and Indigenous Americans may hold beliefs parallel to those of Black American experiences of LEOs. Women of color, particularly Black women, may experience LEOs as negligent and even perpetrators of sexual violence. 

As we engage in a critical deconstruction of our beliefs and attitudes, it is important for us as counselors to empathize with the experiences of those who are marginalized in ways that often diverge from beliefs that center white, cisgender, male, abled, and middle and upper socioeconomic status experiences.

Building knowledge

Deconstructing our current attitudes to develop more critical ones toward the relationship between marginalized groups and LEOs can be a difficult task in isolation. We often need something outside of our current awareness to challenge our current beliefs. Making use of existing expert knowledge can be a great tool to support an ongoing reshaping of our beliefs about LEOs. Rather than re-creating the wheel, counselors may benefit from drawing upon knowledge from abolitionist authors who have written extensively about law enforcement and the broader criminal justice system in the United States. 

I make this recommendation because the counseling profession is often entangled with the criminal justice system. For example, we may be inclined to rely on law enforcement for emergencies or situations regarding a client’s imminent harm to others. Additionally, many counselors are referred to or work with clients who have direct and frequent contact with LEOs and the broader criminal justice system. Abolitionist writing on undue police violence can provide critical knowledge about the system of violent policing, its sociopolitical history and collective struggles against it. The following list of recently published books serves as a useful starting point for counselors:

  • We Do This ‘Til We Free Us by Mariame Kaba
  • Invisible No More: Police Violence Against Black Women and Women of Color by Andrea Ritchie
  • We Still Here: Pandemic, Policing, Protest and Possibility by Marc Lamont Hill
  • Abolition for the People: The Movement for a Future Without Policing and Prisons edited by Colin Kaepernick

In addition to texts that focus on violent policing and abolition, readings specifically geared toward policing and race-based traumatic stress may be useful for counselors seeking to integrate this knowledge into their practice of counseling and advocacy. As a starting point, it is essential for counselors to know that LEOs’ use of force, whether a mere intimidating presence, physical force or use of a weapon, is inherently violent. This simply means that using force to enforce rules relies on behavior that is violent in any other context. As many of us are aware, violence often begets trauma. 

When undue police violence intersects with racism, beliefs of racial inferiority are communicated from LEOs to those who are BIPOC. A message of racial inferiority is also communicated when institutions within the criminal justice system function to permit these practices without accountability. Moreover, these beliefs are further internalized when helping professionals negate, downplay or are simply oblivious to the impact of these experiences. BIPOC clients may exhibit the weight of racialized violence from LEOs in their developed worldview and identity, social and emotional processes, and neurological and behavioral functioning. The following books and articles may be helpful resources for advancing counselors’ knowledge about race-based trauma and violent policing:

  • My Grandmother’s Hands: Racialized Trauma and the Pathway to Mending Our Hearts and Bodies by Resmaa Manakem
  • “The trauma lens of police violence against racial and ethnic minorities” by Thema Bryant-Davis and colleagues, Journal of Social Issues (December 2017)
  • “The experiences of African American mothers raising sons in the context of #BlackLives Matter” by J. Richelle Joe and colleagues, The Professional Counselor (March 2019)

Developing skill and taking action

The purpose of the MSJCC is not to simply hoard knowledge and privately reshape our attitudes. Developing competency in multiculturalism and social justice requires us to export our cultivated knowledge and beliefs to support change as accomplices with the individuals, communities and populations that we serve. Without this accompliceship, we risk portraying ourselves and the broader counseling profession as performative and inauthentic. 

In the remainder of this article, I will emphasize four specific areas where counselors can take action.

1) Assessing for undue police violence and its impact. One way for counselors to begin to address the potential traumatic impact of undue police violence is to conduct an ongoing assessment of such occurrences. According to national databases on police violence such as Mapping Police Violence (mappingpoliceviolence.org) and The Washington Post’s Fatal Force database, Black and Hispanic Americans and individuals who experience mental illness are overrepresented in fatal encounters with LEOs. While less often acknowledged, Native and Indigenous Americans also experience police violence at disproportionately higher rates than do their white counterparts. 

Similarly, women of color and transgender and nonbinary people have experienced increased odds of violent encounters with LEOs that may overlap with sexual violence and aggression. Additionally, those who engage in resistance through protests have a heightened risk of experiencing undue police violence. Other populations, such as those who use substances, people without housing, domestic violence survivors and offenders, incarcerated individuals, and the loved ones of these individuals, also warrant the attention of counselors. 

When we know or suspect that our clients have had encounters with LEOs, we need to provide space for clients to share what happened, how they were impacted and what they are doing to cope and heal.

2) Broaching. Broaching — the intentional invitation to discuss matters of race and culture in counseling — can be a useful tool to initiate conversation and meaning making around undue police violence. We broach by acknowledging the connections between our clients’ cultural identities, sociopolitical history and context, and their wellness. We then invite our clients to share and expand on their experiences in a safe relationship with us. 

Care and attention must be given toward how we broach to avoid causing harm. We want to avoid robotic, scripted or inauthentic invitations. We also want to avoid tokenizing or burdening our clients by asking them to educate us on things that we can easily educate ourselves on. For example, it might not be wise to prompt a Black client out of the blue or simply because we are curious to tell us “what it is like to be a Black person in light of the Black Lives Matter movement.” While such a response acknowledges race, it misses out on communicating the ways in which we are attuned to our clients’ specific experience. 

When teaching about crisis and trauma, I often encourage my students to explicitly share their observations of a client’s emotions, behaviors and thoughts as opposed to offering hollow or cliché comments to acknowledge evident distress and pain. When applied to broaching undue police violence and its impact, we want to let clients know that we can see the weight of their experiences, we understand and believe their experience to be valid, and we value their trust in us to share their narrative. 

When we notice that encounters with LEOs, whether directly or vicariously experienced, impact our clients’ wellness, we might respond by first describing our observations and their relationship to culture and race. From there, we can invite clients to respond to the observations that we have brought forth. Throughout the client’s narrative, we want to communicate our attunement to their past and present emotional experiences through active listening techniques. I often encourage students to honor what is authentically present rather than attempting to “fix” clients or evoke the depths of their suffering. Lastly, we want to acknowledge our clients’ willingness to entrust us with their narrative, especially given the likelihood that their experiences have previously been met with skepticism, arguments or invalidation.

When broaching experiences of undue police violence, it is essential that we avoid interrogating, doubting or attempting to offer a “neutral” or “balanced” perspective for our clients. These behaviors are likely to be perceived as invalidating or antagonizing to clients. We also want to avoid placing our clients in stereotypical boxes. For example, not all Black people will experience undue police violence or, as a function of racial identity development, even share the same beliefs about LEOs. 

These sorts of responses run the risk of creating relational ruptures, poking existing traumatic wounds and further stigmatizing clients’ experiences. Instead, we need to trust that our clients are knowledgeable and truthful in how they describe their experiences. Broaching is less about an extraction of information from our clients or investigating claims around their experiences. It is more about creating a relationship in which clients can share their racial and cultural experiences while being met with a nonjudgmental, attuned, affirming and validating presence from a professional. In doing so, we can cultivate spaces that help our clients cope with, integrate and heal from their distressing encounters with LEOs. 

3) Coping and healing. After inviting experiences associated with undue police violence into the counseling room, we need to consider what coping and healing approaches look like. I have found the article “Toward a psychological framework of radical healing in communities of color” by Bryana French and colleagues in The Counseling Psychologist (January 2020) helpful in distinguishing between these two terms. 

French and colleagues describe coping as surviving the experiences of injustice and oppression that inhibit optimal wellness. Coping entails supporting others in getting by and resuming functioning despite the distress from direct and vicarious exposure to undue police violence. Examples of coping might entail developing skill in affect regulation after exposure, altering one’s cognition to minimize distress associated with LEOs, enhancing connectedness to one’s social support systems or setting boundaries around social media usage following the viral sharing of a killing by an LEO. 

While coping is essential, it is often more of a Band-Aid and does not address common roots of the distress from undue police violence: racism and systemically violent policing. French and colleagues’ article describes healing as fostering the collective critical consciousness and resistance against systemic suffering. On an individual level, healing might entail supporting a client’s growth in their critical consciousness around law enforcement and their advancement in racial identity development. On a collective level, healing may look like bringing community members together to foster hope and collective strength using support groups and healing circles. Healing may also include supporting a client’s engagement in various forms of resistance in their community to advocate for changes in laws, policies and norms that promote racist and violent policing practices. 

As professional counselors, we can and should also be collaborating with our clients outside of the counseling room to enact tangible changes in communities where we operate. This might include active participation in organizing protests, demonstrations and calls for action as a complement to the work that we are traditionally trained to do.

4) Engaging in advocacy. It is essential that we address undue police violence in ways that do not solely reflect individual responsibility for experiencing or being impacted by police violence. Being engaged in our communities and society at large through advocacy is one way to achieve this. The following is a nonexhaustive list of actions that counselors can take and support alongside their clients and communities:

  • Share credible educational resources on police violence.
  • Contribute to public education efforts regarding the intersection of undue police violence and race-based traumatic stress.
  • In moments of community unrest associated with undue police violence, organize with other counselors to open our doors for pro bono crisis counseling.
  • Volunteer to support community efforts toward accountability of local law enforcement.
  • Strategize a long-term plan of action with community leaders to minimize contact between LEOs and the public, particularly those who are BIPOC.
  • Organize and advocate alongside clients to call for a divestment in law enforcement while simultaneously investing in public health and wellness initiatives that would foster community safety.
  • Participate in public demonstrations against undue police violence. Specifically, counselors can collaborate with organizers to infuse culturally authentic wellness practices and strategies for maintaining safety.
  • Conduct research on undue police violence, its impact and strategies toward change.
  • Identify and contribute to resources for mutual aid to establish holistic care for clients in need.
  • Integrate information about undue police violence into the classroom and supervision to better prepare counselors-in-training when working with vulnerable populations.
  • Regarding substance use, advocate with local officials of the criminal justice system to allow for approaches that value harm reduction over punishment (e.g., incarceration) following relapse.
  • In schools, advocate for the removal of school resource officers. When this is not achievable, advocate for a systemic restructuring of the roles of school resource officers to minimize contact with students, particularly those most vulnerable to undue police violence.
  • Support or challenge candidates for local, state and national elected positions to make policy changes that minimize contact between LEOs and members of the public, especially those vulnerable to undue police violence.

Pursuing change in community

While we can build competence in isolation, it may be most effective and efficient to initiate this progress in community with others. When working alone, we may find ourselves avoiding blind spots or struggling to sustain our motivation to undergo change.

alexfan32/Shutterstock.com

To tie the contents of this article together, I strongly encourage counselors to form action-focused reading groups around undue police violence. These groups should be different from traditional book clubs that function to gain new wisdom. Instead, these action-focused reading groups should be centered on making change and acting. To be effective in this goal, we may consider defining specific and actionable goals toward change before participating in these groups. Additionally, we can embed time for collective brainstorming, collaboration and reflection over action taken toward any identified goals.

Although the demands of the task are complex and politically charged, we have a responsibility as counselors to address undue police violence in support of the wellness of the client populations we serve. We should expect resistance, defensiveness and other forms of pushing back as we dig into making such important changes. Nevertheless, addressing and minimizing undue police violence is imperative. With the MSJCC as a guiding framework and with collective support from colleagues, counselors can make substantial gains in developing our competence before the next George Floyd-like tragedy inevitably occurs.

 

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Darius Green is an adjunct professor and counselor educator. He earned his doctorate in counselor education from James Madison University in Harrisonburg, Virginia. Contact him at drdariusagreen@gmail.com and follow him on Twitter @dariusagreen.

 

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, visit 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.

ACA legislative briefing tackles racism, police reform and mental health issues

By Laurie Meyers October 20, 2020

The nation is poised at a historic moment in which the American people’s recognition and understanding of the injustices that happen every day in Black and brown communities is at an all-time high, said Rep. Anthony Brown, D-Md., one of the speakers at the American Counseling Association’s Legislative Briefing on Racism, Police Reform and Mental Health held via Zoom on Wednesday, Oct. 14. He urged legislators, policy makers and advocates to use this awareness to make truly transformational changes to police departments.

Organized by ACA’s Government Affairs and Public Policy department, the briefing consisted of a bipartisan panel of national and local legislators.

ACA CEO Richard Yep opened the session with a statement noting that the association denounces all forms of racism, police brutality, systemic violence and white supremacy. The briefing was offered to ACA’s membership, legislative staff and advocates who are working on bills currently before the 116th Congress, specifically focusing on racism, police reform and mental health.

MSNBC commentator Aisha C. Mills, a longtime political strategist and social impact advisor moderated the briefing. Before turning the discussion over to the first panelist, Brown, she took a moment to acknowledge the pain that was happening in communities all over the country as a result of interactions with police departments.

“It’s fraught—there’s a lot of tension,” Mills said. “One of the conversations that too often gets lost is that law enforcement responds and reacts in a way that is about safety, is about duty to protect communities and is not always able to be flexible and sensitive to the needs of people who are struggling with mental health issues.

“We’re hopeful that through this conversation, we will learn about a variety of solutions that policy makers are thinking about—legislation that can be moved and … that the counseling community will be able to connect with ways that you all can be in better partnership with law enforcement and legislators as we all try to seek solutions together,” she concluded.

The role of mental health in transforming community policing

Mental health professionals play a vital role in the broader public health of our communities, noted Brown. Their expertise must be a key feature in work to combat racism—particularly in police departments.

“The killing of Black Americans at the hands of the police is an epidemic in this country—one that has existed for decades and has gone largely unaddressed,” he continued. The deaths of George Floyd, Breonna Taylor and countless other Black men and women has highlighted the need to fundamentally transform policing in this country.

“I believe we should start by changing the culture of policing by moving the officers who protect us away from a warrior cop mentality toward their proper goal as community guardians,” Brown emphasized. “We must also recognize and acknowledge that officers are often tasked to respond to certain situations where they don’t necessarily have the proper training.”

Police officers are often unable to properly understand the citizens and communities that they are confronting or engaging with and thus cannot  properly de-escalate or manage a situation, he said.

“Since 2016, nearly a quarter of the people killed by police officers have had a known mental illness,” Brown said.

He believes that calling upon the expertise of mental health professionals is a vital part of preventing such tragedies.

“I believe we can save lives by acting more with compassion and understanding rather than force,” he said. “We can save lives and livelihoods when we stop criminalizing mental illness and addiction by instead providing resources and help to those who need it. We must also provide structural reform in police departments.”

This was the intent of H.R 7120, the “George Floyd Justice in Policing Act,” which was passed by the U.S. House of Representatives in June.

The George Floyd Act seeks to transform police departments by reducing their militarization by preventing the transfer of military equipment from the U.S. Department of Defense to local police departments, removing bad officers and banning harmful practices such as choke holds and no-knock warrants. It also proposed training for police departments on diversity and cultural sensitivity, including how to end racial, religious and discriminatory profiling.

“We know that this legislation alone won’t be enough,” he said. To establish a more just country, we need to invest in long neglected policies and programs that meet the social needs of communities and address the structural disparities that harm Black and brown families, Brown said.

This month the House passed the Strength in Diversity Act of 2020 (H.R.2639) to address the persistent racial disparities in the education system. Brown authored an amendment to the act that would provide funds to recruit, hire and train more school counselors.

“School counselors play a vital role in students’ success,” he said.

On the other side of the aisle—and the other body of Congress—Jake Hinch, legislative assistant to Sen. James Inhofe, R-Okla., said that the senator had become interested in the intersection of mental health and policing because statistics show that approximately one in 10 police calls and one in four shootings involve someone with a mental illness.

Inhofe believes that one of the ways to address these issues is with S. 1464, the Law Enforcement Training for Mental Health Crisis Response Act of 2019, which would provide state, local and tribal agencies with federal grant funding for behavioral crisis response training. Inhofe believes that the training would provide knowledge that would assist police officers when responding to calls that include people who are suspected of being under the influence of drugs or alcohol; are possibly suicidal or suffering from mental illness.

A call for counselors to lend their expertise

Charlyn Stanberry, chief of staff for Rep. Yvette Clarke, D-N.Y., began her portion of the panel by noting that Oct. 14, the date of the event, would have been George Floyd’s 47th birthday.

We are in a period of reckoning when it comes to systemic racism, police reform and mental illness, she said.

Rep. Clarke is the vice-chair of the House Energy and Commerce Committee, which has jurisdiction over healthcare—including mental health, Stanberry noted. As part of the Congressional Black Caucus (CBC)—which was specifically tasked by Speaker of the House Nancy Pelosi with putting together the George Floyd Policing Act—Clarke was involved with the public health aspects of the bill, which included discussions on how public safety in all communities could ultimately be reimagined so that it is just and equitable. In practice, such an effort would require bringing all stakeholders, such as law enforcement, mental health professionals and constituents to the table. One of the ways the CBC sought to ensure that would happen was by including a provision within the bill for providing public safety innovation grants for community-based programs, Stanberry explained. The grants would go toward creating task forces that would examine how policing would fit into the community and contribute to public safety in an equitable way.

“That’s a big part of what we as individuals and counselors need to think about,” she said. “How can you play a role if these grants are brought into the communities and talk about what this new 21st century police, community policing or public safety looks like?”

Hinch said that discussions like the ACA briefing are essential for him and other staff to stay aware of crucial issues. Legislative teams cover a lot of different subject areas and rely upon experts to educate them.

“It’s important for counselors to come to their representatives in Congress to explain what the issues are and what they can do better,” he said, adding that Sen. Inhofe wants to hear from everyone, whether they be Democrat, Republican or Independent.

“It’s vital for the senator that we continue to have these kinds of conversations,” Hinch said.

Stanberry added that although they are entering a lame duck session, the 117th Congress will be in session in January. There will be a lot of hearings that have to do with mental health, and she is officially issuing a call for research and expertise from counselors.

The final speaker was Georgia State Senate Majority Leader Bill Cowsert, the head of the state Republican party and chair of the Senate Law Enforcement Reform Committee, which is looking at police practices and procedures. The committee’s intent is to see if police officers are receiving sufficient training to prepare them to deal with potentially confrontational situations such as crowd control or serving warrants or any incidents in which mental health issues may come into play, Cowsert explained. They’ve only had one meeting, but what the committee found is that throughout the country, police departments seemed to be getting a lot of training in de-escalation. Cowsert said he and the committee believe that the training could be improved upon. They intend to hold a hearing with members of the local mental health community in order to gain insight on how to improve training.

As the briefing ended, Stanberry and Hinch both placed their contact information in the comment boxes and urged the audience to get in contact with them to share ideas, comments and expertise.

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Resources

Related reading, from Counseling Today:

 

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Laurie Meyers is a senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

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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.

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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