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Key points
- First-responder work is taxing for the individual and his or her family.
- Successful treatment of first responders in crisis requires a multidisciplinary team of peers, chaplains, and culturally competent clinicians.
- One approach to keeping first responders and their families resilient is a residential retreat.
First responders see things that no one should have to see, do things that no one should have to do, and go places no one should have to go. They console the inconsolable, encounter the unthinkable, and are exposed to some of the cruelest, most tragic moments life has to offer. At times, many of them need psychological help but are stymied in their efforts by stigma, the fear of looking weak, and a lack of culturally competent clinicians who understand first responders and the culture in which they work.
For the past 15 years, it has been my job and my privilege to help first responders with symptoms of PTSD as well as their spouses and significant others. The work is intense and exhausting.
The Elements of Successful Treatment
A community of peers: Because of the stigma against seeking mental health support, first responders can suffer for years. Many teeter on the edge of suicide or divorce. They believe no one but another first responder or first responder family can understand them. They are isolated, often believing they are the only ones dealing with traumatic stress, a failing marriage, substance abuse, or organizational betrayal. Bonding with others who share similar experiences and similar concerns is in itself healing.
Confidentiality: Trust is the cornerstone for healing. These first responders need to know that what they reveal will not be shared with anyone without their explicit, written permission.
A clear mission: Saving lives, not jobs. Cops and firefighters are two to three times more likely to take their own lives than they are to be killed in the line of duty. With treatment, they and their families regain control over their lives and build a better balance between work and home. Many are still working, others are on medical leave, some are retired and others are debating whether to stay at work or find a different career.
Peer support: First responders trust their peers before anyone else, sometimes even their families. It makes sense to trust someone who has walked in your shoes. As a clinician, I've never shot a gun, been in a fight, pulled someone out of a crushed car, or married a first responder.
Trust is critically important. First responders, especially cops, are habitually trained to be skeptical, if not downright suspicious of other people.
Peer-mentors, who have completed their own work, are able to give hope to others and represent what can happen if a first responder does the work as well. Peers are realists. Because they are trained to share their experiences, they model both success and failure. Their willingness to be openly emotional and self-disclosing helps reduce a first responder's feelings of isolation, uniqueness, hopelessness, and shame.
A mind-body-spirit approach: Trauma wounds the mind, body, and spirit. Healing must address all three aspects. On-on one-counseling, prolonged exposure debriefings, bilateral brain stimulation, meditation, yoga, AA, or Al-Anon meetings all help in healing the mind and body. Humor, companionship, and time in nature are also balms to the spirit.
Service to families: The families of first responders have their own trauma histories. Most are struggling to understand the changes work-related stress and trauma have created in their first responder partners. They are exhausted, emotionally drained, and frightened after months, often years, trying unsuccessfully to “fix” their psychologically wounded mates. They’re isolated, falsely believing they are alone, and no other family is going through what they are experiencing. It is important that they restore their self-confidence, distinguish between what they can and cannot control in their relationships, encourage better self-care, and move toward a healthier, more independent lifestyle.
The culturally competent clinician: Not every clinician is a good fit for working with first responders. A good clinician should understand the first responder culture. They should be transparent and open about themselves. They have or are willing to get, experience working with first responders. They can listen to what is grotesque, cruel, or tragic without buckling. They are direct and comfortable with gallows humor.
Paying attention to the roots of first responder trauma: Some first responders have been abused or neglected as children. Coming from a chaotic home, being forced into premature adulthood is perfect training for an emergency responder. They struggle to understand what happened to them, sometimes decades ago, and the ways in which those experiences influence and amplify how they are acting in the present.
Knowing what hurts: The damage done to first responders by their work comes in many shapes and sizes. There are cops who blame themselves because they killed someone, and cops who blame themselves because they didn't. Incidents involving death or injury to a child are among the most psychologically difficult calls for all first responders. And any sort of betrayal—personal, organizational, or administrative—can turn a minor event into a major problem.
To be a hero or a person of valor takes courage: There are many kinds of courage. It takes courage to hold the hand of someone who is dying. It takes courage to deliver a death notice to a family. It takes courage to confront your own flaws and fears, and it takes courage to stand up for your rights as a worker. It takes courage to leave a sick child at home so you can devote yourself to helping someone else's child. Sometimes it takes courage just to show up at work, knowing that whatever you do or don't do that day can land you in the hospital, in court, in the chief's office, or in the morning headlines.
References
See the First Responder Support Network.
