E.196 Supporting First Responders: Effective Therapy Techniques & Approaches

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First responders—police officers, firefighters, EMTs, paramedics, and emergency room personnel—face unique psychological stressors that extend far beyond trauma exposure. In this insightful Podcourse, I'm joined by Steve Bisson, LMHC, to explore the complexities of first responder mental health and how therapists can effectively support this population.

Purchase this Podcourse here!

You will gain an in-depth understanding of the unique challenges first responders encounter, including PTSD, acute stress disorder (ASD), depression, and substance abuse. Steve shares real-world insights and practical strategies for overcoming the barriers first responders face when seeking mental health support.

SEE THE FAQ on Podcourses HERE! (scroll to the bottom of the page)

This episode will equip mental health professionals with evidence-based therapeutic interventions, such as Cognitive-Behavioral Therapy (CBT), Motivational Interviewing, and prolonged exposure techniques, tailored to address the specific needs of first responders. Additionally, listeners will learn how to develop comprehensive treatment plans that incorporate trauma-informed care principles, crisis intervention strategies, and referral resources to enhance the mental well-being of their clients.

If you're a clinician looking to deepen your expertise in working with first responders, this Podcourse is an essential resource.

Remember, while you can listen to the show for free, those seeking continuing education credits can purchase them here. 

Learning Objectives:

• Analyze and describe the unique psychological stressors and challenges faced by first responders, including but not limited to PTSD, acute stress disorder (ASD), depression, and substance abuse.
• Apply and demonstrate evidence-based therapeutic interventions, such as cognitive-behavioral therapy (CBT), Motivational Interviewing, and prolonged exposure techniques, to address the specific needs of first responders.
• Develop and design comprehensive treatment plans that incorporate trauma-informed care principles, crisis intervention strategies, and referral resources to effectively support the mental health and well-being of first responders.

 

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Episode Transcript

Speaker 1 (00:03):
Hi and welcome to Finding your Way Through Therapy
.
A proud member of thePsychCraft Network, the goal of
this podcast is to demystifytherapy, what can happen in
therapy and the wide array ofconversations you can have in
and about therapy Throughpersonal experiences.
Guests will talk about therapy,their experiences with it and

(00:24):
how psychology and therapy arepresent in many places in their
lives, with lots of authenticityand a touch of humor.
Here is your host, steve Bisson.

Speaker 2 (00:38):
I've heard many characters learn something.
Welcome to episode 196.
If you haven't listened toepisode 195, it is with Jennifer
Schrappe.
She is a great interview.
I really enjoy talking aboutdifferent things, including the
trauma and how she got to whereshe was and all stuff like that.
So please go listen.
But episode 196 will be a CEUcourse.

(00:58):
So what this is is Lisa Mustardsdoes pod courses and with the
pod courses you can get one CUfor listening to the podcast
answering a few questions prettybasic stuff, and me and Lisa
Mustard talked about somethingthat's really dear to my heart,
obviously, with the podcastbeing resiliency development and
action, or resiliencedevelopment and action, pardon

(01:18):
me, I really want to talk abouthow to work with first
responders.
This is an hour course, so Ithink it's great, obviously
because I'm biased, but I hopeyou listen to it.
And here it is Getfreeai.

(01:41):
Yes, you've heard me talk aboutit previously in other episodes
, but I'm going to talk about itagain because GetFreeai is just
a great service.
Imagine being able to payattention to your clients all
the time instead of writingnotes and making sure that the
note's going to sound good andhow you're going to write that
note, and things like thatGetFreeai liberates you from
making sure that you're writingwhat the client is saying,

(02:02):
because it is keeping track ofwhat you're saying and will
create, after the end of everysession, a progress note.
But it goes above and beyondthat.
Not only does it create aprogress note, it also gives you
suggestions for goals, givesyou even a mental status if
you've asked questions aroundthat, as well as being able to
write a letter for your clientto know what you talked about.

(02:24):
So so that's the great, greatthing.
It saves me time, it saves me alot of aggravation and it just
speeds up the progress noteprocess so well, and for $99 a
month.
I know that that's nothing.
That's worth my time, that'sworth my money, you know.
The best part of it too is thatif you want to go and put in

(02:47):
the code Steve50 when you getthe service at the checkout code
is Steve50, you get $50 offyour first month and if you get
a whole year, you save a whole10% for the whole year.
So again, steve50 at checkoutfor getfreeai'll give you $50
off for the first month and,like I said, get a full year,

(03:09):
get 10% off, get free fromwriting notes, get free from
always scribbling while you'retalking to a client and just
paying attention to your client.
So they went out, you went out,everybody wins and I think that
this is the greatest thing.
And if you're up to a pointwhere you got to change a
treatment plan, well, the goalsare generated for you.
So getfreeai code Steve50 tosave $50 on your first month.

Speaker 3 (03:37):
Well, hey, friends, welcome back to another episode
of the Therapy Show.
I'm your host, lisa Mustard,and this episode is a pod course
, which means that it qualifiesfor one continuing education
contact hour.
And, as you know, mustardConsulting is a NBCC approved
ASAP provider and this week'sguest is Steve Bisson.

(03:58):
Welcome to the show, steve.
It is amazing to have you back.

Speaker 2 (04:01):
Lisa, thank you for having me back.
Always a pleasure to talk toyou.
We talk regularly, but this isgreat, yeah.
Yeah, I'm so thrilled to haveyou back.
You said thank you for havingme back.

Speaker 3 (04:06):
Always a pleasure to talk to you.
We talk regularly, but this isgreat, yeah.
Yeah, I'm so thrilled to haveyou here talking about how to
work with first responders,because this is your, this is
your thing, this is your, yourniche, so I love it.
Will you share with ouraudience a little bit about who
you are, what you do and maybehow you got into working with
first responders?

Speaker 2 (04:22):
OK, I, you got into working with first responders.
Okay, steve Bisson, I'm an LMHCin Massachusetts.
I've been in practice for myprivate practice for over 12
years, but I've worked in.
My licensure is going on 20years now.
When I first started working inthis field, I worked on a
crisis team, and when we work ona crisis team in the mental
health world, you work out witha lot of firefighters, a lot of

(04:44):
police, and eventually there wasa program in Framingham,
massachusetts, called JailDiversion Program, which has now
been replicated across thecountry, frankly, across the
world, even in Ireland now, andI was part of the first team to
actually go out in the streetsand, you know, co-respond with
the police.
And this is where I startedhaving that experience.
And people are like well,you're saying that you help

(05:06):
people in the community?
Well, no, the experience was.
I saw the stressors that a firstresponder truly had, because
once in a while I'd have a guycome out of the blue say, steve,
you're riding with me.
It wasn't that he wanted me toride with him, he was having
some issues, or she I mean, I'mnot going to pick only males and
it ended up being like oh myGod, they're so misunderstood
because everyone thinks it'strauma and it's so much more.

(05:29):
So I started having afascination for that and between
working there to jail,probation, parole, I started
working outpatient with policeofficers, I want to say 10 years
ago, and then it just went tofirst responders particularly.
You know we talk about fire,emts, paramedics, police, law

(05:51):
enforcement but I alsoconsidered my emergency room
people part of the firstresponder world, because they
may not be on scene but they'rethe first ones to respond in any
medical emergency that occurred.
So, yeah, that's how I got intoit.
I worked because of the crisiswork 15 years.
Definitely, yes, you do the math.
You're going to say, well, yeah, some of them overlapped, so,
but I truly enjoyed working withthat.
And, just, you know, talking tomy colleagues, my, my good

(06:12):
friends, that would say, well,yeah, you talk about trauma.
I'm like, well, no, firstresponder work is so much more
than trauma.
Does it happen?
Sure, but it's usually.
I want to be honest, it's aminute part of the work I do
with the first responders,because the stressors that you
don't think about show up andthe stressors that you have in
your life, they have too.

(06:32):
And so, in one of the things Ilike to start off when people
say what's unique is say well,in your job, if you do something
wrong, you screw up or whathave you.
It's not going to be a firstpage anywhere, either web or
paper.
A police officer does somethingwrong in Missouri.
Well, now, suddenly every copin the United States of America

(06:55):
is a bad cop, and so that's avery different thing than what
most people feel.
So I talk about these uniquechallenges that we don't
typically have in our day-to-daylives, that they have
Interesting, okay.

Speaker 3 (07:06):
So I can kind of see some parallels in the work that
I do with my military servicemembers.
Oh, interesting, okay.
Well, I'm really excited tohear about this topic today.
I honestly, you know, I'm in mybubble of who I work with and I
think there's going to be someoverlap.
So I just want to let everybodyknow that Steve's second
language is English.
Your first language is French.

(07:26):
I think that's just a coollittle fact.

Speaker 2 (07:29):
Thank you, I appreciate that.
So when I have to say THs whilewe're talking, you'll
definitely hear them.

Speaker 3 (07:34):
Right, I can hear your French, you know your
accent a little bit and yourEnglish.
I just think it's so neat, okay, so the learning objectives
that you sent over to me andthey're on my on the websites,
if the learning objectives thatyou sent over to me and they're
on my on the websites, if youguys want to see them after you
listen to this, you know, justhead over to the website.
The link will be in the shownotes, but the first one we have
is analyze and describe theunique psychological stressors
and challenges faced by firstresponders, including, but not

(07:58):
limited to, ptsd, acute stressdisorder, depression and
substance abuse.
So I will let you tell me whereyou want to start with that All
right?

Speaker 2 (08:07):
Well, I'll start off by saying that you're absolutely
right.
A lot of the first respondersthat I work with were in the
military, whether any of thebranches, and so I think,
because you said there's a lotof parallels yeah, because I'd
say that a quarter of my guyshave been some sort of treat
like one of the five branches ofthe military.
So that's definitely why, andthe challenges that we face, you

(08:28):
know, when we talk aboutidentify and describe.
The first thing that I'd liketo remind a whole lot of
therapists is that you're goingto face resistance, because
that's part of it, and I wrotedown a few of the quotes that
I've heard over the course ofyears because I think it
important.
The first thing is guys beforeme didn't need the mental health
support.
Why should I?
I hear that constantly.

(08:50):
My favorite one that I heardmore often than not, mental
health doesn't work.
I've seen people in therapy foryears.
They're not getting any better.
Then you got how are they goingto handle me?
They don't understand what wedo, which you know.
The chronic uniqueness of firstresponders while it sounds like
a criticism, it's reallychronic uniqueness.
Military are the same.

(09:11):
I don't want to make it toomuch about the military, but
there's so many parallels thatcan be drawn between the two.
The other one that I like ishow long is this going to take?
I need this to be quick.
Yeah, because I'll fix 15 yearsof issues in about five hours
give or take, and let's take.
The reason why I want to quotethese things is because, once
you talk about identifying anddescribing the unique

(09:32):
psychological stressors, Iliterally had a call once from
an officer.
He didn't even say hi.
I said you know, steve,speaking, the first thing he
said out of his mouth is are yougoing to take away my gun?
And I'm like, like, well, Idon't know, should I be taking
away your gun, right?
And then like and then heexplained that he never took his

(09:54):
gun away, never had to.
But the the bottom line isyou're going to face that.
And the other part that they'revery scared of is if you go to
see a therapist I mean I won'tuse the colorful language they
use, but they'll tell me about,well, I'll go inpatient if I
talk to a therapist.
And I think that when you thinkabout the unique challenges in
identifying this is that thinkabout going into therapy for

(10:16):
mental health reasons, and thoseare your thoughts and to me,
that's one of the first thingyou've got to identify is that
you're going to face all that.
And when I, when I think aboutthose challenges, it's first
responders don't want like wehave a professionalism that I
think is a standard that we needto follow, but there's almost
like if you're too professional,you'll actually lose them, and

(10:40):
that's a very hard balance toexplain.
But how I explain it is thismeet the language where they're
at, and I think that one of thethings that we do as
professionals in this world wetry to go well, I'm going to
sound professional about myresearch and this and that and
the other thing they don't wantto hear, that they don't want to
hear about cognitivedistortions.

(11:01):
Meet the language where they'reat.
I don't say cognitivedistortions.
When I first meet them.
What I say is your thoughtprocess is messed up, we're
going to work on it, and thatthey respond to oh, I can get
behind that and it's not about.
I want to be clear for thosewho might be listening and
saying well, you're making themout to be simple.
Well, no, they're complex, butthey don't want complex language

(11:23):
, and that's very important toremember For those who also want
to work with first responders.
The biggest turnoff you couldever do is to be in a shirt and
tie.
Why?
Because now, suddenly, you'reevaluating them for their
capacities to live a life and sosometimes, like if anyone who's
known me and I'm certainly, Iknow lisa's known me for years

(11:47):
I'm a t-shirt, I'll put on apolo once in a while, maybe put
put a a vest, but ultimately I'mjust very much a t-shirt and
jeans guy.
And, yeah, you want to keepsome professionalism.
Sure, wear khakis, wear youknow, but don't wear dress pants
, don't look, and the reason whyis that that's imposing to them
and that reminds them of theadministration and reminds them

(12:08):
of other stuff.
So when I think aboutidentifying and how to work, the
unique challenges, even fortherapists, I think being like
informed of who you're going towork with, because they're
looking for what I'm looking for, the right word here it's
you're informed about theircommunity.
And if you're not informedabout their community and you

(12:29):
show up in a way that is notlike that's going to make them
feel comfortable, you'll highlylikely lose them.
We're going to talk a littlebit of trauma-informed stuff
later on, but for me it's likebeing culturally competent
that's the word I was reallylooking for is so important.
I mean working with themilitary.
If you don't understand what itis to move every year, then

(12:50):
it's really hard to get to thatmilitary standpoint.
When you're a police officer andyou've moved from department to
department because you want togo full-time and some of them
are volunteer versus no one hasfull-time to full-time and some
some of them are civil serviceand sometimes they're not, and
some of them are state level,some are not.
I mean there's a lot ofcomplexity.
So you might look at someoneand say, well, you've moved five

(13:12):
times, but there's a culturalcompetency you got to be able to
look into, to understand whysomeone would move five times
and knowing a little bit of the,you know identifying and
describing some of thechallenges is that if they sit
there and they talk about rollcall or I went on a call, which
is a very simple language for mebecause I've worked with them
for so long but I've had peoplelike what do you mean a call?

(13:34):
Isn't that on the phone?
No call is going to the actual.
And knowing that culturalcompetent words are going to be
very key so that you can applyit to those individuals that
you're working with.
So that's where I would startoff with knowing about the
language, what the preconceivednotions may be about mental
health, and then also trying tomeet them where they're at.

(13:55):
I know that sounds veryintuitive for some people, but I
think that there's almostthere's counterintuitive,
because when people hear aboutfirst responders in particular,
oh I got to act reallyprofessional, I, I gotta be even
more professional.
It's actually quite theopposite.
You gotta show up as youbecause they they, like someone
once pointed out to me, we knowwhen someone's lying and not
being themselves, because that'sa job we've done so oh, yeah,

(14:19):
they can sniff it out, like Inoticed, like with, uh, my
military service members.

Speaker 3 (14:23):
They can.
Oh, what you're talking aboutis so true.
I remember, like my first dayon the job, the first event I
had to respond to, is sodifferent than anything I had
ever done as a therapist.
It was, and I've just, I'velearned so much.
I mean it's, I love thepopulation I work with.
I mean they're just the best.
But yeah, they're.

(14:47):
I know we're going to say thisover and over again, but I
totally get what you're saying.
It's almost, it's almostcounterintuitive, because the
way that we want to show up astherapists is when we're in an
office and we're in a setting,versus when you go out, maybe on
, to respond to a situation oran event where they're asking
you to come on site or to comeout in the field.
It's very different.
So so different, so sodifferent.
So I appreciate thatintroduction to the culture of.

(15:08):
I mean that's just one piece ofthe culture, that of working
with the first responders.
Okay, so that's super helpful.
Where else, where else shouldwe go with this objective?

Speaker 2 (15:17):
I think that, thinking about the identifying
and describing the uniquepsychological stressors let's
talk about myths for just onesecond it's not all about trauma
.
One of the first things thatcome to mind for a whole lot of
people who work with firstresponders who think they're
culturally competent, oh, it'ssomething they saw on their
shift or they've seen too manyhard things, which that can

(15:40):
happen.
I'm not saying it's notsomething that happens, but
ultimately it's really about youknow, their personal lives,
their regular schedules, thestigma of reaching out and all
the stuff that I think mostpeople in life face.
And yeah, is there trauma alittle more, of course?
Is it these singularly what Ilike?
I'd say that I probably talkabout trauma 10 to 15% of the

(16:03):
time, that I probably talk abouttrauma 10 to 15% of the time.
So it really is a differentaspect of the treatment.
So it's not all about trauma.
The other part that I hear a lotfrom therapists oh, they must
be so hardened people Likethey've seen so much.
They must be really hardened.
Actually, no, they're prettymuch softies, and what I mean by
that is if you're going to goto be a police officer,

(16:24):
firefighter, an EMT, a paramedic, work in an emergency room, a
sheriff, or even the first, themilitary people.
It's because they either wentthrough their own stuff when
they were a kid and they didn'tget the help, or they want to
help, and so they're notactually hardened.
They get a little frustrated,sure, but they've also had their
own stuff to accept in regardsto what brought them to the job

(16:48):
and they're not actuallyhardened.
They put up some walls, they'recynical, and the other part too
, about identifying, describingunique challenges.
You got to understand thatwhatever you want to call it we
can call it gals humor, darkhumor, inappropriate humor, for
whatever people want to call it,you need, as a therapist, to
identify that and say that's howthey communicate.

(17:10):
That's kind of okay.
Working, working with a lot ofthem, I got to be able to put up
with a lot of stuff, and ifyou're going to be well, that's
inappropriate, well, you'regoing to lose it.
And so when you think about thechallenges and the stressors is
that they deal with it withsarcasm.
They deal with it with beingable to protect themselves
behind gallows humor or whathave you.

(17:31):
And if you're not able tounderstand the difference
between gallows humor or not,you're going to have a lot of
problems.
So I think that that's part ofthe other challenges that I find
with people who are in thatposition.
They don't understand that andthat's why when I do my intro
you talked about being FrenchCanadian I say I can't pronounce
my THs.
If you make fun of me, go ahead.

(17:52):
Being in the Massachusetts areaand being a Montrealer at heart
, I have a lot of Montrealthings in my wall, so they laugh
at me and there's always arivalry.
But it becomes fun.
And I remember when I worked inthe field with them, one of the
officers had told me and it wasso true the day we don't make
fun of you start worrying,because when you're making fun

(18:13):
of you, you're one of us.

Speaker 3 (18:14):
Right right.

Speaker 2 (18:15):
And I think that in therapy you gotta be as a
identifying these things, isthat you're not gonna understand
that dark humor could be adefense mechanism, but it's not
necessarily not adaptive,because if you see enough hard
stuff, you need to be able tolaugh at it in order to succeed
and be able to put up thosebarriers.
I know it sounds weird, butthat's absolutely true.

Speaker 3 (18:36):
Makes sense yeah.

Speaker 2 (18:37):
The other thing is talking clinical.
You know I got to be veryclinical.
I'm going to have to write areport.
Actually, people who want to gointo mental health treatment
don't typically want to have areport.
They just want to be humans andso they want to be able to not
have that uniform on.
Or, you know, because you knowI hate to break it to some of

(18:58):
you If you don't know, you takethat role home and sometimes,
like even you know all most ofmy first responders will tell me
I go home and if there's acrisis in the family or in the
neighborhood, even though I'mnot wearing my uniform, I feel
obligated to do uniform likebehavior.
And so you know you, they, theywant a place where you can close

(19:20):
the door and they go.
Finally, I can be myself, breakdown those barriers and being
able to.
For you to not be clinical,going and saying, well, the
DSM-5 TR dictates based onICD-10.
Like they don't want to hearany of that.
They want to hear about okay,what do you think my problem is
and what, how can we address it?
And be truthful, you being niceand flowery, and sometimes some

(19:45):
clients cannot take the truth,if anything, the one thing I
know those guys can take is thetruth, and I think that the
other part too is like you gotto be careful.
Now they want brutal honestyand thank God that's how I grew
up, so that definitely plays afactor.
And the other last thing that Ireally want to talk about is I

(20:07):
hear a lot they don't want thehelp and they're just showing up
for X, y, Z reasons.
Well, if they called you, theywant the help, they know
something's wrong.
Will they be outwardly sayingthat there's something wrong?
No, but they will.
They called you right.
They're already nervous enoughto say I might have a problem

(20:27):
with my day-to-day life.
We'll call it mental health ifyou wish here, but for them it's
day-to-day life, and then theydon't want it to be affecting
like, oh my God, what happens ifthe administration knows that
I'm here, I'm happy to be in abuilding where there's an
acupuncturist, there's somethingmosaics upstairs and then

(20:48):
there's a resource center sopeople can come in here and
sometimes they literally say oh,I saw one of the guys who knows
me.
I told him I was going in for,you know, chiropractor, because
they don't want to be seen asgoing for mental health.
Those knowing those barriers.
Knowing that management,knowing that there's still a
high stigma in regards to themental health piece, is so

(21:09):
important to remember in orderto identify and describe those
unique challenges.
Because if you tell them, well,let's do breathing exercises,
they're not going to actuallypull someone over and start
doing breathing exercise in themoment.
So I kind of remind them, like,the unique challenges is that
in my job, if I want to go, okay, I need to go and take a
breather.

(21:29):
I can't, they can't just go,all right, I'm going to take my
uniform off and take a breatherand come back.
It doesn't work that way.
So it is a challenge andknowing that those stressors are
real is so important.

Speaker 3 (21:42):
Okay.
So some of the stressors andchallenges.
It's not always going to be.
Don't assume it's PTSD.
Don't assume it's some type ofstress disorder, mood disorder
or even substance abuse.
It could just be not that itjust could be but it might be
relationship issues, it might beparenting, it might be stress,
it might be career transitions.
It's not just because it's afirst responder does not mean

(22:05):
that it is going to be some typeof trauma at all.
I mean it could be somethingcompletely.
But yet knowing the culture andknowing how to be present and
be aware is super important.
It's really good.

Speaker 2 (22:17):
Right, I mean I'm going to just go a couple of
statistics and then we candefinitely talk about that.
Because do I have firstresponders that have a PTSD
diagnosis?
Yes, do most of them have moreof a mood disorder behavior Like
sometimes it's something asadjustment, as easy as
adjustment, sometimes it's morelike MDD or generalized anxiety,
but mostly it's mood disorders,it's actually not trauma.

(22:40):
So, really recognizing that andthe reasons why, you know like
let's talk about some statisticsbefore we go into maybe talking
more about these uniquechallenges, you know they found
that 50, there's a there's astudy out of Florida State
University firefighters had 50%of them had suicidal thoughts at
some point in their career and16% report having attempted once

(23:04):
or more suicide.
Percent report having attemptedonce or more suicide.
And then to estimate thesuicide levels for firefighters
is 18 per 100,000.
The general public is 13 per100,000.
That's one of the highestlevels and if you put all the
first responders together that Idescribed earlier, it's number
one.
I believe that number one islawyers.

(23:26):
Otherwise, but if you go withthe whole of first responders,
they by far are the number one.
You look at the police officers, the law enforcement officers,
are more likely to die fromsuicide than they are of line of
duty stuff.
That's how telling that isabout the suicide and how the

(23:46):
stress plays a factor.
And the number of policeofficers dying by suicide has
just increased in the last fiveor six years I don't quite know
the numbers for 2024, so I don'twant to venture too far ahead
but last year they went up byabout 10% and that's a
significant amount of people.
Massachusetts I can talkintellectually about the nine

(24:08):
reported suicide of firstresponders.
That's just police officers,not even first responders.
Last year alone nine, which isalmost once a month, yeah, and
that's a high number.
So, keeping that in mind, theemts and the paramedics, have
been found that 37 percent ofthem have contemplated suicide
at some point and 6.6% of themhave actually attempted it.

(24:30):
It was a US survey.
The Canadian survey shows that28% have contemplated suicide
and 60% of paramedics or EMTsknew of one person who had tried
.
So the elevated suicide ratesfor first responders.
You can really attribute it toso many things, but what we're
going to talk about is again theunique challenges and stressors

(24:51):
.
Let's go with the one thateveryone knows and I'm just
going to run it through trauma,exposure to trauma.
You know what we would call inour field compassion fatigue.
You know, at one point you seeenough tragedy that you kind of
become cynical about it andalmost like, kind of like give
up the like, the compassion,because oh yeah, I'm going to go
to the same call next week orwhat have you, and so that plays

(25:14):
a factor.
So when you're you see it onceor twice.
That's one thing.
If it's repeated exposure over10-15 years, it will affect you.
So it's not about the trauma ofday-to-day.
Sometimes it's the accumulation, the trauma, the.
The thing that I talk aboutwith some people is it's not the
first trauma, typically it'sthe 27th one and the 27 one

(25:35):
triggers the 26 that occurredbefore that.
So that's, we're going to talkabout trauma, obviously, and one
of the things that I'm hopingthat most of you will get from
this and how to do the treatmentand the challenge.
With the challenges we're goingto talk about treatment later.
If you address it within thefirst six months of the trauma,
it remains acute stress disorderand actually can disappear from

(25:56):
the record.
You don't encourage thattreatment, you keep on not
paying attention to that.
Then it becomes post-traumaticstress disorder and very
detrimental to those individuals.
So I tell people, like, try tokeep an acute stress disorder.
That's great, you just got toget there, and working with them
is kind of like hard, becausewhen it happens, no, I can
handle it.
The other cultural competencything I want to throw in very

(26:18):
quickly is it?
I know we all return our phonecalls timely with our clients
and everything else.
But with first responders, ifyou don't respond within 48
hours of their phone call, theywill not show up to your office,
they will not seek help.
So there's a really, reallysmaller window and, as you said,
you've worked with the military.
I find the military is kind ofthe same.

(26:38):
You have such a smaller window.
If I call back a client whowhat I would call a civilian,
and I call them back a weeklater.
But I would call a civilian andI call him back a week later.
I'm like, oh, thank you so muchfor calling.
I called back the policeofficer.
I don't remember calling you.
I don't know why you're callingme and I'm picking on the
police officers, firefighters.
So I want to mention thatbecause it does play a really a

(26:59):
factor in just keeping in mindthat compassion fatigue is a
real thing for therapists.
It's a real thing for firstresponders too.
And you're at the ER and youwork in certain areas and you're
on your 10th shooting in thelast six months.
The 10th shooting starts likeeither you lose that compassion
or you start going all right,rigmarole, let's go through it

(27:20):
again.
And the challenge is to keepthem caring while not exposing
themselves too much, and that'sa huge challenge in our work.
But we'll talk about how thatcould look.
The occupational stress issignificantly higher.
Not all everywhere is the same,but typically you have three
shifts on the police departmentsand then for EMTs, paramedics
and fire.

(27:40):
Typically you'll have anywherefrom 12 to 24.
Around here in the New Englandarea it's a 24-hour shift.
So think about going to yourjob right now.
Whoever you are, even as amental health counselor, you're
there 24 hours on, 24 hours off.
Then you go back in for another24, and then you're off and I
put that in quotation mark fortwo days.
That's really rough on yourfamily, that's rough on you and

(28:04):
there's so many things that comefrom that.
That is difficult.
And, keeping that occupationalstress in mind, if you're a
police officer, you get to bidon shifts.
That's how it goes.
Or sheriffs are the same way.
You know you always wantedsecond shift.
Well, too bad.
You're the rook.
You got the midnight shift andyou're stuck there for a year or
two because there's not enoughpeople.
Or you want to go in the firstshift and you're someone who

(28:27):
really wants to make adifference and you have some
shifts across the country wherethe first shift is like taking
care of the school, helpinggrandma, and it's not the same
policing that you expected, andso sometimes that can be
frustrating.
And also working with people whohave different experiences than
you.
You know I always hear theolder first responders
complaining about the youngerfirst responders.
I also work with older firstresponders complaining about the

(28:48):
younger first responders.
I also work with younger firstresponders who complain about
the older first responder, whodon't get it.
So, keeping in mind thatthere's always these things and
there's always thesecompetitions, and let's add to
the fact that if you're on for24 hours, we joke around the
firefighters sleep on their job.
Well, if you've got eight callsin a row, I'm sorry you didn't

(29:08):
get to sleep.
And if you've ever beenstressed in your life or had a
big event, you realize that evenif, let's say, the big event
finishes now, you need at leastan hour to 90 minutes to just
like decompress.
So even if you finish quoteeight to eight you're not in bed
till, if you're lucky, nine,930.
And then you got to get back onit in 24 hours.

(29:32):
It's a really tough job.
You do an eight hour shift butin sheriff world and in police
world, I'm sorry we don't haveanyone.
You got to stay, you're forcedto stay.
So now you're doing 16 hours.
I'll go home, go sleep foreight hours, which you're not.
You're sleeping more six andthen come back for your regular
shift.
There's a lot of pressure onyourself.

(29:52):
Let's remove the police officer, the firefighter, all that.
What type of pressure does thatput on your family?
Your partner comes in and theygo.
Well, I thought I was marryingsomeone who's going to be
present with the kids and you'realways gone.
Well, that's part of the shiftand the occupational stress and
that causes marital strife.
And, yes, people in principlesometimes like, oh, I'm okay

(30:14):
with it.
Come the seventh or eighth yearof one of the partners taking
care of the kid more than theother, people get bitter, people
get angry causes a lot ofmarital stress.
So keeping that in mind whenyou think about the challenges
that they have.
The marital stress, to me, isone of the biggest ones that
you're going to face.
You don't need to be a couplescounselor, you just need to be

(30:35):
there to listen and try to findways to resolve it, because a
lot of them to become parentsand I don't know most of us who
have become parents.
We typically do it by choiceand now they feel guilty for not
being there for their kid ormaybe being disconnected from
their kid because they're sotired from their shift or, god
forbid, something happened ontheir shift.

(30:56):
So there's a lot of stress thatcomes from that, and keeping
that in mind is very important.
And I don't know about you, butwhen my sleep patterns are off,
I'm a miserable human being.
Them when my sleep patterns areoff, I'm a miserable human
being.
I know I have seen perky onthis podcast and this pod course
, but typically I get very, verycranky, and so imagine that you
didn't sleep enough because ofthe shifts and everything else.

(31:18):
Then you got to talk aboutsleep patterns and one of the
things that I talk about is howare we going to eat the best we
can?
Because if you're on a shiftfrom four to 12 and you've had
calls till 10, there's no littlewhole foods with a little salad
and everything healthy thatyou're going to sit in your
cruiser and eat.
You're going to go and find theburger and shove it down your

(31:38):
throat, and that plays a factoralso on stress and how you do
all these things.
So and then, let's not forgetthat we're not working on
painting a wall.
We're working in high stresssituation vehicular accidents,
driving people between life anddeath sometimes and yeah, it's
not as often as we think, but itdoes definitely happen.

(32:00):
So that is another stressorsthat you got to keep in mind.
That is going to happen.
The other one, too, that Italked about a little bit
earlier that I want to talkabout is the whole stigma around
mental health.
Going for a mental health isthink about the stereotype that
you can think about.
They highly likely have that.

(32:21):
Do I change that in time?
And a lot of my guys.
It's always very touching thatthe guys have worked with me
long enough that they go aroundlike, oh yeah, my therapist said
this like what?
Like this?
So like they don't typicallysay they're like, oh, I don't
care, I get it.
So you got to work with thistough guy culture and I call it
tough guy because that'stypically what it is and we're

(32:43):
discouraged to get help.
Right, remember the guys beforethey didn't need mental health
support.
Why would I need it?
And so you're working with allthese barriers that they already
created.
Then you got the fear ofjudgment.
What are people going to say ifI go see a therapist Again in
time, these guys get educatedand they get it.
But when you think about thechallenges, if I go to, I've got

(33:06):
a therapist.
You know how many people makefun of a therapist seeing a
therapist?
No one, they're fine with it.
They think it's logical for afirst responder to go see.
Well, you can't handle it.
And then God forbid thatofficer, er, nurse or whatever
go for a promotion.
Well, now they're like well,you went to mental health and
they think that's how it works.

(33:26):
Well, you need mental health,why would we even promote you?
And you got to face all thosethings and that appears to be
weak, but they're not.
And frankly, the one thing Ialso joke around with some of my
guys is you got to remove the Soff your chest.
Or if you're a woman, I saytake the WW from Wonder Woman

(33:48):
and start being a human.
And that's a very challengingthings, because if you need
challenges as a police officeror a firefighter or EMT or ER,
you got to be in control of thesituation.
Firefighter or EMT or ER, yougot to be in control of the
situation.
While me telling you to takeoff your ass, taking out your WW
, you're like, well, no, now I'mvulnerable.
Like yeah, that's hard to bevulnerable when you're usually

(34:10):
in charge.
So that's another stressorchallenge that you're going to
face with first responders on aregular basis.
A couple of more things that Iwant to mention is the social
isolation, because firstresponders they don't you know.
They say why do you hang outwith other cops?
Like well, I don't want to beasked questions about cop work.
Or you know, like I have afriend of mine who happens to be

(34:33):
a police officer.
Every time we go together to anouting they go what was the
worst call you went to?
He doesn't want to talk aboutthe worst call he's been to.
I can't say that Some, he's notmy client, but that's typically
what they ask.
Or oh, I had a ticket andthat's this like I'm not going
to solve your ticket.
And so they end up being withother first responders, but then

(34:54):
you talk about the job and thenyou don't get away from the job
.
So even your social aspect istaken away.

Speaker 3 (34:58):
The job, so even your social aspect is taken away.

Speaker 2 (35:00):
Yeah, yeah so, which also leads to some, some
substance use.
I mean, things have changedsignificantly, but substance use
is a common thing to deal withstress and sometimes, when you
go to these outings with otherfirst responders, there's going
to be alcohol.
And sometimes that becomes away to cope with some of your
feelings and those challenges isthat you can't talk about being
on any substance because, godforbid, is your badge going to

(35:22):
be taken away?
Is your gun going to be takenaway?
So there's all these thingsabout opening up about substance
use.
That's really really difficultfor them.
If I had a problem I've had aproblem with alcohol in the past
no one hears batting out aneyelash about me talking about
that.
As a police officer, I go outand say I had a problem with
alcohol or a firefighter.
Guess what People go, whoa, andthere's such a difficult way to

(35:47):
talk about those things.
And this brings us to the lastpoint I want to make is what
type of access to resources dothey have?
Yeah, there's what they callcrisis intervention, stress
management or response teamsthat they go when there's a
significant event.
That exists.
There's peer support in somedepartments not all departments
where a peer you work with canbe there for you, but they're

(36:09):
not everywhere.
But you know the gossip thathappens in a police, a police
department, of fire department,at er I.
I joke around that I've neverseen so many high school
behaviors other than my firstresponder world, because they're
like gossiping about each other.
Oh, did you hear about this?
You know Steve's going totherapy.
He must have blankety blank.

(36:30):
Well, how do you know?
Why are you speculating?
It becomes such a high schoolenvironment with everyone
gossips and that's a very toughthing.
So when you go for yourresources, some people might oh
you know, what johnny askedabout steve.
He asked for steve's phonenumber.
You know what steve does and sothat plays heavy and you don't
want to be doing any of that.

(36:50):
So, and if I've worked hard inthis community for years and
looking across the country, it'sreally tough.
There's great organization.
I don't want to plug anythinghere so I'm not going to name
them.
There's great organizationsthat help out first responders
and that's great.
The plane for that you got togo to Colorado, I guess,

(37:21):
depending on where you live inNorth Dakota, but pretty much
you got to get on a plane.
Now you got to miss time for it.
Then you get back home.
North Dakota is a smallcommunity.
Everyone knows you went away.
They want to know why, and thenyou start seeing a therapist.
Think about the heaviness ofall those factors combined.
So keeping in mind that theseare challenges that they face on
a regular basis is so important.

Speaker 3 (37:41):
Okay, this is so good .
I'm seeing so many parallelsand crossovers in the military
world.
It's pretty like you weretalking about taking off your S
or taking off your W.
I've said that so many times toservice members.
It's their persona, it's howpeople see them see them, I
guess, and so they feel like ifpeople see them that way, then

(38:04):
that's how they're supposed toshow up.
It's a should, I guess, thatour culture somehow puts out
there but it's a it's a pedestalright oh yeah, you know, you
think about the military.

Speaker 2 (38:17):
Like again, with all the respect I have for the
military and most people whoknow I've worked with the
military before, I don't putthem on a pedestal when you come
into my office.
You're a human, you're just ahuman.
You happen to be in themilitary, you happen to be a
first responder that's great,but you're a human in here, yeah
.
Yeah, they don't have a hugefactor in regards to that and

(38:41):
you know, having the ability tosay, well, we're going to do a
healthy work-life balance.
I don't know, I've never beendeployed for nine months, 12
months, but it's hard to have awork-life balance when you're
deployed for nine to 12 monthsand sometimes and most of the
time, you can't disclose whereyou're at and you can't disclose
to your family anything andyour family's concerned.

(39:02):
And, god forbid, you just had achild or you just got married
or what have you?
Just think about that burdenthat.
Even for police that happenstoo.
A lot of them work for, uh,fema and then they end up.
Yeah, you might know thatthey're in north carolina,
especially recently I had a fewguys go down to north carolina
help out um in 2024, but theycan't exactly tell them.

(39:24):
Okay, my day's going to beeight hours.
I'm going to be done.
I'm going to give you a call atsix, because God knows how long
that is.
And the military faces the samething.
These are challenges that arenot known by the day-to-day
stuff.
If I go to work at a bank,there's specific hours, even in
the non emergency medicalpersonnel from tech for an MRI

(39:48):
machine Well, my hours are fromthis to this and I go home.
It's not like it's going to bean emergency MRI that I got to
stay for.
There's either a person behindus or the emergency room highly
likely has an emergency MRI theycan use.
So you don't need this thing,and I think that that's the
other unique challenges that arenot well known about the work
is that you're carrying itconstantly and you almost never

(40:11):
get a good work-life balancebecause of it.

Speaker 3 (40:13):
Right, absolutely Okay, okay, so.
So let's talk a little bitabout evidence-based therapeutic
interventions that you use towork with your first responders.

Speaker 2 (40:26):
Absolutely.
I mean, the first thing that Iwould talk about is cognitive
behavioral therapy.
Cognitive behavioral therapy,as you know, for mood disorders
is typically more effective thanany other treatment.
And cognitive behavioraltherapy, specifically cognitive
distortion, cognitive dissonanceand stuff like that, they
really respond to that thoughtprocess.

(40:47):
I make fun of it sometimes,especially around all or nothing
thinking, are disqualifying thepositive Cause.
You know, like if you tell acop or a firefighter, hey, you
got an award for doing this,they dismiss it, dismiss,
dismiss it.
And you're in and like whycan't you take some positive?
I mean, you just told me youdidn't get positive from your

(41:08):
colleagues or your bosses.
Suddenly you get an award, youdismiss that too.
So they get that.
And they kind of like, yeah, itcomes off jokingly and I kind
of like, do that.
But and then if they feel likecrap and they say, well, well,
the world is crap, no, you feellike crap because you deal with
a lot of difficult people.
The world is not necessarilycrap.
Emotional reasoning Again.
If I sit there and like let'slook at, attempt cognitive

(41:31):
distortions by David Burton,they're not going to listen to
me.
But if I say because you feellike crap, that doesn't mean the
world is crap, you feel likecrap and maybe part of your life
is crap.
So using those type oflanguages again I go back to
about the treatment.
Cbt is certainly effective forthose mood disorders and it can
be effective for the trauma too.
But I have other modalitiesthat I recommend for trauma that

(41:55):
I certainly practice.
For me it's getting to know theperson when we do the treatment
plan.
If you start off with someoneand say, all right, we're going
to do EMDR and CBT and youdidn't build a relationship,
you're going to lose your clientalmost immediately in the first
response.
Being culturally competent isimportant in showing that you
can be doing that.
And the other part too is firstresponders want the here and

(42:17):
now being treated, and then thenmaybe CBT comes in.
But maybe it's behavioral,maybe it's just listening and
being more of a Rogerian type ofhumanistic approach.
But if you're going to do atreatment man properly, don't
start off with like bing bang,because sometimes that's going
to push them away.
So for me I talk about likebuilding a relationship.

(42:38):
You can call it humanisticapproach.
But first responders want tomake sure they can trust you and
when you talk about militaryI'm sure you've experienced that
too.
They want to make sure they cantrust you.
So therefore, you got to builda relationship first.
Then you can talk about like doI do CBT within the first hour
of working with it?
Yeah, do I call it CBT?

(42:59):
Do I tell them what I'm doing?
No, but being able to notalways identify technique,
technique, technique.
But building a relationship iskey.
The first responder treatment,as well as you know, plant when
you do your your treatmentplanning, essential to go there,
but evidence-based.
As you said, building arelationship is key to any
healthy mental health treatmentfor any human beings.

(43:22):
Now, if you want to go intodeeper stuff and we're going to
go with the trauma stuff,because that's the common one
that people want to hear Well,as a EMDR practitioner, eye
movement, desensitization andreprocessing is really helpful.
You know you start off by youstart.
You don't start off, in myopinion, with eye movement,
desensitization or reprocessing.

(43:43):
I think you build arelationship and then you hear
about maybe traumas hey, maybeEMDR would work for you, Maybe
it's family stuff.
Then you go to CBT and dealwith CBT and how you can think
differently about yourrelationships with others and
how you can change certainthings, your relationships with
others and how you can changecertain things.
But when you have trauma,that's been specifically

(44:04):
building up and we talked aboutthe 27th event that happened in
their life well, EMDR is areally good approach.
It's been proven that it workswell with the military personnel
.
It works well with anyone who'shad trauma.
I know that it's not recognizedunder the DSM-5 TR that complex
PTSD exists, but for me, EMDRanyone who has more than one

(44:29):
event that has been traumatizedhad a trauma from it sorry,
traumatic event, then yeah, EMDRis perfect for that, because
you're going down the channels,you're looking at what's going
on and I know it's sometimespeople say, well, it can take a
long time, EMDR.
I've done EMDR for close to 10years.
It takes eight to 12 sessions,give or take 60 to 90 minutes.

(44:53):
90 minutes are usually thefirst few sessions.
Eventually you break it down toabout 60.
And then you go through thewhole process of EMDR and for
those who don't know EMDR, it'sliterally something that was
developed by a military personand they talk about the movement
.
Eye movement is really whatthey do with the fingers and a
lot of people know about that.
You can do it with your ears,with earphones, and that works

(45:14):
effectively too.
In my experience over the courseof several years of working
with first responders.
I work with the paddles, thevibrating paddles, because they
can close their eyes and stay intheir head Because,
unfortunately, or fortunatelybecause they're first responders
, they tend to be looking around, they get distracted and
they're like oh, what was Iprocessing?

(45:35):
Again, Close your eyes.
We're going to do paddles.
Obviously, if they don't feelcomfortable closing their eyes,
I don't tell them to close theireyes.
I say, focus on something.
But ultimately EMDR has beenproven over and over again that
it's helpful and that can be isa great treatment for trauma and
in my experience, if done right, most of my clients finish EMDR
.
They're like I'm good, andusually we go to every three to

(45:58):
six months just to do check-ins,because I believe in mental
health, obviously, but it's notthreatening to them, because you
help them.
And that's the other key aboutbuilding that treatment plan and
the modalities that areevidence-based is to build them
up for success, not say, allright, clearly you have trauma,
and then pull a sheet out andsay, EMDR, let's do all these.

(46:19):
No, that doesn't work for them.
You got to be able to create arelationship that's safe.
Many, many times they stopseeing me and they give me a
call hey, I need a refresher, Ineed just a, and that's great,
because now they've foundsomeone they can trust and a
little bit of EMDR, just so Ican give a little bit of basis.
For those who don't know, youtake the history and treatment

(46:39):
planning, you do all that firstand then you set up a safe place
or a safe person, or both,depending on who they are.
They don't have to be real.
They can be imagined, but it'sso that if they get to a place
where they're so triggered theycan't find their way back.
You can use that safe personand safe place to bring them
back.
Then you do the preparation forthat, the assessment, and then

(47:02):
the desensitization, the actualwork.
You do the installation of thatsafety.
It takes some time, especiallyin the first session.
As I said, my first sessionsare typically at least 75 to 90
minutes.
Eventually it goes down.
Then you do a body scan andthen a closure, and it's so
important to go through allthose processes.
I think some people want to justget to the movement and say,

(47:24):
all right, you're feeling great,great.
But if you didn't future plan,did you not body scan?
Because maybe they're feelinggood but they're holding it in
their chest or holding it intheir arm, they're holding it
somewhere else to get headaches,Then that is a problem.
So EMDR done right in a like wetalked about evidence-based.
The evidence-based is not to doit quick.

(47:46):
Evidence-based is doing it theFrancine Shapiro way, which is
who I've worked with, their EMDR.
There's nothing plugged here.
This is something that'swell-known across the country.
They are the ones who do thebest training for EMDR, really
very beneficial.
So that's who I use and that'swho I recommend.
And then there's something thatI used to call and this is funny
because while doing someresearch I used to call it

(48:08):
systematic desensitization, butapparently when you talk about
evidence-based treatment andplanning it's now called
prolonged exposure therapy andit's a little bit like EMDR and
I've done a little bit of it.
I never knew how to put it inthose words, but you do the
imagined scenario in the officeso that they can work on that
and be able to be exposed notreally, but exposed in their

(48:31):
mind about these things thatmight occur.
And then eventually you go intoin vivo exposure.
Going back to the community,you know the story.
I will share thatevidence-based for me.
But also you know prolongedexposure therapy and systematic
desensitization has been provenfor years that that works.
But the story I would give youis I worked with a first
responder who got hit by avehicle while doing a detail and

(48:54):
so he was very nervous aboutgoing back to the street,
nevermind, you know, pullingover someone or what have you.
So literally my office is near astreet that has a lot of cars
that go by fairly fast, butthere's a nice barrier between
us and the road.
So what I did is I'd walk himdownstairs and we'd sit there
and not necessarilytherapeutically talk, but I

(49:15):
wanted to expose him to what hemight face again.
And so slowly we move beyondwhere the border is and the
protection to where he wasexposed directly, that if a
vehicle jumps the curve we'redone, and to a certain extent
that's what in vivo exposure isbased on the prolonged exposure
program and eventually, for therecord, this individual back on

(49:38):
duty doing everything right,gives a lot of credit to the
prolonged exposure.
I call it desensitization, buthe gives a lot and they work
really well being able to exposeindividuals that not all babies
are going to be difficult todeal with because unfortunately
when you get a call from aparamedic or EMT perspective,
the baby usually has somethingwrong.
So sometimes it's exposing themto babies that are healthy and

(50:01):
that they exist, in order torealize that it's not always a
problem.
And all these techniques havebeen very effective.
Like I said, I know it's calledprolonged exposure therapy and
there's a great technique.
It's an eight to 12 weekprogram that I absolutely love.
I remember it from thebehavioral schools that I went
to and we talked aboutsystematic desensitization,

(50:22):
which has been very beneficial,exposing people.
I exposed him to vehicles goingfast on YouTube, Not in like
that was my in office thing,there's no danger, you can.
But then we've processed theemotion.
How are you feeling about that?
Ah, that's not going to happenagain.
It's someone's going to gethurt in this and that I'm like

(50:44):
well, how many people got hurtin the video?
Oh, no one.
I'm like okay, so there's apossibility that you may not get
hurt.
So even doing stuff in theoffice and doing that what they
call imaginal exposure is veryimportant to bring it to in vivo
.
No, I did not go on the highwaynext to the vehicle with that
particular officer, but hefigured it out and was able to
go back to work.
But that systematicdesensitization is another one

(51:06):
In substance abuse world.
We talk about motivationalinterviewing, which has been
also proven to work really,really well, and motivational
interviewing, I think, is evengood for the mental health part
for this type of population.
When I talk about like ifsomeone's coming to see you,
yeah, they took an action tocome and see you, but they may
not be ready for change yet,they're not willing to go right

(51:28):
away into action of that.
So sometimes it's thing aboutthem as pre-contemplative.
I don't know if this works, Idon't know if you're a quack or
whatever and I'm not picking onanyone, it's just how it is and
being able to understand okay.
So this is maybe thepre-contemplative part and
they're into contemplative mode.
Then you get them topreparation, Then you get them

(51:50):
to action and I always say yousay relapse.
I know that that's acontroversial subject on the
substance use part, but on themental health part I think it's
all normal and what I mean bythat is if you ever have no
anxiety, you're highly likelynot of this world anymore.
Anxiety happens every day.
So maybe you feel like yourelapse because your anxiety
rebuilt up.

(52:10):
No, you can come back to action.
That's how we're going to dealwith that.
And then change and maintenanceis key and keeping those good
habits going.
So motivational interviewinghas been shown that it works
also really well with the mentalhealth aspect of particular
mood disorders and anxiety.
So I really like to use thatand mindfulness-based therapies

(52:32):
have always been evidence-based.
I put it sometimes in my clientswho are more open to
particularly those who talkabout spirituality and again,
any type of spirituality.
If you talk about God, if youthink that God is Allah, you
think it's Buddha or whatever.
I think that once you have thatspirituality, you can introduce
the mindfulness-based therapy,because it is, again,
evidence-based.

(52:53):
I would argue, though, makesure that your client is open to
that, Because if I sit thereand say let's talk about God,
they might not be willing to doso, and I think that's very
uncomfortable for people.
But for me it's like I listenedto them and, like you know, I
go to church every week.
Oh, now a cue.
Or you know, I go to temple forthe high holidays, like another

(53:14):
cue.
I'll figure that one out.
But being able to putmindfulness techniques which are
evidence-based, be mindful inyour treatment planning that the
person is good at seeing that,Because if they're like, okay,
let's talk about, as someone whodoes quote Buddha a significant
amount, I always say, by theway, I'm not pushing religion,

(53:35):
and just that's a good statement.
And sometimes, you know, dounto others, which is universal
with religion.
I say I'm not saying you got tofollow one particular religion,
but I do think it applies, andthen you can see, engage, how
they react to that.
If they react negatively,probably mindfulness-based
therapy is not part of yourtreatment plan, but it is
evidence-based that it can helppeople.

(53:55):
And the other thing that I'vediscovered I did this starting
in 2018.
I had to stop, unfortunately,for the pandemic years and I
restarted recently is grouptherapy, and the group therapy
is a lot of a supportiveenvironment for first responders
to talk about their ownexperience and see that other
people go through that.
They don't need to explain thatthey're unique challenges

(54:18):
because they're not, as theycall them, civilians.
They're people who know andsupport each other, so they
don't have to explain thatthey're unique challenges
because they're not, as theycall them, civilians.
There are people who know andsupport each other, so they
don't have to explain that.
And then you see that there'sno isolation.
You work on the stigma becauseyou know johnny, johnny from you
know any town usa is the sameas anyville, usa.
Oh my god.
Well, okay, that can be similar.
And then suddenly you can havethose exchanges and and yes,

(54:41):
gallows, humor plays a hugefactor, but group therapy has
been effective.
We'd look at self-help programsto what we're, what I'm doing,
which is a lot of evidence-basedstuff, which is talking about
specific things likeadministration, betrayal,
talking about how to deal with aspouse who's not too happy with
you because you have to take anextra shift for X, Y, Z reasons

(55:02):
, and so how do you communicatethat?
How you know it's not bringingflowers, that's going to fix it.
How are you going to talk toyour partner around these things
?
And so you know, group therapyhas been very effective.
Self-help has been helpful.
It's hard to find a self-helpgroup in that stuff, but those
are the you know, not only areevidence-based practice.

(55:23):
When you think about yourtreatment planning, make sure
that it's appropriate.
If someone doesn't have traumaand say, well, we're going to do
EMDR probably not a goodtreatment plan, cognitive,
behavioral, with somemotivational interviewing,
probably better off for you.
Someone who's resistant thatthey've had trauma, Maybe you
start off with a motivationalinterviewing and building the
relationship so you can get toEMDR prolonged exposure.

(55:45):
But ultimately it's reallygoing through all those things
and, as a therapist, make surethat you know you're trauma
informed and trauma informed isnot oh, I know about trauma and
I hear that all the time.
Well, I know about trauma.
That's not trauma informed.
What's your supportiveenvironment?
How are you reacting to someonetelling you trauma and making

(56:06):
sure that they feel supported inregards to that, and that's how
people say well, I'm atherapist, I'm trained in that,
Are you?
And it's really important to beinformed of that.
Talk about being culturallycompetent.
The therapist's expertise is soimportant for the treatment
planning, as well as theevidence-based.
If they think that you don'tknow what the roll call is, then

(56:29):
they're not going to reallywant to keep on talking to you.
And the common theme.
I forgot to put this in thequotes, one of my favorite
quotes well, a book can'texplain me.
Well, a book can't explainanyone, but that's typically the
defense mechanism that comes upand the accessibility and
availability.
Like I said, time is vitalcalling back right away, making

(56:49):
sure it's within a certainamount of time time and then
making sure your office isreachable.
Like if I'm working withsomeone in Oregon and my office
is in Vermont, that's notaccessible to them and there's
some advantages, but there'salso licensing issues and all
that, but at the end of the day,it's making sure that you have

(57:10):
accessibility.
Some of the guys like hey, Idon't want to go to your office,
I want to do it online.
Fine, I'm accessible.
That way, you know what I wantto go in.
Well, I actually have an officewhere there's a private waiting
room.
So you close the door.
You don't have to be doing that.
So making sure you have some ofthese safety measures, so to
speak.
They're not real safetymeasures.
And the other final point thatI keep I wanted you to consider

(57:33):
not only because of yourtreatment planning, but also as
an evidence-based, typically,first responders.
They don't want to be in themiddle of a room and they want
to be able to be accessing thedoor very quickly.
And that's sometimescounterintuitive for therapists,
because I have to be closer tothe door With first responders.
Make sure they have access tothese outlets, because if they

(57:54):
feel trapped, A, they won't talkand, B, they're going to never
come back.
So those are the other thingsto keep in mind with first
responders.

Speaker 3 (58:03):
Okay, okay.
So all such good stuff I'mtrying to think of, have any
follow-up questions, I mean, youjust really it's really good
overview and primer on how towork with first responders.
Anything come to mind thatmaybe you want to, as you're I?

Speaker 2 (58:17):
know it's going to sound very intuitive.
It's very intuitive and we'veknown each other, lisa.
So the reason why me and Lisaget along is that Lisa's herself
when she's with me and I'mmyself when I'm with her and for
in a professional world.
You think that beingprofessional means you got to be
careful about your facade andbeing professional.
Well, I'm me and Lisa havealways been professional, yet

(58:38):
we're ourselves.
But first responders do not showup, but yourself.
If you forget to show up asyourself, you can talk about
evidence-based.
To me it's a treatmentconsideration and treatment
planning consideration.
If you're going to be puttingup a facade or pretending you're
something you're not like.
You know I've had too manyfirst responders come in and say

(58:58):
I went to see someone who saidthey had experience with first
responders.
Turns out they followed onecourse one time.
This one hour course, whilevery beneficial, does not make
you an expert as a firstresponder.
Get informed, look for that anddon't pretend you're not.
And even if you showed up andsomeone shows up and says I'm a
first responder, what's yourexperience?
If you truthfully say not much,they might actually stay

(59:22):
because you were truthful,rather than saying oh yeah, I
have all this experience.
I never pretend I don't haveexperience.
Don't pretend things thatyou're not, and I know that
sounds very intuitive for us,but you know as much as I do.
Some of us get in, get stuckand they want to look more
important than we are, no morethan we do.
Just be yourself.
They've seen BS from a mileaway.

(59:44):
Don't be the BS-er.

Speaker 3 (59:46):
That's a good point.
And when you were talkingearlier about you know, knowing
what certain terms are, Iremember when I first started
working with the military, I itwas like baptism by fire, I mean
I jumped right in and therewere so many things I didn't
know and I finally, just I waswriting everything down, like
okay, I'm gonna look this uplater, I'm gonna check what this
means.
And I remember finally insession I was like why don't I
just ask the service member?

(01:00:08):
And so finally I was like, okay, wait, before we go any further
, can you tell me what it means?
When X, y and Z, and they werelike, oh yeah, no problem and so
, but the fact that I told themI didn't know what I didn't know
was explain it.
And I think that's, with anyculture that you're unfamiliar
with, it's okay to ask for whatis that?
What is that?
How did that affect you?

(01:00:44):
What does that mean to you?
How would that?
How you know?
Is that normally how it goes?
You know, ask those questions,just be truthful and authentic
and, like you said, don't try topretend that you, you know
everything.
I think that's such good adviceand these are things that I
just learned on the job kind ofthe hard way.
Quote, unquote the fact thatyou're saying this is part of
the culture, it makes sense, andwhen I've given presentations
on how to work with the branchthat I work with, these are some

(01:01:04):
of the things that I bring upnow that at the time didn't seem
to be revelations, but theyreally are.
If you're not used to workingwith this population, it really.
It really is information thatis going to help you when you
encounter because chances areyou're probably going to
encounter somebody who is afirst responder in your, in your
work.

Speaker 2 (01:01:21):
You might not know what they're talking about, but
you got to be able to say it.
And debriefing in the policeworld is different than
debriefing in the military worldand it's different than the EMT
paramedic world.
And ask that question becauseeven within the military world,
I found that debrief meanssomething different from one

(01:01:41):
branch to another.
Whether it's the army, navy,air force, marines, coast guard,
debrief means slightlydifferent things for each one.
So I'm like tell me more aboutyour debriefing.
This is my experience, butplease tell me so, even if you
do have an information andyou're you don't know, just say
you don't know.
They'll respect that a lot.
If you do know, say, hey, thisis what I think it is, and they
might go.
Oh no, the briefing for CoastGuard is right after the event,

(01:02:05):
versus in the army it's after.
You leave your your post forblank amount of months, so just
doing that.

Speaker 3 (01:02:10):
And another thought too is you may not necessarily
specialize in working with firstresponders, but maybe you work
with in women's issues orcouples.
My chances are you're going tohave somebody come in who might
be married to somebody in that,in that culture, in the first
responder military world.
So it's it's good to have thisinformation so you can apply it
as needed.

(01:02:31):
And I've come across manyspouses who, over my years, have
said I just want to talk to youbecause you get it, you
understand what my servicemember is doing, and even if
it's in a long-term relationship, it's like, okay, I want to
talk to her because she gets itand I so.
I think that's something tokeep in mind as you encounter

(01:02:53):
different types of clients andthey're all different all
cultures, all socioeconomicstatus, different parts of the
country, different parts of theworld.
I mean it really iscross-cultural within a culture.

Speaker 2 (01:03:08):
Well, policing in North Carolina must be way
different in Massachusetts andit must be way different in
Vermont or North Dakota orAlaska.
And recognizing that and thejoke that I wanted to share with
everyone is a lot of my firstresponders that I've known for
years.
They're like well, you're oneof us.
I said yes, but I'll alwaysrefer to myself as a civilian
because I don't want someone whodoesn't know me think I have an

(01:03:31):
ego because of this.
And reminding yourself of beinghumble, being curious and
learning all this is soimportant.

Speaker 3 (01:03:39):
Yeah, absolutely Well .
Thank you so much, steve.

Speaker 2 (01:03:41):
Thank you for having me.
This is great.

Speaker 3 (01:03:43):
You're welcome.

Speaker 2 (01:03:45):
Well, that concludes episode 196 with Lisa Mustard.
Again, go to our website forpod courses.
It'll be in the show notes,Just click on it.
Go get your CU.
It's $5.
It's a good CU for $5.
And I hope you really enjoyedit.
But I hope you join me forepisode 197 with the returning
mental men.
So you know from Lisa that'sbeen here a few times, to the
mental man who's been here a fewtimes.

(01:04:06):
So I hope you join me then.

Speaker 1 (01:04:08):
Please like, subscribe and follow this
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A glowing review is alwayshelpful and, as a reminder, this
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If you're struggling with amental health or substance abuse
issue, please reach out to aprofessional counselor for
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If you are in a mental healthcrisis, call 988 for assistance.

(01:04:31):
This number is available in theunited states and canada.