Finding Your Way: Resilience Development in Action

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

• Steve Bisson, Lisa Mustard • Season 12 • Episode 196

Share episode

Send us a text

 

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.

 

Support the show



YouTube Channel For The Podcast




Speaker 1:

Hi and welcome to Finding your Way Through Therapy. A proud member of the PsychCraft Network, the goal of this podcast is to demystify therapy, what can happen in therapy and the wide array of conversations you can have in and about therapy Through personal experiences. Guests will talk about therapy, their experiences with it and how psychology and therapy are present in many places in their lives, with lots of authenticity and a touch of humor. Here is your host, steve Bisson.

Speaker 2:

I've heard many characters learn something. Welcome to episode 196. If you haven't listened to episode 195, it is with Jennifer Schrappe. She is a great interview. I really enjoy talking about different things, including the trauma and how she got to where she was and all stuff like that. So please go listen. But episode 196 will be a CEU course.

Speaker 2:

So what this is is Lisa Mustards does pod courses and with the pod courses you can get one CU for listening to the podcast answering a few questions pretty basic stuff, and me and Lisa Mustard talked about something that's really dear to my heart, obviously, with the podcast being resiliency development and action, or resilience development and action, pardon me, I really want to talk about how to work with first responders. This is an hour course, so I think it's great, obviously because I'm biased, but I hope you listen to it. And here it is Getfreeai. Yes, you've heard me talk about it previously in other episodes, but I'm going to talk about it again because GetFreeai is just a great service. Imagine being able to pay attention to your clients all the time instead of writing notes and making sure that the note's going to sound good and how you're going to write that note, and things like that GetFreeai liberates you from making sure that you're writing what the client is saying, because it is keeping track of what you're saying and will create, after the end of every session, a progress note. But it goes above and beyond that. Not only does it create a progress note, it also gives you suggestions for goals, gives you even a mental status if you've asked questions around that, as well as being able to write a letter for your client to know what you talked about. So so that's the great, great thing. It saves me time, it saves me a lot of aggravation and it just speeds up the progress note process so well, and for $99 a month.

Speaker 2:

I know that that's nothing. That's worth my time, that's worth my money, you know. The best part of it too is that if you want to go and put in the code Steve50 when you get the service at the checkout code is Steve50, you get $50 off your first month and if you get a whole year, you save a whole 10% for the whole year. So again, steve50 at checkout for getfreeai'll give you $50 off for the first month and, like I said, get a full year, get 10% off, get free from writing notes, get free from always scribbling while you're talking 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 point where you got to change a treatment plan, well, the goals are generated for you. So getfreeai code Steve50 to save $50 on your first month.

Speaker 3:

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 qualifies for one continuing education contact hour. And, as you know, mustard Consulting is a NBCC approved ASAP provider and this week's guest is Steve Bisson. Welcome to the show, steve. It is amazing to have you back.

Speaker 2:

Lisa, thank you for having me back. Always a pleasure to talk to you. We talk regularly, but this is great, yeah. Yeah, I'm so thrilled to have you back. You said thank you for having me back.

Speaker 3:

Always a pleasure to talk to you. We talk regularly, but this is great, yeah. Yeah, I'm so thrilled to have you here talking about how to work with first responders, because this is your, this is your thing, this is your, your niche, so I love it. Will you share with our audience a little bit about who you are, what you do and maybe how you got into working with first responders?

Speaker 2:

OK, I, you got into working with first responders. Okay, steve Bisson, I'm an LMHC in Massachusetts. I've been in practice for my private practice for over 12 years, but I've worked in. My licensure is going on 20 years now. When I first started working in this field, I worked on a crisis team, and when we work on a crisis team in the mental health world, you work out with a lot of firefighters, a lot of police, and eventually there was a program in Framingham, massachusetts, called Jail Diversion Program, which has now been replicated across the country, frankly, across the world, even in Ireland now, and I was part of the first team to actually go out in the streets and, you know, co-respond with the police. And this is where I started having that experience. And people are like well, you're saying that you help people in the community? Well, no, the experience was.

Speaker 2:

I saw the stressors that a first responder truly had, because once in a while I'd have a guy come out of the blue say, steve, you're riding with me. It wasn't that he wanted me to ride with him, he was having some issues, or she I mean, I'm not going to pick only males and it ended up being like oh my God, they're so misunderstood because everyone thinks it's trauma and it's so much more. So I started having a fascination for that and between working there to jail, probation, parole, I started working outpatient with police officers, I want to say 10 years ago, and then it just went to first responders particularly. You know we talk about fire, emts, paramedics, police, law enforcement but I also considered my emergency room people part of the first responder world, because they may not be on scene but they're the first ones to respond in any medical emergency that occurred. So, yeah, that's how I got into it. I worked because of the crisis work 15 years.

Speaker 2:

Definitely, yes, you do the math. You're going to say, well, yeah, some of them overlapped, so, but I truly enjoyed working with that. And, just, you know, talking to my colleagues, my, my good friends, that would say, well, yeah, you talk about trauma. I'm like, well, no, first responder work is so much more than trauma. Does it happen? Sure, but it's usually.

Speaker 2:

I want to be honest, it's a minute part of the work I do with the first responders, because the stressors that you don't think about show up and the stressors that you have in your life, they have too. And so, in one of the things I like to start off when people say what's unique is say well, in your job, if you do something wrong, you screw up or what have you. It's not going to be a first page anywhere, either web or paper. A police officer does something wrong in Missouri. Well, now, suddenly every cop in the United States of America is a bad cop, and so that's a very different thing than what most people feel. So I talk about these unique challenges that we don't typically have in our day-to-day lives, that they have Interesting, okay.

Speaker 3:

So I can kind of see some parallels in the work that I do with my military service members. Oh, interesting, okay. Well, I'm really excited to hear about this topic today. I honestly, you know, I'm in my bubble of who I work with and I think there's going to be some overlap. So I just want to let everybody know that Steve's second language is English. Your first language is French. I think that's just a cool little fact.

Speaker 2:

Thank you, I appreciate that. So when I have to say THs while we're talking, you'll definitely hear them.

Speaker 3:

Right, I can hear your French, you know your accent a little bit and your English. I just think it's so neat, okay, so the learning objectives that you sent over to me and they're on my on the websites, if the learning objectives that you sent over to me and they're on my on the websites, if you guys want to see them after you listen to this, you know, just head over to the website. The link will be in the show notes, but the first one we have is analyze and describe the unique psychological stressors and challenges faced by first responders, including, but not limited to, ptsd, acute stress disorder, depression and substance abuse. So I will let you tell me where you want to start with that All right?

Speaker 2:

Well, I'll start off by saying that you're absolutely right. A lot of the first responders that I work with were in the military, whether any of the branches, and so I think, because you said there's a lot of parallels yeah, because I'd say that a quarter of my guys have been some sort of treat like one of the five branches of the military. So that's definitely why, and the challenges that we face, you know, when we talk about identify and describe. The first thing that I'd like to remind a whole lot of therapists is that you're going to face resistance, because that's part of it, and I wrote down a few of the quotes that I've heard over the course of years because I think it important. The first thing is guys before me didn't need the mental health support. Why should I? I hear that constantly. My favorite one that I heard more often than not, mental health doesn't work. I've seen people in therapy for years. They're not getting any better. Then you got how are they going to handle me? They don't understand what we do, which you know. The chronic uniqueness of first responders while it sounds like a criticism, it's really chronic uniqueness. Military are the same. I don't want to make it too much about the military, but there's so many parallels that can be drawn between the two. The other one that I like is how long is this going to take? I need this to be quick. Yeah, because I'll fix 15 years of issues in about five hours give or take, and let's take.

Speaker 2:

The reason why I want to quote these things is because, once you talk about identifying and describing the unique psychological stressors, I literally 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 you going to take away my gun? And I'm like, like, well, I don't know, should I be taking away your gun, right? And then like and then he explained that he never took his gun away, never had to. But the the bottom line is you're going to face that. And the other part that they're very scared of is if you go to see a therapist I mean I won't use the colorful language they use, but they'll tell me about, well, I'll go inpatient if I talk to a therapist.

Speaker 2:

And I think that when you think about the unique challenges in identifying this is that think about going into therapy for mental health reasons, and those are your thoughts and to me, that's one of the first thing you've got to identify is that you're going to face all that. And when I, when I think about those challenges, it's first responders don't want like we have a professionalism that I think is a standard that we need to follow, but there's almost like if you're too professional, you'll actually lose them, and that's a very hard balance to explain. But how I explain it is this meet the language where they're at, and I think that one of the things that we do as professionals in this world we try to go well, I'm going to sound professional about my research and this and that and the other thing they don't want to hear, that they don't want to hear about cognitive distortions. Meet the language where they're at. I don't say cognitive distortions. When I first meet them. What I say is your thought process is messed up, we're going to work on it, and that they respond to oh, I can get behind that and it's not about. I want to be clear for those who might be listening and saying well, you're making them out to be simple. Well, no, they're complex, but they don't want complex language, and that's very important to remember For those who also want to work with first responders.

Speaker 2:

The biggest turnoff you could ever do is to be in a shirt and tie. Why? Because now, suddenly, you're evaluating them for their capacities to live a life and so sometimes, like if anyone who's known me and I'm certainly, I know lisa's known me for years I'm a t-shirt, I'll put on a polo once in a while, maybe put put a a vest, but ultimately I'm just very much a t-shirt and jeans guy. And, yeah, you want to keep some professionalism. Sure, wear khakis, wear you know, but don't wear dress pants, don't look, and the reason why is that that's imposing to them and that reminds them of the administration and reminds them of other stuff.

Speaker 2:

So when I think about identifying and how to work, the unique challenges, even for therapists, I think being like informed of who you're going to work with, because they're looking for what I'm looking for, the right word here it's you're informed about their community. And if you're not informed about their community and you show up in a way that is not like that's going to make them feel comfortable, you'll highly likely lose them. We're going to talk a little bit of trauma-informed stuff later on, but for me it's like being culturally competent that's the word I was really looking for is so important. I mean working with the military. If you don't understand what it is to move every year, then it's really hard to get to that military standpoint.

Speaker 2:

When you're a police officer and you've moved from department to department because you want to go full-time and some of them are volunteer versus no one has full-time to full-time and some some of them are civil service and sometimes they're not, and some of them are state level, some are not. I mean there's a lot of complexity. So you might look at someone and say, well, you've moved five times, but there's a cultural competency you got to be able to look into, to understand why someone would move five times and knowing a little bit of the, you know identifying and describing some of the challenges is that if they sit there and they talk about roll call or I went on a call, which is a very simple language for me because I've worked with them for so long but I've had people like what do you mean a call? Isn't that on the phone? No call is going to the actual.

Speaker 2:

And knowing that cultural competent words are going to be very key so that you can apply it to those individuals that you're working with. So that's where I would start off with knowing about the language, what the preconceived notions may be about mental health, and then also trying to meet them where they're at. I know that sounds very intuitive for some people, but I think that there's almost there's counterintuitive, because when people hear about first responders in particular, oh I got to act really professional, I, I gotta be even more professional. It's actually quite the opposite. You gotta show up as you because they they, like someone once pointed out to me, we know when someone's lying and not being themselves, because that's a job we've done so oh, yeah, they can sniff it out, like I noticed, like with, uh, my military service members.

Speaker 3:

They can. Oh, what you're talking about is so true. I remember, like my first day on the job, the first event I had to respond to, is so different than anything I had ever done as a therapist. It was, and I've just, I've learned so much. I mean it's, I love the population I work with. I mean they're just the best. But yeah, they're. I know we're going to say this over and over again, but I totally get what you're saying. It's almost, it's almost counterintuitive, because the way that we want to show up as therapists 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 or an event where they're asking you to come on site or to come out in the field. It's very different. So so different, so so different. So I appreciate that introduction to the culture of. I mean that's just one piece of the culture, that of working with the first responders. Okay, so that's super helpful. Where else, where else should we go with this objective?

Speaker 2:

I think that, thinking about the identifying and describing the unique psychological stressors let's talk about myths for just one second it's not all about trauma. One of the first things that come to mind for a whole lot of people who work with first responders who think they're culturally competent, oh, it's something they saw on their shift or they've seen too many hard things, which that can happen. I'm not saying it's not something that happens, but ultimately it's really about you know, their personal lives, their regular schedules, the stigma of reaching out and all the stuff that I think most people in life face. And yeah, is there trauma a little more, of course? Is it these singularly what I like? I'd say that I probably talk about trauma 10 to 15% of the time, that I probably talk about trauma 10 to 15% of the time. So it really is a different aspect of the treatment. So it's not all about trauma.

Speaker 2:

The other part that I hear a lot from therapists oh, they must be so hardened people Like they've seen so much. They must be really hardened. Actually, no, they're pretty much softies, and what I mean by that is if you're going to go to be a police officer, firefighter, an EMT, a paramedic, work in an emergency room, a sheriff, or even the first, the military people. It's because they either went through their own stuff when they were a kid and they didn't get the help, or they want to help, and so they're not actually hardened. They get a little frustrated, sure, but they've also had their own stuff to accept in regards to what brought them to the job and they're not actually hardened. They put up some walls, they're cynical, and the other part too, about identifying, describing unique challenges. You got to understand that whatever you want to call it we can call it gals humor, dark humor, inappropriate humor, for whatever people want to call it, you need, as a therapist, to identify that and say that's how they communicate. That's kind of okay.

Speaker 2:

Working, working with a lot of them, I got to be able to put up with a lot of stuff, and if you're going to be well, that's inappropriate, well, you're going to lose it. And so when you think about the challenges and the stressors is that they deal with it with sarcasm. They deal with it with being able to protect themselves behind gallows humor or what have you. And if you're not able to understand the difference between gallows humor or not, you're going to have a lot of problems. So I think that that's part of the other challenges that I find with people who are in that position. They don't understand that and that's why when I do my intro you talked about being French Canadian I say I can't pronounce my THs.

Speaker 2:

If you make fun of me, go ahead. Being in the Massachusetts area and being a Montrealer at heart, I have a lot of Montreal things in my wall, so they laugh at me and there's always a rivalry. But it becomes fun. And I remember when I worked in the field with them, one of the officers had told me and it was so true the day we don't make fun of you start worrying, because when you're making fun of you, you're one of us.

Speaker 3:

Right right.

Speaker 2:

And I think that in therapy you gotta be as a identifying these things, is that you're not gonna understand that dark humor could be a defense mechanism, but it's not necessarily not adaptive, because if you see enough hard stuff, you need to be able to laugh at it in order to succeed and be able to put up those barriers. I know it sounds weird, but that's absolutely true.

Speaker 3:

Makes sense yeah.

Speaker 2:

The other thing is talking clinical. You know I got to be very clinical. I'm going to have to write a report. Actually, people who want to go into mental health treatment don't typically want to have a report. They just want to be humans and so they want to be able to not have that uniform on. Or, you know, because you know I hate to break it to some of you If you don't know, you take that role home and sometimes, like even you know all most of my first responders will tell me I go home and if there's a crisis in the family or in the neighborhood, even though I'm not wearing my uniform, I feel obligated to do uniform like behavior.

Speaker 2:

And so you know you, they, they want a place where you can close the door and they go. Finally, I can be myself, break down those barriers and being able to. For you to not be clinical, going and saying, well, the DSM-5 TR dictates based on ICD-10. Like they don't want to hear any 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 nice and flowery, and sometimes some clients cannot take the truth, if anything, the one thing I know those guys can take is the truth, and I think that the other part too is like you got to be careful. Now they want brutal honesty and thank God that's how I grew up, so that definitely plays a factor. And the other last thing that I really want to talk about is I hear a lot they don't want the help and they're just showing up for X, y, Z reasons. Well, if they called you, they want the help, they know something's wrong. Will they be outwardly saying that there's something wrong? No, but they will. They called you right. They're already nervous enough to say I might have a problem with my day-to-day life. We'll call it mental health if you wish here, but for them it's day-to-day life, and then they don't want it to be affecting like, oh my God, what happens if the administration knows that I'm here, I'm happy to be in a building where there's an acupuncturist, there's something mosaics upstairs and then there's a resource center so people 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 as going for mental health.

Speaker 2:

Those knowing those barriers. Knowing that management, knowing that there's still a high stigma in regards to the mental health piece, is so important to remember in order to identify and describe those unique challenges. Because if you tell them, well, let's do breathing exercises, they're not going to actually pull someone over and start doing breathing exercise in the moment. 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. I can't, they can't just go, all right, I'm going to take my uniform off and take a breather and come back. It doesn't work that way. So it is a challenge and knowing that those stressors are real is so important.

Speaker 3:

Okay. So some of the stressors and challenges. It's not always going to be. Don't assume it's PTSD. Don't assume it's some type of stress disorder, mood disorder or even substance abuse. It could just be not that it just could be but it might be relationship issues, it might be parenting, it might be stress, it might be career transitions. It's not just because it's a first responder does not mean that it is going to be some type of trauma at all. I mean it could be something completely. But yet knowing the culture and knowing how to be present and be aware is super important. It's really good.

Speaker 2:

Right, I mean I'm going to just go a couple of statistics and then we can definitely talk about that. Because do I have first responders that have a PTSD diagnosis? Yes, do most of them have more of a mood disorder behavior Like sometimes it's something as adjustment, as easy as adjustment, sometimes it's more like MDD or generalized anxiety, but mostly it's mood disorders, it's actually not trauma. So, really recognizing that and the reasons why, you know like let's talk about some statistics before we go into maybe talking more about these unique challenges, you know they found that 50, there's a there's a study out of Florida State University firefighters had 50% of them had suicidal thoughts at some point in their career and 16% report having attempted once or more suicide. Percent report having attempted once or more suicide. And then to estimate the suicide levels for firefighters is 18 per 100,000. The general public is 13 per 100,000. That's one of the highest levels and if you put all the first responders together that I described earlier, it's number one. I believe that number one is lawyers. Otherwise, but if you go with the 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 from suicide than they are of line of duty stuff. That's how telling that is about the suicide and how the stress plays a factor. And the number of police officers dying by suicide has just increased in the last five or six years I don't quite know the numbers for 2024, so I don't want to venture too far ahead but last year they went up by about 10% and that's a significant amount of people. Massachusetts I can talk intellectually about the nine reported suicide of first responders. That's just police officers, not even first responders. Last year alone nine, which is almost once a month, yeah, and that's a high number. So, keeping that in mind, the emts and the paramedics, have been found that 37 percent of them have contemplated suicide at some point and 6.6% of them have actually attempted it. It was a US survey. The Canadian survey shows that 28% have contemplated suicide and 60% of paramedics or EMTs knew of one person who had tried. So the elevated suicide rates for first responders.

Speaker 2:

You can really attribute it to so many things, but what we're going to talk about is again the unique challenges and stressors. Let's go with the one that everyone knows and I'm just going to run it through trauma, exposure to trauma. You know what we would call in our field compassion fatigue. You know, at one point you see enough tragedy that you kind of become cynical about it and almost like, kind of like give up the like, the compassion, because oh yeah, I'm going to go to the same call next week or what have you, and so that plays a factor. So when you're you see it once or twice.

Speaker 2:

That's one thing. If it's repeated exposure over 10-15 years, it will affect you. So it's not about the trauma of day-to-day. Sometimes it's the accumulation, the trauma, the. The thing that I talk about with some people is it's not the first trauma, typically it's the 27th one and the 27 one triggers the 26 that occurred before that. So that's, we're going to talk about trauma, obviously, and one of the things that I'm hoping that most of you will get from this and how to do the treatment and the challenge.

Speaker 2:

With the challenges we're going to talk about treatment later. If you address it within the first six months of the trauma, it remains acute stress disorder and actually can disappear from the record. You don't encourage that treatment, you keep on not paying attention to that. Then it becomes post-traumatic stress disorder and very detrimental to those individuals. So I tell people, like, try to keep an acute stress disorder. That's great, you just got to get there, and working with them is kind of like hard, because when it happens, no, I can handle it.

Speaker 2:

The other cultural competency thing I want to throw in very quickly is it? I know we all return our phone calls timely with our clients and everything else. But with first responders, if you don't respond within 48 hours of their phone call, they will not show up to your office, they will not seek help. So there's a really, really smaller window and, as you said, you've worked with the military. I find the military is kind of the same. You have such a smaller window. If I call back a client who what I would call a civilian, and I call them back a week later. But I would call a civilian and I call him back a week later. I'm like, oh, thank you so much for calling. I called back the police officer. I don't remember calling you. I don't know why you're calling me and I'm picking on the police officers, firefighters. So I want to mention that because it does play a really a factor in just keeping in mind that compassion fatigue is a real thing for therapists. It's a real thing for first responders too.

Speaker 2:

And you're at the ER and you work in certain areas and you're on your 10th shooting in the last six months. The 10th shooting starts like either you lose that compassion or you start going all right, rigmarole, let's go through it again. And the challenge is to keep them caring while not exposing themselves too much, and that's a huge challenge in our work. But we'll talk about how that could look. The occupational stress is significantly higher. Not all everywhere is the same, but typically you have three shifts on the police departments and then for EMTs, paramedics and fire. Typically you'll have anywhere from 12 to 24. Around here in the New England area it's a 24-hour shift. So think about going to your job right now. Whoever you are, even as a mental health counselor, you're there 24 hours on, 24 hours off. Then you go back in for another 24, and then you're off and I put that in quotation mark for two days. That's really rough on your family, that's rough on you and there's so many things that come from that. That is difficult.

Speaker 2:

And, keeping that occupational stress in mind, if you're a police officer, you get to bid on shifts. That's how it goes. Or sheriffs are the same way. You know you always wanted second shift. Well, too bad. You're the rook. You got the midnight shift and you're stuck there for a year or two because there's not enough people. Or you want to go in the first shift and you're someone who really wants to make a difference and you have some shifts across the country where the first shift is like taking care of the school, helping grandma, and it's not the same policing that you expected, and so sometimes that can be frustrating.

Speaker 2:

And also working with people who have different experiences than you. You know I always hear the older first responders complaining about the younger first responders. I also work with older first responders complaining about the younger first responders. I also work with younger first responders who complain about the older first responder, who don't get it. So, keeping in mind that there's always these things and there's always these competitions, and let's add to the fact that if you're on for 24 hours, we joke around the firefighters sleep on their job.

Speaker 2:

Well, if you've got eight calls in a row, I'm sorry you didn't get to sleep. And if you've ever been stressed in your life or had a big event, you realize that even if, let's say, the big event finishes now, you need at least an hour to 90 minutes to just like decompress. So even if you finish quote eight to eight you're not in bed till, if you're lucky, nine, 930. And then you got to get back on it in 24 hours. It's a really tough job. You do an eight hour shift but in sheriff world and in police world, I'm sorry we don't have anyone. You got to stay, you're forced to stay. So now you're doing 16 hours. I'll go home, go sleep for eight hours, which you're not. You're sleeping more six and then come back for your regular shift.

Speaker 2:

There's a lot of pressure on yourself. Let's remove the police officer, the firefighter, all that. What type of pressure does that put on your family? Your partner comes in and they go. Well, I thought I was marrying someone who's going to be present with the kids and you're always gone.

Speaker 2:

Well, that's part of the shift and the occupational stress and that causes marital strife. And, yes, people in principle sometimes like, oh, I'm okay with it. Come the seventh or eighth year of one of the partners taking care of the kid more than the other, people get bitter, people get angry causes a lot of marital stress. So keeping that in mind when you think about the challenges that they have. The marital stress, to me, is one of the biggest ones that you're going to face. You don't need to be a couples counselor, you just need to be there to listen and try to find ways to resolve it, because a lot of them to become parents and I don't know most of us who have become parents. We typically do it by choice and now they feel guilty for not being there for their kid or maybe being disconnected from their kid because they're so tired from their shift or, god forbid, something happened on their shift. So there's a lot of stress that comes from that, and keeping that in mind is very important.

Speaker 2:

And I don't know about you, but when my sleep patterns are off, I'm a miserable human being. Them when my sleep patterns are off, I'm a miserable human being. I know I have seen perky on this podcast and this pod course, but typically I get very, very cranky, and so imagine that you didn't sleep enough because of the shifts and everything else. Then you got to talk about sleep patterns and one of the things that I talk about is how are we going to eat the best we can? Because if you're on a shift from four to 12 and you've had calls till 10, there's no little whole foods with a little salad and everything healthy that you're going to sit in your cruiser and eat. You're going to go and find the burger and shove it down your throat, and that plays a factor also on stress and how you do all these things. So and then, let's not forget that we're not working on painting a wall. We're working in high stress situation vehicular accidents, driving people between life and death sometimes and yeah, it's not as often as we think, but it does definitely happen. So that is another stressors that you got to keep in mind. That is going to happen.

Speaker 2:

The other one, too, that I talked about a little bit earlier that I want to talk about is the whole stigma around mental health. Going for a mental health is think about the stereotype that you can think about. They highly likely have that. Do I change that in time? And a lot of my guys. It's always very touching that the guys have worked with me long enough that they go around like, oh yeah, my therapist said this like what? Like this? So like they don't typically say they're like, oh, I don't care, I get it. So you got to work with this tough guy culture and I call it tough guy because that's typically what it is and we're discouraged to get help.

Speaker 2:

Right, remember the guys before they didn't need mental health support. Why would I need it? And so you're working with all these barriers that they already created. Then you got the fear of judgment. What are people going to say if I go see a therapist Again in time, these guys get educated and they get it. But when you think about the challenges, if I go to, I've got a therapist. You know how many people make fun of a therapist seeing a therapist? No one, they're fine with it. They think it's logical for a first responder to go see. Well, you can't handle it. And then God forbid that officer, 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. Well, you need mental health, why would we even promote you?

Speaker 2:

And you got to face all those things and that appears to be weak, but they're not. And frankly, the one thing I also joke around with some of my guys is you got to remove the S off your chest. Or if you're a woman, I say take the WW from Wonder Woman and start being a human. And that's a very challenging things, because if you need challenges as a police officer or a firefighter or EMT or ER, you got to be in control of the situation. Firefighter or EMT or ER, you got to be in control of the situation. While me telling you to take off your ass, taking out your WW, you're like, well, no, now I'm vulnerable. Like yeah, that's hard to be vulnerable when you're usually in charge. So that's another stressor challenge that you're going to face with first responders on a regular basis.

Speaker 2:

A couple of more things that I want to mention is the social isolation, because first responders they don't you know. They say why do you hang out with other cops? Like well, I don't want to be asked questions about cop work. Or you know, like I have a friend of mine who happens to be a police officer. Every time we go together to an outing they go what was the worst call you went to? He doesn't want to talk about the worst call he's been to. I can't say that Some, he's not my client, but that's typically what they ask. Or oh, I had a ticket and that's this like I'm not going to solve your ticket. And so they end up being with other first responders, but then you talk about the job and then you don't get away from the job. So even your social aspect is taken away.

Speaker 3:

The job, so even your social aspect is taken away.

Speaker 2:

Yeah, yeah so, which also leads to some, some substance use. I mean, things have changed significantly, but substance use is a common thing to deal with stress and sometimes, when you go to these outings with other first responders, there's going to be alcohol. And sometimes that becomes a way to cope with some of your feelings and those challenges is that you can't talk about being on any substance because, god forbid, is your badge going to be taken away? Is your gun going to be taken away? So there's all these things about opening up about substance use. That's really really difficult for them. If I had a problem I've had a problem with alcohol in the past no one hears batting out an eyelash about me talking about that.

Speaker 2:

As a police officer, I go out and say I had a problem with alcohol or a firefighter. Guess what People go, whoa, and there's such a difficult way to talk about those things. And this brings us to the last point I want to make is what type of access to resources do they have? Yeah, there's what they call crisis intervention, stress management or response teams that they go when there's a significant event. That exists. There's peer support in some departments not all departments where a peer you work with can be there for you, but they're not everywhere.

Speaker 2:

But you know the gossip that happens in a police, a police department, of fire department, at er I. I joke around that I've never seen so many high school behaviors other than my first responder world, because they're like gossiping about each other. Oh, did you hear about this? You know Steve's going to therapy. He must have blankety blank. Well, how do you know? Why are you speculating? It becomes such a high school environment with everyone gossips and that's a very tough thing. So when you go for your resources, some people might oh you know, what johnny asked about steve.

Speaker 2:

He asked for steve's phone number. You know what steve does and so that plays heavy and you don't want to be doing any of that. So, and if I've worked hard in this community for years and looking across the country, it's really tough. There's great organization. I don't want to plug anything here so I'm not going to name them. There's great organizations that help out first responders and that's great. The plane for that you got to go to Colorado, I guess, depending on where you live in North 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 small community. Everyone knows you went away. They want to know why, and then you start seeing a therapist. Think about the heaviness of all those factors combined. So keeping in mind that these are challenges that they face on a regular basis is so important.

Speaker 3:

Okay, this is so good. I'm seeing so many parallels and crossovers in the military world. It's pretty like you were talking about taking off your S or taking off your W. I've said that so many times to service members. It's their persona, it's how people see them see them, I guess, and so they feel like if people see them that way, then that's how they're supposed to show up. It's a should, I guess, that our culture somehow puts out there but it's a it's a pedestal right oh yeah, you know, you think about the military.

Speaker 2:

Like again, with all the respect I have for the military and most people who know I've worked with the military before, I don't put them on a pedestal when you come into my office. You're a human, you're just a human. You happen to be in the military, you happen to be a first responder that's great, but you're a human in here, yeah. Yeah, they don't have a huge factor in regards to that and you know, having the ability to say, well, we're going to do a healthy work-life balance. I don't know, I've never been deployed for nine months, 12 months, but it's hard to have a work-life balance when you're deployed for nine to 12 months and sometimes and most of the time, you can't disclose where you're at and you can't disclose to your family anything and your family's concerned. And, god forbid, you just had a child or you just got married or what have you? Just think about that burden that. Even for police that happens too. A lot of them work for, uh, fema and then they end up. Yeah, you might know that they're in north carolina, especially recently I had a few guys go down to north carolina help out um in 2024, but they can't exactly tell them. Okay, my day's going to be eight hours. I'm going to be done. I'm going to give you a call at six, because God knows how long that is.

Speaker 2:

And the military faces the same thing. These are challenges that are not known by the day-to-day stuff. If I go to work at a bank, there's specific hours, even in the non emergency medical personnel from tech for an MRI machine Well, my hours are from this to this and I go home. It's not like it's going to be an emergency MRI that I got to stay for. There's either a person behind us or the emergency room highly likely has an emergency MRI they can use. So you don't need this thing, and I think that that's the other unique challenges that are not well known about the work is that you're carrying it constantly and you almost never get a good work-life balance because of it.

Speaker 3:

Right, absolutely Okay, okay, so. So let's talk a little bit about evidence-based therapeutic interventions that you use to work with your first responders.

Speaker 2:

Absolutely. I mean, the first thing that I would talk about is cognitive behavioral therapy. Cognitive behavioral therapy, as you know, for mood disorders is typically more effective than any other treatment. And cognitive behavioral therapy, specifically cognitive distortion, cognitive dissonance and stuff like that, they really respond to that thought process. I make fun of it sometimes, especially around all or nothing thinking, are disqualifying the positive Cause. You know, like if you tell a cop or a firefighter, hey, you got an award for doing this, they dismiss it, dismiss, dismiss it. And you're in and like why can't you take some positive? I mean, you just told me you didn't get positive from your colleagues or your bosses. Suddenly you get an award, you dismiss that too. So they get that. And they kind of like, yeah, it comes off jokingly and I kind of like, do that. But and then if they feel like crap and they say, well, well, the world is crap, no, you feel like crap because you deal with a lot of difficult people. The world is not necessarily crap. Emotional reasoning Again. If I sit there and like let's look at, attempt cognitive distortions by David Burton, they're not going to listen to me. But if I say because you feel like crap, that doesn't mean the world is crap, you feel like crap and maybe part of your life is crap. So using those type of languages again I go back to about the treatment.

Speaker 2:

Cbt is certainly effective for those mood disorders and it can be effective for the trauma too. But I have other modalities that I recommend for trauma that I certainly practice. For me it's getting to know the person when we do the treatment plan. If you start off with someone and say, all right, we're going to do EMDR and CBT and you didn't build a relationship, you're going to lose your client almost immediately in the first response. Being culturally competent is important in showing that you can be doing that. And the other part too is first responders want the here and now being treated, and then then maybe CBT comes in. But maybe it's behavioral, maybe it's just listening and being more of a Rogerian type of humanistic approach.

Speaker 2:

But if you're going to do a treatment 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 like building a relationship. You can call it humanistic approach. But first responders want to make sure they can trust you and when you talk about military I'm sure you've experienced that too. They want to make sure they can trust you. So therefore, you got to build a relationship first. Then you can talk about like do I do CBT within the first hour of working with it? Yeah, do I call it CBT? Do I tell them what I'm doing? No, but being able to not always identify technique, technique, technique. But building a relationship is key. The first responder treatment, as well as you know, plant when you do your your treatment planning, essential to go there, but evidence-based.

Speaker 2:

As you said, building a relationship is key to any healthy mental health treatment for any human beings. Now, if you want to go into deeper 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 and reprocessing is really helpful. You know you start off by you start. You don't start off, in my opinion, with eye movement, desensitization or reprocessing. I think you build a relationship and then you hear about maybe traumas hey, maybe EMDR would work for you, Maybe it's family stuff. Then you go to CBT and deal with CBT and how you can think differently about your relationships with others and how you can change certain things, your relationships with others and how you can change certain things. But when you have trauma, that's been specifically building up and we talked about the 27th event that happened in their life well, EMDR is a really good approach. It's been proven that it works well with the military personnel. It works well with anyone who's had trauma. I know that it's not recognized under the DSM-5 TR that complex PTSD exists, but for me, EMDR anyone who has more than one event that has been traumatized had a trauma from it sorry, traumatic event, then yeah, EMDR is perfect for that, because you're going down the channels, you're looking at what's going on and I know it's sometimes people say, well, it can take a long time, EMDR.

Speaker 2:

I've done EMDR for close to 10 years. It takes eight to 12 sessions, give or take 60 to 90 minutes. 90 minutes are usually the first few sessions. Eventually you break it down to about 60. And then you go through the whole process of EMDR and for those who don't know EMDR, it's literally something that was developed by a military person and they talk about the movement. Eye movement is really what they do with the fingers and a lot of people know about that. You can do it with your ears, with earphones, and that works effectively too.

Speaker 2:

In my experience over the course of several years of working with first responders. I work with the paddles, the vibrating paddles, because they can close their eyes and stay in their head Because, unfortunately, or fortunately because they're first responders, they tend to be looking around, they get distracted and they're like oh, what was I processing? Again, Close your eyes. We're going to do paddles. Obviously, if they don't feel comfortable closing their eyes, I don't tell them to close their eyes. I say, focus on something.

Speaker 2:

But ultimately EMDR has been proven over and over again that it's helpful and that can be is a great treatment for trauma and in my experience, if done right, most of my clients finish EMDR. They're like I'm good, and usually we go to every three to six months just to do check-ins, because I believe in mental health, obviously, but it's not threatening to them, because you help them. And that's the other key about building that treatment plan and the modalities that are evidence-based is to build them up for success, not say, all right, clearly you have trauma, and then pull a sheet out and say, EMDR, let's do all these. No, that doesn't work for them. You got to be able to create a relationship that's safe. Many, many times they stop seeing me and they give me a call hey, I need a refresher, I need just a, and that's great, because now they've found someone they can trust and a little bit of EMDR, just so I can give a little bit of basis.

Speaker 2:

For those who don't know, you take the history and treatment planning, you do all that first and 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's so that if they get to a place where they're so triggered they can't find their way back. You can use that safe person and safe place to bring them back. Then you do the preparation for that, the assessment, and then the desensitization, the actual work. You do the installation of that safety. It takes some time, especially in the first session. As I said, my first sessions are typically at least 75 to 90 minutes. Eventually it goes down. Then you do a body scan and then a closure, and it's so important to go through all those processes.

Speaker 2:

I think some people want to just get to the movement and say, all right, you're feeling great, great. But if you didn't future plan, did you not body scan? Because maybe they're feeling good but they're holding it in their chest or holding it in their arm, they're holding it somewhere else to get headaches, Then that is a problem. So EMDR done right in a like we talked about evidence-based. The evidence-based is not to do it quick. Evidence-based is doing it the Francine Shapiro way, which is who I've worked with, their EMDR. There's nothing plugged here. This is something that's well-known across the country. They are the ones who do the best training for EMDR, really very beneficial. So that's who I use and that's who I recommend.

Speaker 2:

And then there's something that I used to call and this is funny because while doing some research I used to call it systematic desensitization, but apparently when you talk about evidence-based treatment and planning it's now called prolonged exposure therapy and it's a little bit like EMDR and I've done a little bit of it. I never knew how to put it in those words, but you do the imagined scenario in the office so that they can work on that and be able to be exposed not really, but exposed in their mind about these things that might occur. And then eventually you go into in vivo exposure. Going back to the community, you know the story. I will share that evidence-based for me. But also you know prolonged exposure therapy and systematic desensitization has been proven for years that that works. But the story I would give you is I worked with a first responder who got hit by a vehicle while doing a detail and so he was very nervous about going back to the street, nevermind, you know, pulling over someone or what have you.

Speaker 2:

So literally my office is near a street that has a lot of cars that go by fairly fast, but there's a nice barrier between us and the road. So what I did is I'd walk him downstairs and we'd sit there and not necessarily therapeutically talk, but I wanted to expose him to what he might face again. And so slowly we move beyond where the border is and the protection to where he was exposed directly, that if a vehicle jumps the curve we're done, and to a certain extent that's what in vivo exposure is based on the prolonged exposure program and eventually, for the record, this individual back on duty doing everything right, gives a lot of credit to the prolonged exposure. I call it desensitization, but he gives a lot and they work really well being able to expose individuals that not all babies are going to be difficult to deal with because unfortunately when you get a call from a paramedic or EMT perspective, the baby usually has something wrong. So sometimes it's exposing them to babies that are healthy and that they exist, in order to realize that it's not always a problem. And all these techniques have been very effective. Like I said, I know it's called prolonged exposure therapy and there's a great technique. It's an eight to 12 week program that I absolutely love.

Speaker 2:

I remember it from the behavioral schools that I went to and we talked about systematic desensitization, which has been very beneficial, exposing people. I exposed him to vehicles going fast on YouTube, Not in like that was my in office thing, there's no danger, you can. But then we've processed the emotion. How are you feeling about that? Ah, that's not going to happen again. It's someone's going to get hurt in this and that I'm like well, how many people got hurt in the video? Oh, no one. I'm like okay, so there's a possibility that you may not get hurt. So even doing stuff in the office and doing that what they call imaginal exposure is very important to bring it to in vivo. No, I did not go on the highway next to the vehicle with that particular officer, but he figured it out and was able to go back to work. But that systematic desensitization is another one In substance abuse world. We talk about motivational interviewing, which has been also proven to work really, really well, and motivational interviewing, I think, is even good for the mental health part for this type of population.

Speaker 2:

When I talk about like if someone's coming to see you, yeah, they took an action to come and see you, but they may not be ready for change yet, they're not willing to go right away into action of that. So sometimes it's thing about them as pre-contemplative. I don't know if this works, I don't know if you're a quack or whatever and I'm not picking on anyone, it's just how it is and being able to understand okay. So this is maybe the pre-contemplative part and they're into contemplative mode. Then you get them to preparation, Then you get them to action and I always say you say relapse. I know that that's a controversial subject on the substance use part, but on the mental health part I think it's all normal and what I mean by that is if you ever have no anxiety, you're highly likely not of this world anymore. Anxiety happens every day. So maybe you feel like you relapse because your anxiety rebuilt up. No, you can come back to action. That's how we're going to deal with that. And then change and maintenance is key and keeping those good habits going. So motivational interviewing has been shown that it works also really well with the mental health aspect of particular mood disorders and anxiety. So I really like to use that and mindfulness-based therapies have always been evidence-based.

Speaker 2:

I put it sometimes in my clients who are more open to particularly those who talk about spirituality and again, any type of spirituality. If you talk about God, if you think that God is Allah, you think it's Buddha or whatever. I think that once you have that spirituality, you can introduce the mindfulness-based therapy, because it is, again, evidence-based. I would argue, though, make sure that your client is open to that, Because if I sit there and say let's talk about God, they might not be willing to do so, and I think that's very uncomfortable for people. But for me it's like I listened to them and, like you know, I go to church every week. Oh, now a cue. Or you know, I go to temple for the high holidays, like another cue. I'll figure that one out.

Speaker 2:

But being able to put mindfulness techniques which are evidence-based, be mindful in your treatment planning that the person is good at seeing that, Because if they're like, okay, let's talk about, as someone who does quote Buddha a significant amount, I always say, by the way, I'm not pushing religion, and just that's a good statement. And sometimes, you know, do unto others, which is universal with religion. I say I'm not saying you got to follow one particular religion, but I do think it applies, and then you can see, engage, how they react to that. If they react negatively, probably mindfulness-based therapy is not part of your treatment plan, but it is evidence-based that it can help people. And the other thing that I've discovered I did this starting in 2018.

Speaker 2:

I had to stop, unfortunately, for the pandemic years and I restarted recently is group therapy, and the group therapy is a lot of a supportive environment for first responders to talk about their own experience and see that other people go through that. They don't need to explain that they're unique challenges because they're not, as they call them, civilians. They're people who know and support each other, so they don't have to explain that they're unique challenges because they're not, as they call them, civilians. There are people who know and support each other, so they don't have to explain that. And then you see that there's no isolation. You work on the stigma because you know johnny, johnny from you know any town usa is the same as anyville, usa. Oh my god. Well, okay, that can be similar. And then suddenly you can have those exchanges and and yes, gallows, humor plays a huge factor, but group therapy has been effective.

Speaker 2:

We'd look at self-help programs to what we're, what I'm doing, which is a lot of evidence-based stuff, which is talking about specific things like administration, betrayal, talking about how to deal with a spouse who's not too happy with you because you have to take an extra shift for X, Y, Z reasons, and so how do you communicate that? How you know it's not bringing flowers, that's going to fix it. How are you going to talk to your partner around these things? And so you know, group therapy has been very effective. Self-help has been helpful. It's hard to find a self-help group in that stuff, but those are the you know, not only are evidence-based practice.

Speaker 2:

When you think about your treatment planning, make sure that it's appropriate. If someone doesn't have trauma and say, well, we're going to do EMDR probably not a good treatment plan, cognitive, behavioral, with some motivational interviewing, probably better off for you. Someone who's resistant that they've had trauma, Maybe you start off with a motivational interviewing and building the relationship so you can get to EMDR prolonged exposure. But ultimately it's really going through all those things and, as a therapist, make sure that you know you're trauma informed and trauma informed is not 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 supportive environment? How are you reacting to someone telling you trauma and making sure that they feel supported in regards to that, and that's how people say well, I'm a therapist, I'm trained in that, Are you? And it's really important to be informed of that. Talk about being culturally competent. The therapist's expertise is so important for the treatment planning, as well as the evidence-based. If they think that you don't know what the roll call is, then they're not going to really want to keep on talking to you.

Speaker 2:

And the common theme. I forgot to put this in the quotes, one of my favorite quotes well, a book can't explain me. Well, a book can't explain anyone, but that's typically the defense mechanism that comes up and the accessibility and availability. Like I said, time is vital calling back right away, making sure it's within a certain amount of time time and then making sure your office is reachable. Like if I'm working with someone in Oregon and my office is in Vermont, that's not accessible to them and there's some advantages, but there's also licensing issues and all that, but at the end of the day, it's making sure that you have accessibility.

Speaker 2:

Some of the guys like hey, I don't want to go to your office, I want to do it online. Fine, I'm accessible. That way, you know what I want to go in. Well, I actually have an office where 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 of these safety measures, so to speak. They're not real safety measures. And the other final point that I keep I wanted you to consider not only because of your treatment planning, but also as an evidence-based, typically, first responders. They don't want to be in the middle of a room and they want to be able to be accessing the door very quickly. And that's sometimes counterintuitive for therapists, because I have to be closer to the door With first responders. Make sure they have access to these outlets, because if they feel trapped, A, they won't talk and, B, they're going to never come back. So those are the other things to keep in mind with first responders.

Speaker 3:

Okay, okay. So all such good stuff I'm trying to think of, have any follow-up questions, I mean, you just really it's really good overview and primer on how to work with first responders. Anything come to mind that maybe you want to, as you're I?

Speaker 2:

know it's going to sound very intuitive. It's very intuitive and we've known each other, lisa. So the reason why me and Lisa get along is that Lisa's herself when she's with me and I'm myself when I'm with her and for in a professional world. You think that being professional means you got to be careful about your facade and being professional. Well, I'm me and Lisa have always been professional, yet we're ourselves.

Speaker 2:

But first responders do not show up, but yourself. If you forget to show up as yourself, you can talk about evidence-based. To me it's a treatment consideration and treatment planning consideration. If you're going to be putting up a facade or pretending you're something you're not like. You know I've had too many first responders come in and say I went to see someone who said they had experience with first responders. Turns out they followed one course one time. This one hour course, while very beneficial, does not make you an expert as a first responder.

Speaker 2:

Get informed, look for that and don't pretend you're not. And even if you showed up and someone shows up and says I'm a first responder, what's your experience? If you truthfully say not much, they might actually stay because you were truthful, rather than saying oh yeah, I have all this experience. I never pretend I don't have experience. Don't pretend things that you'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 stuck and they want to look more important than we are, no more than we do. Just be yourself. They've seen BS from a mile away. Don't be the BS-er.

Speaker 3:

That's a good point. And when you were talking earlier about you know, knowing what certain terms are, I remember when I first started working with the military, I it was like baptism by fire, I mean I jumped right in and there were so many things I didn't know and I finally, just I was writing everything down, like okay, I'm gonna look this up later, I'm gonna check what this means. And I remember finally in session I was like why don't I just ask the service member? 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 were like, oh yeah, no problem and so, but the fact that I told them I didn't know what I didn't know was explain it.

Speaker 3:

And I think that's, with any culture that you're unfamiliar with, it's okay to ask for what is that? What is that? How did that affect you? 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 to pretend that you, you know everything. I think that's such good advice and these are things that I just learned on the job kind of the hard way. Quote, unquote the fact that you're saying this is part of the culture, it makes sense, and when I've given presentations on how to work with the branch that I work with, these are some of the things that I bring up now that at the time didn't seem to be revelations, but they really are. If you're not used to working with this population, it really. It really is information that is going to help you when you encounter because chances are you're probably going to encounter somebody who is a first responder in your, in your work.

Speaker 2:

You might not know what they're talking about, but you got to be able to say it. And debriefing in the police world is different than debriefing in the military world and it's different than the EMT paramedic world. And ask that question because even within the military world, I found that debrief means something different from one branch to another. Whether it's the army, navy, air force, marines, coast guard, debrief means slightly different things for each one. So I'm like tell me more about your debriefing. This is my experience, but please tell me so, even if you do have an information and you're you don't know, just say you don't know. They'll respect that a lot.

Speaker 2:

If you do know, say, hey, this is what I think it is, and they might go. Oh no, the briefing for Coast Guard is right after the event, versus in the army it's after. You leave your your post for blank amount of months, so just doing that.

Speaker 3:

And another thought too is you may not necessarily specialize in working with first responders, but maybe you work with in women's issues or couples. My chances are you're going to have 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 this information so you can apply it as needed. And I've come across many spouses who, over my years, have said I just want to talk to you because you get it, you understand what my service member 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 it and I so. I think that's something to keep in mind as you encounter different types of clients and they're all different all cultures, all socioeconomic status, different parts of the country, different parts of the world. I mean it really is cross-cultural within a culture.

Speaker 2:

Well, policing in North Carolina must be way different in Massachusetts and it must be way different in Vermont or North Dakota or Alaska. And recognizing that and the joke that I wanted to share with everyone is a lot of my first responders that I've known for years. They're like well, you're one of us. I said yes, but I'll always refer to myself as a civilian because I don't want someone who doesn't know me think I have an ego because of this. And reminding yourself of being humble, being curious and learning all this is so important.

Speaker 3:

Yeah, absolutely Well. Thank you so much, steve.

Speaker 2:

Thank you for having me. This is great.

Speaker 3:

You're welcome.

Speaker 2:

Well, that concludes episode 196 with Lisa Mustard. Again, go to our website for pod 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 enjoyed it. But I hope you join me for episode 197 with the returning mental men. So you know from Lisa that's been here a few times, to the mental man who's been here a few times. So I hope you join me then.

Speaker 1:

Please like, subscribe and follow this podcast on your favorite platform. A glowing review is always helpful and, as a reminder, this podcast is for informational, educational and entertainment purposes only. If you're struggling with a mental health or substance abuse issue, please reach out to a professional counselor for consultation. If you are in a mental health crisis, call 988 for assistance. This number is available in the united states and canada.

People on this episode

Head Shot

Steve Bisson

Host
Head Shot

Courtney Romanowski

Co-host
Head Shot

Lisa Mustard

Guest