Tue, 7 Dec 2010|
And as elementary as it sounds. Most of -- in public safety don't really know when it's appropriate. To see. There are some -- and probably the most we've ever gotten on the subject it's apparent that this one -- it so can you give us a little more insight about. When we should take notice -- something that's happening in our lives should cause us to talk to professional. Excellent question now. After critical instantly got line of duty death and the death of a child a department should have a -- Where everyone who was involved in the -- gets to talk about their spots there. Feelings their reaction and some normal symptoms after a critical incident. After two weeks. If first responder is still having difficulty with physical problems. Or -- emotional difficulties. Then therapy -- it's needed. For example some physical symptoms common after a critical incident that really difficult to manage her people are headaches. Waking up in the morning with a -- because -- jot it -- at night. Difficulty falling asleep or staying asleep -- are on the other side of the spectrum. Sleeping too much. Difficulty eating or keeping food down stomach problems. -- -- you need to eat at -- after or before every Neil. Back -- tension in your muscles. Just feeling like you're not -- stuff. Some emotional problems that people experience after critical incident might be anger or irritability. Feeling frustrated all the time. Arguing would definitely more settled that -- excessive use of alcohol. Some of these things that they last longer than two weeks he might want to seek help for. A little bit -- that we probably heard before. But most first responders are probably pretty bad at recognizing the symptoms in themselves or if they do recognize them. They're very likely to think that well that's normal we just want to -- -- a tough and and actually I'm gonna get over so. How do. In light of that how to first responders really recognized that it is time professional. -- -- that would be a great place for peer support. Because often colleagues -- the first to notice. Changes in -- first responder and I really believe that here's need to take care of each other. So one of your colleagues notices a difference and you thank you haven't been showing up -- we haven't been going fishing lately. We -- then out running likely usually are you avoiding us. If appears says hey something's not. -- listen to your probably listened to your -- officers that you work. Secondly. Family members might notice these changes in a person. For example if a firefighter is having trouble sleeping are having night terrors or grinding their teeth at night. All her having difficulty falling asleep their -- can -- Their spouses could see pat changes in the family different stresses on the family produces. Behavior changed so if the family members say something happened what's rock that might be a -- to get out. Well that naturally leads to the question of what is -- If you have been through it that people are a little bit scared of what might beat it kind of afraid you're gonna. Cracked them open and exposed every little thing about and -- uncomfortable so tell us a little bit about what actually happens there. We'll therapy can be -- that. So you might come into your psychologist office and say I'm having problems at work. You might talk about some of your symptoms I have headaches can't stomach aches. I can't seem to concentrate on anything. And for those fifteen minutes you decide on the -- what do you want out of this therapy. What do you want to be different when -- when you leave here because there is temporary. Some therapists -- ask you to do some homework assignment like some journal they might ask you a question in therapy and the first responder doesn't have the answer so the homework assignment is to go right about that go journal about that. About spots you're feeling you're behaviors. The beliefs that you -- about yourself. First responders are natural problems offers they want it. Therapy doesn't always work like -- so it may be frustrated. Therapy is not miracle it's not magic it's not voodoo. Therapy is -- time. For you and your therapist to look at your spots you're feeling your behaviors. Your symptoms. Things that -- -- making life really difficult at this time. Not forever but that this temporary time -- -- critical incident. Therapy is confidential. If you see a psychologist. Or a therapist or counselor. They can't speak about what you discuss. To anyone. Unless you give written permission. So it's confident it's as safe spot just for you to look at your reactions -- your feelings in your current difficulties. How do you find a circus that's appropriate for you. Well that's a good question hiring -- therapist is not like hiring a painter you can't drive around and today. Look at the good job they did on this house they cleaned up after them hope that they were there in time it's a little bit different. That therapist that a first responder -- should fit well they should have what's called cultural competence. They should get it. You don't want -- therapist who can not handle the traumatic events. Your incidents in your work life. You don't wanna therapist who is going to cry when you are talking about. The death of a child for. -- therapist that fits with you or. Personality. And your style and everything -- paste is different so if you -- -- and you don't like them. You know give them a chance for awhile but they don't get it then it's time to shop -- around. You might ask for a recommendation from somebody it's one of your colleagues. The list that your department provides on insurance will tell you what therapists except your insurance. Not necessarily what -- a therapist is a good fit for you. Anything else we wanted to looking forward to -- You want to therapist to be licensed in your state. That insurers a certain level of competence. And quality you want therapist that -- spent -- He won a therapist with. Some experience in your difficult. Let's say you have an alcohol problem -- drug problem in addition to do some work difficulties in in you'd want an. Experienced therapist in addictions. Or perhaps you're having some marital problems you'd like a counselor or a psychologist. That has done. Experience treating Apple's. Another thing to consider is. That therapist's experience with that particular type that -- There -- might have experience working with sexual assault victims for example. And if you're working with sexual assault victims that's a different type of trauma and the critical incidents that first responders are. Exposed to involved -- it in their shops. You wanna look for a therapist that has experience and trauma specifically. The job related trauma debt first responders -- -- -- What about the notion that no one can treat. Firefighter. Police officer -- in a statement firefighters police officer and he is out of necessity. Look a personal decision for the first responder the first -- gets to pick it therapist. And that's important to him -- her that -- fine criteria attack. Certainly there are few. Psychologists who have also -- -- police officer who also had been a firefighter. What I tell the veterans that I work quit it is. I haven't been to a -- Is important for you that I have been to Iraq or that I have a map to get out of where you currently. Along the same lines. Some people with drinking problems think that only an alcoholic can help them because only an alcoholic would understand substance abuse. And that is certainly a very personal decision for that first responder for that alcoholic or are addict. And if that's important to that person that. There's therapist -- -- addicted themselves are in recovery from addiction themselves and that's certainly a personal decision that I would respect. From the first responder. This used to be all kinds of people in the therapy field and you see different titles in different letters after people's names. How do we know which of those is appropriate for problem the first responder might be having after a critical incidents. Very good question most people are often confused by the difference between -- psychiatrist. Psychologist. A counselor. Therapist social worker so that's a great place to start. A psychiatrist. Is a medical doctor. -- positioned basically. Who can prescribe medication. For emotional difficulties. For depression a psychiatrist might prescribe. An anti depressant. A psychologist. Is also a doctor but not a medical doctor not a physician. Psychologists. In most states cannot prescribe. Medications. Still the way they would treat depression would be through therapy. Counselors. Therapists. Are all general terms. Or people that -- counseling. A master's level person can't -- therapy a psychologist can perform therapy. Psychologist. Can counsel people. A therapist can counsel people counseling and therapy art in interchangeable basically -- you can college counselor. A fair test or counselor you can college psychologist counselor therapist. But you can't call a therapist or counselor who -- a master's level person psychologist. Psychologists are doctors. The way to tell. If a person is right for you is how you want to approach the problem. Some people avoid medication they don't want to take medication for their difficulty. So there's no need to see a psychiatrist. First. For that type -- individual. You might start off with a therapist at the masters level. And if you feel comfortable with them and you're able to make changes if you feel -- if you're acting different and feeling good. Stick with a person. If you feel like that therapist does not get it is not culturally competent. -- find somebody else ask for our referral. Psychologist as a doctor. You don't need to have a doctorate to do therapy so it's really a personal decision. What they mean by cultural competence. Is does -- counselor that -- -- get it. When you described how. Brains and the black -- splattered all over the while. Do you -- react. Or can they hold that type of trauma when you talk about your shift work. Or your sleep difficulties that job related do they understand -- If you're not seen. Medical doctor. And you need medication a psychologist or a therapist a certainly a master's level therapist can't prescribing most states. So the psychologist you're seeing would need to collaborate with a psychiatrist that -- seen the psychiatrist me you may only visit once a month. To talk about the side effect of medication. Or if you're feeling better or you're responding to the medications prescribed. They'll consult with a psychologist that your -- because you're seeing a psychologist more often maybe even on a weekly basis. And a psychologist is a little bit closer to you in terms of monitoring near -- Monitoring your depression. Watching to see if your anxiety is last. If you're having less trouble with traders. If things -- bother you less at work. What kinds of therapy are either I mean when -- in the market. For -- what are my choices. Well there's individual therapy group therapy and family therapy. Individual therapy is a one on one meeting with a psychologist or counselor. Sessions usually last about fifteen minute they're focused on your symptoms in your current difficulties. Then there's group there. Group therapy might be related to -- particular problem. Like alcohol or addiction or a divorce -- -- group. In first responder communities that appears -- -- groups are really important. In their Stanley therapy perhaps the difficulties. And -- In the fire service -- -- police work are really interfering with family life. Maybe it dispatcher becomes really irritable and arguing a lot with their spouse. Then it might be time to bring the family in and sessions can be fifteen minutes QX. Sixty or ninety minutes. They me would be composed of just the couple. -- they -- bring the whole family and to explain the problem that difficulty and really focus on getting their family has a system. In actually. Another way to look at individual therapy as by -- style or approach therapist we just don't do it all the same way. Some therapists. Look at attachment. And how you're relating to other people. Some therapists take the approach of focusing on fox feelings and behaviors. Some therapists. Look at other relationships that you -- -- in your past for your president. So this style of a therapist and the way they approach problem solving her symptoms may be different. It's a very personal decision and you need to ask. If they have experience with these types of difficulties you can ask. What their approach to therapy is you can ask what a typical session is like. Most first responders I work with her for a very active and directive approach. Their problems hoppers they want to fix it or solve this problem and they probably won't do you feel comfortable with a neutral. -- -- blank space. Type of approach from a fair -- And you mentioned earlier that sessions with a -- -- confidential. Is that 100% are other exceptions the confidence yeah. Well there are some limits to confidentiality. In California there are history. -- to self or others the abuse of -- child. Or an elderly person being -- For example if you tell me that your mother -- lot it is can't get her own groceries for example. And someone is supposed to be bringing her food and she's not being -- -- In California were mandated reporters of elder abuse. If you tell me that you are abusing your child beyond spanking -- -- mandated reporter for child abuse. If you tell me that you are going to commit suicide today at 4 o'clock with a revolver that's in your glove box I have to take some steps to make you say. If you say that you're feeling suicidal if you say that you would like to die those are different circumstances. And certainly suicidal thoughts are. Symptom of post traumatic stress disorder or sometimes after a critical incidents. Still feeling suicidal and doing something about that are different but if you're actually going to commit suicide. Therapists. In California are mandated reporters for that it's called the terrorist -- flock. Different states have different rules. California's not usual from what I understand. But a person would want to check with their State's rules and what applies what limbs of confidentiality rules apply to. I think most people in the public safety you don't think that. If -- having problems. For weeks after a critical incidents that they must have PT ST. Is that true. It's possible. One possibility is that they have had to -- Incidents. This is it's this last critical incident was the straw that broke the camel's back. There bucket is -- And they need some help coping you need to stop drinking maybe. They need to get back into their exercise program. They need to get out of isolation. They may have. Something other then posttraumatic stress disorder. If they have PT FT. PT SD is treatable posttraumatic stress disorder is treatable it is manageable. A bigger problem is this stigma that's associated with posttraumatic stress disorder are problems after critical incident and post traumatic stress disorder is treatable. It's manageable. The stigma associated with post traumatic stress. Worked out like that. If you are severely burned people can see that people notice that. People can see -- disfiguring and and no this person is -- and really easy for appears to reach out to each other it's really easy to pick up the phone Wednesday you know when they cast come off or would advantage is mobbed -- when can we come and see. But if you go out on disability due distressed or -- seeking help for post traumatic stress. Isolation is a huge. Factor depression actually and and exhaustion that cluster of symptoms. For emergency responders can be debt. What I tell people about the state not and it. Okay you don't want it tell people you that PT SD you don't wanna get help. Well there are gonna find out at -- funeral if you commit suicide. Just because you have some of the symptoms -- PT ST. You may not meet criteria for the diagnosis of PT SD you can get help for some of the symptoms and not have that diagnosis. And even if you -- PE ST it doesn't happen. And your career you can learn some new tools to deal with some of the symptoms you can can -- coping skills. It doesn't have to end your career in the fire service you can still work as a police officer with. You can still work as a dispatcher you can still function. This is treatable it doesn't have to and your career or your marriage. So first responder might not have -- ST. Well another way that people in my field are looking at the difficulties that first responders face. Is a new concept called emergency responder exhaustion syndrome. This has developed -- product on the West Coast. Right the late doctor Al banner doctor -- -- doctor mark can Mena and doctor Hamburg shall. The way we are conceptualize. -- the difficulties first responders face. It is by something called emergency responder exhaustion syndrome. It's characterized by depression. Isolation. And exhaustion. Depression since symptoms may include lack of interest and. -- not -- an appetite. Not need not be able to eat anything are eating everything in sight that dirt reed is that McDonnell. The junk food. And it's not being able to sleep or sleeping all the time weight gain or weight loss without trying. Sad mood or anger and irritability all the time. Isolation. Is characterized by not answering people's acts or. Not answering your cell -- getting 300 email. Going into your -- where you just have your channel surfing. Remote button. Or your video games. Or WW dot fill in the blank dot com. Where you just spend all your time on your computer on Internet porn web site you're isolated from your family from your friends. And -- -- every ounce of energy -- you get out and get going during the day. Exhaustion. Everything you do. Takes an enormous amount of effort to showering and making -- copy seems like not -- maybe. So exhausted. That you simply don't care. Therapists and first responders are. Vulnerable to compassion. And this can be just characterized by. I really don't care if you're suffering -- you're hurting anymore -- -- Care about my kids' homework I can't care that we're out of -- I'm just exhausted and I don't wanted to anymore. So emergency responder -- syndrome. Might be. A better world way of looking at some of the symptoms and some of them Mal -- coping techniques that a first responders dealing. I think if most public safety professionals are. Are not feeling well for an extended period of time after critical incidents they're probably gonna talk to colleagues first you're -- -- that your network. -- is that a good idea and if if so. Winds should they recognize that they need to talk to somebody be on that network maybe talk to professional. In my -- with three urban search and rescue teams that were deployed from California to New York following the terrorist attacks in 2001. It appears we're actually rated at the easiest persons to talk to. About their deployment experiences spot while they were deployed after they returned home. At the bottom of the list were -- -- -- professionals and apple. So I think talking with the year about your symptoms and you're difficulties is -- great ways to break through the isolation. Normalize the symptoms. And get a good handle on what you can't expect -- a critical incidents. Now after some time if you're still having difficulty in your marriage which -- spam if you are still not able to sleep at night. If you are still having physical problems like -- stomach aches to headaches that I mentioned. -- support -- doesn't necessarily. Affect us -- -- you may want to seek a therapist. After two weeks if this is just not going away after you've tried exercise. After you've tried re connecting with your friends in social work. After you've tried staying away from alcohol for two weeks if things don't get better -- Whether or not there what can they do to make things better themselves and what might be doing this. -- Some unhealthy coping mechanisms that I've seen in my practice. Our number one alcoholic. Alcohol use can. Affect a person's -- Most people think if you drink that'll make -- -- Drinking is the worst thing you can do for sleep actually. I'm not being an exercise not. Not exercising having a regular exercise program is really healthy that is the best thing if -- don't wanna do medication. Exercise is -- best thing for you especially cart. That can really increase your serotonin in those chemicals in your brain that can be that can influence a better -- it. Being with your friends and being with your family not going home and watching the TV or being on WW dot -- the -- dot com. Not being on Internet porn sites. Not being. Away from people where social creatures we need to be friends and went. -- only critical incident that might give rise to -- possibility. Of therapy for first responders. I would say -- there are three types abstract. Critical incidence stress. Is one -- the other three types are acute. Cumulative. And chronic. So acute stress is a big spike in adrenaline. In Oakland California we recently had four police officers murdered that Meeks the newspaper everybody recognizes. That this was a critical -- as a big event. Chronic stress. Is something that goes on all the time. War veterans coming back from Iraq or Afghanistan. Has banned in combat there are on duty 24/7. And and they never know when that next -- Domestic violence relationships are characterized with chronic stress. This if they can never let their guard down because they never know when they're gonna get -- -- again those are of chronic stress. Cumulative stress. Is everything come -- so it's. The line of duty death then having to respond to this suicide -- different then having that ordinary hassles of getting kids to and from school. Then arguing with your wife. Then you know losing the promotion are being passed over at work. Then having to deal with that colleague -- just really irritates you that cumulative stress. Critical incident stress by definition. Overwhelms the ability to -- it wouldn't be traumatic if you could cope with that. So it's not just the acute stress or the critical incident stress win a therapist could be helpful. A therapist might be helpful. In helping you resolve marital problems. Or helping you deal with a child who -- a learning disability. Or some of the other dated -- Strasser. As the work that first responders -- as that builds up sometimes it can affect family. And once the family situation has been resolved or is better or the whole family has. Tools to deal with that and sometimes that can't get each -- going through a divorce. In this profession. Cameo really draining time. Where -- therapist might be helpful. So there are a lot the -- That a therapist can be helpful sites critical incidence stress. The normal everyday problems with the death of a parent or the death or illness of a parent. The death or illness of a spouse marital problems. Children who are having difficulty in school learning disabilities. Therapy can help in those. Ordinary life experiences. As well as. Be helpful with Kirkland -- mr. Here's a loaded question -- -- work. Yes it guys. I tell my client it's not like getting -- -- -- you're not gonna feel better in fifteen minute. But eventually. Talking about difficulties does help. It's not a miracle here it's not magic it won't work overnight. It needs to needs to be put. Good effort into it you'll get out of therapy what you put into fair if you are not telling your therapist. About your critical incidents. About your alcohol use -- gambling. Then you're not gonna get very far but if you put your cards on the table then the therapist can help with what you bring. Therapy doesn't work by itself. You have to give it a sustained effort and combine it with things like out alcohol extension for thirty days. Give -- alcohol for thirty days -- you're trying counseling. Get exercised. Research is full of studies where exercise makes the most difference in depression. And anxiety and other difficult especially cardiovascular. Exercise. Therapy is not exotic it's not the end -- -- -- it's not for the week people. It doesn't mean that you're damaged. Police officers had a -- TO somebody to show them. The ropes a therapist can be somebody that shows you the ropes on how to deal with depression are critical incident stress. A therapist could be just another tool in your toolbox. Therapy is not for ever. Once you start therapy you're not -- have to be it for years and years can be time limited. He can -- that articles that you think are important along with your therapist or your family that's what -- pursuing. So it's very helpful.