| INTRODUCTION
Every time we
dial 911, we expect that our emergency will be
taken seriously and handled competently. The police
will race to our burgled office, the firefighters
will speedily douse our burning home, the ambulance
crew will stabilize our injured loved one and
whisk him or her to the nearest hospital. We take
these expectations for granted because of the
skill and dedication of the workers who serve
the needs of law enforcement, emergency services,
and public safety.
These "tough
guys" (Miller, 1995) - the term includes
both men and women are routinely exposed
to special kinds of traumatic events and daily
pressures that require a certain adaptively defensive
toughness of attitude, temperament, and training.
Without this resolve, they couldn't do their jobs
effectively. Sometimes, however, the stress is
just too much, and the very toughness that facilitates
smooth functioning in their daily duties now becomes
an impediment to these helpers seeking help for
themselves.
This article first
describes the types of critical incidents and
other stresses experienced by law enforcement
personnel. Many of these challenges affect all
personnel who work in public safety and the helping
professions, including police officers, firefighters,
paramedics, dispatchers, trauma doctors, emergency
room nurses, and psychotherapists (Miller, 1995,
1997, 1998a, 1998b, 1999, in press); however,
the focus here will be on the stressors most relevant
to police officers, criminal investigators, and
other law enforcement personnel. Secondly, this
article will describe the critical interventions
and psychotherapeutic strategies that have been
found most practical and useful for helping cops
in distress.
The target audience
for this article is a dual one. This article is
for law enforcement supervisors and administrators
who want to understand how to provide the best
possible psychological services to the men and
women under their command. It is also for mental
health clinicians who may be considering law enforcement
consultation and therefore want some insight into
the unique challenges and rewards of working with
these personnel.
STRESS AND
COPING IN LAW ENFORCEMENT
Police officers
can be an insular group, and are often more reluctant
to talk to outsiders or to show "weakness"
in front of their own peers than are other emergency
service and public safety workers. Officers typically
work alone or with a single partner, as opposed
to firefighters or paramedics, who are trained
to have more of a team mentality (Blau, 1994;
Cummings, 1996; Kirschman, 1997; Reese, 1987;
Solomon, 1995). This presents some special challenges
for clinicians attempting to identify and help
those officers in distress.
The Patrol Cop
Even those civilians
who have no great love for cops have to admit
that theirs is a difficult, dangerous, and often
thankless job. Police officers regularly deal
with the most violent, impulsive, and predatory
members of society, put their lives on the line,
and confront cruelties and horrors that the rest
of us view from the sanitized distance of our
newspapers and TV screens. In addition to the
daily grind, officers are frequently the target
of criticism and complaints by citizens, the media,
the judicial system, adversarial attorneys, social
service personnel, and their own administrators
and law enforcement agencies (Blau, 1994).
Police officers
generally carry out their sworn duties and responsibilities
with dedication and valor, but some stresses are
too much to take, and every officer has his or
her breaking point. For some, it may come in the
form of a particular traumatic experience, such
as a gruesome accident or homicide, a vicious
crime against a child, a close personal brush
with death, the death or serious injury of a partner,
the shooting of a perpetrator or innocent civilian,
or an especially grisly or large-scale crime;
in some cases, the traumatic critical incident
can precipitate the development of a full-scale
posttraumatic stress disorder, or PTSD (Miller,
1994, 1998c). Symptoms may include numbed responsiveness,
impaired memory alternating with intrusive, disturbing
images of the incident, irritability, hypervigilance,
impaired concentration, sleep disturbance, anxiety,
depression, phobic avoidance, social withdrawal,
and substance abuse.
For other officers,
there may be no singular trauma, but the mental
breakdown caps the cumulative weight of a number
of more mundane stresses over the course of the
officer's career. Most police officers deal with
both the routine and exceptional stresses by using
a variety of situationally adaptive coping and
defense mechanisms, such as repression, displacement,
isolation of feelings, humor often seemingly
callous or crass humor and generally toughing
it out. Officers develop a closed society, an
insular "cop culture," centering around
what many refer to as The Job. For a few,
The Job becomes their life, and crowds
out other activities and relationships (Blau,
1994).
In the United
States, two-thirds of officers involved in shootings
suffer moderate or severe problems and about 70
percent leave the force within seven years of
the incident. Police are admitted to hospitals
at significantly higher rates than the general
population and rank third among occupations in
premature death rates (Sewell et al, 1988). Interestingly,
however, despite the popular notion of rampantly
disturbed police marriages, there is no evidence
for a disproportionately high divorce rate among
officers (Borum & Philpot, 1993).
Perhaps the most
tragic form of police casualty is suicide (Cummings,
1996; Hays, 1994; McCafferty et al, 1992; Seligman
et al, 1994). Twice as many officers, about 300
annually, die by their own hand as are killed
in the line of duty. In New York City, the suicide
rate for police officers is more than double the
rate for the general population. In fact, these
totals may actually be even higher, since such
deaths are sometimes underreported by fellow cops
to avoid stigmatizing the deceased officers and
to allow families to collect benefits. Most suicide
victims are young patrol officers with no record
of misconduct, and most shoot themselves off-duty.
Often, problems involving alcohol or romantic
crises are the catalyst, and easy access to a
lethal weapon provides the ready means. Cops under
stress are caught in the dilemma of risking confiscation
of their guns or other career setbacks if they
report distress or request help.
Special
Assignments and Units
Aside from the
daily stresses and hassles of patrol cops, special
pressures are experienced by higher-ranking officers,
such as homicide detectives, who are involved
in the investigation of particularly brutal crimes,
such as multiple murders or serial killings (Sewell,
1993). The protective social role of the police
officer becomes even more pronounced, at the same
time as their responsibilities as public servants
who safeguard individual rights become compounded
with the pressure to solve the case.
Moreover, the
sheer magnitude and shock effect of many murder
scenes, and the violence, mutilation, and sadistic
brutality associated with many serial killings,
especially if they involve children, often overwhelm
the defense mechanisms and coping abilities of
even the most seasoned officers. Revulsion may
be tinged with rage, all the more so when fellow
officers have been killed or injured. Finally,
the cumulative effect of fatigue results in case
errors, impaired work quality, and deterioration
of home and workplace relationships. Fatigue also
further wears down defenses, rendering the officer
even more vulnerable to stress and impaired decision-making.
Dispatchers
and Support Personnel
In addition to
line-of-duty officers, s vital role in law enforcement
is played by the workers who operate "behind
the scenes," namely the dispatchers, complaint
clerks, clerical staff, crime scene technicians,
and other support personnel (Holt, 1989; Sewell
& Crew, 1984). Although rarely exposed to
direct danger (except where on-scene sand behind-scene
personnel alternate shifts), several high-stress
features characterize the job descriptions of
these workers. These include: (1) dealing with
multiple, sometimes simultaneous, calls; (2) having
to make time-pressured life-and-death decisions,
(3) having little information about, and low control
over, the emergency situation; (4) intense, confusing,
and frequently hostile contact with frantic or
outraged citizens; and (5) exclusion from the
status and camaraderie typically shared by on-scene
personnel who "get the credit."
After particularly
difficult calls, dispatchers may show many of
the classic posttraumatic reactions and symptoms,
but they are often overlooked by police supervisors
and consulting mental health clinicians alike.
As with other tough jobs, these individuals deserve
the proper treatment and support.
INTERVENTION
SERVICES AND STRATEGIES
To avoid overly
"shrinky" connotations, mental health
intervention services with law enforcement personnel
are often conceptualized in such terms as "stress
management" or "critical incident debriefing"
(Anderson et al, 1995; Belles & Norvell, 1990;
Mitchell & Bray, 1990; Mitchell & Everly,
1996). In general, one-time, incident-specific
interventions will be most appropriate for handling
the effects of overwhelming trauma on otherwise
normal, well-functioning personnel. Where posttraumatic
sequelae persist, or where the psychological problems
relate to a longer-term pattern of maladaptive
functioning, more extensive individual psychotherapeutic
approaches are called for. To have the greatest
impact, intervention services should be part of
an integrated program within the department, and
have full administrative commitment and support
(Blau, 1994; Sewell, 1986).
Critical
Incident Stress Debriefing (CISD)
Although components
of this approach comprise an important element
of all therapeutic work with traumatized patients,
critical incident stress debriefing, or CISD,
has been organizationally formalized for law enforcement
and emergency services by Jeff Mitchell and his
colleagues (Mitchell, 1983, 1988, 1991; Mitchell
& Bray, 1990; Mitchell & Everly, 1996),
and the "Mitchell model" of CISD is
now implemented in public safety departments throughout
the United States, Britain, and other parts of
the world (Davis, 1998/99; Dyregrov, 1989). CISD
is a structured intervention designed to promote
the emotional processing of traumatic events through
the ventilation and normalization of reactions,
as well as preparation for possible future experiences.
CISD is an essential technique associated with
efficient and effective Critical Incident Stress
Management (CISM).
According to the
Mitchell model, following a critical incident,
there are a number of criteria on which peer support
and command staff might decide to provide a debriefing
to personnel. These include: (1) many individuals
within a group appear to be distressed after a
call; (2) the signs of stress appear to be quite
severe; (3) personnel demonstrate significant
behavioral changes; (4) personnel make significant
errors on calls occurring after the critical incident;
(5) personnel request help; (6) the event is unusual
or extraordinary.
The structure
of a CISD usually consists of the presence of
one or more mental health professionals and one
or more peer debriefers, i.e. fellow police officers
or emergency service workers who have been trained
in the CISD process and who may have been through
critical incidents and debriefings themselves.
A typical debriefing takes place within 24-72
hours after the critical incident, and consists
of a single group meeting that lasts approximately
2-3 hours, although shorter or longer meetings
are determined by circumstances.
The formal CISD
process consists of seven standard phases:
Introduction:
The introduction phase of a debriefing is when
the team leader introduces the CISD process and
approach, encourages participation by the group,
and sets the ground rules by which the debriefing
will operate. Generally, these guidelines involve
issues of confidentiality, attendance for the
full duration of the group, however with nonforced
participation in discussions (no "hot seat"),
and the establishment of a supportive, noncritical
atmosphere.
Fact Phase:
During this phase, the group is asked to describe
briefly their job or role during the incident
and, from their own perspective, some facts regarding
what happened. The basic question is: "What
did you do?"
Thought Phase:
The CISD leader asks the group members to discuss
their first thoughts during the critical incident:
"What went through your mind?"
Reaction Phase:
This phase is designed to move the group participants
from the predominantly cognitive level of intellectual
processing into the emotional level of processing:
"What was the worst part of the incident
for you?"
Symptom Phase:
This begins the movement back from the predominantly
emotional processing level toward the cognitive
processing level. Participants are asked to describe
their physical, cognitive, emotional, and behavioral
signs and symptoms of distress which appeared
(1) at the scene or within 24 hours of the incident,
(2) a few days after the incident, and (3) are
still being experienced at the time of the debriefing:
"What have you been experiencing since the
incident?"
Education Phase:
Information is exchanged about the nature of the
stress response and the expected physiological
and psychological reactions to critical incidents.
This serves to normalize the stress and coping
response, and provides a basis for questions and
answers: "What can we learn from this experience?"
Re-entry Phase:
This is a wrap-up, in which any additional questions
or statements are addressed, referral for individual
follow-ups are made, and general group solidarity
and bonding are reinforced: "How can we help
one another the next time something like this
occurs?" "Was there anything that we
left out?"
For a successful
debriefing, timing and clinical appropriateness
are important. The consensus from the literature
and my own clinical experience support scheduling
the debriefing toward the earlier end of the recommended
24-72 hour window (Bordow & Porritt, 1979;
Solomon & Benbenishty, 1988). To keep the
focus on the event itself and to reduce the potential
for singling-out of individuals, some authorities
recommend that there be a policy of mandatory
referral of all involved personnel to a debriefing
or other appropriate mental health intervention
(Horn, 1991; McMains, 1991; Mitchell, 1991; Reese,
1991; Solomon, 1988, 1990, 1995). However, in
other cases, mandatory or enforced CISD may lead
to passive participation and resentment among
the conscripted personnel (Bisson & Deahl,
1994; Flannery et al, 1991), and the CISD process
may quickly become a boring routine if used indiscriminately
after every incident, thereby diluting its effectiveness
in those situations where it really could have
helped. Departmental supervisor and mental health
consultants must use their common sense and knowledge
of their own personnel to make these kinds of
judgement calls.
Special
Applications of CISD for Law Enforcement
To encourage participation
and reduce fear of stigmatization, the administrative
policy should strongly and affirmatively state
that debriefings and other postincident mental
health and peer-support interventions are confidential.
The only exceptions to confidentiality are a clear
and present danger to self or others, or disclosure
of a serious crime by the officer. Where only
one officer is involved, as in a shooting, or
as a follow-up or supplement to a formal group
debriefing, individual debriefings may be conducted
by a mental health clinician or trained peer (Solomon,
1995).
In an officer-involved
shooting, when there is an ongoing or impending
investigation, Solomon (1988, 1995) recommends
that the group debriefing be postponed until the
initial investigation has been completed and formal
statements have been taken by investigators. Otherwise,
debriefing participants may be regarded as witnesses
who are subject to subpoena for questioning about
what was said. For particularly sensitive or controversial
situations or complicated internal affairs investigations,
it may be advisable to postpone the group debriefing
until the investigation has been officially resolved.
Individual interventions can be provided for the
primarily involved officer(s) in the meantime,
and/or a group debriefing may proceed with other,
nonprimarily involved personnel who may have been
affected by the incident, especially where the
response team was multidisciplinary and multidepartmental
(police, firefighters, paramedics, etc.).
Finally, as a
follow-up measure, Solomon (1995) recommends holding
a critical incident peer support seminar, in which
the involved officers come together for two or
three days in a retreat-like setting, several
months postincident, to revisit and reflect upon
their experience. The seminar is facilitated by
mental health professionals and peer support officers.
Sewell (1993,
1994) has adapted a CISD-like stress management
model to the particular needs of detectives who
investigate multiple murders and other violent
crimes. The major objectives of this process are:
(1) ventilation of intense emotions; (2) exploration
of symbolic meanings; (3) group support under
catastrophic conditions; (4) initiation of the
grief process within a supportive environment;
(5) dismantling of the "fallacy of uniqueness;"
(6) reassurance that intense emotions under catastrophic
conditions are normal; (7) preparation for the
continuation of the grief and stress process over
the ensuing weeks and months; (8) preparing for
the possible development of physical, cognitive,
and emotional symptoms in the aftermath of a serious
crisis; (9) education regarding normal and abnormal
stress response syndromes; and (10) encouragement
of continued group support and/or professional
help.
Perhaps the most
comprehensive adaptation of the CISD process comes
from the work of Bohl (1995) who explicitly compares
and contrasts the phases in her own program with
the phases of the Mitchell model.
In Bohl's program,
the debriefing takes place as soon after the critical
incident as possible. A debriefing may involve
a single officer within the first 24 hours, later
followed by a second, with a group debriefing
taking place within one week to encourage group
cohesion and bonding. This addresses the occupationally
lower team orientation of most police officers
who may not express feelings easily, even
or especially in a group of their fellow
cops.
The Bohl model
makes no real distinction between the cognitive
and emotional phases of a debriefing. If an officer
begins to express emotion during the fact or cognitive
phase, there is little point in telling him or
her to stifle it until later. To be fair, the
Mitchell model certainly does allow for flexibility
and common sense in structuring debriefings, and
both formats recognize the importance of responding
empathically to the specific needs expressed by
the participants, rather than following a rigid
set of rules.
In the emotion
phase itself, what is important in the Bohl model
is not the mere act of venting, but rather the
opportunity to validate feelings. Bohl does not
ask what the "worst thing" was, since
she finds the typical response to be that "everything
about it was the worst thing." However, it
often comes as a revelation to these law enforcement
"tough" guys that their peers have had
similar feelings.
Still, some emotions
may be difficult to validate. For example, guilt
or remorse over actions or inactions may actually
be appropriate, as when an officer's momentary
hesitation or impulsive action resulted in someone
getting hurt or killed. In the Bohl model, the
question then becomes: "Okay, you feel guilty
what are you going to do with that guilt?"
That is, "What can be learned from the experience
to prevent something like this from happening
again?"
The Bohl model
inserts an additional phase, termed the "unfinished
business" phase, which has no formal counterpart
in the Mitchell model. Participants are asked,
"What in the present situation reminds you
of past experiences? Do you want to talk about
those other situations?" This phase grew
out of Bohl's observation that the incident that
prompted the current debriefing often acts as
a catalyst for recalling past events. The questions
give participants a chance to talk about incidents
that may arouse strong, unresolved feelings. Bohl
finds that such multilevel debriefings result
in a greater sense of relief and closure than
might occur by sticking solely to the present
incident. In many cases, it has also been my own
experience that feelings and reactions to past
critical incidents will sometimes spontaneously
come up during a debriefing about a more recent
incident, and this must be dealt with and worked
through as it arises, although team leaders must
be careful not to lose too much of the structure
and focus of the current debriefing.
The education
phase in the Bohl model resembles its Mitchell
model counterpart, in that participants are schooled
about normal and pathological stress reactions,
how to deal with coworkers and family members,
and what to anticipate in the days and weeks ahead.
Unlike the Mitchell model, the Bohl model does
not ask whether anything positive, hopeful, or
growth-promoting has arisen from the incident.
Officers who have had to deal with senseless brutality
might be forgiven for failing to perceive anything
positive about the incident, and expecting them
to extract some kind of "growth experience"
from such an event may seem like a sick joke.
A final non-Mitchell
phase of the debriefing in the Bohl model is the
"round robin" in which each officer
is invited to say whatever he or she wants. The
statement can be addressed to anyone, but others
cannot respond directly; this is supposed to give
participants a feeling of safety. My own concern
is that this may provide an opportunity for last-minute
gratuitous sniping, which can quickly erode the
supportive atmosphere that has been carefully
crafted during the debriefing. Additionally, in
practice, there doesn't seem to be anything particularly
unique about this round robin phase to distinguish
it from the standard re-entry phase of the Mitchell
model. Finally, adding more and more "phases"
to the debriefing process may serve to decrease
the forthrightness and spontaneity of its implementation.
Again, clinical judgement and common sense should
guide the process.
LAW ENFORCEMENT
PSYCHOTHERAPY
As noted above,
police officers have a reputation for shunning
mental health services, often perceiving its practitioners
as "softies" and "bleeding hearts"
who help criminals go free with over complicated
psychobabble excuses. Other cops may fear being
"shrunk," having a notion of the psychotherapy
process as akin to brainwashing, a humiliating
and emasculating experience in which they lie
on a couch and sob about their dysfunctional childhoods.
More commonly, the idea of needing "mental
help" implies weakness, cowardice, and lack
of ability to do the job. In the environment of
many departments, some officers realistically
fear censure, stigmatization, ridicule, thwarted
career advancement, and alienation from colleagues
if they are perceived as the type who "folds
under pressure." Still others in the department
who may have something to hide may fear a colleague
"spilling his guts" to the shrink and
thereby blowing the malfeasor's cover (Miller,
1995, 1998c).
Administrative
Issues
There is some
debate about whether psychological services, especially
therapy-type services, should be provided by a
psychologist within the department, even a clinician
who is also an active or retired sworn officer,
or whether such matters are best handled by outside
therapists who are less involved in departmental
politics and gossip (Blau, 1994; Silva, 1991).
On the one hand,
the departmental clinician is likely to have more
knowledge of, and experience with, the direct
pressures faced by the personnel he or she serves;
this is especially true if the psychologist is
also an officer or has had formal law enforcement
training or ride-along experience. On the other
hand, in addition to providing psychotherapy services,
the departmental psychologist is likely to also
be involved in performing work status and fitness-for-duty
evaluations, as well as other assessments or legal
roles which may conflict with that of an objective
helper. An outside clinician may have less direct
experience with departmental policy and pressures,
but may enjoy more therapeutic freedom of movement.
My own experience
has been that officers who sincerely come for
help are usually less interested in the therapist's
extensive technical knowledge of The Job,
and more concerned that he or she demonstrate
a basic trust and a willingness to understand
the officer's situation the cops will be
more than happy to provide the grim details. These
officers expect mental health professionals to
"give 100 percent" in the psychotherapy
process, just as the officers do in their own
jobs; they really don't want us to be another
cop, they want us to be a skilled therapist
that's why they're talking to us in the first
place.
Many cops are
actually glad to find a secure haven away from
the "fishbowl" atmosphere of the department
and relieved that the therapeutic sessions provide
a respite from shop talk. This is especially true
where the referral problem has less to do with
direct job-related issues and more with outside
pressures, such as family or alcohol problems,
that may impinge on job performance. In any case,
the therapist, the patient, and the department
should be clear at the outset about the issues
relating to confidentiality and chain of command,
and any changes in ground rules should be clarified
as needed.
Trust and
the Therapeutic Relationship
Difficulty with
trust appears to be an occupational hazard for
workers in law enforcement and public safety who
typically maintain a strong sense of self-sufficiency
and insistence on solving their own problems.
Therapists may therefore frequently find themselves
"tested," especially at the beginning
of the treatment process. As the therapeutic alliance
begins to solidify, the officer will begin to
feel more at ease with the therapist and may actually
find comfort and sense of stability from the psychotherapy
sessions. Silva (1991) has outlined the following
requirements for establishing therapeutic mutual
trust:
Accurate Empathy:
The therapist conveys his or her understanding
of the officer's background and experience (but
beware of premature false familiarity and phony
"bonding").
Genuineness:
The therapist is as spontaneous, tactful, flexible,
and nondefensive as possible.
Availability:
The therapist is accessible and available (within
reason) when needed, and avoids making promises
and commitments he or she can't realistically
keep.
Respect:
This is both gracious and firm, and acknowledges
the officer's sense of autonomy, control, and
responsibility within the therapeutic relationship.
Respect is manifested by the therapist's general
attitude, as well as by certain specific actions,
such as signifying regard for rank or job role
by initially using formal departmental titles,
such as "officer," "detective,"
"lieutenant," until trust and mutual
respect allow an easing of formality. Here it
is important for clinicians to avoid the dual
traps of overfamiliarity, patronizing, and talking
down to the officer on the one hand, and trying
to "play cop" or force bogus camaraderie
by assuming the role of a colleague or commander.
Concreteness:
Therapy should, at least initially be goal-oriented
and have a problem-solving focus. Police officers
are into action and results, and to the extent
that it is clinically realistic, the therapeutic
approach should emphasize active, problem-solving
approaches before tackling more sensitive and
complex psychological issues.
Therapeutic
Strategies and Techniques
Since most law
enforcement and emergency services personnel come
under psychotherapeutic care in the context of
some form of posttraumatic stress reaction, both
clinical experience and literature (Blau, 1994;
Cummings, 1996; Fullerton et al, 1992; Kirschman,
1997) reflect this emphasis. In general, the effectiveness
of any intervention technique will be determined
by the timeliness, tone, style, and intent of
the intervention. Effective interventions share
in common the elements of briefness, focus on
specific symptomatology or conflict issues, and
direct operational efforts to resolve the conflict
or to reach a satisfactory conclusion.
In working with
police officers, Blau (1994) recommends that the
first meeting between the therapist and the officer
establish a safe and comfortable working atmosphere
by the therapist's articulating : (1) a positive
endorsement of the officer's decision to seek
help; (2) a clear description of the therapist's
responsibilities and limitations with respect
to confidentiality and privilege; and (3) an invitation
to state the officer's concerns.
A straightforward,
goal-directed, problem-solving therapeutic intervention
approach includes the following elements: (1)
creating a sanctuary; (2) focusing on critical
areas of concern; (3) specifying desired outcomes;
(4) reviewing assets; (5) developing a general
plan; (6) identifying practical initial implementations;
{7) reviewing self-efficacy; and (8) setting appointments
for review, reassurance, and further implementation
(Blau, 1994).
Blau (1994) delineates
a number of effective individual intervention
strategies for police officers, including the
following:
Attentive Listening:
This includes good eye contact, appropriate body
language, and genuine interest, without inappropriate
comment or interruption. Clinicians will recognize
this intervention as "active listening."
Being There
With Empathy: This therapeutic attitude conveys
availability, concern, and awareness of the turbulent
emotions being experienced by the traumatized
officer. It is also helpful to let the officer
know what he or she is likely to experience in
the days and weeks ahead.
Reassurance:
In acute stress situations, this should take the
form of realistically reassuring the officer that
routine matters will be taken care of, deferred
responsibilities will be handled by others, and
that the officer has administrative and command
support.
Supportive
Counseling: This includes effective listening,
restatement of content, clarification of feelings,
and reassurance, as well as community referral
and networking with liaison agencies, when necessary.
Interpretive
Counseling: This type of intervention should
be used when the officer's emotional reaction
is significantly greater than the circumstances
that the critical incident seem to warrant. In
appropriate cases, this therapeutic strategy can
stimulate the officer to explore underlying emotional
stresses that intensify a naturally stressful
traumatic event. In a few cases, this may lead
to ongoing psychotherapy.
Not to be neglected
is the use of humor, which has its place in many
forms of psychotherapy, but may be especially
useful in working with law enforcement and emergency
services personnel. In general, if the therapist
and patient can share a laugh, this may lead to
the sharing of more intimate feelings. Humor serves
to bring a sense of balance, perspective, and
clarity to a world that seems to have been warped
and polluted by malevolence and horror. Humor
even sarcastic, gross, or callous humor,
if handled appropriately and used constructively
may allow the venting of anger, frustration,
resentment, or sadness, and thereby lead to productive,
reintegrative therapeutic work (Fullerton et al,
1992; Miller, 1994; Silva, 1991).
Departmental
Support
Even in the absence
of formal psychotherapeutic intervention, following
a department-wide critical incident, such as a
line-of-duty death or a particularly stressful
rescue or arrest, the mental health professional
can advise and guide law enforcement departments
in encouraging and implementing several organizational
response measures, based on the available literature
on individual and group coping strategies for
public safety personnel (Alexander, 1993; Alexander
& Walker, 1994; Alexander & Wells, 1991;
DeAngelis, 1995; Fullerton et al, 1992; Palmer,
1983). Many of these measures are applicable proactively
as part of training before a critical incident
occurs. Some specific measures include the following:
(1) Encourage
mutual support among peers and supervisors. The
former typically happens anyway; the latter may
need some explicit reinforcement. Police officers
frequently work as partners and understand that
shared decision-making and mutual reassurance
can enhance effective job performance.
(2) Utilize humor
as a coping mechanism to facilitate emotional
insulation and group bonding. The first forestalls
excessive identification with victims, the second
encourages mutual group support via a shared language.
Of course, the mental health clinician needs to
monitor the line between adaptive humor and unproductive
gratuitous nastiness that only serves to entrench
cynicism and despair.
(3) Make use of
appropriate rituals to give meaning and dignity
to an otherwise existentially disorienting experience.
This includes not only religious rites related
to mourning, but such respectful protocols as
a military-style honor guard to attend bodies
before disposition, and the formal acknowledgment
of actions above and beyond the call of duty.
Important here is the role of "grief leadership,"
in which the commanding officer demonstrates by
example that it's okay to express grief and mourn
the death of fallen comrades or civilians and
that the dignified expression of one's feelings
about the incident will be supported, not denigrated.
CONCLUSION
Psychotherapy
with law enforcement and emergency services personnel
entails its share of frustration as well as satisfaction.
A certain flexibility is called for in adapting
traditional psychotherapeutic models and techniques
for use with this group and clinical work frequently
requires both firm professional grounding and
"seat-of-the-pants" maneuverability.
Incomplete closures and partial successes are
to be expected, but in a few instances, the impact
of successful intervention can have profound effects
on morale and job effectiveness that may be felt
department-wide. Working with these "tough
guys" takes skill, dedication, and sometimes
a strong stomach, but for mental health clinicians
who are not afraid to tough it out themselves,
this can be a fascinating and rewarding area of
clinical practice.
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