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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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