By Dena Ali
“Sitting with clients in therapy, I am frequently overwhelmed by their experiences of loss, heartache, and suffering. Many of my clients did not have the opportunity to grieve or feel the weight of their suffering. Messages sent and received with good intentions functioned to suppress emotional expression. But suppressing emotions does not mean they go away; sooner or later, they come out, often in ways that end up being destructive to the individual and her relationships. Within the safety of the therapeutic relationship, these emotions are encouraged towards an appropriate expression.” – Margaret Shull
In February, the North Carolina State Firefighter’s Association went live with its $2,500 reimbursement program for post-traumatic stress counseling services. As the director of the North Carolina Peer Support Team, I was elated to see such an incredible resource provided to firefighters across our state. In my years working with other first responders, I have often found two barriers to getting them appropriate professional help: financial concerns & fear of vulnerability.
With the financial stress of seeing a professional counselor now eliminated by the NCSFA’s grant (https://ncsfa.com/post-traumatic-stress-counseling-reimbursement-program) and North Carolina Peer Support’s funding, I would like to share information on therapy and finding a therapist.
I believe therapy is quite possibly one of the most underutilized yet helpful resources available for a first responder. Personally, I have found that just about any and every first responder has the power to benefit from its use. Like me, many first responders have a belief that by seeing a counselor, you are admitting to being damaged, unfit for duty, or having “problems.” Or worse, that by seeing a counselor, you are exposing your deepest, darkest vulnerabilities. I also believe that our historical stigma against mental health has increased the first responder’s reluctance to seek professional help.
A couple of years ago, while teaching a peer support class in Durham, North Carolina, one of our peers, Alexis John, introduced herself, shared her story, and said: “THERAPY IS AWESOME!” I’ll never forget how quickly shouting changed the entire group’s view of therapy and opened conversations. Several in-class then shared their experiences with therapy, and suddenly, therapy became supported rather than shameful. I was so grateful for her explanation that THERAPY IS AWESOME!
I personally needed to hear that. After some poor childhood experiences with counselors, I was one of those people who was deathly fearful of mental health services. I will never forget the day of my first appointment with my counselor. While driving, my heart started pounding, my palms were sweating, and the only thing that kept me from turning around was my commitment to our peer support team and other first responders. Despite my fear, as soon as I walked into her office and sat down, I was overcome by a sense of calm and safety. I struggled to put that experience into words. I felt welcomed, heard, and understood. Suddenly, I had the self-compassion to become more curious about my insecurities. I remember leaving her office that day, thinking that if I had come in years sooner, it might have saved myself years of suffering.
It is safe to say that we all have blind spots in our lives and negative ways to manage stress. A counselor’s job is to simply help individuals identify their blind spots, have compassion for their experiences, thoughts, and beliefs, and create healthy habits. Some people think clinicians “fix” broken people, but that’s not their job; their job is simply to help provide perspective and tools for the individual to create a healthy map of their future. Many people also appreciate utilizing their clinician’s office as a safe place to vent and voice complaints about those closest in their lives ;).
Before I get any deeper into therapy and mental health services, I want to define a few terms.
A counselor is a broad umbrella term for a person trained to give guidance on personal, social, or psychological problems. If they have been formally trained, they have a master’s degree and are licensed as a counselor. Some counselors are informally trained and do not qualify as licensed counselors.
A psychologist is a person skilled in a particular kind of therapy. There are many evidence-based psychotherapies available, and most clinicians have a few that they are trained to specialize in. A psychologist has received doctoral-level training in addition to a master’s degree.
A social worker is a person who has either a master’s degree or a doctoral degree and engages in therapy. Social workers often, but not always emphasize skill-building.
A clinician is a general term that can refer to a trained counselor or psychologist or social worker who provides therapy (rather than teaching or research). The therapist is another broad term that can apply to either a counselor or psychologist or social worker who provides therapy. There is no licensing for clinicians or therapists because these are general terms.
Counseling is often a conversation or short series of conversations that include insight and advice where therapy leads to self-understanding and intrinsic motivation for change. Therapy requires more commitment and effort and can be difficult for the client if trust is not established between them and the clinician.
Therapy focuses on self-understanding and intrinsic motivation for change. Therapy requires more commitment and effort and can be difficult for the client if trust is not established between him/her and the clinician.
For example, when I was depressed and having thoughts of suicide, I could have benefitted from a clinician or therapist who could have utilized evidence-based therapy to help me manage my thoughts, feelings, and behaviors. However, by the time I made an appointment, I was no longer experiencing depression or suicidal thoughts, so I met with a counselor. She simply helped me understand myself and gave me the insight to have more compassion for my experiences.
This counselor was trained in a few therapies and could have provided me with one if I needed it, but we simply worked on routine maintenance, and she gave me a better understanding of my thought processes. One of the greatest benefits I received from seeing her was more self-compassion for some of my self-protective behaviors. I think that guidance helped to keep me from experiencing depression later. We have self-protective behaviors that can get in the way of our understanding and prevent us from recognizing negative behavior patterns. With the help of a trained professional, we can identify these behaviors and recognize them in future situations. This understanding often helps us change our thoughts before those thoughts impact our feelings and behaviors.
In my years of learning more about first responder mental health, I have learned that there are no treatments of choice for first responders, and there is no one-size-fits-all mental health clinician. While we believe it is important for first responders to work with culturally competent clinicians, we have learned that the relationship between the two is a better predictor of client/clinician success. The client must like, trust, and feel safe with their therapist. Dr. Bessel Van Der Kolk recommends seeking a clinician that is curious enough to find out “what you, not some generic ‘PTSD’ patient, needs.”
I have often heard that finding a good clinician is like finding the right running shoes. There is no one brand that works for everybody, and sometimes you must try on a few before you figure out which one is the best fit for you. When looking for the right clinician, the overall recommendation is to find somebody you feel comfortable with because safety is the only necessary condition for healing to take place.
It’s a bonus if the clinician is culturally competent (meaning they understand first responders). While early in peer support work, we advocated for connecting first responders with culturally competent clinicians, today, we see that this advice has some negative consequences. We have first responders refusing to work with clinicians unless they are culturally competent, and this is preventing those responders from finding their right fit or any clinician at all. Unfortunately, there are more first responders who need clinicians than clinicians who are culturally competent. If you bypass finding a clinician you connect well with for one who claims to specialize in first responders, you may handicap the relationship from the start.
Because data suggest that 65% of clients’ healing is attributed to his/her relationship with his/her therapist, it is critical that you find a therapist you connect well with. Generally, the first few sessions establish that relationship and learn about each other. This is where, if you find a great therapist who is not culturally competent, you can increase their competency simply by sharing yourself and your work with them.
On the topic of cultural competency, my friend Brandon Dreiman says:
“I have played a part in developing that culture, and it’s regrettable. In AA, we always say ‘A drunk’s a drunk.’ Harsh, but ultimately true … what we do for a living is completely meaningless to step work. I have come to realize that the same is true of any mental health work. Does the provider listen? Do you feel you can share your ‘unshareables’? Those are the relevant questions … more so than ‘Have you treated firefighters before?”
With television shows like Chicago Fire, Cops, Grey’s Anatomy, and World News Tonight, one must be living under a rock not to suspect the trauma experienced by first responders. So, most of the time, we must help clinicians learn about our terrible sleep rhythms, organizational stressors, relationship challenges, leadership woes, and other atypical stressors for shift workers.
The work is not solely on the therapist, it is also on the first responder to have patience and curiosity to explore their true sources of pain. Often the roots of our problems rarely have to do with our jobs and have more to do with ourselves. Until we identify our true sources of pain, healing will continue to escape us.
Here are some recommendations for finding a counselor/therapist.
Remember, because finding the right clinician is like finding the right pair of running shoes, you might have to try a few before you settle. Most clinicians provide prospective clients with a 15-minute skype or phone interview. I would suggest scheduling three or so until you find the clinician that your gut says is the right one.
My go-to resource for finding a clinician and the one I would use tomorrow if I needed a new clinician is the Psychology Today website: https://www.psychologytoday.com/us/therapists
Start there. Make sure you go to filters and fill in your location, insurance, and what you are looking for help with. You can add as many filters as you like, down to the clinician’s gender and their types of therapy.
In his book “The Body Keeps the Score,” Dr. Van Der Kolk offers these tips for looking for a clinician:
- No one treatment of choice for trauma. Find out what their specialties are.
- They must be open to learning from you and helping you figure out what approach you may need. If they don’t specialize in what you need, will they help connect you with an appropriate therapist.
- Do you feel comfortable with this therapist?
- Critical question: “Do you feel that your therapist is curious to find out who you are and what you, not some generic “patient” needs?
If the therapist claims they are the best and can help anybody and everybody, RUN FAR FAR AWAY. A good clinician will be humble enough to admit that they aren’t the right fit, and they will help you find that person.
If the first clinician doesn’t work, don’t give up. Just like there are firefighters and paramedics out there who we wouldn’t want to come to our house, there too are clinicians we wouldn’t want to help our family. There are also good clinicians that we may not feel comfortable with. It’s the nature of human personalities in all professions.
NCPS Team Clinician Cheryl Corbin offers this tip: “The conversations and goals should always be about the individual and not the therapist. The individual should set the pace because each individual knows internally what speed is right, and that’s important for the therapist to understand. The body wants to and is wired to heal; sometimes it just needs some gentle guidance and assistance from a therapist.”
And remember, therapy is awesome.
If you have any questions or need help connecting with a clinician, please feel free to reach out to me at firstname.lastname@example.org or reach out to our peer support network, where we specialize in being a bridge to care further: ncffps.org.
Dena Ali is a captain with the Raleigh, NC Fire Department where she has worked her way up the ranks. Ali has a degree from North Carolina State University and an MPA from the University of North Carolina—Pembroke, where her research focused on firefighter suicide. She received the NC Office of State Fire Marshal Honor, Courage, and Valor award in 2018 for her steadfast effort to bring awareness to firefighter mental health through her vulnerability. She is an advocate of awareness, education, and understanding of mental health disorders and suicidality. She speaks locally and nationally on these topics and is a QPR Suicide Prevention Gatekeeper Instructor and is the founder and director of North Carolina Peer Support where she helped to develop their statewide curriculum. She is also a founding member of the Carolina Brotherhood, a group of cyclists/firefighters in North Carolina who honor the fallen and their families annually.