To commemorate National First Responders Day on October 28, we turned to EMDRIA member Bonnie Rumilly, LCSW.
10 Tips for EMDR Therapists Working with First Responders
Guest Blog Post by Bonnie Rumilly, LCSW
First responders are a special character and have a unique culture. They are loyal and committed to their profession of serving the public. It is essential for EMDR therapists to be culturally competent and knowledgeable about first responder culture to work with them in a clinically effective way.
It is also important to note that first responder culture is quite nuanced between the branches of police, fire, EMS, dispatch, corrections, animal control, etc. While traits and values are shared between the branches, each has its own culture. Each workplace and volunteer setting is also very different, so one cannot assume one Department is the same as another.
Here are some tips and things to consider for EMDR therapists working with first responders:
- Make sure you can manage the subject matter.
First responders need to be able to go to therapy and receive EMDR without being “worried” about their clinician. They need to believe you can handle what they are about to tell you without being traumatized yourself. First responders are keenly observant and can tell immediately when someone is timid or visibly impacted by their graphic stories and language.
- Be culturally competent when working with first responders.
If you aren’t familiar with the culture, seek out information and exposure to educate yourself. There are plenty of wonderful books, documentaries, and podcasts (such as Responder Resilience Podcast) to help you familiarize yourself with this population. Seek out first responders or ask your local fire department if you could swing by for coffee to learn about their culture.
- It’s okay to ask questions.
If you are new to this population or still learning, asking them questions is okay. However, the questions should not be the purpose of your session, as has been reported by some first responders. If the first responder you are working with uses an acronym you are unfamiliar with or a piece of equipment you have never heard of, ask them to explain. This shows you are genuinely interested in their profession and understand their viewpoint, further building trust.
- Build trust with your first responder.
It is important to build trust by being fully present (mentally), as first responders will read your body language, and if they feel you aren’t interested, then trust cannot be built. Mean what you say and say what you mean. First responders generally appreciate direct communication, not beating around the bush about a topic or question. They need to work quickly and efficiently in their line of work, and they will expect the same from you.
- Facilitate and use humor.
First responders have a unique sense of humor, often “dark” and misunderstood by civilians and therapists as inappropriate or disturbing. It is essential to understand that you are working with a population that sees the abnormal every day, and that becomes their normal. They use humor, often gallows in nature, to cope with the constant barrage of disturbing and graphic scenes. An EMDR therapist working with first responders should facilitate and validate the use of humor. Many first responders do not like when their therapist tries too hard to “match” the humor, but meeting them where they are goes a long way. It’s okay to joke with these clients and allow yourself to laugh with them.
- Work efficiently.
First responders are used to getting quick results with rapid interventions on the scenes they manage. EMDR therapy is the quickest and most efficient way to treat first responders. They often love EMDR for this reason. They can see and feel results very quickly, which is gratifying and gives them hope to heal.
- Watch for guilt, helplessness, and self-blame.
First Responders struggle with these negative beliefs after difficult calls, accumulating such calls, or their careers impacted by their personal lives. It is widespread for first responders to feel they failed or did not do enough to save a life or lives. Be keenly aware of this in Phase 1 when assessing and taking history.
- First responders often had difficult childhoods.
It is important to know that many first responders had challenging and often chaotic childhoods with attachment trauma, abandonment, abuse (physical, verbal, emotional, sexual), neglect, substance abuse, and domestic violence in the home. Assessing a first responder’s ACES score will give you a significant understanding of their background and how it impacts them at present and in the future. This “comfort in the chaos” means that many First Responders were parentified children or “little adults”, which makes them excellent at managing the complex and chaotic nature of scenes. Many First Responders are not aware that their childhood may have led them to their present careers.
- Be sensitive and aware of finances.
In working with this population, you need to be aware of the financial burdens many first responders carry. Poor pay often leads first responders to simultaneously have two, three, or even four jobs to make ends meet. They are not fairly compensated for the risk they take on mentally and physically each day. Take this into consideration when deciding on your fee. Many therapists take insurance and are self-pay but offer a sliding scale to first responders. Finances should not hinder mental health treatment, especially EMDR therapy.
- Be aware of sleep disturbances.
The first responder population is deeply impacted by lack of sleep. Long work hours, night shifts, and overtime all contribute. Additionally, if there are acute trauma or post-traumatic stress symptoms, the first responder’s sleep will also be impacted. They may experience difficulty falling asleep, staying asleep, nightmares, and some also have untreated sleep apnea. Sleep patterns tell you a lot about how your first responder functions.
First responders are the most rewarding clients. The joy of watching a first responder build trust in us, let us walk with them deeply in their pain, and then allow us to help them heal is a true gift. I hope you will feel the passion and utter blessing it is to work with this unique population.
Bonnie Rumilly is a Licensed Clinical Social Worker specializing in the treatment of adults and First Responders. She worked in Newtown treating trauma directly after the Sandy Hook School shootings and is an EMDRIA Certified Therapist. She became an Emergency Medical Technician in 2000 and is a retired Captain of New Canaan EMS. Bonnie is one of the Clinical Directors of the Fairfield County Trauma REsponse Team, Inc., a co-host of Responder Resilience podcast, and co-leads a weekly peer support group for First Responders.
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