| 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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