“For many people who work in helping professions, taking that first step and asking for help is hard,” says Tamrah Stepien, LICSW. “The decision to seek support is commendable and shows a commitment to both personal wellbeing and professional growth.”

First responders are a group of people trained to protect and keep people safe in many different ways. Firefighters, law enforcement, corrections, emergency medical services, emergency room personnel, doctors, nurses, and public works, these individuals play a critical role in safeguarding our communities and saving lives. 

But who’s looking out for them?

Repeated exposure to life-threatening and distressing traumatic events and high-stress environments can weigh heavily on first responders’ body and mind. 

One of the most effective resources available for first responders is therapy. Therapy provides a safe and confidential space to process trauma, learn effective coping strategies, develop resilience, improve interpersonal relationships, and discover oneself. 

Tamrah Stepien, Licensed Independent Clinical Social Worker was a police officer for 11 years before pursuing a career in social work. She taught crisis intervention training for first responders and first responder mental health education for several years. Tamrah works with first responders in the clinical setting, and advocates for improving mental wellness for first responders and reducing the stigma that prevents people from asking for help. 

We sat down with Tamrah to learn more about what therapy for first responders involves and why it’s important for first responders to seek support from a trained mental health professional.

Mental Health Challenges First Responders Often Face

For first responders, exposure to stressful and hazardous situations is in the nature of their jobs. 

“Therapists who work with first responders understand that their jobs are inherently dangerous and they’re exposed to ongoing traumatic events. On any given day, first responders may encounter death, grief, loss, pain, physical injury, and violence,” says Tamrah. 

As a result, first responders often experience:

• Threats to personal safety
• Long work hours
• Frequent shifts 
• Poor sleep
• Various physical hardships 

These risk factors, in addition to traumatic events on the job, increase the risk of first responders developing mental health conditions, such as depression, anxiety, and post-traumatic stress disorder (PTSD). 

“Therapy is a preventative measure to combatting mental health problems before they manifest, promoting good mental and physical health, and empowering people to manage their well-being,” says Tamrah.

What Does Therapy for First Responders Involve?

1. Developing Rapport and Earning Trust:

“Typically, first responders don’t trust very quickly or easily outside of their field so they’ll have a much longer rapport building stage with their therapist,” says Tamrah. “They may avoid talking about vulnerable or engaging topics until they get past the rapport building stage.”

Therapists will patiently and consistently work to create a safe and supportive environment for first responders to open up and address their concerns. Therapists will also continuously reevaluate what their clients need as they move through their sessions together. 

“Trust is the foundation for the work we do together,” says Tamrah.

2. Meeting Clients Where They’re At and Finding a Common Language

“When first responders come into sessions, I’ll always meet them where they’re at that day,” says Tamrah.

“I’ll also find a common language to share with clients. Many first responders are the last to ask for help, and may not feel comfortable or familiar with sharing their emotions. We’ll work together to find concrete ways of translating their experiences and discuss strategies to combat feelings of anxiety, stress, burnout, and depression,” says Tamrah.

3. Exploring the Window of Tolerance 

First responders and their therapist will explore where they typically fall within the window of tolerance, the zone of arousal in which a person is able to function and deal with day-to-day stress most effectively. 

“Oftentimes, first-responders’ window of tolerance, where they’re able to function, emotionally regulate, and self-soothe is very small. Clients often come into therapy showing signs of hyperarousal: such as rigid thinking, obsessive behavior, disinterested, checked out, anxious, overwhelmed, impulsive decision making, among others. Clients may also show signs of hypoarousal, in the freeze response zone, such as emotionally unavailable, checked out, disconnected, feeling separated from their self, feelings, and emotions, among others,” says Tamrah.

“A lot of our work together involves widening the comfort zone, where the nervous systems are in a state of balance, allowing clients to engage in flexible thinking, effective communication and actions, and able to cope with daily stressors and regulate their emotions,” she adds.

Strategies to widening the window of tolerance:

• Mindfulness exercises to be in there here and now 
• Grounding exercises to slow down the nervous systems, such as deep breathing
• Techniques for self-soothing to calm the body and regulate emotions
• Identifying limiting thoughts and beliefs and countering them with positive statements about oneself

4. Addressing First Responders’ Trauma

Trauma in first responders can manifest in different forms, including post-traumatic stress disorder (PTSD), feelings of anxiety, depression, guilt, and burnout. Repeatedly experiencing traumatic events can lead to emotional numbing, desensitization, hyperarousal, hypoarousal, intrusive thoughts, and avoidance behaviors. 

What a First Responder Could Experience as a Result of Trauma:

• Hyperarousal, hypoarousal, and shock
• Quiet vs chaos
• Numbing
• Vicarious trauma
• Compassion fatigue 
• Disallusionment
• Burnout and compassion fatigue
• Adrenaline (Adrenal) fatigue 
• Cortisol imbalance
• Circadian rhythm imbalance 

“All of the stress and trauma of their job can spill over into first responders personal relationships,” says Tamrah. “One of our strategies in therapy will be to develop transition plans to manage the boundaries between work and home life.”

“Because first responders’ work environments are filled with unpredictability and high demands, we’ll slow down and explore their own beliefs about themselves and what their purpose is,” says Tamrah. “Therapy is a process of getting to know oneself to develop healthier coping strategies and build resilience.”

There are various therapeutic approaches that will be helpful for first responders’ trauma. Each client who decides to seek therapy will work with their therapist to find the approach that best fits their needs. 

5. Identifying and Engaging in Healthy Outlets

Implementing good self-care strategies is essential to reducing stress, compassion fatigue, burnout, depression, anxiety, and building resilience in oneself. 

“We’ll work together to identify self-care habits and healthy outlets that fit the clients lifestyle.

Whether it’s getting outside in nature, exercising, working on a creative project, or spending time with friends and family, first responders need to give themselves time for healthy outlets,” Tamrah says.

What Advice Would You Give to First Responders Who Are Curious About Therapy?

“If nothing else, therapy is a great place to talk about hard things,” says Tamrah.

“If something challenging happens, and a first responder is already working with their therapist, they have someone to rely on for support, rather than trying to find support in the midst of a critical incident,” adds Tamrah.

Therapy can improve clients’ home life, interpersonal relationships with friends and family, and performance at work. It can reduce clients’ feelings of isolation and encourage clients to discover and reinforce healthy outlets, improving their overall wellbeing.

Find a Therapist in Massachusetts to Start Working With Today:

Therapy is a safe and confidential space for first responders to discuss their thoughts, feelings, and experiences without judgment. It’s an early intervention option that can boost your resilience, enhance your quality of life, and improve your interpersonal relationships and professional efforts for years to come.

At Handel Behavioral Health, our therapists offer a deep knowledge of clinical interventions and education to support the unique needs of first responders. 

To start working with one of our therapists trained in working with first responders online in Massachusetts or in-person from our offices in Amherst, Franklin, West Springfield, Wilbraham, or Natick, contact us today at (413) 343-4357 or request an appointment online!

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