There are a number of ways of getting at this, but one I would recommend is to think of it in terms of what would you look for in a partner? If you were going to choose a partner on the job to back you up in a difficult, complex and perhaps even dangerous situation, what characteristics would you want them to have? I am constantly on the lookout for therapists who are suitable to refer first responders to, so what follows are some of the things I look for. Feel free to add your own issues and questions as you see fit.
In general terms I want to know if they are competent in terms of first responder culture, trauma, and moral injury, and are they trustworthy?
First of all, do they get it? Do they have an understanding of, appreciation for, and a respect for first responders, the culture they work in, and the realities that they face?
Do they understand the culture? Do they understand first responder values? Do they want to understand? Unfortunately there are therapists who see the culture as being the fundamental problem, without realizing that the culture is the way it is for some very good reasons. Now, I am not talking about the abuses which have taken place in various first responder cultures, but I am talking about those core characteristics without which first responders would not be able to deal with the emergencies they face. There are other therapists who view the therapeutic relationship as a place to bring their sociopolitical agenda to bear, which automatically disqualifies them from being appropriate first responder therapists.
Do they confuse and conflate the unfortunate abuses of first responder culture, with the core values and necessities of the culture itself? For example, there are some therapists who will claim that the problem with first responder culture is the chain of command, and if that were eliminated, then many of the problems would be solved. While it is true that the chain of command has been misused by some to abuse various members of the community, to eliminate it would make it impossible for first responders to effectively deal with the emergencies that they face. This would be like telling a paramedic that their problems would be solved it they stopped working with dead and mangled bodies. I should hope that I don’t need to point out that that is absolutely absurd. If the therapist is not able or willing to see this distinction, then they have no business dealing with first responders.
Now, I am not saying that they have to know all that there is to know about first responder culture, but do they know enough to be an asset rather than a liability? Are they willing and secure enough to admit what they don’t know, but are willing to learn?
Are they trustworthy? Are they more concerned about being trusted, or being trustworthy? If it is the former, it is all about their ego, and they will never be trustworthy. Trustworthy people don’t mind if you question them, because they know that trust is something that they have to earn. A great therapist friend of mine, will ask his clients in the first session, “do you trust me?” And if they say yes, he replies “don’t, don’t trust me until I have earned it.” It doesn’t matter how competent they may be in other areas, if they are not trustworthy, then the requisite therapeutic alliance will never develop.
What does it mean to be trustworthy? This is more than just confidentiality. Can you trust them to be there when you explore the traumas you have faced, or will they be overwhelmed and have to either disengage or cut and run? Are they doing it for the right reasons? Why do they want to work with first responders? Is it just a way of padding their client list? Is it a way of satisfying their voyeuristic curiosity? One first responder described her experience with a counsellor by saying “it became obvious, very quickly that this was about their fascination with my job, not about me.”
Are they in it just for the money? Are they PTSD profiteers? Do they have a referral list of people they can refer you to in case things don’t work out? If not either they are not adequately prepared with backup themselves, or they are driven by ego or financial considerations. Any of these will make them ineffective in working with you. I have five therapists I can refer clients to should the need arise.
Do they truly know what it means to be authentic? Do they hide behind their degrees, or training certificates? If so, they are an empty suit, and will not have the substance necessary to accompany you on the path you need to walk to heal. One of the things I love about working with first responders is that they have the most finely tuned BS detectors in the world, and will not let you get away with anything. Competent first responder therapists don’t mind the level of scrutiny that first responders will put them under.
How do they deal with mistakes? We all make them, and the issue is not about being free from mistakes, but how do we recover from them? As one of my early mentors in my career told me, “If you make a mistake, let us know right away, so we can fix it as soon as possible. . .” Are they secure enough to admit what they don’t know, and when they make a mistake?
Hopefully this will give you an idea of what I look for, and what I would suggest you look for. To get at these issues, these are some of the questions I ask and would recommend you ask any therapist you are dealing with.
• Why do you want to work with first responders?
• How do you know you can work effectively with first responders?
• Why should I trust you?
• What is more important to you, to be trusted, or to be trustworthy?
• How do I know you won’t run away from me when I need you most?
• What backup do you have, and if not, why not?
• What do you do when you make a mistake?
These are some of the questions I ask to get at the various issues. Prepare your own ahead of time, add others as you see fit, and don’t be afraid to ask them. Be on the lookout for defensiveness or other things which indicate that they are driven by ego or other things which will hinder the relationship and keep you from getting the assistance you need and deserve. When you find a good one, support them and recommend them to others. Let me know as I am always on the lookout for good therapists to refer people to. Let organizations such as TEMA and Badge of Life know so they can pass it on. And if you find a bad one, let your peers know so that they will not be damaged.
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