Treating Traumatic Stress in First Responders

Resource Type: Article
  • First-responder work is taxing for the individual and their family.
  • Successful treatment of first responders in crisis requires a multidisciplinary team of peers, chaplains, and culturally competent clinicians.
  • A residential retreat is one approach to keeping first responders and their families resilient.

First responders see things that no one should have to see, do thing that no one should have to do, and go places no one should have to go. They console the inconsolable, encounter the unthinkable, and are exposed to some of the clife’slest, most tragic moments in lifetimes; many of them need psychological help. Still, they areihamperedheir efforts by stigma, the fear of looking weak, and a lack of culturally competent clinicians who understand first responders and the culture in which they work.

For the past 15 years, it has been my job and privilege to help first responders with symptoms of PTSD as well as their spouses and significant others. The work is intense and exhausting.

The Elements of Successful Treatment

A community of peers: BecauFirst responders can suffer for years becausehe stigma against seeking mental health support, firy teeter on the edge of suicide or divorce. They believe no one but another first responder or first responder family can understand them. They are isolated, often believing they are the only ones dealing with traumatic stress, a failing marriagesubstance abuse, or organizational betrayal. They are bonding with others who share similar experiences and concerns rising.

Confidentiality: Trust is the cornerstone for healing. These first responders need to know that what they reveal will not be shared with anyone without their explicit, written permission.

A clear mission: Saving lives, not jobs. Cops and firefighters are two to three times more likely to take their own lives than to be killed in the line of duty. They and their families regain control over their lives with treatment and build a better balance between work and home. Many are still working, others are on medical leave, some are retired, and others are debating whether to stay at work or find a different career.

Peer support: First responders trust their peers before anyone else, sometimes even their families. It makes sense to trust someone who has walked in your shoes. As a clinician, I’ve neI’veshot a gun, been in a fight, pulled someone out of a crushed car, or married a first responder.

Trust is critically important. First responders, especially cops, are habitually trained to be skeptical of other people, if not downright suspicious.

Peer mentors, who have completed their work, are able to give hope to others and represent what can happen if a first responder does the job as well. Peers are realists. Because they are trained to share their experiences, they model success and failure. Their willingness to be openly emotional and self-disclosing helps reduce a first respondresponder’sgs of isolation, uniqueness, hopelessness, and shame.

A mind-body-spirit approach: Trauma wounds the mind, body, and spirit. Healing must address all three aspects. On-on one-counseling, prolonged exposure debriefings, bilateral brain stimulation, meditation, yoga, AA, or Al-Anon meetings help heal the mind and body. Humor, companionship, and time in nature are also balms to the spirit.

Service to families: The families of first responders have their trauma histories. Most struggle to understand the changes work-related stress and trauma have created in their first responder partners. They are exhausted, emotionally drained, and frightened after months, often years, trying unsuccessfully to “fix” t”eir” psychologically wounded mates. They’reThey’reed falsely believes they are alone and no other family is going through what they are experiencing. They must restore their self-confidence, distinguish between what they can and cannot control in their relationships, encourage better self-care, and move toward a healthier, more independent lifestyle.

The culturally competent clinician: Not every clinician is a good fit for working with first responders. A good clinician should understand the first responder culture. They should be transparent and open about themselves. They have, or are willing to get, experience working with first responders. They can listen to what is grotesque, cruel, or tragic without buckling. They are direct and comfortable with gallows humor.

Paying attention to the roots of first responder trauma: Some first responders have been abused or neglected as children. Coming from a chaotic home, being forced into premature adulthood is perfect training for an emergency responder. They struggle to understand what happened to them, sometimes decades ago, and how those experiences influence and amplify how they act in the present.

Knowing what hurts: The damage done to first responders by their work comes in many shapes and sizes. Some cops blame themselves because they killed someone, and cops who blame themselves because they didn’t.didn’tents involving death or injury to a child are among the most psychologically challenging calls for all first responders. And any personal, organizational, or administrative betrayal can turn a minor event into a significant problem.

To be a hero or a person of valor takes courage: There are many kinds of courage. It takes courage to hold the hand of someone who is dying. It takes courage to deliver a death notice to a family. It takes courage to confront your flaws and fears and to stand up for your rights as a worker. It takes courage to leave a sick child at home so you can devote yourself to helping someone else’s. Sometimes it takes courage to show up at work, knowing that whatever you do or don’t day can land you in the hospital, court, the chief’schief, or the morning headlines.


Kirschman, E. (2023, February 8). Treating traumatic stress in first responders. Psychology Today. Retrieved March 23, 2023, from