One of the most important pieces of equipment to maintain through a prolonged incident like the COVID-19 pandemic, and certainly through a career in law enforcement, is the human mind. Just like any tool of the trade, the mind benefits from regular maintenance. These days, more personnel are thinking about preventive maintenance of the mind, rather than waiting for a problem to show up. The right clinician can provide assistance in that maintenance and may be needed now more than ever.
Unfortunately, during times like these, some individuals, even clinicians, will show up to try and take advantage of the situation for personal gain. In my community, many clinicians are out of work or have drastically reduced caseloads and they see first responders as a revenue opportunity. There is a group of clinicians that have begun working together to market to first responders in hopes of building up full caseloads. My thought is, if they were interested in helping first responders, why are they only now reaching out to this group?
Just because a clinician has a license, empty caseload, and a desire to help, doesn’t mean he or she is appropriate for the law enforcement community. So, how does one find a clinician that would be a good match for law enforcement personnel? A good place to start is understanding how NOT to choose a clinician. Below are some poor strategies law enforcement personnel have admittedly used in order to find a clinician.
- Google search: Making an appointment with a clinician that appears at the top of a Google search is not a good idea. Being the first entry on a search doesn’t mean the clinician is more skilled than the others, and certainly doesn’t mean the clinician knows the law enforcement culture.
- Saw a flyer posted: A clinician dropping a lot of money to create an expensive looking flyer does not guarantee clinical skill. Likewise, having a fancy flyer doesn’t mean the clinician has the necessary skill or experience working with law enforcement.
- The clinician was attractive (my personal favorite): Law enforcement officers in the past have reported to me this is how they chose a clinician. Think about this: would you choose a physician to treat a medical problem because the physician was good looking? Or, would you want a physician appropriately skilled for your condition?
Alright, so how do you choose a clinician? A good first step is to check with your agency and see if there are already clinicians who have been vetted by others in the agency. It’s even possible your agency is one of the growing number who have embedded clinicians readily available to you. In agencies where my staff are embedded, I’m always surprised by the amount of personnel who don’t even know we’re there! If your agency has no one to refer you to, or you’re not comfortable asking, you’ll need to do more homework.
Your next step would be to do a Google search- however don’t just call the first name that shows up. Visit the websites to see if any clinicians in your area mention in their online data that they work with first responders, or even that they specialize in law enforcement. It is kind of like looking for Bigfoot. Once you’ve reviewed some websites, now you can start calling. Just because you call one clinician doesn’t mean you should go ahead and schedule an appointment. First, you must ask some important questions.
Even if the website says the clinician works with law enforcement or first responders, it doesn’t necessarily mean that they do or can. Ask a prospective clinician if they’re familiar with the law enforcement culture. The American Counseling Association and the American Psychological Association are clear in their recommendations that counselors be familiar with the culture they intend to work with. Law enforcement is a very unique culture and can be difficult to understand. Ask the clinician how many first responders they are currently working with. Ask if the clinician is a member of a peer support or CISM team. If they are, this is a good sign that they know something about the culture and they even donate their free time to help first responders. If they are unfamiliar with the culture, don’t allow that clinician to explore the culture or learn about the culture through you. Time for the next call.
Next, make sure the clinician is using evidence-based treatments (EBT). This is an important term, so make sure you ask. EBT means the treatments the clinician uses have been through rigorous scientific research that shows the treatment is helpful for most people. EBTs are also less likely to be the typical talk-therapy or “How does that make you feel?” treatment. Listen for the clinician to report that they use some form of Cognitive Behavioral Therapy (CBT) for depressive and anxiety disorders. If you think you have PTSD, ask the clinician what EBT they use for this. Listen this time for the clinician to mention Prolonged Exposure (currently the gold-standard treatment), Cognitive Processing Therapy, or EMDR. If a clinician proudly reports that they use an “eclectic” approach, run far and run fast.
If the clinician gives you the right answer about using EBT, you still have more questions to ask. Now, ask where that training in EBT came from. All too often, clinicians take a one-day or two-day workshop in an EBT and they start advertising they are trained in this treatment. That’s similar to someone going through a two-day BLET and starting on patrol immediately afterward. To be appropriately skilled and competent in evidence-based therapies takes many months of intensive training. The Academy of Cognitive Therapy recently upgraded their training requirements and for clinicians to be considered competent to practice CBT and eligible to apply for credentialing, they must have completed an accredited nine-month intensive training program (up from the previous 6-months of intensive training).
Other things to note about EBT include that if a clinician is using EBT with fidelity, you can expect to measure the treatment duration in weeks instead of months. Most EBT are designed to be ‘brief therapies.’ You will know that you’re getting EBT if the clinician is having you complete a symptom questionnaire at the beginning of each session. Another way to know you’re getting EBT is if the clinician assigns homework at the end of each session.
Once you’ve selected and even sampled a clinician, you still have to be alert and responsible. It’s almost impossible to know if the clinician is a good match until after having a few sessions. If you’re not feeling connected to the clinician, you’re under no obligation to continue. It’s even alright to mention the lack of connection to the clinician. Clinicians are trained to understand and handle that scenario, and even offer assistance finding a clinician you may connect better with. Law enforcement personnel have shared with me other common examples of when it’s a bad match and these are some important red flags to pay attention to:
- The clinician reacts emotionally and starts crying when hearing the officer’s story.
- The clinician brings up the idea of changing careers.
Law enforcement personnel are generally good judges of personality. If you have a session or two with a clinician and notice any of the above red flags or you’re just not feeling it, listen to your gut and find another clinician. The rapport you have with a clinician is an important factor in determining the outcome of the treatment. It’s exciting to see clinical behavioral health care gaining more and more acceptance in the law enforcement culture. More agencies, large and small, are forming referral relationships with clinicians, and each year more are embedding clinicians within the agencies. Utilization of good clinical care increases officer safety, public safety, reduces suicidality, improves the relationships at home, and helps our officers enjoy long and productive careers. Doing your homework and finding good clinical care is especially important now.
If you continue to struggle to find suitable clinical care in your area, email me and I’ll have someone from my staff assist you in finding a clinician in your area.
Rick Baker, has been providing evidence-based behavioral health services to first responders and responder agencies in North Carolina since 2007. He is the current Clinical Director of the Western North Carolina Peer Support Network, providing oversight of and post-critical incident services to all first responders in North Carolina’s 22 westernmost counties. Rick is one of only three clinicians the Department of the Interior and Dept of Agriculture contract with to provide post-critical care to our nation’s wildland firefighters and law enforcement. He founded Responder Support Services (RSS) in 2018, providing a broad range of clinical and non-clinical services to first responders, responder agencies, county/local governments. RSS most specialized product is placing culturally competent embedded behavioral health care in law enforcement and fire departments. Rick recently completed a one year train-the-trainer program at Emory University on Prolonged Exposure therapy, the gold standard treatment for PTSD in first responders and military veterans.