Police and fire responders report that they often overcome a reluctance to seek treatment only to be met with a provider who understands little about their work and has difficulty handling their trauma.
Psychologists providing treatment and specialized services with their agencies and departments may encounter ethical challenges as well.
A primary mistake therapists make in treating emergency responders is a failure to understand what they do and how they do it. The culture is closed and infused with high levels of distrust, yet treatment requires self-disclosure. Responders may be trained interrogators or simply guarded. Self-disclosure, or transparency, in treatment with responders is essential. A therapist lacking transparency is seen as unsupportive, paranoid and mistrustful.
They want to be sure that they can trust you with their innermost secrets and won’t have to rescue you. They want to make sure that you can tolerate their critical incidents and pain and not judge them.
One story heard was from a law enforcement officer who had been involved in his third shooting. The therapist asked if he was ready to stop being a “paid killer.” He did not return.
Dual or multiple relationships are the most frequently encountered ethical challenges. The emergency responder world is relatively small and there may be times that the psychologist has a patient attending a training they are conducting.
Encounters occur in the gym, parking lot, bathroom, at weddings, funerals and parties, deathbeds and christenings and AA meetings. There is nothing inherently harmful about these encounters; however, the APA Ethics Code 3.05 cautions to avoid such relationships if it impairs objectivity, competence or effectiveness.
It is best to notify patients of the possibility of such encounters during explanation of your statement of understanding (informed consent). The question is not whether one should avoid such relationships, rather to anticipate what to do when they occur.
Treating responders while simultaneously interacting with public service agencies creates a need to establish clear boundaries. For example, a chief may ask how an employee that you are treating is doing. This may present an opportunity to educate administrators about the need for confidentiality in treatment. Having a mental script to anticipate such questions is recommended.
Another issue that frequently comes up is that police and public safety psychologists do not generally conduct both pre-employment psychological or fitness for duty evaluations and also engage in conducting psychotherapy with responders.
Avoiding harm (3.01), cooperation with other professionals (3.09), maintaining confidentiality (4.01) and explaining confidentiality (4.02) are consistently employed in working with this population. We also are guided by principles of beneficence and non-maleficence, safeguarding the welfare and rights of co-workers and keeping an awareness of vicarious or secondary trauma that may occur.
Having integrity, seeking justice and respecting the dignity of those with whom we come in contact includes clarifying roles and responsibilities, upholding standards of conduct and managing conflict between standards and organizational needs while establishing trusting relationships.
Consultation is extremely important to deal with trauma and being able to review one’s work with other experts. We believe that you don’t know what you don’t know. These colleagues may point out omissions or errors that serve as teaching and learning opportunities for all.
Other considerations involve training and specialized education. For example, several states require five years of experience in police and public safety, three of which must be post-doctoral, and 12 hours of continuing education biannually that must be completed in order to be able to provide pre-employment psychological evaluations, according to California Police Officer Standards and Training (frequently referred to as POST requirements.)
Training is available through continuing professional education offered by several organizations: APA section on police and public safety, Academy of Forensic Psychology, International Association of Chiefs of Police psychology services section, Society of Police and Criminal Psychology, American Board of Professional Police and Public Safety Psychology and the American Academy of Police and Public Safety Psychology.
Mark Kamena, Ph.D., ABPP, MBA, MCrim, is co-author of Counseling Cops: What Clinicians Need to Know (Guilford Press, 2013) and co-founder and director of research for the First Responder Support Network Adjunct Faculty at Wright Institute, Berkeley, Calif. His email is: firstname.lastname@example.org.