First Line Counseling is a full-service family-oriented practice that specializes in working with first responders. Our uniquely skilled and dedicated team members have the training, experience and professional knowledge to serve you like no one else can.
We are one of the only practices in the entire country that has two licensed therapists who are also full-time police officers. One of our therapists grew up in a firefighter household, has other firefighter family members, and has experience and training in working with a wide range of first responders. We also have team members who are trained to work with the children and families of first responders.
We are 100% confidential, are NOT affiliated with any employer, and are 100% independent. We understand and honor the sensitivity it requires to serve first responders. When you work with us, your information will be held confidential in accordance with the law in the state of Maryland. Your employer will never know you went to therapy unless you tell them.
Who Are First Responders?
First responders are the people who run toward the things most people run away from—fires, violence, natural disasters, car accidents, medical emergencies, traumas, environmental hazards, and profound human suffering. We are the first people on the scene, often arriving before anyone fully understands what just happened or even if it’s safe for us to be there. Depending on the definition you use, first responders include:
- Police officers (federal, state, and local)
- Firefighters and other fire crew members
- Emergency medical technicians (EMTs) and paramedics
- Other emergency medical service (EMS) and ambulance workers
- Hazardous materials (hazmat) removal workers
- Emergency service and 911 dispatchers
- Mental health crisis workers and teams
- Adult and child protective workers
- Parole and probation officers
- Park police and park rangers
- Search and rescue workers
- School resource officers
- Crime scene technicians
- Correctional officers
This list is not exhaustive, but it paints a picture of the kinds of situations first responders deal with and the range of roles we play.
While first responders are trained in a wide variety of professional roles and skills, what we share in common is that we are called to respond to situations that are dangerous, hazardous, and extreme. We have to think on our feet to quickly determine the nature of the situation we are dealing with and figure out what we have to do to neutralize the danger and save lives. Many, if not most, of these situations directly expose us to trauma.
The Impact of Trauma
As first responders, we may witness or experience acts of violence and extreme human suffering that meet the strictest clinical definitions of trauma and that constitute some of the most extreme trauma anyone will ever face. We respond to scenes where people died suddenly or violently; we witness deaths in real time; we are threatened with severe injury or death in the course of performing our duties; and we respond to calls about sexual violence and abuse.
In addition to experiencing trauma firsthand, we are constantly learning about and coming into contact with details of trauma. When we examine a crime scene, look at pictures or videos of violence or abuse, or hear colleagues discuss the details of a harrowing case, we are affected. Over time, especially when repeated, secondhand trauma can have the same effect on the mind as firsthand trauma. Symptoms of trauma exposure include:
- Experiencing intrusive or unwanted memories of the traumatic event
- Having recurrent distressing dreams or nightmares about the event
- Experiencing “flashbacks,” or dissociative episodes where it feels like the traumatic event is occurring again
- Having exaggerated startle reflexes or other physical reactions to environmental triggers that remind you of the traumatic event
- Being hypervigilant or “on alert” and feeling like you’re constantly having to look over your shoulder
- Going to great lengths to avoid reminders, memories, thoughts, or feelings related to the traumatic event
- Having diminished interest or pleasure in activities you used to enjoy
- Blaming yourself for the event or otherwise harshly judging yourself
- Experiencing mostly negative emotions like anger or shame
- Engaging in reckless, dangerous, or self-destructive behavior
- Feeling irritable or having angry or aggressive outbursts
- Having a hard time experiencing any positive emotion
- Feeling detached or estranged from other people
- Having trouble falling or staying asleep
- Not being able to concentrate or focus
Not all trauma symptoms and reactions are like what we see in the movies. While many people do, not everyone gets flashbacks or wakes up in a cold sweat from terrible, graphic nightmares. Sometimes, the aftermath of trauma is more like a low-grade depression where you feel numb and gray. You have trouble relating to the people you care about and start to avoid them. You may start using substances, overeating, or overworking to try to feel better or to try to feel numb. These coping mechanisms can help us get through the moment, but they don’t help us get better, and the longer we rely on them, the more likely things are to get worse. Untreated trauma can trigger or intensify other mental and physical health issues.
Common Symptoms and Issues First Responders Experience
Trauma-related mental health conditions like post-traumatic stress disorder (PTSD) aren’t the only mental and physical health issues that first responders face. Even when you haven’t been exposed to trauma, the nature of your work as a first responder is that you are constantly having to function in highly stressful environments and situations. This takes a toll on your mind and body. Conditions that can be caused or worsened by chronic stress include:
- Heart disease
- Chronic fatigue
- Sleep problems
- Eating disorders
- High blood pressure
- Substance use disorders
- Gastrointestinal problems
- Reduced immune system function
- Significant unwanted weight loss or gain
- Skin and hair problems like acne and hair loss
- Diabetes and other chronic medical conditions
Complications of trauma can make it hard to take the steps necessary to treat and recover from these conditions. One common response to trauma is to blame yourself for things that were out of your control and that you couldn’t have prevented. The self-blame can spread into blaming yourself for the coping mechanisms you’ve developed, such as having trouble with alcohol, other substances, food, sleep, or your health. You can start to feel like you deserve to be unhealthy.
Traumas confront us with the deepest spiritual and existential questions we can contemplate. They can lead us to question or lose our faith, or at least to struggle with it. When terrible things happen to people who didn’t seem to deserve it, and when we see evidence of horrors happening again and again, we can start to question the meaning of it all.
Without the proper support to help us process what we went through, we can start to think, “There’s no point.” We can stop caring for our physical or mental health. It’s especially hard when we feel like no one else understands us—when the people whose help we might seek haven’t seen the things we have. How can we trust their perspective when they haven’t seen people and the world at their worst, like we have? In our sometimes-accurate assessments of other people’s overly-rosy perspectives, we can lose sight of how our perspectives are becoming warped, too.
What Is Burnout?
Burnout isn’t a technical term but it’s something we understand all too well. We all probably saw it in our first weeks on the job, when we met colleagues who seemed to just drift through their days, cynical, watching the clock and waiting for each shift to end. We swore to ourselves that we would never let it happen to us.
Most of us start out our careers feeling inspired and ready to show the world what we’re made of. But over time, chronic stress wears away at our idealism. We see the failures of the system. We ourselves fail, or at least think we did, blaming ourselves for the people we couldn’t save and the emergencies that only got worse after we arrived on scene. Over time, we have trouble accessing the feelings we had in those early years. Work doesn’t feel satisfying any more, even on days we have “wins” or save lives. Simply put, we’re burned out.
There are two main types of burnout that first responders experience: professional burnout and compassion fatigue. Both types of burnout share symptoms in common. They both make us feel tired and affect our ability to perform well at work. Both are caused by the intense, long-term stress of our jobs, and both can have significant consequences for our mental health. But compassion fatigue can have additional symptoms that can resemble and even cause post-traumatic reactions.
Compassion fatigue comes from working closely with other people who are suffering and from sharing in their emotional pain when we’re in the room or on the scene with them. Other terms for compassion fatigue are vicarious traumatization and secondary traumatic stress. This kind of burnout can have effects that extend far beyond the workplace, making it harder for us to connect to our loved ones. Responding to others’ pain with an open heart every day for years can wear us down, and we can build emotional armor to cope, making it harder to access or express the tender feelings our loved ones want and expect from us.
Dealing with Stigma
Fortunately, the stigma against therapy and mental health treatment is fading. It’s much more common for people to talk about their experiences in therapy, including celebrities or media figures who are in the public eye. Unfortunately, despite this trend, much of the stigma remains for first responders who want to get mental health treatment.
Most first responder jobs draw in people who are brave and strong or who want to become braver and stronger. After all, we do so many things that other people aren’t willing or able to do. When it starts to get to us, it makes us question ourselves. We wonder if we’re weak after all, if we’re just not cut out for work like this. Not wanting to lose our jobs and careers, we don’t tell anyone, and we hope no one notices, calls us out, or questions whether we’re fit for the job. It would be different if we talked about it openly, because it’s not just a few of us who face these issues—it’s most of us. But the silence around these issues can make it seem like we’re alone.
Some first responders fear that getting therapy might make them “soft,” but this isn’t what therapy actually does. Processing and healing unresolved stress and trauma helps us become more resilient. It allows us to continue in our careers in a healthy way. Untreated emotional wounds fester just as much as untreated flesh wounds, sapping our energy and vitality. Dealing with the emotional shrapnel trauma leaves behind helps us become stronger, not the opposite.
Coping with Stressors at Work and Home
It can feel cheesy when someone recommends stress-busting techniques like playing a game of cards or taking a relaxing bath. But even when the simple things aren’t enough to help us cope, they’re a good place to begin.
One of the first lies the traumatized brain tells us is that there’s no point even trying any more, that we might as well surrender to sadness or despair. But staying engaged in activities we enjoy is an important buffer against stress and depression. One of the best things any of us can do for our physical and mental health is exercise, especially when we have fun doing it. Eating and sleeping well are essential, too.
Sometimes, though, healthy extracurriculars aren’t enough. This is often the case for us, because trauma cuts deeper into the mind and body than stress. And when it goes untreated and unresolved, it can make it harder for us to do the things we used to enjoy. We’re too anxious, depressed, or numb. This can become a vicious cycle.
It gets even worse if we don’t take enough breaks or vacations, which is something we often resist. The same drive that brought us to this work can make it hard to take a break from it. Over time, it all adds up, and our coping mechanisms—healthy and unhealthy—stop working.
Ultimately, we all need to talk to someone. Talking can help us express and vent otherwise pent-up feelings and help us reflect and make sense of what happened to us.
When we’re hurting, one of the best things we can do is talk to our loved ones about what we’re going through. But that can be hard for us to do. We don’t want to inadvertently traumatize our families by exposing them to the details of our work, and we don’t expect them to understand the complexity of what we endure.
The result, unfortunately, is that often we can become distant or estranged from our loved ones. Even if we’re doing it for noble reasons, our refusal to talk can break down our relationships, leaving us feeling, and becoming, more alone.
Sometimes, we find a peer or colleague we can open up to, and sometimes, that’s enough. But often, we hold back even with the people we tell the most. We don’t tell them everything.
And that’s where therapy comes in.
How We Can Help
First responders are up to three times as likely to develop PTSD as the general population. When left untreated, PTSD, depression, and other serious mental health conditions that first responders experience can have severe complications. More firefighters and law enforcement officers die by suicide than from line-of-duty deaths.
What makes this even more tragic is that PTSD, depression, and other mental health conditions are highly treatable. One study found that about 75 percent of people with PTSD fully recovered after receiving intensive cognitive behavioral therapy. Another study showed that of over 1,500 people treated for depression, about 50 percent had a full recovery, and 70 percent had a clinically significant remission of symptoms. With treatment, it’s not only possible to feel a little better—it’s possible to get your life back. You can heal and reconnect to your work, your passions, your family—and yourself.
Our team members are trained in therapeutic methods that effectively treat a wide range of mental health conditions. Perhaps even more importantly, given our experience as and with first responders, we get it. You don’t have to worry that we’re condescending to you, or that we can’t possibly understand. We’ve been there. And we can be there for you.
You don’t have to suffer in silence, watching as untreated trauma and depression wreak havoc on your life and take away the things you love. You can fight back. You can reclaim the life you deserve. Just give us a call.