Friday, January 27, 2012

Post Traumatic Stress Disorder and the Service Culture

People tend not to understand me when I tell them that there is such a thing as a policing culture. My colleagues (other psychotherapy or social work students) tend to cock their heads and look at me inquisitively.

So, what is the big difference between us and them?

That's right, I am going to say "us and them." I realize that statement alone is making some of my fellow social workers cringe thinking that I'm not being sensitive enough and that I am othering. I assure you, I'm not. 

There is a systemic difference that sets most civilians apart from police officers, military personnel, paramedics, firefighters, etc. We expect them to do some of the most psychologically demanding, emotionally draining work there is and then criticize them harshly when mistakes happen in those respective professions. We as a society are hard on our first responders and military personnel. The last proverbial nail in the coffin is that the Service Culture that surrounds them, doesn't help. Service members are quick to learn that they're not allowed to cry, breakdown or show emotion. There is a notion that one must be tough and stoic. This expectation sets them apart. In fact I would say that health professionals, nurses, doctors, social workers, etc. also suffer from a similar culture.

Counsellors need to be competent when it comes to working with service members; establishing a therapeutic alliance is not as simple or involve the same skills it would take with a non-service member client. Consider, is there stigma associated with coming to a therapist for this person? Many people experience those feelings in coming to counselling but I hypothesize that this culture of service that our service members are a part of makes this more challenging for the service members.

A method to overcoming this may as simple as asking questions. If you don't know the particulars of policing culture or the air force.. ask! The service culture that I described above are typically closed systems, so finding context here is extremely important for us practitioners. Having a routine that works with many clients may not engage an individual who is coming from this system. This does not mean being affective in addressing the issues is any different clinically. In fact evidence based practices are well published from prolonged exposure therapy, cognitive behavioural therapy, cognitive process therapy, or problem solving are all within a practitioners grasp already. Instead reflect on your interpersonal relationship, your ability to foster an environment where you understand that this client may not believe it's okay to get help. I suggest that education may help eliminate this stigma, labelling issues that service members are experiencing may increase their awareness of what they're experiencing as a result or something causal of what they have been exposed to. Again, this could be helpful.

Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) is almost common language now and there's even a "For Dummies" book on the subject but intimate partner violence, suicide, substance abuse, adjustment disorders, depression, familial issues of secondary stress are far less publicized in regards to police officers, Canadian forces, firefighters, etc.

I believe that a holistic approach to these issues is essential. I have made it my work for several years to work with first responders and military personnel. This short article is only the tip of the iceberg, I plan on spending a significant amount of time blogging on the subject so please, feel free to chime in with your thoughts and comments.


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