Therapeutic Techniques

Law Enforcement Traumatic Stress: Clinical Syndromes and Intervention Strategies by Laurence Miller, Ph.D

Full article
Trust and the Therapeutic Relationship
Difficulty with trust appears to be an occupational hazard for workers in law enforcement and public safety who typically maintain a strong sense of self-sufficiency and insistence on solving their own problems. Therapists may therefore frequently find themselves “tested,” especially at the beginning of the treatment process. As the therapeutic alliance begins to solidify, the officer will begin to feel more at ease with the therapist and may actually find comfort and sense of
stability from the psychotherapy sessions. Silva (1991) has outlined the following requirements for establishing therapeutic mutual trust:
Accurate Empathy: The therapist conveys his or her understanding of the officer’s background and experience (but beware of premature false familiarity and phony “bonding”).
Genuineness: The therapist is as spontaneous, tactful, flexible, and nondefensive as possible.
Availability: The therapist is accessible and available (within reason) when needed, and avoids making promises and commitments he or she can’t realistically keep.

Respect: This is both gracious and firm, and acknowledges the officer’s sense of autonomy,control, and responsibility within the therapeutic relationship. Respect is manifested by the therapist’s general attitude, as well as by certain specific actions, such as signifying regard forrank or job role by initially using formal departmental titles, such as “officer,” “detective,”lieutenant,” until trust and mutual respect allow an easing of formality. Here it is important for clinicians to avoid the dual traps of overfamiliarity, patronizing, and talking down to the officer on the one hand, and trying to “play cop” or force bogus camaraderie by assuming the role of a colleague or commander.

Concreteness: Therapy should, at least initially be goal-oriented and have a problem-solvingfocus. Police officers are into action and results, and to the extent that it is clinically realistic, thetherapeutic approach should emphasize active, problem-solving approaches before tackling more sensitive and complex psychological issues.

Therapeutic Strategies and Techniques
Since most law enforcement and emergency services personnel come under psychotherapeutic care in the context of some form of posttraumatic stress reaction, both clinical experience and literature (Blau, 1994; Cummings, 1996; Fullerton et al, 1992; Kirschman, 1997) reflect this emphasis. In general, the effectiveness of any intervention technique will be determined by the timeliness, tone, style, and intent of the intervention. Effective interventions share in common the elements of briefness, focus on specific symptomatology or conflict issues, and direct operational efforts to resolve the conflict or to reach a satisfactory conclusion.

In working with police officers, Blau (1994) recommends that the first meeting between the therapist and the officer establish a safe and comfortable working atmosphere by the therapist’s articulating : (1) a positive endorsement of the officer’s decision to seek help; (2) a clear description of the therapist’s responsibilities and limitations with respect to confidentiality andprivilege; and (3) an invitation to state the officer’s concerns.

A straightforward, goal-directed, problem-solving therapeutic intervention approach includes the following elements: (1) creating a sanctuary; (2) focusing on critical areas of concern; (3)specifying desired outcomes; (4) reviewing assets; (5) developing a general plan; (6) identifyingpractical initial implementations; {7) reviewing self-efficacy; and (8) setting appointments for review, reassurance, and further implementation (Blau, 1994).

Blau (1994) delineates a number of effective individual intervention strategies for police officers, including the following:

Attentive Listening: This includes good eye contact, appropriate body language, and genuine
interest, without inappropriate comment or interruption. Clinicians will recognize this intervention as “active listening.”

Being There With Empathy: This therapeutic attitude conveys availability, concern, andawareness of the turbulent emotions being experienced by the traumatized officer. It is alsohelpful to let the officer know what he or she is likely to experience in the days and weeks ahead.

Reassurance: In acute stress situations, this should take the form of realistically reassuring the officer that routine matters will be taken care of, deferred responsibilities will be handled by others, and that the officer has administrative and command support.

Supportive Counseling: This includes effective listening, restatement of content, clarification of feelings, and reassurance, as well as community referral and networking with liaison agencies, when necessary.

Interpretive Counseling: This type of intervention should be used when the officer’s emotional reaction is significantly greater than the circumstances that the critical incident seem to warrant.

In appropriate cases, this therapeutic strategy can stimulate the officer to explore underlyingemotional stresses that intensify a naturally stressful traumatic event. In a few cases, this may lead to ongoing psychotherapy.

Not to be neglected is the use of humor, which has its place in many forms of psychotherapy, but may be especially useful in working with law enforcement and emergency services personnel. Ingeneral, if the therapist and patient can share a laugh, this may lead to the sharing of moreintimate feelings. Humor serves to bring a sense of balance, perspective, and clarity to a world that seems to have been warped and polluted by malevolence and horror. Humor evensarcastic, gross, or callous humor, if handled appropriately and used constructively may allow the venting of anger, frustration, resentment, or sadness, and thereby lead to productive, reintegrative therapeutic work (Fullerton et al, 1992; Miller, 1994; Silva, 1991).