Policing is stressful business. Most cops will see more death, despair and human cruelty in the first few years of their careers than the rest of us will see in a lifetime. This takes a toll. As a police psychologist, I’ve been up close and personal with the suffering that such exposure can create.

I volunteer to co-facilitate a six-day retreat for six first responders struggling with the symptoms of post-traumaticstress.  I do this four times a year as part of a team of clinicians, peer supporters (cops, fire fighters, dispatchers) and a chaplain.  None of us get paid. We do this out of respect for first responders and appreciation for the many sacrifices they make to keep the rest of us safe.

The work is intense. It has to be. Our clients are in deep trouble. Some have spent years trying to cope on their own and are only here because they are perilously close to some major catastrophe like suicide, divorce, or alcoholism. Of all six days, Day One is the hardest. Walking in our front door may be the bravest thing any of them have done.

Why do cops and other first responders wait so long to get help when early intervention could save them and their families years of trouble and misery? At least one of the following five mistaken beliefs affects everyone we see.

•Seeking help means I’m weak:  Cops work in a macho culture of rugged individualism. They consider themselves to be problem solvers, not people with problems. Feeling shame, they hide their problems from others and sometimes from themselves. They think that people who need therapy are weak or crazy. We think it means they are human.

•I don’t deserve help: There’s a lot of peer pressure in police work. And a lot of comparing. We urge officers not to judge their insides by somebody else’s outsides. The officer who looks calm and in control at a critical incident  just might be drinking a fifth of bourbon every night. Everyone reacts to trauma differently, depending upon how well they cope, what else they have on their plate, how much support they receive, and what other health(physical and mental) problems they may have. Incident envy, the belief that another client’s incident is worse and therefore more worthy of attention, is simply wrong. Everyone, no matter what brought them to our retreat, deserves to get the help they need to live happy, wholesome lives.

•Only another cop can understand me:  This is both true and not true. There is no question that to help a cop it’s critical to have a deep understanding of police work and the police culture. This is why peer support is so beneficial. And why we welcome the many police officers who have become therapists in their second careers. It is also why my two colleagues, doctors Joel Fay and Mark Kamena, both retired cops, wrote CounselingCops: What Clinicians Need to Know (2014) as a guide to help therapists become culturally competent to treat police officers and their families.

•I won’t take medication: Cops will drink coffee and caffeine laden drinks until their hands shake, but have a hard time accepting that they may benefit from the same medications they associate with drug addicts and psychotic street people. They also have concerns about confidentiality, legal issues and the effect of medication on their response time. Therapy does not automatically include medication. There are many other options such as exercise, meditation, or tactical breathing. But for serious discomfort, medication may be the answer to overwhelming anxiety, nightmares, and depression. Side effects, when they occur, can be managed. Cops are also concerned that taking medication might get them in trouble if they are required to take a blood test following a shooting, a vehicle accident or some other incident. Department policies vary from agency to agency, but generally speaking, the agency is looking for benzodiazepines (anti-anxiety drugs), illicit drugs and alcohol.

•If I have therapy, I’ll lose my job: It’s hard to understand why some officers would rather lose their lives than lose their jobs. One reason is because police work, for many, is an identity, not just a job. Our retreat is a back to life program, not a back to work program. Many of our clients are so traumatized and worn down, they shouldn’t be working. At the base of this mistaken belief is concern about confidentiality. If an officer suspects that their therapist cannot be trusted to safeguard confidentiality, they won’t be able to form the needed  therapeutic alliance that is the foundation of good treatment. We tell our clients they are only as sick as their secrets. A common secret we hear about is childhood abuse or neglect, both of which are risk factors for developing PTSD. Coming from a dysfunctional family is perfect training for dealing with the chaos of police work. Officers will unload their secrets only when they trust the therapist to guard their confidentiality.

Can these mistaken beliefs be changed? This is a tough question. Normalizing therapy and encouraging psychological as well as physical self-care is the goal. When senior officers speak openly about their own experiences in therapy, it reduces stigma. Embedding culturally competent clinicians in the day to day life of a police agency breeds familiarity and encourages trust because cops are often more comfortable talking to someone they know. Finally, increasing the quantity and quality of time devoted to resilience training when officers are still in the academy may be the beginning of healthy career-long habits including getting help in a timely way.

I wish my readers, many of whom are first responders, Happy Holidays and a safe, peaceful, and healthy 2018.