Webinar presenter Dr. Grant McDougall answered a number of your questions after his presentation, Under Siege: The Psychological Impact on Law Enforcement in these Troubled Times. Here are just a few of his responses.

Audience Question: What is the best intervention or form of treatment for law enforcement personnel? Is there one particular? And also, is there a difference between treatment for employees not in uniform?  

Dr. Grant McDougall: That’s a great question. I’m not sure I can give you a specific answer. If you’re looking for that silver bullet. That one thing that you can do for law enforcement officers. I need to preface this; it really depends on what your agency or which officers are struggling with. But I think, having support from the agency. I don’t want to downplay the significance of media and some of the things that have happened in our society lately and the impact it’s had on law enforcement officers – it is powerful, and it is pervasive. But what I have seen is that the agencies that provide support for their officers, from the command staff, from leadership on down, those agencies experience less turnover, less attrition, and have employees that are more resilient. This may be out of your control, if you’re a frontline officer, how do you get your share of your police chief, your administration, to provide better support? But in answer to your question, I would say if I could think of one thing that would impact an individual law enforcement officer or help them, I would say the support of the agency, not the public. The public is going to do with the public’s going to do, the media is going to do with the media is going to do. But if you know that your agency has your back, I think you’re able to cope with the things that are coming from external sources much better. With regards to differences in uniformed officers versus non-uniformed officers, that’s a really good question. I’m not entirely sure I know how to answer that. I do believe that there are certainly significant differences. Over the years I have worked a lot with law enforcement marriages. Let’s say we have a husband who is a Deputy Sheriff and has been for 15 years and his wife comes in for some assistance. He sees the world a certain way. He’s exposed to certain things. And I don’t expect the spouse to understand that necessarily, but she also is experiencing certain things in certain ways, and we need to understand and respect her experience and her perspective in things. So, for example, you know, he might be accused of being controlling towards her and she might feel that from him. We need to honor and respect that. He might feel as though he’s not being controlling, he’s just trying to be protective of her. So, there are certainly different differences between uniform individuals and non-uniformed individuals based on the job and the kind of life that they live. But I will also say this. For example, telecommunication officers, 911 operators. In many of the agencies for which I work, they’re not considered uniformed officers. They come in for therapy or treatment. I’m not so sure that I treat them or approach therapy any differently with them than I do with a uniformed officer. So, I would have to say, in short, it’s on a case-by-case basis. I think that a lot of it depends on the culture from which that individual is coming from to seek treatment. Law enforcement is a very, very distinct culture. It has very distinct cultural dynamics, and you have to put those into play when you’re trying to provide therapy or help or that individual. So, I look more at the cultural dynamics than I do anything else.

Audience Question: What is the name of that book you referenced?  

Dr. Grant McDougall: It’s Emotional Survival for Law Enforcement by Dr. Kevin Gilmartin. I started my career years ago and again; I want to be very clear about this. I have no affiliation with Dr. Gilmartin. I’ve never even met the gentlemen. So, this isn’t a marketing ploy on my part. I am passionate about helping law enforcement supporting law enforcement and I have read countless books on how to do so. It is a very short read. And in my opinion, this is just my opinion, I think is one of the best books ever written regarding the psychological dynamics of law enforcement, the challenges that those individuals face, and how we can help them.

Audience Question: You talked about cumulative trauma and complex PTSD. And then there’s this other term, secondary trauma. Help us out. What’s the difference between all these terms?  

Dr. Grant McDougall: That’s a great question, and sometimes I get frustrated. I’m not even sure I know. We throw a lot of terms around in my industry. For example, complex PTSD, if you look in the DSM V as a Diagnostic and Statistic Manual that we use to diagnose people, that’s not even a disorder in that manual. It’s a term that we have made up. There’s secondary trauma. There is vicarious trauma. And the difference, because it’d be very, very subtle, but in general terms, what I’ll tell you is that vicarious trauma or secondary trauma, a lot of times has to do with trauma that you don’t experience directly, but you are affected by the individual, the person’s situation. So, I’ll give you an example. So, let’s say that I am talking with an individual who’s a friend of mine, and he experienced the death of a child. And he goes into very graphic detail about that, and then maybe, later on, I talk to somebody else about one, and then somebody else about one eventually it begins to wear on me, and I’m experiencing trauma through their trauma. That’s what we would call vicarious trauma. Where I see it is really prevalent in law enforcement, and I’m not saying it doesn’t happen in other areas of law enforcement. I see it a lot in 911 operators and telecommunications officers. They’re not exposed to trauma directly, they’re on a phone, but you will see them, their traumas are very, very real. We can call it secondary trauma, vicarious trauma. But I’ve had numerous patients over the years that have symptoms that look identical to post-traumatic stress disorder, but they haven’t directly experienced the trauma. They’ve experienced secondary trauma or vicarious trauma. So, does that make sense?

Audience Question: I’ve attempted therapy a few times. My problem is with a therapist that she’s tried to work with. They don’t understand the issues that they’re dealing with that she’s dealing with. Sounds like law enforcement culture, especially. And so, they have a hard time wrapping their heads around some of the things that they, as law enforcement officers come across. What’s your advice?  

Dr. Grant McDougall: Let me first apologize. That’s a shortcoming by the people in my industry. And I say this all over the country, we are culturally incompetent when it comes to law enforcement. And I get frustrated, because, again, it is such a distinct culture. My practices have grown exponentially, and I was looking for another psychologist to help me out. And it took a very, very long time for me to find one that I felt was culturally competent. My advice to you is, you’re going to have to shop around. And I think if you’re in a small town or in a rural area, it can be much, much harder. I would say. Look for individuals that have had clinical experience with veterans, military veterans, that a lot of times can bridge the gap for you. Look for individuals that have worked with first responders, not necessarily the law enforcement, but firefighters, EMTs, individuals like that. I’m a big proponent. Therapists are a lot like a pair of shoes, sometimes. You got to try for you to get a good fit. And I think it’s important that you interview the therapist before you start a counseling relationship with him or her. Asked them poignant questions. What kind of experience do they have? Have they worked with first responders or law enforcement individuals? Do they have cultural competence in that area? We’re quick to ask questions if it comes, you know, to sexual orientation, or gender or race, or whatever. Unfortunately, it’s an incredibly important issue when you’re talking about law enforcement because it is such a distinct culture. So, I would say, certainly interview the therapist, try to find somebody that has some experience working with military first responders. You can go online and there are some websites out there, you’re welcome to e-mail me, I can connect you with them. I will say that it becomes a lot more challenging when you’re in rural or isolated areas, it becomes a really, really big challenge. But when you get close to metropolitan areas, typically, you can find somebody. But your struggle is real. I hear that all the time, where people are willing to reach out for help, but they feel like they’re talking to somebody that just can’t understand what they’re talking about when they do go get some support.

Host: One of our longtime presenters, Amy Morgan, who runs Academy Hour, also has the Certified First Responder Counseling program, as well as a list of certified counselors. I know that’s one of the things she also talks about, is understanding that cultural fit.

Dr. Grant McDougall: Let me add really quick, I neglected to say, I’m not pushing any type of religious or spiritual counseling. But a lot of agencies have chaplains and clergy. And there’s a misunderstanding often that if you go see a chaplain or you go see a clergy who have experience with law enforcement personnel, that they’re going to preach to you, or they’re going to frame all of their therapy or their support in a religious context. In my experience, that is not the case. If you want it framed in religious contact or spiritual context, they will do that. But if you want to just simply get support outside of that context, they can do that as well, and most of the chaplains and clergy that work with law enforcement certainly have experience in that area. So, you can try that route as well.

Audience Question: Sarah mentioned an interesting point or question. She said law enforcement personnel records are now available for scrutiny by defense attorneys. It makes it kind of difficult to get people to open up, even if they’re having minor issues. So, doesn’t this mean that if an officer has gone for mental health, or that it’s recommended doesn’t it mean that this could eventually become public and used against them?

Dr. Grant McDougall: Fantastic question, and we don’t have enough time and training sessions on just this issue, confidentiality. And I’m really glad she brought that up. In a nutshell, what I’ll tell you is, it varies from state to state. HIPAA is a federal law, and it protects medical records. The question that I ask individuals and people to ask is, who is the payer? So, for example, if the agency pays for you to go to counseling, there’s a reasonable chance, and I want to be very clear about this, I’m not an attorney, I’m not telling you about the laws in your state, but there’s a reasonable chance they’ll have access to their mental health records. If the payer is an insurance company, or you’re a private pay individual, or so forth, and there’s a very, very good chance that the agency will not have access to those records. Again, subpoenas, and laws state by state, do vary. But I can tell you in my state, in Florida, if an individual comes into my office and they are coming through an EAP program, or private insurance. The law enforcement agency for which they work, number one, doesn’t know they’re coming to me, and number two, has zero access to their records, no access to their records. Confidentiality is a really big issue, and it’s something that needs to be addressed by your clinician, that you go see on your very first visit. That should be when the first things that your clinician talks with you about are what are the boundaries of confidentiality for that treatment? And you need to have a really, really clear understanding of that. Again, that the easy thing to ask is who’s paying for that counseling session. And if it’s not the agency, then it’s very unlikely they are going to have access in any way, shape, or form to your counseling records. Usually, there’s something called the Tarasoff Law, which means a therapist or a medical provider has the duty to warn. So, if he or she deems you as a threat to yourself, or somebody else and all bets are off, and they will notify authorities. But that is, lightning-strike-rare. I can tell you, in my decades of practice, I’ve never done that. So that’s very, very rare. But there are specifics within each state, and that’s something you would want to check into. Unfortunately, that is a barrier that keeps a lot of officers from reaching out to get help. So, I wish I could give you a more specific answer, but it really depends on the state within which you live.

Click Here to Watch a Recording of Under Siege: The Psychological Impact on Law Enforcement in these Troubled Times.