Not all therapy is created equal. One firefighter’s raw journey through bad sessions, breakdowns, and finally finding the kind of help that actually worked

Nobody joins the fire department to become a therapist, and I didn’t either, but somehow it happened. How it happened was I went to therapy and discovered a few things, but in order for that to make sense, I need to go back to explain and tell you about problems I found along the way.

Like many of you know, and as (unfortunately) many of you will find out, because of the chronic over-exposure to the trauma we see, post-traumatic stress disorder has become more than just a job hazard. It’s now becoming an expected facet of our profession.

When I received my diagnosis, I was about 15 years into the job. I had recently been promoted to captain after spending my career as a firefighter/paramedic. I presented with all the symptoms we all read about and, of course, I didn’t realize I was displaying any of them.

I had become that one smelly kid in class who everyone else knows is stinky, but he has no idea. My behavior began to affect everyone around me in my personal life, and the only place I felt peace seemed to be at the station. I started working there as often as possible and just kind of stopped going home. When I was there, my family walked on eggshells (that were really hand grenades), which caused fights that led me to retreat into work even more.

Then the divorce came, accompanied by all the horrible things that come with it. This led to a dark depression which led to thoughts of suicide. My crew was the first to do an intervention and they, ever so gently (eye roll) told me to go get some help. This is where the problems started.

I went to our department-funded EAP, knowing literally nothing about therapy. I wasn’t against it but certainly didn’t trust it. Getting there though, I had a nice therapist who got to know my story over the first two sessions. When I went to the third session, she informed me my session limit with the EAP had been reached, and I had to go see someone on my insurance.

PROBLEM 1: While EAP programs can be useful, most nationwide are limited in their number of sessions and specialization.

I went to the first name the EAP therapist had highlighted on my insurance list. When I walked into his office, he had a water wall, wind-chimey, sitar music playing, and the office smelled oddly of patchouli.

Soon a short, very overweight, bearded fellow in a green sweater vest came out and asked me to go into his office (you can already see where this is going). He had me start over from the beginning (very frustrating) and by the end of the session he was crying. A lot. He kept saying he didn’t know how we (first responders) do what we do but he wanted me to know of the gratitude he felt for us. I didn’t know how to respond to this. I wanted to ask him if he needed to trade places with me or if he needed a hug or something. Instead, I just left, deciding therapy was a waste of time.

PROBLEM 2: Most therapists are not trained to deal with the type of trauma our PTSD brings to the table, and many don’t understand what it is we actually do.

When my symptoms progressed, so did my suicidal thoughts, until I couldn’t say I felt safe anymore. I decided to give therapy one last chance. I randomly found a place and walked in and by some luck or miracle happened to find a wonderful therapist who grew up in a first responder family and was trained in some of the therapies that work best for us. She spoke our language, understood my behavior, and wouldn’t put up with any bullshit of my trying to get out of doing the work. She was perfect. She had the key necessary to really help me and others like me. Understanding! We call this understanding “cultural competency.”

PROBLEM 3: I got lucky. Very lucky. Please don’t use this as a method of finding the right therapist, it was stupid. The point of this article is to give you the tools to know what to ask when looking for a therapist so you can find a good fit.

Cultural competency is the most important thing we can find in a therapist. When I went through my therapy, because my therapist was culturally competent, she was able to reach me at my level, with an understanding that required minimal explanation and wasn’t scared or traumatized by what I brought forward. She employed sound techniques and had patience. She was able to help me heal to the point where I remarried my ex-wife, and was able to rejoin my family in full and find happiness in my life outside of work.

So, what do we need to look for in finding a culturally competent therapist? Great question. In choosing a therapist, look for the following and more importantly, ASK FOR THE FOLLOWING:

  1. Do they follow best practice guidelines for us?
    Our leaders through both the IAFF and NFFF have recommended that therapists who work with us use evidenced-based therapies (like cognitive behavioral therapy or CBT), are trained in dealing with complex trauma and PTSD, and are trained in trauma adjunct therapies like eye movement desensitization processing (EMDR) and accelerated resolution therapy (ART).
  2. How long have they been doing therapy and have they worked with first responders, specifically in the area of the service you are in?
    So, if you are a firefighter/paramedic, have they ever worked with a firefighter/paramedic? If so, how many? Look at it like this: would you trust a mechanic working on your fire apparatus that had only been certified for six months and only worked on police cruisers? I hope not. And I hope it goes without saying but I’m gonna say it: going on one, or even several, ride-alongs doesn’t make cultural competency.
  3. And this one is the most important, are they a “good fit?”
    Meaning, if the relationship feels off, or you don’t feel comfortable opening up to them it’s absolutely necessary you say so. Trust me, the therapist won’t be offended by this, in fact, they’ll help you find someone who is a better fit for you and your needs.
  4. DO NOT GIVE UP!
    If your therapist isn’t a good fit, or if they aren’t helping, don’t give up. In my case, it took going to three different therapists to find the right fit.

The last thing I wanted to add is an impassioned plea to my fellow firefighters/EMS people. Peer support works so well for us because it is by us for us. But peer support is limited. There are few therapists out there who are current or former firefighters/EMS. To really help each other, we need more therapists from our pool who can provide therapy for us. So please consider going back to school and getting trained and licensed. It’s a super rewarding experience and let’s be real, we need the help.

The views expressed are those of the author and do not necessarily reflect those of his organization or its leadership.