HEALTHMentalThoughts on Therapy for Firefighters

Thoughts on Therapy for Firefighters

talk therapy and psychotherapy for firefighters

By: Tori Mikulan

When firefighters think of psychotherapy, they might picture someone lying on a leather chaise lounge while a cross-legged therapist peers over his glasses, frowns and asks, “How does that really make you feel?” But have you heard of talk therapy? Or maybe we imagine splatters on a page and being asked what we see in an image as undefined as a cloud. Such images feel more than slightly pretentious and may only inspire eye-rolling rather than true inspiration. The truth is, therapy looks like that only on television but we’ve seen it so often that many people believe it’s real. 

Psychotherapy and evidence-based practice

According to the American Psychological Association, psychotherapy – which we most often think of as “talk therapy” involves:

Psychologists applying scientifically validated procedures to help people develop healthier, more effective habits. There are several approaches to psychotherapy – including cognitive-behavioral, interpersonal, and other kinds of talk therapy – that help individuals work through their problems.

Psychotherapy is a collaborative treatment based on the relationship between an individual and a psychologist. Grounded in dialogue, it provides a supportive environment that allows you to talk openly with someone who’s objective, neutral, and nonjudgmental. You and your psychologist will work together to identify and change the thought and behavior patterns that are keeping you from feeling your best.

Another common misconception is that an individual needs to be undergoing a severe crisis to warrant seeking out therapy. This is absolutely false. There is no threshold of struggling that needs to be met before you can attend therapy; it isn’t like an amusement park ride where, instead of a height requirement, there is a measurement of misery and suffering that needs to be achieved in order to make you eligible for therapy. 

Anyone can partake in therapy and find it beneficial. 

Talk Therapy

Talk therapy is often used as part of a treatment plan for a condition or illness, in addition to helping individuals overcome the aftermath of specific experiences. While talk therapy is used by some as part of a treatment plan for a condition or illness, many people go to therapy for a variety of other reasons.

Some go to deal with short-term problems or to get through a difficult time, while others go to better understand their emotions and learn why they feel and react in certain ways, and still others go because they want to work on themselves. None of these reasons are wrong or right. Therapy is a very personal process and what works for one person may not necessarily work for another. 

Cognitive Behavioral Therapy

Different types of therapies work for different people. Cognitive behavioral therapy (CBT), an evidence-based practice (EBP), is a short-term and goal-orientated psychological treatment. It centers on change such as identifying and changing problematic thinking and behavioral patterns, some of which can lead to conditions such as anxiety, depression, and PTSD.

Therapists and clients work together to determine the most effective way to apply this treatment in order to align with the client’s goals. 

The American Psychological Association states that CBT “emphasizes helping individuals learn to be their own therapists,”as they learn coping skills and identify and change problematic patterns or actions.” CBT focuses on the present and on developing more effective coping skills to deal with life’s challenges. These skills can be uniquely beneficial to firefighters to improve their preparedness in facing future obstacles. 

Dialectical Behavior Therapy

Another EBP that may be beneficial to firefighters is Dialectical Behavior Therapy (DBT) which is defined by the “Everyone Goes Home” initiative as “a cognitive (thinking), behavioral (acting) approach that focuses on mindfulness and emotional self-regulation to improve one’s relationships with self and others.” (Fire Service Behavioral Health Management Guide, 2017)

Mindfulness and emotional self-regulation help individuals to understand their emotions and improve their emotional control. Distress tolerance is also included in DBT and teaches how to make logical, sound decisions in stressful and difficult situations. It emphasizes tolerating stress rather than trying to change it. 

The IAFF Recovery Center states that it has proven effective for individuals who struggle with suicidal ideation/thoughts, self-mutilation, compulsive behaviors, and co-occurring addiction.

Eye Movement Desensitization and Reprocessing

Another approach to psychotherapy is Eye Movement Desensitization and Reprocessing (EMDR). This is based on the theory that the body naturally heals mental wounds just as it does physical wounds. During EMDR, individuals reprocess past traumatic memories using bilateral eye movements and other sensory methods.

Processing the disturbing or distressing aspects of the situation helps the individual heal from the trauma, eliminate symptoms, and move forward from the experience.  


We all process and respond to events differently, but as firefighters, we face cumulative stress that grows from exposure to repeated traumas. In fact, multiple traumatic experiences increases the likelihood of developing PTSD. Experiencing the traumatic event is difficult enough but ignoring the issues that stem from trauma can result in an experience that is even worse and may have deadly consequences.

Therapy offers the support of a trained counselor and proven techniques to help us live through the emotions of the aftermath. 

The misconception that seeking help to manage and treat your mental health makes you weak is not only a dangerous misconception (since it acts as a barrier to some people who then choose not to get help), but is arguably the most incorrect. 

Just as spending time in the weight room makes an individual physically stronger, undergoing therapy helps develop mental strength. Getting help is what makes you stronger in life, off and on the job. 

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