S6 E39 Veterans Turned First Responders: A Deeper Dive with Guest Dr. Stacy Raymond

SPEAKER_01 0:00

So there's approximately 5% of sworn police are veterans. Fire, it's approximately 23% of career firefighters are veterans. You can't just work with them because you think it's cool or sexy on some level. Like that's not the reason. Your heart has to be in it. That trust is earned. It is not automatic. And I think any clinician should never pretend and keep nodding as if they know what those things mean. Like you really need to take the time and say, I'm sorry, I don't know what that term means. We need more and more clinicians that are comfortable working with these populations. I just can't emphasize that enough. You're not there to be impressed by them. You're there to help them.

Voiceover 0:46

Welcome to Responder Resilience. I'm David Dashinger. Today, Dr. Stacy Raymond's not in the co-host seat, but she's in the subject matter expert seat, and we're going to be speaking about treating veterans who are now first responders. If you caught part one of our clinician's guide master class on treating veterans who are now first responders, you know what we covered and why so many veterans walk straight from one uniform into the other, what ACES tells us about who's drawn to this work in the first place, and the most common issues clinicians see in this group. It actually became one of the most downloaded episodes we've ever put out. And that told us something. A lot of you are sitting across from veterans who became first responders and you still want more. So Dr. Stacey Raymond is back. Today we go past the overview. We're not asking what the challenges look like anymore. We're asking what you actually do when a client tells you you couldn't possibly understand. We're talking moral injury versus PTSI, the hypervigilance that kept someone alive and won't let go, and the line a clinician cannot afford to get wrong around firearms and suicide risk. So this is the master class. Let's get into it right after this. This episode is brought to you by Fight Camp, real training on your schedule. Head to jointfightcamp.com/slash RR and use code RESILIENTES for 10% off. There's a new app built by Firefighters for Firefighters, and it's called Crackle. Download the app now for free as a legacy member and get early access to exclusive content, tools, and updates as they drop. Get the free app at crackle.responderTV.com. We invite you to like and subscribe YouTube Responder Resilience, Facebook Responder TV. We're on LinkedIn, Apple Podcasts, and Spotify, and our website is respondertv.com. We'll be right back to speak with Dr. Stacey Raymond right after this. Ask a first responder who they are, and you're likely to hear I am a police officer. I am a firefighter. I am a paralebocker. I am a 911 communications operator. Not I do this work, but I do this job. Ask a clinician why they work with first responders. And they may say, There's no fire falling and helping out. Join us in shaping a culture where mental health, wellness, and leadership are priorities, not whispering, where support is a sign of strength, not failure, and where no one has to carry the weight alone. Welcome to Responder Resilience. We try to spotlight on the unseen battles of first responder reality and celebrate the powerful wins that come from the grit of post-traumatic growth. We understand the culture, honor the trust, and bring you conversations from the change makers, passionate about helping first responders come home whole. With your host, retired Lieutenant David Dashing, Dr. Stacy Raymond, and Bonnie Roomily, LCSW EMT. Today we have Dr. Stacy Raymond as our subject matter expert in a quick bio on Stacy. She's a clinical psychologist in Ridgefield, Connecticut, with over 27 years in private practice, specializing in trauma and EMDR. She's an MDRIA-approved consultant, an approved clinician for the FOP and IAFF, and a member of the IACP's Police Psychological Services section. Half of her practice serves First Responders and Veterans, which is personal for her as the daughter of a retired police officer and U.S. Marine. She's a member of the Fairfield County Trauma Response Team and co-leads a free weekly peer support meeting with Bonnie Roomily, our other co-host. Stacy co-hosts the Responder Resilience Podcast. She also co-authored Helping the Helpers, the Clinician's Guide to First Responder Mental Wellness, and she authored Dump the Bucket, Dealing Trauma in Police with EMDR. Stacy, welcome.

SPEAKER_01 4:37

Thank you. It's great to be here, David.

Voiceover 4:40

So since we recorded part one, what have you noticed with this population? Anything you're seeing now with those first responders slash veteran clients that you weren't seeing back when we recorded part one?

SPEAKER_01 4:51

Anything that I'm seeing now. Um, just that I've seen more, you know, um first responders who are veterans, you know. I just as time goes on, and that solidifies my understanding of working with this population. And it also makes it all that much more important in my mind that you know that there are clinicians who are trained in, you know, working with veterans who are first responders. So um, you know, and that's and I'm not just saying that to plug the book, but um, you know, this book, our book came out last year, Helping the Helpers, a clinician's guide to working with uh to first responder mental wellness. And you know, I just can't emphasize enough how important that book is. And I'm not saying this just because, you know, I'm not trying to promote the book because anybody who's authored a book knows that you're not gonna get rich from from unless you're Stephen King or something like that. But um, but really it's just such a it's such a good read um for any clinician that wants to work with these populations.

Voiceover 5:58

Let's look at some of the data, numbers, percentages, what percentage Yeah. What percentage of police are veterans versus what percentage of police are concurrently active or reserve duty?

SPEAKER_01 6:10

Or so that those numbers are as follows. So there's approximately five percent of sworn police are veterans, and about six percent are concurrently, you know, they're they're both police and they are enlisted in the military. So five percent and six percent respectively.

Voiceover 6:28

Okay, and for fire, what does that look like?

SPEAKER_01 6:30

For fire, I was surprised when I did my research on this. You know, for fire, it's approximately 23% of career firefighters are veterans. That's and when you compare that to police, that's pretty high. It's one in four.

Voiceover 6:46

Yeah, it surprised me.

SPEAKER_01 6:47

Yeah, but that's what the research shows. And then as far as um those firefighters who are concurrently enlisted in the military, that's somewhere between three to five percent.

Voiceover 6:59

Okay. Let's talk about just culture, um, and and the clinician side of this. How does military culture change the way a therapist should establish trust with one of these people that was a veteran now first responder?

SPEAKER_01 7:13

Right. Well, you you know, you have to understand the the warrior ethos. You know, there's this emphasis on self-reliance, loyalty, um, emotional control, and um focus on on one's mission, whatever that mission is, you know, this is what they're coming from. Um, and also uh a big piece of it, especially, you know, for clinicians to be aware of is the distrust of outsiders. You know, the you know, because the the clinician is going to be seen as a as a uh civilian. But, you know, if if the clinician happens to be a veteran or is close to the first responder world in some way, um, that does go a long way. And I can attest to that because of my dad being marine, he's 90 years old now, um, and of that uh generation where they don't talk, you know, that there wasn't there's no way that that generation would go into therapy and get any help. Um and watching him suffer with his post-traumatic stress and how that you know affected my mother and and all my brother and I. Um and and the fact that he went on to become a police officer, you know. So I've got b both. Um, I've been exposed to to both. And so it's no surprise that I end up working with this population now, you know, decades later.

Voiceover 8:36

Right.

SPEAKER_01 8:36

Yeah, it's interesting how uh all these um how it unfolds, you know, yeah, like seeds are planted in uh in the planted and they've grown, and I'm very comfortable with this population, and so I just feel so strongly about um having clinicians that I mean we need more and more clinicians that are comfortable working with these populations, and so I just can't emphasize that enough that you really you really you need to become familiar before you before you sit in front of you know a veteran who's now a first responder. It's just it's critical.

Voiceover 9:11

You're trained to help people heal, but first responders, they carry trauma that's buried under silence, stigma, and stress. Helping the helpers gives you the framework to connect, to speak their language, earn their trust, and actually make an impact. From the experienced team and clinicians behind the Responder Resilience Podcast, this isn't theory. It's real-world support for the ones who need you most. And this book isn't just for clinicians. If you're an agency leader, peer support team, chaplain, EAP, wellness program coordinator, or family member, helping the helpers will equip you with the tools, language, and insight to make a difference. Be the resource they can count on. Order your copy of Helping the Helpers on Amazon today, what would you suggest for a clinician who wants to work with this population but just hasn't had any, you know, opportunity? Like what would be a way to get some time, you know, working with them so they they build some uh That's a good question.

SPEAKER_01 10:24

I'll tell you what I did. Um, when I was and I didn't know that I would end up working with uh first responders who were also veterans. Um my internship part of it was assigned at the uh the Newington VA hospital. And so that was my first uh exposure, other than being raised by my father, um uh Marine, um, you know, just sitting with with veterans uh in the hospital situation and talking to them about mental health, you know, that that was my my first foray into working with that population. So and I found them just very interesting. And they're a little suspicious of me, you know, being um training as a clinician. And plus I was like, you know, I was 26 years old or whatever, so they really weren't interested in talking about themselves, more interested in interviewing me. But um, but that was my first exposure. So, you know, having you know, some, you know, it maybe doing an internship uh or at least a practicum, you know, in a in a VA environment would be important. Um, if you can't do that, then you know, reading up on working with this population, there are several books out there that are really good. Um, but then working with first responders, um, going on ride-alongs, very important. You know, working with police, um, you know, going to your local police department, seeing if they have a citizen police academy. I took that at Danbury Police Department and I learned so much from that beyond being raised by a police officer, you know, for 18 years. Um and then um I decided I was actually invited to become the clinical supervisor of the peer support team, you know, at that very department. So um I did a ride-along with every officer who was on the peer support team. And if they were a detective, then they took me into the DB and they, you know, they would show me whatever they could show me, you know, within reason about the work that they did. And so, you know, I I was just hungry for information. You gotta be hungry, you have to be interested in this population. Um, you can't just work with them because you think it's cool or sexy on some level. Like that's not the reason. You have to really, you know, your heart has to be in it that you realize what these individuals are exposed to and how that affects them. And so then I on the uh fire side, I also did several ride-alongs with a uh deputy chief, you know, not just in his vehicle, but also on the engine, you know, with this with the uh sirens screaming and you know, just bouncing along in the on the seat, you know, because it's it's a very bumpy ride. But um, you know, and going to a few small fires, you know, that was that was exciting. And just watching the you know, the seriousness on the um the firefighters' faces as they're you know pulling up as they're rolling up to a fire. It was just and they everybody knew what to do. They you know, so it was just fascinating. And then um, and then after the call, um going back to the firehouse and uh sitting around the dining room table and having a meal with them and listening to them banter, you know, and the gallows humor that they would engage in and the foul language, and it didn't matter that I was there, you know. But uh what an educational experience that was. So that I would suggest any and all of the above.

Voiceover 14:01

You know, we tend to just think of firefighters, EMS police doing a couple of jobs, a couple of tasks, you know, that we see all the time, putting out a fire or, you know, pulling over a car. But there's so much more that goes on in these departments, and I'd say specifically law enforcement that we have usually have no idea that exists, but behind the scenes, so many different um aspects that if you don't take one of these um or participate in one of these uh civilian police academies, you'll never know what what it entails. So um important stuff.

SPEAKER_01 14:36

Look at police. Uh I the last statistic that I heard, 60% of their calls, you know, at this local police department were CIT calls. So, you know, crisis intervention team calls where someone is in having a mental health crisis, whether they need to be on medication or they stop taking their medication, they're having symptoms, they're hearing voices, they're suicidal, um, they've overdosed. You think of policing, they're carrying a gun and they're out there chasing the bad guys, but there's there's a lot of mental health calls that they have to go to. And then what I learned on the fire side was I most of the ride-alongs that I went on was because somebody fell, an older person fell, or it was an older person who could not breathe easily. They're having trouble breathing and they needed transport to the hospital. So, you know, it wasn't a raging fire that we were rolling up to.

Voiceover 15:31

So yeah, very common uh call for fire is also automatic fire alarms, which um you know that get activated and you're going to check if there is an actual problem, but that's uh that's pretty common. Let's let's shift into the um veteran population a little more specifically. So, how should a clinician who's working with a veteran um who says, you couldn't possibly understand what I've been through? Like, how should they respond or work with that that client?

SPEAKER_01 15:59

My experience with that is they don't say it, but they're thinking it. Uh, you know, they usually they're in front of me because they've been offered an ultimatum, usually by their significant other, like you better go to therapy. You know, your fuse is so short, you're drinking too much, you're not sleeping, you're you're being nasty to the kids. You better go to therapy. And so the the first responder in many cases is there, not not of their own accord. It's you know, they're placating someone else. Um, and um there is that kind of looking at me, you know, through the side-eyed, you know, kind of like I don't want to traumatize you, lady, you know, with the stuff that you know I saw either in combat or as a uh police officer, firefighter, or EMT paramedic, whatever, whatever the case may be. Like there's this um trying to protect me, you know, not wanting to blow me out of the water with um the worst of the worst of what they are have been through and that still bothers them. Um but I I do also know that they're thinking that, you know, if you haven't served, and I haven't served, and I don't know what it's like to, you know, be in the military, um, I I don't know what it's like to be shot at, uh, which is a good thing. But that doesn't mean that a caring, compassionate, quiet therapist can't sit and interview someone and ask a lot of good questions and not pretend like you know what all the acronyms stand for, you know, stopping and asking questions like I don't know what you know MIA means. Can you please help me understand what that means? Um, you know, there's a lot of terms that get thrown around, whether you know they're a veteran or or not a veteran, just a first responder. Um, and I think any clinician should never pretend and and keep nodding as if they know what those things mean. Like you really need to take the time and say, I'm sorry, I don't know what that term means. It doesn't mean that you can't understand someone who's about to tell you about their possible combat experience, but do be quiet and listen after you've you've asked the question. The other thing is don't be all fawning all over them because they were, you know, they did see combat, you know. You know, the yes, you might privately be fascinated that you're sitting with somebody who, you know, might have been on the front line, may have been in the Afghanistan War or the Iraq War, whichever, um, Vietnam. I mean, a lot of those guys are in their 70s now, mid to mid to late 70s. Um, but you still may end up seeing a uh Vietnam veteran. Um, you know, to not outwardly marvel at, you know, what they're telling you about because that doesn't read well, you know, that doesn't come off well. You know, you're not there to be impressed by them, you're there to help them. So, and to realize this is probably the most important piece of it, that trust is earned. It it is not automatic, you know, and so they're probably gonna test you with some of the lesser stuff just to see if you can handle it. You know, and if you're marveling too much at it, like, oh my god, really? You were shot at, and um or you were you were in a 30-minute firefight, really? Yeah, you know, it's it's really not gonna come off very well and sit well with them, you know. Um the you they're gonna test you with what they share, and then they're not gonna get into the real, you know, heavy material until you've proven to them that you can handle the lighter stuff.

Voiceover 19:55

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SPEAKER_01 20:42

Um there's it seems like that's true because they might lose somebody in uh, you know, another platoon or another squad, you know, or or they hear stories of what happened to Joe, you know, or they they see what happened to Joe, you know, after he he's gets back. And you know, that's called vicarious trauma. And then they live in fear that, hey, that could what happened to Joe could happen to me. So absolutely. So even if they they don't see um combat themselves doesn't mean that they can't be traumatized. Um plus they're also in in um areas, excuse me, they're also in areas where you know they may s they may see poverty, they may see children without parents, um, they may witness war crimes that are that are happening, and especially if someone is captured and they're being tortured. Um, and then that leads, you know, that could lead to moral injury, which is something else that we can talk about and compare that to post traumatic stress injury. Um so yes, there the uh veteran who has not seen combat absolutely can be traumatized.

Voiceover 22:03

Oh, absolutely. Yeah.

SPEAKER_01 22:05

Which happens. You know, you'll have a lot of female veterans that um report that, unfortunately. It's that's that's really unfortunate. Yeah. Mm-hmm.

Voiceover 22:16

Well, speaking of moral injury, let's talk about that and kind of do a comparison. We talk about PTSD, PTSI quite a bit, and moral injury is now a kind of hot topic as well. So how do we distinguish between them and why does it matter?

SPEAKER_01 22:31

Yeah. So just to outline, you know, why do we why are we throwing around the term PTSI? Because I stands for injury. It's something that you can heal from. I've sat with so many people, both veterans, first responders, and civilians, who have come in and they've met the criteria for the DSM five's version of post-traumatic stress disorder. You know, there's certain criteria that that you go down the list, and if they you meet the that criteria, then you have that diagnosis. But then after proper treatment, they don't have that disorder anymore. So I don't I don't like um using PTSD because disorder is, it makes me think of like attention deficit disorder. That's something you usually don't grow out of. If you've been diagnosed with attention deficit hyperactivity disorder, you know, you're probably gonna have that for life. And it just looks a little different when you're an adolescent than when you're uh an adult. But um, needless to say, it's not something that people uh tend to grow out of. But with uh PTSI, I like to look at it as a brain injury, and um mainly because you know people with the proper treatment can uh you know can resolve that. So what's the difference between moral injury and post-traumatic stress injury? That's a vital question nowadays, um, because PTSI is more so it develops in the face of something extreme, something that's threatening, something where your um body experiences a cortisol and adrenaline dump, and it happens to such an extent or to such chronicity that it actually injures the brain temporarily. And so that's why we call this you know PTSD brain, you know, where the person is hyper-vigilant, they have hyperstartle, their fuse is short, they can't sleep, it's very hard for them not to stay busy. Um so moral injury is more so an injury of the soul or injury of the spirit, an injury of the conscience. You know, you've you've witnessed something that um is outside of what your moral code deems uh okay. So something you witness something that happened. Maybe you you know you know that this torture that's happening within a combat situation, or um, you know, a child has been uh given a grenade or some sort of explosive device and has been sent, you know, or go give this to the Marines that are standing over there. And then the you know the child has to be taken out. Um that can lead to what's called moral injury because most of us would say it's not okay to first of all, it's not okay to give a bomb to a child to go and give to the Marines, knowing that you're sacrificing that child and they don't even know what they're they think that they're giving some food or or a present or something or you know to the enemy. The child is innocent. And um, most of us would say that violates our moral code. But then in order to protect your own troops, you know, to have the sniper notified that there's a child who's moving toward the troops with with a bomb, and then to have to take out that child, uh, you know, that in and of itself is also, you know, can lead to a moral injury to anyone who's witnessing that, including the sniper who has to carry through with that. So so I hope I described you know the difference between moral injury and post-traumatic stress.

Voiceover 26:18

Yeah, I think so. And um, we've covered that also in some of our other episodes. So, anyone who wants uh take a deeper dive, um, we covered uh moral injury with a couple of different guests, Brooke Bartlett, Dr. Brooke Bartlett comes to mind as one of the more recent episodes. So let's talk about avoidance. What does that look like in veterans when it outwardly doesn't appear to be avoidance?

SPEAKER_01 26:44

So, veterans that avoid, um, now that's going to be your typical presentation of veteran um because they they were trained to be self-reliant and emotionally contained. You don't let emotions um drive the sh, you know, drive the bus, so to speak. Um, and so they're buttoned up and they're not gonna wear their emotions on their sleeves. So that's part of their training. And so to, you know, how do we get past that is a is a whole nother um can of worms. But how do they present as avoidant? They might be um working too much, um, they might be blocking a lot of their emotions, you know, and be very cerebral, be very cognitive in their presentation, very intellectual. Um, they might be just very angry, you know, because it's a lot safer for them. The emotion of anger is is probably the safest for veterans and for most men. Anger is very safe. Sadness, not safe. Hurt, which is usually what's underneath anger, not safe for them. And um, appearing anxious is also not a safe thing. So if you stay busy, you know, if you deflect, if you answer with a uh an intellectual type answer, that's a way to avoid the real stuff that's going on underneath. And but you can get to that over time, and and a clinician has to be patient. You know, you could have a a civilian that comes in and says, you know, I'm really struggling with sadness, you know, and you're not gonna get that with with veterans, they're not gonna just come in and say something like that. But you know, you might, as a clinician, because you're empathic, sense that there's sadness under there, but I wouldn't go after that immediately because that's gonna leave the the veteran feeling really vulnerable and exposed. You know, they need their armor, they were trained to have armor for good reason, and it probably helped them survive very difficult situations, and so you you you let them have their armor by all means, and then earn their trust, and then they'll let you peek behind the armor. That's really how therapy is works the best with this population, I think.

Voiceover 29:25

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SPEAKER_01 30:36

Anger usually isn't the primary emotion. It's usually um it's it masks sadness or hurt. So how do we address that? Um, you know, I I would certainly first just uh recognize that well, you see you really when you're talking about that incident, it seems like there's a lot of anger that goes along with that. Depending on where I'm at in my therapy with that client and how comfortable they feel with me, I might just point blank ask them, might there be anything underneath that anger? If you just take a moment and don't answer too quickly, just take a moment and take a breath. Might there be anything else that's underneath, you know, that anger? And and if they do pause and and take a breath, they might actually get to some more tender, more vulnerable feelings. That's how I would approach it with with a uh a first responder. But if I get the feeling like they're so much safer feeling angry, then I'm just going to roll with the anger.

Voiceover 31:46

Good.

SPEAKER_01 31:46

Yeah.

Voiceover 31:47

Okay. Um, so let's talk about this. When what happens when a veteran's military identity was adaptive in service but becomes maladaptive in civilian life?

SPEAKER_01 32:00

Yeah. I I tend to be um kind of playful and snarky with uh with my veterans, and I'll say something like, How's that working out for you at home? You know, and and they smile, they laugh, and they'll they know exactly what I'm what I'm talking about. They know that they're not getting along with their spouse or their kids are you know, don't want to spend any time with them because of the way, you know, that they're just like so hyper-vigilant about, you know, Junior going outside or walking down this, you know, the street, and it's it's let's say that uh the sun is going down and Junior wants to go over to the neighbor's house, but you know, the the uh the veteran is afraid that you know maybe there's just some someone out there that's just waiting to do some harm or something like that, and either you know, wants to accompany Junior when Junior feels like, no, I'm old enough, I can walk down the street, thank you very much, you know, dad or mom, you know, you're you're being a little bit over the top. Um and you know, getting more information about, well, why is it that that you feel like you always have to be in the in protective mode and you really can't let your guard down? And you might you might then learn that you know there was there were some memories back when they were in the military where somebody got hurt. And so we may need to do the processing of those memories and then and then make the point gently that you're not in combat anymore, you're not in a combat theater, you know, you're in your neighborhood, you know, you're in Bethel, not a whole lot of crime happening in Bethel, not a whole lot of violent crime happening. Um, you probably can let Junior, you know, walk down the street and and and be confident that nothing, you know, no, he's he's not going to be harmed or she's not gonna be harmed. Um so that's how I would approach that.

Voiceover 34:00

Let's talk about processing trauma. When is trauma processing appropriate and when should the therapist slow down?

SPEAKER_01 34:07

That's a really good question. I can um, you know, there's a uh there's a client that comes to mind who uh was a first responder, and and I'm just gonna be as vague as I I I possibly can, but give you this example, um, who was also he fought in um Iraq and he did see combat, he was shot at, he saw people killed, um, and unfortunately also was uh the victim of physical abuse as a child. And so uh one day we were um he he wanted to talk about some of what was happening as a as a child and how his his siblings would wrap him in a blanket and um and then hit him with a with a baseball bat. And the parents were just working, you know, the parents were really not monitoring the situation, so he really had no protection and he had no way to defend himself. But as he started telling me about this um this memory, he uh he stood up and he he you know the blood had drained from his face and he looked really pale and he said, Um, excuse me, I need to go to the restroom. And so he excused himself. He went to the men's room. A couple of minutes later, he came back and his eyes were kind of water, watery and moist, and um the blood had come back, the the color had come back to his face, and I kind of just knew that he had gone to the men's room to vomit. I just I just knew that. And so let's say his name was um Ed. And I said, Ed, um, you know, what just happened? And he's like, you know, doc, I I really don't know. He's like, I I just went to the men's room and vomited, and I really don't know what happened there. And so I would say in in a case like that, and the way that I handled it with him, I said, Well, you know, maybe we touched on something where the emotions were just so intense, and it brought you back to a time when you were a little boy and being, you know, beaten by your siblings when having no one there to protect you and look out for you, that you know, you didn't have words for it then and you don't have words for it now. And he just looked at me and he was just like, yeah, yeah. And I and I so I said to him, let's proceed gently on this memory. Let's let's just approach this very gently because clearly you have some strong feelings about what was happening to you when you were a little boy, and it's still those those tender feelings are still there. And I, you know, I I don't want you to have to feel like you have to, you know, get sick, you know, in order to deal with it. So let's let's approach this very gingerly so that doesn't happen again, you know. So that's where I join the client in, you know, avoiding jumping into the deep end of the pool. You know, that's where you go into protective mode because now, you know, this is a corrective emotional experience. He didn't have the protection of his parents for whatever reason when he was a kid and he was being beaten with the baseball bat by his siblings. But now it's my role as the clinician to kind of offer some nurturing and to kind of protect him so that he doesn't feel like he's floundering in the deep end of the pool. I can't emphasize enough that you know you're gonna have veterans, most of whom are male, most of whom are alpha males, where they don't have the words for you know what happened to them.

unknown 38:01

Yeah.

SPEAKER_01 38:02

You know, whether it was from childhood or from their military experience or from their work experience as a first responder. They just don't have the words. Part of that is because of our, you know, the social sociocultural expectations of how, you know, men are supposed to be tough. You know, and it's okay for girls to cry, but it's not okay for for boys.

Voiceover 38:29

So what you're talking about, is it possible that that has to do with the trauma resides in the brain, that it's in a place where there is no access to verbal communication skills?

SPEAKER_01 38:40

Right. Most trauma that's not resolved, it resides in the limbic system. So the limbic system is underneath the cortex and it sits on top of the brain stem. So there's a you know, there's an analogy. If this is the brain stem, if my forearm is the brain stem, now it's a lot wider than it would be if you use this as the brain. The cortex are my four fingers that wrap around my thumb, and my thumb would be the um the limbic system, the emotional part of the brain, the survival part of the brain. So any memories that are in that part of the brain, it's very hard to link that to words. And this is one reason why, and I hope not to upset too many clinicians, but in the case of extreme trauma, talk therapy is really not the best way to you know to access and heal, in my opinion, as an EMDR clinician, eye movement desensitization and and reprocessing. So talk therapy is a top-down approach. So going back to our analogy here, the top being, you know, the cortex, you know, what are your thoughts about what you went through? Why do you think you're feeling that way? What are you feeling? Um, and EMDR being a bottom-up approach, you know, uh, what's the emotion that you feel right now? Where do you feel that in your body? Give it a number from zero to ten, with 10 being the worst anxiety or the worst anger that you've ever felt, whatever the emotion is that the uh that the client is giving you. So so that's a very good question, David.

Voiceover 40:26

Well, I would add to that, and we've had this conversation with uh Dr. Joanna Rosen on part one of Deep Brain Reorienting, that um that's another um therapy that can address deeply lodged traumas that are absolutely the in the brainstem. Yeah, even further down. So even further down. Exciting news. We're gonna be doing part two with Dr. Rosen soon and uh uncover more interesting information about deep brain.

SPEAKER_01 40:51

It's fascinating. It's it's a fascinating approach to understanding trauma.

Voiceover 40:56

It's very nonverbal.

SPEAKER_01 40:58

Yes.

Voiceover 40:58

There's virtually no talking about it. This episode is brought to you by the First Responder Center for Excellence. Because even the best of us face unexpected challenges. They've got the tools, the training, and the resources to keep you strong, safe, and resilient. Equip yourself at FirstresponderCenter.org. Let's talk about childhood trauma. When do or how do childhood trauma and attachment wounds interact with military trauma?

SPEAKER_01 41:26

Well, if you think, you know, those those wounds are foundational, you know, so they're gonna set the stage for trusting other humans um for safety. So it's I I think it's pretty well known now um clinically that those individuals that go on to uh join the military and or become first responders oftentimes will endorse a questionnaire, items on a questionnaire, such as the um uh adverse childhood experiences questionnaire, which is a 10-item survey that indicate things such as you know being raised in a household where there was either drug or alcohol abuse, where there was mental illness of any kind, including uh anxiety, extreme anxiety and depression, where there might have been verbal abuse, physical abuse, um, emotional neglect. And so what I mean by that is feeling like you were not um important or special in any way in your family uh environment where people didn't really look out for each other. You know, so there's 10 items that load onto this um ACES scale, adverse childhood experiences scale. So what we've what we clinicians know who work with first responders and military is that our our clients um tend to score higher on the ACES uh questionnaire than civilians do. The average for civilians is a one. And in my research with police, it was just over a two. So that's twice as high. I know it doesn't sound like much, you know, it's like, oh, well, it's only one point higher, but we're talking about an average here, which means that you know, there were some people that scored three or four, and some people that scored zero. Um, but the same, you know, it's the same uh questionnaire that was given to 17,500 civilians, and the average was a one. So um when you look at police research, you're you're finding um that the average score is somewhere two or or upwards of two, all the way to three. Um so it's very important to Know this about your clients, you know, no matter what branch of the military they were in or what um branch of public service that they're in, to realize that that trauma also needs to be addressed because it is foundational and it does affect the person's personality, it affects how they attached, it affects whether or not they're gonna feel comfortable going to a therapist and talking. Um so that I would encourage any clinician to definitely explore ACEs with not just first responders and uh and veterans, but all of your clients.

Voiceover 44:40

So here's an interesting question. What do you do when the veteran believes they don't deserve to heal?

SPEAKER_01 44:48

To me, that smacks of moral injury and shame. And you know, there's something that they um that happened to them where they uh they feel as if they should have done something different or they you know they they shouldn't have done something that they did do. Um if if a person feels that they don't deserve to get better, um like I said, that really links to shame, which is different than guilt. Guilt is I did something wrong or I failed to do something right. Um shame is I am wrong as a person, I am a bad person. So it's it's it's really uh it's a lot closer to one's heart and how one feels about oneself. Um and so as a clinician, I would really want to know what that's tied to. What underlies, you know, the fact that you you think you don't deserve to get better? How could you, you know, what could you possibly have have done or failed to do um that leads you to believe that you yourself don't deserve to get better than the way you feel right now, you know, and to and to ask that in the most ginger way possible. Because I can tell you it's gonna lead to some revelation. Like it could be something like, well, my father, every time he came home from work, he would drink and then he would beat my mother, and I didn't protect her. And then so the next question is, Well, how old were you? Well, this was before they got divorced, so I was probably anywhere seven, eight, nine years old. So, do you think that a seven, eight, or nine-year-old could be in a position to protect an adult from another adult who's aggressing toward her? You know, and then that that gives them pause, like, oh, yeah, I was just a kid. So and so then we we try to generate a feeling of compassion for that seven, eight, or nine-year-old who had to witness that that type of behavior. And they their hands were tied because there is no seven, eight, or nine-year-old who's going to be able to fix something like that.

Voiceover 47:09

Okay, fascinating stuff.

SPEAKER_01 47:10

Yeah.

Voiceover 47:11

So this is a uh key question in many other important questions. And how should a therapist address firearms and suicide risk without destroying the therapeutic alliance?

SPEAKER_01 47:24

Yeah, that's really important because you know, every every cop that I've treated carries and carries in in the um office. And then there are plenty of firefighters, EMTs, paramedics that have access to firearms, you know. Um, so definitely do a thorough analysis of whether or not the person is thinking of hurting themselves, you know. And then, you know, asking those questions directly, you know, do you do you have any intention or any thoughts about hurting yourself and really exploring that because you're really looking for not just for means, because they have a means. Um, you know, as I said, even even the non-police officers, they have access, many of them have access to firearms. But it's really what you what you want to know is do they have um a plan? Like I'm gonna go home and put a gun in my mouth. Um do they have intention? You know, I'm doing I'm gonna do that right after the session. As soon as we're done talking here, I'm going home and I'm going to do that. That would be a super critical, red alert, you know, situation. Luckily, I've never, as a clinician, been in that situation. But I'm not afraid, nor should you be afraid, you know, any clinician out there to ask someone if you're getting the sense that they're really down on themselves and they really are hopeless and they they have no place else to turn except to um end their own life, that you look them in the eye. You look them in the eye and you ask them point blank, do you intend to hurt yourself? And then to go from there. Anytime that I've had to have that conversation with a client, they very much appreciate that I cared enough and found it important enough to look them in the eye and ask them and to be sure. I've never been brushed off as, oh, doc, you're crazy, you know. Like, how could you even think that or whatever? I'm not going to ask those questions unless I have some gut sense that this person is, in fact, really hopeless and they feel like there is no other place to turn.

Voiceover 49:44

What suggestions do you have for clinicians that find themselves in the position you just described as far as having resources at their fingertips so they're not scrambling in this moment of crisis to try to find the right resources? Like, how how do you prepare? What do you have, have you prepared for this type of situation?

SPEAKER_01 50:04

Right. Well, I make myself available and I've done that, where I'm concerned about somebody, you know, it could be that their spouse just left them and they're devastated, and they can't see past their own nose. They don't know what tomorrow brings, they don't know if the spouse is ever gonna reconcile with them. They don't know if for sure it really is over, or maybe this is just somebody stormed out and and and said some pretty serious words, but they, you know, a week from now it might be very different. So what we want to do is get them through the next couple hours and even the next couple of days. So I will I you know, a couple hours after that session, I will I'm I will call that client and and say, hey, you know, uh we we just finished up a couple hours ago. I'm just checking in with you to see how you're doing, whatever. I'm and I haven't lost anyone, you know, so I will put myself in that position of uh checking in with them both the same day and and clearly early on in the next day, most definitely. And and and if I need to see them two days from now, if I deem that that's what's necessary, then that's what I'm gonna schedule with them. Because I want to keep an eye on them and I want to keep you know them close in communication with me to let them know that they're not alone with this, because that's probably the worst feeling, you know, in a situation like that where your primary relationship has just ended or you think it's ended, at least that's the impression that you have, um, feeling like there's nowhere else to turn. You know, and um, but in many cases, it could just, like I said, it could just be someone, you know, in the heat of the moment, storming out, saying, saying something that they don't really mean a week from now. Filling the time between now and the next time I see that person is very important. The other thing is um seeing if I can engage another family member to be with them so that they are not alone, they're not going home to an empty house because you know, clearly I'm not gonna be able to do that, but I can stay in contact with them on the phone. But, you know, see if there's a a friend or a family member who can who can be with them. You know, there there is um a statistic, David, from my own research that still astounds me to this day. And it's something that when I when I do presentations, um I can see the look on the audience's uh faces when I give this statistic. But I I polled 177 sworn police officers in the state of Connecticut. I did that in 2025. And what I found was 36% of them endorsed the following statement. I probably need therapy, but I feel like I should figure it out by myself. 36% felt that they knew that they had some issues and that they should probably go to someone, a professional, and deal with those issues, but they would they would prefer to just work out those issues by themselves. And when you look at the suicide rate of among police, which is greater than the suicide rate for fire and um EMS, it's it's very concerning. It deeply concerns me. Like something needs to shift in how we give permission to police, and not just police, but fire and EMS and dispatch as well, um, to feel comfortable to get the help that they need. Something needs to shift because 36 percent is is a big number. That's you know, it's one-third of a pie chart.

Voiceover 54:16

Yeah, yeah.

SPEAKER_01 54:18

So yeah, that's that's something that's I'm passionate about trying to turn the tide on that.

Voiceover 54:25

And uh speaking of that passion, uh, where can people find you and uh your books? Where where can you anything else you want to share that you're up to?

SPEAKER_01 54:33

So um both of the books, the one that um you and I and Bonnie co-authored, that's helping the helpers, uh, that's on Amazon, as well as Dump the Bucket, Healing, Trauma, and Police with EMDR. That's on Amazon as well. My um website is drstacyraymond.com. And just for that matter, my Gmail is um drstacyraymond at gmail.com. If anyone had any questions, wanted to reach out to me. Um I am um presenting with my co-presenter, Officer Elstee. Um, anywhere that anyone wants to hear what we have to say, which has everything to do with my research on um on police, you know, you can reach out to me and we'd be happy to come to your department and uh and give our presentation.

Voiceover 55:25

Fantastic. Yeah, and then one last plug is um you Bonnie and I have um recently collaborated with the First Responder Center for Excellence with a cultural awareness training online, absolutely no cost at uh First ResponderCenter.org, I believe is the URL. They have a whole training component where you can uh take various courses in mostly mental health, but ours is cultural awareness that any clinician that wants to kind of get an awareness level um course in working with this population. And we do include some information about veterans in that. Go to First ResponderCenter.org and look for their training for our cultural awareness module. And Stacey, uh your wealth of knowledge on this topic. You uh obviously have a very interesting background that contributes to this, but also your your ongoing work and research makes you absolutely a superstar when it comes to talking about this topic. So appreciate you coming back to talk about part two.

SPEAKER_01 56:27

All right, thank you so much, David. I really um enjoyed this conversation today.

Voiceover 56:32

Absolutely. Remember to like and subscribe, YouTube Responder Resilience or Facebook Responder TV. Go to LinkedIn, Apple Podcasts, and Spotify, and our website is respondertv.com. Until the next time, stay safe, be kind to yourself. Take care.