It takes people years to make that first call for therapy. Picking up the phone can be very, very hard, especially for you, a first responder who prides yourself on your strength. Asking for help in this way is very different than asking for help on the job and is still stigmatized despite our efforts to destigmatize it.
Until going to therapy is fully destigmatized, I want to talk to you today about some of the barriers to going to therapy and some ways to overcome those barriers. Please comment if I missed any barriers or solutions. I’ll be happy to respond and add if I can. I am always interested in feedback.
I spoke above about the stigma of therapy. Knowing that exists, if you look for a therapist who has as much confidentiality as possible, it may make going to therapy easier. All therapists should adhere to HIPAA guidelines for confidentiality but there might be other factors to consider. For example, do they have separate entrance and exit doors so you don’t run into someone else in the waiting room walking out? What other types of businesses are in the building, or are they a standalone office? Does the therapist have flexibility in their schedule so they can see you as you likely don’t work Monday-Friday 9-5? An important thing for you to know also is you do not need to tell anyone you are going to therapy if you don’t want to. None of these factors are vital, but things that may help you find a therapist if you’re concerned about them.
Another barrier is what will going to mental health treatment cost to your work life? Some people may lose their position if they are in counseling. Also, some first responders fear that if their boss finds out, they won’t be able to go on calls because they aren’t “stable enough.” I never condone lying, but maybe looking outside the box can solve some of those barriers. Does the therapist do coaching? Coaching is VERY different from counseling and the therapist really needs to have specific training in coaching and know the boundary between counseling and coaching, but if you find a therapist that does coaching, they can help with specific skill building.
We have health insurance to minimize our cost to access to healthcare, but there are downfalls to using insurance. Insurance companies need to justify the services they are paying for. Because of this, you need to have a diagnosis to be treated. Many first responders don’t meet the full criteria for any specific “disorder.” Once you have a diagnosis on file, it can follow you for a long time as part of your permanent record. To minimize this risk, going to someone out of pocket may be the answer. Deductibles are so high these days that often what you pay out of pocket won’t be too different from what your deductible will be. Some therapists accept flexible spending accounts or health savings accounts as well.
If you’re considering going out of pocket for services, a question to ask yourself is: would you see a general practitioner or primary care doctor for a specialized problem or would you go to a specialist? Maybe going to a therapist who specializes in PTSD of first responders is an out of pocket expense, but if they can get you functioning and back to yourself sooner than the therapist you see through insurance, is that worth it? You may end up paying approximately the same over time anyway.
Timing may be another barrier. Many first responders don’t work a traditional Monday-Friday work schedule. Volunteer firefighters often have a full time job on top of their passion. There are many therapists that work early morning, late evening and weekend hours who can accommodate your schedule. “Making” time for therapy is a better way to think about it than “finding” time due to all of your home responsibilities as well.
Will the therapist understand you? Many first responders don’t want to share details and don’t want the therapist to ask. You don’t want to be seen as weak. This solution may go back to seeing a specialist. First responders have a different culture than the rest of the population. Even when you find a specialist, there is no guarantee that you and the therapist will be right for each other. If you feel uncomfortable, let the therapist know. Most therapists will have no problem providing referrals elsewhere as they are there for you. Additionally, if you found a therapist who specializes in first responders, they’re likely to know others who do as well.
You already use coping skills. What can a therapist do for you? Coping skills are only half the battle. What you see and do everyday will have an impact on you and going to the gym, gun range, or using less healthy options such as gambling or drinking will let out some of the energy, but will not put your experiences to rest inside of you. A therapist will help you get your mind back. They will help you lessen the impact in your head which in turn will help you sleep better, eat better, improve your relationships and mood, and maintain your career. I know you are doing everything in your power and using your skills. You are not weak. Even so, these coping skills aren’t always enough.
I’m sure I haven’t captured all of the barriers of going to therapy. However, I hope I hit on several that will give you whatever you need to pick up the phone and make that call. There is no shame in going to therapy. There is a hope that you will reclaim your life, relationships, and maintain your career. You are worth every cent you pay to the therapist. If you aren’t sure where to locate a therapist for you, feel free to email (firstname.lastname@example.org) or call (860-501-9767; 941-462-4807) me. I’d be happy to help you locate someone.