Mental health for first responders | Line One

First responders run toward danger when the rest of us run away, but the weight of those moments doesn’t just disappear. Trauma-informed therapy helps firefighters, police officers, EMTs, active military and veterans process the invisible wounds they carry. This specialized care understands the unique pressures of the job, offering safe, confidential support that respects their experiences. On this Line One, host Dr. Justin Clark and his guest discuss mental health in first responders.

HOST: Dr. Justin Clark

GUEST: Paul Gaines Jr. – Psychology Services of Alaska

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Click Play below to listen to the audio from the live show.

Transcript:

Dr. Justin Clark: Welcome to Line One, Your Health Connection. I’m your host, Dr. Justin Clark. On today’s program, we will be discussing the complexities of mental health in our first responders and healthcare personnel. 

First responders run toward danger when the rest of us run away. In the field, this could include police officers, firefighters, EMTs, as well as our active military and veterans. On the hospital side, it includes doctors, nurses, and hospital staff. These professionals carry the weight of the community on their shoulders, but who carries them? The truth is, the stress, trauma, and long hours don’t just disappear when the shift ends. It follows them home, affects their health, and can weigh on their family. It can lead to unhealthy habits and self-destructive coping mechanisms. That’s why trauma-informed therapy for first responders and healthcare workers is so important. 

Therapy is not about weakness. It’s about resilience. It’s about finding tools to manage stress, process trauma, and stay strong for the people who count on you. 

Today, I am very grateful to have Paul Gaines, Jr. with us today from Psychology Services of Alaska. Paul is a licensed clinical social worker and a licensed professional counselor who focuses on trauma-informed therapy. Paul walks the walk. As a former EMT and firefighter, he understands firsthand the pressures and consequences of being a first responder. Paul, welcome to Line One, Your Health Connection. 

Paul Gaines Jr.: Thank you, doctor. It’s good to be here. 

Dr. Justin Clark: It’s fantastic to have you. I’m really excited about this show because I was thinking, I graduated from medical school in 2006. So, I’ve been a doctor for almost 20 years, and residency was the first 5 years after medical school, and that was slightly traumatic. That was a unique experience to go through. In 5 years’ worth of time, I worked the equivalent of 10 years in hours. My first year was before they instituted the 80-hour workweek rule for us, so I was working between 100 and 120 hours a week, which was personally very, very challenging for me and for my family. We experience in the health industry and the first responders too, so much difficulties related to our job, and yet we still have this calling to do it. So, I’m really interested to talk to you today about your techniques and thoughts behind treating these patients. 

What I would like to start with is to give our listeners a sense of who Paul Gaines Jr. is, where you came from, how you got into this line of work, a little bit about your history. 

Paul Gaines Jr.: Sure. I came from Newport, Rhode Island. I’ve been in Alaska since 2014. I took a break in 2016 to start my practice and came back up here. I think most kids want to be firefighters. The police parade would go by my house every day in Newport, Rhode Island, and you see the big engine coming through, and these giants in their firefighter uniforms, and we all kind of fantasize about being that one day. When I came to Alaska, I was wondering how I could get involved in the community, and a friend said, “Why don’t you become a volunteer firefighter?” That’s pretty much what started it, and everywhere I’ve moved I try to find a volunteer house and lended my experiences there. It’s a great career. I’ve met some of the finest people I’ve ever met in fire departments, and so I was lucky to be around some great individuals. 

Dr. Justin Clark: Great. You came to Alaska in 2014. At what point did you start transitioning your career into professional counseling?

Paul Gaines Jr.: I’ve been a therapist – I earned my Master’s Degree in 2002 and then got my MSW in 2013. I’ve always wanted to be a therapist. Actually, I wanted to be a therapist in the military, but they didn’t accept LPCs, and so I had to get an MSW but by the time that I did that, I was working with veterans in the University of Connecticut. I realized  I would probably be more effective on the outside than on the inside when they were telling me about maybe the lack of confidentiality that therapists have with command staff. So, I morphed away from joining the military and started my own practice, and started seeing veterans and first responders through that. 

Dr. Justin Clark: Your experience as a first responder through EMT and firefighter, I’m sure, played a crucial role in your ability to work with these individuals. 

Paul Gaines Jriuy.: It did. First thing I learned is that I can’t provide therapy to myself, that I need help as well, because we see things, and not only do we see things, but things happen to us as well. We get injured, we have firefighters that sustain injuries, and then there’s the emotional toll of the things that we see shift to shift, day to day, year to year, that if we don’t take care of ourselves, those things pile up. We do a really good job of locking them away and forgetting about that because once we’re off shift, we have to take care of our families, we have other things we need to do before we go back to the fire department. We are conditioned to help everyone else and putting our own needs at the bottom of that priority list. But, it has a toll. It takes a toll and then it starts to come out in ways that we don’t expect and in ways that we never thought possible. By that time, it’s not too late, but that is the time when we realize that we really need to talk to someone about this. 

I want folks to get ahead of the game and talk to someone before it gets to that point. Before you cause damage either to yourself to your career or to your family and friend relationships. 

Dr. Justin Clark: Yes. It’s very easy to think that you’re stronger than those feelings, that you see this on a daily basis, but it doesn’t really impact you, or it doesn’t affect you until it does. You have to sort of have a release, or you can start to develop some really bad habits. 

Paul Gaines Jr.: We do develop bad habits, but we’re also adrenaline junkies. We don’t do a good job of sitting down and processing what we’ve gone through and he we are now, it’s September, it’s the moose hunt. It’s easy to avoid talking about traumatic stress when we can go off-grid and camp with our buddies and do all the things that prevent us from addressing those core issues that will affect us down the line. 

Dr. Justin Clark: Trauma-informed therapy, what does that mean in the context of a first responder?

Paul Gaines Jr.: Trauma-informed therapy is essentially just a collection of evidence-based therapeutic approaches that address and reduce the impact that traumatic experiences have on our wellness. It’s reduced by having the client employ behaviors and reframing their thoughts regarding their trauma so they don’t re-traumatize themselves. 

Dr. Justin Clark: Let’s take police officers, firefighters, because that’s what you are most familiar with. They see horrific things sometimes on a daily basis when they’re on their shifts. How is the trauma that someone might experience from emergency work different than other types of trauma?

Paul Gaines Jr.: There are essentially 4 categories. There is the repeated exposure to trauma. When we are on a shift, we might have several calls, all of which are a different type of traumatic event as opposed to somebody who might have one or two in their lives and I’m not here to mitigate the impact of people that have daily trauma in their lives, but first responders, we are expected to see these things and to go through the process of helping people go through the worst days of their lives. 

There’s also the cumulative stress and the critical incidents. It’s not just one single traumatic event. You could have a lot of sub-threshold traumatic events that build up over time. 

Then, there are the moral injuries. What’s the worst thing we can see of someone dying, and then go down the strata of what’s the next worst thing every time someone experiences that. That’s a moral injury that’s done to our psyche and that has other types of effects. We can become desensitized to the suffering of others. We can become desensitized to the suffering of people and our family. If we were in a car accident and there were tremendous injuries, then we go home and our partner or our child gets hurt. To them, that’s a serious issue; to us, by comparison, it’s nothing, and so we can run the risks without being empathetic or be sensitive to the suffering of people who aren’t in a life-threatening situation.

Then there are cultural barriers. We like to tough it out. We don’t want to give the impression that we are hurting. For one, other folks in the department might think that we are weak or that  we are incapable of handling the job, so we button it down. That culture can prevent people from seeking help, and they will button it down and act like nothing is wrong until something bad happens to them. 

The impact on personal relationships, when first responders come and talk to me, they won’t just talk about the shift. They talk about their family, they talk about their children. They talk about the impact the job has, their inability to do things with their children, or the need to work overtime so they can help make ends meet. When folks come in, they don’t just talk about the job. They talk about everything that impacts their wellness, and therapy can help with all of that. 

Dr. Justin Clark: Yes, this is Paul Gaines from Psychology Services of Alaska. We’re talking about mental health, particularly in first responders and health care workers. So Paul, I’m a healthcare worker, I’ve oftentimes thought about  – some of the stuff we’re dealing with, this is life and death on a daily basis, sometimes it’s heavy. What barriers prevent people like me, first responders and healthcare workers, and police officers from seeking therapy?

Paul Gaines Jr.: Stigma. If I work in a healthcare facility, I might be reluctant to let another healthcare peer know that I’m going into therapy or that I’ve got trauma or some major depression because of what I’ve experienced on the job. There’s also the avoidance – “I’ve got other things to do”, “I don’t have time for therapy. I got to get home and spend time with the kids. I don’t have time for therapy. We’re going fishing for the weekend.” In Alaska, it’s really easy to find things to do rather than sit in therapy. It’s a beautiful state. There are a lot of reasons to get out there. 

For some people, for a lot of people, that is their therapy. If that works for you, then that’s fine, but the mountains can’t give us skills to mitigate stress. They can’t teach us how to improve our sleep hygiene. They can’t inform us how to reduce our drinking when we get stressed. It’s helpful, but it’s not the only thing that you can do.

Then there’s the lack of resources and referral programs. It would be great if we had a facility that dealt exclusively with first responders, similar to what the military and veterans have both with the Cohen Clinic, which is a phenomenal resource. The Chris Kyle Clinic, the VA, and there are lots of places where veterans can go to get support. First responders, we don’t have it. 

A lot of therapists are well-trained in trauma, but first responders have a different culture, a different mindset, and we are wary of a lot of things. The most important thing for our first responders is seeing safety. Can I trust this person? If I can’t trust him, who do I go to? I’m going to go out and go hiking. I don’t really want to share this with anyone because I don’t want to look vulnerable. That avoidance and that stigma compounds our own trauma. 

Dr. Justin Clark: We have a call here. Mary is calling from Wasilla. Welcome to Line One, Mary. 

Mary: Hi. I was calling about my husband. He is actually was a 911 dispatcher and I think that something that’s not like super talked about is the mental health that they have to go through and a lot of times they’ll get a call about having to give instructions to someone about CPR or they’re having to help someone give birth from the back seat, but then they don’t know the outcome of what happened because once the first responder gets there, they hang up and they’re like “I hope that person’s okay, because I don’t know”. So I think that’s something that my husband really struggled with. It’s like he had to hear people go through suicidal ideation on the phone and then not really know if anything good came of it. 

Dr. Justin Clark : Yes. That lack of resolution is probably a thing just all by itself, not just the trauma of hearing this sort of thing, but that lack of resolution. Thank you for your call. Paul, what are your thoughts about Mary’s comments about 911 dispatchers?

Paul Gaines Jr.: Absolutely, there’s a lot of survivor’s guilt that goes on where we lend our support to someone, first responders show up, and dispatch disconnects the call. The lack of closure is something else that can be traumatizing for folks. “I don’t know what happened,” and so there’s no closure, there’s no…the circle hasn’t been complete on that call, and so those are tough. Thank you so much, Mary, for calling because folks don’t recognize and realize the impact that 911 calls have on 911 dispatchers. It’s fantastic that you called. I have not worked with any dispatchers, but I would certainly be open to that as well. Without the dispatchers, we don’t get the calls, and the dispatchers not only have to help the client, they also sometimes have to help us get to where we’re going because in rural Alaska, the caller might be giving landmarks to the dispatch and then the dispatch relays it to our driver. They have a tremendous role because without the dispatchers, we don’t get there in time. 

Dr. Justin Clark: That sort of stress that they are taking on seems to me to be a very difficult thing to handle. 

Paul Gaines Jr.: Yes and they have to be calm and not get drawn into the energy of the event and it takes a special person to do that because I don’t know a lot of folks who could listen to this call and not want to jump out of their seat and try to do more than just help that person try to stay calm and get them through the process of administering first aid before we show up. 

Dr. Justin Clark: Before we take a break, Paul, for someone like a 911 dispatcher, let’s discuss the lack of follow-up or the lack of resolution. What would be the first steps in talking to someone like this? What sort of therapeutics would you start with or recommend?

Paul Gaines Jr.: I always tell clients that therapy is doing things that are uncomfortable and unfamiliar, and if you’re doing the uncomfortable, unfamiliar thing, you’re moving away from the thing that is familiar and maybe not productive. Recognizing that we don’t have closure is difficult to identify, but that is also the most helpful aspect of my work if I were working with the dispatch. You realize you’re not going to know the outcome, and you have to find a way to be okay with that. How can I be okay with not being okay? I think that recognizing that and practicing those mindfulness exercises, when we wonder what’s going to happen, we’re putting ourselves in the future – boy, what’s going to happen? I’m nervous about what’s going to happen. If we recognize that we don’t know what’s going to happen, that’s practicing being more mindful and present in the moment. Be okay with not being okay, with what the outcome is on that call. 

Sometimes in therapy, people say, “That’s okay. Things will be okay”. Well, sometimes things aren’t okay, and we have to recognize that despite all of our efforts, we aren’t going to know the outcome, and we have to be okay with that. We have to be okay with knowing that we’re not going to know what happens. 

Dr. Justin Clark: With that, we’re going to take our first mid-break here. You’re listening to Line One, Your Health Connection. After the short break, we will continue our discussion on trauma-informed therapy for first responders with Paul Gaines, Jr. from Psychology Services of Alaska. 

Welcome back to Line One, Your Health Connection. I’m your host, Dr. Justin Clark. I’m joined today for a discussion on trauma-informed therapy for first responders, police officers, firefighters, and health care workers with Paul Gaines Jr. from Psychology Services of Alaska. 

We have a few calls coming in, and one of them looks to our next topic, which is discussing how therapy may help with common challenges such as burnout. I would like to welcome Scordino, from Anchorage, to Line One. Welcome Scordino. 

Scordino:  Hey, Dr. Clark, thank you so much for taking my call. 

Dr. Justin Clark: You’re welcome. I see you have a question, maybe about burnout? Tell us how we can help you.

  Scordino: I guess it’s more of a sort of pontificate upon because one of the things that show up repeatedly in the literature is about moral injury and moral hazard for mostly within the healthcare community, about the lack of resources that we have to provide for our patients whether it’s the lack of substance abuse options for these people – housing options, home,  healthcare options more frequently sending them back out and being like, i hope for the best because we have nothing that we can offer them from a medical perspective and what they really need is wraparound support and they frequently don’t have those resources. If it comes to moral injury that many of us experience within the healthcare community, and I’m sure that’s true for obviously other first responders as well as the police, who frequently are left wondering, what can I actually do to help this individual who truly does need help, but I have limited resources that I can truly help them with. Definitive question, but I’d be interested in your thoughts on that, and how do we move forward with that, because it does remain a persistent issue that comes up repeatedly in every single burnout, say at least, within the physician and nursing community. 

Dr. Justin Clark: Yes. Scordino, thank you for your call today. We’ll take the answer off air. So, Paul, in a healthcare setting, we struggle with this. When I take trauma calls and stuff, and sometimes people come in and homeless people or just other people, we have nowhere to send them after the hospital, and it’s like you push them off and hey, good luck. But man, that does weigh on you because you see these people come back and they go out and they fail because they don’t have the resources. They’re leading to that burnout feeling. What are your thoughts on what Scordino has to say?

Paul Gaines Jr.: Anyone who works in this field, either in the healthcare setting or as a responder, shares that pain, and it’s heartbreaking. We do the best we can, but we know that we are sending people back into an environment that’s going to cause a return of our service, a return of our needs. All we can do is the best we can. We know that Alaska is woefully short on resources for a lot of different populations, but as long as we know that we have done the absolute best we can, we’ve treated this person with the utmost respect and compassion, knowing that they’re going back into an environment that is neither compassionate nor supportive of them. For that brief moment, we can realize that we have given them – we’ve been humane to them. We’ve restored, even for a short time, their belief that kindness does exist. That’s a small consolation for a lot of us, but sometimes the best we can do is the only thing we can do, which is to offer compassion and support and ease their suffering in the best way we can, knowing that we’ll probably see them again. 

Dr. Justin Clark: You can’t always impact the system on a system level, but what you can do is impact your own care and how you treat people. So, reframing the focus on that sounds like one aspect that you would work on. 

Paul Gaines Jr.: That’s why it’s important for us to make sure that we are not becoming desensitized to the suffering of others because of the trauma that we are experiencing. That’s really where therapy comes in because it helps us restore empathy both within ourselves and the empathy that we can give to other people. But once we’ve gone to the point we are so desensitized to suffering, someone comes in, like I said before, with a minor injury, maybe we won’t be using all our resources to give them compassion and support. Maybe we’ll make a comment, “Oh really, it’s nothing, it’s just a couple of stitches. Get over it.” But for them, that could be a highly traumatizing event. Making sure that we are always empathetic for every call ,regardless of the nature of the injury. 

Dr. Justin Clark: Thank you for your call, Scordino. We have another call from Paul in Fairbanks. Paul, welcome to Line One. 

Paul: Hi. How are you today?

Dr. Justin Clark: Wonderful. How are you? What can we talk about for you?

Paul: Just caught me off guard hearing this broadcast this morning. I’m originally from Massachusetts and medically retired, in stable environment. It was 2003, I had an injury from fighting a fire that stopped me from doing what I love and in 2019, 22 years of being a paramedic, 30 years of being a paramedic [unclear] how to get my head straight and it’s nice to hear there’s someone else out there trying to look at first responders because mostly the culture is we don’t talk about what goes on in the job and a part of that needs to change. I just want to say thank you for having someone out there to help our first responders.

Dr. Justin Clark: Well, Paul, thank you for your comment today, and thank you for everything that you’ve done for all those years and all those people that you helped. We appreciate your call today. Let me ask you this first before we get to our next call. How do you deal with negative versus positive perception in first responders? Let me qualify that. You are a fireman; people are happy to see you show up. They call you and you show and you’re there to help, and maybe that’s in an EMT standpoint or putting out a fire, you know, you are kind of this hero for the moment. Then on the flip side, police officers, some people may be happy to see them, but a lot of people may not be happy, and this is a negative perception out there. Especially in the last few years. Defund the police and all of this. That must just weigh heavily on the actual police officer. How would you work with people on this negative versus positive perception?

Paul: Good question. My father was a police officer, and towards the end of his career, that’s when public shift reels badly into negative towards police officers. Honestly, that is why I chose to go to the fire department and just because I didn’t want to deal with that negative persona that goes along with law enforcement. Likely wrong, 

Dr. Justin Clark: Thank you, Paul. Appreciate that. Paul Gaines, what are your thoughts on that negative versus positive perception?

Paul Gaines, Jr.: Police have it much harder than firefighters and first responders. Recently, we have had incidents where firefighters and EMTs are ambushed, but with police, they are often referred to as the bad guys. I don’t really like that. That’s not fair. These are folks who are putting themselves in harm’s way much more regularly than firefighters and EMTs. No one has ever written a song like F the fire department. To hear that, it’s wow, it’s a heavy toll. I had not worked with many police officers. In my experience, the police officers who work are coming in primarily for family issues and not work-related issues. I think that there are also services in police departments to deal with their stressors there. 

We got to get through these stereotypes of all kinds, where they are bad and these people are good. All people are inherently good, and for police officers to be at the broken end of the bottle just because they want to serve their community and do the right thing and keep people safe, it’s tragic how people perceive the police. These are folks who want to do well, and they do do well. So the acts of the few affects the ones that I’ve seen. Even though they are coming in and talking to their families, they know that when they go to a call, is someone going to jump them, or someone going to say something to them, or try to spit on them, or do something harmful to them. Fire and a lot of first responders don’t have that, and so I think that reducing the stigma that people have against the police is something that all of us need to start doing. 

I did want to say something about Paul, the firefighter. I want to thank him for his years of service. There is something else that happens when we get injured and we can no longer do our job. That loss of purpose also exacerbates trauma, as well as our depression. So, even if someone has safely navigated their career and then they have an injury and they can no longer do it, that loss of purpose also leads to a loss of sense of self. “I’ve been doing this for 30 years, now what do I do? I wasn’t ready to retire, I’ve been forced into retirement,” and that can lead to other types of depression and other coping strategies which are not helpful. 

Dr. Justin Clark: That’s a great thought. Tina is calling from Anchorage. Tina, welcome to Line One. 

Tina: Hi. How is it going? 

Dr. Justin Clark: It’s going great. How can we help you today?

Tina: I have a role that – I work in sex crimes for seven years, but not as a police officer. I feel like my role has always been on the periphery. It’s not a job that’s ever been like, oh, thank you, law enforcement, and your EMS and your fire. Sometimes I feel like I’m a little burned out too lately, but am I allowed to be? I’m not like one of these big three, but I still like very much have work. I worked with victims for four years, and now I’m working with the perpetrators for three years. I feel like my job is kind of lost in the shuffle, and I’m like, maybe that’s affecting me a little bit more than I realize.

Dr. Justin Clark: Tina, thank you so much for your call because you are absolutely on the frontlines, and maybe you’re not one of these big three, but all of us who work with healthcare, and especially the type of stuff that you’re describing – it’s got to be very personal. Paul, any thoughts on Tina for her job?

Paul Gaines, Jr.: Tina, thank you. Sincerely, thank you. When I was an intern back in Rhode Island, I was interested in becoming a forensics counselor, and when I went to one of the in-services to listen to a man who had been working in it for 20 years, the look on his face, the burnout that he had, was profound, even though he was giving a presentation. That turned me off of that career immediately. I knew that I didn’t have the chops to handle that type of content. I had a friend who went through it, and she also burned out tremendously from that. I don’t think it’s part of the big three. I think forensic counseling for sex crimes workers is a big one. Frankly, I think if you’re feeling burned out, that’s a good place because you know that something is not working out for you. I’m always concerned about the people who don’t feel burned out, who don’t ever allow themselves to be empathetic towards the suffering of others. So, it is a big deal, and you should be feeling burned out. That’s a heavy toll. Absolutely, get yourself some help, even if it’s once a month, once every couple of weeks. I advocate for therapy, which I think everyone can benefit from, by talking to someone outside of their social circle, even if it’s once a month, just to check in to make sure that your emotional balance is still solid and that you’re still heading true north. Absolutely, get some help. You should be burned out from that position because it’s incredibly tormenting, the stories that you hear. So thank you, and definitely find someone to talk to. 

Dr. Justin Clark: Thank you for your call Tina. Now we have Stu, who is calling from Eagle River. Welcome to Line One, Your Health Connection, Stu. 

Stu: Thank you for taking my call. Anti-stress debriefing is a phrase that was used in the profession – I’m referring to ski patrol, both volunteer and professional. I experienced the one circle of professionals after we had a [unclear] and I found it remarkably helpful. I assume a lot did not continue in the profession after that and other events, but at other times, I wish we had the anti-stress debriefings. You know, [unclear] femur fractures, not enough people to take care of, screaming. Eventually, people threw in the towel because they don’t have a circle to discuss the issues. But, I just hope that that kind of process is available to first responders because you just see things repeatedly over and over, and you got to go home with that screaming. Anyhow, I would just hope that those circles are continued by professionals and fellow workers. I think they are really important, and unfortunately, they can’t afford it at a lot of places where people work. I think if they did, they’d probably keep more workers longer. Thanks for taking my call. 

Dr. Justin Clark: You’re welcome, Stu. Paul, any thoughts on Stu’s comments?

Paul Gaines, Jr.: Yes. He’s exactly right, and a lot of the fire departments are now starting with critical incident management training and so they’ll have senior officers or captains who can do some emotional triage. It’s not therapy, but it helps them get through an immediate traumatic response due to a call that just happened. I know that at Steese, we had our chaplain and myself; we’re both available at any time if a firefighter or a first responder had a bad call and needed to speak with someone. The shift captain had our phone numbers. They could call us. Some folks would rather speak to a man of the faith, and others prefer to speak to me, and again, it’s not therapy, but it helps get them through a difficult moment. The sooner someone can have those issues addressed, the less likely they are to be retraumatized in subsequent calls. The third infantry division had mental health specialists in the field; these were soldiers who went outside the wire with their patrol, and if something happened, they were debriefing before they even got back inside the wire. That helped reduce the impact of that traumatic stress. I think the more progressive first responder facilities can be in addressing those immediate traumas, the less likely they will be traumatized again. 

Dr. Justin Clark: Yes. Well, we’re going to take our second break here. You’re listening to Line One, Your Health Connection. After the short break, we will continue our discussion on trauma-informed therapy for first responders and healthcare workers with Paul Gaines Jr., from Psychology Services of Alaska. 

Welcome back to Line One, Your Health Connection. I’m your host, Dr. Justin Clark. I’m joined today for a discussion on trauma-informed therapy for first responders and health care workers with Paul Gaines Jr., from Psychology Services of Alaska. 

Paul, I want to give you a chance about some of the techniques that you use for therapy. Now, before we do that, I did want to piggyback on a comment that was made earlier about loss of empathy and compassion, and I see this personally in a healthcare setting. So, I sort of see that, either in myself or in colleagues, it’s kind of a late stage or burnout phase, and it’s like – it can be a red flag to me. Like, man, you’re jaded, you need a break because you just saw this horrible thing, and it like hasn’t… even when you’re talking bad stuff about this person. How do you approach someone who maybe has gotten to that stage where they have sort of lost empathy or compassion with their patients?

Paul Gaines, Jr.: Find time to check them on it as soon as the patient has left. Like, “hey, where did that come from? I’m noticing…” That’s one of the things you do, you notice attitude changes, personality changes, snide remarks. Sarcasm is a form of anger, but anger is a secondary emotion, and it’s usually a mask for sadness or other types of emotional pain. So, when I hear someone making a sarcastic remark, I’ll note it and say maybe that was just having a bad moment, but then if I start to notice a pattern, I’ll say, “Hey, what’s happening with you?” I think we owe it to ourselves to check our colleagues. I’m not saying running off to HR and getting them in trouble, but just doing a check-in. “Hey, are you okay? I’ve noticed you’re a lot quieter than you are. You are not making as many jokes, or you’re not coming in with the energy that you’ve have. I just want to make sure you’re okay.” We don’t do a good job at that because we know that the people coming in are far less fortunate than we are. We can kind of overlook the things that we notice in the workforce, in the workplace. Finding a time to just ask, “Hey, are you alright?” I think that’s helpful because in most cases, when you ask someone if they’re okay and they’re not, and they trust you, they’re going to start talking about stuff. Say, “Ah, well, I got things going on at home,” or “I don’t know. I just don’t feel right. I’m a little ticked off with management and what-have-you…” Give someone a form to talk and that’s really what therapy does. It’s just a form for people to open up and talk about things that are troublesome to them. 

Dr. Justin Clark: Yes. So, some of the techniques that you utilize based on the website, which is psychak.com , talk about some of the techniques you use, such as CBT, EMDR, and DBT. That’s a lot of acronyms there, so I will ask you to explain what these are and how they’re potentially useful in your therapy for anybody, but particularly for first responders. I guess let’s start with CBT. 

Paul Gaines, Jr.: CBT stands for Cognitive Behavioral Therapy. If you imagine a triangle, at one point of the triangle, you put an F for feeling, and at one a B for behavior. If I ask you what’s the creepiest animal you know, and you say it’s a spider, okay, a spider walks, and what do you do? Oh, I get up and I smash it. I kill it. Okay. So you had a big feeling and a big behavior. At the top of the triangle, there’s a T for thought. Did you think, was this really a spider, or was it me pulling a rubber spider towards you or was it a dust bunny coming up underneath the floor? If we can think through a big feeling, it might lead to a different behavioral outcome. It might be the same outcome,  but chances are it’s going to be different because the part of our brain that deals with hypervigilance and states of consciousness gets activated. That part of our brain does not care about do I have Tex-Mex or Italian for dinner, it’s in a survival mode. I either have to kill that thing or have to run away from it. The moment that we engage thought, even if for a nanosecond, that shuts off that part of our brain and allows our executive functions to take over, to make a different decision. Let’s say it’s a real spider and it is poisonous or venomous and it’s coming at you, then your killing it would be the correct decision, but more often than not, we don’t want that part of our brain to make choices for us because 90% of the time, it’s going to be the wrong decision. 

Dr. Justin Clark: So, someone’s been in a car accident or some sort of trauma that involved a loud noise, a gunshot, or like military, and then maybe every time they hear a loud noise or a clap or a door slam, it can activate that same pathway. 

Paul Gaines, Jr.: That’s right. CBT, the hallmark of this is challenging these irrational beliefs that we have, so that we can change it to a rational belief, which leads to a more rational behavioral pattern. 

Dr. Justin Clark: Okay. So that’s one of the techniques utilized?

Paul Gaines, Jr.: Yes. Folks, a lot of first responders and veterans are comfortable with it because we don’t get into the weeds of sharing our emotional experiences. It’s about – this is the problem, this is the thinking error, and this is how you can change a thinking error so you can make a better decision. A lot of folks who are adverse to therapy prefer CBT because they don’t have to talk about their feelings; they’re talking about their thoughts and their behaviors. 

Dr. Justin Clark: So it may be better for somebody who is a little bit less inclined to seek help or that sort of stereotypical therapy of lying on the couch and bearing your soul. 

Paul Gaines, Jr.: Yes. There’s no couch in my office. 

Dr. Justin Clark: Just chairs. What is EMDR?

Paul Gaines, Jr.: EMDR is Eye Movement Desensitization and Reprocessing. I actually have a lot of experience with that because I had to deal with my own trauma as a first responder. I had nightmares about this one particular call for years, and I had maladaptive ways of coping with that, and so I went to EMDR training. In order to become an EMDR therapist, you would have to go through the training yourself. I went through two 90-minute sessions with another therapist who was training, and I can talk about that scene now, but for years, that call gave me nightmares. Nightmares. Waking nightmares and sleeping nightmares, and so I understand how powerful a tool EMDR is. I can attest to that one. That was the most helpful modality that I’ve had, and I’ve had a lot of therapy. EMDR is a powerful tool. There is some screening that is required, and it’s a long process, but I’m a fan of EMDR. It’s the most helpful for me. 

Dr. Justin Clark: I guess more in a basic description, I mean, how does eye movement and desensitization sort of – what is the technique necessarily?

Paul Gaines, Jr.: You’re basically activating the left and right hemispheres of your brain alternatively. It used to be eye movement; it can also be sensory inputs on your hands, anything that activates the left and right hemispheres back and forth, back and forth, back and forth. As you’re doing that, you’re also thinking of a specific target image and an associative negative thought. We call that negative cognition associated with that. As your right hemisphere is firing off, that subconscious brings that target image into play, and you can actually relive and reexperience everything that happened in that target image. I would like to think of it as the hemispheres are the parents and the subconscious as the kid. When the parents are busy, the kid runs out the back door and plays in the yard. With EMDR, we want that kid to go out into the yard because it creates a structured dissociative event. The client is safe in the room, but they are locked into their target image, and they can see and feel and experience everything that happened in that event, and it’s a therapist’s job to remind them that they are safe. Our memories cannot hurt you. They can scare you, they can terrify you, but they cannot hurt you. You are not in any physical danger. That type of window of tolerance where 50% of that client’s existence is in the room and 50% is in that target image. Through that, they can develop a path of cognition about that event and not have that subjective unit of disturbance, which is that feeling that we get in our bodies when we are feeling traumatized or depressed. We can minimize that feeling and then replace the negative cognition with a positive cognition. So, the next time they see that image, it doesn’t affect them the way that it had in the past. 

Dr. Justin Clark: Wow. Sounds really interesting. For me, it sounds incredibly complicated and complex, but I imagine with practice and time, people can utilize this technique to reframe some of their trauma. 

Paul Gaines, Jr.: Yes. One thing that I also need to point out is that television shows and movies have done no service to the healthcare profession. People don’t get their trauma resolved in a 15-minute conversation in front of a studio audience, or your favorite character has a traumatic event, and then the next episode, they’re completely fine. Therapy is a lifestyle change, not just a behavioral change. We might have to say goodbye to things that we are accustomed to and that are familiar in our lives. It takes months and years to get through some of these things, especially if we’ve installed them and had them in our minds set for years and decades. It’s not a one-stop shop. It’s not a get-healthy-quick scheme. It’s a lot of work. Sometimes you may feel worse before you feel better. But just trust the process. The goal of therapy is not to feel better at the end of the session; it’s to feel better a year from now, 10 years from now, for the rest of your lives, and that takes a lot of work. 

Dr. Justin Clark: Yes. Debra. Debra is calling from Anchorage. Welcome to Line One, Debra. 

Dr. Deborah: Hello. This is Dr. Deborah. 

Dr. Justin Clark: Oh, I’m sorry. 

Dr. Deborah: No, it’s fine. It’s not about the name. That’s why I had to come on, and I said Dr. Deborah. I needed to share because what I heard right now, this hurts my spirit very much because that’s the thing that we’re… I listened and excellent information, I just heard about some of the things that we can do to facilitate maybe this. But, what’s so difficult is the simplicity that we couldn’t get there. I understand the 15 minutes doesn’t work, but what I know, and it’s probably not well-known enough, I worked with helping those who help others and working within facilities into military bases in Fort Louis – McChord for years. Here in Anchorage, even, we offer this within the bases, the military bases. Because the people who are doing the work, if they are raggedy, they can only deal raggedy. If they are in the facility and we would have sessions that they would come to and he’s right, it’s not a one size fits all first thing, and it’s not a you can just snap your fingers and do it or all of that, but if you are able to get some assistance and it’s right there for you within those facilities and it is promoted, they come and they get to work and they realize what they’ve missed. They find out, and they don’t know that they might be missing anything, because with everything that they can do, working is as hard as it can be, but this is exactly what they are doing: they are working. They are unable to give what is needed because they don’t even have it within them. So, helping others who are helping others is how it was working, and it worked well from the top up. The top is the one that says, Yes, we need this because we want to help people who are whole. Wholeness. We want them to have everything. We want them to have some vitality. We want them to have clarity. We want them to have those things within, and if we can promote that and provide it, then it doesn’t cost. It doesn’t cost. 

Dr. Justin Clark: It pays dividends. Well, thank you so much for your call, Dr. Deborah. I appreciate it, and Paul raises an interesting thought about mental health care for mental health care providers. 

Paul Gaines, Jr. : Yes. I’ve always told my staff we can’t provide therapy effectively if we are not in therapy ourselves because we will hear things in session that might sound eerily similar to our own experience, and then we are providing advice, and therapists don’t provide advice, we provide recommendations, and we listen. I’d like to point out, as the caller, Dr. Deborah said, raggedy.  If we aren’t buttoning it down and taking care of ourselves, our practice and our service delivery will become ragged,y and we will start to do things that are not in line with core ethical principles. So I’ve always told my staff, I don’t need to know what they talk about in therapy, I don’t need to know who their therapist is, but they better be in therapy because it will show up in their work, and I have seen it. You see it in there – people becoming a little less neat in their writing, a little more jaded, a little more sarcastic in team meetings because this job is supposed to affect you. I don’t want someone in my staff who can experience all this and not be affected, at least on some level. I want some level of empathy with my staff. We also have our own personal challenges. There isn’t a person listening today who isn’t going through their own little hell or big hell. Find someone to talk to, even if it’s once a month, and for my staff, a little more regularly would be helpful. At least once every two weeks because even as a supervisor, I’m not their therapist. Even my friends, my partner, I’m not their therapist. I tell her, go talk to someone. I love you, but I’m not your therapist. Find a therapist, and I don’t need to know what you’re talking about. So, we need to be especially focused on our wellness if we’re in this field. 

Dr. Justin Clark: Yes. That would go under self-care care and I think we just have 2 more minutes here, Paul. What are your thoughts on getting therapy for yourself in these situations of self-care? Any recommendations on self-care for people before we have to close up here?

Paul Gaines, Jr.: For me, self-care is woven into the fabric of my day. It’s not something I do once a week. “Oh, my self-care, I’ll go yoga or I’ll go for a run…” I try to incorporate self-care in between sessions. I have some stress relievers in my office. I’ll work out or go for a walk around the office or around the building. It’s something that we have to do perpetually every day as often as we can. If we’re not caring for ourselves, how can we honestly care for other people? This might sound selfish, but we need to be the most important person in our lives so that we can then  be there for everyone else in their lives. If we’re not squared away, then we can be ineffective in lending support to the people we love and especially to our clients and to our fellow first responders. 

Dr. Justin Clark: Absolutely. Thank you, Paul. We have about 1 minute left. I want to give you an opportunity to make any closing remarks to our listeners, any thoughts that you would like to get across to people, and also, what are the resources we could use if someone wants to talk with you?

Paul Gaines, Jr.: I’m available at Psychology Services of Alaska, and for first responders, there’s a great book out there called Fit For Off-Duty by Peter Salerno. He is the son of a firefighter. He is a therapist in California, and it’s a short read, it’s an easy read, but I found it to be one of the most helpful books that I can refer out to other people. It’s called Fit For Off-Duty because we need to be sure that we are fit when we go home to be with our families, not just fitness for duty, but fit for off-duty, so I think the title is remarkably appropriate, and I just want to thank all the first responders out there. There is help for you. Don’t wait until it’s too late to ask for help. 

Dr. Justin Clark: All right. With that, special thanks to our guest for being with us today, Paul Gaines, Jr., from Psychology Services of Alaska. That’s psychak.com 907-531-8149. Thanks to our audio engineer, Chris Hyde, and our Producer, Madeleine Rose. You can find more information on this in previous programs on our website at alaskapublic.org . This program will also be available on-demand through Apple Podcasts, Spotify and Amazon Music. Let us know your thoughts or suggestions by emailing us at lineone@alaskapublic.org . 

This has been Line One, Your Health Connection. I’m your host, Dr. Justin Clark. Stay healthy, Alaska. 

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