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00:00:04.833Welcome to the CopDoc podcast.
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00:00:10.473This podcast explores police leadership issues and innovative ideas.
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00:00:19.449The CopDoc shares thoughts and ideas as he talks with leaders in policing communities, academia and other government agencies.
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00:00:29.975And now please join Dr Steve Morreale and industry thought leaders as they share their insights and experience on the CopDoc podcast.
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00:00:32.926Hello again everybody.
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00:00:37.529Steve Morreale coming to you here in Boston and we are on a bi-coastal conversation.
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00:00:40.249I have Stephanie Kahn, dr Stephanie Kahn.
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00:00:43.529She is in Beaverton Oregon today, so hello there.
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00:00:44.371Hi, how are you?
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00:00:45.604I am fine, thank you.
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00:00:46.865I found you on LinkedIn.
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00:00:51.067It seems to be the way to do it, and one of the ways I found is that you police officer.
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00:00:52.359Now you're a police psychologist.
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00:00:56.826You've written a book on resiliency and it really drew my attention, especially, stephanie.
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00:01:05.971With what's going on in our world and the threats that are pushed upon police officers the things you see, the things you can't unsee there are certainly a number of stressors.
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00:01:08.734So I wanted to get you on and thank you for coming.
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00:01:18.087I wanted to ask you to tell the audience about how you got involved in this, how you came from policing to psychiatry?
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00:01:18.668Yeah Well, psychology, yeah.
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00:01:20.793I was the daughter of a police officer.
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00:01:29.000My dad was an officer for almost 40 years, so I grew up in a household seeing the impact that first responder work had on the first responder and their family members.
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00:01:34.224Then I became a dispatcher, call taker, did that for three years, then became an officer, did that for nine.
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00:01:43.590And when I was an officer and I was an officer for Fort Worth police in Texas one of my coworkers was shot and killed in the line of duty and I became a peer supporter.
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00:01:48.024And because I wanted to be a peer supporter and another coworker of mine got killed.
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00:01:51.743Before we continue in our conversation, we're talking with Dr Stephanie Kahn.
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00:01:55.358She is in Beaverton Oregon right now and a police psychologist.
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00:01:56.903My mistake about psychiatrist.
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00:01:59.391I'm sorry about that, but but you were.
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00:02:05.510You were talking about two horrible things that happened in your life Offic officers who have been shot and killed.
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00:02:08.105That's where you were, so talk about that in Fort Worth.
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00:02:14.512So the second officer that was killed in the line of duty was actually hit by a drunk driver and tracked and burned alive in his car.
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00:02:25.187And so I was a peer support team member at the time and between one officer being killed and then a year later another one being killed, we had had a changing of the guard from a police psychologist to a city psychologist.
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00:02:34.623So we had someone that actually understood policing to someone that understood psychology and counseling, certainly, but didn't have any specialized training in working with first responders.
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00:02:53.507And so when I was supporting people as a peer supporter, they were wanting to have someone that actually understood them and the profession and the unique challenges first responders face, and I couldn't find anyone when I looked out there to try to see who to refer them to, and I had people wanting very specific help to their work and not just wanting to talk to anyone.
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00:03:09.906So I made the very difficult but well considered choice of stepping out of policing to get my counseling doctorate so that I could come back and help my brothers and sisters, not just in policing but in other first responder professions, because I felt like I had the cultural competency to do it.
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00:03:10.907I dispatcher as a call taker.
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00:03:27.467As a police officer, you know you were engaged to a firefighter.
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00:03:39.453You're married to another police officer, so it gave people the confidence to see me and so I never got to return to policing because my practice as a clinician has been so busy since I opened it.
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00:03:40.474Why do you think that is.
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00:03:42.062Let's just talk about that for a moment.
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00:03:48.453I understand you know, having been in the business for 30 years the importance of if I'm going to take my clothes off.
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00:04:01.824I want the person on the other end to understand what I go through, to understand the stressors, to understand the difficulties that come from the organization itself sometimes, because sometimes we eat our own and how important that is.
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00:04:22.973I'll say this One of the things I'm beginning to talk about and hear about across the country is the move towards a concept called a checkup from the neck up, in other words, a required sit down with a psychologist or a psychiatrist on a regular basis, which sort of melts away that negative feeling that so many people have about mental health counseling.
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00:04:23.822So talk about that.
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00:04:24.584Talk about that.
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00:04:26.793Yeah, I mean there's two, two pieces there is.
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00:04:34.141One is you know, if you're going to psychologically take your clothes off, so to speak, you don't want to have to be explaining your profession to other people.
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00:04:38.021You need someone to give you something you know don't need to be giving to someone else.
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00:04:44.874And if you're having to educate other people on your job or explain why you do what you do or how the organization does whatever it does, then it's more.
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00:04:57.947It takes more away from the first responder than it gives them, at least initially, and so you want someone that is already up to speed or fairly up to speed, so they can kind of start from where you are and move forward and help you move through things.
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00:05:16.401The checkup from the neck up I think there's a lot of value in that and I do that for a lot of agencies I work with because it takes away that threshold where I got to be a certain level of screwed up I got to be hurting in a bad way before I ask anybody to check in with me, but rather make it more.
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00:05:25.610Hey, we don't wait till there's smoke bellowing out of the hood of the car before we check the oil or check the other fluid levels or these kinds of things.
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00:05:32.105We should probably get ahead of it and do something, because it's easier to do that with a car and do that with a person than it is.
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00:05:34.312Try to deal with it once it becomes damaged.
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00:05:36.326So let's talk about that if you don't mind.
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00:05:57.447Confidentiality, I know, is important, but when you do a checkup from the neck up and you walk into the organization presumably in many organizations the first time that's happened how much time do you have to spend to talk about why you're doing it in the first place, what you're trying to allow that person male or female first responder to talk about, to sort of vent and to purge?
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00:06:00.333You know, my sense is you and I spoke about in the beginning.
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00:06:06.641Here we are talking on 9-12 and 9-11, it hits me because I brought a team down to New York.
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00:06:13.690I did not suffer half of the problems that so many of my colleagues did there, but being there unto itself was something I can never erase.
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00:06:16.100What I saw, the pain and the suffering, the death and such.
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00:06:21.653But I wonder how much time you have to spend to explain to somebody that I'm here for you.
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00:06:22.963We're here to help you.
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00:06:27.685The cumulative effect of stress can burn somebody out, so talk about that.
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00:06:36.622Yeah, and I'm pretty lucky Well, I say lucky it's by design and the agencies that I work with as I try to introduce myself or others introduce me.
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00:06:39.408Because I work so closely with peer support team members.
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00:06:53.223They will introduce me to their peers as someone that they trust, someone that has been one of them at some point, and so it takes a lot of the work away from me of building that rapport, because I've built that rapport with the peer supporters.
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00:07:03.721Or I will go to the roll call and sit beside the sergeant at the roll call at 11 o'clock at night which is not banker's hours or clinician hours, if you will, and that says something.
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00:07:29.413I'll come out to the station at 11 o'clock at night or six in the morning, or sometimes both on the same day, which is horrible and just introduce myself and just shoot the breeze with them and that allows them to feel a bit more of a trust that this is not the normal situation where you just go see a clinician and then I spend a lot of time talking about confidentiality, claiming that I don't keep notes on these wellness checks.
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00:07:30.334I don't write notes.
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00:07:48.134I don't write notes afterwards If I bill the agency, and I do, and I think 100% of the cases of these wellness checks depending on the agency contract sometimes they don't even know who had the wellness appointment or in cases where they're incentivized where they get paid, then I'll be I have to let their employer know so they can get their incentives paid for it.
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00:08:00.002But there's nothing else shared with them and I think some of that takes away some of the fear that there's going to be something recorded that's going to get them at some point or cost them a promotion or some other kind of scenario.
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00:08:13.497And so I think there's a bit of work put in through the relationships I build, through the transparency of the process, not acting in manners that are consistent with their expectations, which is an old hostage negotiation trick, if you will, or tactic.
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00:08:21.841It's not a trick of just showing up at odd times to be there for people or doing ride along part of how all that works, that breaks down the barriers.
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00:08:25.507I can see that and I recognize why that would be of great value.
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00:08:26.750So you've written a book.
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00:08:31.644I see it behind you Increasing Resilience in Police and Emergency Personnel Resiliency.
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00:08:32.846What's that all about?
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00:08:33.750Yeah, and that's.
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00:08:37.486I wrote a mental health column for a police magazine for about three and a half years.
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00:08:43.927So every month I'd write like a page on sleep or improving communications or dealing with secondary traumatic stress, that kind of business.
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00:08:50.523And I had many people readers from that magazine send me emails saying, hey, this resonated with me, that resonated with me.
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00:08:52.528You should put this all together in one place.
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00:09:01.267And then my research for my master's and my doctorate was about what helped people deal with their exposure to trauma, what helped people maintain a life outside of their work.
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00:09:11.705And so I thought and then my work as a peer supporter and working with peer supporters I thought I really should put this all together and treat resilience, as I see it, as an officer safety tool.
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00:09:33.469Because when you go to a call whether you're a police officer, firefighter, but let's just use the police example when you go to a call, you're assessing what your risk factors are, what kind of assists you need, how you need to respond to things, because you're constantly assessing what the threats are and making adjustments to your response based upon that, but you're also assessing your protective factors.
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00:09:34.572Do I have an assist with me?
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00:09:35.522Do I have a perimeter?
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00:09:36.163Do I have a dog?
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00:09:36.705What do I have?
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00:09:38.450And making moment-to-moment decisions.
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00:09:48.567If we treat our resilience in a similar fashion and saying what's working for me, what's not working for me, okay, I'm not exercising, I'm not really connecting with my significant others, I need to shore that up.
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00:10:06.523If we treat it like that, we tend to be safer psychologically, which is our resilience, if we are remaining aware of what's working and what's not working for us in our life just like we would on a call.
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00:10:10.019As you're talking new clients I suppose the fact that you have a relationship with an organization in many cases and you know, the big piece in policing is a vouch.
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00:10:12.004When you get a vouch, you're okay.
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00:10:13.206How is this, stephanie?
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00:10:16.352She's okay, you can trust her, she understands, she knows.
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00:10:19.809I think in a lot of ways, cops love to cut right to the chase.
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00:10:22.684I'm not looking for flowery stuff, just here's the story.
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00:10:23.523You want to hear it?
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00:10:24.044This is it.
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00:10:27.480I don't know how it's affecting me, but I'll tell you what I'm feeling.
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00:10:28.282And I'm sure.
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00:10:28.602I mean.
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00:10:36.168Your job is eliciting feelings and thoughts through questions in a lot of ways, and so talk me through that.
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00:10:42.533Somebody comes to you, not just for a checkup, but for some person who might be in crisis, it's me today.
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00:10:46.101How do we start that conversation?
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00:10:57.767And the reason I'm doing this I'm asking you this, stephanie is because so many potentially listeners have balked at talking to somebody, and so I'm trying to, through you, to have people understand that this is not a bad thing, properly executed.
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00:11:21.373Yeah, I mean, that's the thing is that again and I try to draw parallels between my work as a clinician to my work as a police officer, in that if they come in and say, hey look, this is what I'm not sleeping, I'm irritable my spouse or significant other says that I'm withdrawn or I'm being a jerk or what have you, then really my work as an assist to them is to say OK, so how did this start?
00:11:21.373 -->
00:11:25.490You know what happened here and how do we figure out what you do about it?
00:11:25.490 -->
00:11:34.792And to fill in the blanks on the information they might not have as to why they would be having, why their brain keeps sending them images of that dead kid, they know that the event is over.
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00:11:38.659Why is their brain sending them reminders or physical anxiety, that kind of stuff?
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00:11:58.235So my work is really trying to help them understand why certain things are happening and what to do about it and to take the weakness element out of it, but really to recognize that it takes pardon my French a lot of fucking strength to face things that you'd rather just shove down.
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00:12:09.352It takes a lot, you know, and I oftentimes say there is no courage without fear, and it takes a lot of courage to do what you do and to push through it and it's okay.
00:12:09.352 -->
00:12:17.499That's kind of how it would start out is just trying to figure out what's going on and what do we do about it and why is it happening.
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00:12:39.221And help them to understand why it's happening, because I think a lot of times the answer, the default answer, is it's happening because I'm weak, it's happening because I'm broken, it's happening because something's wrong and I can't handle it anymore, versus really recognizing that a lot of the symptoms people have is survival brain kicking in and trying to help them and send them all these signs and symptoms so they will address it.
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00:12:43.244Just like a headache tells you something's going on in there, you need to address it.
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00:12:47.155Some of these quote unquote psychological symptoms are doing the same thing.
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00:12:50.211That's an interesting perspective that I've not often heard.
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00:12:54.061So thank you for sharing that, and I'm sure the term you used earlier was a clinical term.
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00:12:58.581I'm sure you learned it at school or in policing or whatever it was.
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00:13:13.962I appreciate the honesty and I think that's so important because part of what I think it is look, police officers, firefighters, emts are called into situations at the worst of time and, as I said before, so often you don't have a choice.
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00:13:27.216But once you see it, it's very hard to unsee and I think the strength in us and in some cases this is a guy oriented piece, not that it couldn't be for women, but the guy sometimes will think look, this is my job, I have to do it, suck it up, buttercup, whatever that is.
00:13:27.216 -->
00:13:32.640But let's talk about the cumulative effect that we start hearing a lot.
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00:13:33.975Is there such a thing?
00:13:33.975 -->
00:13:38.761It's almost like you're going to die from a thousand paper cuts, the old adage.
00:13:38.761 -->
00:13:41.476Is that real?
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00:13:43.039Okay, so talk about that.
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00:13:53.370Yeah, and it has so many names, and Ellen Kirshner referred to it as death by a thousand cut, and it's also referred to as the pyramiding effect, where it's just like at the bottom of the pyramid.
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00:14:00.278You know, year one, here's all these traumas kind of building up at the bottom of the pyramid, and then year two, five, eight, 10, 25.
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00:14:14.701And I have some people that are quite surprised that when something forms the tip top of their pyramid in year 20 or 15 or what have you, that it lights up everything that occurred underneath and they're like why am I losing my shiz over this call that I handled 10 years ago?
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00:14:18.177Why am I seeing the images of this person that had that or whatever now?
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00:14:46.322And I said that's because it's basically broken open some of those trauma membranes and because it's unfinished business, right, and it's almost like that's why we have this cumulative and we know that the cumulative is the real deal because it's talked about in our diagnostic manual is this chronic exposure to the suffering of other people, and it is more often the case of post-traumatic stress or post-traumatic stress disorder than that singular event, and they call it the dose effect.
00:14:46.409 -->
00:14:50.902The greater the dose, the greater the effect, and so it's not uncommon for me to see that.
00:14:50.902 -->
00:14:58.556In fact, it's rare that I see a singular event be someone's reason for coming in, unless you're mandated, you know, for like a critical incident or what have you.
00:14:58.556 -->
00:15:03.667And so I say, okay, we're going to go to that first one, because I do trauma treatment, so I do EMDR.
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00:15:16.418We're going to go to that first one and we're going to work on that with EMDR, and maybe some of the other ones are going to come up, and that's all right, we're just going to put those on a shelf, we'll come back to those and we're going to systematically knock them out, which sounds really absolute.
00:15:16.418 -->
00:15:18.261But EMDR is pretty impressive.
00:15:18.261 -->
00:15:22.912It's pretty good at taking out the reminders of specific traumas, can you?
00:15:22.972 -->
00:15:23.995talk about that for a moment.
00:15:23.995 -->
00:15:26.673I've heard that a number of times, but never from a clinician.
00:15:26.673 -->
00:15:27.397What does that mean?
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00:15:27.979Emdr.
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00:15:30.691Yeah, that's a lot of psychobabble, it's a lot of mouthfuls.
00:15:30.691 -->
00:15:32.513So EM stands for eye movement.
00:15:32.513 -->
00:15:35.518So when we go to sleep at night we have REM sleep.
00:15:35.518 -->
00:15:37.841If we're lucky, we have to get some decent REM sleep.
00:15:37.841 -->
00:15:44.376Rapid eye movement, and so that's when our eyes are moving back and forth spontaneously and they're processing the drama and the trauma of the day.
00:15:44.376 -->
00:16:00.297What happens is we don't always get good sleep when we've had really significant trauma or we've got shift work or other kinds of things going on in our life, and so our brain doesn't get to continue with its process of rapid eye movement, sleep, so processing drama and trauma.
00:16:00.297 -->
00:16:04.115So stuff gets stuck in our brain in an incomplete, unfinished state.
00:16:04.115 -->
00:16:10.534And so what we do when you're awake as an EMDR clinician is, I say okay, steve, I want you to focus on.
00:16:10.534 -->
00:16:12.681What is the image of the thing that's most disturbing?
00:16:12.681 -->
00:16:13.510Okay, name it.
00:16:13.510 -->
00:16:14.212All right, that's it.
00:16:14.273 -->
00:16:16.099What's the negative belief you have about yourself?
00:16:16.099 -->
00:16:23.123And sometimes it, you know, I didn't do well enough or I'm weak because of this response, and other times I'm weak because I continue to have this effect.
00:16:23.123 -->
00:16:26.679So sometimes it's an operational critique and sometimes it's a psychological one.
00:16:26.679 -->
00:16:27.160All right.
00:16:27.160 -->
00:16:29.335So there's the image, there's the negative belief.
00:16:29.335 -->
00:16:31.317What physical sensations do you notice?
00:16:31.317 -->
00:16:35.681You know I've got this pain in my chest, knot in my throat, tightness in my jaw, pit in my stomach.
00:16:35.681 -->
00:16:37.062Okay, usually in the midline.
00:16:37.062 -->
00:16:38.982And then what emotions do you notice?
00:16:38.982 -->
00:16:40.864Okay, anger, frustration, blah, blah, blah.
00:16:40.864 -->
00:16:41.164Okay.
00:16:41.245 -->
00:16:43.885So then I just say I don't want you to focus on all of those pieces.
00:16:43.885 -->
00:16:58.456I'm basically taking all the pieces of the trauma and I'm having them do the eye movement back and forth while they and just, let us just let your mind go wherever it goes and I can do this in person or virtual, it doesn't, it doesn't make.
00:16:58.456 -->
00:17:13.364When you're doing the eye movements, then it helps the brain process the trauma and D the EMDR, the D is desensitizes you to it, so you're no longer traumatized by it, it doesn't have the same physical effect that it has before.
00:17:13.364 -->
00:17:45.199And then, as you reprocess it, it becomes something that becomes more in the past, rather than feeling very present for you and any negative belief you had about yourself, about being weak or not having done something properly on an operational level, you reprocess it as I did the best I could, or you know I can be better now, or I can heal from this or something else that is more adaptive and it is so incredibly effective and so fast compared to, say, talk therapy, because it goes into the subcortical regions of the brain where the trauma is stored.
00:17:45.318 -->
00:17:48.394But it's become the treatment of choice for first responders and people in the military.
00:17:48.394 -->
00:17:55.647There's actually books on it, emdr for first responders that outlines the protocols for specifically working with it.
00:17:55.647 -->
00:17:58.413I've been doing this for 11 years, day after day, and have.
00:17:58.413 -->
00:18:03.582Yet, whether you believe it works or you don't believe it works, your brain knows that it works and so it works.
00:18:03.882 -->
00:18:06.050I appreciate the lesson because that's pretty important.
00:18:06.050 -->
00:18:10.971I've heard some people who have had some very good experiences in that, so thank you for sharing.
00:18:10.971 -->
00:18:13.837And now I know what EMDR means, and so do the listeners.
00:18:13.837 -->
00:18:27.815And as you were talking, a trauma cap it's the first time I'd heard that, because I speak in terms of boxes that we put little things in lock boxes, which is probably the same thing and sometimes, at the strangest times, these little things leak.
00:18:27.815 -->
00:18:36.579Sometimes it's fatal, sometimes it is a suicide, sometimes it is a murder, it's a rape, whatever it might be, sometimes it's 9-11.
00:18:36.579 -->
00:18:49.173And so it seems to me I mean just from my own experience and your own experience for the listeners that I think coming to the realization that these do have impact on you, whether you'd like them to or not.
00:18:49.173 -->
00:18:53.791They have a long lasting impact and they'll show up sometimes when you least expect it.
00:18:53.791 -->
00:18:55.958So what am I saying as I'm talking?
00:18:55.958 -->
00:18:57.382What are you hearing as I'm saying that?
00:18:57.382 -->
00:18:59.998How would you explain that to somebody coming to you?
00:18:59.998 -->
00:19:00.941Who would say that to you?
00:19:05.430 -->
00:19:06.474Yeah, I would say there's some level of that.
00:19:06.474 -->
00:19:17.154That makes sense because and we know this from looking at what happens in retirement is sometimes we're so busy being outwardly focused, handling that, call the situation, that family demand, whatever that when you shove stuff down, there is no space for it to come back up.
00:19:17.154 -->
00:19:33.261But then other times, when you're off on admin leave because you've been involved in a shooting, you're off on injury leave or that kind of stuff, it almost like you create an opening for these things to be able to pop up and or something will activate it, like a date, an anniversary of something or a memory of something.
00:19:33.261 -->
00:19:37.153And so then it pops open and you're like, oh crap, what is that?
00:19:37.153 -->
00:19:38.556Why is that coming up now?
00:19:38.957 -->
00:19:54.894And so, again, we know that that happens and so I don't want people to be freaked out by it to think, okay, this must mean I'm coming unraveled, because we have so many ways of saying you know I'm losing it, or this broke down or that kind of stuff, and it's like you didn't break down, you didn't come unraveled.
00:19:54.894 -->
00:20:00.102Trauma popped up either because it had the opportunity to, or something popped open.
00:20:00.102 -->
00:20:01.904Popped open that, yeah, that member in it.
00:20:01.904 -->
00:20:06.170People hate the word trigger because they're like oh, everybody's triggered about everything and needs a tri-closet.
00:20:06.691 -->
00:20:21.163No there's actually yeah, there's validity to these things being activated and so, instead of being mad that it happened or being alarmed or making it worst case scenario, okay, so that just needs, that needs to be dealt with.
00:20:21.163 -->
00:20:23.233That is something that you need to deal with.
00:20:23.233 -->
00:20:29.519It's almost like if, been so busy doing something else, you didn't notice your elbow hurt and then finally you're not busy doing something.
00:20:29.519 -->
00:20:31.734You're like, oh gosh, my elbow does actually hurt.
00:20:31.734 -->
00:20:37.596It's been there all along, you've maybe just not, it's not come to the surface until it did and then deal with it.
00:20:37.737 -->
00:20:40.682I don't mean to downplay how hard it is to deal with it.
00:20:40.682 -->
00:20:43.315I just even remember my own traumas as an officer.
00:20:43.315 -->
00:20:48.934You know an auto ped of a pregnant, visibly like seven, eight month pregnant, woman and she's.
00:20:48.934 -->
00:20:54.134You know I wasn't even dispatched to it, I just rode up on it one week on my own, just barely out of training.
00:20:54.134 -->
00:21:06.115And I just ride up and there's this woman dying on the ground and her 11 month old wasold was a few feet away, been thrown from the stroller she was pushing when she was hit and her mom screaming the most horrible, blood-curdling screams.
00:21:06.115 -->
00:21:08.200I had images of that, right, I had.
00:21:08.200 -->
00:21:11.355I'm not saying meaning to downplay the horrificness of.
00:21:11.355 -->
00:21:17.279That's a word, but there's remedies, there's ways to address this if you have someone that's trained in trauma.
00:21:17.460 -->
00:21:18.760So we're talking to Stephanie Kahn.
00:21:18.760 -->
00:21:24.586She is a police psychologist and she's out in Oregon former police officer and I apologize if the audio isn't perfect.
00:21:24.586 -->
00:21:32.392My board is not working 100 percent, so we're using this through the technical drills of cell phones.
00:21:32.392 -->
00:21:46.086So all of the players that you engage with that, I suppose, would be clients at this point, patients, whether it's fire, police or EMS how do we overcome, how do agencies overcome, the stigma of mental health counseling?
00:21:46.145 -->
00:21:59.773Because I think for so many the fear is, if I admit, I'm going to lose my gun, I could lose my job because of it, and it seems to me that we need to do a much better job of overcoming that stigma, helping people and letting them back on track.
00:21:59.773 -->
00:22:03.859So I'm sure you're playing a role in that, but what's your thought on that as a former officer?
00:22:04.019 -->
00:22:15.355Yeah, and I think again it comes down to the relationships I have with the peer support teams that I'm attached to, that I see on a quarterly basis and talk to on a regular basis, you know, because they can text me anytime or call me anytime.
00:22:15.355 -->
00:22:23.281Obviously, when I'm with clients my phones are silent but and so it's the relationship I have with them that they in turn are able to share with the peer that's struggling.
00:22:23.281 -->
00:22:47.942But then it's also the ride along's the myths about confidentiality and the things that would cause a first responder to fear, because a lot of them think that because of the confidential nature of what it is we do, they think other people aren't getting help or that other people that are.
00:22:47.942 -->
00:23:03.871I'm like gosh, if I could just break confidentiality and tell you five of your peers were in a bad way and came to see me and maybe were even suicidal at some point or abusing substances or whatever, and got help and never lost their job.
00:23:03.871 -->
00:23:11.118But the secrecy of that because of confidentiality is a bit of a disservice to the stigma of like.
00:23:11.159 -->
00:23:17.641I remember there was one agency I was at and they were just like, oh, this person really needed help and blah, blah, blah and no, but nothing happens.
00:23:17.641 -->
00:23:18.663And for these people or whatever.
00:23:18.663 -->
00:23:20.885And I was at and they were just like, oh, this person really needed help, and blah, blah, blah and no, but nothing happens for these people or whatever.
00:23:20.885 -->
00:23:30.540And I was just sitting there thinking, yeah, actually they did get help and I happened to know what happened and they were taken to the hospital and through the back doors and received support and then when they were released they came to me.
00:23:30.540 -->
00:23:33.365So that's the thing is the secrecy of all this doesn't help.
00:23:33.445 -->
00:23:43.624It's an interesting thing because there are some first responders who are trying to take an active role in debunking those myths by saying, hey, I got help, I didn't lose my job, I got help.
00:23:43.624 -->
00:23:49.229It not only did I not lose my job, but it actually made me better at my job and I promoted and it saved my marriage.
00:23:49.229 -->
00:23:53.182And so some first responders are taking an active role in that.
00:23:53.182 -->
00:23:56.891And then I remember one of the last ride-alongs I did before COVID.
00:23:56.891 -->
00:24:07.730I got to sit with officers at dinner on the ride-along and answer questions they had about confidentiality, because they thought that sessions were recorded and stuff was reported back to their agency.
00:24:07.730 -->
00:24:09.722There's just a lot of misinformation.
00:24:09.722 -->
00:24:13.721I was like I actually started laughing and I said oh my God, no, no way.
00:24:13.923 -->
00:24:15.790Can you talk about the pink sheets?
00:24:15.790 -->
00:24:17.057You use the pink sheets.
00:24:17.057 -->
00:24:20.005What I don't in our state I may be wrong.
00:24:20.005 -->
00:24:26.625In our state any psychological or psychiatric discussions are on pink sheets, so any notations are on pink sheets.
00:24:26.625 -->
00:24:28.349You don't do that in oregon, so what?
00:24:28.390 -->
00:24:30.102happens, is I want to explain why.
00:24:30.102 -->
00:24:37.050Because when I was with hhs, I was in with the inspector general's office and we had walked into a place and I had to seize there was a fire.
00:24:37.050 -->
00:24:37.902There was a fire.
00:24:37.902 -->
00:24:44.683It killed nine or ten people, all medicaid recipients, right, and the smell of the smell of burned bodies was horrible.
00:24:44.703 -->
00:24:54.963But I brought my troops there and the first thing I wanted to do is to seize all rec and the nurses intervened, said you can't seize the pink records because those are psychiatric and psychological records.
00:24:54.963 -->
00:24:59.614And I said, indeed I can, but you'll be here when I go seize them, when I seal them, and they will be.
00:24:59.614 -->
00:25:01.106They will be going to a judge.
00:25:01.106 -->
00:25:03.398The judge will determine whether or not we can see it.
00:25:03.398 -->
00:25:08.090Maybe we have to hire a psychiatrist to do that, but anyway, that protected that.
00:25:08.090 -->
00:25:08.700That's what I'm saying.
00:25:08.700 -->
00:25:17.736There was that extra layer of protection, and so I think that's important, that confidentiality side that you experienced and, as a clinician yourself, you're not going to give that up.
00:25:17.736 -->
00:25:19.098You're not going to give up your records.
00:25:19.098 -->
00:25:20.142You're shaking your head.
00:25:20.142 -->
00:25:21.849I can see you, so talk about that.
00:25:22.050 -->
00:25:23.819You know, I mean I hope it will allay fears.
00:25:23.960 -->
00:25:25.806just to explain that it's important.
00:25:25.885 -->
00:25:30.544Yeah, I mean we have HIPAA, so you know the Health Information Protection and so Portability Act.
00:25:30.544 -->
00:25:34.289Yeah, there are significant protections for that information.
00:25:34.289 -->
00:25:57.307I have even had people and it's very, very rare, it's usually in a workers' compensation case where they have subpoenaed records, and the case law is there that says even in a subpoena case which again the client usually consents to the release of this information I can come back and say well, some of this isn't work-related, so we can redact some of it that isn't specifically work related.
00:25:57.307 -->
00:26:01.907So let's just say, fake name client Bob had been sexually abused as a child.
00:26:01.907 -->
00:26:09.692He disclosed that when he talked about his history and he recently was involved in a shooting where he was shot or whatever.
00:26:09.692 -->
00:26:17.804Well, his sexual abuse as a child has nothing to do with him having been shot later on in the line of duty or being in shooting or whatever the case might be.
00:26:18.005 -->
00:26:28.239And so I have the ability in the case law to redact that and say that is actually not pertinent to this and so there are those kinds of protections.
00:26:28.239 -->
00:26:34.573But even when I get involved with things like workers' comp cases, I educate clients from day one.
00:26:34.573 -->
00:26:36.048I mean very first session.
00:26:36.048 -->
00:26:40.145This is not confidential because you've asked and you've signed that away.
00:26:40.145 -->
00:26:52.650You have to do that, so I want you to bear that in mind as we talk about and think about what you're talking about, because I want you to be in control of what information is contained here, so you'll attempt to limit what they talk about.
00:26:52.730 -->
00:26:55.780So does that mean that's an interesting thing that I'd never heard?
00:26:55.780 -->
00:27:08.950Does that mean I come to you on a workers' comp and I come to like your style, your approach, your likability, your approachability, and so we start kind of walking in a different area about what makes me tick?
00:27:09.009 -->
00:27:10.911You're saying I don't want to deal with that.
00:27:10.911 -->
00:27:13.752You don't have to Remember that you're signing it over.
00:27:13.752 -->
00:27:15.534Is there any way for you to sever that?
00:27:15.534 -->
00:27:21.597Or would I then have to go to another clinician to talk about what makes me tick, as opposed to why I'm sick or why I'm out?
00:27:21.759 -->
00:27:24.847And I'm not saying no, I wouldn't say you need to go see someone else.
00:27:24.847 -->
00:27:30.151But even workers comp won't, doesn't want to foot the bill for your relationship issues, right, so it all has.
00:27:30.151 -->
00:27:31.481I mean that just kind of makes sense.
00:27:31.481 -->
00:27:57.243So even not just protecting the client, but then also being aware of what I'm hired to be treating as well and so, but it's really all again, transparency is super important for the trust for them to understand, because I did have an instance where a person had been sexually abused as a child and he was quite embarrassed by it and I said and then he wanted to later talk about signing a release for stuff, and I said, no, you put that in writing.
00:27:57.243 -->
00:27:58.105Do you understand?
00:27:58.105 -->
00:28:02.611If you sign this stuff that's going to be released, I'll do whatever you want me to do.
00:28:02.671 -->
00:28:03.231But is that?
00:28:03.231 -->
00:28:10.566You know I do have to give the initial intake paperwork that's requested, and so he could make an informed decision on what was best for him.
00:28:10.566 -->
00:28:17.002So, yeah, it's all about, but also being thoughtful about okay, I still need to know, understand the person in context.
00:28:17.002 -->
00:28:21.025We can't we can't, sever the personhood from the event either.
00:28:21.025 -->
00:28:25.188And so you know, just knowing that a workers' comp case, or has the potential for that.
00:28:25.188 -->
00:28:26.648I'm just very thoughtful.
00:28:26.648 -->
00:28:33.073I don't mean to sound like I'm doctoring records or that kind of business, but I'm conscientious about how records are kept.
00:28:33.532 -->
00:28:37.256And what can be released and what might be released, and how it might harm somebody.
00:28:37.336 -->
00:28:37.675We're talking to.
00:28:37.695 -->
00:28:38.276Stephanie Kahn.
00:28:38.276 -->
00:28:39.517She's in Beaverton Oregon.
00:28:39.517 -->
00:28:48.851She is a police psychologist, but really not just a police psychologist, I would say a first responders psychologist, and so we talked a lot about police but fire and EMS.
00:28:48.851 -->
00:28:52.242Are there as many problems I don't mean problems with coming to see you?
00:28:52.242 -->
00:28:56.171Is there as much reluctance in fire and EMS as opposed to police?
00:28:56.813 -->
00:28:59.818Is there as much reluctance in fire and EMS as opposed to police?
00:28:59.818 -->
00:29:02.925Yeah, fire, ems, corrections and dispatch all the same, and less about.
00:29:02.925 -->
00:29:06.392I'm going to lose the ability to carry a weapon, but I'm still.
00:29:06.392 -->
00:29:12.326I'm going to lose my job, or this is a sign of me being weak, this is a sign that I can't handle the job.
00:29:12.326 -->
00:29:42.851You know, because there's this historical mantra this is what you signed up for, Right and so, even though there might not be the same level of pre-psych or fitness for duty, in the other categories of first responders there's still a stigma of being weak and so I see, is almost always overlooked but they have a very difficult job and they have their own issues that they deal with and the things that they see cannot be unseen.
00:29:42.871 -->
00:29:44.412So I'm glad you raised that.
00:29:44.412 -->
00:29:51.414What do you think about the co-responder models in so many places where there's a clinician with a police officer showing up on mental health calls?
00:29:52.835 -->
00:29:56.096a great tool if done appropriately.
00:29:56.096 -->
00:30:07.347I was pleased to be able to be a part of that very early on, actually, because I was a crisis intervention trainer for my department.
00:30:07.347 -->
00:30:10.259They sent me to Memphis to learn it and to come back and train other police officers to do crisis intervention.
00:30:10.259 -->
00:30:34.201And then I partnered with the mental health law liaison and so I went out with the mental health person to people in crisis and those kinds of things and forged those relationships and got to know those folks so that when they came in and did any training in our agency I was able to say, hey, I've been going out with these folks, they're not delusional, they don't think you just go around hugging everybody and everything's going to be okay.
00:30:34.201 -->
00:30:39.596They're actually quite aware of the challenges of helping people with mental health and the reward of it too.
00:30:39.615 -->
00:30:50.152I'm not here to paint everybody with mental health as being violent, but oftentimes if the police are co-responding, then there's some propensity for a person being harmed of themselves or someone else.
00:30:50.152 -->
00:30:52.203So I believe it can be done well.
00:30:52.203 -->
00:31:06.846I've seen the memes where it's the new SWAT, which is social workers and therapists, where they're saying let's just send that SWAT team out and I'm fearful of that becoming a replacement for police, because I don't believe.
00:31:06.846 -->
00:31:15.303Social workers and therapists are usually trained to handle that level of danger on their own, and nor should they be.
00:31:15.303 -->
00:31:16.406That's not their line of work.
00:31:16.487 -->
00:31:17.991So as we wind down again.
00:31:17.991 -->
00:31:23.709We've been talking to Stephanie Kahn and she's a police psychologist and we're talking with her in Beaverton, Oregon.
00:31:23.709 -->
00:31:44.032And I wanted to know where you think policing is going with the wellness push, in other words, the wellness of officers, and I'm sure that some of the things that you do training on everything, everything from getting proper sleep and proper diet and you tell us what makes up this whole wellness effort.
00:31:44.099 -->
00:31:47.346Yeah, I think it is very interesting because I didn't.
00:31:47.346 -->
00:31:50.854When I wrote my book and it was actually in 2018 was when it was published.
00:31:50.854 -->
00:31:55.825I wasn't and I started writing it in 2015, 2014, something like that.
00:31:55.825 -->
00:32:05.576I don't guess I predicted that we would have this swell of resilience training and push and all this other kind of wellness programs and these kinds of things that we've had.
00:32:05.576 -->
00:32:07.799So it was interesting timing that it was launched.
00:32:08.059 -->
00:32:16.335And what I'm seeing as I watch the trainings that are out there is there tends to be kind of two camps of the training and the wellness.
00:32:16.335 -->
00:32:19.505One is I'm going to go out and tell war stories and you're all going to.
00:32:19.505 -->
00:32:24.445All of my war stories are going to resonate with you and we're all going to hurrah, hurrah, the war stories.
00:32:24.445 -->
00:32:35.251And then the other is we're going to talk about some of your hardships and some of your challenges and we're going to give you some real concrete advice on how to deal with it and real concrete recommendations and some resources.
00:32:35.251 -->
00:32:38.993And I'm not saying there's not value in stories, there should be stories in the other one as well.
00:32:39.114 -->
00:32:50.881And so I'm seeing kind of two camps where I've had some people say, well gosh, they just came in and complained a lot about some of the horrible stuff that we didn't get anything out of it and you're like, and they charged a fortune for it and you're like, well, that's too bad.
00:32:50.881 -->
00:32:57.424So I think that agencies are sometimes throwing money at wellness programs because they don't know what they don't know.
00:32:57.424 -->
00:32:58.965It's not their line of work.
00:32:58.965 -->
00:33:01.907The line of work is firefighting or police or corrections.
00:33:01.907 -->
00:33:18.241Their line of work isn't in resilience, and so they really sometimes get lost in knowing how to build a wellness program, how to train, how to vet clinicians to be good resources for them, whether it be for training or for wellness program development or what have you.
00:33:18.241 -->
00:33:24.705Because there are some people in this profession that do it because their heart's in it and they come from that background.
00:33:24.705 -->
00:33:31.920And then there's some that I hate to say it see money to be made and a name to be had, and they don't always look very different on the outside.
00:33:32.280 -->
00:33:35.988Well, I think that happens all of the time that I love what you said.
00:33:35.988 -->
00:33:36.588You don't know what.
00:33:36.588 -->
00:33:43.885You don't know Everything from technology to training and what wellness means, what community policing means when you talk about that.
00:33:43.885 -->
00:33:48.291There's so many variations of that, too, and we can't seem to get a handle on it.
00:33:48.291 -->
00:33:53.853So let me wind down by asking you a question and giving you virtually the last word.
00:33:54.300 -->
00:34:06.806As a clinician, as somebody who has seen countless numbers of people in crisis, or people just trying to figure out what's going on with themselves in police, fire corrections and EMS and dispatch.
00:34:06.806 -->
00:34:13.188What's the benefit of reaching out to somebody like yourself, in your view, and what could happen if you choose not to?
00:34:13.288 -->
00:34:14.590I want to end on a positive note.
00:34:14.590 -->
00:34:18.889So I'm going to start with if you choose not to what you resist, persist as they say.
00:34:18.889 -->
00:34:30.471So you can resist, you can pretend like you're not hurting, you can pretend like you're not having trouble sleeping or your relationship isn't failing, and it will continue and it will likely worsen.
00:34:30.471 -->
00:34:32.280I don't know unless you.
00:34:32.280 -->
00:34:44.652I mean and I'm not saying it's seeing a clinician is the end all be all, Perhaps something you'll read some health, some self-help book or get involved in some other kind of thing and find a way on yourself Right, and so talk to a chaplain and do something else.
00:34:44.652 -->
00:34:46.806So it's not impossible for that to happen.
00:34:46.806 -->
00:34:48.782But if you ignore it, it's not going away.
00:34:48.922 -->
00:35:04.818So, coming to see someone like myself, you know, and I think one of the first things and I've heard I've had this feedback from people before is one of the first things you get is hope, and embedded in the hope is the belief and the expectation that you will get better if you.
00:35:04.818 -->
00:35:06.300That's what hope is.
00:35:06.300 -->
00:35:14.365I think that's the first thing you get, and I've had people say once I had a name for it and understood it, I believed I could do this and I expected I would get better if I did that.
00:35:14.365 -->
00:35:17.327I can get on board with that Very powerful stuff.
00:35:17.327 -->
00:35:21.201There's a book on the anatomy of hope that talks about how that works.
00:35:21.201 -->
00:35:45.532And then you get systematic support and guidance where you just go, be yourself in a confidential setting to try to navigate things you can't unsee, as you said, you can't unhear, you can't not know, so that you not just aren't fighting your demons anymore, Also be happy in life, you can thrive and be well, and I think every first responder deserves that, so the last question.
00:35:45.574 -->
00:35:47.340I guess I thought that was the last question.
00:35:47.340 -->
00:35:50.320But, listening you make me wander in different areas?
00:35:50.320 -->
00:35:55.443How does a first responder find a first responder knowledgeable clinician?
00:35:55.670 -->
00:35:57.436That is my big mission.
00:35:57.436 -->
00:36:05.077That's some of the work I'm doing with the National FOP Fraternal Order of Police, where we're creating what's called the approved provider bulletin, the APB.
00:36:05.077 -->
00:36:17.518So nationwide it will be a list of first responder clinicians that are vetted according to the criteria that I co-created with another psychologist in California, dr David Black out of Cortico.
00:36:17.518 -->
00:36:19.416So that's what we're creating.
00:36:19.416 -->
00:36:25.074I'm the first clinician on the list in the nation of probably hundreds of us, if not more.
00:36:25.315 -->
00:36:28.682There are some Serve and Protect actually maintains a list.
00:36:28.682 -->
00:36:29.672They're out of Nashville.
00:36:29.672 -->
00:36:34.489You can find them serveandprotectorg and they also maintain a list.
00:36:34.489 -->
00:36:52.382They vet people on the phone themselves and sometimes just Googling it and looking for things like the APB or the FOP stamp of approval or the National Emergency Responder and Public Safety Center training certificate will indicate those kinds of things.
00:36:52.382 -->
00:36:58.931Psychology and the IACP psych services section also has, I think, 200 of us that specialize in this.
00:36:58.931 -->
00:37:07.887So there's a few groupings that they're kind of fragmented and we want to pull them all together into one national database which is again kind of full circle from.
00:37:07.887 -->
00:37:17.480My original mission when I was a peer supporter is how do we connect people with culturally competent help so they don't have to go to someone and who asked them why they had their gun out.
00:37:17.730 -->
00:37:19.396Yeah, I understand that all too well.
00:37:19.396 -->
00:37:29.697Again, one of the things I do wonder is COVID changed everything and COVID forced an awful lot of us to do exactly what we're doing, where we're talking to each other on Zoom, even though I'm using audio.
00:37:29.697 -->
00:37:32.556And now you have telehealth and that's becoming more prominent.
00:37:32.556 -->
00:37:42.074How would somebody overcome it's so much easier in a lot of ways, but how would somebody overcome?
00:37:42.094 -->
00:37:43.601I don't want to be taped, I don't want one of those kinds of things.
00:37:43.601 -->
00:37:44.545In other words, that trust that needs to be.
00:37:44.545 -->
00:37:49.311I'm talking to you on the other end, I like you, but I don't know what you're doing over there because I can't see whether you're writing or whether you're recording.
00:37:49.311 -->
00:37:50.231How do you overcome that?
00:37:50.291 -->
00:37:51.253Well, one, I let them know.
00:37:51.253 -->
00:37:53.717Just like in the top left-hand corner it says recording.
00:37:53.717 -->
00:37:56.563You can see if it's recording and they have to acknowledge it.
00:37:56.563 -->
00:38:07.271And then when I say I'm not taking note because I'm doing like an OIS follow-up or critical incident follow-up, I literally sit there with my hands in the screen of the video so that where they can see I'm not writing anything down.
00:38:07.271 -->
00:38:11.717And then if they say, hey, can you send me a handout on that, I'll say I'm going to write down that I'm going to.
00:38:11.717 -->
00:38:14.900And then I'll go over and write down that I'm going to send them a handout.
00:38:14.900 -->
00:38:20.027And then I put my hands back up and do you again that transparency and that trust is it's like air.
00:38:20.027 -->
00:38:21.588You don't have it.
00:38:21.588 -->
00:38:23.474You absolutely notice, you don't have it.
00:38:23.534 -->
00:38:26.882So have you found success in telehealth in your practice?
00:38:27.831 -->
00:38:34.355Too much, actually, because it's opened me up to first responders all over the state versus the ones that were within driving range.
00:38:34.554 -->
00:38:39.695Yeah, too much, and I'm not complaining, it's just it's hard to sometimes meet the demand.
00:38:39.695 -->
00:38:53.675So, yeah, I think it's made it helpful for people that have shift work, people that have kids, people that live in remote areas and might not want to access services for fear that they'd see someone walking into or out of the clinician's office on Main Street when there's just two streets in the town.
00:38:53.675 -->
00:39:05.139I think it's helped a lot of people, even people that didn't think they would like it meet with me initially in person, come to build that rapport and say, hey, you know, thursday would be easier if I just did virtual, is that okay?
00:39:05.139 -->
00:39:16.938Like, oh, yeah, you know, and so they can kind of go back and forth as their schedule allows and their childcare allows and that kind of business, and so I think it's been a significant help for some, and then for others they're just like nope, I want to.
00:39:16.938 -->
00:39:18.561I want to have my eyeballs on you.
00:39:18.561 -->
00:39:20.063I understand.
00:39:20.083 -->
00:39:21.806Well, listen, this has been amazing.
00:39:21.806 -->
00:39:24.717It's been a lesson for me and, I hope, a lesson for all of the listeners.
00:39:24.717 -->
00:39:33.092You have added so much, so many dimensions to wellness and to the help mental health for first responders, and I appreciate it.
00:39:33.092 -->
00:39:34.657So we've been talking to Stephanie Kahn.
00:39:34.657 -->
00:39:40.092Thank you for being here, stephanie, you're welcome.
00:39:40.092 -->
00:39:40.534Thanks for having me.
00:39:40.534 -->
00:39:42.123No problem, so that's another episode of the Cop Doc in the books.
00:39:42.123 -->
00:39:45.213We've been talking to a police psychologist and I hope you have found it interesting.
00:39:45.213 -->
00:39:48.021Stand by for more episodes and thanks for listening.
00:39:50.070 -->
00:39:54.679Thanks for listening to the Cop Doc podcast with Dr Steve Morreale.
00:39:54.679 -->
00:40:02.139Steve is a retired law enforcement practitioner and manager, turned academic and scholar from Western State University.
00:40:02.139 -->
00:40:08.617Please tune into the CopDoc podcast for regular episodes of interviews with thought leaders in policing.
