Post Traumatic Stress Disorder and the Service Culture

People tend not to understand me when I tell them that there is such a thing as a policing culture. My colleagues (other psychotherapy or social work students) tend to cock their heads and look at me inquisitively.

So, what is the big difference between us and them?

That's right, I am going to say "us and them." I realize that statement alone is making some of my fellow social workers cringe thinking that I'm not being sensitive enough and that I am othering. I assure you, I'm not. 

There is a systemic difference that sets most civilians apart from police officers, military personnel, paramedics, firefighters, etc. We expect them to do some of the most psychologically demanding, emotionally draining work there is and then criticize them harshly when mistakes happen in those respective professions. We as a society are hard on our first responders and military personnel. The last proverbial nail in the coffin is that the Service Culture that surrounds them, doesn't help. Service members are quick to learn that they're not allowed to cry, breakdown or show emotion. There is a notion that one must be tough and stoic. This expectation sets them apart. In fact I would say that health professionals, nurses, doctors, social workers, etc. also suffer from a similar culture.

Counsellors need to be competent when it comes to working with service members; establishing a therapeutic alliance is not as simple or involve the same skills it would take with a non-service member client. Consider, is there stigma associated with coming to a therapist for this person? Many people experience those feelings in coming to counselling but I hypothesize that this culture of service that our service members are a part of makes this more challenging for the service members.

A method to overcoming this may as simple as asking questions. If you don't know the particulars of policing culture or the air force.. ask! The service culture that I described above are typically closed systems, so finding context here is extremely important for us practitioners. Having a routine that works with many clients may not engage an individual who is coming from this system. This does not mean being affective in addressing the issues is any different clinically. In fact evidence based practices are well published from prolonged exposure therapy, cognitive behavioural therapy, cognitive process therapy, or problem solving are all within a practitioners grasp already. Instead reflect on your interpersonal relationship, your ability to foster an environment where you understand that this client may not believe it's okay to get help. I suggest that education may help eliminate this stigma, labelling issues that service members are experiencing may increase their awareness of what they're experiencing as a result or something causal of what they have been exposed to. Again, this could be helpful.

Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) is almost common language now and there's even a "For Dummies" book on the subject but intimate partner violence, suicide, substance abuse, adjustment disorders, depression, familial issues of secondary stress are far less publicized in regards to police officers, Canadian forces, firefighters, etc.

I believe that a holistic approach to these issues is essential. I have made it my work for several years to work with first responders and military personnel. This short article is only the tip of the iceberg, I plan on spending a significant amount of time blogging on the subject so please, feel free to chime in with your thoughts and comments.

Tim.

Can I talk to my social worker about medication?

Psychopharmacotherapy is not a hot topic in social work but it should be. People who are using medication, especially psychotropics should be able to talk to their counsellor (yes, I know I'm shoulding right now but hear me out). There is a real and serious reluctance in social work to talk about medication, we can't diagnose (in Canada), we certainly can't prescribe medication and this results in most social workers telling clients that they are not able to talk about medications.

Well, why the heck not? I implore you, my fellow social work students and practitioners to broaden your understanding of medications, their effects and how individuals experience them in their many varied ways. I'm currently working in an interdisciplinary medical team and getting some great insight from nurses, psychologists and psychiatrists on medication but the best words are from clients sharing their experiences.

So here I am left wondering how much is too much when it comes to my talks about medication. Should I just listen intently and nod in acknowledgement to my clients insights and concerns but withholding any information; or do I share the stories I've heard/read to help clients understanding and making meaning out of their medication. I propose that talking about medication is a good thing, exploring it's strengths and perceived benefits for clients or acknowledging limitations. Once a social worker becomes comfortable with medication terminology and navigating the world of pharmaceuticals, a social worker could become proactive and prepare clients who are awaiting psychiatric evaluation, making referrals or sharing information on medication.

Your thoughts?
Tim.

Excuse my absence.

I have been gone for some time. November of last year was a very busy month with a full course load which brought with it many major papers and assignments due. I also was planning my trip to India and by the time I left I didn't have time to write for the blog. I did however bring along a beautiful journal and pen to write my thoughts and now that I'm back in the comfort of my own home, I can sit back and reflect. Well, not quite.. I am back in class come Monday and practicum starts Tuesday. Which means I'm going to be a busy guy. Yoga teacher training will also be in full swing by the end of this month. So, I guess you could say the blog will be my escape, a place for sharing new ideas and reflecting. First, allow me to address my recent trip to India from which the attached picture is from. I have wanted to go for a very long time. Several years ago my best fried Josh and I were supposed to go together, a work emergency caused me to postpone my departure and ultimately cancel my trip. It was a great disappointment at the time and Josh went without me. Now, I was planning on visiting Josh and his girlfriend in their new home on Vancouver Island but I told Josh I was thinking about going to India instead with all my time off. He thought it was a great idea. He gave me a lot of advice which included picking up a copy of Lonely Planet. Now, Lonely Planet was rather helpful but I must note that it is laid out rather poorly, meriting much confusion between the mis-colored metro lines in Delhi, confusing maps and too many instances of page flipping to find things that were on the map but didn't appear to be listed with a description. Let me be clear that my motivation for going to India was to seek spiritual enlightenment and learn about a lifestyle that involves spirituality in the everyday. This was something that deeply interested me previously but now as a yogi, I was even more motivated to explore the birthplace of yoga. I had never been to a "third world nation" What I discovered though was not as much to my liking as I would have preferred however, I believe I'm a much richer person for it. Just not richer in the way I had hoped. I am left believing that the real yoga renaissance is happening right here at home.

I left India with a real and deep sense of gratefulness, when people would ask me where I was from I would tell them Canada, they would always respond with "Oh! That is a very good country." and I would politely thank them. I didn't realize until a few days into my trip that they didn't mean Canada was picturesque or beautiful, they meant it's a good place in that we have universal healthcare, equality is a priority, social welfare programs, we take care of our people. After seeing the poverty and the suffering in India, I understood. Poverty was everywhere, the standard of living is shockingly low even when staying with my friends who by all accounts are middle or at least upper middle class.

I had a hard time being confronted with the hardships everywhere, even to see the living conditions that my friends and their children live in which by Indian standards are excellent. I grit my teeth and tried to bare what was difficult. There were times when I broke down. I saw a man in the streets desperately trying to repair a tarp that was his shelter, his efforts seemed helpless but what was I to do? Stop and tell him the tarp was ripped and tattered beyond repair, what good would that have done. I continued to walk and about five steps later I found a man digging in a dumpster, he threw the carcass of a small chicken that had been cooked to a dog that sucked at the remaining meat with it's long tongue. The man found something vegetable looking that was edible for himself and he held the minimal amount of food close to his mouth as he ate. I walked on and began to tear up. A muslim man walking with one child on his shoulders and two children walking beside him down the makeshift sidewalk stopped me, he saw what I saw, he saw my reaction and smiled at me putting his hand to my heart and gave me a long look into my eyes as if to say he knew, or that he understood and felt my pain. I don't know. I really appreciated it though.

I don't ever want to forget what I saw I just want to understand it better so that I can make use of it to help more people.

With love,
Tim.

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