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by Samuel Simon, MSW
Trauma-informed care has transformed behavioral health. Understanding occupational culture may be the next step.
Imagine beginning your shift by responding to the suicide of an 11-year-old child. Before you have time to process what you have witnessed, you are dispatched to a neighborhood noise complaint. Minutes later, you are mediating a domestic violence call. Before your shift ends, you are standing beside a fatal motor vehicle crash, comforting family members whose lives have changed forever. Tomorrow, you will likely do it again. For most people, even one of these events would be life changing. For many first responders, it is simply another day at work.
Mental health professionals often ask why first responders avoid therapy. The answers most frequently discussed include stigma, confidentiality concerns, fear of career consequences, and a culture that rewards emotional control. Those barriers are real. But after more than two decades in law enforcement, my own recovery from occupational trauma, and years working alongside first responders in peer support and behavioral health, I have come to believe those explanations tell only part of the story.
Many first responders do not avoid therapy because they believe therapy does not work. They avoid therapy because they fear they will not be understood. Before meaningful therapeutic work can begin, many feel compelled to explain not only the traumatic event, but also the profession that shaped how they experienced it.
Trauma does not occur in a vacuum. Police officers, firefighters, paramedics, dispatchers, correctional officers, and other emergency professionals experience repeated exposure to violence, tragedy, human suffering, and life-or-death decision-making. Over time, these experiences help create an occupational culture built on loyalty, composure, dark humor, emotional compartmentalization, and the expectation that the mission comes before the individual. These adaptations often allow first responders to perform extraordinarily difficult jobs. Outside that context, however, they can easily be misunderstood as resistance, indifference, or emotional dysfunction.
One of the most common questions first responders ask during the early stages of therapy is not, “How do I process this call?” Instead, it is, “Why am I so angry? Why am I this way? I was never like this before.” These questions and thoughts often reflect cumulative trauma rather than a single critical incident. Years of repeatedly placing emotions on hold can eventually influence identity, relationships, emotional regulation, and physical health.
This is where cultural competence becomes essential. Therapists do not need to have worn a badge or responded to emergency calls to provide outstanding care. They do, however, need to appreciate the occupational culture that shapes how first responders interpret trauma, define strength, build trust, and decide whether it is safe to be vulnerable. Curiosity, humility, and a willingness to learn from the client can be just as important as technical expertise.
Evidence-based treatments such as Cognitive Behavioral Therapy and Cognitive Processing Therapy remain among the most effective interventions for trauma-related disorders. Yet even the strongest treatment model depends upon a therapeutic alliance built on trust. When clinicians recognize occupational culture as an important part of the clinical picture rather than background information, they create space for first responders to feel understood before they are expected to heal.
As mental health professionals, we routinely recognize the importance of culture in shaping human behavior. Occupational culture deserves the same consideration. Understanding the realities of emergency service professions does not replace trauma-informed care; it strengthens it. It helps clinicians see not only what happened to the client, but also how the profession influenced the meaning of those experiences.
First responders do not require therapists who have worn the same badge or uniform. They require therapists who are willing to understand the profession before attempting to treat the person.
When that happens, therapy becomes more than symptom management. It becomes the beginning of trust—and trust is where healing begins.
Selected Readings
Chopko, B. A., Palmieri, P. A., & Adams, R. E. (2015). Critical incident history questionnaire replication: Frequency and severity of trauma exposure among officers from small and midsize police agencies. Journal of Traumatic Stress, 28(2), 157–161. https://doi.org/10.1002/jts.21996
Haugen, P. T., Evces, M., & Weiss, D. S. (2017). Treating posttraumatic stress disorder in first responders: A systematic review. Clinical Psychology Review, 51, 66–77.
Klimley, K. E., Van Hasselt, V. B., & Stripling, A. M. (2018). Posttraumatic stress disorder in police, firefighters, and emergency dispatchers. Aggression and Violent Behavior, 43, 33–44. https://doi.org/10.1016/j.avb.2018.08.005
National Association of Social Workers. (2021). Code of ethics of the National Association of Social Workers. https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English
SAMHSA. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach (SMA 14-4884).
Samuel Simon, MSW, has more than 20 years experience in law enforcement, is a peer recovery specialist, and recently graduated with his MSW from Barry University. His experience includes wellness instruction for first responders and cultural competency for clinicians with his wife Vania Simon.