Sharing Below the Surface for First Responders

“The iceberg analogy is particularly relevant for first responders, because they tend to internalize the gut-wrenching situations they face on a chronic basis – and they often have an overwhelming fear about reaching out for help due to the perception that it shows weakness,” says Lindsay Pliner, MSW, LCSW, LCADC, Senior Social Worker with First Responder Treatment Services at Penn Medicine Princeton House Behavioral Health. “First responders want to be seen as the helpers, not the ones needing help, especially in the eyes of those closest to them.”

However, as Pliner points out, secrets make us sick. Withholding the reality of the situation from family members has a ripple effect that will eventually worsen any conflict at home. And research shows that first responders have higher success rates for recovery when loved ones are involved. 

“Family members who have a better understanding of what’s below the surface – and how common this is among first responders – can provide support and assist with accountability while taking this knowledge into account on their own path to healing,” says Pliner.

Ideally, family members may also seek behavioral health services. But even when providers are just treating the first responder, they can encourage sharing information with loved ones to benefit the family as a whole. Once a rapport is established between provider and patient, strategies can include:

• Exploring the reasons behind hesitancy or concerns about sharing with loved ones
• Normalizing that it can be painful to bring other people into one’s true struggles
• Reinforcing that while difficult, sharing has important benefits
• Recommending a goal of involving at least one significant source of support beyond the behavioral health provider

Family involvement, with patient consent, is integral at First Responder Treatment Services. Not only do meetings or calls with the treatment team provide the opportunity to voice concerns and ask questions, but they also ensure that the family has the same road map to understand goals and navigate inpatient and follow-up care.

“When one person struggles with mental health issues or addiction, the whole family goes through it,” adds Pliner, who provides therapy and case management services targeted to the specific needs and concerns of first responders. “Acknowledging and communicating what’s really going on can alleviate some of the emotional toll and help first responders and their families begin to work toward getting their lives back on track.”