John W. Reiman   Ph.D.
Licensed Professional Counselor (L.P.C.)

Distressing Duty Experiences

Police officers, firefighters, paramedics and 911 dispatchers respond to emergency and critical incidents that frequently involve individual/multiple fatalities, children, threat to one's own life, etc. A single overwhelming incident or the cumulative effect of routine calls can impact a responder's well-being and functioning at home, at work, and in relationships. Despite our incredible resilience as human beings and ability to bounce back, there may be times when professional assistance is necessary to support enhanced understanding, coping and job performance.

What type of therapy do I provide?
My overarching goal in therapy is to assist clients in choice-fully responding rather than choice-lessly reacting in their lives, and to cease being captive to the experiences that cause them to seek help.

Counseling begins by establishing a sense of safety for the individual in the therapeutic relationship. I work in active partnership with each client in the development and implementation of a treatment plan and in continuously reviewing the effectiveness of our work.

Multiple modes of therapy and care are often necessary to achieve optimal results. In response to each client's needs and in conjunction with the client, one or a combination of modes may be utilized including:

  • EMDR (eye movement desensitization and reprocessing, explained in sections below)
  • Cognitive behavioral therapy (identifying and modifying faulty or distorted negative thinking styles and the maladaptive behaviors associated with those thinking styles);
  • Somatic experiencing (using body awareness at different levels to reprogram the body out of trauma states);
  • Mindfulness-based cognitive therapy (correcting automatic reactions by practice of noticing/accepting thoughts and feelings without judgment - vs. pushing away).

What is EMDR and what kinds of problems can it treat?
Eye Movement Desensitization and Reprocessing (EMDR) is a proven method of psychotherapy developed in 1987 by a psychologist, Dr. Francine Shapiro. It has evolved through contributions of therapists and researchers worldwide. Today, EMDR is a standardized protocol that incorporates elements of many different treatment approaches. Proven effective for post-traumatic stress, EMDR therapy can help clients replace their anxiety and fear with positive images, emotions and thoughts. Symptoms that can be helped by EMDR include:

  • High anxiety and lack of motivation
  • Depression
  • Memories of a traumatic experience
  • Fear of being alone
  • Unrealistic feelings of guilt and shame
  • Difficulty in trusting others
  • Relationship problems

How does EMDR work?
How any psychotherapy actually works in the brain remains largely unknown. When someone is very upset, however, their brain is unable to process information in its ordinary way. A moment of extreme upset can become 'frozen in time' and, when remembered, feel as bad as the first time because the original images, sounds, smells and feelings haven't changed. Such memories can have a lasting negative impact and interfere with the way a person experiences life. EMDR seems to help normal information processing resume, freeing a person to no longer relive the painful details each time the original event comes to mind. Disturbing material can be processed, and then experienced in a less distressing way. What happened is not forgotten, but is less upsetting. While other types of therapy have similar goals, EMDR seems similar to what happens during dreaming or REM (rapid eye movement) sleep.

Is there evidence of EMDR's effectiveness?*
EMDR is an evidence-based intervention in the treatment of PTSD according to at least 20 controlled outcome studies and many reputable organizations and national health guidelines including: the Cochrane Database of Systematic Reviews (2007) and The American Psychiatric Association Practice Guideline for the Treatment of Patients with Acute Stress Disorder and Posttraumatic Stress Disorder (PTSD) (2004). The U.S. Department of Veterans Affairs and Department of Defense has placed EMDR in its highest category of therapies recommended for treatment of PTSD (Clinical Practice Guidelines, 2004). In addition, the International Society for Traumatic Stress Studies (ISTSS) gave EMDR an "A" rating for treatment of adult PTSD (Foa et al., 2009). EMDR has been determined to be efficacious in the treatment of trauma by several international health and governmental agencies including the United Kingdom Department of Health (2001), the Israeli National Council for Mental Health (2002), the Dutch National Steering Committee Guidelines Mental Health Care (2003), French National Institute of Health and Medical Research (2004), (UK) National Institute for Clinical Excellence (2005), and the Medical Program Committee/Stockholm City Council, Sweden (2003).
*A bibliography of research on EMDR may be found at www.emdria.org

What happens in a session?
The therapist and client first identify a specific problem as the focus for treatment. The client brings to mind a disturbing issue/event and what was seen, heard, felt, and thought - as well as what thoughts and beliefs are currently held about that event. The therapist facilitates directional movement of the client's eyes or other dual attentional stimulation of the brain, while the client focuses on the disturbing material and simply notices whatever comes to mind. The client observes whatever comes to mind without making any effort to control direction or content. Each person processes information in a unique way based on values and personal experiences. Eye movements continue until the memory becomes less disturbing and is associated with positive thoughts about one's self (for example, "I did the best I could.") Intense emotions may arise during EMDR, but most people report a great reduction in the level of disturbance by the end of the session.

How long does EMDR take?
One or more sessions are required for the therapist to understand the problem and determine that EMDR is appropriate. The therapist will discuss EMDR and answer questions. Once the therapist and client decide that EMDR is appropriate, therapy may begin. A typical session lasts 60-90 minutes. The kind of problem, life circumstances and trauma history will determine the number of treatment sessions needed.