Working with Traumatized Police-Officer Patients

A Clinician's Guide to Complex PTSD Syndromes in Public Safety Professionals

Daniel Rudofossi, Dale A. Lund, Alan W. Benner

• Publisher: Routledge
• Year: 2020
• ISBN:
  9781351840514
• Edition: 1
• Topic: Psychology
• Subtopic: Post-Traumatic Stress Disorder (PTSD)
• Index: Psychology

An insider perspective from a 'cop doc on the job, ' this book is the first of its kind written in response to a need for a specialized guide for clinicians that operationally defines and responsibly treats what Dan Rudofossi terms Police and Public Safety Complex PTSD. In reading this book, you are led through an understanding of how to work with police officers who experience cumulative loss in trauma. "Doc Dan" initiates you into an original cultural competence of how and why his theory works in practice. You will leave the journey with a practical sense of how the ecological context and ethological motivation are part of the psychological presentation of almost all officers suffering from complex trauma and loss.This guide is crucial reading, original in its breadth and scope of perspective on how to intervene with the traumatized officer. Toward that end, Rudofossi presents his Eco-Ethological Existential Analysis of Police and Public Safety Complex Post Traumatic Stress Disorder. Emotive, affective, cognitive, behavioral, and existential ranges of expression of trauma are vast, diverse, and often intense in police officers. This book delivers applied theory with clinical examples, including practical interventions for the clinician and handouts for the officer-patient. The clinician will be assisted in encountering officers' existential suffering from the edge of despair to the precipice of meaning. The guide is at once stimulating, exciting, and very serious in its potential for clinical interventions.

PART I


Initiation: Rites of Passage—Cultural Competence

CHAPTER 1

A Brief Tutorial on the Nature of Trauma in Policing

In this chapter I will amplify a few points on the nature of trauma in policing. Toward that end, I will present a summary of findings from qualitative research, quantitative analysis, and clinical experience garnered from the early 1990s into the new millennium. As a new police officer—with the exception of some very general textbook approaches to the real shocking and horrific scenarios in which we would become involved—I was little prepared for what I would experience in terms of trauma and loss. Seeing numerous peers numbly recounting their unusual experiences, which would horrify, repulse, disgust, and infuriate any sane person—I asked myself: “Why shouldn’t that be true for police officers?”

Hence, my motivation to study the effects of what happens to an officer who experienced trauma and loss started with my own disturbing experiences. I knew, going through those experiences, that I was not being overly sensitive. After these traumatic experiences, a simple “Snap out of it” or “Just get over it” with a pat on the back and “Sorry Dan, you’ve got a day off” seemed to be an empty platitude. I sensed my humanity being sapped out of me. Introspectively, I sought to understand what the affect of my own experiences was, as well as the impact on my peers with multiple traumas. Intuitively (along with a psychology background), I knew administrative stress was present in all occupations and was not the hub of stress in policing, as it was not in Vietnam veterans.

The real cumulative loss, through the lenses of trauma in walking the beat for years, is unique to law enforcement and public service. It has a very enduring impact in different ways for different officers. The life of a cop can truly be one of quiet desperation, especially when losses are disenfranchised; that is, not even considered a loss. Further, this and the following chapters are not written to criticize the extraordinary intelligence, perceptiveness, and resilience of my peers, from cops to chiefs. What follows offers the reader a heightened understanding of the evolutionary sensibility and ecological realities for the multiple determining influences affecting the individual officer in her or his life.

“It’s the Job, Get Over It”: A Commitment and Stand

I realized how much of my own humanity had actually been numbed and dissociated. It had gradually become hidden, as a person who never had humanity has no need to forget it. I questioned the wisdom that said, “It’s just the job, get over it. Don’t change what works, forget about that soft civilian sentimentality.” I turned my questions into a commitment as a street cop and graduate student. I questioned and searched with a passion for the meaning that these experiences had in my own life and in the lives of my peers. The predominant belief was that trauma and loss were not significantly different for police officers.

Among my major findings, I discovered, contrary to anecdotal wisdom, that real police stress is overwhelmingly related to the multiple and cumulative experiences of trauma and loss, not to the administrative stress and bureaucracy common to most professions. I conducted two small-scale pilot studies in 1992 and 1993 (Rudofossi, 1994) and followed up with one large-scale explorative study of 576 participants conducted in 1994–1995, written up in 1996, and published in 1997 (Rudofossi, 1997).

After finishing my research and clinical training, I became the first formally acknowledged Uniform-Psychologist, Medical Division, appointed in the history of the New York Police Department (NYPD). This formal acknowledgment and support was done through the ingenuity and integrity of Chief V. Mansfield, NYPD, Commanding Officer of the Medical Division, who gained support through Chief of Personnel M. Markman and NYPD Commissioner Dr. Ray Kelly. They issued me the historic first Identification Card, which displays the title Uniformed Psychologist. In a department historically rigid in accepting changes in mental-health policies, their support was a significant and progressive step forward. To endorse such a meaningful change was an experiment and a challenge to the status quo from within the structure of the police bureaucracy (Ainsworth, 1995; Astor, 1971; Benner, 1999; Neiderhoffer, 1967; Schlossberg, 1974).

My new venue included responsibility for crisis intervention as necessary, such as in the service to an officer-patient, who would present with any of a spectrum of active symptoms, including panic attacks, critical incidents, extreme anxiety, severe depression, and acting out through self-destructive and suicidal behaviors. I conducted all “fitness for duty” evaluations and had the authority to place officers on sick report, restricted duty, or full duty with or without firearms.

I set up triage and treatment planning with other medical and mental-health professionals, as well as assessed and monitored the mental-health status of the participating officers, creating a multiaxial profile of psychiatric/psychological disorders. Further, I made decisions regarding premature return or the appropriate and timely return of the officer to prior levels of duty without undue delay. Finally, in cases of chronic psychopathology, I would write up and coordinate the survey for disability. This survey was followed through to completion with the combined support of treating health professionals outside of the NYPD or Union loop from 1996 to 1999. As the NYPD is an exempt agency, and because of the humanistic goals of the medical division and peer-support experiment, this was possible and even warranted in its initial stages. The process of being a liaison between and for the NYPD and the police Unions was not without difficulties and superb rewards. It was my privilege to work with some of the finest uniformed and civilian professionals in the NYPD, the police unions, the clinical field, and academic world.

INTRODUCTION

It is as a participant observer that I offer the psychologist and allied mental-health professionals an inside view behind the “blue wall of silence.” A close friend and mentor, Dr. Al Benner offers clinicians seeking to work with police and public-safety officers a direct caveat:

The term “suede shoe psychology” connotes exaggeration of one’s qualifications, experience and ability to “deliver.” New and inexperienced mental health professionals often “dive in” and attempt anything with anyone. This can lead to mistakes or poor outcomes that occur from ignorance rather than intent.…Individual mental health professionals feel isolated and powerless. The “journeyman professionals,” the seasoned and competent, participate in managed care as minimally as is economically possible already. They have tired of reduced fees, onerous reporting procedures, arbitrary and uninformed case management and limited appointment authorization. If they raise their voices in protest, individually or collectively, they are capitated (modern euphemism for being fired) or accused of being self-serving. As journeyman professionals move on or reduce their participation in managed care, they are replaced by less experienced and less expensive individuals. Increasingly, the mental health profession and the consumers’ loss are the entrepreneurs’ gain. Something else is needed … (1999).

One solution Dr. Benner, Captain and former Director of SFPD Psychological Services, suggests is for professionals to gain cultural competence with police officers. I cannot agree more. This book delivers the perspective of a participant observer: I did over 200 individual assessments for fitness for duty and crisis intervention, and was the official Uniform-Psychologist for the NYPD Membership Assistance Program from its initiation through its first 4 years. Prior to that appointment, I did extensive research including hundreds of interviews, and distribution of instruments involving trauma experiences with patrol and ranking officers. Still my perspective is only one. Other talented and astute Cop Docs have views differing from my own. The following chapters may be tempered with that qualification in mind.

The reconstruction of dynamics that are specific and unidentified in police and public-safety culture will hopefully emerge as a unified perspective for most clinicians. If that is achieved, my goal is accomplished. An added goal is facilitation of your skill and empathy as a trained professional clinician working with, anticipating working with, or seeking to gain information about working with police and public-safety officers as patients.

The first question confronting us is, what term can we use to adequately capture the frequency, intensity, duration, and cumulative effect of traumatic events that police encounter? Parallel to this question is another: Can PTSD (Post Traumatic Stress Disorder) illuminate the psychological impact of the distinct experiences of trauma officers will endure as individuals? In order to answer both questions, we have to discriminate whether PTSD is adequate to operationally define the diverse syndromes pertinent to police experiences. My years of research and clinical assessment through my street-cop background suggest that both ecological events and the psychological experiences of the individual officers, which includes ethological components and existential choice, are neglected and hidden aspects of the experience of loss in traumatic events: an operational definition that highlights the fact that police experiences of trauma include repetitive, intense, and cumulative loss, with much of that experience remaining hidden. Yes, hidden even from the experienced clinician. The presentation of a functionally intact officer-patient may belie the real state of disenfranchised loss.

PTSD TO POLICE AND PUBLIC SAFETY: COMPLEX PTSD (PPS-CPTSD)

Our first move in an integration of the complexity of the events police experience, and the psychological meaning of those events on the individual officer-patient, shape our choice of an appropriate term. For a definition to have value, it must underscore the complexity of a traumatic event and the individual differences of disenfranchised loss (Doka, 2002; Ellis, 1994; Worden, 2001) that officers experience. Fortunately, such a phrase, as well as a concept, Complex Post Traumatic Stress Disorder (C-PTSD), exist and have support from a wide range of research and clinical experience (Chu, 1998; Herman, 1992; Terr, 1990). In presenting a new integration of theory that operationally defines the complexity of the traumatic events, integration of existential analysis, and eco-ethological influences among police officers, I have termed this constellation of trauma and loss syndromes, Police and Public Safety Complex PTSD (PPS-CPTSD).

My theory of PPS-CPTSD is part of a larger applied framework that will help increase your effectiveness in establishing an individualized approach with officer-patients suffering from PPS-CPTSD. I have titled this treatment approach, the Eco-Ethological Existential Analysis of PPS-CPTSD. However, an Eco-Ethological Existential Analysis can be applied only after you have achieved a thorough grounding in the basics of PPS-CPTSD. (In a follow-up work, I will present my advanced theory of PPS-CPTSD as well as assessment and intervention with a focus on personality differences.) PPS-CPTSD revolves around ecology of loss in trauma. The ecological demands of complex trauma are frequent, intense, cumulative Potentially Traumatic Events (PTE), which is mainly disenfranchised from the officers who experience it. Two researchers have come up with similar findings indicating Complex Trauma as disenfranchised loss:

It is frequently remarked by nonmilitary psychiatrists that the military service or a state of war produces no new types of psychiatric reactions. However, there occur in military service certain florid schizophrenic like states with sudden onset and rapid recovery which are seldom seen under other circumstances except perhaps in penal institutions (Solomon & Yakovlev, 1945).

The quote above is a field observation made during World War II. The clinicians observed schizophrenia-like symptoms in combat-stress conditions. This description generalizes to what I observed time and again in police officers. In my previous publication, my reflection was:

Without the skills or support to reintegrate the impact of events of trauma and loss that many police officers endure, on a frequent and intense level, an almost schizophrenic disintegration of a sense of self is likely engendered through physiologic and psychic processes of oppositional conflict (Rudofossi, 1997).

Police cultural mores foster an underlying motivation that offers a selective advantage to the officer who defends against expressing his or her loss. This process of defenses against loss begins through the evolution of identity formation from civilian to uniform police officer.

ECO-ETHOLOGICAL DEVELOPMENT IN IDENTITY FORMATION AS A POLICE OFFICER

Communality and the interpretation of one’s own experiences take place within the context of ecology of public-safety mores. These customs in the macroculture of public safety affect on the formative stage of identity formation. One’s age at being appointed a police officer may critically impact on one’s sense of self. Even in the most supportive environment, the stage of development of young adulthood is very stressful between impulsivity and restraint wherein the “fragile ego” of the late adolescent is particularly vulnerable to trauma. Many police and public-safety departments have had a policy to recruit police candidates spanning the stages of late adolescence and early adulthood.

Erikson’s stage of accomplishment of “identity formation” versus “identity diffusion” is the dominant phase for this age group (Erikson, 1968). For achieving a healthy sense of one’s “real identity,” the achievement of a history and continuity between the past and present must exist (Erikson, 1968). This establishment of a late adolescent’s or a young adult’s real identity may be compounded by the additional stress of establishing her or his parallel “police identity.” In the formation of a police identity, the officer must prove that he or she is capable of being selfless. Being a hero to peers by risking everything to help is given the highest status. Those who tire or do not show competence in this area may be deemed incapable of succoring status among peers. This positive reinforcement of being a “cop’s cop” becomes high in the hierarchical ladder of identity formation and status. It also serves a survival reward, is instrumentally reinforced, and is enforced in the anthropological rules of officer identity development. Conversely, a minimal level of performance as an officer may elicit an overcompensation to avoid swift retribution by peers in the locker and muster rooms. The negative reinforcement of receiving the label of “a...

Table of contents

• Cover
• Title Page
• Copyright Page
• Table of Contents
• Foreword
• Preface
• Acknowledgments
• Introduction
• PART I Initiation: Rites of Passage—Cultural Competence
• PART II Strategic Approaches toward Achieving Alliance and Effective Assessment with Public-Safety Patients
• PART III Eco-Ethological Existential Analytic Method of Therapy in Treating Police and Public-Safety Complex PTSD
• Glossary
• Appendix A—Mission Statement: NYPD, Uniform-Psychologist
• Appendix B—Continued Treatment and Relapse Prevention
• Appendix C—Intake Protocol Uniform-Psychologist
• Appendix D—Suicide/Self-Harm Prevention Contract
• Appendix E—Map Contract While Out on Sick Report/Restricted Duty Status
• Patient and Therapist’s Handout: Self-Awareness: Stop Drinking Worksheet. Start Coping!
• Patient’s Handout: Loss and Meaning: My Living Bridge
• Therapist’s Handout: Clinical Technique: Getting Law Enforcement Officers Motivated to Commit to Grief, Trauma, and Crisis Intervention Therapy Using Animal Metaphors
• Contributors
• Index