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Therapy Treatment & Counseling for First Responders

Therapy Treatment & Counseling for First Responders

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What is a First Responder?

A first responder is someone with specific training who is among the first to arrive at an emergency site and offers assistance or helps resolve the issue.1 An emergency can be anything, such as an accident, catastrophe, medical emergency, structural fire, crime, terrorist attack, or related.

First responders must continuously deal with and be exposed to traumatic, frequently horrific incidents as part of the demands of their specialized training. Many of these incidents can have a significant, perhaps crippling, impact on a first responders’ psychological and physical wellness. Nothing can thoroughly prepare someone for what may happen while responding to an emergency in the real world, even substantial preparation in the form of ongoing training.

First responders can include:

  • Firefighters
  • Members of law enforcement
  • Paramedics
  • EMTs
  • Flight attendants
  • Other persons, including employees of a legally organized and recognized volunteer organization, whether compensated or not.

Statistics on Mental Health & First Responders

  • As opposed to 20% in the general population, it is believed that 30% of first responders experience behavioral health issues, such as depression and [PTSD].2
  • According to a study on suicidal ideation, firefighters have greater rates of ideation and attempt than the overall population.
  • 125 to 300 police officers commit suicide each year, according to some estimates.
  • Stress and extreme exhaustion are to blame for more than 50% of firefighter fatalities.3
  • More firefighters and police officers commit suicide than die in the line of duty.4
  • According to estimates, PTSD affects 18–24% of dispatchers and 35% of police officers.5
  • Due to the unpredictable nature of their jobs, first responders frequently experience direct and indirect hardship and traumatic experiences, which place a heavy weight on their physical, physiological, and mental health. This can lead to depression, anxiety, and stress.6
  • Nearly 70% of first responders complain that they don’t get enough downtime in between the traumatic incidents they encounter, and 7% of them experience clinical depression.7
  • According to studies, between 17% and 24% of public safety telecommunicators experience post-traumatic stress disorder (PTSD) symptoms, and 24% experience depressive symptoms.8
  • According to data from an ongoing study, frontline healthcare workers and other essential workers are at a lower risk of contracting COVID-19 than first responders, which includes firefighters, law enforcement, corrections officers, and other emergency responders.9
  • Compared to frontline healthcare personnel, first responders had double the rate of COVID-19 infection (13.2% vs. 6.7%).10
  • Almost all first respondents (93%) agree that maintaining mental health is just as important as maintaining physical health. In addition, more than eight in ten (83%) think that people who receive counseling get better, according to a recent online study from the University of Phoenix. However, 47% believe that receiving professional counseling would impact their employment.11
  • The good news is that most first responders are open to receiving the assistance they need, despite the existing stigma. According to a survey, 67% of respondents sought or considered professional help.
  • According to research, 20% of first responders with PTSD also have a substance abuse condition.12

Common Reasons First Responders Seek Therapy Treatment

Common reasons first responders may seek therapy include:

  • Burnout
  • Post-Traumatic Stress Disorder (PTSD)
  • Depression
  • Anxiety
  • Suicide Ideation
  • Substance Misuse
  • Sleep deprivation
  • Relationship Problems
  • Stress

Insurance may be able to help cover the cost of therapy. Find out if your insurance provider can help with the costs by filling in our confidential insurance verification form below.

What Happens in Therapy for First Responders?

Depending on the mental health issues you are seeking to address, there are different types of evidence-based therapy for first responders, including, but not limited to:13

  • Cognitive Behavioral Therapy (CBT): an especially effective therapy treatment for burnout and anxiety.
  • Dialectical Behavioral Therapy (DBT): useful for people having suicidal thoughts.
  • Psychodynamic Therapy: People who struggle with self-esteem, self-confidence, self-expression, depression, and anxiety might consider this a viable alternative.
  • Eye Movement Desensitization and Reprocessing (EMDR): In EMDR, a form of psychotherapy, the patient recalls traumatic events while receiving bilateral stimulation, such as tapping on each side of the body or side-to-side eye movement.14

Each therapy session typically lasts 45 to 60 minutes and occurs weekly. However, the times and frequency can vary, depending upon the specific issues you require therapy for, the type of therapy you’re receiving, and other factors.

When you meet with your therapist for the first time, be prepared to discuss the facts of your condition, what you’ve done to address it, whether you’ve previously sought treatment, and the results of that experience. Your therapist will probably also inquire about your past experiences, childhood, and treatment objectives. Many people struggle during their first therapy session, which is entirely normal.

In addition, medication may be prescribed or recommended as part of first responder counseling services. This depends on the severity of your issue(s) and any potential diagnosis, such as PTSD.

Furthermore, your objectives could change as you continue working with a therapist. Therefore, it’s perfectly acceptable to discuss the possibility of changing the course of your treatment or switching therapists entirely.

Things to Consider When Seeking Therapy for First Responders

The intimate collaboration between patients and therapists makes finding the proper match essential. Establishing a therapeutic bond with your therapist is crucial. Finding the right therapist is the first obstacle to overcome when considering first responder therapy. Whether to repair a relationship or recover from trauma, first responder counseling can provide the coping mechanisms necessary.

Inquire with potential psychiatrists in Tennessee about their training, professional experience, and success in working with first responders and handling issues comparable to yours. In addition to pricing, insurance, and office hours, don’t hesitate to ask many other questions. Below are some examples of questions you may want to ask when seeking first responder counseling:

  • What is your background in dealing with emergency personnel?
  • How many patients have you seen?
  • How much are you exposed to the fire/EMS culture? Have you ever gone along for the ride?
  • What treatment methods and philosophies do you favor?
  • What distinguishes counseling for first responders from counseling for civilians?
  • How long have you been a practicing mental health professional?
  • What must I do for my counseling to advance?

When searching for therapists and mental health treatment centers, you’ll probably find a series of letters following licensed mental health professionals’ names, which you may or may not be familiar with.

The prerequisites for each degree are different. For example, a clinician with LCSW (Licensed Clinical Social Worker) qualifications in Tennessee must have at least 3,000 hours of clinical practice in addition to a master’s degree in social work. At least 100 hours include direct supervision, 60 of which are one-on-one.15 And a psychologist (usually with a Ph.D. or PsyD) has training in various forms of psychotherapy and psychological assessments.

You should locate a psychiatrist or medical professional who can write prescriptions if you believe you’ll require medication. Consider looking for a therapist who participates in support groups or group therapy sessions if you want to be a part of a community of people who can relate to your experiences. In addition, online therapy is an option.


First responders should be aware of their counselor’s confidentiality regulations, as practitioner confidentiality standards might vary. People should carefully read this information before signing anything. Discuss any worries you may have with the clinician as soon as possible after your initial visit if they relate to the information in the paperwork.

A person must first complete intake paperwork before they can begin a counseling relationship.

A few pages defining confidentiality and outlining what is expected of the client and counselor should be included in this packet of material. Find another counselor quickly if you don’t receive this information.

It’s natural to be concerned about confidentiality before beginning first responder therapy. You’re used to handling sensitive information; therefore, it makes sense that you’d be wary of entrusting others with your private information and emotional issues. Many are even concerned that what they tell counselors could endanger their careers. In a consensual counseling partnership, confidentiality exists so that people feel comfortable disclosing sensitive material and receiving the mental health support, resources, and relief they require.16

Client privacy has moral and legal implications. Counselors and other mental health professionals must protect confidentiality through their professional oath, personal ethics, and legal licensure. As a result, counselors are prohibited by law from divulging anything disclosed during the confidential client-counselor interaction. Counselors take confidentiality concerns extremely seriously since violating confidentiality could result in losing their licenses.

Additionally, a set of regulations known as the Health Insurance Portability and Accountability Act (HIPAA) safeguards people’s private health information, including mental health records. Anyone who violates HIPAA in the medical field may be subject to civil or even criminal fines.

With all that said, there are certain factors that require a therapist to break confidentiality. Situations in which a clinician must violate therapist confidentiality vary by state and could include:17

  • To manage a situation where the client poses a serious risk to himself or others
  • If the therapist suspects elder, dependent adult, or child abuse
  • Whenever the patient has asked the therapist to discuss their issue in public
  • Whenever the therapist receives a court order

Benefits of Therapy for First Responders

Benefits of therapy for first responders may include:

  • Lack of side effects: There are potential side effects when people with mental health conditions are instructed to take prescription drugs. One may experience weight gain, sleep disturbances, and liver or kidney damage, among other harmful things. However, there are no adverse side effects with evidence-based talk therapy.
  • Enhances effective and beneficial communication: First responder counseling can assist couples in developing communication strategies that satisfy the needs of the spouse and the first responder.
  • Safe space: A place where you can feel comfortable and safe sharing your perspectives.
  • Develop coping mechanisms: Assist people in developing more healthy coping mechanisms to deal with challenges and/or challenging job calls.
  • Replacing unhealthy behavior and thoughts: Recognizing negative thought patterns and replacing them with positive emotional responses.
  • Feeling empowered: Improving communication, practicing healthy habits, and developing coping mechanisms can lead to feelings of control and empowerment.

Behavioral Health Resources for First Responders

First responder counseling services include national behavioral and mental health resources. Among these are:

  • All Clear Foundation is a vast library of resources devoted to enhancing the life expectancy and general well-being of first responders and their families.18
  • Copline: At 800-267-5463, a 24-hour law enforcement hotline staffed by retired officers who have been trained as peer listeners and who may offer assistance to law enforcement personnel and their families.
  • Crisis Text Line: First responders who text “BADGE” to 741741 and are experiencing a mental health crisis can receive 24/7 counseling and crisis intervention.
  • Frontline Helpline: Call 866-676-7500 to speak with former first responders who provide help for those affected by their horrific experiences among first responders and their families.
  • National Suicide Prevention Line: Anyone in suicidal crises or mental distress can contact a 24/7 network of local crisis centers for emotional support at 988.
  • SAMHSA Disaster Distress Helpline: Call or text the 24-hour, 365-day-a-year helpline at 800-985-5990 if you’re experiencing emotional distress due to natural or manmade disasters.
  • Firestrong.org: an online resource hub for information about firefighter PTSD that includes access to peer support and mental health services provided by numerous fire departments.
  • Significant Others and Spouses: Program from the First Responder Support Network designed to assist first responder families in coping with problems and family disturbances brought on by the demands of their employment.
  • Behind the Frontline: Supporting the Families of Frontline Staff and First Responders Podcast: The inaugural season of the Center for the Applications of Substance Abuse Technologies (CASAT) Conversations podcast was entirely devoted to the behavioral health problems that first responders face. The podcast offers advice on raising resilient children, stress-reduction methods, and family resilience-building strategies.


  1. “First Responder.” Cornell Law School, www.law.cornell.edu/definitions/uscode.php?width=840&height=800&iframe=true&def_id=34-USC-1467705710-1237373853&term_occur=999&term_src=title:34:subtitle:I:chapter:101:subchapter:XXXVIII:section:10705. Accessed 25 Oct. 2022.
  2. Luster, Rodney, PhD. “First Responders and Mental Health: When Heroes Need Rescuing.” Psychiatric Times, 9 Sept. 2022, www.psychiatrictimes.com/view/first-responders-and-mental-health-when-heroes-need-rescuing.
  3. Stanley, Ian H et al. “Differences in psychiatric symptoms and barriers to mental health care between volunteer and career firefighters.” Psychiatry research vol. 247 (2017): 236-242. doi:10.1016/j.psychres.2016.11.037
  4. Ruderman Foundation. “Ruderman White Paper on Mental Health and Suicide of First Responders.” Ruderman Family Foundation, 10 Apr. 2018, rudermanfoundation.org/white_papers/police-officers-and-firefighters-are-more-likely-to-die-by-suicide-than-in-line-of-duty.
  5. Weaver, Conrad. Documenting the Traumas of First Responders | NAMI: National Alliance on Mental Illness. 12 Mar. 2021, www.nami.org/Blogs/NAMI-Frontline-Wellness/2021/Documenting-the-Traumas-of-First-Responders.
  6. Li, Yufei et al. “Prevalence of depression, anxiety and post-traumatic stress disorder in health care workers during the COVID-19 pandemic: A systematic review and meta-analysis.” PloS one vol. 16,3 e0246454. 10 Mar. 2021, doi:10.1371/journal.pone.0246454
  7. Bentley, Melissa A et al. “An assessment of depression, anxiety, and stress among nationally certified EMS professionals.” Prehospital emergency care vol. 17,3 (2013): 330-8. doi:10.3109/10903127.2012.761307
  8. Lilly, Michelle M., and Heather Pierce. “PTSD and Depressive Symptoms in 911 Telecommunicators: The Role of Peritraumatic Distress and World Assumptions in Predicting Risk.” Psychological Trauma: Theory, Research, Practice, and Policy, vol. 5, no. 2, American Psychological Association (APA), Mar. 2013, pp. 135–41. https://doi.org/10.1037/a0026850.
  9. Ellingson, Katherine D., et al. “Incidence of SARS-CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential Workers During a Prevaccination COVID-19 Surge in Arizona.” JAMA Health Forum, vol. 2, no. 10, American Medical Association (AMA), Oct. 2021, p. e213318. https://doi.org/10.1001/jamahealthforum.2021.3318.
  10. “AZ HEROES Data Show First Responders at Higher Risk of COVID-19 Infection.” UArizona Health Sciences, 22 Oct. 2021, healthsciences.arizona.edu/newsroom/news-releases/2021/az-heroes-data-show-first-responders-higher-risk-covid-19-infection.
  11. By University of Phoenix. “Survey Finds 93 Percent of First Responders Say Mental Health Is as Important as Physical Health.” University of Phoenix, 11 Sept. 2018, www.phoenix.edu/media-center/press-release/university-of-phoenix-survey-finds-93-percent-of-first-responders-say-mental-health-is-as-important-as-physical-health.html.
  12. Bradley University. “Strategies for Counseling First Responders.” Bradley University Online, 22 Nov. 2021, onlinedegrees.bradley.edu/blog/counseling-for-first-responders.
  13. “5 Types of Therapy: Which Is Best for You?” Cleveland Clinic, 25 Oct. 2021, health.clevelandclinic.org/types-of-psychotherapy.
  14. “EMDR: Eye Movement Desensitization and Reprocessing.” WebMD LLC, 2022, https://www.webmd.com/mental-health/emdr-what-is-it
  15. Writers, Staff. “Social Work Licensure in Tennessee | Find Accredited Programs.” SocialWorkLicensure.Org, 1 July 2019, socialworklicensure.org/state/social-work-licensure-tennessee.
  16. American Military University. “What You Need to Know About First Responder Counseling.” EMS1, www.ems1.com/amu/articles/what-you-need-to-know-about-first-responder-counseling-QLgP8GhqsQis9j5i. Accessed 26 Oct. 2022.
  17. Caldwell, Ben PsyD. “When Can a Therapist Break Confidentiality?” SimplePractice, 24 Oct. 2022, www.simplepractice.com/blog/therapist-break-confidentiality.
  18. “Health Care Professionals | NAMI: National Alliance on Mental Illness.” National Alliance on Mental Illness (NAMI), NAMI, www.nami.org/Your-Journey/Frontline-Professionals/Health-Care-Professionals. Accessed 23 July 2022.

If you suspect that you or someone you love suffers from mental health disorders, contact Athena Care today.

One of our friendly associates will help you get the help you need. Take this first step to feel better and take control. 

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