Holding the Line: Supporting the Mental Wellness of First Responders

First responders—EMTs, firefighters, police officers, dispatchers, and others—are trained to run toward danger. They carry the weight of life-or-death decisions, witness the aftermath of human suffering, and are often expected to stay composed through it all. However, while their training prepares them to respond in crisis, it doesn’t always prepare them to process what happens afterward—and that’s where clinical support becomes vital.

As a therapist who specializes in trauma and holds a certification in First Responder Counseling (CFRC), I have seen firsthand the unique emotional toll this work can take. My approach to supporting first responders is grounded in cultural competence, a phased approach to trauma therapy, and, most importantly, building safety, both in and out of the therapy office.

Why First Responders Struggle in Silence

Many first responders are reluctant to seek help for mental health concerns. There are several reasons for this. Here are a few:

• Stigma: Mental health struggles are often equated with weakness in high-performance environments.

• Culture of stoicism: “Suck it up and move on” is often the unspoken rule.

• Shift work and burnout: Irregular hours, exposure to critical incidents, and cumulative stress erode resilience over time.

• Lack of trust: Many worry that a therapist “will not get it” unless they have walked in their boots or can trust that their therapist can handle the traumas that they have witnessed, the calls that stay with them.

Nevertheless, beneath the surface, many are experiencing symptoms of chronic stress, Occupational Stress Injury, PTSD, moral injury, or compassion fatigue—while still showing up to serve others.

A Trauma-Informed Approach That Honors the Role

When working with first responders, I integrate a phase-based model of trauma treatment with an understanding of how repeated exposure to traumatic events, or as I hear often, “death by a thousand cuts,”  impacts the brain and nervous system.

Session goals often include:

• Increasing awareness of chronic stress and nervous system dysregulation

• Building tools for real-time regulation during and after shifts

• Processing cumulative and acute trauma (line-of-duty deaths, pediatric calls, near misses, etc.)

• Navigating relationship strain, sleep disruption, and identity fatigue

• Creating emotional safety for vulnerability in a nonjudgmental, confidential space

I also validate that resistance to therapy is often a protective response. Many first responders have learned to compartmentalize to survive—and undoing that takes time, trust, and attunement.

What Therapy Can Look Like

Every client is different, but most sessions involve a blend of:

• Psychoeducation: Understanding how trauma rewires the body and brain

• Nervous system tracking: Learning to notice fight/flight/freeze responses.

• Somatic regulation skills: Breathing, grounding, and calming practices

• EMDR: reprocessing and integration

• Relational repair: Exploring how trauma impacts family and intimacy

• Reintegration and Post-Traumatic Growth 

Sessions are intentionally paced—nothing is forced, and control always remains with the client.

Final Thoughts

If you’re a first responder reading this, I want you to know:

You are not broken.

You are not weak.

You have been carrying more than most people will ever see.

You deserve a space to lay some of it down.

If you are a fellow clinician hoping to work with this population, know that your ability to sit in quiet presence and respect the culture of the job while gently expanding your client’s emotional range is your most powerful tool.