Trauma Response Profile Beverly Anderson, Ph.D., B.C.E.T.S.

For nearly 20 years, Dr. Beverly Anderson has provided psychological services to law enforcement agencies around the nation. She has consulted on traumatic stress to more than thirty international and national law enforcement organizations. Dr. Anderson has been a featured speaker on Posttraumatic Stress Disorder (PTSD) for Good Morning America, CNN, and dozens of television news stations. She is featured in the Channel 4 News video"Cops Under Fire." She has been invited to present her research on Police Trauma Syndrome® to several organizations and groups including the International Society for Traumatic Stress Studies. Dr. Anderson is the Clinical Director and Administrator of the Metropolitan Police Employee Assistance Program in Washington, D.C. Moreover, she is President of The American Academy of Police Psychology, an organization that is dedicated to addressing the unique concerns and stressors of the law enforcement community. Dr. Anderson is a Diplomate of The American Academy of Experts in Traumatic Stress and the Academy is privileged to have her serve on the Board of Scientific & Professional Advisors.

JSV: I know that you have been very committed to providing psychological services to law enforcement agencies for almost 20 years. Can you tell me about the positions that you currently hold?

BJA: I am the founding Clinical Director and Administrator of the Metropolitan Police Employee Assistance Program and have been since 1988. This program is unique in that it is a joint union-management approach to addressing the serious stress-related problems that are a direct result of policing. I do not work for the Police Department or the City. My contract is with the Fraternal Order of Police Labor Committee. The best part about this independence is that it ensures confidentiality. The records belong to me as a private clinician which facilitates trust in those whom we assist. We have 3,500 officers in the Washington Metropolitan Police Department. We are not an employee assistance program in the true sense. We are actually a long-term services program and provide individual therapy, family therapy, marital therapy, play therapy, and various group therapies including Veteran officers groups, alcoholism prevention and relapse groups, and weekly critical incident debriefing groups. With regard to this latter point, we have an average of two police-involved shootings per week. Subsequently, we have ongoing debriefings. Our police department must contend with one of the highest murder rates in the United States for a city of our size. Moreover, we have one of the highest rates of ambushes and unprovoked attacks on police officers in the nation. There is a lot of gang violence, drug-related problems and the like. We have a situation here that demands all of the emotional resources of the force. We also do a lot of training. The foundation of our comprehensive program is based on training. We have a critical incident program that begins with the recruits in the police academy and involves family members. We are on call 24 hours a day. In fact, just this morning at 1:30am, I was paged to a police-involved shooting and had to go to the Homicide Division. I sat with the officer to assist with what is best referred to as defusing. This involves debriefing the officer after the shooting and then for six mandatory meetings within three months of the shooting. We are also engaged in research. We have done work with Dr. Frank Putnam from the National Institute of Mental Health on Secondary Post-traumatic Stress Disorder in the children of police officers. We are still compiling data. In working with police families over the years, we have noted a preponderance of symptoms in the children to include hyperactivity and attentional problems. I believe that this is a direct result of experiencing the effects of parental exposure to trauma.

JSV: As you are aware, The American Academy of Experts in Traumatic Stress is a multidisciplinary organization comprised of professionals from over one hundred forty specialties. Many of these individuals respond on the "front lines" of risk and, at times, danger which are significant stressors. How does law enforcement stress differ from other occupational groups such as firefighters and Emergency Medical Technicians (EMTs)?

BJA: The first thing that comes to my mind is the public response to firefighters and EMTs. For the most part, it is a very positive response when compared to the police. Think of being stopped by a police officer for speeding, for example, and you think that you are going to get a ticket. One of the first things that you may do is try to get out of it, be nice, or lie. The public mind set toward the police officer seems to be more negative. Although there is a clear danger potential in all of these groups, the danger is different for police officers. As the level of violence in this country escalates, the echos of that violence reverberate throughout the police community. Unprovoked attacks on police officers are at an all-time high. Just a year ago, D.C. Master Patrol Officer Brian Gibson sat in his patrol car at a stop light and was shot execution style by a young man who was put out of a local night club by a police officer. Another example is Officer Wendall Smith who was exiting his vehicle after returning home from his evening shift. When the attackers saw that he was a police officer, they shot and killed him. In 1995, Scot Lewis was shot in the head and killed by a passerby while Officer Lewis and his partner were assisting a hearing-impaired person. The assailant then turned the gun on Scot's partner, Officer Keith Deauville who returned fire, fatally wounding the attacker. In these situations, the danger is not obvious and you don't know who is going to attack you. The police officer always has to be ready. That is why officers have what I call "cop-face" (the need to be hypervigilant). They have "cop-face" because they never know (when they have to move into action). The unpredictability of the job of policing is an added stressor. This means that the stress hormones need to remain elevated at some level (recall the General Adaptation Syndrome). The police officer is always looking for what is "wrong" in the picture. Shift work and midnight duties are common to other professions but the unpredictability and the violence make police work unique. You can add to this, a revolving-door justice system, with the person you locked up today, back on the street tomorrow. A police officer also has to contend with mixed messages from police administration. On one hand they are told to lock-up and arrest those involved with crime and, on the other hand, always remain professional while doing it. There is public scrutiny of police work, and at times, media misrepresentation of events. There is always a threat of civil law suits. There is significant stress associated with the use of deadly force - having to kill another human being. I have yet to meet an officer who is emotionally ready to kill another human being. Many officers say that the first thing that came to mind after they fired the fatal bullet was "Thou shall not kill." All of these stressors make police work different from other professions. Of course, the on-going, day-to-day exposure to murders, assaults, rapes, child abuse, domestic violence and "man's inhumanity to man" intensifies this stress-related burden.

JSV: What is the most significant stressor for police officers?

BJA: If you ask a police officer about the most significant stressor of policing, they often report "police administration." However, the nightmares they experience are not about administration. These nightmares are about the use of deadly force, shooting their guns, and being shot. It becomes apparent that the most considerable stressor is the constant exposure to trauma, especially over prolonged periods of time. However, problems regarding "police administration" are very real for officers and sometimes constitute the "second wound." Officers expect that the public and the media will mistreat them; they don't expect betrayal from the very organizations they risk their lives for every day.

JSV: This is quite consistent with combat veterans who serve multiple tours of duty.

BJA: This is absolutely correct and I think that you bring something out that is so much a part of the police experience. Without minimizing the trauma of combat, consider the following. During wartime, soldiers go to a foreign land, and are likely to remain there for six months to a year. Police officers are likely to see twenty years of peacetime combat, in their own country where they do not always know who the enemy is. The enemy could be anybody.

JSV: What is "Police Trauma Syndrome®" and why do you think that it has taken so long for its wrath to be examined in the trauma literature? What are the stages leading to this syndrome?

BJA: Police Trauma Syndrome® is a diagnostic term that I authored several years ago to depict the cluster of symptoms many police officers suffer as a direct result of the job of policing. It is now a registered trademark. In diagnosing trauma-related disorders with police officers, we have found great difficulty with the criteria set forth in both the DSM-III and DSM-IV (Diagnostic and Statistical Manual of Mental Disorders). It has been problematic for us to use the DSM-III or DSM-IV criteria for police officers because they typically do not fit into the Posttraumatic Stress Disorder (PTSD) criteria per se. A police officer can witness, inside of one week, more trauma than most people see in a lifetime. Not only is it qualitatively different but also, quantitatively different. They see so much trauma. If you examine the first of the DSM-IV criterion (for PTSD), it states that the person's response to the event must involve intense fear, helplessness, or horror. Police officers are more often than not, the first responders to a scene. They have been tuned to dissociate from their emotions or suppress their emotions in order to be able to endure the scene. Theoretically, in most cases, police officers would not fulfill this first criterion. They are trained to respond behaviorally (not emotionally). Also, we tend to see a biphasic response which oscillates between anger or intrusive thoughts and numbing. We see extremes in their responses. This does not imply that police officers get used to being exposed to trauma, because we know that this is not the case. Chronic, long-term and cumulative stress takes its toll on police officers. When we talk about the issue of police brutality, it becomes clearer that the effects of such stress will come out one way or another. Police Trauma Syndrome® can result after a single, catastrophic event such as when an officer witnesses his partner being killed, and then having to defend his own life perhaps by killing the assailant. This could precipitate full-blown PTSD or Police Trauma Syndrome® in an officer. On the other hand, after years of traumatic exposure, Police Trauma Syndrome® can be triggered by an incident that is not immediately life-threatening, like the following incident.

A veteran officer with young children at home got a call to respond to an unconscious person. Well, what do you think of when you hear "unconscious person" - a street person, a person who is intoxicated, a stroke or heart attack victim? There is not too much warning in these situations. The officer goes into an apartment and there he finds an eight-month-old baby with a core body temperature of 106 degrees. He immediately begins mouth-to-mouth resuscitation because the baby is not breathing. The baby vomits sour milk into the officer's mouth. The ambulance finally gets there and the baby is taken to the hospital and dies. No one tells the officer what the baby has died of. He doesn't know if the baby is HIV positive, has meningitis, or is contagious! No one will talk with him because there has not yet been an autopsy. He goes home. Can he touch his children? He cannot look at his young baby without having intrusive thoughts and overwhelming feelings about the baby who had just died. In this case, the officer had an acute reaction and this triggered memories of other experiences and he was in a full-blown crisis. Another example is the veteran officer who had been on the scene of many suicides over the years. On one particular occasion, he began to tremble and hallucinate, and he experienced panic symptoms, etc. This was a person with 22 years on the force! There are so many factors involved. The important thing to convey about Police Trauma Syndrome® is that when a clinician sees this term, consider that the individual is suffering from events experienced primarily on the job. It is a direct result of the occupation of policing. Our veteran officers group has identified several stages leading to full-blown Police Trauma Syndrome®. (This group has been meeting for four years and is comprised of officers with 17 years or more on the Department. They have all been high achievers on the job but have paid a price emotionally). They have defined a five-stage model.

In the first stage, the "Rookie" Stage, an officer is "shocked" by the world he sees - the violence, the neglect and cruelty toward children. He sees a world that he didn't know existed. The second stage is the "John Wayne" Stage and is marked by an uncertainty as to the "balance" of the badge. The officer is filling a role as he/she understands it. The "tough" image portrayed by the media cops is all that officers may know. The officer may take pride in owning all of the police gadgets. Their communicative style is primarily one of "commanding, ordering and directing." During the third stage, the "Professional" Stage, the officer has a good sense of his/her own identity. No matter how much verbal abuse they encounter, they remain courteous and in control (e.g., responding to an angry motorist he has just ticketed, you might hear, "Well, sir, I am sorry that you are making reference to my mother right now; however, you did go through that stop sign and I am required by law to cite you"). While for appearance's sake, this may seem problem-free, in actuality what's happening is that the officer may be "numbing" his natural emotions. "Dehumanizing" citizens as a coping mechanism will cost the officer in his personal life. Defense mechanisms that help an officer adapt to the job are maladaptive in his/her personal life.

These stages do not necessarily follow a consecutive pattern. Our experience has been that officers can jump from one stage back to an earlier stage. For example, a veteran officer who is in the "Professional" Stage may revert to the "Rookie" Stage upon witnessing a gruesome, traumatic event. We found this in many officers who responded to the Air Florida crash in 1982. The carnage and death they were exposed to that night and during the body recovery days after changed their lives. Many of the officers experienced the "Burnout" Stage which is number four in our model. Anger and contempt for the criminal justice system, the Department, politicians, and the citizens highlight this stage. The officer begins to isolate from family and friends - believing that they do not "have a clue" as to what the world is really like. The fifth and final stage is full-blown "Police Trauma Syndrome®." The individual is no longer able to function effectively as a police officer. This state is characterized by sleep problems, anxiety and/or depression, flashbacks, intrusive thoughts, mood swings, rage attacks, social isolation, and a deterioration in relationships. The officer may consume alcohol or other drugs or experience an escalation in usage. Suicidal thoughts may arise. This condition is far more pervasive than one might think. Sadly, what usually happens, without intervention, is that the officer retires (if he/she can) and disappears into obscurity. We are working very hard to prevent Police Trauma Syndrome®.

JSV: What about the use of deadly force? For example, what do police officers go through after they are involved in a deadly shooting? Does the use of deadly force affect police officers more than other stressors?

BJA: Involvement in a police shooting may be the cataclysm of a police career. When I began working with officers, it was almost unheard of for an officer to be involved in a shooting. It was rare. Now in this city (Washington, D.C.), we average two police-involved shootings a week. There are many factors involved in the event that have to be examined. For example, was the officer injured? How lasting was the injury? Was the officer's partner injured or killed? Was the suspect killed? Who was the suspect - an adolescent, elderly person, a mentally ill person? How grotesque was the shooting? What was the physical proximity of the officer to the suspect? For instance, I remember one officer who told me how the suspect looked at him before he died and asked "why did you kill me?" That is what the officer will remember. Was the officer taken by surprise? For example, one minute the officer was giving directions to a citizen and the next, he has a gun pointed at him. Also, were other people in danger of being killed or injured? Was the use of deadly force appropriate or can the officer be potentially convicted of homicide? There is also the potential for civil liability. What is the officer's coping style? Is there substance abuse? Police officers oftentimes use self-destructive coping mechanisms such as drinking, gambling, workaholism, etc. What was the department's response to the shooting? Were they supportive or punitive? Some departments take an officer, remove his weapons, and place him in the back of the car. Who else goes in the back of the car? Suspects! What is the emotional impact on an officer when this happens? He feels that he must have done something wrong. Another factor that affects officers in the aftermath of a shooting is how the media handles the reporting of the shooting. So often, in their haste to report a story, the media will distort the facts and not usually to favor the police. Officers have a favorite phrase they use to describe the media, "Don't let the truth get in the way of a good story."

Immediately after a police shooting, a quick response by management and mental health personnel is crucial. Counselor support within hours of the shooting as well as follow-up services send a critical message: "You are important to this Department and this community." Follow-up services should also include the family. We have prepared a booklet for officers, officials and family members that discusses how to best manage police critical incidents.

JSV: Recently, in New York, there was a very unfortunate encounter for some police officers involving "Suicide-by-Cop" in which an individual, who apparently wanted to kill himself, pointed a plastic gun at officers and was, subsequently, fatally shot. In your experience, how often does this occur and how do you assist officers who confront such an event?

BJA: This is yet another very sad fact of life for law enforcement officers - one that happens all too often. The kind of individual who uses police officers for his/her own suicide will influence the officer's reaction. Individuals who commit heinous crimes and then precipitate an officer's use of deadly force will evoke a different response from an officer than a depressed adolescent who just wants to die and doesn't have the nerve to do it himself. The natural response for the officer is often one of anger. When a person makes a decision to point a gun at a police officer, that officer must react to protect his life. The public doesn't seem to understand this. Citizens will ask "couldn't you have shot him in the arm?" or "couldn't you shoot the gun out of his hand?" Our job is to help the officer place the responsibility on the person who caused this event. At the same time, we validate the normal feelings that accompany such a tragedy.

JSV: Police officers are often portrayed in the media as the "cool" and "calm," Clint Eastwood-type. In your opinion, what effect does such a stereotype have on officers, if any?

BJA: We have worked very hard to dispel that myth and it seems to be working with our younger officers. With officers on the job ten years or so, you see that macho-mystique portrayed in the Lethal Weapon movies. I remember Mel Gibson taunting the police psychologist in one particular movie after she had voiced concern for him. That image is not helpful for the public or the police. I have yet to meet a cop who has a "make my day" philosophy of policing. However, the rigid, macho mentality that does exist is a barrier to debriefing after a critical incident. In the long run, it makes the officer more vulnerable to the cumulative effects of traumatic exposure.

JSV: From time to time the media has highlighted cases of police brutality such as the Rodney King beating in 1991 in Riverside, California. Do you think that police "brutality" is a problem in this country?

BJA: Yes, I do think it is a problem. I also say that we have to look at this problem in context. This begins with verbal abuse which, I believe, is a direct result of chronic exposure to trauma such as death, suicide, rape, assault, etc. (i.e., precipitants for Police Trauma Syndrome®). Police departments need to begin to deal with this more appropriately and more efficiently. They need to do more than one debriefing meeting. They need to train recruits and supervisors in an ongoing, comprehensive fashion. Standards need to be set high and kept high. Unless there is change, I think that we will continue to see this problem. We need to look at stress education and training in the same manner as we look at body armor (i.e., bulletproof vests). This equipment prevents physical trauma to the body. Likewise, if a department has a good stress inoculation training program that is ongoing, then this is the kind of armor that is needed to prevent (or mitigate) some of the psychological trauma.

JSV: On that note, how is critical incident stress debriefing in the Metropolitan Police Employee Assistance Program conducted by you and your colleagues?

BJA: Knowledge about the debriefing process begins in the Police Academy. The recruits and their family members are given a booklet entitled Critical Incident Stress Debriefing - Important Information for Officers and Family Members. We begin with that education in the Academy. The recruits go through stress training. If and when they have an incident, they become more responsive. As soon as an incident occurs, one of the on-call therapists responds. The protocol of immediate intervention involves normalizing and validating feelings. We may also educate the officer (e.g., "these are some of the reactions that you may have and the important thing for you to remember is that this is normal"). After that, debriefing times are offered to the officers who will attend a total of six mandatory debriefings on department time. If they come when they are off of their shift, they receive compensation time for attending. Our offices are not located near a police facility. We are in an office building away from police facilities. There is ensured confidentiality. The meetings are held in a group setting. They are co-led by police officers who have been through a critical incident. The officer is not acting as a therapist, but talks about his/her own reactions. Appropriate boundaries between the police and therapist roles are essential for the success of the program. The debriefings involve stress education and exploration of each police officers' event. They learn that they all respond in a relatively consistent way and there is normalization of their responses. They are able to hear other officer's "story" which helps many officers to believe that they can heal from their experience. To quote one officer, "You see things through new eyes." I refer to this process of debriefing as a cognitive-affective-behavioral intervention. They understand what has happened to them, learn about their feelings, and have to go an extra step to learn how this event is going to change them. The ultimate goal is to help officers find some meaning in the event and take their experiences to a new level. This is what survivors need to do. It is not just survival but prevailing and overcoming. We have to help officers respect the enormity of what has happened to them and understand that it is powerful. We also have to help officers realize that, in time, they have to make the event a part of the past. It does not need to be a constant torment even if the memory may last forever.

JSV: Although there is an increasing recognition of the psychological effects of domestic violence on victims, considerable research still needs to be conducted. With regard to the effects of domestic violence on children, what recommendations could you give to officers who respond to domestic violence calls where young children have witnessed a traumatic stressor (e.g., mother's battering, etc.)?

BJA: There are some states that have passed laws that are much more stringent with regard to protecting people. However, there is so little that a police officer can do. He/She can arrest a perpetrator, which he may have to do. But, when it comes to removing a child from the household, it becomes painful for a police officer. I have spoken to officers who have described a desire to take the child home with them which, as you can imagine, can cause other problems. Officers are so powerless in many situations. This powerlessness is close to police officers. They must live with this. The only thing we can tell them is that they should talk about it but, they oftentimes, don't want to talk about it. It hurts to talk about it. They say, "What good does talking do, it doesn't change the situation." This is another stressor for police officers. When they go home, they say they don't want to talk about it because they "leave the job at work." The real reason they don't talk about it is because they are trained on the job to suppress their emotion. So, if they begin talking about it at home, they can't just tell it like a story that happened to somebody else. They may become overwhelmed with emotion and they don't know what to do with those feelings. We go back to that biphasic response - numbing and dissociation. Many officers are uncomfortable with their own emotions.

JSV: As a member of the Board of Scientific & Professional Advisors of The American Academy of Experts in Traumatic Stress, are there any suggestions or concluding comments that you could offer with regard to helping survivors of traumatic stress?

BJA: The big word for me is "depathologize." We need to look at the public health problem of traumatic stress in society. We need to look at traumatic stress not as a mental illness but as a public health issue. I read an interesting comment recently in an article. The author said that "PTSD is to the world of psychology what AIDS is to the world of medicine." I think that this is true. There is a preponderance of traumatic events (e.g., the increase in violence, natural and man-made disasters, etc.) in society. Those who are exposed to trauma need to receive assistance and should not have to feel that they are "crazy" when they seek help.

JSV: As you are aware, The American Academy of Experts in Traumatic Stress recognizes that traumatic events are an unfortunate part of the human experience that individuals from many disciplines work with on a regular basis. What do you see as the major advantage of an organization such as the Academy that is dedicated to increasing awareness and ultimately, improving the treatment for survivors of such events across such an eclectic group?

BJA: The American Academy of Experts in Traumatic Stress serves a unique and vital purpose. We have to take traumatic stress out of the exclusive domain of psychology and psychiatry. We have to do this! Traumatic stress and its aftermath belong to all of us - medical doctors, lawyers, police departments, psychologists, psychiatrists, teachers, insurance companies, legislators, etc. Education is a crucial step and the issues must be addressed in a public forum (as the Academy's mission statement indicates).

JSV: Tell me about The American Academy of Police Psychology. I understand that you are the President of this organization which is the first organization of its kind to address the concerns of the law enforcement community.

BJA: The American Academy of Police Psychology is an organization dedicated to addressing the unique concerns and stressors of the law enforcement community. Some of the major goals of our organization are to establish standards for police counseling, debriefing, and stress programs and to initiate research in the area of police trauma. Moreover, we are committed to educating police departments, family members, police officers, educators, and criminal justice programs about the nature of law enforcement and the unique stressors associated with this profession. With regard to this latter point, this must be dealt with in order to have a healthy work force. This can benefit the police officer, their families and the community. As an organization, we want to focus exclusively on law enforcement. We have had other agencies approach us who want to affiliate with us and work on other issues. However, we want to remain focused on law enforcement stress and traumatic exposure of police officers. We want to advise communities and police departments on how to put programs together that can be preventative in nature. Many police officers, when they retire, suffer in silence. Twice as many police officers kill themselves each year than are killed in the line of duty. The high incidence of divorce is reflected in the fact that intimate relationships are difficult for many police officers. There is a high incidence of trauma-related problems that really demands that we take care of law enforcement officers in the way that they take care of us. We have nearly 700,000 law enforcement officers in this country. They have spouses and many have children. All of those people are affected as well. Law enforcement is an emotionally and physically dangerous job. The Academy's mission is a singular one - helping those who protect and serve.