Coping with Secondary Traumatic Stress by General Duty ... · Coping with Secondary Traumatic Stress by General Duty Police Officers 273 impact of stress on police Multiple studies
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StephanieM.ConnLeeD.ButterfieldAdler School of Professional Psychology
abstractThis study used the Critical IncidentTechnique to examine the factors that helped,hindered,ormighthavehelped10generaldutypoliceofficerstocopewithsecondarytraumaticstress.Thedatawerebestrepresentedby14categories:self-care,family/signifi-cantothersupport,talkingwithco-workers,emotionalengagement,workenvironment,mentalhealthresources,personality,abilitytohelpthevictim,relatabilitytothevictim,scenereminders,continuousexposure/dwelling,exposuretohumannature,vulnerabilityofthevictim,andpresenceofadditionalstressors.Thefindingsarepresentedandrec-ommendationsareofferedforcounsellorsworkingwiththispopulationandforpoliceagencyadministrators.
résuméPourmenercetteétude,leschercheursonteurecoursàlatechniquedesincidentscri-tiquespourexaminerlesfacteursquiontaidé,quiontnui,ouquiauraientpuaiderà10agentsdeservicesdepolicegénérauxdans leurgestiondustresspost-traumatiquesecondaire. On a mis les données dans 14 catégories qui les représentent le mieux :auto-soins,soutienfamilialetsoutiendelapersonnelaplusproche,conversationavecdescollèguesdetravail,engagementémotionnel,milieudetravail,ressourcesensantémentale,personnalité,aptitudeàaiderlavictime,capacitéd’établirunrapportaveclavictime,élémentsderappeldelascène,expositioncontinueoutendanceàrevenirsanscessesurl’incident,expositionàlanaturehumaine,vulnérabilitédelavictime,etprésenced’élémentsstressantssupplémentaires.Onprésentelesrésultatsetlesrecommandationsàl’intentiondeconseillersquitravaillentauprèsdecettepopulation,ainsiqu’àl’intentiond’administrateursdecorpspoliciers.
Operationalstressorsofpoliceworkcanbedividedintoprimaryandsecond-arytraumas.Aprimarytraumainvolvesathreattothepoliceofficer’slife,asinthecaseofanofficer-involvedshooting.Thestressfromthistypeofeventhasbeendocumentedextensivelyintheresearchonpolicestress(Everly&Mitchell,1995;Gilmartin,2002;Kirschman,2000;Patonetal.,2009).Anothersourceofstressforpoliceofficersisrepeatedexposuretothesufferingofothers.Exposuretosecondarytraumamayresultinsecondarytraumaticstress(STS).“Secondarytraumaticstress(STS)referstoasetofpsychologicalsymptomsthatmimicpost-traumaticstressdisorder,butisacquiredthroughexposuretopersonssufferingfromtheeffectsoftrauma”(Baird&Kracen,2006,p.181).ResearchonSTShasonlyrecentlybegunandhastendedtofocusmoreontherapists,counsellors,andsocialworkersthanemergencyservicespersonnelsuchaspoliceofficers.Studieshaveindicatedthatpoliceofficerswhorepeatedlyrespondtotraumavictimsareat riskofdevelopingSTS, if notposttraumatic stress disorder (Hafeez, 2003;Marshall,2003;Salston&Figley,2003).
Inadditiontotheirexposuretooperationalstressors,policeofficersalsosuf-ferfromexposuretotheorganizationalaspectsofpolicework(Brough,2004;Hart,Wearing,&Headey,1995;Libermanetal.,2002).Documentedexamplesoforganizationalaspectsofpolicingthatcancauseoccupationalstress includeshiftwork,personnel issues, andpaperwork.Exposure to routineoccupationalstresshasbeenfoundtobeastrongerpredictorofpsychologicaldistress,includ-ingposttraumatic stress symptoms, than is thecumulativeexposure tocriticalincidentsordanger(Libermanetal.,2002).
The Enhanced Critical IncidentTechnique (ECIT) (Butterfield, Borgen,Maglio,&Amundson,2009;Flanagan,1954)wasusedtodevelopapictureofthecopingstrategiesemployedbygeneraldutypoliceofficersthatcouldnotbecapturedbyresponsestoquantitativesurveys.Priortobeginningtheresearch,approvalfortherecruitmentstrategy,protocolsused,planstoprotectparticipantconfidentiality,methodology,andcounsellingresourcesforparticipants,ifneeded,wasreceivedfromaninstitutionalResearchEthicsBoard.Noparticipantsrequiredthecounsellingresourcelist.
methodology
TheCriticalIncidentTechnique(CIT)isaqualitativeresearchmethodthatarose from industrial and organizational (I/O) psychology duringWorldWarII(Flanagan,1954).FlanagandevelopedtheCITtodeterminewhatdecisionsandbehavioursflightcrewsengagedinthatallowedthemtoreturnsafelyfrombombingmissions(Flanagan,1954).Hethenusedtheinformationtoselectandclassifyflightcrews.TheCITisexploratorybynatureand“isappropriatetousewhentheresearcherisinterestedinlearningmoreaboutlittle-understoodevents,incidents,factors,orpsychologicalconstructs”(Butterfieldetal.,2009,p.268).Itisdesignedtoelicit“criticalincidents,orfactors,thathelppromoteordetractfromtheeffectiveperformanceofsomeactivityortheexperienceofaspecificsituationorevent”(Butterfieldetal.,2009,p.266).
Supportfromfamily,friends,andsignificantotherswasalsocitedby8ofthe10participantsasahelpfulfactor(80%participationrate,13incidents).Thelackofsupportwasdeemedashinderingby6participants(60%participationrate,6incidents).Therewasonewishlistitemfrom1participant(10%participationrate,1incident).Family or significant other support wasdefinedinthisstudyastheparticipant’sabilitytorelyonfamilymembers,suchasparentsandsiblings,andsignificantotherstohelpmeethisorheremotional,psychological,andspiritualneeds.Forthisstudy,lackofsupportmeanttheabsenceorunavailabilityoffamilymembersandsignificantothersoralackofunderstandingfromfamilymembersandsignificantothers.Significantothersincludedlovepartnersandfriends.Forsomeparticipants,friendsreferredtonon-policefriendships,andforothersitin-cludedpolicefriendshipsoutsideofwork.Formsofsupportandmeansofmeetingtheofficers’emotional,psychological,andspiritualneedsvaried.Oneparticipantwhoidentifiedfamilysupportashelpfultocopingreported:
Talking with co-workers was tied with family/significant other support asthesecondmostprevalentfactorthathelpedparticipantscopewithSTS(80%participationrate,13incidents).Forthisstudy,talking with co-workers included informalconversationswithoneormorefellowofficersafteranincident.Timingofconversationsincludedbothimmediatelyfollowingtheconclusionoftheinci-dentandthosethatoccurredlaterinthesameshiftordaysorevenweeksaftertheincident.Theywerenotinthecourseofastructuredoperationalorpsychologicaldebriefing.Oneparticipantstated:
Threeparticipantsidentifiedhavingaformaldebriefingasbeinghelpfulfortheircoping.Aformal debriefingforthepurposesofthisstudywasastructuredinterventionperformedbymembersoftheCriticalIncidentStressManagementTeam and/or designated mental health professionals that offered a forum fordiscussingone’semotionalreactiontoacritical incident.Acritical incidentinthiscontextreferstoatraumaticeventoneencountersatwork.Itshouldbedis-tinguishedfromacriticalincidentintheECITresearchcontextthatconstitutes“factorsthatpromoteordetractfromtheeffectiveperformanceofsomeactivityortheexperienceofaspecificsituationorevent”(Butterfieldetal.,2009,p.266).Oneparticipantreported,“Ispoketomembersonourcriticalincidentteamandtheywereveryhelpful,andtheyjustsaid,‘Youknowyou’regoingtothinkaboutitforacoupleofweeksandthat’sfine,that’snatural,andcontinuetoprocessthat’”(Participant#4).
FourparticipantsidentifiedthatmentalhealthresourceshelpedthemtocopewithSTS(40%participationrate,4incidents).Threeparticipantscitedhavingmentalhealthresourceswouldhavehelpedwithcopingifithadbeenavailable(30%participationrate,3incidents).Therewerenohinderingcriticalincidentscitedthatfitintothiscategory.Mental health resources fortheparticipantsinthisstudymeanttheprovisionandutilizationofpsychologicalservicesandmaterialsthatpromotepsychologicalwell-being.Itincludedaccessingprofessionalpsycho-therapeuticservicesormaterialspertainingtopsychologicalwell-being.Itincludedtheknowledgeand/orutilizationoftheseservicesandsourcesofinformation.Oneparticipantrelayedhowaccessingmentalhealthresourceswasahelpingfactor,saying“Iwenttoseeacounsellorandthatmadeahugedifference,justnormal-izingandjustsittingtheretalkingtosomebodyactuallythat’stotallynotinvolvedinyourlife”(Participant#8).
ThreeparticipantsindicatedthattheabilitytohelpthevictimpromotedtheirabilitytocopewiththeSTSofthatcall(30%participationrate,3incidents).Theinabilitytohelpvictimshinderedcopingforthreeparticipants(30%participationrate,5incidents).Onewishlistitemrelatedtotheabilitytohelpthevictimwasalsocited(10%participationrate,1incident).Inthisstudy,ability to help the victim referredtothebeliefthatonecanmakeadifferenceorchangethecircum-stancesofthevictimorvictims.Theinabilitytohelpvictimswasoperationalizedasfacingasituationwhereonefeelshelplesstomakeadifferenceorchangethecircumstancesofthevictimorvictims.Participantsrelatedthatthisfeelingmay
havebeenbecausethevictimwasdeceasedwhenthepoliceofficersarrived,oritmayhavebeenthatthesituationrequiredalong-termsolution(Participants#2and10).Someparticipantsreportedfeelingtheywereunabletohelpthevictim,even referring to it as “helplessness” (Participants#2,5, and10).Oneofficerreportedthatshiftinghowoneinterpretedtheabilitytohelpthevictimhelpsoneselftocopebetter,stating:
Two participants identified their ability to relate to the victim as helpful(20% participation rate, 2 incidents) while 4 participants cited this factor ashinderingtheircopingwithSTS(40%participationrate,5incidents).Nowishlistitemswerecitedthatfitintothiscategory.Relatability to the victimwastheparticipant’s identificationofsharedtraitsorcircumstanceswiththevictimorvictim’sfamilythatpromotedempathicfeelings.Oneparticipant’sabilitytore-latetothevictimfamily’ssituationpromotedthisofficer’scoping,asevidencedbythisquote:
I think it’sprobably just the fact that itwas suchanabnormal situationofhavingto,likeIsay,getthatlittlementalsnapshotsomanytimes,isprobablywhyitwasdifficulttocopewith.Justbecauseit’slikeyou’reouthere,you’rebyyourself,you’retired,andtimeisjustdraggingby.Youcan’tdoanything,youcan’tleave…it’sgoingtobealongnight.(Participant#2)
Threeparticipantsidentifiedthepresenceofadditionalstressors ashinderingtheirabilitytocopewithSTS(30%participationrate,4incidents).Therewerenohelping factorsorwish list items thatfit into thiscategory.For this study,presence of additional stressors signifiedthepresenceofstressfulsituationsoutsideofworkthatcompoundedtheamountofstressexperienced.Itincludedpersonalproblemssuchasfinancialdistress,relationshipproblems,andscrutinyfromthedepartment,thepublic,andthemedia.Oneparticipantidentifiedmultiplesourcesofscrutinyasahindrancetocoping,andstated:
The study illuminated several factors that helped, hindered, ormight havehelpedpoliceofficersincopingwithSTS.Overall,thefindingswereconsistentwithexistingliteraturepertainingtocopingstrategiesforSTS.Oneofthemostcommonlycitedhelpingcategories,Self-Care,hasbeendocumentedasaprotec-tive factor throughout the stress and coping literature (e.g., Gilmartin, 2002;Kirschman,2000;Palm,Polusny,&Follette,2004).Themostcommonlycitedhindering category,WorkEnvironment, has also beenwell-documented (e.g.,Burke&Paton,2006;Libermanetal.,2002;Patonetal.,2009).
Twosurprisingresultsarosefromthecurrentstudy.First, theprevalenceoftheexpresseddesireforaccesstomentalhealthresourcessuchascounsellingandeducation (80% participation rate) was a surprise based upon a documentedreluctancetoseekmentalhealthservicesamongpoliceofficers(e.g.,Graf,1986;Miller,1995).Second,noneoftheparticipantsrelayedusinganyofthemala-daptive behavioural coping mechanisms such as consuming alcohol or usingexcessiveforce.Thiswasunexpected,giventheextensivedocumentationofthesemaladaptivecopingmechanismsinthepolicestressliterature(Cross&Ashley,2004;Gershon,2000).Theresearcherscannotdeterminewhattheseunexpectedresultsmean,asthiswasnottheprimarypurposeofthestudy.Thisisthereforeanareathatwarrantsfurtherstudy.
Thepoliceofficers’ inabilitytohelpthevictimmaycreateanexistentialdi-lemma referred to as confrontingunfixable suffering,whichhasbeenused torefertoloneliness,angst,thrownness,andambiguity(Plomp,1997).Itcanbeastateofbeingoranaffectivereactiontocircumstancesonefaces.Participantsexpressedexperiencesconsistentwiththreeofthefourconcepts:loneliness,angst,andambiguity.Twoparticipantsreportedfeelingsofisolation.Angstreferstothefeelingsofhelplessness,andsomeparticipantsinthecurrentstudyrelatedfeelingsofhelplessnesstochangethecircumstancesforthevictim.Feelingsofambigu-itywerealsoexpressedbysomeparticipants,astheyexperiencedstresswithrolechangesanduncertainty.Aspreviouslymentioned,oneparticipant(#10)sharedanexperienceofshiftingperspectivetoredefinetheconceptualizationofhelpingpeople fromlong-term(changingsociety) to short-term(connectingwithonesmallchild,orhelpingthevictimbygettingaconviction).Thisnewperspectiveontheofficer’sabilitytohelpvictimspromotedcoping,changingtheinabilitytohelpthevictimfromahinderingincidenttoahelpingincident.
TheresultsofthisstudyarealsoconsistentwiththefindingsofMaddiandKobasa(1991),whocontendthatwhenpeoplehaveacontroldisposition,theyfeelasthoughtheycanhaveinfluenceoverthevariedcontingenciesinlife;con-sequentlytheydonotfeelhelpless.Thepersonperceivesasenseofcontrolinhisorhercircumstances.Itdoesnotimplythatonebelievesthatheorshehastheability tohave complete controloveroutcomes and eventsbut ratherhas thesensethatonehastheabilitytoinfluenceoutcomesbyexercisingskills,choices,andknowledge.Oneparticipant(#2)relayedthattheinabilitytouseskillsandknowledge to change circumstanceswas a sourceofdistress andhindered theabilitytocope.Theabilitytointerpretsituationsaschallengesinsteadofthreatsrequiresacertainlevelofflexibility(Maddi&Kobasa,1991).Thispersonalat-
tributewasidentifiedbyoneparticipant(#4)asafactorthathelpedtheofficertocope.Commitment indicates involvement,activeness, andapproaching theproblemratherthanavoidingit.Thisappearstoberelatedtothetask-orientationthatseveralparticipantsspokeof(Participants#1,2,3,4,6,and10).Participantsmentioned task-orientation during the critical incident to avoid experiencingemotionalengagement,buttheyalsouseddistractionactivitiesoutsideofworktoavoidexperiencingtheresidualsecondarystressfromwork.
Oneofthefrequentlycitedhelpingfactorsinthisstudywastheuseofself-care.Self-carehasbeen suggested for those inotherhelpingprofessions, suchas therapists, socialworkers, andnurses (Figley,1995;Pearlman&Saakvitne,1995).Palmetal.(2004)suggestspendingtimeinactivitiesthatgiveasenseofpurpose.Theyalsosuggestmaintainingbalancebyattendingtorolesoutsideofwork.SalstonandFigley(2003)echothissentimentandaddthatpeoplewhoworkwithtraumatizedpersonsshouldalsomaintainbalanceamongtheirphysicalself,emotionalself,andspiritualself.ThisrecommendationisconsistentwiththeidentityaccumulationtheoryproposedbyThoits(1983).
Itwasnotsurprisingthat60%oftheparticipantsidentifiedthelackofsup-portfromfamily/significantothersasahinderingfactorfortheircoping,giventhat80%identifiedthesupportoffamily/significantothersasahelpfulfactorfortheircoping.Forsomeoftheparticipants(#2,3,9,and10),theirfamily/significantotherswerenotable toprovideadequate supportbecause theydidnotfullyunderstandthejob.Thismaybeduetothestressor-supportspecificityprinciple, based upon Cohen andWillis’ (1985) buffering hypothesis, whichstatesthatthesourceofoptimalsupportmaybematchedtothesourceofthestress.For instance,workplace stressmaybestbe counteredby social supportfrom those in the workplace while familial support may be better suited forstressors outsideof theworkplace.Anotherparticipant (#10)didnotwish totalk to family/significantothers about traumatic experiences andexpose themtothetrauma.Thisshieldingmaybewarranted,asresearch indicates that thetransmission of traumatic stress from the police officer to the partner and/orfamily members interferes with their ability to provide support to the officer(Dwyer,2005).
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Regardlesswhetherornotthepoliceofficersharesthetraumaticexperiencewiththefamily,thetraumatizationofthepoliceofficerhasbeenfoundtobeafamilystressoraffectingothermembersofthefamily(Dwyer,2005;Ruzek,2006).Dwyer(2005)foundthat28.2%ofpolicewivesmetthecriteriaforSTS.Higherlevelsofdistressexperiencedbypoliceofficerhusbandsrelatedtohigherdistresslevelsintheirspouses.TheliteratureonpreventionofSTSalsorecommendstheextensionof training initiatives to the familyofpoliceofficers (Anshel,2000;Gilmartin,2002;Kirschman,2000;Sewell,1993).Implicationsforcounsellingarediscussednext.
Techniquestooffsettheimpactofcontinuousexposuremayalsobetaughtby the therapist.Task-orientation (Endler&Parker,1994) and/or some formofrelaxationtechniquemightprovehelpfulforanofficerforcedtoremainatadistressingcall.Researchhas indicatedthat individualswhobecomedistressedbecomeself-preoccupied,whichimpairstheirperformanceandheightenstheir
Itmightalsobehelpfultohelpofficersstrikeahealthybalancebetweende-tachmentandengagementtomitigatetheimpactofSTS,consistentwithFigley’s(1995) approach to avoiding compassion fatigue.Relatability to the victim, aconceptpossibly related to emotional engagement,might alsoneed tobe ad-dressed.Theliteratureoncountertransferenceamongtherapistsdiscussesover-identificationanddistancingfromthetraumavictim(Dutton&Rubinstein,1995;Pearlman&Saakvitne,1995).Theredonotappeartobestrategiesdesignedtoaddressthissamedilemmawithpoliceofficers.Itispossiblethatthetreatmentfortherapists’countertransferenceissuescouldbeadaptedtosuittheneedsofpoliceofficerswhomaybetroubledbytendenciestoover-identifywithordistancefromvictims.Counsellingimplicationscanbedrawnfromtherecommendationsaris-ingoutofthecountertransferenceliterature,whichincludesfosteringself-insight,differentiationofselffromothers,self-integration,conceptualability,empathy,andanxietymanagement(Hayes,2004).
behaviouralinterventions
Self-carewas a stronghelping factor forparticipants in this study,with an80%participationrate.Counsellingtreatmentplansencouragingself-caremightmitigatetheimpactofSTSforofficers.AccordingtoThoits’(1983)identityac-cumulationtheory,counsellinginterventionspromotingalifeoutsideofwork,participation in hobbies, and extracurricular activities might also counter theaccumulationofposttraumaticstress.ThesestrategieswouldbeconsistentwiththeadvicedirectedatofficersbyGilmartin(2002),whocontendsthatofficersarewell-advisedtobeactiveoutsideofworktocombatthe“biologicalrollercoaster”thatoccurswhenofficersleaveworkandreturnhome.
Related to the counselling interventions are theways inwhich counsellingservicesaredelivered.Severalimplicationsarisefromthisstudy,whicharedis-cussednext.
A systemic approach. Resultsofthisstudyhighlightedtheimportanceofsupportfromfamilyandsignificantothers.Itispossiblethatfamilyandsignificantothersareprotectivefactorsthatcouldbeincorporatedinthetherapeuticplan.Asystems
Familiarity with policing. Counsellorsmightwanttobecomeversedinbooksthatprepareofficersandtheirfamiliesforpolice-specificexpectations,aswellasbecomeeducatedonthecultureofpolicinganditsinfluenceonhelp-seekingbe-haviourandcommitmenttotherapy.Sewell(1993)suggestsmentalhealthprac-titionersshouldnotonlyunderstandtheworkofpoliceofficers,theyshouldalsobefamiliarwiththedepartmentandbefamiliarwithinthedepartmenttoavoidbeingregardedas“outsiders”or“uninvitedguests.”Additionally,Sewellsuggestsmental health practitioners should be sufficiently trained and experienced inboththephilosophyandtechnicalproceduresoftraumadebriefing.Criticalinci-dentstressdebriefings(CISD)havebeencriticized,purportingthattheyactually
Anothermethodofalleviatingtensionisthroughtheuseofhumour.Partici-pantsinthecurrentstudyreportedusingdarkhumourtocopewithexposuretoSTS.Extendingthisnaturalcopingmechanismtothecounsellingsettingmaybehelpfulforworkingwithofficers.Miller(1995)suggeststhattheuseofhumourincounsellingcanbringasenseofbalancetohorrificcircumstances.Millercon-tendsthatincorporatinghumourintherapeuticworkalsoallowsofficerstoventtheiranger, frustration,andresentment. Incorporatinghumour in therapeuticworkcouldbeachievedbymakinglightofdarksituationswithjokes.Ofcourse,thetherapistshouldexercisecautionwiththistechnique,refrainingfromusingituntilrapporthasbeenestablishedandheorshehasnotedthattheclientusesdarkhumourasacopingmechanism.
to thevictim,emotionalengagement,andsceneremindersalsomerits furtherinvestigation.Theunexpectedfindingthatnoneoftheparticipantsreportedusingdrugsoralcoholasacopingmechanismshouldalsobeexploredinfutureresearch.
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AppendixACredibility Checks for the Enhanced Critical Incident Technique
ThedescriptionsbelowofthecredibilitychecksfortheCIT/ECITresearchmethodarebasedonmaterial the readercanfind inButterfieldetal. (2005);Butterfieldetal.(2009);Flanagan(1954);andWoolsey(1986).Theyarelistedintheorderthecheckswouldtypicallybeconducted.1. Audio-recordinginterviews.Thishastodowiththedescriptivevalidity
of thedata,andspecificallywiththeaccuracyof theaccountofwhatparticipantshavesaid.Iftheaccountisnotaccurate,thenitispositedthatthedataanalysisandsubsequentresultsarenotaccurate.TheaccuracyoftheaccountisestablishedinaCITstudybyaudio-orvideo-recordingtheinterviews,havingthemtranscribedverbatim,andworkingoffthetranscriptsforthedataanalysis.
2. Interviewfidelity.Thiscredibilitycheck is related tohowwell the re-searcher adheres to the interview guide and to the principles of CITinterviewing.ThisisestablishedbyhavinganexpertintheCITresearchmethodlistentothefirstinterviewandapreviouslyagreed-uponsampleofsubsequenttapedinterviewstoensuretheinterviewerisconsistentlyfollowing the interview guide, asking probing questions for clarifica-tionwithoutprompting,andelicitingappropriatesupportinformation
7. Cross-checkingbyparticipants.Thisoccursafterthedatafromthefirstinterview have been analyzed and the critical incidents and wish listitemsplacedintothecategories.Thepurposeofthisistoensurepartici-pants’ experienceshavebeen represented accuratelyby the researcher,andconsistsofseveralsteps.First,theparticipantisaskedtoreviewthecritical incidents and wish list items extracted from the interview bytheresearchertoensuretheyarecorrect.Next,theparticipantisaskedtoreviewthecategories intowhichthecritical incidentsandwish listitemshavebeenplacedtodeterminewhetherthecategoriesmakesense.Finally,theparticipantisaskedtocommentonthecategorytitlesanddefinitionstoensurethecategoriesaccuratelyrepresenttheirexperiences.Ifaparticipantisunsureaboutwhetheranitemisacriticalincidentorwishlistitem,additionalcontextfromtheinterviewmaybeofferedto
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the individual tohelp themmake adetermination. If theparticipantultimatelydecidesthatanitemlistedisnotacriticalincidentorwishlistitem,itisnotincludedinthefinaldataanalysisreport.Lastly,thisdiscussionwithparticipantsallowstheresearchertofollowuponanyitemsfromtheoriginalinterviewthatappeartobecriticalincidentsorwishlistitemsforwhichsupportinginformationwasnotobtained.
8. Expertopinions.Twoexpertsareaskedtoreviewthecategoriesthathavebeencreatedtocommentonwhethertheythinktheyareuseful,whethertheyaresurprisedbyanyofthecategories,andwhetherthereisanythingmissingbasedon their experience.The rationale for this is that theiragreementwiththecategoriesenhancesthecredibilityoftheresults.
About the AuthorsStephanieM.ConnisagraduateoftheAdlerSchoolofProfessionalPsychology,VancouverCam-pus,andaregisteredclinicalcounsellorinprivatepracticeinVancouver,BC.Asaformerpoliceofficer,hermaininterestsincludementalhealthissuesaffectingpoliceofficersandpolicefamilies.