Working with First Responders and Military Veterans

Saturday, March 18, 2023 5:39 PM | Anonymous

Interview with Nina Reyna, LMFT and Liliana Ramos, LMFT, Director-at-Large

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Liliana: Welcome! Could you please introduce yourself, who you are, what you do?

Nina: My name is Nina Reyna and I’m an LMFT, licensed in California and Texas. I’m also a veteran and the wife of a retired police officer. I joined the Navy in 2001 and served during 9/11 as an intelligence specialist. One of the most exhilarating, yet frightening assignments I had while serving, was being in Guantanamo Bay, Cuba interviewing detainees. After my time in the navy, I resided in California with my husband, who was a police officer and detective for 15 years, before being medically retired. I met my husband of 18 years while I was stationed in California. We lived through deployments apart, long separations, and acclimating when trying to live together again. Even for officers in the Bay Area, it was typical to live in a lesser expensive area. We lived the military and first responder lifestyle of living apart. I now have my private practice in Texas, but do telehealth work in California. I am EMDR trained working on my certification.

Liliana: Can you please address the intricacies of doing therapy with veterans and first

Nina: As you know, these populations are a dynamic culture. They choose to join and embrace
this culture, which requires the immersion of the first responders, military, and their families,
something important to understand in order to understand the culture. Sometimes, there is a
culture clash and there is a need to bridge that culture. This is why I thought it was important
to become a therapist, having been a veteran.

Liliana: When you say culture clash, are you saying the clash after they leave the military?

Nina: When I say culture clash, I mean society and therapists. Veterans and first responders
work more from a collaborative and directive approach. Therapists are used to think about
helping them gain autonomy. Yet, they’re used to being told what to do. We are more
empathetic, while they thrive from a directive approach. They also have a fear of being
misunderstood or judged by society. I get a lot of clients who have a hard time being
vulnerable. The other complex parts of working with first responders and military is trauma
versus complicated grief. They don’t always experience trauma. Sometimes it’s complicated
grief from the loss of significant relationships. They’re moving around, getting deployed,
transferring, leaving their families, missing out on important events, and obviously losing
comrades in the line of duty. I find myself talking a lot about military, but find this with first
responders, too.

Liliana: I was going to ask you about the missing out on family events. Is that true for first
responders too? Do they not have a choice of their duty times?

Nina: Absolutely. Their shifts often range from 12+ hours for several consecutive days a week, sometimes only getting one day off. They miss important events, such as the birth of children, birthdays, graduations, and holidays. Even when they’re physically present, they’re oftentimes not mentally present. This is true about first responders, military, and veterans. This is also the case for the veterans who go through loss of identity when they get out. They have to learn how to live outside their service and how to acclimate to civilian life.

I read an article stating there is 1% of military versus civilians. They feel alone much of the time.
The other part of that is survivor’s guilt; not just survive in life but to survive with loss of limbs and the loss of the support that they had in the military. Those are all important to keep in mind. This is a population exposed to continued and extreme levels of stress that keep their system in a hyper-arousal state, which makes this population unique. Even when they’re home, off-duty and have taken off their uniform, they are still in that high level of hyper-arousal. They’re not aware of this. Sometimes they’ve been retired from the military or department for years and still don’t understand the connection, or disconnection rather between their body and mind.

Liliana: Do you ever work with their families?

Nina: Yes. The families are immersed in this culture. I have experienced this firsthand. It’s equally important to provide them the necessary support to be a successful unit at home.

Liliana: You’ve been on both sides.

Nina: Yes, I’ve been on both sides at the same time as an active-duty service member, while my husband was an active-duty law enforcement officer. It’s stressful because the family of first responders and military are often in a constant state of distress themselves. The need to want to support and fix their partner, but don’t know how to do it and don’t have the tools to connect. They’re physically together, but unable to emotionally connect. This is true for the children of the members as well.    

Liliana: So what made you decide to do this work – changing from military to therapy and then
helping veterans and first responders?

Nina: I was most influenced in my boots on the ground, being in the military, and being the
wife of a police officer. My undergrad was criminology and restorative justice because I
thought I was going to become a cop like my husband. My internship was on mediating: I was
intrigued by that. It was through the mediation part that I saw people connecting and healing
from experiences. This is when I decided that I was going into therapy. I have this level of
empathy and compassion for all my clients. I also have this personal experience with this
population. Not all my clients are veterans and first responders, but a number of them are.

Liliana: I would think that having experience in both gives you more credibility.

Nina: Yes, having the experience of being in the military, understanding the demands and the stress that is endured, as well as being my husband’s wife while he was serving on the police force. Additionally, not only did I experience my own difficult transition to civilian life, but also witnessed my husband’s shift in him becoming a civilian after his retirement. It was really difficult to watch him struggle with depression and anxiety. We rarely talked about work while serving, so we were really great with bottling our emotions and pushing forward. As a mom and wife, I just tried to keep things calm while he was doing his job and I was taking care of the kids. Most of our first responders and military are not just dealing with the stress of their jobs and the aftermath of that, but the stress of life and the world. That’s the complicated grief part that has so many layers.

Liliana: Why do you think this is important work?

Nina: This population has a duty to protect and serve: both first responders and military. Even
veterans walk away with that mentality. Not just for their community but their family as well.
They are not able to fully do this if they are suffering in silence, which is what most of them are
doing. They need a safe place to be able to be vulnerable. It’s important as therapists, we provide them with that safe space.

Liliana: This might be a good time to talk about EMDR. There are lots of ways to treat trauma,
what made you decide on EMDR?

Nina: My first experience with EMDR was as client many years ago. I found it to be an effective treatment in reprocessing my own trauma to repair the mental injuries I had endured. After I became license, I decided to complete the EDMR training. It has been a great tool to add to my practice as it has proven to be effective for treating my clients with PTSD and trauma as well as depression, anxiety and panic disorders.

Liliana: What other techniques do you use with your clients?

Nina: There are a variety of techniques that I use in therapy with my clients. The most appropriate techniques depend on the individual needs. Cognitive Behavioral therapy, dialectical behavior therapy, solution-focused therapy, psychodynamic therapy and mindfulness-based interventions are all techniques I utilize, to list a few. It’s important to remember that therapy is a collaborative process, and the most effective technique will depend on the individual’s unique needs and preferences. It’s essential for a client to find a therapist who is trained and uses techniques that resonate with them.

Liliana: Is there one issue that is really prevalent in one or both?

Nina: Suicide is a serious public health issue that affects individuals, families and communities. Suicide is a complex issue that can have multiple causes, including mental health conditions, substance abuse, trauma and social and economic factors. First responders, active-duty military and veterans are at a higher risk of experiencing suicidal thoughts and behaviors due to the nature of their work. They are often exposed to traumatic events and high-stress situations, which can lead to mental health problems such as depression, anxiety and PTSD. These mental health conditions can increase the risk of suicidal thoughts and behaviors among first responders. It is important to reduce the stigma surrounding mental health and seeking help for mental health issues. First responders should feel comfortable seeking help for mental health problems without fear of being stigmatized or discriminated against.

Liliana: What is the takeaway that you would want therapists to have.

Nina: The takeaway for therapists is to be aware of their biases and how that might affect their clients. Show your clients that you want to learn from them, not just teach them what you want them to know. Our clinical judgment is important, but our clients know their experiences. It might be helpful to ask during their intake paperwork if the client has served in the military, or if they know someone who has served in the military. Even though not every military member has experienced trauma, checking in with that part of the client’s experience can be helpful to be aware of. They might be coming in with a present issue they want to work on, but not realize that their present issues are carried over from the past.

Liliana: Yes because during the whole military service you’re trained to not think about
yourself, rather about the mission. I’m guessing it’s the same for first responders. Families are
trained to go along with it to support that person. So when it comes to therapy you can miss
that whole rich background.

Nina: Absolutely. They might not think to bring that part of them into therapy. Although it’s embedded into their identity, they try to get away from it and don’t bring it up. It’s important to screen for it and meet them where they’re at. They might not want to talk about it, but at least you have that information.

Liliana: Is there anything else you would like to add?

Nina: I just wanted to thank you for giving me this opportunity. I will say that I take random
trainings. I know that the need for culturally competent therapists for this population is high:
they need more therapists. There is an abundance of online and in-person training (PESI and
Psychotherapy Networker), take the time to learn about them.

Liliana: Thank you for doing the interview and for all of the information. This was great. As a
retired military veteran, I appreciate the work that you do. Thank you for your service and for
your work.

Nina Reyna is a Marriage and Family Therapist, licensed in the state of California as well as Texas. She is also a United States Navy veteran and the wife of a retired police officer. She has almost 8 years of clinical experience working with family/relationship issues, trauma survivors, anxiety, depression, and addictive disorders. She is dedicated to providing safety to those she serves and utilizes her expertise to help active-duty military, veterans, first responders and their families deal with the stressors they must endure on a daily basis, including PTSD and deployment/reintegration issues. She is also trained in Eye Movement Desensitization and Reprocessing (EMDR) Level II.


Schaeffer, K. (2021, April 5), The changing face of America’s veteran population. Pew Research Center. Retrieved March 17, 2023, from


COPS – Concerns of Police Survivors:

Veterans Administration -

Military One Source:

Suicide and Crisis Lifeline:  988 

Crisis Text Line:  Text BADGE to 741741

COP 2 COP:  1-866-COP-2COP (267-2267);

FIRESTRONG:  1-844-525-FIRE (3473);

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