<p>First responders represent a unique clinical population with high rates of trauma exposure, heightened risk for posttraumatic stress disorder (PTSD), and often complex clinical presentations. Their occupational demands and cultural norms foster resilience, but also create vulnerabilities that shape how they cope with stress and engage in therapy. While trauma-focused psychotherapies are effective, providing treatment to first responders also requires an understanding of their unique experiences. This article provides an overview of the clinical features of PTSD in first responders, their strengths and challenges, their occupational culture, and barriers to seeking and engaging in treatment. In addition, the authors offer practical recommendations for clinicians, to build rapport and tailor core components of trauma-focused psychotherapies – including psychoeducation, emotional regulation, safety planning, trauma processing, in-vivo exposure, and relapse prevention - in a way that leverages first responders’ existing resources while addressing their psychological needs.</p>