• Patrick Barnes

What Should Every Attorney Know about Secondary Trauma?


Attorneys and other legal professionals work with traumatized clients on a regular basis. According to the American Psychological Association, trauma is “an emotional response to a terrible event like an accident, rape or natural disaster.”(1) The National Center for PTSD found 61% of men and 51% of women report a traumatic event experience, so the likelihood of working with a traumatized client as an attorney is high.(2) Working with traumatized clients and hearing about, or looking at, traumatic material can cause attorneys to experience traumatic symptoms, even without directly experiencing the event.(3) This is known as secondary or vicarious trauma.(4)


Françoise Mathieu describes secondary trauma as, “the profound shift that workers experience in their world view when they work with clients who have experienced trauma.”(5) Secondary trauma coupled with exhaustion from burnout is referred to as compassion fatigue. The wide range of associated physical and emotional issues negatively affect an attorney’s professional and personal lives, as well as their sense of self. Every attorney should know what the signs and symptoms are, along with methods of correcting and preventing it. 


A Wisconsin State Public Defender Office poll found “34% of attorneys met criteria for secondary trauma and 75% met criteria for functional impairment (disruption in personal life, family life).(6) As you will see these symptoms can have a great influence on daily living and can stifle productivity and job satisfaction. One third of the profession with secondary trauma is too high, and could be mitigated through awareness and implementing trauma-informed practices. I also want to note that although I refer to attorneys throughout this article, paralegals, administrative assistants, judges, court staff, or any other legal professionals, are also susceptible to secondary trauma. 


Symptoms


Three common categories of symptoms are psychological distress or dysfunction, cognitive shifts, and relational disturbances.(7)


Psychological symptoms include, distressing emotions, intrusive imagery, and physiological arousal.(8) Distressing emotions include sadness, grief, depression, anxiety, dread, fear, rage, or shame.(9) Attorneys are exposed to traumatic material on a constant basis, including graphic photographs of accident scenes or crime scenes, depiction of injuries, crimes, or other situations that would cause distress. These images or stories may be difficult to leave at the office, and may find their way into thoughts or dreams. Attorneys may be more used to feeling panicked or anxious than not. Physiological arousal could be a sensitive startle reflex, or being jumpy or quick to assume the worst in every situation.(10) Lawyers attribute these symptoms to the stress of the job, but based on the 34% of attorneys meeting criteria for secondary trauma, they may be due to daily interaction with traumatized clients. 


In order to avoid distressing emotions, attorneys may use avoidance behaviors or dissociation.  Avoiding clients or tuning-out during conversations because the attorney knows the material will make them feel unwanted emotions is dangerous from an ethical perspective. One of the top reasons for attorney grievance and malpractice is failure to communicate with the client effectively.(11) Yet when these symptoms are present, returning calls to clients that will likely cause anxiety, anger, or sadness can seem impossible. As the urge to avoid contacting clients grows, some attorneys can experience shame, doubt in their ability to do the job, and disillusionment associated with working in the legal profession. This growing discomfort can cause decreased emotional wellbeing and more negative professional worldview. 


All lawyers at some point or another have represented someone that drains your energy and leaves you exhausted by the end of the call or meeting. The reality is that traumatized clients often seek control due to a depleted sense of safety and trust.(12) These clients that leave attorneys exhausted are likely not doing so intentionally, and arguing, double checking of work, micromanaging, or frustration may be caused by trauma. Reframing from a “difficult” client to a “traumatized” client may allow the attorney to exercise additional patience and allow themselves time between these interactions to recover. The exhaustion that comes from these interactions with traumatized clients is a natural consequence of practicing with empathy and compassion. 


Adjusting behavior to avoid distressing feelings can affect the attorney’s social and personal lives on a daily basis.(13) To numb the intrusive thoughts away from the office, or worse yet, while at the office, attorneys may turn to substance abuse. Addictive and compulsive behaviors are symptoms of psychological distress from secondary trauma.(14) Dr. Mike Barnes cited a 2016 attorney survey in a recent blog post that found 20.6% of attorneys were positively screened for “hazardous, harmful, and potentially alcohol-dependent drinking.”(15)


Another category of symptoms commonly associated with secondary trauma is cognitive shifts in thinking. In the legal profession, an example may be witness guilt.(16) Attorneys in all types of practice areas may experience struggles finding joy in their own life knowing their client is struggling. A workers’ compensation attorney may experience witness guilt during the pending litigation of an injured worker awaiting a determination of currently denied benefits. Injured with no income, concern with the ability to feed their family, and a hearing that is weeks away can cause the attorney to feel guilt as they return to their own family after the work day. 


Another cognitive shift is to blame the victim or client.(17) This occurs when an attorney feels a client is “threatening, manipulative, or exploitative.”(18) When an attorney communicates with a traumatized client, who is likely trying very hard to maintain control of a difficult and confusing process like the legal system, the attorney might feel that the client is micro-managing or manipulating them instead of letting them do their job. This can build resentment and blame towards the client, greatly affecting the attorney’s ability to communicate with the client. Attorneys need to be able to set boundaries with the client, and structure the conversation so that the client is able to be heard but allows the attorney to do their job.  


The final category of secondary trauma symptoms is relational disturbances.(19) Similar to avoidance behaviors and dissociation, attorneys may distance themselves from loved ones or friends because they do not believe those people will understand their response to the work.(20) I believe attorneys do not discuss these secondary trauma symptoms with other attorneys for fear that they would be the only one experiencing them, when in reality they should be the perfect source to discuss them. Instead, fear of getting in trouble or being thought of as less-than leads attorneys to pretend that they don’t have these feelings, which does nothing to address this issue plaguing the profession. 


Attorneys may also over-identify with their clients and their situation.(21) Getting too personal with their own emotions may compromise the attorney’s ethical duties, and take actions or act inappropriately with opposing counsel. Another potential issue with becoming too personally invested is that an attorney’s anger, frustration, or sadness about a client’s situation may be greater than that of the client. The client may then begin to filter facts presented to the attorney for fear of upsetting them too much.(22) If the client isn’t able to honestly present the information to their attorney for fear that the attorney can’t handle it, would be a serious issue with the attorney’s ability to represent the client. 


Awareness and Prevention


Awareness of secondary trauma and associated symptoms may be enough for attorneys to modify some of their procedures or be more self-aware of their own situation. Additionally, prevention methods are available, and should be implemented when working with traumatized clients. 


Prevention takes many shapes, including maintaining a healthy body, obtaining proper sleep, exercising, and eating properly. Attorneys work too hard, and the first thing to go is exercise, diet, and sleep. Stress builds from a perpetual whirlwind of to-do lists and deadlines, late-night take out during trial prep, and endless voicemails to return. Attorneys must self-reflect and determine what their body needs in order to maintain the difficult  lifestyle. 


Psychological prevention includes maintaining a good work/life balance, relaxation, experiencing nature, finding a creative outlet, meditating or practicing spirituality, self-awareness of your symptoms, and humor.(23)


Attorneys need a social system to be able to debrief and discuss how they feel candidly.(24) Normalizing these feelings is crucial in avoiding the distancing discussed earlier. Another good outlet for debriefing would be a psychologist or counselor. Coaches may also be able to help the attorney improve work/life balance as well. Regardless of who it is, attorneys need to be able to talk about how they feel. 


From a professional standpoint, attorneys need to ensure there is a good work/life balance in place and that boundaries are set with clients and with their firm. Taking stock of how much work is possible, and being able to maintain a case load within those limits is crucial. 


Finally, managing partners and supervising attorneys need to be aware of these symptoms, and look for them in their staff. They should recognize the times in their careers that they had similar issues and feelings, and understand the cost of turnover. Putting a system in place that allows dialogue between employees for debriefing and peer support is vital.(26) Managers and supervisors need to be good role models for staff, and make sure mentors, supervision, and adequate lines of communication are open. 


As mentioned above, attorneys are often uncomfortable talking about these symptoms for fear that they will be made to feel less-than. This is certainly true when talking to a boss or figurehead of the firm. Managing partners and supervising attorneys need to acknowledge secondary trauma as an occupational hazard, and not something unique to the employee. As secondary trauma becomes normalized within the firm, employees will be able to acknowledge their symptoms and work towards healing. 


Firms in general need to focus on employee wellness. Offer gym memberships, make counseling/therapy available to employees, create peer meetings to discuss how they feel instead of facts of the cases. 


Firms can hire a consultant like Wave of Change Coaching and Consulting, LLC to come in and assess for compassion fatigue and secondary trauma. Goals of the consulting would be to educate the firm on trauma, compassion fatigue, and secondary trauma, help modify practices to ensure they are trauma-informed, and develop an employee wellness procedure so the firm can better assist employees that may be dealing with these symptoms. 


Secondary trauma is a real issue in the legal community, and can lead to compassion fatigue. Awareness is critical, as there are likely a lot of lawyers feeling the same way, but too afraid to speak up for fear of the judgement of others. The more out in the open this topic becomes, the more attorneys will realize they are not alone and can work together to heal from the trauma they are exposed to on a daily basis. 



References

1 “Trauma.” American Psychological Association, https://www.apa.org/topics/trauma/.

2 How Common is PTSD in Adults?: PTSD: National Center for PTSD, U.S. Department of Veterans Affairs, https://www.ptsd.va.gov/understand/common/common_adults.asp.

3 Figley, Charles R. “Compassion Fatigue as Secondary Traumatic Stress Disorder: An Overview.” Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized, edited by Charles R. Figley, Routledge, Taylor & Francis Group, 1995, p. 11.Dutton, Mary Ann, and Francine L. Rubinstein. “Working with People with PTSD : Research Implications.” Compassion Fatigue as Secondary Traumatic Stress Disorder: An Overview, edited by Charles R. Figley, Taylor & Francis Group, 1995, p. 83. 4 Dutton, Mary Ann, and Francine L. Rubinstein. “Working with People with PTSD : Research Implications.” Compassion Fatigue as Secondary Traumatic Stress Disorder: An Overview, edited by Charles R. Figley, Taylor & Francis Group, 1995, p. 83.

5 Mathieu, Françoise. “Chapter 2: Understanding the Cost of Caring.” The Compassion Fatigue Workbook, Taylor & Francis Group, LLC, 2012, p. 9.

6 A.P. Levin, L. Albert, A. Besser, D. Smith, A. Zelenski, S. Rosenkranz, Y. Neria (2011). Secondary Traumatic Stress in Attorneys and Their Administrative Support Staff Working With Trauma Exposed Clients. J. Nerv. ment. Dis. 199(12(, 946-55.

7,8,9,10 Dutton, Mary Ann, and Francine L. Rubinstein. “Working with People with PTSD : Research Implications.” Compassion Fatigue as Secondary Traumatic Stress Disorder: An Overview, edited by Charles R. Figley, Taylor & Francis Group, 1995, p. 85.

11 Weiss, Debra Cassens. “These Common Mistakes Can Lead to Lawyer Ethics Complaints .” ABA Journal, 10 Feb. 2016, http://www.abajournal.com/news/article/these_common_mistakes_can_lead_to_lawyer_ethics_complaints.

12 Barnes, Michael F. “Drmikebarnes.com.” Drmikebarnes.com, 29 Dec. 2019, http://drmikebarnes.com/blog/compassion-fatigue-and-the-need-for-trauma-informed-legal-practice.

13,14 Dutton, Mary Ann, and Francine L. Rubinstein. “Working with People with PTSD : Research Implications.” Compassion Fatigue as Secondary Traumatic Stress Disorder: An Overview, edited by Charles R. Figley, Taylor & Francis Group, 1995, p. 85.

15 Barnes, Michael F. “Drmikebarnes.com.” Drmikebarnes.com, 29 Dec. 2019, http://drmikebarnes.com/blog/compassion-fatigue-and-the-need-for-trauma-informed-legal-practice. (Citing: Krill, P. R., Johnson, B. R., & Albert, L. (2016). The Prevalence of Substance Use and Other Mental Health Concerns Among American Attorneys. Journal of Addiction Medicine. January/February 2016, 10(1), 46-52.

16,17,18 Dutton, Mary Ann, and Francine L. Rubinstein. “Working with People with PTSD : Research Implications.” Compassion Fatigue as Secondary Traumatic Stress Disorder: An Overview, edited by Charles R. Figley, Taylor & Francis Group, 1995, p. 86.

19,20 Dutton, Mary Ann, and Francine L. Rubinstein. “Working with People with PTSD : Research Implications.” Compassion Fatigue as Secondary Traumatic Stress Disorder: An Overview, edited by Charles R. Figley, Taylor & Francis Group, 1995, p. 87.

21,22 Dutton, Mary Ann, and Francine L. Rubinstein. “Working with People with PTSD : Research Implications.” Compassion Fatigue as Secondary Traumatic Stress Disorder: An Overview, edited by Charles R. Figley, Taylor & Francis Group, 1995, p. 88.

23 Yassen, Janet. “Preventing Secondary Traumatic Stress Disorder.” Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized, edited by Charles R. Figley, Taylor & Francis Group, 1995, p. 183-88.

24 Yassen, Janet. “Preventing Secondary Traumatic Stress Disorder.” Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized, edited by Charles R. Figley, Taylor & Francis Group, 1995, p. 188.

25 Yassen, Janet. “Preventing Secondary Traumatic Stress Disorder.” Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized, edited by Charles R. Figley, Taylor & Francis Group, 1995, p. 189-195.

26 Yassen, Janet. “Preventing Secondary Traumatic Stress Disorder.” Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized, edited by Charles R. Figley, Taylor & Francis Group, 1995, p. 194

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