Vicarious trauma or secondary traumatic stress refers to the cumulative effects of exposure to the traumatic experiences and distress of others, as described in my first article (see LawTalk 873, 11 September 2015).

Those cases, images and interactions that stick in your mind and the negative impact that they can have on your worldview and day-to-day functioning.

The examples given in the first article may be more applicable to those working in the area of criminal law, but those in other specialties such as conveyancing, immigration, commercial and family law may also be exposed to considerable client distress and, with it, the associated risk of secondary traumatic stress.

For example, in Canterbury, ongoing issues related to the Christchurch earthquakes continue to cause marked distress not only to clients, but also to practitioners who may be caught up in their own difficulties.

Workplaces may also be viewed as more stressful in general with clients who have greater expectations and practitioners being aware of the ever-present risk of being subject to a complaint.

Helping others

Most people go into the practice of law with a view to helping others but sometimes helping people can take its toll.

This is not always recognised and even if it is there remains a stigma that prevents people from speaking out or seeking help, with concerns about confidentiality, reputation and registration.
Often it is not until a complaint is received or the damage is done that an issue is identified. Until there is a change in this view and a more widespread and proactive approach to maintaining well-being, those in the legal profession will continue to experience higher rates of depression, anxiety and other mental health issues than the general population.
Vicarious trauma is one factor that can impact on well-being.

The first article looked at the impact that vicarious trauma may have on individuals and some of the research in this area relevant to the legal profession. This article will consider who may be more vulnerable to vicarious trauma and ways in which the impact of this can be mitigated.

Vulnerability

Since the concept of vicarious trauma was first described in 1990 there have been a number of studies across a range of professional groups which have attempted to identify who may be more at risk or more vulnerable to the effects of being exposed to other peoples trauma.
Variables such as support, level of experience and personal history of trauma have all been investigated with some inconsistency in the findings, but overall the research suggests that those who lack good social support, those who are early on in their career and those with a personal history of trauma are more vulnerable.

Research has shown that certain types of case are more likely to be associated with vicarious trauma. Not surprisingly cases involving violence towards children have a greater impact, as do those where you can identify in some way with the victim, for example “it could have been my partner”.

Mitigation

Turning now to what steps or processes may be put in place to mitigate the effects of exposure to vicarious trauma, Pearlman and Saakvitne, two of the authors who first wrote about this concept, have broken this down into categories of awareness, balance and connectivity, across the realms of personal, professional and organisational.

Awareness refers to education, acknowledgement and exploration of the potential impact of vicarious trauma, which can facilitate open discussion.

People are often aware of the experience but do not have a name for it. It is important not to over-pathologise, but having an understanding of what is occurring can be beneficial.
Some law schools in the United States now incorporate education about vicarious trauma into their programmes. Some employers have implemented initiatives in this area in response to health and safety requirements and also in recognition of the impact that vicarious trauma can have on staff burnout, absenteeism and staff retention.

For example, in Australia the County Court of Victoria has implemented the Supporting Judicial Resilience Program, a pilot programme for judges utilising a model of regular supervision with psychiatrists and psychologists.

Judge Felicity Hampel noted in the September 2015 Law Institute of Victoria Journal: “We can no longer ignore the evidence of the risk to judges and court staff of vicarious trauma or other consequences of stress. We should not wait for a catastrophic breakdown before doing something about it”.

Strategies that can aid awareness on a personal level are professional supervision and peer review/support, although this may be limited as many in the legal profession work in relative isolation and there can be an environment of competitiveness.

Professional supervision

Professional supervision is a proactive approach that involves meeting with a suitably qualified colleague or other professional on a regular basis, usually monthly.
Unfortunately there is a misperception that supervision is for those who are still in training or those who are weak, incompetent or ethically unsound. On the contrary, being prepared to make time to reflect upon your practice and identify your vulnerabilities requires strength, maturity and commitment.

Supervision provides an opportunity to process and make sense of difficult experiences from the work environment and can cast a different perspective on problematic areas of practice.
Understanding why certain clients or cases “push your buttons” can allow you to take a different approach. Communication problems are at the heart of many complaints and a better understanding of what is really going on in the lawyer/client dynamic may enhance communication.

Professional supervision can be provided by a variety of professionals with a range of skills and qualifications, including counsellors, social workers, nurses, psychologists and psychiatrists.
One of the key elements to successful supervision is the development of an effective collaborative working relationship with an emphasis on trust, openness and confidentiality.
The supervisee is expected to prepare for supervision between sessions and to set the agenda by bringing along particular cases or problems, which may involve clients, colleagues or organisational issues.

Different models can be utilised to explore the issue such as the “Five Realms” as described by David Owen. This was devised for medical practitioners but the model readily adapts to the legal profession.

The five realms for exploration are the presenting problem (which may be exposure to a traumatic case); the client (who may be very distressed or traumatised); the lawyer; the supervisory relationship and the social or organisational context. All five realms provide different perspectives that can enhance understanding and awareness and reduce any negative impact from exposure to traumatic material.

Balance

Balance is also important in mitigating potential negative effects from exposure to the trauma and the distress of others.

This includes trying to ensure balancing work with other aspects of life and being involved in interests and creative activities outside of law.

The medical and legal professions have long been associated with working long hours, partly through necessity but also as an expectation, often at the expense of personal and family life. Working longer does not necessarily mean working better or more productively and over working can be a response to vicarious trauma or can be a sign of other problems.

Balancing caseloads with colleagues is helpful and balancing the type of case in your workload is important, for example not solely focusing on cases of child abuse.

Connectivity

Connectivity refers to connecting and communicating with others at home, in the workplace and in the community.

Vicarious trauma from working in a field such as law can create negativity and cynicism with cognitive distortions around trust and safety. You can readily develop beliefs that others are manipulative and not to be trusted and to overestimate the likelihood of negative events arising.

Connecting with community groups and activities can help to balance this perspective and provide a sense of altruism that may otherwise be absent.

Vicarious trauma does not affect everyone in the legal profession but it is worthy of recognition and discussion.

Creating an environment that acknowledges the emotional and cognitive impact of working in a field that can be stressful and challenging as well as rewarding, is an important step in leading to a greater sense of wellbeing. Healthy Mind, Healthy Body, Healthy Practice is a philosophy that I would fully endorse.

I am interested in the views of those in the legal profession with regards to the concept of vicarious trauma and would be interested to hear your opinion. Please don’t hesitate to contact me at helen@mindfix.co.nz to share your views.

Dr Helen Austin is a consultant forensic psychiatrist. Over her 10 years of practice in this area, she has developed an interest in the effects of exposure to traumatic material in the occupational setting and the associated concepts of burnout and resilience. She has conducted research in this area and has spoken at conferences and courses on this topic. She runs a service named MindFix New Zealand Limited and is now offering one-to-one supervision and support to professionals in a confidential setting with flexible appointment times. She is also available to provide small group workshops or seminars on this topic on request.

https://www.lawsociety.org.nz/__data/assets/pdf_file/0008/96137/LawTalk-876-WEB.pdf

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