When earning my doctorate at Florida State University, my faculty mentor asked me and a group of my peers to assist in preparing the first book on Compassion Fatigue. Dr. Charles Figley’s Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized (1) was published in 1995. Since that time, compassion fatigue and helping helpers to maintain their health and job satisfaction has been a focus of my career. I have trained many groups of helping professionals to better understand the relationship between burnout and secondary trauma and to look inward at the emotional and physical cost of working with traumatized clients in stressful situations.
Since 1995, recognition of the significant incidence of trauma in clients and families who seek assistance has magnified the importance of working within a trauma-informed culture where employee and organizational health, compassion fatigue, self-care, and honest organizational assessment are necessary. Over the years, I have wondered if other professions are starting to adopt similar trauma-informed practice.
My son Patrick is an attorney. Since passing the Bar in 2012, he has specialized in Workers Compensation and Personal Injury law. We have had many conversations about the rewards and struggles of working with clients who have experienced significant workplace injuries or serious and life threatening accidents. We have talked about the difficulty of working with clients who often present as controlling, hypervigilant, and who frequently respond to the legal process with frustration, anxiety, and emotional dysregulation.
A little over a year ago, Patrick and his family moved to Florida. As he prepared to take the Florida Bar, he began to consider the impact of his work with traumatized clients. As he identified the emotional cost that he and many of his peers have incurred as a result of their work as lawyers, he began to identify ways that he could assist other attorneys who have also struggled in this regard. As we discussed his desire to assist others (2), we researched trauma as an issue within the practice of law. It quickly became evident that lawyers, bar associations, and law school faculty were beginning to investigate the concept of Trauma-Informed practice (3,4,5).
Based on our findings it is clear that working with traumatized clients can impact every area of legal specialization. Personal injury attorneys assist clients who have experienced life-altering automobile accidents or work-related injuries. Civil litigators assist victims of violent crimes. Family lawyers assist victims of domestic violence and abuse. Veterans attorneys assist service members with combat-related struggles. Judges and other officers of the court are exposed to cases where testimony and other evidence requires almost constant emersion in traumatic material. Legal professionals in each specialty spend hours interacting with traumatized clients, listen to emotional stories of traumatic events and reviewing graphic photos and medical records.
The potential impact of trauma on legal professionals is significant and multifaceted. First, traumatized clients often present symptoms that challenge the legal team and its efforts to successfully represent their concerns. Traumatized clients typically enter the legal process with a strong need to feel safe. As the legal process is unfamiliar and potentially threatening, traumatized clients often enter the relationship with a need to be hypervigilant, to feel heard and believed, and in control of the process. Failure to recognize this need can result in distrust, manipulation, and conflict between the client and the legal team.
Second, trauma memories are often fluid and can change over time. A client's inconsistent accounting of what happened during the event can make case conceptualization, completion of a thorough and accurate assessment, and preparation for deposition or trial difficult. As members of the legal team become frustrated, they may avoid interacting with clients, which creates even greater conflict and increased efforts on the part of the client to regain control of the situation.
As caseloads build with traumatized clients, team members become more vulnerable to stress, burnout, and secondary trauma from their daily work responsibilities and client interactions. As a result, professionals can experience reduced job satisfaction and increased emotional consequences. In all helping professions these struggles can result in increased turnover, the desire to leave the profession, and increased problems with mental health and addiction issues. Recent research on turnover rates in law firms found that 44% of new associates change firms within the first three years of practice. This turnover rate is estimated to cost firms over $9 billion annually (6). Large numbers of attorneys are also leaving the profession. A 2014 report (7) stated that 24% of attorneys who were licensed in 2000 were no longer practicing law in 2012.
Addiction and mental health struggles are also evident in the legal profession. A 2016 survey (8) of 12,825 attorneys found that 20.6% screened positive for "hazardous, harmful, and potentially alcohol-dependent drinking." In this same survey, 28% of the respondents reported depression, 19% reported anxiety, and 23% reported significant levels of stress in the work environment. Issues associated with addiction and mental health struggles have implications that go beyond the attorney’s wellbeing. Attorney impairment is not a mitigating circumstance for failing to provide clients with appropriate representation (9).
All of these issues are not directly associated with working with traumatized clients, but the importance of these growing concerns should be carefully considered!
Recommendations for law firms and County, State and Federal courts: 1. Accept the reality that trauma and frequent interaction with traumatized clients can harm outcomes, reduce work performance and job satisfaction of employees, and create emotional and behavioral consequences for employees and the organization as a whole. 2. Work with a consultant to assess the impact of trauma, compassion fatigue, and organizational trauma on the overall health of the organization. 3. Develop trauma-informed policies and procedures for working with all clients. 4. Provide training for all employees on trauma, best practices for working with traumatized clients, and prevention of compassion fatigue, burnout, and secondary trauma. 5. Provide resources for employees who are struggling with compassion fatigue, burnout, or secondary trauma, addiction and other mental health issues. These resources should include coaching, therapy, treatment and access to an Employee Assistance Program. It is also important to provide preventative opportunities for self-care, consistent utilization of PTO, etc.
Recommendations for Law Schools: 1. Provide training in trauma, best practices for working with traumatized clients, preventing and addressing compassion fatigue, burnout, and secondary trauma for all students. 2. This training should be mandatory for all students regardless of the student's stated areas of interest.
Recommendations for addiction professionals and other mental health professionals: 1. It is critical to remember that working with attorneys and other legal professionals should include a thorough trauma assessment, assessment of compassion fatigue, and burnout. 2. It is important to remember that Trauma-Integrated Legal Practice is relatively new concept in most legal practices, courts, and governmental legal environments. Trauma education, including education on compassion fatigue (i.e., burnout and secondary trauma) is critical for attorneys to accept the serious impact of trauma in their work environment. 3. From this perspective, all addiction and mental health treatment should be trauma-informed and trauma-integrated. Working with attorneys and legal professionals should be seen from the same perspective of working with other helping professionals (i.e., medical professionals, first responders, therapists, etc.).
Special Thanks to Patrick Barnes, Esq. for providing input and feedback on this blog post. · For more information on Trauma-Informed Legal Practice, go to Wave of Change Coaching and Consulting, LLC (www.waveofchangecoaching.com).
Footnotes 1 Figley, C. R. (1995). Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder In Those Who Treat the Traumatized. Brunner/Mazel. New York: NY. 2 https://www.waveofchangecoach.com/ 3 https://www.lawcare.org.uk/news/lawyers-and-vicarious-trauma 4 https://www.lsc-sf.org/wp-content/uploads/2015/10/Article_Establishing-a-Trauma-Informed-Lawyer- Client-Relationship.pdf 5 https://www.aals.org/wp-content/uploads/2015/06/Katz-Haldar.pdf 6 https://www.attorneyatwork.com/confronting-lawyer-turnover-in-law-firms/ 7 http://www.abajournal.com/magazine/article/after_the_jd_study_shows_many_leave_law_practice 8 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. 9 https://www.lawpracticetoday.org/article/evaluating-impaired-attorneys/
Dr. Mike Barnes is the Chief Clinical Officer at the Foundry Treatment Center Steamboat, a rehab and substance use disorder treatment center located in Steamboat Springs, Colorado.
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