Vicarious trauma or secondary traumatic stress is a concept that many in the helping professions have little awareness of and is seldom spoken about.
That summary of facts that you suddenly find yourself thinking about when you are home alone; those crime scene photographs that you can still picture in your mind; the recurring soundtrack of a particular court case; feeling emotionally drained after interviewing a distressed client or hearing details of child abuse in the Family Court; wanting to avoid particular cases or clients or avoiding going into too much detail; being overly cautious and protective of your own children; needing that extra glass of wine or shot of whisky at the end of a hard day; being more irritable and impatient at home – do these experiences sound familiar?
These are all experiences that are consistent with vicarious trauma and they can have an insidious effect. Forensic psychiatrists have described the examples above from their own practice but it is likely that those in the legal profession would have similar experiences.
The concepts of vicarious trauma and secondary traumatic stress were first described around 25 years ago by Pearlman and McCann and reflect the cumulative effects of exposure to the trauma and suffering of others.
They noted that those working with clients who have experienced trauma may develop painful images and emotions associated with their clients’ traumatic memories and incorporate these memories into their own memory systems. As a result, they may find themselves experiencing symptoms including intrusive thoughts or images and painful emotional reactions.
They also suggested that secondary exposure to trauma might disrupt cognitive schemas related to fundamental psychological needs including safety, trust, power, esteem and intimacy.
Research
There has been research on the effects of this in a range of helping professionals including emergency responders, domestic violence counselors, funeral directors, child protection workers, forensic scientists, lawyers and judges.
Of relevance to the legal profession, Levin and Greisberg (Pace Law Review 2003) surveyed three different groups in New York – attorneys working with victims of domestic violence and with criminal defendants; mental health workers and social services workers.
They found that the attorneys demonstrated higher levels of secondary traumatic stress and burnout than the other groups, with higher levels of intrusive recollection of traumatic material, avoidance of reminders of the material and difficulties with sleep, irritability and concentration.
Vrklevski and Franklin (Traumatology 2008) studied vicarious trauma in the Australian legal profession, comparing the impact on criminal and non-criminal solicitors using a number of number of rating scales.
They found that the level of vicarious trauma in criminal lawyers was higher with higher levels of subjective distress, depression, stress and cognitive changes in relation to safety and intimacy. Higher levels of avoidance, intrusions and hypervigilance were also noted.
Jaffe et al (Juvenile and Family Court Journal Fall 2003) surveyed symptoms of vicarious trauma in 105 judges from across the United States.
They found that the majority of judges reported at least one symptom that they identified as a work-related vicarious trauma experience, including anger, anxiety, flashbacks, loss of faith in humanity, lack of empathy and a sense of isolation from others.
Female judges reported more symptoms, as did judges with seven or more years of experience. The authors noted the need for greater awareness and support for judges.
Better care
Of interest, there does now appear to be greater awareness of this issue in the wider legal community with an article on vicarious trauma being the cover story for the Canadian Lawyer magazine in February 2015.
A number of international associations and journals for legal professionals have published articles describing the concept of vicarious trauma and urging better self care for legal professionals, including the New Zealand Law Society with the Practising Well initiative.
There is also increasing organisational awareness of the need to address this issue to protect employees’ health and well-being.
The Age newspaper in Melbourne, Australia, has recently reported upon the topic of judges being at risk of being traumatised by serious criminal cases. One judge described having been able to “compartmentalise” his work in the past but had recently found things “seeping through the compartments” – a good description of vicarious trauma.
County Court of Victoria Chief Judge Rozenes commented upon this in the court’s Annual Report. “Judges, because of the way they work and the company they keep, become isolated, lonely and immersed and enmeshed with their work, which as you all know is complex and difficult, onerous and troubling at times,” Chief Judge Rozenes wrote. “Twenty years ago this conversation would not have been taking place. I encourage all judicial officers to have it now.”
In response to this issue the County Court of Victoria has initiated the Supporting Judicial Resilience Program, an initiative designed to debrief judges and provide one-to-one support to manage stress, with 20 judges having volunteered to participate.
Recognition needed
The effect of repeated exposure to trauma and human distress needs to be recognised and can be a significant contributor to stress and burnout, common experiences in both the medical and legal professions.
These problems can impact upon practice, and can adversely affect relationships with colleagues, clients, partners and families. Maladaptive ways of dealing with stress can lead to further difficulties, with drug and alcohol abuse being a common coping mechanism.
Barriers to recognising or addressing these issues include beliefs that keeping a professional distance will be protective and also that as a professional one is expected to be able to handle it or else be seen as weak. Issues around privacy, stigma and confidentiality are also important barriers.
The technique of compartmentalising or boxing things off is frequently described but over time this technique may break down and suppressing emotions and reactions may take its toll in other ways.
There are a number of strategies that are thought to be able to reduce the impact of exposure to trauma and other work stressors, including the elusive work/life balance and various self-care strategies. One of the most effective tools is regular supervision, a practice that is well recognised in a number of helping professions, but is under utilised in the medical and legal professions.
Supervision involves meeting on a regular basis with a suitably qualified professional. This provides a confidential space in which to reflect and to explore issues within the workplace and the impact that they may be having both professionally and personally.
A willingness to consider one’s vulnerabilities should be seen as a strength not a weakness and can translate into more effective, balanced and compassionate practice.
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 (www.mindfix.co.nz) 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.