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Vicarious Trauma. Compassion Fatigue in Attorneys Appellate Defenders, Inc MCLE Program - February 23,2018 Ellen Stein, Ph.D. PSY15085 (619-595-4005; [email protected]) lime leplc 12:00 pm Welcome Introduction of Presenter; MCLE Overview 12:05 arn What 12:15 am Symptoms of Compassion Fatigue/Vicarious Trauma 12:25 am Managing Vicarious Trauma. Mitlgatiog.lrnp_a£t. 12:35 am Impact of Vicarious Trauma and Compassion Fatigue on Attorneys 12:55 pm Conclusion / Final Comments 01:00 pm End

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Page 1: Vicarious Trauma. Compassion Fatigue in Attorneys ... of Compassion Fatigue There are ways to mitigate compassion fatigue. • Awareness. Understand what compassion fatigue is and

Vicarious Trauma. Compassion Fatigue in AttorneysAppellate Defenders, Inc MCLE Program - February 23,2018Ellen Stein, Ph.D. PSY15085 (619-595-4005; [email protected])

l i m e l e p l c

12:00 pm W e l c o m eIntroduction of Presenter; MCLE Overview

12:05 arn W h a t

12:15 am Symptoms of Compassion Fatigue/Vicarious Trauma

12:25 am Managing Vicarious Trauma. Mitlgatiog.lrnp_a£t.

12:35 am Impact of Vicarious Trauma and Compassion Fatigue on Attorneys

12:55 pm C o n c l u s i o n / F i n a l C o m m e n t s

01 :00 pm E n d

Page 2: Vicarious Trauma. Compassion Fatigue in Attorneys ... of Compassion Fatigue There are ways to mitigate compassion fatigue. • Awareness. Understand what compassion fatigue is and

Compassion Fatigue

Compassion Fat igue

What is Compassion Fatigue?Compassion faliguc is the cumulative physical,emotional and psychological elfcci of exposure to traumaticstories or events when working in a helping capacity, combined with the strain and stress of everyday life.It's important to note that comptission fatigue is different than burnout. While bumoul is predictable,building over time and resulting in work dissatisfaction, compassion fatigue has a narrower focus.Someone affected by compassion fatigue may be harmed by the work they do, experiencing intrusiveimagery and a change in world-view.Compassion fatigue is also known as vicarious trauma, secondary traumatic .stress, second hand shock and.secondary stress reaction. Regardless of the term used. compas.sion fatigue affects those in the helpingprofessions, including the legal profession, and is treatable.

Symptoms ofCompu.s.sion Fatigue• Perceiving the resources and support available for work as chronically outweighed by the demands• Having client/work demands regularly encroach on personal lime• Feeling ovenvhclmed and physically and emotionally exhausted• Having disturbing images from cases intrude into thoughts and dreams• Becoming pessimistic,cynlctii.lrrilahic.and prone to anger• Viewing the world as inhercnliy dangentus, and becoming increasingly vigilant alxtut personal

and family stifely• Becoming emotionally detached and numb in profes.siona[ and personal life; experiencing

increased problems in personal relationships• Withdrawing .socially and becoming emotionally disconnected from others• Becoming dcmorali/.ed and queslioning one's professional compelence and effectiveness• Secretive .self-medication/addiction (alcohol,drugs, work, sex, ftxxl. gamhjing, etc.)• Becoming less productive and effective professionally

Page 3: Vicarious Trauma. Compassion Fatigue in Attorneys ... of Compassion Fatigue There are ways to mitigate compassion fatigue. • Awareness. Understand what compassion fatigue is and

Treatment of Compassion FatigueThere are ways to mitigate compassion fatigue.

• Awareness. Understand what compassion fatigue is and periodically self-assess for it.• Debriefing. Talk regularly with another practitioner who understands and is supportive. This in-

volves talking about the traumatic material, how you think and feel about it, and how you arepersonally affected by it.

• Self-care. Proactively develop a program of self-care that is effective for you. This includeshealthy eating, exercising regularly, getting adequate rest, and learning how to tum off the "fight-or-flight response" of your sympathetic nervous system and turn on the "relaxation response" ofyour parasympathetic nei^ ous system.

• Balance and Relationships. Take steps to simplify, do less, ask for help, and stop tiying to be allthings to all people, including your clients. Start thinking about how you can work on balancerather than the reasons you can't. Working to develop and maintain healthy interpersonalrelationships will also increase your resilience.

• Professional Assistance. Treatment from a licensed provider specializing in trauma may be benefic i a l .

• Being Intentional. If you arc ovenvhelmed and struggling with depression, anxiety, substanceabuse, or compassion fatigue, put a plan for change in place. Recognize that the attributes thatcontribute to your professional success (e.g., motivated, pcrfectionistic, achievement-oriented,driven, fixer) and your work environment may be contributing to an imbalance in your life.Monitor your thoughts, emotions, and behaviors. Seek assistance to help you implement changeand redirect the thoughts that tell you, "I should be able to do this by myself." Your new mantracan become, "I don't have to do it all by myself."

How Compassion Fatigue Affects LawyersLawyers, like others in the helping professions, are at risk for experiencing compassion fatigue. Lawyers incertain practice areas, such as criminal, family or juvenile law may be especially susceptible to compassionfatigue, as they are regularly exposed to human-induced trauma, and are called on to empathetically listento victims' stories, read reports and descriptions of traumatic events, view crime or accident scenes, andview graphic evidence of traumatic victimization. Those with high caseloads and those with a highcapacity for empathy are also at risk for experiencing compassion fatigue,lawyer assistance programs (LAPs) are here to support lawyers. Judges, students and other legalprofessionals who experience compassion fatigue. Contact vour slate or local LAP.

How to Help a Colleague Affected by Compassion FatigueIf you believe a colleague may be experiencing compassion fatigue, encourage him/her to seek help.Contact a LAP for additional support and resources.

Page 4: Vicarious Trauma. Compassion Fatigue in Attorneys ... of Compassion Fatigue There are ways to mitigate compassion fatigue. • Awareness. Understand what compassion fatigue is and

iViichiGDn :yi' jOc^'


_ i . - e ^ -■ \ -

racticing We ness

.Qwyers and Post-Traumatic Stress DisorderBy Tish Vincent

I ] t h e a m r i R H n i i . - - i n i l i c c m i r t -

Aliiiii>c were Kiiind. Oiirini; mylime ns a law derk in lli.ii onin.I was involved with coid-vasc

m u r d e r i r i a l s i n t o u r < i t i l i e c o i i n n K i n i s . o n e

ot'wliich liad |usi tjcen lemodeled. 't he |myciuiir.-. were dee|5 IwiRundy. the wikxI panel-mji looked ridi and serkuis. and 1 aanem-t)er teeiinj: like I was in an episode of l.ciwa n d O r d e r T h e c o u r t r o o m s v a r i e t l . h u t t h e

cokl-case murder trials had a haiinlint; .sim

ilarity. The defendants had committed heinous crimes iong ago and ilKHighi ihey hadgotten away with 11.

1 viewed many photos—of\ictims. weapons. and crime scenes. I listened to victims'

family members and i<i defense argumeni.s.Three months into this internship, I iK'ganTO have ilie nightmare. I was in a big roomthat was dark except for the glow of a ceiling light hanging higli above my head. 1stood beside a circle of .six giirneys. likeyou'd see in an emergency rcxim. On eachgtirney was a dead bixly—iniiiries obviousanci horrifying—drape-d m .1 buigiindy blanket. I would wake up lernfied and unable togo hack to .sleep, ixxising my husband, whowould alxiiit my dream.

"It's tiiat internship!- he'd say. "Ii's getting to you'"

V i ca r i ous t r ouma l i za l i on

Many clienis seeking aliornevs have expo-lienced significant iniiima. Often, the traumais a factor in the circumstances com[K'l!ingthem to seek legal assistance. As jran ofjiroviding services. llie lawyer will fora lull account ofwliat iranspirexl. Lawyersare trained to manage their emotions and"s t i ck to the fac ts . " bu t the I 'ac is can be d is

turbing 10 liear.

Over lime in a busy piaciice, legal pro-fe.ssion.ils can .suffer die .same symptoms of

posi-iraumaiic stress disorder experiencedby iheir clients. In the therapy world, wev . i l l t h i s l i c a r U i i i s l i m i i > i a i i : < i l i i > i i . I t i s n n -

deisiood that piole.s.sionals who wxirk withpeople needing their help begin to experience the same einotion.s aiul even .some olthe same symptoms as their clients. Judgesare ixirticulariy susceptible to vicarious trau-mali/aiion Irecausc they are exposed tom.iny more than aiiorneys.

Post-trcumatic stress tjisorder

I'ost-traumalic stress disorder developswhen .vjmeone experiences a severe traumathat doe.s or can result in .serious injury orkxss of life, 'lb meet criteria for this diagnosis. the trauma needs to Ire vcrv" .seriotis and

engender real tear of harm,The .symptoms of posiirauinaiie stress

d i s o r d e r a r e :

• I n t r u s i v e m e m o r i e s o j t h e t r a u m a

• Disiie.ssmg dreams

• I l ashba t ks

• I n t e n s e i l i s t i e s . s

• M a r k e d r e a c t i o n s t o c u e s t h a t

symitoli/e iraum.nic events• I'ersisienl avoidance of .similar .siimuii'

Those suffering with this condition havealterations In ttieir aioiistil level ivsulting in;

• .Angry or irritable outbursts

• > e l f - d e s i r u c t i v e I x ' h a v i o r

• l!y]>cr-vigilance

• bxaggerated startle response• I ' r o b l e n i s w i t h c o n c e n t r a t i c r n

• Sleep distuiirance

• irepersonali/ation, a liierapeutic term

de.scribing the feeling of detachmentfrom life and the sense of ob.sen'ingo n e s e l f i n a c t i o n

• Oerealizatlon. an altered sense of the

outside world leading one to perceivetilings as unreal"

I ' o s i - t r a u m a t i c . s i r e s . s d i . s o r d e r c a n l e a i l

to the overuse of unhealthy coping mechanisms, particularly .substance abuse. Thenaumaflzed or vle.iriously traumatized individual seeks escape from symptoms causing emotional discomfort. Alcohol and otliersubstances may initially seem like a solution. but the stJulion is temporary and maywel! lead to other prciblems.

If one considers a murder trial in which

the prose-culor. defense attorney, and judgeview crime .scene photos. Iiear grisly details of the defendant's actions, li.sten to thedefendant and the v ict im's re lat ives, i t is

.awyers ore trained to manage their emotionsand "stick to the facts/' but the facts con bedisturbing to hear.

Page 5: Vicarious Trauma. Compassion Fatigue in Attorneys ... of Compassion Fatigue There are ways to mitigate compassion fatigue. • Awareness. Understand what compassion fatigue is and

Jjn^ 20M MichiQcn 6o' Journal

D racticing Wellness

nol clifficull i<> iinaf;ii)c thai .some, if nolall, of llie loijal profcsMonals invol\eJ mayoxiXTlcnco vicarious tniumati/.uion. Theyare ihon piitecl aj;aiivsl one anoilier in aniii.anil are ilic locus of eKjX.-ciaiions and dis-appoinimcnis of many inlere.sied panics.

Treatments for post-traumaticstress disorder andv i ca r i ous t r auma t i zo t i on

P o s t - l i a u m a i i c . s t r e s s c i i . s o r t l e r a m i v i c a r

ious irauniatizaiion respond to therapeuticinienention. Wlien an mdis idiia) struiyjlin^Willi tliese conditions makes an appointment with a therapi.M. there is a .sense of rel i e f t h a t s o m e < i n e w i l l l i s t e n a n d . s t r i v e t o

understand. A therapists office can be a satehaven for letiii) profe.ssjimals 'iverwhelmcdby symptoms,

I le.iling ircaimeni-s are eo.sniiive Ixih.iv-ioi.ii techniciiies. eye movement de.sensili-zatlon K-traininft. and empathic listcninji.I-olliAvini; ev.iluaiion by a mental healthprnte.vsional. .in individual may be reterrcdto a personal physician or a psychi.iirist formedication if therapy Is not progre.ssini;.


vie live in a lime when many educated

people aa- iryiiij; to understand the f.iciorsDiniributinp lo the of praciicins law..A better umlerslandin}; ot pnst-iraiimatics i r e . s s i l i . s o r d e r a n d v i c a r i o u s t r a u m a i i / a t i o n

coiitribute.s !•> a legal prole.ssionnl's .strategies tor self-caie Hopeluily. this brief articleoilers Insight and guidance lor tliose seeking aildiiional lielp from a qualified mentalhealth piole.ssional. ■

Tifh Vincenc, MSW, ]D,L M S W. A C S W. C A A D Cis a l icenseddinica!sociut

worker with expertise inthe tre.iirnenr of stihsldnceuse and merttul healthdisorders. She is also a licensed anorney with expe

rience in health law and alternative dispute resolution. Vincent is the program administrator Joithe State Bar of Michigan Lawyers and judgesAssistance Program.

E N D N O T E S1. Motional Institute ol iVental t-teolih. Pcf-cauirair

Svea DiSO'Ce' iPiSOl <hllp://\ oltii/publicoiions/posttiouniQlic-s'iess-disoidB'-p»sd/:fide>..5h'inl> (oaesscd Voy 21, 20M]

2. See id: JoHe. Ctoob. Dunloid-Jooftcn. & Town,VrCan'ouJ "011.1710 in /edges' The personal chol/enge claispemir.g jus'ce. 54 Juvenile und Fomil/ Coi''t J IiFo'! 2CC'3).

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Page 6: Vicarious Trauma. Compassion Fatigue in Attorneys ... of Compassion Fatigue There are ways to mitigate compassion fatigue. • Awareness. Understand what compassion fatigue is and

Sccondun or Vicarious Trauma Among Judges and Courl Pcrs... hup://« \

H O M E A M N U A L P U B U C A T K O N M O O T H L V T a C N O S A R I K U I S C L O S E U P C O U fl T B U Z Z C O K T A C T O S

Secondary or Vicarious Trauma Among Judges andC o u r t P e r s o n n e l

D e e o r a r 6 W n e d S f W x , S e ^ e r i < , ' e * 4 < d O c » n d H i e ' ^ u c . m S o v c c s A r x » y $ E . C c m c r 6 0 " S U K c C o u n t s

JudgciAnd otri^r court $tafi rr>Ay oe .M riskof swH«<ir9 trom >«cor>CAfyor vcarKMSUAumo strategics tor Ouild«ng rcsilicr^ce thai can noipindividual'j deal witrt tKis isauu.

The research on secondary or vicarious trauma mitiariy focused on profess ons&ucn as nu'ses.erT>er9cr>cy resporyJers. therapists, and other hctpmgprof ession 6 who we r« ro pea ted iy ox DOsed to the traumatic events that affected the people iney were charged witnnelping V/hile somoallempts havebeen m ado to dof 1 no a nd d if f e ro nt 1 a te between t he te r ms com passion fat rgue, burnout, secondary i raum a, a nd vica r 1 o us t r au ma. t hey cont rnue to bo usedinterchangeablyQlThefifiheditionof ihoOagnosticand Statistics Mar>gai (DSM-S) was released m Way 2013 arvd for the first time included vicarioust r a u ma dcf 1 ried as * re ceated c ext re mo oxposure t o detd» is of t he eventfs} * E» posu re tnroug r> p ctu res or media to someone else's t rau ma d id not q u a iifyun less it wa 5 re i atcd to wo rK .121T h 15 is e«a ctiy w hat nap pens m a ecu' I every day. The repeated exposu re to dcta 11 ed acco u nts. 0 ictu res. and vi deos oftraumatic events affected someone else is a daily occurrence for judges ar>d other court personrvcl

Trial judges, to some degree, are isolated as they must rrako their rui r>gs anddecisonsmd vidually without tr>e ab<Iity to discuss ongomg cases, in addition,legal and judicial training do not typically focus on how one feels. Judges are usually (aw trained, and lawyers as a group are known to be at high risk fordeo'ess^on and substance apuse in 2003, tOS judges working m criminal, famiiy, and juvenile court completed surveys on trauma while attending variousjud ic I a( confere nces Based on i he responses. 63 pc rcent 'eoor ted symptorro of work- re ated wear tous Iraum a m A 2009 study tested law students f0'anxiety and depression to determine if the individuals who chose law school vvere already experiencing these symptoms. Whife now law students were nomore anxiousor depressed than the general public, at six rrionths a dr,imat»c increase was seen. This eiovation of stress symptoms continued dunr^g thethree years of law school and for at least tvsc years after. While it «s r>ol c'eor wnat causes th s increase m anxiety and depression, it is clear thai faw-lrainedindividuals sre more susceptible to the effects of daily stressors R(

People do nottypicaHy go to court for hapcy reasons.Thcy may be involved tncnrpinal cases Involving homfic details or crvjf cases involving evictions, childa buse, or fa m I ly b f eakdo wns Judges are ex pectefl to add ress each sit uat on ind v«dualiy. ^rsten im part a?Jy to w tnesses, a nd view ot her evi dence. Today,evidence comes in many formats, including gnsiy pficlos and v.deosor frigmenirvgema is. vorce mails, and text messages Everyone isiakir^g pictures andvideos at Crime scenes With dash cameras, bcdy-v/orn cameras Oh the case of lovv enforcement), and smart phones This repeated exposure to traumaticdetai ls that judges and other court ce'sonne^ face dai ly lead to secondary or v>carious trauma in addit ion to p'es'dmg over cases involving traumaticevents, judges in emotionally charged cases may have corvcems about safety Fma ly. the high case'oads that rrtaiy^udgesdeai with can add to tne stress

levels, which inturnma kos t h em mor c susceptib le to vi car lous tr.-»u ma IS)

The symptoms of vicarious trauma are similar to Post Traumatic Stress Disorder (PrsO). They can include

h y p e r v i g i l a n c e

h o p e l e s s n e s s

inability to embrace complexityinability to listen, avoidanceanger and cynicisms l e e p l e s s n e s sf e a r

c h r o n i c e x h a u s t i o n

physical ailmentsminimis inggu i l t

Many of these symptoms can interfere with the judicial deciSKjn-ma'ong process lal

Our brains nr© wirod to feni empathy, .-^od our bodies m.iyoxoetrenco this through ser^ry neurons known as "mirror neurons," This was first discoveredwith ph>%<cal motions, such as viewing someone dunking a glass Of water. Tr>esame neurons lignt up in tno person v ewing the action as in the persondr in ki ng the water Sim tie > ly, w hen (isl© n 1 ng t o o 1 viewi ng someone else's traurrta. our bodies can ei pe rie r>ce t heir pa 1 n tnroug h ou r mi rro r> neuron sysie m.

Wo can also use our mirror*neuron system to vicariousiy c.ilm oursoivos To do this w© must develop rcsHiorsco. and there are wsys to do thi&

Awarencss-'First. it is important to know the sigr^s and symptorrs of vicarious trauma ir> yourself and in your col leagues This can be accomplishedby providing training to court personnel that identifies the stressors, symptoms. ar>d techniques for preventing or addressing vicarious trauma bybuilding resilience This type of training can emphasize that developing these types of reactions to trauma is part of being human and not a sign ofw e a k n e s s .

Balance—The second aspect of building resilience is the importance of self care, individualswho arc exposed to these daily descriptions andpicturcsofthetraumaexpenenccd by others must learn to set boundaries between their work and private tive& To some extent, this can beaccomplished by the usual admonitions to get enough sleep, to participate in an exercise program, and to eat a healthy dieL Other importanttechniques include mod uat ion, yoga, and mindfulness training

Connection—Because trial judges are typically Isolated in dealing with specific cases, rt is important to debrref with colleagues who understand theSituation. When this is not possible, or is not enougn, a therapist can provide this type of connection and support. Individuals facing this kind ofvicarious trauma need to bo surrounded by a strong system of supportive roiaiionships

6y usin 91 hese tec h niques. courts can ensu re i h at ;uOg n ar^d ct her cou rf st aff nave me resources tney need to a ddross the sym pioms of vi car iou$t r a u m a i 2 i

] o i ' 2 2 / 3 / 1 8 . 9 ; 5 7 A M

Page 7: Vicarious Trauma. Compassion Fatigue in Attorneys ... of Compassion Fatigue There are ways to mitigate compassion fatigue. • Awareness. Understand what compassion fatigue is and

Secondary or Vicarious Trauma Among Judges and Court Pers. htlp;/Av\v\,

Many courts are doir just tlrat tjy providing training for judges and court staff Different training models and curriculum are available. Some courts useoutside educators to provide training while others develop in-house products A leading expert in the area of secondary trauma, who has been used mseveral states for judicial training, is Laura Van Dernoot-Lipsky. author of Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others(Oakland. CA: Berrett-Koehler Publishers. 2009).|filThe Amencar* Bar Associatren has also provided programming for secondary trauma to lawyers, judges,and other court staff. The Professional Quality of Life website at provides resources for creating individualized training on secondary trauma.These include slides, handouts, screening tools, bibliographies, and other materials that can be customized for training purposes jSl

Judges and court staff arc susceptible to vicarious or socond«iry trauma duo to the combination of working in a busy court, hearing repeated accounts ofharrowing or traumatic events, and worrying about safety issues thai may arise around volatile or emotionally charged cases. Law-trained individuals havet)een found to be at high risk for anxiety and depression, and this may be traced back to the laW'SChool ehvironment. Courts can address these issues byproviding resilience training based on an awareness of the signs and symptoms, the need for balance and self-care, and the importance of connecting witha strong support system that may include friends, colleagues, family, and professional therapists.

s* Psychiatric Times 27. no 11 (2010): 24-26.

J," Professional Counselor 4. no. 3 (2014).

U13. A Boscarino. R. E. Adams, and C. R. Figley. -Secondary Trauma Issu^^ fof Psvgni.ilrtsts.' Psychiatric Times 27. no. 11 (2010): 24-26.

121L K Jones and J L. Curelon. 'Trauma Redefined m the DSM-5 and imD!.ratiQr>s for Conn- eimo Practice." Professional Counselor 4. no. 3 (2014;P C- Jaffe el aL "VicariousTrauma m Judoes: The Personal Challenge of Oisr^ensmo Justice.' Juvenile and Family Court Journal (Fall 2003): 1.

Lil T. D. Peterson and E. W. Peterson. -Stemmir^otheTirteof i awStudi m D.:>Dresvom What Law SchooK Need to Leam ffom thft Science of P lt'VePsychology ' Vale Journal of Health Policy. Law. and Ethics 9. no 2 (2009).

jSl J. Chamberlain and M. K. Miller. 'Fvidence of Secondary Traumntir Stress. Safety Concor ns and Burnout Among a HomoQeneous Grouo of Judoes ■n aSingle lurisdiction.' Journal of the American Academy of Psychiatry and the Law 37. no 2 (2009): 214-24.

|6I A. Chambers. "2 L" Missouri Lawyers' Assistance Program. 20)7.

j2l K. M. Hazilla. •VicariousTrauma Prjmerfof thg luveniie Court Pr.vtiticno'.' Youth. Rights and Justice Juvenile Law Reader 13. no 3 (2016).

ISJ Responses to Ask ommunitv ouerv on secondary trauma. November 2016

121 American Bar Association. 'unrjersLindma the impact of SoconclaProfessional Development. Chicago, 2016

1 with Cniicfren and Forr.i'.Kys.* presentation. Center for

Reportsare part of the National Center for sraTt> rou»t< Report on Trends m State Courts' and 'Future Trends in State Courts'series

Opinions herein are those of the authors not necessarily of the National Center for State Courts.

2 o f 2 2/3/18.9:57 AM

Page 8: Vicarious Trauma. Compassion Fatigue in Attorneys ... of Compassion Fatigue There are ways to mitigate compassion fatigue. • Awareness. Understand what compassion fatigue is and

htj Dianne Molvi^

A groundbreaking study of WisconsinState Public Defender attorneys

examines the effects of "compassion

fatigue" - the cumulative physical,emotional, and psychological effects

resulting from continual exposureto others' traumatic experiences,

This article discusses factors contributingto the risk any lawyer may face

of experiencing its symptoms, and

what can be done to mitigate it.

Ben Gonring spends his days representing 10to 17 year olds wiio are in trouble witli thelaw. Alter 15 years in the juvenile unit of" theWisconsin State Public Defender (SFD) Officein Madison, he says the best part of his Job isgetting to know liis young clients well, so he canbe an effective advocate for them in court. But

gaining that knowledge also has a dark side."When you ilig into these kids' stories," he

says, "you realize what sort of life they're livingand the trauma they see evers' single day. On theone hand, you inaivel at their abilit)' to survive.On the otlier hand, it makes you so sad. Youleani about a lot of bad stufT, and you have to tryto process tliat every day. It's hard. Really hard."

Judy Schwaemle retired from the Dane

4-Wisconsin Lawyer - December 2011

n « i

Page 9: Vicarious Trauma. Compassion Fatigue in Attorneys ... of Compassion Fatigue There are ways to mitigate compassion fatigue. • Awareness. Understand what compassion fatigue is and

Taking o break from her work as a public defender in Milwaukee, Yvonne Vegas says awareness is thefirst thing lawyers need to mitigate the effects of clients' trauma in their personal lives, "lawyers need

to know that what they're feeling Is real and that it's something they can discuss - that they don't have

to feel embarrassed or ashamed for feeling this way. That's a step in the right direction."

Page 10: Vicarious Trauma. Compassion Fatigue in Attorneys ... of Compassion Fatigue There are ways to mitigate compassion fatigue. • Awareness. Understand what compassion fatigue is and

Compassion Fatigue

Key Study FindingsThe study loond thot 5PD attorneys reported significotiily higherlevels of compassion fatigue than administrative support staffond the general popuiotion, when dota for the lotter wereovaiioble for comparison. The study's findings breok down by

specific symptoms of compassion fatigue as follows.'A mojor finding of our study," Dr. Andrew Levin reports,

"is ihot the extent of caseload and lawyers' exposure to other

people's trouma were clearly rebted to symptoms of compavsion fotigue." Interestingly, foclcrs such as years on the job,

age, office size, gender, and personal history of traumo madeno significant differences in compassion fatigue levels.


Depressed mood, loss of interest or pleasure, disturbed sleep,loss of appetite, low energy, poor concentration, feelings ofguilt or low self-worth

• General population; 10 percent• SPD administrative support staff; 19,3 percent• SPD attorneys: 39.5 percent

PosHraumatic Stress Disorder

PTSD, triggered by a terrifying event; symptoms include flosh-backs, nighlmores, severe onxiely, uncontrollable thoughts

• General population: 7 percent• SPD support stoff; 1 percent• SPD attorneys: 11 percent

Functional Impatrment

The extent to which exposure to traumatic materiol interfereswith functioning in work, sociol/leisure life, and fomily/homelife

• SPD support stcff: 27.5 percent• SPD ottorneys: 74.8 percent

Secondary Traumatic StressThe 'cost of coring* about another person who has experienced trauma; symptoms are similar to those of PTSD

• SPD support stoff; 10.1 percent• SPD attorneys: 34 percent

B u r n o u t

Job-induced physical, emotional, or mental exhaustion combinedwith doubts about one's competence ond the value of one's work

■ SPD support staff: 8.3 percent• SPD ottorneys; 37.4 percent

Compassion SatisfactionThe study olso measured 'compassion sclisfactlon," or the pleasurederived from one's work. Reports of high levels of satisfaction wereOS follows:

• SPD support staff: 25.7 percent• SPD cltorneys: 19.3 percent

What the Numbers MeanAre we to conclude from the key findings thai SPD attorneys oreimpaired on the job? Absolutely not, soys Dr. Andrew Levin,medical director at the Westchester Jewish Community Center inHortsdolo, N.Y., and cobcililalor of the study. Bear in mind, heemphasizes, these results come from self-reporting instruments,which indicate trends, not diagnoses of conditions.

Toko, for instonce, the depression statistic. 'It shows thot olmost40 percent of attorneys ore over the threshold number on thedepression inventory," levin expbins. 'Thot does not mean theyhove a clinical diagnosis of depression. Ail it means is that theyhove a likelihood for being ot risk for depression."

Likewise, the functionol impairment measure doesn't mean SPDlowyers ore biling to function well on the job. 'It may meon, forexomple, thot you hod o lough day at work,* Levin explains, 'endwhen you got home you weren't obb to pay as much attention toyour family os you would hove liked, or you were irritable. Your jobis interfering with your home life."

If onything, the dota show just how resilient the study portici-ponts ore, Albert points out. "Despite the foct thot they endureongoing exposure to trouma and hove these high caseloads, theycontinue to rrteel the requirements of their employment,* she soys,"it's omozing that they do. They ore handling the demands of thejob, but not eosily and not without it having on impact on theirlives.*

Dianne Molvig. Madison, is a frequent contributor to area and national puUicattons. Photos: Corey Hengen

6-Wisconsln Lawyer-December2011

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Count)' District Attomevs Office lust\ear after 27 vears. Man\' times in liercareer, she saw horrifv-ing e\idence ofwhat one human did to another. Those

(listiirlnng images often lingered andintnided into her thoughts away fromwork. Es'en now that she's retired,i i ie inor ies remain.

"To tliis day," slie sa\"5, "when I go[W.St a place where a homicide occurredthat I prosecuted, 1 tliink about it,iwer)- time. I dris'e past and think, that'swhere Sarah was killed."

I'ixperiences such as these can takea toll on lawyers. Recentlv, the StateBar of Wisconsin undertook a studs' tolearn just how significant that toll is andwhat can be done to mitigate it.

The study examined tlie presalenceof what's knossn as "compassioni'atigue" - that is, the cumulativepbs'sical, emotional, and psx'chologicaleffects of continual ex'posure totraumatic stories or events when

working in a helping capacitx'.

On a late fall day, State Public Defender lawyers Ben Gonring and

Deb Smith talk about how the nature of their jobs may contribute to

compassion fatigue. "When you dig into kids' stories, you realizewhat sort of life they're living and the trauma they see every single

day.... You learn about a lot of bad stuff, and you have to try to

process that every day," says Gonring, who represents juveniles,"It's hard. Really hard."

Smith, SPD director of assigned counsel, agrees. "Many ofus who have been around for a while know there can be a cost,

emotionally and psychologically, to doing this kind of work. Evenfor lawyers who know how to maintain an appropriate professional

demeanor and distance, this stuff seeps in. It changes your

perspective on the world."December 2011 — Wisconsin Lawyer-7

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Compassion Fatigue

^ More from rtie authors ...wV/tJ 1* ' "'5 video, at,WisLAP coofdinotor Lindo■ • Q r v i i f K A i r A / ^ ^ r ^ / M i n c a l t k a S p M

xr§r Albert ond Deb Smith, director of ossigned counsel for the SPD,discuss the agency's involvement with the Stole Bar's compassionfatigue study, what it learned, and what it will do to help supportIts staff.

Ill psycliolopcai laiijruaj e,exposura to iinotiRT [xtsoii s tnumiais refermd to lus seeoiulaiy touinia."Tliere's ro.searcli on the impactof secoiular)'trauma on liunianbeings, hut it's never been lookedat extensively with lawyers. We'reon the forefront oftliLs," says Linda.•\]bert, cooalinator of (tie StateBar's \\asconsin Lawvers Assistance

Program (WisLAP) and cofacilitator ofthe compassion fatigue studs'.

Research exists on the effectsof stress on attomes's, and someresearchers bas e used some of the

language related to compu-ssionfatigue. "But no one has studied itsystematically;" says Dr. Andrew Levin,medical director at the Westchester

Jewish Community Center inHartsdale, N.Y., who facilitated thestudv with Albert. "So this was aneffort to .say, "People have made theseobsen'alions. They seem to have some\ aliditx'. Can we establish that more


Roots of the Study.As WisL-AP ccKirclinator, -Albert hasp\cn presentations aixiut compassionfatigue to maiw gniups of legalprofessionals in recent years. She'sseen tlie topic liit home again amiagain with \'arious andiences.

"I've done this with liankmptcylaw\ers, guartliuns ad litem, publicdefenders, pniscx-utors, judges, coui-tcommissioners.... Rvery time it'sresonated," she sax's.

Lcxin and .Albert learned oftheir niutnai intea'st in the topic ofcompassion fatigue and decided todo a formal studv of its effects onWisconsin attomcxs. Thev decidedto focus on one S[)ecific group: statepublic defenders.

"Compassion fatigue is aniinjwrtant issue," says Deb Smith,director of assigned counsel for tlieSPD and the agenc\''s ]H)int |)ersonfor tlie studx'. "Manv of us wiioha\e been around for a while kaiowthere can he a cost, einotionalh'and psyxhologically; to doing thiskind of work. We deal with a lot of

unplciisantness. Even for lawyerswho kniow how to maint;iin an

appropriate prufe.ssioiial demeanorand distance, this stuff seeps in. Itchanges xour [XTSiwctixe on theworld."

To leam more aliout sucheffects, studx' questionnaires wentout to a total of 474 SPD attonicwsand administrative siqiixirt staff.ResjKinse rates for c<)m|)lele<Isurxex's weixt reniarkahle: 78 [x-rcentof attomex's ami 65 |)ertx*nt ofsupport staff.

While the study's target groupxx-as public defenden. SmithIieliexes it will haxe x alue for theprofession as a whole. "There'sa large comnninitx' of laxxyersxx'lio deal with trauma-exqxisedclients and who need to Ix awareof compassion fatigue," she says,'■'i'liese laxx-x'ers need to make surethev'a' taking care of themselxes.This isn't just a public defenderissue; it's a lawyer issue."

Count judges among thoseaffected by compassion fatigue, aswell. Neal Nielsen, an eight-yearxeteran on tlie circuit court bench inVilas County, sas-s judges' exposureto trauma differs from iaxxvers".".Attomess are much more closelyrelated to the facts of the case for amucii longer period of time than arejudges," he notes.

Still, judges sit on the benchliearing, day in and day out, abouta procession of incidents of traumaindicted or endured by people intheir courtrooms. ".And 1 can sithere now and call up in my mindWilli great accuracy all the autopsyphotos I've ever seen," Nielsen says.

In the Trenches

Dana Smetana sees a key messageher felloxv SPD altomexs ought totake awax' from the studv results:There's iiotliing xxTong xx"it]i you."I think sometimes laxxyers thinkthex''re going craTix'," says Smetanaof the SPD Eau Claire office, xx hcreher duties include trx-ing tnises asxx'cll as being a regional superxisor.She's been xvitli the SPD for 27xears. "If lawxers are feeling this

What you don't expect is that as you're trying to keep people safe - whether

It's keeping an individual safe from on abuser or keeping society in genera

safe from a psychopath - you won't get the support you need to do your job.- Robert Ko/ser, Dene County ossisfcnf dhfn'cf attorney

8 - Wisconsin Lawyer - December 2011

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Compassion Fatigue

To this day, when 1 go post a place where a homicide occurred that I

prosecuted, I think about it, every time. I drive past and think, that's whereSarah was killed. - kdy Schwaewie, Dane County assistant district attorney, retired

way, it's tlie symptoms of what's goingon with this job. It's nothing negativeabout you as a person. Awareness ofthat is a huge factor."

As a supervisor, she knowsyoung SPD lawyers must leam toput up protective boundaries, tokeep their emotions in check. 'Theolder attorneys get good at that,"she observes, "but then when theygo home, they have trouble liftingthose boundaries" with families andfriends.

Not letting the effects ofexposure to trauma spill over intoone's personal life is one of themost difficult aspects for lawyers,agrees Yvonne Vegas, a 22-\TearSPD veteran who's now in theMilwaukee office. "Our clients havea lot of trauma in their lives: povert)',lack of education, homelessness,joblessness, mental health issues,substance abuse issues," she says."Their issues become ours. Youabsorb that on a day-to-day basis,and you take it home with tou. It canmake you irritable and short-fusedwith )'our family."

like Smetana, Vegas believesawareness of these dynamics iscritical for lawyers exposed to clients'trauma. "Lawyers need to know thatwhat they're feeling is real," she says,"and that it's something they candiscuss - that they don't have to feelembarrassed or ashamed for feelingthis way. That's a step in the rightdirection."

Some observers, of course, mightpoint out that public defenders andprosecutors kmow what they're in forwhen they decide to pursue this type

of law practice. True, sa\s formerdistrict attorney Schwaemle. "Youkmew this would he coming," shesays. "But there's knowing, and thenthere's knowing."

The effects can cut deeper thansome might have imagined. Take,for in.stance, prosecuting a sexualassault case. "When you prepare forthe trial," Schwaemle says, "you put

yourself in the place of the victim. Youiiave to ask yourself why the victimbehaved a certain way because youhave to explain that to the jury. Yourelive the victim's experience and putyourself in her shoes."

Robert Kaiser also has seen

"inexplicably, indescribably horribleevidence" in his 34 years as a districtattorney, the last 24 of those in Dane

Coping with Compassion FatigueExposure to clients' Irouma isn't going to stop. But you con mitigate the effects this exposure has on you. Here ore o few strategies:

• Debrief. Talk with another lawyer who understands what you're going through

ond con offer support. Debriefing con become a port of the office culture. Remember, thisis 0 discussion about how the cose is affecting you as a person, not a rehashing of legalstrategies.

• Take care of yourself. Eat healthy foods. Exercise regularly. Get enough sleep.Leom relaxation techniques so you con let go of stress and disturbing, repetitive thoughts.Know what truly brings you joy in life and make time for it.

• Strive for balance and interconnection. Give up the urge to be all things

to oil people, including clients. Allow time to connect with friends and family to counterbalance the stresses you feel at work and put everything back in perspective.

• Come up witfi a plan. When compassion fatigue is weighing on you, it con

be difficult to get off the treadmill and set a new course. Slop long enough to notice howyou're feeling, reacting, and behaving at work and at home. Develop a plan of actionfor yourself. What needs to change? Where con you start?

• Seek help. If you think compossion fatigue is interfering with your work or per-sonol life, reach out for help. A good place to start is WisLAP. Call the 24-hour helpline,ot (800) 543-2625, or coordinator Undo Albert at (800) 444-9404, ext. 6172. All

inquiries are confidential.

Decemiier 2011 - Wisconsin Lewyer - 9

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Compassion Fatigue

"We have to acknowledge what people in crimina

justice, not just public defenders, go through. We neecto recognize how difficult it is to see people in crisis

every single day. And we have to be able to talkabout it."

County and the remainder in Chicago.He never ■wanted to be anytliing but adistrict attorney, and he knew exposureto trauma would be part of the job.

"What you don't e.xpect," Kaisersays, "is that as you're trying to keeppeople safe - whether it's keepingan indixidual safe from an abuser, orkeeping society in general safe from ajsychopath who will victimize anybodyle can get his hands on - you won't getthe support you need to do your job."

The combination of burgeoningcaseloads and shrinking budgetsmakes it increasingly difficult fordistrict attorneys to fulfill their duty toprotect the public. Kaiser notes. In hiseyes, lack of support sends a messagethat crime victims and the districtattorneys' wiork don't matter.

"We're saddened by our work," hesays. "We're certainly affected by it.But when you live it and then peopleact as though what you do is notimportant, tliat's trauma."

Public defenders, too, are hurtby budget cuts. And they're targetsof public scorn for simply doing tlieirjob: defending people's constitutionalrights.

Thus, heavy caseload andexposure to trauma aren't the onlyfactors fueling compassion fatigue inattorneys. In the State Bar's study,SPD participants wrote in commentsabout additional contributing factors.The top three were lack of respect,lack of control in one's work life, and

- Kelli Thompson, Sfofe Public Defender

lack of enough time to process issuesand give or get support.

'AVTien you have those factors,"observes WisLAP's Albert, "on topof exposure to trauma and heavycaseloads, that's where I see tlie perfects t o r m . "

Next Steps

The State Bar's study puts compassionfatigue on the legal profession's radar."We have to acknowledge what peoplein criminal justice, not just publicdefenders, go through," sa) StatePublic Defender Kelli Thompson. "Weneed to recognize how difficult it is tosee people in crisis every single day.And we have to be able to talk abouti t . "

Going forward, she sa)s, the SPDwill provide more staff training toeducate people about compassionfatigue and to learn coping skills. Openday-to-day communication in the officeis also critical, she says. "Our lawyers

need to k-now it's okay to take a breath,"she says. "You can't live with a terriblecase for a )'ear, close it, and tlien justsay, 'On to tlie ne.\t one."'

The results of the study, tlie first ofits kind, apjiear in tlie December issueof the Journal of Nervous and MentalDisease and wiU draw wider attentionto the topic of attorneys' compassionfatigue. Albert already has spokenabout it at a Canadian conferenceand for the national conference of theAmerican Bar Association's Commissionon Lawyer Assistance Programs. Inaddition, Albert is working with theSPD to develop strate es that bothindividual attorneys and the agencycan use to minimize work-relatedstress. She anticipates adapting tliesestrategies for use by lawyers in otherpractice areas.

"I think these findings will beunsettling for the legal profession,"Albert says. "The implications of thisstudy definitely will go way beyondW s c o n s i n . "

The State Bar is one of severalbar associations prticipating in asecond study that seeks information onfactors, personal and professional, thatcontribute to life and career satisfactionor dissatisfaction. The study, to beconducted in May 2012, is headed byDr. Kennon Sheldon, University ofMissouri, Department of Psychology,and Prof. LawTence Krieger,Florida State University College ofLaw. "WisLAP will use the data to

develop ways to prevent and mitigaterrofessionaiism, ethics, and mentallealth and substance abuse problemswithin the profession," Albert sa)'s.

There's research on the impact of secondary

trauma on human beings, but it's never been looked

at extensively with lawyers. We're on the forefront- Linda Albert, V/isLAP coordinafor

10 - Wisconsin Lawyer - December 2011