Research into the occupational hazards of stress, trauma, and vicarious traumatization resolves the seeming paradox of the compassionate lawyer who worries that she has “lost her compassion.” It is, in fact, not that lawyers, either intensively for a single client or for many clients over a time, must lose their compassion for their clients but rather that the intensity of their compassion and empathy creates tremendous strain on the lawyer’s daily functioning. The intensity of the work itself engenders stress in the life of the lawyer which takes its own toll on the lawyer’s ability to function in a difficult daily life. In addition, the intensity of this compassion and empathy over time creates the potential for vicarious traumatization of the lawyer. The concept of vicarious traumatization explains that lawyers working with clients who perceive their lives in traumatic terms—facing death or grievous loss—may find themselves deeply affected by the client’s trauma and experience post-traumatic effects themselves. In other words, just as our clients experience trauma in a way that leaves long-term post-traumatic effects, the lawyer working with traumatized clients will also experience post-traumatic effects at a lower level of intensity. Specifically, many traumatized people experience a combination of post-traumatic symptoms that alternate between a sense of numbing and denial about the trauma, on the one hand, and intense and almost overpowering feelings, on the other. Simply put, the lawyer’s sense that she has ceased caring for her clients is actually false; the intensity of her caring and empathy for her clients has led her to experience post-traumatic symptoms like numbing and denial that may faintly echo her client’s reactions.
Writers on stress and vicarious traumatization emphasize that they are occupational hazards both intrinsic to this work and unavoidable. Indeed, the only way to avoid stress in the daily life of a lawyer is to either work or care much less than is necessary. Similarly, the only way to avoid vicarious traumatization is to fail to engage compassionately, even empathetically, with one’s client. For the diligent, humane lawyers, stress and vicarious traumatization are unavoidable occupational hazards. Because they are hazards that can severely impair the lawyer’s ability to provide the best service to clients, the lawyer must carefully understand and address both stress and vicarious traumatization, as they occur, for the lawyer and for the client. And like many occupational hazards, the effects of stress and vicarious traumatization in the life of a public interest lawyer can be mitigated, even if they cannot be completely eliminated.
Teaching Concepts of Vicarious Traumatization
When teaching vicarious traumatization, it is important to begin by defining the basic concepts of stress and trauma and distinguishing them from other related concepts, including burnout and counter-transference, the package of emotions and reactions that a lawyer has to any individual client. These concepts are discussed in turn below and in Jean’s chapter. Many of these concepts can be illustrated through the use of an extended analogy: the raging river.
The Raging River:
A client lives in the center of a raging river. His lawyer stands at the edge of the river as a huge boulder is dropped just in front of the river dweller. The client is knocked down by the immediate towering wave that the boulder creates. The waves completely envelop him, washing over him, soaking him: the impact of the rushing water topples him each time the river dweller struggles to right himself. Once he regains balance, the wake of the splash continues to wash over him, occasionally overpowering him and toppling him again. The lawyer standing at the periphery of the river is struck by lesser waves and ripples, to a much decreased or milder extent. The waves she receives are vastly different in amplitude, but similar in shape and character to the initial waves. The lawyer also stands at the intersection of many such rivers, receiving similar waves and ripples from many directions. 1
The raging river analogy provides an overall visual image for the concepts defined below. The client lives in the raging river under day-to-day conditions that are already stressful. The boulder represents a trauma occurring in the life of the client. The towering initial wave represents the client’s initial experience of the trauma while it is happening. The wake of the wave represents the post-traumatic effects felt by the client. The lesser waves and ripples represent the secondary trauma effect experienced by the lawyer. The lawyer’s reaction to standing with the client in the raging river is the lawyer’s counter-transference reaction to the client. The cumulative effect of standing at the periphery of many rivers with many clients and its effect on the lawyer over time is vicarious traumatization.
Concepts of Vicarious Traumatization
Stress: The Raging of the River
Life in the raging river is a life under stress. In its essence, stress is defined as “a disrupted interaction between environmental demands on the one hand, and the needs and skills of the individual on the other.” 2 Stress has been studied as a scientific concept since the 1930s, with focus on research into physiological and psychological responses to stress, as well as research into extreme circumstances of stress that include trauma. The client in the center of the raging river may experience stress as a result of his interactions with any one of a number of factors, ranging from specific factors such as his familial economic situation and interactions with his family, the legal system, and the social service system, to larger factors including poverty, racism, and violence in his community. The client feels the rigors of living in such a challenging, chaotic, and hard-to-control environment, day to day. For many of our clients, daily life itself can challenge their full capacities to the extreme.
There is little doubt that the lawyer’s life in the raging river alongside his client is also a life under stress. In addition to the stress emanating from one client’s world, Lawyers regularly face the challenge of contentious court appearances, deeply unhappy clients and their families, demanding judges, and legal personnel with whom the lawyer may not see eye-to-eye. In many environments, the lawyer has an extraordinary number of clients, often far too many to be able to represent them with the individual attention that she would like to give them. In addition, the environment in which the lawyer works may lack resources and regular opportunities for support and feedback.
Burnout: The Cumulation of Stress
The cumulative effect of chronic everyday stress and chronic emotional strain is sometimes called burnout. In Representing Children, Jean discusses research that suggests one’s tolerance for this continual stress gradually wears away under the never-ending onslaught of emotional tensions, changing over time. 3 Burnout has been defined as an “emotional exhaustion, de-personalization, and reduced accomplishment that can occur among individuals who do ‘people work’ of some kind.” Burnout is unique from stress because the stress-like feelings associated with burnout come from the continued interaction with clients.
The most salient factors associated with burnout include the lawyer feeling she does not have the ability or capacity to deal with her clients’ issues and the lawyer feeling the tension of trying to help her client within a system that is seemingly set against her client.
Trauma: The Boulder
The boulder represents a trauma occurring in the client’s life. There is no consensus about the definition of trauma or its differentiation from stress. Some suggest that stress is the large category of which trauma is one extreme subset. This camp suggests that “stress and trauma are not two independent concepts, but rather two overlapping concepts; stress has a much broader meaning.” 4 Others suggest that stress and trauma are on a continuum but are distinct in kind. What life events are cataclysmic enough to be defined as trauma? This elusive question has not definitively been resolved. The DSM-V defines exposure to a traumatic event to be:
Exposure to actual or threatened death, serious injury, or sexual violence in one (or more) of the following ways:
- Directly experiencing the traumatic event(s).
- Witnessing, in person, the event(s) as it occurred to others.
- Learning that the traumatic event(s) occurred to a close family member or close friend. In cases of actual or threatened death of a family member or friend, the event(s) must have been violent or accidental.
- Experiencing repeated or extreme exposure to aversive details of the traumatic event(s) (e.g., first responders collecting human remains; police officers repeatedly exposed to details of child abuse). 5
A predecessor definition of post-traumatic stress disorder suggested that the traumatic stressor must be outside the range of usual human experience. More recent DSM definitions recognize that studies of trauma should focus on the interaction between the person and the event. 6
In identifying whether something rises to the level of trauma, Laurie Pearlman, a leading author in the field of vicarious traumatization, provides a more expansive approach to that determination from the point of view of the person experiencing the trauma. 7 Her definition of trauma, which differs from the DSM’s diagnostic conceptualization, reads:
An experience is traumatic if it,
- is sudden, unexpected, or non-normative,
- exceeds the individual’s perceived ability to meet its demands, and
- disrupts the individual’s frame of reference and other central psychological needs and related schemas. 8
Pearlman’s definition does not appear to require a fixed level of harm or threatened harm to be experienced as traumatic.
Secondary Trauma: The Ripple Effect
A substantial number of a lawyer’s clients will have experienced some trauma and its aftermath. The ripple effect felt by a lawyer in a particular client’s case is called secondary trauma. One expert defines secondary traumatic stress as the “natural consequent behaviors and emotions resulting from knowledge about a traumatizing event experienced by a significant other. It is the stress resulting from helping or wanting to help a traumatized or suffering person.” 9 Note that this is distinguished from vicarious traumatization below because it concerns the effect on the professional of the exposure to an individual trauma; vicarious traumatization concerns a cumulative effect on a professional life exposed to multiple traumas over time.
The DSM-V definition of psychological trauma, focusing as it does on the interaction between the person and the event, makes it clear that any person “confronted with” an event involving threats to life and physical integrity has been exposed to a traumatic experience. Experts agree that professionals serving these clients who in the course of their work learn about and work with these traumatic events are “confronted” with their clients’ trauma. 10 Looking closely at the DSM-V definition, it is clear that concerned professionals seeking to serve traumatized clients also fit the DSM-V definition, if in addition to being confronted with the traumatic events involving actual or threatened death or serious injury or threat to the physical integrity of their clients, they also experience a response involving intense fear, helplessness, or horror.
These secondarily traumatized professionals also experience post-traumatic effects, again broadly described as the oscillation between intense re-experiencing of the trauma and hyper-reactivity on one hand and avoidance and numbing of that re-experience on the other hand. While our clients experience the immediate effects, secondarily traumatized professionals may undergo the same repertoire of effects, at a far more attenuated level. The lawyer experiences an echo, if you will, of the client’s post-trauma reaction. The waves of post-traumatic symptoms that hit the client later hit the lawyer in similar shape and character, but much diminished in intensity. No one suggests that lawyers experience the post-traumatic symptoms with the same intensity that their clients do. Nevertheless, even an echo or shadow of the client’s experience can produce noticeable reactions in the helping professional. These reactions, conglomerated, are called secondary traumatic stress. Other writers have suggested the words compassion fatigue or compassion stress as alternative names for secondary traumatic stress and its related secondary stress disorder. 11
Counter-Transference: The Lawyer’s Reaction to Her Experience in a Single River
The lawyer’s reaction to her experiences in any individual river is the counter-transference that she experiences on her case. Secondary trauma and vicarious traumatization (defined below) differ from counter-transference in the following way. Counter-transference describes the package of emotions and reactions that a lawyer has to any individual client. This counter-transference may include secondary trauma based on work with a specific client, and vicarious traumatization, as well as many other inferences. A lawyer may undertake the legal work for clients based on his or her counter-transference, that is, his or her own package of emotions and reactions to a client’s life, as opposed to the client’s subjective experience of her own life. A lawyer’s counter-transference, including his stress, secondary trauma, and vicarious traumatization may create obstacles to a lawyer’s excellent service to the client. Put another way, the lawyer must mind not only his or her own package of emotions as it relates to the specific facts of any given case, but also the cumulative effect of his or her work over time upon the ability to be an effective lawyer. The concept of vicarious traumatization describes this cumulative effect.
Vicarious Traumatization: The Effect on the Lawyer of the Experience in Many Rivers
Vicarious traumatization is the cumulative effect on the lawyer of both the ripples and the experience of being in the river. Vicarious traumatization, a term coined by Pearlman and Saakvitne in 1990, in an article which began a systematic professional look into secondary trauma and vicarious traumatization, focuses on vicarious traumatization not as an isolated event nor as a pathology of some kind, but rather as the “transformation in the inner experience of the [lawyer] as a result of empathic engagement with survivor clients and their trauma material.” 12 Vicarious traumatization focuses on the cumulative transformative effect on those working with survivors of traumatic events. Pearlman and her collaborators emphasize that they see vicarious traumatization not as a disorder or syndrome, but as an occupational hazard; that it is “not something that clients do to us; it is the human consequence of knowing, caring, and facing the reality of trauma.” 13 Unlike researchers of secondary traumatic stress, who increasingly defined a syndrome and the symptoms of its pathology, Pearlman and her collaborators focused on the cumulative and pervasive effect of working with trauma survivors and how the helper’s self is thus transformed and challenged.
Clearly, vicarious traumatization has commonalities with burnout in the disillusionment and cynicism that often result. As with other kinds of traumatization, each person’s profile of vicarious traumatization is unique. The experience of empathy with the client interacts with each person’s unique resources, history, and context. While the literature offers useful general information and a specific repertoire of possible effects experienced by people who have been vicariously traumatized, each person’s vicarious traumatization profile must be developed specifically and with care for that person.
A strategy for dealing with vicarious traumatization is necessary because the trauma will not abate on its own. Essentially, vicarious traumatization is a recurring, occupational hazard, as it results from empathic engagement with another person. Since a lawyer would never want to lose that empathy, which can be one of her greatest offering to her clients, lawyers must accept that vicarious traumatization will always be with them. Lawyers must identify how vicarious traumatization is manifesting in their lives. Then they must devise a plan to manage their VT. The approach that trauma therapists endorse is to seek delight in our daily lives. When a lawyer’s world threatens to devolve into an overwhelming preoccupation with the evils she most fervently opposes, she must constantly remind herself that life is more than the injustices she seeks to eradicate. Thus, for lawyers to keep the perspective, the energy, and the hope needed to carry their client’s cases to fruition, it is crucial and indeed their ethical imperative to preserve the things that give them personal, deep joy. This joy is the essential ammunition in the fight against the despair and fragmentation that trauma brings.
Discussion Questions for Concepts of Vicarious Traumatization
When teaching about vicarious traumatization and related concepts, the following questions may help spark discussion:
- When do we experience stress?
- How do we experience stress?
- Can we be stressed about good things?
- Is feeling stressed always a “bad” thing?
- Have we experienced burnout?
- Have we experienced burnout in our clinical work?
- What does burnout feel like?
- How does burnout manifest?
- Are there specific factors that trigger burnout? (Poor systemic resources, unresolvable problems, return clients, recurring bureaucratic obstacles might be some examples.)
- Where do we see trauma in our clinical work?
- How do we see trauma in our clinical work?
- How does trauma manifest in our client’s life?
- How does trauma manifest in our interactions with our clients?
- How does secondary trauma compare to trauma?
- Have we experienced secondary trauma?
- What does secondary trauma feel like?
- How does secondary trauma manifest in our personal lives?
- How does secondary trauma manifest in our clinical work?
- Have we experienced counter transference in the clinical setting?
- What factors trigger counter-transference?
- How does counter-transference manifest?
- Have we experienced vicarious traumatization?
- How is it similar to secondary trauma?
- How is it different from secondary trauma?
- How does vicarious traumatization manifest in our personal lives?
- How does vicarious traumatization manifest in our clinical work?
- Acknowledge the professional obligation to identify and address impairments to quality legal work, such as stress, burnout, and vicarious traumatization as part of the lawyer’s overall commitment to excellent legal service.
- Keep in mind the operation of trauma symptoms: the alternation between numbing reactions, on the one hand, and intense, strong feelings, on the other.
- Understand how the signs of stress and vicarious traumatization build one’s occupational hazard profile.
- Recognize that each concept reflects a different experience. And because each experience is different, each may require different coping methods.
- Take time to recognize what is being experienced and how it may change how the lawyer interacts with the world.
- Jean Koh Peters, Representing Children in Child Protective Proceedings: Ethical & Practical Dimensions, 388-89, (2nd ed., 2001). ↩
- Id. at 389. ↩
- Id. at 390 ↩
- Id. at 391. ↩
- DSM-V, Posttraumatic Stress Disorder, 309.81(F43.10). ↩
- See Peters, supra note 1, at 391-95. ↩
- Id. at 392. ↩
- Id. ↩
- Id. at 399. ↩
- Id. ↩
- Id. at 400. ↩
- Id. at 401. ↩
- Id. ↩