Managing Stress and Vicarious Traumatization

You understand some of the key concepts related to stress and trauma. You’ve identified some symptoms in your own practice, or you’ve noticed some of your students displaying symptoms. What can you do? What must you do?

The first step in managing vicarious traumatization in your life or in helping your students to do so in theirs is to acknowledge the ethical obligation to identify and address impairments to quality representation, such as stress, burnout, and vicarious traumatization.

This stems from three interrelated ideas: vicarious traumatization is unavoidable for the lawyer who hopes to engage deeply in empathetic representation of her clients; managing vicarious traumatization means enabling, not shirking, a lawyer’s responsibilities to her clients; and having a strategy to manage such trauma is in fact required for full ethical representation of clients.

1. Writers on stress and vicarious traumatization emphasize that these occupational hazards are both intrinsic to this work and cannot be avoided. Indeed, the only way to avoid stress in the daily life of the lawyer for marginalized communities is either to work much less than is necessary or to 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 lawyer, stress and vicarious traumatization are thus unavoidable occupational hazards.
2. To successfully manage vicarious traumatization as a lawyer, you have to know that it’s ok to take the time to actually manage it. Lawyers who take care of their own needs and work thoughtfully with themselves to combat these occupational hazards then have the ability to give more authentically and consistently to their clients. Better self-care in turn engenders better service. Without that kind of careful, ongoing care of ourselves and of the things that give us meaning, we would eventually have nothing to give our clients and no resources through which to provide services.
3.  More than being just acceptable, managing vicarious traumatization in our lives is an ethical duty we owe to our clients. To lawyers who are used to thinking in terms of ethical responsibilities concerning confidentiality, fee setting, and other such non-psychological concerns, a duty to address this internal process and to take care of oneself may seem startling. Yet any commitment to the hard work of representing clients requires that the lawyer have excellent personal resources at hand. In order to prevent our needs from intruding into the representation of our clients, we must regularly and systematically strive to meet those needs outside the context of the representation. As Habit Five demonstrates, excellent cross-cultural lawyering requires your best self at work. Compassionate lawyering for social justice requires care and nurture of the lawyer, as well as the client, and this self-care is our ethical duty.

Once we recognize vicarious traumatization as inevitable and as an ethical imperative, what can we do?

The second step in successfully managing vicarious traumatization is to address the three signature negative effects of vicarious traumatization through reintegration of self, reconnection to others, and reaffirmation of meaning.

Pearlman and Saakvitne tell us that “antidotes for vicarious traumatization must address both stress and demoralization.” Karen W. Saakvitne and Laurie Anne Pearlman, TRANSFORMING THE PAIN: A WORKBOOK ON VICARIOUS TRAUMATIZATION 72 (1996).  Using the analogy of the raging river, attempting to address vicarious traumatization by focusing only on stress management would address the river but not the boulder. Stress management techniques may be necessary—and may overlap with strategies to address trauma– but they are not sufficient by themselves to mitigate the impact of vicarious traumatization.

Once we note that vicarious traumatization “operates to disrupt one’s sense of self, one’s connections to others, and one’s sense of life’s ultimate meaning,” a natural strategy to address it is focusing on reintegration of one’s self, one’s connections to others, and one’s sense of meaning into one’s daily life. Through her work, Jean has recognized these three sub-principles as forming the core of effective strategies for lawyers to combat stress and vicarious traumatization.

1) Sub-Principle I—Reintegrate Self

Every aspect of the self can be deeply affected by psychological trauma. Vicarious traumatization can dissolve one’s spirituality. It can diminish one’s inner sense of connection to others. It can reduce one’s self-awareness. It can attack one’s self-esteem. It can distort memory and perception. As a lawyer seeks to identify the ways in which stress and vicarious traumatization uniquely affect them, it may be useful to note the disruptive effects specifically in one’s experiences in daily life. Often this will lead to a logical suggestion for an antidote that is a strategy that will reintegrate that which has been disrupted by the trauma.

2) Sub-Principle II—Reconnect to Others

Since trauma operates through creating a sense of isolation, effective confrontation of vicarious traumatization relies on reestablishing connections to one’s peers and to one’s community. Healthy, growing personal relationships wherever they occur in one’s life are a sound antidote to this pervasive and pernicious sense of isolation. Within the work environment, at home,and among one’s larger communities, both geographically and historically, thoughtful supportive peers are invaluable. Writers in the field of vicarious traumatization emphasize that we cannot do this work alone. Trauma, combined with the duty of confidentiality, can operate to isolate the lawyer from the many loving resources available in one’s life whether in the professional circle or personal networks. Actively seeking connection and reconnection to trusted others is a critical antidote to vicarious traumatization.

3) Sub-Principle III—Reaffirm Meaning

As lawyers—particularly lawyers for social justice—enter their work, they may lose contact with the heartfelt imperatives that drew them into the work. This may be manifested by cynicism or hopelessness; many practitioners cite a sense of loss of hope or disillusionment as a key part of burnout or high turnover in their offices. Theorist clinicians like Pearlman and Saakvitne suggest, however, that this hopelessness and despair, and even the cynicism, reflect the disruptive effect of vicarious traumatization on the practitioner’s sense of mission and contribution. Since trauma operates to rob people of their intrinsic sense of life’s meaning, effective antidotes to vicarious traumatization must focus on reaffirming the lawyer’s sense of meaning and purpose in his or her life generally. Seeking to reconnect with one’s spiritual roots, either through organized religion, meditation practices, or art, dance, literature, or music—one’s sense of the larger forces of the world in which they reside—can begin the process of healing this spiritual breach.

So what to do? Pearlman and Saakvitne suggest that strategies to manage stress and disrupt the negative effects of vicarious traumatization can fit into three ABC buckets: awareness, balance, and connection. “Awareness” strategies are those that help us understand our own unique occupational hazard profiles—what are the most likely triggers for stress and trauma in our own lives? How do they manifest? What strategies are most helpful in addressing them? “Balance” strategies help temper the stress and demoralization that come from vicarious traumatization by encouraging time for work, play, and rest. Finally, “connection” strategies push us to deepen our relationship with others in our communities and ourselves, thereby advancing each of the three above-mentioned sub-principles of managing vicarious traumatization.

Below, Jean presents 10 strategies that can be incorporated into a lawyer or student’s daily life to manage stress and disrupt the negative effects of vicarious traumatization. (**Randy, need two alternatives here: footnote to VT Chapter by cite and LINK deep into the chapter to the start of the ten strategies; Jason still hoping to figure out how we get permission to use this.) Each of the strategies can operate in the three different spheres of concern for the lawyer: the lawyer’s self, consisting of body, mind, and spirit; the lawyer’s web of connections at work with clients, colleagues, and other members of the system; and the lawyer’s larger life and world beyond himself or herself and his or her work. These three spheres are, in a sense, the lawyer-as-context—the different contexts of the lawyer that have been fragmented through the process of stress, burnout, and vicarious traumatization. Additionally, as you read each strategy, you might think about how it can be used to increase awareness, balance, or connection in your own professional life as lawyer or teacher.

1) Examine your daily life for the negative effects of stress, burnout, and vicarious traumatization.

While the workings of stress and vicarious traumatization are deeply psychological and largely unconscious, their manifestations occur throughout our daily lives. Both the negative effects and the absence of important things from our daily activities can constitute evidence of the impact vicarious traumatization has on our lives.

2) Keep in mind the operation of trauma symptoms: the alternation between numbing reactions, on the one hand, and intense strong feelings, on the other.

In looking at daily life experiences, our strong feelings, even negative ones, may be easier to spot than our reactions of numbness and helplessness. Identifying how both manifest in our lives is critical to developing a comprehensive strategy for addressing stress and vicarious traumatization.

3) Understand how the signs of stress and vicarious traumatization build one’s occupational hazard profile.

Stress and trauma interact with each person in an extremely individual way. Over time a lawyer can construct a profile of her own vicarious traumatization reactions by understanding its component elements. When warning signs appear, is there a connection to stress and trauma issues at work?

4) Use your concrete experiences of empathy with your client to improve your representation.

The lawyer can use the intense negative experience, including the disruption of her own daily functioning, as a window of empathy into the client’s behavior. The window of empathy creates hope that even the lawyer whose experience is very different from that of the client can still develop a gut level understanding of what the client may be experiencing, which will allow the lawyer to convey that understanding to courts and service providers in the system. This is ultimately a gift to our advocacy and thus a gift back to our client.

5) Take your own advice: do the same things for yourself that you would see your clients do.

The lawyer is often an excellent problem-solver for others—why not for herself? Even more importantly, lawyers should also remember to use the same compassionate skills of listening and non-judgmental understanding with themselves that they use with clients.

6) In re-examining one’s commitment to one’s self care, start with the basics.

Both primarily and secondarily traumatized persons, as well as those merely suffering from extreme work stress, often find that the disruption of trauma seeps into the very core functions of daily life. Therefore, it makes sense to start at these core functions in remedying the effects of vicarious traumatization. Consider focusing on:

• Sleep (the right amount—not too little or too much, uninterrupted, and without disruptive dreams)
• Proper Nutrition
• Breathing
• Exercise
• Time Off
• Work and Home Environment

7) In seeking fun and recreation, look for activities that give you deep satisfaction and balance out the experiences at work, as opposed to numbing activities which may replicate the experience at work.

Confronting vicarious traumatization requires one to be strategic even about one’s recreation. Hours of games on your cell phone may be numbing activities that reinforce the numbing of VT when you actually need to recharge and reenergize. Certain TV might reinforce the harried, stressful nature of work in your home life. Again, the choice of recreation is deeply individualized. What might be engaging for someone—such as watching the news on television—could be numbing for someone else.

8) Examine and strengthen your connections to yourself, people at work, and your larger communities.

In order to combat feelings of isolation, the lawyer’s support system within and without should be carefully examined. Both in the office and at home, the sense of mutual support, that “we are all in this together,” will best break the feeling of isolation that is such a classic symptom of stress and traumatization.

9) Reconstruct your daily schedule: integrate a routine of self-care, proactive strategies that work, and commitments beyond work into daily life.

The crucial final task of any person addressing these occupational hazards is to complete the fight against fragmentation through integration of the various solutions into a regular daily routine. By incorporating changes in the basics, building connections to oneself and to others at work and beyond work, and looking carefully at one’s choices of recreation, a more balanced and less trauma-centered daily life should slowly emerge. At a minimum, a plan of nutrition, family time, exercise, sleep and time off can make the unmanageable manageable. One can also expand the frame to look more at the week as a whole.

10) Be prepared to address vicarious traumatization on an ongoing basis because it is a process, not an event.

As long as the work with our traumatized clients continues, and as we continue to process the work, we will struggle to fight its fragmenting effects and to maintain hope. We will also continue to be subject to the interaction between our empathic engagement with our clients’ experience and the experience of our own lives. Therefore, self-care, peer support, and continual reassessment must be an ongoing process, even a lifestyle.

***

A thread runs through all of the strategies: the restoration of hope. All of the hazards, particularly vicarious traumatization, attack the lawyer’s ability and faith in his or her ability to do constructive work and improve matters for the client. As we have seen, vicarious traumatization in particular attacks hope paralleling the assault our clients feel on their own sense of life’s meaning. Throughout the strategies, the lawyer will be encouraged to seek and regain hope in whatever small or large measures can be attained. Even the tiniest steps forward may offer a window of hope that had been closed through the negative effect of these occupational hazards. It is our goal that opening this window of hope for the lawyer will also open the same window for the client.

Teaching Managing Vicarious Traumatization: Experiential Learning

Because each person has their own stress and vicarious traumatization profile, it is up to each lawyer and student to develop their own arsenal of strategies that work for them. We encourage you to be creative in teaching students how to manage vicarious traumatization; it is natural to pair that teaching with a lesson on concepts in vicarious traumatization and on identifying vicarious traumatization. A successful lesson will address the ideas that managing vicarious traumatization is an ethical imperative in lawyering and that to do so, students might focus on reintegrating their sense of self, reconnecting with others, and reaffirming the meaning in their work.

Consider trying the following exercises:

The “If Only” Questionnaire

Stemming from strategy one, have each student fill out the following questionnaire. The six questions should be answered as quickly as possible and should take no more than two minutes in total.

1. Write down the first thing that comes to mind.
   1. If only ______________________ , my daily life would be better.
   2. If only _________________________ , I could do this job right.
   3. If only ________________________ , the world would be better.
2. Name a single pesky recurring problem that needs to be resolved.
   1. If only _____________________ , my daily life would be better.
   2. If only _________________________ , I could do this job right.
   3. If only ________________________ , the world would be better.

When answering the first group of three questions in which they were asked for the “first thing that came to mind,” lawyers often mentioned large, general concerns. The answers to the second set of questions, about a pesky recurring problem, gave even further insight into these three levels of daily life, work, and life beyond work. With respect to question 1.c., most of the comments targeted the overarching systems.

This two-minute questionnaire can open the door to a process of observing one’s own daily life and looking for clues to the causes of stress, burnout, and vicarious traumatization. It can also serve as a launching off point for a class to discuss possible solutions to particular sources or manifestations of these hazards.

The Silent Witness Activity

Part 1 of the Silent Witness is used to help students identify symptoms of vicarious traumatization in their own lives. Laurie Pearlman explained to Jean that this is one of two key elements of any VT training. (The second is the Future Self Exercise, also developed by Pearlman and Saakvitne; a version adapted and recorded by Jean will be forthcoming.) Jean has often used a version of the Silent Witness in which Part 2 helps close the loop by allowing students to identify possible strategies to address those symptoms.

Like the first half of the exercise, distribute post-it notes to each student. Drawing off of the strategies and principles discussed in the lesson, students should write down one possible strategy to address the symptom of vicarious traumatization they identified earlier. The teacher or the lawyer can then collect the post-its and place them next to the post-its from the first half of the exercise. Students can take 5-10 minutes silently looking at the symptoms and strategies together. The class can debrief with a discussion on insights or observations students had while either brainstorming possible strategies or observing the class’ strategies as a whole.

The Five Senses to Disrupt Trauma

One student in Jean’s Clinical Teaching Practicum seminar developed a simple, sense-based exercise for disrupting vicarious traumatization in the moment (link will open a Powerpoint file) Focusing on how each of the five senses could be harnessed to mitigate stress, relax the body, and reduce trauma, the class got to experience a number of strategies they could carry with them in their backpacks throughout the day. For taste, we tasted dark chocolate and learned about the science behind flavonoids, an anti-inflammatory compound found in cacao beans. For sound, we listed to a relaxing song and learned how music can affect brainwave length. For smell, we each got a strip of paper infused with peppermint essential oil and got to experience the stimulating and relaxing power of menthol. For sight, we combatted digital eye strain (ever-present in law schools where students spend the bulk of their time on computers) by looking at an object twenty feet away for twenty seconds (something we’ll now try to do every twenty minutes). For touch, we all received our own stress balls. In squeezing them, we blocked the intellectual brain channel that can fixate on negative thought processes. For a bonus sense, we practiced deep, belly breathing, slowing down our bodies and relaxing our minds.

The lesson benefited students by teaching them short-term strategies easy to pull out in the numbed or overwhelmed moment while also allowing them to experience the powerful effects of sensory stress-relief in the lesson itself. Further Reading: For additional reading, you might wish to look at some of Jean’s work on managing vicarious traumatization.