PTSD-like symptoms possible from legal cases involving trauma

July 2016 | Around the ABA

Carly Baetz began to notice something was wrong with her when working on a particularly difficult case. As a staff attorney with a juvenile rights practice at the Legal Aid Society in New York, she was no stranger to heart-wrenching cases of child abuse, but this one really got to her.

The six-year-old Baetz represented was being transferred from one foster home to another after being removed from the care of her abusive biological parent. All the little girl wanted was to live with her mom, but the girl’s mother didn’t want the child. Knowing she couldn’t get the girl what she wanted distressed Baetz immensely.

Baetz began to avoid work. “My instinct was to run away from the case,” she recalled.

Baetz was also constantly irritable and had stomach aches all the time. And, she began to lose her cool with others, lashing out at caseworkers and her opposing counsel.

She didn’t know it at the time, but Baetz was suffering from the ill effects of hearing about the abuse of her clients day in and day out, emotional duress often called secondary traumatic stress (STS).

Turns out that exposure to trauma – even indirectly, as a lawyer listening to client stories of hardship – can result in several symptoms most often associated with post-traumatic stress disorder (PTSD). Baetz had many of the primary signs, including avoidance of the trauma, irritability and physiological symptoms such as headaches, stomach aches and nausea. Other symptoms include hyper-vigilance or feeling on edge; difficulty concentrating, focusing and sleeping; as well as hopelessness and depression.

“STS may not be as severe as the symptoms that people with PTSD experience, but it is still incredibly distressing and can cause functional impairment as well,” Baetz said, noting that STS can make it difficult to get through the day, often resulting in a withdrawal from life activities and personal relationships.

Secondary trauma should not be confused with burnout. Burnout develops over a long period of time, is more related to the demands of a job, and it doesn’t involve exposure to trauma, she said.

Now a psychologist with the Center for Child Trauma and Resilience at New York’s Mount Sinai Health System, Baetz shared her story during the recent ABA CLE, “Understanding the Impact of Secondary Trauma on Lawyers Working with Children and Families,” where she also reported on the surprising prevalence of the disorder among lawyers.

According to Baetz, the research on STS and lawyers is minimal, but some studies have indicated the susceptibility to STS among lawyers working with clients suffering from trauma.

In one study, rates of STS for family and criminal court lawyers were higher than for mental health professionals. And, in another recent study, it was found that almost 35 percent of public defenders meet the criteria for STS and about 75 percent of those with STS symptoms meet the qualifications for functional impairment.

One study found that even jurors can develop symptoms of STS. “If jurors are susceptible after just one case in court, then attorneys certainly are, too, working with clients day in and day out,” Baetz said.

The bottom line: “STS is a normal and understandable response to the job,” emphasized Baetz, who said that STS symptoms often make those suffering from them feel like they aren’t fit for the work. Rather, the symptoms are actually unsurprising considering the trauma dealt with on a daily basis, she said.

“This work is really, really tough. And there are so many pressures associated with the work,” Baetz explained. She recalled a contested delinquency case where the family pulled her into a prayer circle and thanked God for bringing her to them because she was going to save their son. “It highlighted the enormous pressure of winning cases for which I was not the decider of the outcome. We can do our best, but superheroes we are not.”

Part of Baetz’s job at Mount Sinai involves addressing STS among juvenile justice professionals. Baetz said that some of the same techniques used to reduce stress can also help with STS symptoms. These strategies include taking vacations and frequent breaks; self-care, such as exercise, healthy eating and sleep; hobbies and activities outside of work—and most important, connecting with friends and family, as well as with a mental health professional, if faced with significant life impairment.

“It’s ideal if the therapist has experience treating individuals with trauma—not all of them do,” Baetz recommended. She noted  that if lawyers seek such counseling that they look into whether there will be punitive repercussions or confidentiality issues, as there sometimes are with counseling offered through an employer.

Setting clear boundaries at work also helps, Baetz said, noting that lawyers with high case loads are especially vulnerable to STS.

Yoga, meditation and mindfulness practices have also been shown as effective ways of dealing with STS. Baetz said that mindfulness exercises have been particularly helpful to her, and recommended the resources and free guided meditations offered on the UCLA Mindful Awareness Research Center website as a place to start.

Many people managing STS often lose sight of why they’re doing this type of work in the first place. Baetz recommended a technique developed at the University of Connecticut, called “targeting.” The exercise involves thinking of a thought or image that reminds you of who you are, your value and your purpose.

For Baetz, she visualizes all the people she’s helped in the past. “So, when I’m working with a client, and it’s not going well, that can domino into, ‘I don’t know why I’m doing this. I can’t help anyone.’ Visualizing some of the clients that I’ve actually helped can knock me back into, ‘ok, this is why I’m doing this work.’”

Beyond self-care techniques, Baetz emphasized the importance of a supportive workplace, where conversations about STS are frequent, and where confidential, non-punitive professional help can be easily accessed. Creating a culture that emphasizes the well-being of its employees is vital.  That kind of culture often includes wellness or STS committees, staff trainings on trauma and a de-briefing protocol for responding to workplace trauma.

Baetz underscored the importance of getting help with a metaphor. “When you’re on an airplane and that oxygen mask comes down, they tell you to put that mask on yourself before you help anyone else. And that is a really good metaphor for this, because in order for you to zealously advocate for your client, you need to take care of yourself first.”

“Understanding the Impact of Secondary Trauma on Lawyers Working with Children and Families” was sponsored by the ABA Center for Professional Development, Center on Children and the Law, Commission on Disability Rights, Commission on Youth at Risk, Division for Public Services, Health Law Section, and Standing Committee on Legal Aid and Indigent Defendants.