Coming to Terms with Stress

Overwhelmed with sadness, confusion, and suppressed rage, I began to see a therapist. I dreaded each weekly appointment, because it meant that I’d have to confront the things I was avoiding. Nonetheless, once a week I dragged myself to the weekly appointments. One day, the counselor nodded empathetically and then without judgement explained, “what we call that dynamic is…” My weekly therapy appointments occurred while I was in college. To this day, I have no idea what I was talking about to prompt the therapist’s explanation or what the term was that she used. What I do remember is the intense relief I felt when I learned that what I had experienced was common enough to deserve a name.

I felt a similar relief in these past few months while researching vicarious trauma. As I wrote last month, I hit a low point in my career about a year ago where I doubted myself, treated my family rudely, and obsessed over cases when I wasn’t in the office. Turns out all that has a name. Several names in fact. In this post I’ll break down the different kinds of stress and trauma faced by public defenders, to help you understand what they are and what you can do. In my next posts, I’ll provide more examples of how the effects of stress and trauma pop up in our work and personal lives and give suggestions for managing that stress and trauma.    
 
When mental health professionals talk about the negative effects of stressful jobs that put you in close contact with other people’s suffering, they usually use one of the following terms: secondary stress trauma (STS), compassion fatigue, vicarious trauma, or burnout. Caveat emptor! When I describe these terms I do this not as a trained psychologist or therapist. Please do not diagnose yourself based on a blog post. That’s what WebMD is for, or better yet, a medical professional.
STS is similar to Post-Traumatic Stress Disorder (PTSD). PTSD refers to the long lasting adverse effects of a traumatic event on the person who experienced it. A typical example is the soldier who returning home from a war perceives everything around her as a potential threat. STS is brought on by exposure to other people’s trauma. Just listening to a client’s detailed descriptions of childhood abuse, or counseling a survivor of a vicious gang assault in prison can bring about symptoms of PTSD in the person working with the victim of the trauma. STS is also called compassion fatigue.  Symptoms include intense emotions like depression, anxiety, dread, and fear; experiencing nightmares and flashbacks about your client’s trauma; and physical problems like insomnia, stomach problems, or heart palpitations.[1]  It is measured by Secondary Traumatic Stress Scale (STSS).

While STS can occur after just one session with a client, vicarious trauma is a response to an accumulation of exposure to the pain of others. Vicarious trauma alters your thoughts and beliefs about the world with respect to safety, trust, and control.[2] 

Because of our work, we often tend to view the streets of our neighborhoods differently from those who aren’t immersed in the criminal justice system. Sometimes those views are a response to the trauma we experience, and end up causing more trauma. For example, one colleague describes walking down the street in her neighborhood and seeing a young man swinging a baseball bat. Instead of reminding her of peanuts and crackerjacks, the bats reminded her of indictments and handcuffs. She had to fight the urge to approach the boy and frantically tell him to put the bat away as swinging it could be interpreted as Menacing or Criminal Possession of a Weapon under New York law.

Crime and negative police interactions become the lenses through which we see the world. Often we forget that those lenses are attached to glasses that we can take off.  Wearing those glasses all the time and believing that’s the only way to view the world is a response to trauma.

Shockingly, burnout is not just slang, but a term used by psychiatrists and social workers who study people in stressful jobs. Like vicarious trauma, it develops over a long period of time.

Burnout has three dimensions: emotional exhaustion, depersonalization, and a reduced feeling of personal accomplishment.[3]  We’ve all had moments of emotional exhaustion, where we just can’t summon the energy to listen empathetically to one more crying family member.  A friend told me that one day in his career as a juvenile rights attorney, he found that he couldn’t be nice to anyone for an entire day. Finally, a judge called him up to the bench and advised that he needed a vacation.

Depersonalization manifests itself as cynicism and detachment. In other words, looking at that pile of work on your desk, muttering, “they’re all going to take pleas anyway” and cutting out of the office at 3 p.m., rather than sticking around and working up your cases. 

Often public defenders lack feelings of accomplishment, as many of the dispositions we reach aren’t satisfying. This can lead to a vicious cycle of doing less work believing that there’s nothing that can be done to achieve a better result for our clients. Failure to investigate, comb through discovery, and file motions does lead to worse outcomes, and can be a symptom of burnout. Burnout is correlated with vicarious trauma but it is not a necessary effect of it. It’s measured by the Maslach Burnout Inventory.

The symptoms of STS, Vicarious Trauma, and burnout are similar. In my next post I’ll discuss the unique ways they manifest themselves among public defenders. Please share with me any stories of burnout and stress. Naturally, I’ll ask permission if I use any of them, and will keep identifying details confidential. 
STS, vicarious trauma, and burnout are not permanent conditions. They’re normal responses to the pain with which our clients entrust us. We can learn to take care of ourselves as we take care of our clients. The first step is recognizing that these responses to stress exist.
If you want to connect with other defenders, I encourage you to check out the Facebook group Public Defense Zen -A place for public defenders, investigators, social workers and other in the field of public defense to share resources related to developing resilience and coping with the challenges of our work. This is a place to find encouragement and strength from others who take on this challenging work. Share inspiring stories, resources on wellness issues, and your experiences in building your own ability to bounce back and thrive.

[1]Piowowarczyk, Lin and Sarah Ignatius, et, al, Secondary Trauma in Asylum Lawyers, Bender’s Immigr. Bull. March 1, 2009 at 3
[2]National Child Traumatic Stress Network, Secondary Traumatic Stress: a Fact Sheet for Child-Serving Professionals  at 2
[3]Maslach, C, Schaufeli, W.B., & Leiter, M.P. (2001) Job Burnout. Annual Review of Psychology, 52, 397-422.