“Help! My Tank is Empty.”
Recognizing and Addressing Compassion Fatigue in the Legal Profession
Compassion fatigue refers to a combination of physical, emotional, and cognitive effects experienced by professionals such as nurses, trauma workers, therapists, and lawyers who have continuous and direct contact with trauma-exposed clients. The secondary trauma experienced by these professionals can lead to post-traumatic stress disorder comparable to that experienced by combat soldiers and victims of violence and to career burnout if left untreated. Some of the more common symptoms include disturbed sleep, avoidance and withdrawal, apathy, depression, and a reduced quality of work and communication [See Chart 1 for detailed symptoms].
Research suggests that lawyers specializing in family and criminal law may be most at risk for developing compassion fatigue. A 2008 study comparing attorneys working in criminal courts to those in the civil arena found more depressive symptoms, subjective stress, and changes in sense of safety and intimacy among the criminal attorneys. Other studies, albeit with small samples, have pointed to caseload as a major factor: A comparison of attorneys working in criminal and family courts to mental health professionals and social service workers found higher levels of secondary trauma and burnout among the attorneys that were strongly correlated with caseload, and a third study of attorneys specializing in asylum cases confirmed an association between hours per week devoted to those cases and trauma levels.
In a large, 2010 study conducted with attorneys and administrative support staff affiliated with the Wisconsin Public Defenders Office (PDO), researchers sought to address the limitations of the earlier studies and assess the relationships between exposure to clients’ traumatic experiences and an array of negative outcomes. A comparison of PDO attorneys and administrative support staff found that attorneys reported a significantly higher incidence of symptoms associated with posttraumatic stress disorder (PTSD), depression, functional impairment, secondary traumatic stress (STS), and burnout than did staff. The attorneys also reported lower scores on the Compassion Satisfaction scale which measures the pleasure derived from being able to do one’s work well.
Whereas some earlier studies of mental health and social service providers had identified gender, years on the job, and a personal history of trauma as risk factors for the development of compassion fatigue, the Wisconsin study did not find a significant relationship, nor did it find a significant association between age or office size and reported levels of distress. However, two factors previously identified in other studies as significant contributors to compassion fatigue— long work hours and high levels of direct contact with trauma-exposed clients — were significantly associated with symptoms of compassion fatigue in the Wisconsin study. Although both attorneys and staff interacted with trauma-exposed clients, the longer work hours of the attorneys and their greater direct contact with these clients appeared to heighten their vulnerability to PTSD, depression, functional impairment, STS, and burnout. The key findings of the Wisconsin study are shown on this link.
In many ways this study illustrates the resilience of attorneys despite their heavy caseloads and direct exposure to trauma-exposed clients. Still, the degree of symptoms and the finding that 37.4 percent of the attorneys were at risk for or actually encountering burnout, clearly indicate the need to identify symptoms early and implement effective interventions.
Given that the primary predictors of the trauma scores are the hours worked per week and the extent of direct contact with trauma-exposed clients, the study’s authors suggest the solution may be more structural than individual. The challenge for organizations is to find ways to distribute workloads that will limit the traumatic exposure of any one attorney. This may mean rotating attorneys between different types of services and reducing the actual hours worked. The prevalence of underfunded public defender and district attorney services makes these types of institutional changes especially difficult but no less needed. Solo practitioners and small firms who serve high numbers of trauma-exposed clients must also act to reduce their secondary exposure to trauma.
In addition, attorneys who work closely with trauma-exposed clients may be able to mitigate some of the negative effects by (1) debriefing/seeking support from peers and supervisors; (2) increasing their leisure and physical activities; (3) developing their repertoire of coping skills; and (4) pursuing supportive counseling. NMJLAP is here to help individual attorneys and organizations assess their situations and develop action plans that are effective and appropriate.
Differentiating Compassion Fatigue from Life Stress
The Professional Quality of Life Scale (PROQOL) is designed to help you determine to what extent you might be experiencing symptoms of compassion fatigue and whether you need to pursue assistance or take action to change your circumstances.
The Life Changes Questionnaire is a review of major life events regarded as significant stressors. Since any type of stressor causes the body to make changes to adapt to the demand, physical illness becomes more likely when a large number of stressors are present in one’s life. To reduce your risk of illness:
(1) regularly seek diversion and rest, (2) limit the number of life-changing events wherever possible, and (3) practice proven relaxation techniques.