Vicarious Trauma in Lagal Practice

Transcription

1 Bond University Centre for Professional Legal Education Resources Centre for Professional Legal Education Vicarious Trauma in Lagal Practice Colin James The Australian National University Follow this and additional works at: Part of the Law Commons This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License Recommended Citation James, C. (2018). Vicarious Trauma in Lagal Practice. Retrieved from This Conference Presentation is brought to you by the Centre for Professional Legal Education at epublications@bond. It has been accepted for inclusion in Centre for Professional Legal Education Resources by an authorized administrator of epublications@bond. For more information, please contact Bond University's Repository Coordinator.

2 Vicarious Trauma in Legal Practice 2018 National Wellness for Law Forum Bond University February 2018 Dr Colin James ANU School of Legal Practice, ANU College of Law

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4 Originally..

5 Now.. Physical trauma still common in medical discourse Psychological trauma a deeply distressing or disturbing reaction to experiencing a terrible event PTSD DSM Criterion A: person was exposed to: death, threatened death, actual or threatened serious injury, or actual or threatened sexual violence (ICD 10, F43-1, 2016)

6 Direct experience Witnessing the trauma Learning that a relative or close friend was exposed to a trauma

7 DSM-5 Criterion A-4 Repeated or extreme indirect exposure to aversive details of the event(s), usually in the course of professional duties (eg, first responders, collecting body parts: professionals repeatedly exposed to details of child abuse). DSM-5 Criterion A4 American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (5 th Ed). Arlington, VA: American Psychiatric Publishing, DSM-5, Criteria A4 Ref.23, p 558.

8 Criterion B (one required) The traumatic event is persistently re-experienced, in the following way(s): Intrusive thoughts Nightmares Flashbacks Emotional distress after exposure to traumatic reminders Physical reactivity after exposure to traumatic reminders (now see Criteria C, D, E, F, G, and H) -

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10 Figure 1. A conceptual model of vicarious trauma and its spectrum of impacts on workers (from Beth E. Molnar et al, 2017, 131)

11 Why is it important? - USA High job turnover % of social workers in high impact areas like child abuse leave their job each year Eg. 2014, Robinson-Keilig, Secondary Traumatic Stress and Disruptions to Interpersonal Functioning Among Mental Health Therapists, Journal of Interpersonal Violence 29(8)

12 Why is it important? - USA Re family and criminal court attorneys..rates of STS higher in lawyers than in mental health professionals - Andrew P. Levin and Scott Greisberg, Vicarious Trauma in Attorneys, 24 Pace L. Rev. 245 (2003) Available at:

13 Volume 199, Number 12, December 2011 N = 238 attorneys Wisconsin State Public Defender Office 75% met criteria for functional impairment 34% of attorneys met criteria for STS 11% met clinical criteria for PTSD

14 Why is it important? - Canada For many the violent, disturbing reality they witness inside and outside the courtroom can become debilitating - Moulton (2015) Vicarious Trauma: the Cumulative Effects of Caring Canadian Lawyer, Feb 2, 2015,

15 Gradual acceptance in Australia 36 lawyers and 30 MHP (As hypothesized) the lawyers showed higher symptoms of VT than mental health professionals - Maguire & Byrne (2016)

16 Related (negative) constructs Bullying Compassion fatigue Occupational burnout Secondary trauma stress Acute Stress Disorder - ASD Post Traumatic Stress Disorder PTSD Vicarious Trauma (VASD, VPTSD)

17 Related (positive) constructs Compassion Satisfaction Vicarious PTG Vicarious Resilience Transformation

18 Occupational Burnout The burnout syndrome has been defined as a combination of emotional exhaustion, depersonalization, and reduced personal accomplishment caused by chronic occupational stress. - Bianchi et al (2015)

19 Occupational Burnout Signs & Symptoms Exhaustion, lack of enthusiasm, low motivation, critical self-talk Attitude at work cynicism, apathy, pessimism, reduced efficacy and engagement Chronic fatigue, panic attacks, headaches Inability to relax or to do nothing Physical symptoms chest pain, stomach pain, reduced appetite, heart palpitations.. - Carter 2006

20 Secondary Trauma Stress (STS) Compassion Fatigue - Similar constructs Signs & Symptoms Somatic complaints (body pain, sleep, appetite), fear/anxiety, intrusive images, avoidance of clients Diminished capacity Cynicism/ Loss of empathy (a defence)

21 Vicarious Trauma (a different ballpark)..it is more than just the stress of overwork; it is a disintegrating ray gun aimed at your sense of who you are, what you think the world is like, and where you find meaning in the world. - Peters, Silver & Portnoy (2004) Yale Law School Legal Scholarship Repository

22 Vicarious Trauma (a different ballpark) harmful changes that occur in professionals views of themselves, others, and the world, as a result of exposure to the graphic and/or traumatic material of their clients. - Baird & Kracen 2006 Counselling Psychology Quarterly, June 2006; 19(2):

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24 The birth of Vicarious Trauma DSM 5 (2013)..following 9/11 DSM inclusion of vicarious/secondary exposure to trauma leading to PTSD helped to de-stigmatize the reactions of first responders and reinforce the need for wellness training and postexposure care.

25 Vicarious Trauma (some) Signs and Symptoms Change in self-concept cognitive changes, unusual negative thoughts about self and others, reduced sense of safety, reduced trust in others, sense of impending doom Hypervigilance low mood, anxiety, appetite, sleep, anxiety, intrusive disturbing images Increased absenteeism reduced efficacy, drop out from workforce

26 Vicarious Trauma some symptom domains Emotional symptoms Behavioral symptoms Physiological symptoms Cognitive symptoms Spiritual symptoms (hope, optimism)

27 Vicarious Trauma some risk factors Lack of supervision Occupational burnout Too much work Feeling isolated High compassion Personal trauma history (contentious) Poor coping strategies Personal/life stresses

28 Is VT about too much empathy? (2016) - Moral empathy (bad) - biased, stupid, innumerate, illogical, dangerous, short-sighted, parochial, can spark violence, it fails morality, and is corrosive of personal relationships - Cognitive empathy/ compassion (good)

29 Vicarious Resilience..in response to client trauma survivors own resiliency - Hernández, Gangsei, & Engstrom, a unique consequence of trauma work - Sally Hunter 2012

30 Post-traumatic Growth? PTG is seen in some trauma survivors who report - improved relationships, - new possibilities for one s life, - a greater appreciation of life and personal strength, - and spiritual development - Tedeschi & Calhoun, 1995, 2004

31 Post-traumatic Growth? 30 70% trauma survivors report some form of subsequent benefit. cancer (Cordova, Cunninham, & Carlson, 2001), sexual assault (Frazier & Berman, 2008). the 9/11 terrorist attacks (Park, Aldwin, Fenster, & Snyder, 2008)

32 Post-traumatic Growth? PTG is not the opposite of PTSD - they often go hand in hand PTG is the process of change not the outcome.

33 Post-traumatic Growth? 5 potential benefits of PTG - Sheryl Sandberg & Adam Grant personal strength deeper relationships discovering more meaning in life and seeing new possibilities

34 Post-traumatic Growth? 5 potential benefits of PTG - Sheryl Sandberg & Adam Grant Viktor Frankl "in some way suffering ceases to be suffering at the moment it finds meaning (It won t just happen you have to work on it)

35 Ok, what about Vicarious Post-traumatic Growth? Psychological Trauma: Theory, Research, Practice, and Policy 2013, Vol. 5, No. 6, for VPTG to occur trauma workers need to be exposed to their clients own growth

36 Responses Treatments and Preventions for VT

37 an ethical duty..to attend to the ways in which trauma and vicarious trauma disrupt ourselves and to repair that on a regular basis.

38 (because) 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 render service. Peters et al, 2004, 854

39 How? Self-care Meaning Rachael Field, James Duffy and Colin James (eds), Promoting Law Student and Lawyer Well-Being in Australia and Beyond (Ashgate, 2016)

40 Five (validated) strategies - likely to enhance meaning in life which may improve individual resilience against Vicarious Trauma, STS, Compassion Fatigue and Burnout Self-determination Theory Broaden and Build Theory of Positive Emotions VIA Character Strengths Professional Quality of Life ProQoL Mindfulness practice

41 Self-Determination Theory (SDT) Ryan & Deci (2000, 2017) - intrinsic motivation requires the satisfaction of three psychological needs: Autonomy Competence Relatedness Similarly, to enhance and promote the natural tendency toward eudaimonic well-being - Joseph, 2011 p.112

42 Broaden-and-Build Theory Positive emotions broaden people s momentary thought-action repertoire. - Barbara Fredrickson (1998, 2001, 2004, 2008)

43 VIA

44 ProQol - Professional Quality of Life Compassion Satisfaction The positive aspects of helping Compassion Fatigue The negative aspects of helping (Jang et al, 2016)

45 Professional Quality of Life Compassion Satisfaction Compassion Fatigue Burnout Secondary Trauma

46 Mindfulness through vulnerability WE CAN T PRACTICE COMPASSION WITH OTHER PEOPLE IF WE DON T TREAT OURSELVES KINDLY. Brene Brown, Social Worker

47 (2017, - 3,358 studies reduced to 18) One of several highlights: Mindfulness-based treatments are effective in ameliorating symptoms of PTSD.

48 Tania Singer Enhancing professionalism by enhancing compassion with Cognitive Perspective Taking Enhanced compassion - has measurable effects on attitude and resilience

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52 Organisational Support

53 Organisational Support (my top three) Foster a safe and supporting environment: Enhance EAP support, supervision & CPD training on trauma-affected work, (insulate against stigma) Enable frequent breaks, ensure case-load supervision and ban overworking Implement a de-briefing protocol

54 Critical Incident Stress Debriefing - International Critical Incident Stress Foundation Home Page of Jeff Mitchell's ICISF includes information about critical stress debriefing. - Crisis Intervention and Management Australasia CISD Reference List, compiled by Dr. Atle Dyregrov An updated listing of published research on critical incident stress, psychological debriefings, and related group work. (up to 2006)

55 Personal Support - step back for perspective Strategies for self-care and self-distancing Visualize an observer (be the fly on the wall) Self-talk in third person ( you can do this ) Write about it (journaling what is important now and why) Reflection: imagine forwards: from 1 week in the future, then a year, then 10 years

56 Personal Support - for enhancing resilience Mindfulness Wherever you go, there you are Jon Kabat-Zinn Wherever you are, make sure you re there - Dan Sullivan How to meditate when you can t sit still - Fitness + food + sleep (habits!) Friends and relationships

57 Thank you Slides, too many references and other links here m/ybh2eb8o