Sexual Abuse Casework and Secondary Trauma: An Occupational Hazard for Professionals

1. Sexual Abuse Casework and Secondary Trauma: An Occupational Hazard for Professionals Presented by: Joan Meier, Esq., GW Law School and DV LEAP Margot Richters, PhD Moderated by: Nancy Drane, Esq., Children’s Law Center

2. Presentation Goals • Provide an Overview of Secondary Trauma • Discuss how Secondary Trauma is an Occupational Hazard • Share Personal and Organizational Strategies to Manage Secondary Trauma

3. OVERVIEW: WHAT IS SECONDARY TRAUMA?

4. What’s in a name? • Shell shocked • Combat stress • Battle neurosis • Burnout • Compassion fatigue • Vicarious trauma • Secondary traumatic stress

5. Stress Basics • Stress is a normal physical response to events that make you feel threatened or upset your balance in some way. • The stress response is the body’s way of protecting you. • When working properly, it helps you stay focused, energetic, and alert • Your body doesn’t recognize the difference between psychological and physical stressors

6. Trauma Basics • Trauma is a psychologically distressing event that is outside the range of normal human experience • Trauma involves intense fear, terror and helplessness • Trauma leads to changes in thinking, feeling and behavior • The experience triggers a “fight or flight” reaction • Processing narrows to non-verbal information such as sights, sounds, smells, physical sensations

7. Burnout • Emotional, psychological and physical exhaustion caused by long term involvement in emotionally demanding work • Progressive process • Sense of personal accomplishment seems to mitigate the development of burnout • People with high expectations for positive outcomes may be at greater risk because they may work harder to achieve goals

8. Vicarious Traumatization • Caused by exposure to victim’s traumatic stories • Empathic engagement with traumatic material of the client causes an internal transformation - Can affect personal schemas regarding trust, safety, power, intimacy, control, esteem - Can impact sense of self, world view, spirituality, affect tolerance, interpersonal relationships • Changes are cumulative and occur over time • Changes are not pathological but are pervasive • Best conceptualized as an occupational hazard

9. Secondary Traumatic Stress • Defined as a syndrome that is nearly identical to PTSD except exposure is not directly to a traumatizing event but to knowledge about a traumatizing event experienced by another • Symptoms include reexperiencing images, numbing and persistent reactivity (heart rate, startle response etc.) • STS is tied to the adjustment and recovery of the traumatized person; as PTSD resolves, so does the STS

10. Who is at risk? • History of trauma that has not been resolved • History of psychological problems • High percent of trauma cases • Working primarily with children • Level of experience • Inadequate supervision • Capacity to be empathic • Working long hours

11. Who is at risk? • Professionalisolation • Lack of support network • Unrealistic organizational expectations • Organizational pressure • Ambiguous success • Lack of time for professional development • Sense of control • Attitude and outlook • Ability self-soothe

12. Emotional Symptoms • Overwhelmed • Disillusioned • Helpless • Frustrated • Numb, disconnected, dissociative • Resentful • Depressed, trouble experiencing pleasure • Despair, hopeless • Trouble tolerating emotions • Intense emotions (anger, fear, sadness)

13. Cognitive Symptoms • Cynicism • Loss of meaning (loss of faith in god, life, fairness) • Feel like a failure, incompetent • Anxious thoughts, worrying • Feel unworthy, unlovable, self-loathing • Rescue fantasies • Question right to be happy/alive • Poor decision-making • Difficult concentrating • Lack of trust • Intrusive imagery • Loss of sense of humor

14. Behavioral Symptoms • Increased interpersonal conflicts • Isolating from others or difficulty being alone • Intolerant, judgmental • Distant, tuning out • Moodiness (crying, angry outbursts) • Controlling • Avoidance of traumatic events • Change in appetite • Sleeping too much or too little • Using alcohol, cigarettes, or drugs to relax

15. Physical Symptoms • Exhaustion, physical depletion • Feeling unsafe, hypervigilant • Intrusive auditory, visual, sensory, olfactory imagery • Sleep disturbances excessive sleep, insomnia, nightmares • Weight loss/gain • GI problems • Frequent colds, aches and pains

16. SECONDARY TRAUMA: AN OCCUPATIONAL HAZARD

17. FOR ALL PROFESSIONALS WHO DEAL WITH TRAUMA, VIOLENCE, OR GREAT SUFFERING • Traditional focus has been on mental health professionals, shelter workers, and emergency relief workers Increasing attention is now being given to the impact on legal personnel • An unavoidable concomitant to working hard and caring: “[T]he only way to avoid vicarious traumatization is to fail to engage compassionately, even empathetically,” with the victims. - Jean Koh Peters, Representing Children in Child Protective Proceedings

18. Examples From Myself • Short temper with clients, students • Feelings of hopelessness, depression, sense of overwhelm by work • From Students • RH story • Student who had no reaction to horrific stories • From Professionals • Sarah Rosenbaum story – Doctors missed the obvious • Judicial Reactivities – Sometimes miss the law, are rageful at litigants/lawyers • Lawyers sometimes over-identify with clients, take on abusive or victim personae

19. What does this have to do with our Ethical and Professional Performance? • Can “forget” important information or research, overlook the obvious, risk of malpractice • When we over-react or over-identify, we may behave unprofessionally, may be intolerant of clients or inappropriate with other party/lawyer • When we are overwhelmed we simply cannot perform at our best – may shut down, neglect the case, or simply under-perform

20. Some Ethical Guidelines to Consider Attorneys • A lawyer shall not represent a client or… shall withdraw from the representation of a client if… [t]he lawyer’s physical or mental condition materially impairs the lawyer’s ability to represent the client. (DC Rules of Professional Conduct, Rule 1.16, Declining or Terminating Representation) Social Workers • Social workers should not allow their own personal problems, psychosocial distress… or mental health difficulties to interfere with their professional judgment and performance or to jeopardize the best interests of people for whom they have a professional responsibility. Social workers whose personal problems, psychosocial distress… or mental health difficulties interfere with their professional judgment and performance should immediately seek consultation and take appropriate remedial action by seeking professional help, making adjustments in workload, terminating practice, or taking any other steps necessary to protect clients and others. (National Association of Social Workers Code of Ethics, Rule 4.05, Impairment)

21. Study of DV Judges • “[J]udges do, unequivocally, experience trauma symptoms with respect to their work.” - Peter Jaffe et al, “Vicarious Trauma in Judges”, Juv & Fam Ct J. (Fall 2003) • 63% of (105) judges experienced some symptoms. Female judges more likely than male. Judges w/7 or more years of experience more likely than those with less. • In another study, spouses were more aware than judges themselves of their symptomatology, and how this particular caseload had affected them. • Biggest challenges in coping with these stresses were the isolation of the judicial role, and the extreme workload.

22. Andrew P. Levin, MD (Columbia), Secondary Trauma and Burnout in Attorneys: Effects of Work with Clients Who are Victims of Domestic Violence and Abuse, ABA Commission on DV eNewsletter vol. 9, Wtr 2008 Studied DV Attorneys at Pace Women’s Justice Center and compared them with mental health professionals and social services workers serving similar populations Found that “attorneys were consistently higher [than MHPs] on both secondary trauma and burnout scales” “It actually feels good to hear that I am not the only one who feels depressed and helpless and that these issues are worth studying. Fortunately, the stress has decreased with experience and time for me, but I still have vivid memories of quite traumatic experiences representing victims of domestic violence who were so betrayed that it was difficult to continue to have faith in humankind.” – One respondent to survey Study of DV/CA Attorneys

23. Levin et al Findings, cont’d • Supervisors had reported “a pattern of fear and revulsion in attorneys . . After initial contact with traumatic material, followed by over-involvement with clients, diminished performance, and high rates of turnover.” • Women had higher scores than men; prior mental health treatment also correlated; but prior childhood and adult trauma history did not correlate to higher scores • Higher scores were correlated with number of clients and somewhat correlated with hours per week • Attorneys had significantly more traumatized clients than MHPs • A prior study of 23 Canadian prosecutors working with DV and incest cases revealed symptoms of demoralization, anxiety, helplessness, exhaustion, social withdrawal. Major factor was the high caseloads (many put in 10-40 hours/week overtime)

24. What are your experiences?

25. Systemic Contributors • Problems in the court system, especially family and juvenile courts, can contribute to vicarious trauma for all participants • Lack of resources including time, personnel and space, excessive caseloads, inadequate fact-finding and lack of representation, and lack of supportive services, are both indicative of and contribute to vicarious trauma - Ann Freedman, “Fact-Finding in Civil Domestic Violence Cases: Secondary Traumatic Stress and the Need for Compassionate Witnesses,” 11 A.U. J. of Gender, Soc. Pol. & Law 567 (2003)

26. MANAGING SECONDARY TRAUMA

27. Interventions for Disruptions toSense of Self • Water, food, sleep and breathing • Balancing work, play and rest • Socializing • Creative activities • Physical activities • Relaxation strategies (yoga, massage, meditation) • Vacations • Reading

28. Interventions for Disruptions inMeaning of Life • Spend time with happy children • Travel • Engage in organizations with a sense of community • Nature • Art, poetry, music • Structure day to include positive activities

29. Interventions for Disruptions in Relationships • Connect with loved ones • Reach out to support network • Stay connected with colleagues • Seek emotional support • Express emotions with others • Discuss upsetting material with significant others • Educate significant others about the impact of stress and trauma

30. Coping Strategies • Set clear limits, say “No” • Use humor • Give and receive supervision • Personal therapy • Education • Learn what your ‘triggers’ are • Remind self about value of work • Remind self that client has survived and now has access to resources and recovery • Request a more balanced caseload

31. Coping Strategies (cont’d) • Peer Support - Emotional support - empathy, normalize, accept stressors as real - Information -correct distortions, reframe, clarify issues - Social companionship - problem taken on by group, cohesiveness - Instrumental support - paperwork, phone calls, back-up, problem-solve

32. Organizational Strategies • Support your staff!! (flextime, do not pressure them to overwork, support time off) • Bring celebration and pleasure into workplace • Provide education on vicarious trauma • Challenge systemic contributors (e.g., unrealistic dockets, lack of resources, etc) • Allow staff (students, etc) to have emotions, sadness, in relation to their work

33. What ideas do you have about managing secondary trauma?

34. The GOOD News • While doing work involving traumatic stresses can be difficult and painful, it can also be profoundly rewarding, and can do enormous good. Just being a caring listener is a profound gift to survivors. • Your struggles with painful material show you are empathically connected and you are humanly alive. THE WORLD NEEDS THIS! • Being a “compassionate witness” to suffering helps both the sufferer and society, and furthers justice, which heals both parties and society See Ann Freedman, “Fact-Finding in Civil Domestic Violence Cases: Secondary Traumatic Stress and the Need for Compassionate Witnesses,” 11 A.U. J. of Gender, Soc. Pol. & Law 567 (2003)

35. QUESTIONS AND COMMENTS?

36. THANK YOU FOR THE WORK THAT YOU DO • Joan Meier, GWU Law School and DV LEAP • 202-994-2278 • jmeier@law.gwu.edu • Margot Richters • 301-315-0915 • mlrichters@gmail.com • Nancy Drane, Children’s Law Center • 202-467-4900 ext. 502 • ndrane@childrenslawcenter.org