Secondary Traumatic Stress

Secondary Traumatic Stress

I fled pupillage in 1974 to seek refuge as in-house counsel to a marine insurance company.

I did not know then that I was experiencing secondary traumatic stress (STS) and exhibiting a prime symptom, that of leaving a field of work prematurely. Six months exposure to child sexual abuse cases, plus working on two gruesome murder cases, had embedded the trauma.

At the time traumatology, as a field of expertise, was in the nascent stages of development, birthed by the impact of the Vietnam War upon American soldiers. Accordingly, my legal education could not equip me with the crucial skills, tools and knowledge I needed to enable me to identify the symptoms of STS and to deal with the adverse impact of distressing cases upon my wellbeing and work performance. Had I known, I doubt I would have had the courage to challenge my pupil master or head clerk by asking to them to limit my vulnerability to trauma transmission by putting boundaries around the case material to which I was exposed. Besides, they could not have done so. I worked in family and criminal law chambers. All cases were distressing. We acted for people who suffered and who usually caused suffering, on a daily basis. This exposed members of chambers and staff to the unavoidable impact of STS, a condition that adversely affects professionals exposed to people who suffer and/or traumatic case content.

My pupil master’s reaction to some symptoms I was displaying, such as loss of concentration, increased errors and poor judgment, was to call me ‘lamentable’. This observation followed working together on the sexual mutilation and murder of a baby case. We did not know I was ‘traumatised’. The impact of traumatic case material upon health and wellbeing, plus the professional impairment which accompanies it was not spoken about. It was the era of showing a ‘stiff upper lip’. The suppression of emotional responses to upsetting cases was regarded as ‘professional’, rather than unhealthy and uninformed.

Workplace stigma
Forty years on little has changed. Whilst green shoots of change are emerging with the work of the Bar Council Wellbeing Working Group, resistance about acknowledging the psychological, mental and emotional impact of cases remains. The Bar Council study found, for example, that the level of workplace stigma around reporting stress was high and a blocker to individuals seeking help. The majority of respondents (63%) thought that showing signs of stress at work indicated personal weakness. Those working within the criminal Bar reported higher work pressure, significantly higher rates of low mood and lower levels of life satisfaction. It found that respondents who were mentored at work, either formally or informally, were significantly less likely than others to report their mood as low.

There is still, then, an unspoken fear that if an individual admits to being adversely affected by their cases, they will be judged ‘unprofessional’ by their peers. This perception is inaccurate. What people are experiencing is the natural and unavoidable stress of STS. People at risk include criminal, family and personal injury lawyers, judiciary, secretarial and support staff.

What is STS?
Secondary traumatic stress, also known as compassion fatigue or compassion stress, can be summarised as: ‘the natural behaviours and emotions that arise from knowing about a traumatising event experienced by a significant other – the stress resulting from helping or wanting to help a traumatized or suffering person’ (Figley et al, 1995, Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder In Those Who Treat The Traumatized, New York: Brunner/Mazel).

Unlike burnout, which is a slow process into a state of physical, emotional and mental exhaustion that can be prevented, STS can strike suddenly, without warning. For example, a professional who watched video evidence of a baby being raped while a Christmas carol played in the background has flashbacks to those scenes of abuse whenever he hears that carol.

Factors which exacerbate or mitigate the impact of traumatic information include the level of organisational support, attitudes and resources; individual coping styles; personal circumstances; quality of education and training provided; and the nature, complexity and severity of the trauma being worked with.

Individual vulnerability is heightened by exposure to children’s trauma. Empathy acts as a magnet to STS also. Advocates who have experienced a previous traumatic event in their lives often minimise the impact of traumatic material, thus drawing STS to them. According to the National Association of People Abused in Childhood, it has been estimated that a million children a year in the UK suffer some form of abuse; and that around one in four children are abused at some time. Figures from An Overview of Sexual Offending in England and Wales, the first ever joint official statistics bulletin on sexual violence released by the Ministry of Justice, Office for National Statistics and Home Office (January 2013), showed that nearly half a million adults are sexually assaulted in England and Wales each year, with one in five women aged 16-59 having experienced some form of sexual violence since the age of 16. It is axiomatic, therefore, that some members of the legal profession and staff will have experienced this kind of traumatic event. Unless dealt with, unresolved trauma can be activated by disclosures of similar trauma in clients, with an adverse impact upon personal wellbeing and work performance, and perhaps causing unintentional harm to clients, case handling and third parties, such as family members.

Cumulative effect
Experiences likely to induce STS include witnessing or hearing of an individual’s experience; the disclosure of details; identifying with a witness; and/or proximity to the trauma. Left unaddressed, the cumulative effect of working on traumatic cases will seriously affect health, potentially manifesting as secondary traumatic stress disorder (STSD). The psychological and physical symptoms are similar to those in untreated survivors of trauma experiencing post-traumatic stress disorder (PTSD). These include numbness and avoidance of feelings, depression, anxiety, self-medication through drug and alcohol abuse, overworking and compulsive eating. There can be persistent re-experiencing of intrusive imagery, recollections of client’s traumatic material, nightmares and flashbacks. One lawyer gained 14 kilos within six months following exposure to child abuse cases. Somatic complaints such as sleep difficulties, headaches, gastro-intestinal problems and an impaired immune system leading to illness, are also common.

Secondary exposure to trauma can affect personal and professional relationships too. Advocates may find they have difficulty with intimacy issues when the traumatic material includes intentional violence and abuse. Isolation from family and colleagues is a recognised symptom. Cynicism is also common, which if not acknowledged, can express itself in mismanagement of clients, delays in dealing with cases and forgotten appointments. Irritability, leading to staff conflicts can also occur.

Increasing strain on the courts
More people are disclosing accounts of child sexual abuse and sexual assault. An estimated 66,000 girls in the UK have experienced female genital mutilation, according to the Desert Flower Foundation, and some of these emotionally demanding cases are now starting to come through the courts. It is crucial that advocates, judiciary, support staff and indeed jury members, are given the training and skills enabling them to deal with the personal and professional impact. Peer support groups need to be established to break the isolation and misperception of stigma.

Last November, Judge Dingemans is reported to have wept when sentencing Nathan Matthews and Shauna Hoare for the murder of Becky Watts. The Lord Chief Justice, Lord Thomas of Cwmigedd, warned of the strain that judges are increasingly coming under at his annual press conference. ‘Few people have any idea of the sheer depravity to which people can sink and a judge often has material in front of him which cannot but distress people,’ he said. ‘Some of the images of pornography are beyond belief in what they show and it undoubtedly does have an effect on people,’ he went on. ‘We consider it very important to give judges as wide a variety of cases as possible,’ but ‘the difficulty we face at the moment is that the rise in sexual offending is continuing.’ He said that most judges drew strength from being able to talk issues through privately with fellow judges who had similar experiences.

Setting boundaries
STS must be planned and prepared for. Advocates need to know how to identify and manage symptoms; and how to process and integrate traumatic material so that it is no longer disruptive to functioning. Self-care plans are essential. Boundaries are needed, to limit exposure to traumatic cases. Judges, advocates and staff should not be working back-to-back child abuse cases without respite, for example. They are at greater risk of experiencing STS and/or burnout. It is time to evolve professionalism, confront the reality of trauma transmission; acquire the knowledge to deal with it and exercise the courage to talk about it. In doing so, we honour the values of integrity, excellence and justice to which we aspire.

Contributor Lee Moore is founder of the Association of Child Abuse Lawyers and a speaker, writer and trainer. See www.leemooreco.com

DEALING WITH STS: FIRST STEPS

  • Read The Advocates Gateway (TAG) Toolkits 17 & 18 Vulnerable Witnesses and Parties in the Civil Courts and Working with Traumatised Witnesses, Defendants and Parties
  • The TAG toolkits identify sources of education and training on how to recognise, and deal with, burnout, STS, vicarious traumatisation and trauma transmission, and are recommended as good practice for advocates, practitioners and members of the judiciary.
  • Advocates also need to know how to perform a self-diagnosis and institute a self-care plan. There is a real possibility that some advocates may not realise that they are accepting instructions when they are not fit enough to do so, which is contrary to professional conduct rules.
  • Alliances should be formed, so that support can be provided, the stigma negated and to initiate and drive the momentum for a radical change of attitudes and outdated beliefs.

Article source: https://www.counselmagazine.co.uk/articles/secondary-traumatic-stress

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