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Other Mental Health Concerns

Stress

Modern life is full of hassles, frustrations, demands, and deadlines. For many individuals, especially those in the legal profession, stress has become so commonplace that it may seem to be a normal way of life.

While stress can provide motivation and may even improve performance in small doses, operating in a constant emergency mode exacts a high price on the body and mind. Your body doesn’t distinguish between physical and psychological threats – every type of stressor stimulates the primitive “flight or fight” response that releases a flood of stress hormones.

The brain prepares itself for the challenge by calling the body’s systems to action: the heart beats faster, the muscles tighten, blood pressure increases, the breath quickens, and the senses become sharper.

Over time, the body’s repetitive response to stress can lead to and/or exacerbate numerous physical and mental health problems, including: heart disease, obesity, substance abuse, depression, job burnout, premature aging, infertility, and pain of any kind.

Pathways to Well-Being

Although some degree of stress is unavoidable, it is possible to reduce many stressors and improve one’s ability to deal with those which remain. The foundation of successful stress reduction consists of (1) establishing realistic expectations of oneself and others, (2) approaching situations with a positive attitude, and (3) prioritizing intrinsic values above external ones.

It is essential to establish realistic expectations regarding hours of work, case loads, acceptable legal maneuvers, and other aspects of a practice, even though these changes may seem foreign and produce discomfort initially. Remember, if the goal is to lead a healthy and fulfilling life (one not riddled with stress), then the course of action is to pursue a work-life balance in which one thrives both professionally and personally.

Negative thinking is probably the single most significant contributor to stress. 
Your perceptions of a situation or a person impact how you feel about them. If you tend to interpret people and events in a negative manner, then you will feel anxious and miserable much of the time. To change this, take time to notice what you’re thinking when you feel anxious, irritated, down, etc. Replace the negative thought with a positive one whenever realistic; for example, instead of feeling angry because the traffic jam is interfering with your schedule, re-frame it as an opportunity to listen to your favorite music or to tune into the news. Because your thoughts are virtual instructions to your subconscious, strive to replace negative thoughts with ones that are true, but not malignant. Instead of thinking, “I will never get caught up with all these cases,” tell yourself that “I am making headway and I will do my best to get caught up.”

Research also shows that people primarily concerned with the personal and interpersonal aspects of their lives — personal growth, relationships, helping others, or improving their community, are significantly happier and more satisfied with their lives. Conversely, individuals whose major focus is on external rewards and values over which they have minimal control such as affluence, fame, and power, experience less happiness and fulfillment.

Based on his research with law students and lawyers, Florida State University Law Professor Lawrence Krieger has identified “thinking and acting like a lawyer” as another factor that creates stress and can result in a disconnection from basic values and feelings. Krieger cautions that the analytical thinking and defensive posture equated with being a successful lawyer must be paired with self-awareness to ensure it is used appropriately. Looking for the weakness in opposing council and reinforcing your counter position may win cases, but it won’t support healthy personal relationships. As one lawyer quipped, “I argue very well. Ask any of my remaining friends.”

Successfully Countering Stress

To reduce stress and its negative effects:

  • Identify what (people, places, things) is causing stress, and
  • determine which stressors can be altered.

Once you establish a clear picture of your major stressors, create a plan to:

  • eliminate stressors wherever possible,
  • reduce exposure to the unavoidable stressors,
  • modify your attitudes and expectations regarding the remaining stressors.

Lastly, share your list and plan with a trusted person before you implement it. Doing so may give you a different perspective on stressors you considered unavoidable and unchangeable. It also builds accountability and support for your efforts.

Resources

How Vulnerable Are You to Stress?: This tool helps you identify your strengths and your areas of vulnerability, providing direction for developing a targeted self-care plan of action.
Lawyers: Find Freedom from Anxiety, Anger, and StressCalm Clinic: A Web resource with over 500 pages of information about anxiety, including self-tests, symptoms and causes, and effective treatment approaches.

Gambling: When Fun Becomes Compulsive

Surveys indicate over 70% of adults in the US gambled at least once in the past year. Researchers indicate approximately 1% of gamblers meet the criteria for pathological gambling in a given year and another 2-3% experience less significant, but still serious problems with their gambling (i.e., problem gamblers). Seniors were the fastest growing group of gamblers between 1974 and 1989, and online gambling has become increasingly popular among teenagers and young adults.

Pathological gamblers are significantly more likely to have substance abuse disorders, depression, and anti-social personality disorder. In addition, a strong association exists between suicide and pathological gambling.

Problem gambling has been referred to as the “hidden addiction” because there are few outward signs until the disorder is well-advanced. Below is one commonly used screening instrument that can help detect a gambling problem:

Indicators of a Gambling Problem

  • You have often gambled longer than you had planned.
  • You have often gambled until your last dollar was gone.
  • Thoughts of gambling have caused you to lose sleep.
  • You have used your income or savings to gamble while letting bills go unpaid.
  • You have made repeated, unsuccessful attempts to stop gambling.
  • You have broken the law or considered breaking the law to finance your gambling. 
  • You have borrowed money to finance your gambling.
  • You have felt depressed or suicidal because of your gambling losses.
  • You have been remorseful after gambling.
  • You have gambled to get money to meet your financial obligations.

If you or someone you know answers “Yes” to any of these statements, consider seeking assistance from a professional regarding this gambling behavior.

Resources

It’s important to seek gambling-specific help. Utilize services and individuals with experience, certification or licensure in problem gambling counseling and treatment. The NM Gambling Helpline (1-800-572-1142) offers crisis intervention and referrals to certified counselors and support groups 24 hours a day, 365 days a year. For further information, visit: www.ncpgambling.org.

Compassion Fatigue

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 Findings

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. 

Study Conclusions

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. 

 


 

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