The Cost of Justice: A Desk Manual on Vicarious Trauma

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Criminal, Family and Immigration Law

Lawyers, judges and other Court personnel, especially those working in criminal justice, child welfare and protection, immigration and family law will routinely experience parties and witnesses who have suffered trauma. Some will exhibit the symptoms of Simple or Complex Post Traumatic Stress Disorder. Often, to be effective in their various roles as legal practitioners, lawyers and judges have to be able and willing to identify Post Traumatic Stress by learning to recognize and identify PTSD reactions.Further, legal practitioners need to understand and support these individuals through the legal process. The more effective legal practitioners become in recognizing, coping with and supporting these individuals and their personal histories, the greater the risk that the legal practitioner will experience vicarious or secondary trauma.

Charles R. Figley, an early pioneer in the field of Traumatic Stress Studies, stated,

It has become increasingly apparent that the effects of traumatic events extend beyond those directly affected. The Term Secondary Traumatic Stress has been used to refer to the observation that those who come into continued close contact with trauma survivors, may experience considerable emotional disruption and may become indirect victims of the trauma themselves. Consequently, Secondary Traumatic Stress is becoming viewed as an occupational hazard of providing direct services to traumatized populations. - Development and Validation of the Secondary Traumatic Stress Scale, Research on Social Work Practice, Vol. 13 No. x, Month 2003 1-16

Figley has defined Secondary Traumatic Stress as “the natural, consequent behaviors and emotions resulting from knowledge about a traumatizing event experienced by a significant other. It is the stress resulting from helping or wanting to help a traumatized or suffering person.” The negative effects of secondary exposure to a traumatic event are nearly identical to those of primary exposure; with the difference being that exposure to a traumatizing event experienced by one person becomes a traumatizing event for a second person. Thus, Secondary Traumatic Stress is defined as a syndrome of symptoms nearly identical to those of Post Traumatic Stress Disorder, including symptoms of intrusion, avoidance and/or arousal.

While the study of Secondary Traumatic Stress is a rapidly growing field, the majority of existing literature is conceptual in nature or reports only anecdotal evidence of the phenomenon. While science strives to catch-up with this anecdotal evidence, the genie is now out of the bottle for the legal profession, where a wide range of highly respected judges and lawyers have experienced severe problems from the caustic and corrosive evidence they absorb as legal practitioners. There is growing recognition in legal Bar Organizations such as Canada’s Legal Profession Assistance Conference that serious symptoms, burnout and disability are a growing concern.

Direct Trauma Effects

Lawyers, judges and other Court workers can come in contact with individuals who have suffered extreme trauma including past and present physical and sexual abuse, childhood neglect and emotional abuse, natural and human-caused disasters, war and military combat, as well as personal assault and a whole range of terrifying events or ordeals in which grave physical harm occurred or was threatened.

The result of exposure to these traumatic events has been called Post Traumatic Stress. The continuing experience of Post Traumatic Stress is called Post Traumatic Stress Disorder (PTSD) in the clinical literature.

The Centre for Addiction and Mental Health (CAMH) in Toronto, Canada, provides this definition:

A traumatic experience is an event that continues to exert negative effects on thinking (cognition), feelings (affect) and behaviour, long after the event is in the past.

Some of the symptoms of PTSD have become fairly well known through stories and the media. It may be helpful, however, to review the three categories or “clusters” of responses that are associated with Post Traumatic Stress:

• Reliving the event through recurring nightmares, flashbacks or other intrusive images that “pop” into one’s head at any time. People who experience PTSD may also have extreme emotional or physical reactions, such as uncontrollable shaking, chills or heart palpitations, or panic when faced with reminders of the event.
• Avoiding reminders of the event, including places, people, thoughts or other activities associated with the trauma. People who experience PTSD become emotionally numb, withdraw from friends and family and lose interest in everyday activities.
• Being on guard or hyper-aroused at all times, including irritability or sudden anger, difficulty sleeping, lack of concentration, being overly alert or easily startled.

(see: Bridging Responses, Lori Haskell, CAMH)

Experts have learned that people react to traumatic experiences in vastly different ways. Some of the responses are obvious, such as intrusive memories or panic attacks. Other responses, such as feeling numb and empty are subtle and difficult to identify. It is well known, however, that responses may continue for many years following the traumatic events, even after the responses appear to have subsided for a period.

Experts have also delineated two different kinds of Post Traumatic Stress. Simple Post Traumatic Stress results from a one-time incident such as a serious accident or a violent assault. This is markedly different from the complex set of responses that follows chronic, multiple and/or ongoing traumatic events. These events can include chronic childhood abuse or prolonged experiences of assault and violence in an intimate relationship or continuing exposure to violence and personal danger. CAMH has identified three broad areas of psychological disturbance that distinguish Simple PTSD from Complex PTSD. The first area involves the types of responses or effects, which are more complex, wide-spread and persistent in Complex PTSD, due to the prolonged nature of the trauma. Secondly, the kinds of characteristic personality changes that accompany complex PTSD include difficulties with relationships and personal identity.Thirdly, the survivor’s increased vulnerability to further victimization continues both in the forms of self-harm as well as harm perpetrated by others.

There are additional problems which can include:

• Depression and self-hatred.
• Significant difficulties dealing with emotions and impulses, including aggression.
• Dissociative responses.
• Self-destructive behaviour.
• Inability to develop and maintain satisfying personal relationships.
• A loss of meaning and hope.
• A loss of trust.

Recognizing the signs of Post Traumatic Stress Responses

The Centre for Addiction and Mental Health (CAMH) suggests the following physiological and psychological symptoms common to Complex PTSD:

Mental Health Problems:

• Depression
• Chronic difficulty sleeping.
• Dissociation.
• Depersonalization.
• Derealization.
• Anxiety Disorders and Panic Attacks.

Impaired Sense of Self:

• Shame, guilt and self-blame.
• Self-hate and self-loathing.
• Damaged, defiled or stigmatized.
• Helpless or paralyzed in terms of taking initiative.
• Completely different from others.

Relationship Difficulties:

• Unable to trust others.
• Frequent conflicts.
• Not feeling entitled to set boundaries.
• Frequent conflicts.
• Repeated search for a rescuer.
• Sexual difficulties.
• Unable to develop and maintain close attachments.
• Experiences of re-victimization.
• Issues with sexual identity.

Problems with Memory

• Gaps in memories of childhood.
• Difficulty remembering discussions from the previous week.
• Amnesia or intense recollection of traumatic events.

Behavioural Expressions of Distress

• Problems with alcohol or drugs.
• Suicidal impulses.
• Self-inflicted harm.
• Eating disorders.
• Shoplifting or other criminal activity.
• High risk sexual behaviours that may result in unintended pregnancy or sexually transmitted diseases or list of abuse.

Physical Problems

• Chronic pain with no medical basis.
• Stress-related conditions such as chronic fatigue syndrome or fibromyalgia.
• Headaches.
• Sleep disorders.
• Breathing problems or asthma.

Treatment Theories

There is now significant support for the concept that the treatment tools, options and resources that are effective in diagnosing and treating persons with PTSD are also appropriate for persons with Secondary or Vicarious Trauma symptoms.

Why? Firstly, it has been established that the symptoms for both primary PTSD and for Secondary/Vicarious Trauma are the same. If so, it follows logically that the tools of diagnosis and treatment would be the same, or at least similar. Secondly, practice and treatment expertise in this area is rapidly expanding as our knowledge grows.

As the tools of diagnosis and treatment have improved for PTSD, the best strategy has been to employ the same tools for other related traumas. While it is possible, and perhaps even likely, that these tools will evolve differently in the future, the best practice approach in the context of here and now is to pursue the same diagnostic and treatment tools. In our experience, a Solution-Focused Therapy will offer the best outcomes in the majority of cases.