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Roadmap to Healing

We at the Lawyer Assistance Program write and talk about the fight/flight/freeze response in law practice all the time. As a result, many lawyers across the state have come to understand the ways in which we, as lawyers and judges, may struggle with compassion fatigue and secondary trauma from repeated exposure to client trauma. While many of us are exposed to the traumatic experiences of our clients, we don’t often think in terms of experiencing trauma first-hand, personally or professionally. We like to think it would never happen to us, that it could never happen to us. But trauma does not discriminate. A traumatic experience can happen to anyone, anywhere, and for reasons that make no sense at all, as the recent shooting death of a NC lawyer by his client demonstrates.

While the left-brain/right-brain framework is an over-simplified description of how our brains actually work that is not backed by the latest neuroscience, it remains a useful shorthand to illustrate thought processes that most people understand. Lawyers operate from a left-brain perspective: executive functioning, analysis, strategy, sequencing, and logical thinking fall in this realm. But when a traumatic experience occurs, the left side of the brain shuts down and the right-side of the brain takes over to process the event. Right side functions include creativity, intuition, emotion, imagination and the like.

A traumatic event isn’t logical or reasonable; it doesn’t follow linear or strategic thinking and therefore doesn’t make sense to our left-brain way of operating in the world. This processing disconnect makes it more difficult for us to process through the trauma because we can’t make that round peg fit in the square hole, so to speak. So, in the aftermath of a traumatic event, it may be difficult to identify, integrate or process certain emotions. Even if we can identify them, we may find it almost impossible to regulate them. Traumatic events are difficult for all people, but lawyers may have an especially difficult time processing through because of the way we are trained to think.

In the wake of the recent shooting, many have asked what they could do to help someone who has experienced a traumatic event. My hope is to equip you with the tools and information you may one day need to enable you to help a friend or colleague who has suffered an acute trauma. Or in the event you experience a traumatic event, this article can serve as a roadmap to healing.

So, what exactly is a traumatic experience? A traumatic experience is an extraordinary and stressful event that shatters one’s sense of safety and security. These events often involve situations that potentially place our life or the lives of others at risk. But any situation that leaves one feeling fearful, overwhelmed, and isolated can result in a trauma response, even if it doesn’t involve physical harm. It is not the objective circumstances that determine whether an event is traumatic for an individual. Rather, it is that person’s subjective emotional experience of the event. In other words, the real determinant is not the situation or event itself, but how one reacts to it. People don’t interpret the same events in the same way. Two individuals could be in the exact same situation and each person could have a different reaction. There is not a right or a wrong way to react to any situation.

Tip: Even though we think we know, or would like to think we know, how we would react to any given traumatic situation, we actually have no idea. We cannot predict how we will react. We will likely react in a way that surprises us or that we might feel is ‘out of character.’ It is, therefore, critical that we not judge anyone (or ourselves) for their (or our) reaction. The only way to begin healing is by having a safe, non-judgmental space.

Why do people react or respond the way they do? There is no way to predict how an individual will be impacted by a traumatic event. Factors that might influence how one will react include: the type and severity of the event, the amount of support received following the incident, current life stressors, certain personality traits, developed resilience skills (or natural levels of resilience), and any previous traumatic experiences.

What should we expect to see in the immediate aftermath? If a person experiences a trauma response, it will temporarily disrupt the individual’s ability to function at the level they normally do. But they may not realize it. They may exhibit a numb, dazed or shell-shocked response. Or they might exhibit the opposite. In certain life-threatening situations like a car crash or a situation involving physical violence, the adrenaline system goes into hyper-drive. A person could have a reaction that looks hypo-manic, ADHD, or hyper-adrenalized for a few days, talking constantly, unable to sleep, until about 48 to 72 hours later, when comes the inevitable crash as the body’s energy is totally depleted. Thereafter, a person may be lethargic and have to sleep for a few days.

Tip: Do not try to convince someone they are having more of a reaction than they think or say they are. You just need to be aware that their acute reaction is just that – an acute reaction that will usually subside over time as a part of the mind and body’s natural healing and recovery process.

While everyone responds differently to trauma, these reactions and responses typically fall into four basic categories of psychological/emotional, physical, cognitive, and behavioral.  Being able to recognize these responses helps us to attach no judgment to them, whether we are helping a friend or recovering ourselves. Understanding what is happening and why helps us cope better and recover more quickly if we have suffered a traumatic experience. If we are supporting someone else, it will help us better understand what they may be experiencing.

Psychological/emotional:

               shock, denial, disbelief (especially initially)

               heightened anxiety or fear

               irritability, restlessness, or overexcitability

               sadness, crying

               helplessness or hopelessness

               numbness or detachment

               estrangement or isolation from others

               “survivor guilt”

               self-blame or wishing you could/should have done something different

               sudden, dramatic mood shifts

               depression

Physical:

               headaches

               nausea or upset stomach

               exaggerated startle response (tendency to startle easily at noises)

               fatigue or feeling slowed down, lethargic

               sleep disturbances including insomnia

               changes in appetite

               distressing dreams and/or nightmares

               worsening of existing medical conditions

               racing heartbeat

               excessive sweating

Cognitive:

               re-experiencing the traumatic event, including intrusive thoughts or images (flashbacks) of the event

               repeatedly playing certain parts of the event over in the mind

               difficulty concentrating

               feeling confused or dazed, slower thought than normal

               distracted

               difficulty handling tasks or making decisions

               memory problems

               trying to understand how and why it happened

Behavioral:

               hyperactivity, or less activity

               being overly protective of others

               withdrawal, social isolation

               accident prone

               avoidance of activities or places that remind one of the traumatic event

               strong need to talk about the event, read accounts about the event

               refusal to talk about the event or any impact from it

               hypervigilance to surroundings, scanning for possible danger

               wandering around or just sitting and staring without direction

               using alcohol or other drugs to numb or escape feelings

How long does it take to process a traumatic experience? The time it takes to process through a traumatic experience varies as much as the reactions do. It is impossible to predict how long any one individual will experience the effects of a traumatic experience. With proper treatment, the effects should gradually decrease over time. Being intentional about self-care strategies will help minimize the intensity and duration of these reactions. There are plenty of effective self-care strategies. Each individual needs to find what works best for them.

Some Do’s and Don’t’s

DO…

Talk about it…It’s a step toward healing. While it may be uncomfortable, talking about it takes some of the power out of the trauma and can be cathartic. Some people even need to talk repetitively about it, so talk as much as you need to – but only to folks who can listen and support you.

The inherent difficulty with this suggestion is that after experiencing a trauma, people feel different from others, even if it was a group experience. The experience typically feels surreal and often makes us question the necessity and value of mundane, daily activities in our lives. We often believe that nobody can fully understand what we have experienced or how it has impacted us, so we think or assume that sharing our feelings, thoughts, and reactions related to the trauma isn’t helpful. It is helpful if we can let go of the need for (or idea that) anyone is going to truly “get” what we experienced. They may, they may not. It is still helpful to talk about it to reduce the power of it.  

Tip: If you are supporting a friend, just listen. If they do not want to talk about it, do not try to force the issue. Just let them know you are available to listen should they want to talk about it, then turn your attention to being present with them in other ways. On the other hand, if they need to talk repetitively about it, remember that this is normal and do not try to make them stop or ‘let it go’ or be more rational. Please be aware that you probably cannot fathom what the person has been through, so it is best not to try to manufacture similarities based on your historic experience as it will likely come across as minimizing, insincere or invalidating. Just hold the space and listen. That being said, it can be emotionally exhausting to listen for prolonged periods of repetitive processing. It is OK to also take care of yourself and take a break when you need to. For a suggestion about how best to do this, please see the tip under seeking support.

Express your feelings as they arise…Gradually confront what has happened, but don’t try on one hand to force it or on the other hand to block it out. Allow yourself to cry, rage, and express your feelings when you need to in a healthy and appropriate way. Recognize that you have been through a distressing and/or frightening experience and you will have a reaction to it. Talk through your feelings, write them down, or seek professional help if you need guidance. Don’t bottle up your feelings or self-medicate them as it will only make things worse. Try not to get angry or frustrated with yourself if you are not able to do things as well or efficiently as normal. That is to be expected.

Seek support…from supportive people. Tell people what you need, even if it is nothing specific other than them just being there if you need them. Sometimes the best support is just in knowing others care about you and are willing to help if they can. It’s also important to tell people what you don’t need or what is not helpful. Be honest with yourself when you need to seek professional help.

Tip: When we are in the supportive role, it can be exhausting. It is always a good idea to have a specific time frame established on the front end to set the expectation going in. For example, when you arrive, you can tell your friend that you can only stay one hour (or two hours, etc.), and that you can come back the next day (also set a time frame for that visit when you arrive the next day). What we are trying to avoid is a situation that feels invalidating to the trauma victim. Because they will be in processing mode, whether they are talking or not, any “surprise” exit (whether two hours later or six) can feel unsupportive. Setting the expectation on the front end helps protect everyone from misunderstandings and potential hurt feelings.

Confront memories and/or feelings brought up by the trauma…Allow yourself to acknowledge them, verbalize them, or find other healthy ways of confronting them because trying to force yourself not to think about them will only make them more intense and harder to deal with. When intense feelings arise, allow them, then immediately think of a fond memory, look at photographs of your favorite places or people you love, and so on. The reason for this has to do with neuroscience. There is a saying for this: “What fires together wires together.” Repetitive thinking lays down embedded neuropathways. This suggested activity helps neutralize the “felt” sense memory from the trauma event. While it will take time and intention, you can get to a place where the feelings are replaced by increases in the positive thoughts and memories. If the trauma involves the loss of someone you loved, this will also affirm the essence of who they were and help appease the images (real or imagined) of what happened to them.

Understand that flashbacks may occur… A special word here about triggers and flashbacks. A trigger is a stimulus that sets off a memory of the trauma or a specific portion of it. A trigger can be any sensory reminder of the traumatic event: a noise or sound, a smell, a temperature, or other physical sensation, or a visual scene. Some triggers are obvious and therefore can be anticipated and avoided easily, but many are subtle and inconspicuous, which catches us off guard and thus ratchets up the intensity of the feelings. A trigger may set off a memory or a flashback.

A flashback is more than an unexpected memory that pops up. A flashback is the reexperiencing of a previous traumatic experience as if it were actually happening in the moment. In a flashback we often react the way we did during the traumatic event. Flashback experiences are usually very brief and typically last only a few seconds, but the emotional aftereffects can linger for hours or days. Flashbacks are commonly initiated by a trigger, but not necessarily so. Sometimes, they occur out of the blue. Other times, specific physical states increase a person’s vulnerability to having a flashback, (e.g., fatigue, high stress levels, etc.).

One might think that flashbacks only occur in the immediate aftermath, but again, not necessarily so. Flashbacks can happen months or even years later. These can be very disturbing not only for the intensity of the experience, but because they seemingly come out of the blue.

Tip: It is critical to understand that this is a normal process that is to be expected. When this happens, knowing what it is (a flashback) and that it is normal will help remove internal self-judgmental dialogue. Also, knowing it is a flashback can help reduce the emotional impact. Similar to waking up from a nightmare, when we startle awake, while we may still have lingering feelings from a nightmare, knowing it was one helps us resolve the lingering emotions. So, recognize a flashback for what it is, then turn your attention to getting grounded back in the present moment.

Practicing mindfulness…will help you stay in the moment where you are safe and not in the past where it is traumatic. Try feeling your feet on the floor. Try the 5-4-3-2-1 sensory exercise. It will also help to focus on the positive things around you, such as aspects of nature, that we sometimes don’t stop long enough to appreciate.

Eat well, sleep well, get rest…After a trauma the body must come out of its state of heightened arousal. The internal alarms need to turn off, the high levels of energy have to subside, and the body needs to re-set itself to a normal state of balance and equilibrium. So, listen to your body and respond accordingly. Rest when you are tired and do something productive if you experience a boost of energy or hyperactivity. It is common to feel exhausted at times even if you haven’t done a lot. It’s your body working hard internally to get back to homeostasis.

Exercise…Physical activity helps cleanse your body and mind of tension and stress. It helps to combat the “fight or flight” response associated with the trauma, and thus helps get us back to homeostasis. It may not be at the level of exercise you did before, but any movement is good.

Relax and enjoy…Use relaxation techniques such as yoga, breathing or meditation. Do things you enjoy and that feel nurturing to you. Go to a place where you feel your best.

Keep your normal routine…or return to it as soon as possible. That includes when you eat and sleep, not just going back to work or school. It helps make life feel more normal and thus safer and/or more secure. Staying busy allows our minds to be distracted for a while. But we do not want to do it to the point of avoiding dealing with the feelings we are experiencing.

Find meaning in what happened…Focus on positive ways to fit the trauma into the way you think about yourself, other people, or the world in general. Use it as the catalyst to make positive changes in your perspective, and perhaps eventually in your life. Affirm you did your best, reacted the way you did because of the circumstances, and so on. Don’t allow unhelpful thoughts such as self-blame, would-have, could-have, should-have, or what-ifs to distort the reality in that moment of time.

DON’T…

Don’t isolate…Spend time with others even if you don’t feel like talking or doing much of anything. It’s often comforting just knowing you are not alone. Sometimes all we need is “sacred silence,” which means just sitting silently and being present with someone.

Tip: If you are supporting a friend, when you offer to spend time with them, ask them how they would like to spend the time then defer to the request. Don’t impose your needs.

Don’t self-medicate…Using alcohol, drugs, food and other activities as a way to cope are only brief numbing agents and not coping mechanisms. They will only complicate your situation by preventing you from using healthy coping skills and have the potential to create other problems.

Don’t let the trauma confine your life…so don’t go out of your way to avoid certain places, situations, or people that remind you of what happened. However, you may need to ease back into it as well. It won’t likely feel comfortable or easy at first, but the longer you put it off the more difficult it will become.

Don’t let the trauma control your life…but also recognize you can’t control everything in your life either. It’s natural to become more controlling initially because it gives us a sense of security. But it is a false sense and can create even more stress when things don’t go as we wanted or planned.

Don’t make any major life decisions…or big life changes if at all possible. You don’t want to make permanent decisions based on temporary emotions. It’s also not a time to put pressure on yourself to do anything out of the ordinary. Stability helps you concentrate on the here-and-now and focus on taking care of yourself.

Healing and recovery from a traumatic experience is a process. It takes time, energy, and intentional effort. We need to be kind and gentle with ourselves and others. Accept that you will not feel your normal self for a while. Eventually, this will get better, and you will return to functioning at your former level. Keep reminding yourself that your responses are normal responses to an abnormal and very stressful situation. Give yourself permission to do whatever you need to do to take care of yourself. Your body and mind will tell you what you need to do—your job is to listen to them.

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