Trauma creates change you don’t choose. Healing is about creating change you do choose.—Michelle Rosenthal
Over the past 15 months, we have had the privilege of sharing our message with readers of GPSolo eReport and have greatly valued your feedback. By and large, our most popular articles have focused on trauma (see footnote 1). Indeed, although recent efforts to promote attorney well-being have included acknowledgment of secondary trauma and strategies to implement a trauma-informed law practice, we have noticed that these initiatives have largely failed to include a critical piece of the puzzle—unresolved primary trauma. As we continue our exploration of ways to curb the negative effects of trauma within the profession, we turn now to the concept of adverse childhood experiences, or ACEs.
Addressing childhood trauma is an intrinsic aspect of promoting attorney well-being as ACEs actually underscore many adult mental and physical illnesses. ACEs can also hinder our ability to effectively manage and cope with stress, which can have dire impacts on our professional responsibilities and overall well-being. Our objective is to raise awareness about ACEs and to provide lawyers with yet another tool to help prioritize their health and well-being. Further, by gaining insight into ACEs, legal professionals will be better equipped to serve clients at a deeper level.
What Are ACEs?
Adverse childhood experiences are potentially traumatic events in early life that, if left unchecked, can lead to long-term negative consequences for our health, relationships, and career. Although you may be hearing about ACEs for the first time, the scientific community has been studying this concept for decades. (See this TED talk by Nadine Burke Harris.) The foundations of ACEs research began after a physician noticed a pattern of trauma history among many of his weight-loss patients. The scientific question became: Was there a connection between childhood trauma and this health concern in adulthood? The answer was an unequivocal yes.
In the 1990s, the U.S. Centers for Disease Control and Prevention (CDC) partnered with Kaiser Permanente to conduct a large-scale study of childhood trauma and its impacts on health and well-being. The study found that trauma is pervasive and exists across all demographics. The CDC defines ACEs in the following basic categories:
● Abuse: physical, emotional, and sexual.
● Neglect: physical and emotional.
● Household challenges: severe unmanaged mental illness, incarcerated relative, mother treated violently, substance abuse, and divorce.
This original study found that almost two in three people in the United States have experienced at least one ACE, and one in four have experienced three or more. Indeed, the more ACEs that we accumulate, the more our risk increases for myriad negative health outcomes, including diabetes, cancer, and even premature death.
Subsequent ACEs research has consistently shown a link between childhood trauma and negative outcomes in adulthood, including substance abuse, mental illness, risk-taking behavior, and even lost earning potential. The evidence is resounding—much of the illness and dysfunction affecting adults is the result of unresolved traumas from our early lives.
Why Should ACEs Matter to Lawyers?
Ultimately, ACEs are deleterious to our overall health and well-being because they cause toxic stress that can negatively alter brain development and even our DNA. While temporary, positive stressors are healthy, ACEs contribute to toxic stress over the long term, which can wreak havoc on our cognitive functioning, including shortened attention span, increased impulsivity, and negative impacts on our ability to learn and make decisions.
Those who grew up with toxic stress may struggle with emotional regulation and find it difficult to form stable relationships and communicate effectively. Critically, if toxic stress goes unmanaged, its negative effects can actually be passed down to our children, a phenomenon known as intergenerational trauma. This means that ACEs can put future generations at risk of negative health and social outcomes even if they have never experienced trauma directly themselves.
By understanding and managing our own traumas, we will be better able to advocate for our clients and ourselves. Given the prevalence of ACEs in the general population, many attorneys will experience long-term negative health outcomes if their own childhood traumas go unacknowledged and, thus, unresolved. ACEs can make us more sensitive to stress overall, including intensified reactions to relatively minor stressors, let alone the high-stress environment of practicing law. In addition, lawyers will inevitably encounter clients who are experiencing unresolved trauma and who can benefit from trauma-informed law practices. The following simple steps are designed to help attorneys facing their own childhood trauma or provide trauma-informed support to clients:
Assess yourself. A good starting point is to determine your own ACEs score by taking the ten-question ACEs Test. Higher scores indicate increased risk for poor adult health outcomes, especially if you have four or more ACEs. According to the Stop Abuse Campaign, however, as compared with those who score zero, adults with an ACE score of one are twice as likely to be alcoholics and the chance of alcoholism quadruples for those who score two out of ten.
Seek professional support. Those ready to face past trauma may very well be uncomfortable with the feelings that accompany painful memories. Some may even dismiss the past trauma as insignificant and try to remain in that great comfort zone of denial. However, your co-authors can assure you that the journey is worthwhile as the reward can be newfound resilience in all aspects of life. Becky will personally attest that getting into therapy is the single best decision she ever made, and she maintains this therapeutic relationship to this day.
Engage in extreme self-care. Take charge of your life today and commit to building a healthy lifestyle. Creating a strong foundation both physically and mentally will position you to withstand future stresses and challenges. Besides, don’t you owe it to yourself to live your best life? What’s holding you back? Specific self-care tips are outlined in our article “Health and Well-Being for Lawyers - The Time is Now.”
Screen for individual and family mental health concerns. We can dispense sounder advice and provide stronger advocacy if we have been presented with complete and accurate details of a client’s situation. In some areas of law, this can include information about mental health concerns faced by the client or their family members. In particular, attorneys practicing either family or criminal law need to understand how these issues can affect the outcome of each and every case. Kevin Chroman, author of “Making the Case for ACEs: How the Legal System Can Further Help Children and Take Meaningful Steps to Address Adverse Childhood Experiences (ACEs)” (LACBA, vol. 18, no. 3, Fall 2020), suggests administering a screening at the inception of each matter in order to gain deeper insight that will improve the quality of our service.
Provide referrals and resources to your client. Screening results will put you in the best position to make the appropriate referral to a qualified mental health professional or perhaps to a social worker who has access to an array of social services. For example, a family law attorney may suggest that clients seek counseling services for their children because divorce or separation is classified as an ACE. Overall, ACEs are preventable, and early intervention and treatment may very well save a child years of unnecessary misery. As you continue to educate yourself on the topic of ACEs, be sure to share newly discovered information with your clientele.
For more ways to implement trauma-informed legal services, see our article, “Strategies for a Trauma-Informed Law Practice.”
Lawyers who are aware of and have a basic understanding of ACEs will be in a unique position to provide more meaningful representation to clients, as well as heal trauma experienced directly in their own lives.
The importance of prioritizing attorney well-being has become more widely touted over the past few years. Indeed, bar associations, law firms, and other legal organizations have made sincere efforts to make resources readily available. As these lawyer wellness initiatives continue to evolve, we hope to see more emphasis placed on building awareness and normalizing conversations about the harmful effects of primary childhood trauma on attorneys’ well-being.
In our next column, we will explore various communication styles and platforms and offer suggestions on improving intergenerational communication in the legal setting.
Endnote 1. The following two “Legal Burnout Solution” columns provide useful background on the problems surrounding trauma in the legal context: “How Secondary Trauma Impacts the Mental Health of Legal Professionals” and “Strategies for a Trauma-Informed Law Practice.”