The Impaired Professional, Part IIThe Attorney as Client: Insights for Understanding an Especially Challenged and Challenging Population

Lawyers, judges, and even law students are far more likely than average to need chemical dependency and mental health services, but also far less likely to seek them. Once they do seek services, these individuals can present special challenges for the counselors, therapists, and other health care providers who work with them. In this article I will examine some of the barriers to treatment that many lawyers cite; outline some of the profession-specific causes for the heightened prevalence of behavioral health problems in law; identify what traits, characteristics, and behaviors of attorneys are likely to impede the therapeutic process and block their recovery; and discuss some of the important aftercare and workplace reintegration considerations that are unique to this population.

Background  

When it comes to professions, perhaps none are faced with the same striking levels of behavioral health problems—while simultaneously refusing to acknowledge or deal with them—as attorneys and judges. Despite whatever popular culture images we may have of attorneys’ lives, and the plentiful stereotypes and clichés that fill our imaginations about their personalities, the reality is that they are a troubled lot, oftentimes depressed, chemically dependent or both. The substance use and mental health problems faced by this profession have been so longstanding and widespread, that almost all state bar associations offer some form or version of a Lawyer Assistance Program, a resource often funded by membership dues and intended to provide free and confidential support to impaired or struggling attorneys. For reasons I will discuss, however, only a tiny fraction of attorneys who need help ever step forward to get it.

While the exact dimensions of the behavioral health problems in the legal profession have been subject to slight inconsistencies among available data, and minor differences of opinion between various stakeholders in the profession, the overwhelming consensus has always been that the problems are substantial. A new, nationwide survey of licensed attorneys is currently being administered by the American Bar Association and the Hazelden Betty Ford Foundation to determine present rates of substance use, depression, and anxiety in the legal profession, the results of which will be published in 2015. Until that data is analyzed and the study released however, the old numbers are what we have to work with, and the old numbers aren’t good: available estimates peg the addiction rate of attorneys to be roughly twice that of the general population (Benjamin, Darling, & Sales, 1990). That’s right, double. Perhaps even more alarmingly, attorneys are nearly four times as likely to struggle with depression as the average adult (Eaton, Anthony, Mandel, & Garrison, 1990).   

But what’s behind those extreme rates of depression and substance abuse? That answer is less straightforward, but the rampant, multidimensional stress of the profession is certainly a factor.  Not surprisingly, there are also some personality traits common among lawyers—self-reliance, ambition, perfectionism, and competitiveness—that aren’t always consistent with healthy coping skills and the type of emotional elasticity necessary to endure the unrelenting pressures and unexpected disappointments that a career in the law can bring.  

Despite whatever preconceptions or judgments many people may have of the work lawyers do, there are some facts about the practice of law that can’t be denied: it’s tougher than most people think and frequently less fulfilling than they would ever believe. If you find yourself with a lawyer as a client, there’s a good chance you’ll learn that they don’t love what they do for a living and, more importantly, that it has played a perhaps significant role in the development or worsening of their addiction or other mental health problems. 

Barriers to Treatment  

 

In spite of the heightened rates of addiction and other mental health problems present in the legal profession, attorneys tend to be disproportionately underrepresented in treatment and, generally speaking, quite treatment resistant. Why? One huge factor that can’t be overlooked is stigma.  While individuals from all walks of life continue to perceive and experience stigma related to addiction and other mental health conditions, the phenomenon is especially pronounced in the legal profession. As members of the bar and officers of the court, attorneys are expected to uphold both an oath and an image. The oath creates a duty, an obligation, and the pressure of an expectation that, quite frankly, few other professions have historically imposed or might presently replicate. The practice of law—or indeed even the education, preparation, and admission to practice law—brings with it an unmistakable and affirmative obligation to follow certain behavioral guideposts and clear specific ethical hurdles not readily found along most other career paths. Standards of professional comportment are, in a word, heightened. Fear of falling short of these standards—or more accurately of being perceived as falling short—will lead many attorneys to ignore, deny, and attempt to trudge past their problems even as those problems progress and cause greater impairment.

 

In fact, the very topics of substance abuse, addiction, and depression—the mere reference to a compromised mental or physical state could impair a lawyer’s functionality and ability to uphold their oath—will evoke bristling and dismissal from many attorneys and law students. In short, they just aren’t willing to “go there.” So how does this resistance to seeking help or acknowledging their problems manifest, and what does it tend to look like? Overblown egos, a malignant unwillingness to admit defeat, a penchant for arrogance, highly refined powers of denial, rationalization, and minimization—these are some of the less charitable characterizations. Among the more favorable would be an apparent predisposition towards hard work, independence, and self-reliance, a commitment to solving others’ problems instead of their own, and a fear of harming the profession’s image or disappointing clients.   

However, regardless of what is actually driving an attorney to overlook their own internal warning lights and disregard the concerns of others, there are some very common and almost universal reasons why they are likely to say they are not in a position to get help. Depending upon the size of their practice and the scope of their caseload, most employed attorneys will cite an inability to step away from their work for an extended period of time as a threshold barrier between them and treatment. I regularly speak to attorneys and judges from all over the country who are finally exploring treatment—oftentimes at the insistence of an employer or spouse—and the number one reason why they say they just can’t do it is work: their clients, their business, their practice. It will all fall apart if they step away and tend to something as trivial as a chronic disease.   

Now to be clear, in the event that an attorney is in solo practice and without much or any backup support, there is some real legitimacy to their concerns about their practice taking a hit, their deadlines being missed, and their clients or the court becoming angry. As I often explain to these individuals though, with varying levels of success, the situation they are facing with their addiction or depression is really no different from another personal health crisis which could befall them. Do they mean to suggest that if they had a heart attack, received a cancer diagnosis, were in a bad car accident or otherwise found themselves indisposed for a period of time due to a pressing health issue that their legal practice would really fall apart? For some, this analogous reasoning is enough for them to reconsider their position; for others it is entirely unpersuasive, mostly because they wouldn’t be ashamed or embarrassed to tell people if one of those other situations occurred.

For attorneys who practice in a firm where others could shoulder some of the workload in their absence, an excuse about the impracticality of seeking treatment because of work is far less valid, but nonetheless frequently offered. For these individuals, the ultracompetitive and unsupportive work environments they often find themselves in may generate a substantial fear of falling down the food chain, being passed up for promotions, and losing out on new business opportunities because they have a substance use or mental health “weakness.” As I will discuss in the next section, the professional climate within the legal profession tends to be emotionally isolating, rigorously demanding, anxiety-provoking, and devoid of adequate consideration for any type of balance or personal wellness. Most attorneys wear their hard-earned ability to swim in such rough professional waters as a badge of honor—they aren’t inclined to let others know they suddenly “can’t cut it.” And it’s that fear—that others will find out they’re weak, vulnerable or troubled—that is the second most common reason attorneys are likely to cite about why treatment isn’t a good option for them. 

Whether it’s their colleagues or their clients, lawyers are overwhelmingly reluctant to let anyone in their professional universe know about a personal problem that could make them appear incompetent, unreliable, untrustworthy or otherwise not up to the job. Sometimes their fears are exaggerated and somewhat out of touch with the reality of their situation, but sometimes they are not: the legal profession, as an industry, is way behind the curve in terms of dealing with substance abuse and mental health issues. Most law firms maintain an implicit head-in-the-sand, look the other way approach to attorney behavioral health. In the event that they are forced to deal with the issue, firms tend to take a reactive and defensive approach that is focused more on damage control than employee wellness. Proactive HR policies and affirming, supportive management styles that encourage self-disclosure and treatment are the rare exception rather than the typical rule, which gives some credence to the fears an attorney might have about the professional fallout from acknowledging or attempting to deal with their problems while employed at a law firm.

A Breeding Ground for Addiction and Depression  

As I’ve mentioned, substance abuse and mental health problems are essentially an occupational hazard in the legal profession. But why is that? What are some of the unique stressors that a lawyer might face that could fuel a mental health problem? The list is long, but these are some of the highlights. These facts should be considered in the dual context both of how they might have precipitated the client’s presenting problem in the first place, and also how they could represent an unhealthy recovery environment following treatment.

Work Environment  

By nature, the work environment of attorneys is inherently conflict-driven and competition laden. The US uses a two-sided legal structure known as the adversarial system. This system includes external sources of conflict and competition (e.g., opposing counsel and often the judge) and internal sources of conflict and competition (e.g., competition within the law firm for clients, advancement, etc.)

Negative Emotions  

Clients are generally starting from a place of unpleasant emotions such as loss, anxiety, grief, conflict, and anger. In other words, people generally aren’t  happy to be seeing an attorney.

Problem-Solving  

The job of an attorney revolves around solving problems, but those problems are rarely solved to the complete satisfaction of the client (including the bill at the end). This constant tension between expectations and performance can create feelings of inadequacy and disillusionment. These high and possibly unrealistic client expectations include a favorable outcome, being in constant communication, always putting them first, and other factors. 

Workplace  

Good courtroom skills don’t necessarily translate into a good workplace or interpersonal skills. For example, there is increased emphasis on “winning” instead of collaboration and lawyers may be more skilled at “debate” and “arguments” rather than communication, discussion, and teamwork.

Furthermore, there is the distrust of colleagues and inability to share frustrations, problems, personal issues, or emotional and behavioral conditions. Lawyers can have the pervasive fear that they will look weak or colleagues will use it against them.

The work frequently involves isolation; long hours holed-up in an office or otherwise cut off from social interaction and support. Time pressures abound, such as deadlines from the court, administrative agencies, and the client. The overall work hours for many lawyers to be successful are between sixty to ninety hours a week.

The law is increasingly an anxiety-based profession with an excess number of lawyers and limited number of jobs. The financial pressures include:

 

• The required billable hours (if working for a firm)
• The requirement to develop business and generate clients (which oftentimes involves socializing with alcohol)
• Lawyers are no longer assured a good living—many new lawyers have gone to law school for three years and have massive debt and are lucky to even get a job, moreover be capable of paying off their loans.

 

 

Alcoholism  

Frequent drinking is completely normalized within the profession and there is an unwritten expectation that a lawyer drinks at least socially. Alcohol is omnipresent and seems to be attached to everything from social interactions with peers and colleagues to business development and entertaining of clients. It really is everywhere in the legal profession.

Traits of Lawyers Become Roadblocks to Recovery  

In attempting to understand why so many lawyers and judges struggle with alcoholism and depression, clinicians, researchers, and members of the legal profession themselves have written, theorized, and debated about whether it’s the culture and structure of the profession that is more to blame, or whether it’s the personality types of people who are drawn to law school in the first place that make them more susceptible to developing these problems. In reality, it’s both and more. Not only does the culture of the legal profession encourage and foster some very unhealthy behaviors—starting in law school when they are deeply ingrained in the psyches of would-be attorneys—but the personalities and values of those attracted to the law as a career oftentimes provide fertile ground in which those behaviors can take root.  

This nonexhaustive list represents some of the more common personality and behavioral traits that many lawyers exhibit and openly identify with. As someone whose program treats over one hundred attorneys, judges, and law students from around the country on an annual basis, my experience has been that almost all clients willingly identify with many if not most of these traits when presented with a list and asked to select the characteristics to which they can relate and that which may stand in the way of their recovery. However, it is fundamentally important to understand that these aren’t just traits that the clients feel they possess—many of these are also traits that are expected and rewarded in lawyers. Their education, training, and experience cultivate, reinforce, demand, and prize these characteristics as part of the toolkit for being good at what you do for a living.  

 

• Strong ego
• Always be in control
• Intellectualization is the comfort zone
• Logic and critical thinking far more important than trusting their gut
• Avoid risk-taking or potential exposure to rejection or criticism
• Predisposition towards denial and shifting blame
• Experts at rationalization
• Competitiveness
• Emotional detachment
• Circumspection, skepticism, and questioning
• Advanced verbal skills
• Argumentativeness
• Self-centeredness
• Overidentification with professional self; self-worth based on being a lawyer 
• Terminal sense of uniqueness; strong feeling of being different than non-attorneys
• Stubbornness and a reluctance to give up
• Self-reliance
• Be a problem-solver, not someone who has problems
• Winning irrespective of the cost to self
• Arrogance
• Secretive; everything is confidential
• People-pleasing
• Black and white thinking
• Comfortable isolating
• Intolerance
• Perfectionism
• Comfortable manipulating facts and situations

 

 

If, after reading that list, you conclude that your attorney clients might be facing an uphill battle in terms of developing and using recovery skills, you would be right. At the same time however, there is some good news of which I always remind my clients: recovery is hard work and they are individuals with a demonstrated track record of being able to work hard when they want to. When reminded of their capacity for high achievement—their ability and willingness to go to extraordinary lengths in their academic and professional endeavors—and then asked to employ some of that same work ethic and determination to their recovery, many lawyer clients appreciate the challenge and take comfort knowing that they’ve accomplished very difficult things before. Empowering these clients in this way can be very constructive as they begin to reorient themselves away from ignoring and denying their problems and towards acknowledging and tackling them. 

Aftercare and Workplace Reintegration  

As a general matter, we know that the longer someone is engaged in treatment services of some kind and the more actively they embrace a program of recovery following the delivery of services, the more likely they are to be met with a favorable outcome. For an attorney client who may have railed mightily against receiving treatment in the first place and been very reluctant to leave work behind, there can be a strong tendency to minimize the need for continuing care and follow-up support for their recovery. Many of these clients will be predisposed to a quick resumption of old workloads and stress levels, a predictable pitfall they should be strongly cautioned against and helped to navigate around with a thoughtfully designed plan.

If attorney clients are self-employed, the nature of their aftercare plan will be more one-dimensional and tailored directly towards meeting their own recovery goals and needs. The most important aspects of such a plan will emphasize accountability (a monitoring program, when appropriate) the need to avoid jumping back into a full workload right away, the need to avoid isolation, and the need for giving their recovery the priority it requires. 

For attorneys who may work in a firm, corporate or other non-solo setting, their aftercare plan will involve additional considerations that should be taken into account. Now clearly not all legal professionals who take a leave of absence from their employment to address a behavioral health issue will ultimately return to the same employer—sometimes they won’t be welcomed back and sometimes won’t want to go back. Still, for many who do seek treatment and successfully embark upon recovery, a return to their previous employment may be in the cards. For those clients—or for those who are trying to balance the demands of their practice with receiving counseling on an outpatient basis—it’s important to be aware of, anticipate, and help your client prepare for some of the challenges they may face when their career and their recovery collide. Keep in mind that protecting their professional reputation and maintaining appropriate confidentiality will likely be of paramount concern to these clients, and they may also be experiencing a significant amount of guilt and shame that they should be encouraged to process.

On a practical level, some of the issues facing an attorney and a law firm can be just as formidable after someone addresses their problem as they were beforehand—albeit for different reasons. A posttreatment return to work can represent a significant stressor, both for attorneys returning to work and the office that is welcoming them back. More times than not, however, this stress can be avoided or mitigated by preparation and planning. Having a solid, workable, and well-informed plan in place before someone returns from treatment can substantially increase the likelihood of a smoother and more successful reintegration.   

The plan should address the needs and challenges of both your clients and their employer, keeping in mind that mismatched expectations are common but avoidable through clear and open communication of the issues faced by both parties. 

For newly recovering attorneys returning to work, their issues may include:

 

• Anxiety and discomfort about facing colleagues now that their chemical dependency or depression is out in the open
• Anxiety and discomfort about facing colleagues if the reason for their absence was not fully disclosed to all of them
• Concern about being judged, stigmatized, and labeled
• An unrealistic expectation that they can immediately repair past damage to relationships
• An unhealthy desire to “hit the ground running” and quickly resume a substantial workload
• Feeling pressure to prove themselves
• Concern about social and work functions that involve alcohol
• Embarrassment about needing to prioritize their recovery over their practice

 

 

For the law firm that may be welcoming attorneys back, their issues may include:

 

• Confusion about how to support the attorneys
• Uncertainty about trusting them
• Lingering emotional wounds or unprocessed resentments from past behavior
• Reservations about including them in social functions where alcohol may be served
• Lack of education and/or understanding of addiction as a medical disease
• Unrealistic expectations that the individual is “cured”
• Concern about how to protect the firm and the clients in the event of a relapse
• Reluctance to involve them in big cases, major decisions or important client meetings out of fear that they are or will be perceived as “damaged goods”

 

 

While these lists are not comprehensive and every client will face their own unique challenges and obstacles, most return to work scenarios do not pose challenges so insurmountable that they can’t be adequately addressed through thoughtful planning and preparation. At the same time, given the toxic and unsupportive environment frequently present in the law, clients may wish to give serious thought to whether a change of some sort might be in their best long-term interest.

Conclusion  

For a variety of reasons, lawyers struggle with mental health and addiction problems at an alarming rate. While they may face a variety of substantial challenges in their efforts to overcome those problems—including many of their own personal attributes and the work environments they frequently find themselves in—they can and do recover if they receive appropriate treatment that is informed by adequate knowledge of their career-specific issues and that helps them plan for the obstacles they are likely to face.  

 

 

References  

Benjamin, G. A., Darling, E. J., & Sales, B. (1990). The prevalence of depression, alcohol abuse, and cocaine abuse among United States lawyers. International Journal of Law and Psychiatry, 13(3), 233–46. 

 

Eaton, W. W., Anthony, J. C., Mandel, W., & Garrison, R. (1990). Occupations and the prevalence of major depressive disorder. Journal of Occupational Medicine, 32(11), 1079–86.