The Issues of Life in Law: LCL Perspectives

A Word to the (Recovering) Wise

2011-12-23T13:22:00.001-05:00

As the days grow shorter, colder and darker, people find themselves inclined to “batten down the hatches” and stay indoors. This time of the year is known in recovery circles as the “trifecta” (Thanksgiving, Christmas, and New Years). This trifecta creates a very seductive season, with all the commercials, parties, office treats and overabundance of all things sweet, so folks in recovery need to make a very conscious decision to re-commit to sobriety.

If the holidays are for you a joyous time filled with fun and family, relaxation and enjoyment, then hats off to you! If, on the other hand, work is scarce, money is tight, and you are not optimistic about what comes next, or if spending time with family feels like a root canal without Novocain, or simply more of an endurance test than a Norman Rockwell moment, the holidays may require all the determination you can muster to keep yourself sane and content.

Determination to stay sane and content starts with taking stock of what you have and reflecting on ways you can change to meet conditions as they are, recalling you have no control over people, places and things. Regardless of how you feel about the holidays, it is always a good time to think about what you are grateful for, and despite the current difficulties, how it is better than your pre-recovery days of confusion and turmoil.

Remember also that the holiday season, whether good or not so good, will pass – so don’t make decisions about the worth of your life when things are tough…it gets better…nothing stays the same.

The trifecta gives up the opportunity to go to a lot of meetings, reach out to others, and try to find the goodness in as many places as we can!

Making the Most of the Holidays

2011-12-08T12:01:00.001-05:00

The holiday season is once again upon us. Do you welcome it? Dread it? Get depressed by it? Is your sobriety challenged during this season? Most of us have some understandably jaded feelings about the holidays, the annoyingly early and unrelenting commercialism, the non-stop media portrayals of idealized family gatherings, the presumption of abundance, and the pressure to spend beyond our means. In addition, memories, losses, unfulfilled hopes and dreams, and now economic reversals and uncertainties can take the luster off of a season that once held expectations of excitement and delight. The following tips may be helpful in not becoming a victim of the season:

Manage your mind: Depression thrives in that petri dish of negative thought about oneself, others, or life in general. A powerful causal relationship exists between what we think and believe, and what we feel emotionally. Negative thoughts beget negative feelings, which beget negative expectations, which beget negative behaviors, which create a cycle of negativity. An effective way to fend off depression involves being willing to become aware of when your thinking is veering into negative territory, and then consciously and deliberately taking it back into happier territory. Managing your mind takes determination, patience, persistence, and practice. And as with any exercise, you gradually build muscle – mental muscle! And you will gradually feel better and better, both emotionally and physically, the mind-body connection now being a well-established medical fact. A good starting point might be to remind yourself of all you have to be grateful for. Gratitude and depression cannot co-exist for long. An “attitude of gratitude” will change your life.

Participate and give: If you are one of the lucky ones whose life has been transformed by working the steps of AA or another 12-Step program, you are likely to have practiced, in one way or another, all of what is written here, and have learned repeatedly the joy of giving service, lending a hand, 12th-stepping. But you, too, may need the extra support and inspiration of the Program, its members, and its wisdom at this time of year. The opportunities for growth keep presenting themselves, and the Program never fails to offer perspective and hope. Keep going back.

Define your goals: Take charge and ask yourself, “What can I do to make this (or something else) better?” In other words, don’t be a sad victim. Do you want more control over your calendar orpractice management? Call LOMAP. Do you want more energy? Join a gym. Do you want a better relationship with your spouse? Talk (and listen) with him/her about it. Do you want to learn to deal with stress? Call LCL. These self-empowering steps help defeat depression. And when it comes to the holidays, ask yourself what you can do to make it a little happier for yourself and others. And, then, act.

Yes, act! A symptom of depression is helplessness. But helplessness is an illusion, often quite a persuasive or seductive one, but still an illusion. The truth is, if we’re willing, we can all dodge
that sense of defeat by exerting some control over our own lives. (Trying to change someone else is a futile substitute, guaranteed to fail and increase misery.) Acting in our own behalf often involves maintaining a determined attitude, and may require the use of various sources of support such as family, friends, your spiritual community, or LCL.

Take care of yourself, personally and professionally: Respect yourself by taking care of yourself, and you will enjoy better mental and physical health. When you treat yourself with respect, others are likely to do the same. We all know what good self-care means: eat nutritious food and avoid the more available junk food – but enjoy the holiday treats within reason. Sleep – at least 7 hours a day, more if necessary or possible, and take a mid-afternoon nap. Read a good book, take a walk in the woods, have breakfast with friends, go for a run, drop a bad client, or take your spouse to the movies.

Laugh: Especially at yourself. Resist taking things too seriously. Humor doesn’t mean you don’t take your work seriously; it just acknowledges a wider perspective. Keep the funny bone in gear so the kid inside can come out to play when the time right, be goofy even, have some belly laughs; it refreshes both the brain and the spirit and wards off depression. The people you make laugh will always be happy to see you coming.

Plan a vacation: It does not have to be the extravagant trip of a lifetime, although it can be, but plan your vacation time. (If you lack a travel companion, join a tour, or a club; then you’ll have many.) And don’t underestimate the value of one-minute vacations: close your eyes, relax your body, and envision yourself doing what you love. As with laughter, envisioning doing something, or being somewhere you adore refreshes mind and body and can lead to action that turns it into reality. If you can allow yourself to take a vacation.

Adjust your expectations: As a group, lawyers tend to enjoy challenges and set high expectations for themselves, especially at work. For some, seductive financial rewards for unreasonable productivity demands serve to reinforce a potentially destructive imbalance. This is a good time of year to re-evaluate priorities in favor of that which enhances year-’round peace and harmony in both spheres of life – professional and personal, work and love. (Of course, such re-balancing acts can represent a major change and must be carefully thought out, and discussed and planned in conjunction with others who would be affected, maybe even feel threatened, by them.) Balance helps create the conditions for health and happiness.

Change one thing: As creatures of habit and routine, we all know how tough change can be. It’s best to start slow and let the momentum build. Choose just one thing that you can realistically do differently. Consider what will have to shift (Fewer clients? Less TV? Making your own lunch to pay for housecleaning, a babysitter, gym membership? Less complaining?), and evaluate your willingness to make them. Journal your efforts, slips and progress. Keep visual reminders everywhere (write on your bathroom mirror, car windshield, or refrigerator). Enlist the support of a friend, consultant, or counselor to hold you accountable to your intention. Incremental changes are more likely to become habitual. Taking charge of one’s own life is empowering and confidence building and counteracts depression.

Finally, compassionate and good-humored self-acceptance greatly enhances our capacity for genuine enjoyment of ourselves and of others. A healthy, reality-based love of self, warts and all, generates and attracts more love. And love always partners with happiness.

Firm Future Conference Returns for 2011; Free Registration for LCL Blog Readers

2011-11-08T22:01:00.002-05:00

The Firm Future Conference, taking place December 1, is put on by the Warren Group and co-sponsored by Lawyers Concerned for Lawyers, the Law Office Management Assistance Program, the Massachusetts Bar Association, and other Massachusetts legal stakeholders. The conference will feature programs on social media marketing, business development (including law practice start-up), mobile practice, alternative billing, work-life balance and more. Rodney Dowell, executive director of LCL; Barbara Bowe, clinician at LCL; and, Jared Correia, law practice advisor at LOMAP, will combine to appear on several conference panels. Nationally prominent experts presenting at the conference include: Larry Bodine (http://www.larrybodine.com/), of Lawyers.com (http://www.lawyers.com/); Reid Trautz (http://reidtrautz.typepad.com/), of the American Immigration Lawyers Association (http://www.aila.org/); Susan Cartier Liebel (http://solopracticeuniversity.com/about/about-history/_, of Solo Practice University (http://solopracticeuniversity.com/); Jay Shepherd (http://prefixllc.com/jay-shepherd/), of Prefix, LLC (http://prefixllc.com/); and, Alan Klevan (http://www.lawpracticestrategies.com/?page_id=2), of Klevan & Klevan, LLP (http://klevan.hytech.org/).

Visit the Firm Future Conference website (http://www.firmfutureconference.com/), for the complete agenda (http://www.firmfutureconference.com/agenda/index.html), including a full roster of speakers.

LCL Blog (http://lclma.blogspot.com/) readers can register for the program for FREE through November 17.

Click here (http://www.firmfutureconference.com/forms/attendeereg?company=Lawyers%2BConcerned%2BFor%2BLawyers) to register for the conference for free, compliments of LCL.

When You Feel Trapped in Your Work

2011-09-30T15:48:00.001-04:00

Even at a time like this, when most employed people (lawyers and others) are happy to have a job, we recurrently meet lawyers who feel suffocated and stuck in work settings that we have come to refer to as “toxic.” It is crucial, in such circumstances, to work toward a plan of escape, whether that is ultimately by way of leaving the job, effecting changes on the job, or finding better ways to cope, internally, with the situation.

Sometimes, as Sartre asserted in No Exit, “Hell is other people.” While the most obvious hellish person at work may be the boss (such as a law firm partner who applies great pressure but offers no support, or an experienced but burnt out attorney who offloads all difficult cases to his/her underling), coworkers, support staff, and draining clients can also exert a poisonous effect.

Sometimes the accumulating impact of spending months or years in such circumstances results in observable symptoms of stress, anxiety, or depression, manifested for example by sleeplessness, poor concentration, feeling paralyzed in thinking, or even getting panic attacks. (The self-tests at LCLMA.org can be one way to evaluate these syndromes.) Less overt are effects such as increased physical illness, deteriorated relationships, and declining self-esteem or regard for the profession.

One of the most useful psychological tools ever to come down the pike is the Serenity Prayer, well known to anyone familiar with 12-step meetings, and originally composed (with slightly different wording but making the same points) by theologian Reinhold Niebuhr. It distinguishes between things that are outside an individual’s realm of influence, which must be accepted (e.g., the culture of this law firm is unlikely to change) , and those areas in which a person does have potential impact, if one summons the “courage” (e.g., self-assertion with key figures who may have the capacity to listen, acquiring new skills, getting outside help, or changing one’s own ways of perceiving and defining negative situations). Both approaches require developing a level of awareness/ability to self-observe, and a degree of cognitive flexibility.

A major advantage to gaining this kind of perspective is that it can decrease the sense of entrapment and passivity, which in turn is likely to improve one’s mood, outlook, and readiness to grasp opportunities for positive change when they present themselves. It is also important to realize that we are each responsible to prioritize our own wellbeing (including health, some kind of balanced life, some gratification in each day) – external people or environments may severely challenge our personal needs, but they do not hold all the cards.

Many lawyers seem to forget that they need not be completely alone in facing such stresses. Although no one, including LCL, can swoop in and come to the rescue, there is value in having sources of information, new perspectives and tools, emotional support, etc. There is no reason to go it alone.

Our Heroes

2011-08-26T15:01:00.001-04:00

Observed annually each September, “Recovery Month” sponsored by the US Department of Health & Human Services, promotes the societal benefits of treatment for substance use and mental disorders, celebrates people in recovery, lauds the contributions of treatment providers, and promotes the message that recovery in all its forms is possible.

What better time to recognize the success of LCL’s founding members whose commitment to sobriety, perseverance in recovery, generous sharing with their peers of experience, strength & hope, time energy & resources proved time and again that new life awaited the recovering alcoholic. As lives were healed, families salvaged, careers restored, and self-respect regained, our early recovering members, like those entering recovery today, became a source of inspiration and hope to others.

The challenges of recovery faced by our senior membership, however, were somewhat different from those of today. Extensive research conducted over the last 30 years has dispelled much of the ignorance about addiction and alcoholism that gave rise to social stigma and moral judgments. But in those days, discussions of the topic and the afflicted were conducted in hushed tones, or with angry indignation and condemnation. The alcoholic, already disempowered by his disease, was further disabled by disgrace and shame and by consequent deepening isolation. In view of the attitudes of the day, their recovery is all the more courageous and heroic.

Thankfully, things have changed. In the last few days the headlines proclaim that addiction, far from representing the moral issue of yesterday, is a “chronic brain disorder,” with observable and measureable physiological and neurochemical mechanisms that differ from those not afflicted. While this might make the disease a target for high-stakes pharmaceutical interventions, and perhaps a re-categorization by insurance companies, it also, we hope, supports the growing body of evidence that the alcoholic is not to be judged and condemned but medically treated and supported with compassion. Ideally, this information will enable physicians, who are often not comfortable raising the subject of alcohol and illicit drug use with their patients, to now more comfortably make such screening a routine part of their physical exams. And we can hope that its treatment, including relapse prevention, will be viewed like other chronic conditions, such as heart disease, as a long-term endeavor.

‘”The behavioral problem [associated with addiction] is a result of brain dysfunction,” agrees Dr. Nora Volkow, director of the National Institute on Drug Abuse, which estimates that 23 million Americans need treatment for substance abuse but only about 2 million get that help. She adds that doctors and families alike need to know that the frustration of relapse is common for a chronic disease. This expanded understanding of addictive behavior, including alcoholism, does not alter the diagnostic criteria. Symptoms remain the same, and typically boil down to behaviors that are repeated despite the harmful consequences to health, occupation, family, finances, social connections, or legal status. And the affected individuals still have to do the challenging work of recovery, i.e., change their behavior, an effort best made using appropriate treatment resources and recovery supports.

Many recovering alcoholics will hasten to say that alcoholism defined as a “chronic brain disorder” is not new information to them. They learned about their disease and what they had to do to manage it from the Big Book, from meetings and their peers in AA, from the self-discovery made possible by their work with their sponsors and therapists and 12 Steps, and from the perspective afforded by their own lives transformed from bondage to freedom. How could anyone have anything but deep respect for those who have confronted their disease, met the difficult challenge of behavioral change, addressed old wounds to self and others, and who keep moving forward, one day at a time - ever mindful of where they have been, of those who have helped them on their journey and those now in need of their support. Is a more complete life possible? LCL is proud of its members, and still considers it a privilege and priority to support and serve those in recovery, and those seeking recovery.

Another Look at Lawyer Suicide

2010-11-19T13:00:00.005-05:00

Over a year ago, my first LCL blog of any substance dealt with the issue of lawyer suicide, at a time when 3 prominent lawyers had recently ended their lives, leaving many others not only saddened but also perplexed in a “Richard Cory” way. (For anyone unfamiliar with this reference, click here and also click here.)

Today, in the usually futile effort to reduce the pile on my desk, I came across Richard Schmitt’s article, “A Death in the Office” in the November 2009 issue of the ABA Journal that comes to the LCL office. Schmitt details the abruptly self-terminated life of Mark Levy, an ultra-capable, widely admired attorney with a seemingly perfect academic and professional background specializing in appellate practice.

This is a case that feels closer to me because, though I never knew him, I discovered that Mr. Levy was my classmate at Yale College (where, while I got by and spent most of my time on a cappella singing groups, he graduated summa cum laude). He went on to excel at Yale Law, then to clerk for the judge involved in both Watergate and the Pentagon Papers, and subsequently worked for a series of prestigious law firms as well as spending some years at the Justice Department.

Despite all of his accomplishments and a record of both successful cases and professional generosity, he was not adept at marketing or drumming up business. Like so many others in my generation, his values and grooming were oriented toward being a professional, valued for intellectual achievement and service to his society, not so much a businessman, valued for talent at making money or enhancing corporate growth. My own health-related field, too, has become a big business, with mega-hospital conglomerates competing for a piece of the insurance pie even as insurance companies vie to maximize shareholder profit -- and business sense tends to trump clinical savvy for those who flourish nowadays. This shift has come over our society as a whole, and there seems to be no way to turn it around (any more than to decide that the world was better off without Twitter and Blackberries), but it’s a shame.

One of my first clients at LCL, back around 1998, was a 50-ish man who had graduated Harvard Law. When he graduated, in the mid 1970’s, just doing a good job led to word-of-mouth referrals, and he made a fine living in a suburban solo practice. By the time he saw me, never having fancied himself a self-promoter and responding too late to the new realities, he was unable to keep up with the monthly obligations of supporting his family. And this was long before the economic meltdown.

At a much more elevated level, Mark Levy found that, distinguished career or not, he had become a commodity of decreasing value, having moved from one law firm to another in recent years. Taking his life in the very office from which he was being evicted (not even permitted, given his firm’s mentality, to remain there unpaid for a transitional period ) may have served partly to make a statement about today’s professionals –- disposable.

On an individual level, however, one wishes that no one would absorb that notion. So many lawyers have come into my office in a state of disappointment with their careers, alienated from their profession, unable to make enough of a living, etc., understandably exhibiting a depressed mood and perspective. Embedded in their reactions, to some extent, is an acceptance of the prevailing notion that financial success is the measure of personal and professional success. They are naturally hoping that someone will offer a straightforward solution, a way to switch career tracks and be redirected toward success (money, position). The reality for many of them is that they will need to cut back on lifestyle, make adjustments in their practices, maybe sell the house before it is foreclosed upon, and walk through a kind of grief process, mourning their former expectations, before turning the page to what can be a satisfying new chapter.

To psychologically survive such changes, it is important not to equate the vicissitudes of the professional market with any valid measure of one’s own worth. Rather, lawyers who face unanticipated setbacks must connect with the values and missions that originally inspired them to enter the profession, and continue to respect their own qualities and talents, even as they remain active in taking practical steps to readjust and reconfigure so as to make a living. Though there may be a reflexive or shame-based impulse to pull away from friends, family, and colleagues, these are the times when it matters most to connect with others, engage in new learning, find new ways to make an impact (even through endeavors that may produce no financial reward), and maintain hope for ultimately finding a new path that may even be more gratifying than what came before. In order to be at least partially immunized from the ever-changing environment, it helps if a healthy portion of the reward for one’s work comes from within.

When we, at LCL, seek to connect disheartened lawyers with therapists (especially those lawyers who are loathe to burden friends with the wounds to their self-esteem) or with career coaches or our comrades at the Law Office Management Assistance Program, or to our own recurrent Layoff Group series, it is because we see the potential for finding such a new path. Equally important is the recognition that to focus one’s sense of identity and value too much on career status (and too little on family, community, the arts, nature, reflection, charity, fun, etc.) is to accept the faulty notion that personal worth is a function of supply and demand.

Counterpoint to Myself (re plight of new lawyers)

2010-10-28T12:29:00.002-04:00

Inasmuch as my previous post (“Is the Legal Profession Neglecting its Young?”) could be considered a bit inflammatory (though it is meant solely to support the needs of the profession’s newcomers), allow me to convey some additional information provided to me by lawyers within the walls of our suite.

With regard to the sorely missing training element of apprenticeship:

• Some states do offer some kind of apprenticeship. Delaware and Vermont require at least a few months (Delaware, 5; Vermont, 3) of full-time clerkship in a licensed lawyer’s office in order to be eligible for admission to the bar.
• Some other states, including New York, permit law students to behave as lawyers in certain settings, offering but not requiring the opportunity for this kind of real-life experience prior to independent practice. Here in Massachusetts, Northeastern University School of Law’s co-op program provides each student with four distinct 11-week work experiences in real-life settings as a standard feature of legal training. Some other law schools provide a “clinical” component that also offers some exposure to real legal work under the supervision of a licensed attorney with a Supreme Judicial Court Rule 3:03 certification. (This is more analogous to the practicum components of other kinds of graduate schools than to the post-graduation internship and supervised work experience.)
• A limited number of students each year who attend University of New Hampshire School of Law are permitted to bypass the bar exam by participating in a program of supervised practice.
• In Vermont, Virginia, California, and Washington, one may actually be admitted to the bar without having attended law school, but having instead spent an extended apprenticeship under the aegis of a judge or licensed lawyer.
• Many countries do require (and thus offer) an apprenticeship after achieving a law degree. These include: China, Israel, Japan, Belgium, Denmark, Finland, Germany, Ireland, Italy, Netherlands, Sweden, Switzerland, United Kingdom, and Canada. [This list of countries comes from Wikipedia, so we cannot fully attest to its accuracy. Other information provided above was confirmed via review of official state or university web sites.]

With regard to deficiencies in availability of post-law school education and guidance:

• For help with practice management (as opposed to the how-to of handling cases), Massachusetts attorneys are fortunate to be able to get guidance from the LOMAP program, in areas including marketing, technology, proper handling of client funds accounts, etc. Also useful in this regard is are the articles posted on the Board of Bar Overseers/Office of Bar Counsel web site, covering a wide array of topics.
• Although Massachusetts does not require continuing education, according to the ABA (http://www.abanet.org/cle/mcleview.html), all but 6 states do.
• While available mentoring programs are limited in their scope and intensity, they are available in one form or another through various bar associations. Our widely knowledgeable colleagues at the LOMAP program have offered two very useful blog posts on locating mentors, which you may access by clicking these links: http://masslomap.blogspot.com/2009/02/finding-mentor-tool-for-success.html, http://masslomap.blogspot.com/2010/05/mentor-de-perseverance-mountain-legs.html .
• Despite the paucity of guidance offered in any routine fashion to new lawyers, a lawyer who puts enough energy into the legwork can, I am told, develop his or her own cluster of mentors by continuing to approach candidates and not being deterred by those who decline.
• More so than in the clinical professions, sufficient reading/research (accompanied these days by all kinds of listserv options), can elicit much of the guidance a lawyer needs to address novel challenges. Resources include West Law’s Mass Practice, LexisNexis, Social Law Library, ABA’s SoloSez listserv, and more.

So, although the legal profession generally offers much less than other professions in structured, routine guidance and grooming, it’s out there for those who go after it. Those newly admitted to the bar must recognize that, even without formal requirements or supervised experience, their professional education is by no means finished upon obtaining the degree.

Is the Legal Profession Neglecting its Young?

2010-10-21T13:33:00.004-04:00

Physicians follow their academic training with years in hospitals, through internship and residency, partly as cheap labor, but under the watchful/critical eye of more experienced physicians. Psychologists follow their years of classes with a year’s internship and two years’ supervised experience (generally in a clinic or hospital) before they can be licensed for independent practice. Social workers must also garner two years’ of closely supervised clinical experience before seeking independent licensure. Nurses, teachers, barbers, etc. all have mandated mechanisms for apprenticeship before allowing novices to go out and practice on their own.

Not so for most lawyers. After a mere three years in law school, and usually very little exposure to the real-life practice of law, new attorneys leave the nest on their own and, to mix metaphors, dive right into the deep end. Those who obtain employment in agencies or large firms at least have some kind of structure in place to undo their mistakes and provide some kind of quality control, though many find that they are highly stressed, given little guidance and many demands. But the many, many new lawyers who jump right into solo or small firm practice are often forced to learn on the job, making their inevitable mistakes at the expense of real clients. Those who care deeply about doing the best job often develop anxiety symptoms. Those who are less troubled by such worries may find themselves doing things that could come back to haunt them by way of undesired input from the Office of Bar Counsel.

Overwhelmed young lawyers may also find it harder to justify taking the time for continuing education courses – these, too, are mandated for health professionals, teachers, etc., but not for Massachusetts attorneys.

I am not pointing any fingers – this is the way the profession has evolved, and systems that are firmly in place are notoriously difficult to change, even if there were a consensus. Given this perilous state of affairs, it is impressive to recognize that, in the vast majority of cases, it seems that no great harm comes to clients or to lawyers’ careers (aside from stress-induced effects on health, family life, etc.). Is this because new lawyers get case-specific help from their more seasoned colleagues? Not so much.

Some bar associations have mentoring programs, generally offered in a group format, that provide a helpful kind of overarching support, but not specific advice on what to do at the moment when a lawyer, trying to appear knowledgeable, is suddenly confronted by an unforeseen development in the evolution of a case. When I was a new psychologist, as anxious as I felt when a patient seemed potentially suicidal or otherwise unsafe, it was immensely helpful to know that I could contact my clinical supervisor for guidance. In the analogous legal situation, some new attorneys are fortunate enough to have personal relationships with voices of experience, or are assertive enough to track down those they don’t know but who are often kind enough to offer their perspectives. (At least one other setting reportedly provides close supervision to newer attorneys: agencies that operate under the Committee for Public Counsel Services.)

When new and anxious practitioners come to LCL for consultation, we try to help them identify and pursue sources of helpful input. In some of our discussion groups, like the Solo Practitioners Forum, they get support. But let’s hope that, over time, the profession itself will find additional ways to guide its progeny into the jungle of real life practice.

[Coming very soon: Counterpoint to the above.]

BEHAVIORAL HEALTH COVERAGE -- COMING BACK TO THE PARITY

2010-08-09T16:28:00.002-04:00

One of our main activities at LCL is referring lawyers, law students, etc to see behavioral health professionals. In my blog of August 2010, I briefly described the history of efforts to achieve insurance coverage for mental health and addictions treatment that was roughly equivalent to coverage for physical conditions. Laws with this purpose have been known as “mental health parity” laws. [None of this pertains to the more recent health care reform package.]

A major improvement of the Massachusetts parity law of 2000 came in 2009, when alcohol/drug abuse/dependence, as well as eating disorders, PTSD, and autism, were added to the list of diagnoses for which coverage was mandated. These illnesses, like those already included (e.g., major depression, bipolar disorder, schizophrenia, panic disorder), were no longer subject to arbitrary maximums of treatments, and even less severe conditions had to be covered up to 24 outpatient visits a year.

Then, the new federal parity law was to take effect in 2010, apparently bringing all psychiatric diagnoses under the parity umbrella, and applying even to most self-insured plans (which had been excluded from the state law, along with MassHealth and Medicare).

But things have become murkier with the advent of 2010. Some or all of the federal law seemed to be on hold and awaiting feedback until July. And I have not found any finalized word in my own Googling efforts. However, I notice that at least some Massachusetts insurers who post benefit information on line are no longer providing information about treatment maximums (which may suggest that the maximums no longer apply).

The upshot is that the chances that your behavioral health treatment will be covered are probably enhanced with the convergence of the federal and Massachusetts parity laws. But certainly you should be prepared for exceptions, which include plans through employers with 50 or fewer employees, and insurers may still find a way to exclude some conditions. And don’t forget that, if you have an HMO (and even the rare PPO, such as the Harvard Pilgrim plan now available through the state’s GIC program), no services will be covered without pre-authorization. Through the process of pre-authorization, the managed care company will determine how much treatment is “medically necessary.” Even without maximum numbers of visits, the mere fact that you and your treatment provider believe that therapy/counseling is indicated does not mean that the insurer will agree that they should be paying for it.

Although coverage remains as uncertain and ambiguous as ever, the overall trend is toward improvement. And though I wanted you to be an informed consumer, aware of the pitfalls, I certainly do not want you to use these complexities as an excuse to avoid getting the help you need.

Unsolicited Advice to Lawyers with Associates

2010-06-07T13:28:00.001-04:00

Since I joined the LCL staff in 1998, I have personally seen 2 or 3 lawyers a year who come in distressed, and often depressed, with regard to their role as associate in a law firm. In some cases, they function as sole underling to a seasoned veteran who has taken them into an otherwise solo or small practice. In other cases, they are making a big income with a giant and prestigious firm. In either situation, the associates that I see (who are, of course, self-selecting to come to LCL) are struggling to keep their heads above water.

They complain that they feel swamped with work demands, but ill-equipped to do a good job. The more senior attorneys to whom they answer are quick to point out the associates’ errors, but mostly unavailable to provide guidance. (In some cases, their “door is always open,” but on most given occasions they are too busy.) In a small practice, the associate is sometimes in the predicament of having to try to juggle many different kinds of cases at once, all of them with little previous experience, further reducing their chances of attaining mastery. They have little or no say about how they are to spend their time or how a case is to be addressed (i.e., the senior attorney expects that it will be handled just as s/he would have done). Many of these individuals were highly successful in law school and now feel much less competent, humbled if not humiliated.

Some of these associates blame the seemingly uncaring boss to whom they answer. Others blame themselves. Either way, as their mood declines, so does their productivity. They respond by working more hours. As their home lives or social lives deteriorate, their lives become less balanced and they are less able to function in a healthy way. Eventually, they either make it through this “rite of passage,” gradually master the needed skills, and re-achieve personal equilibrium, or they leave the firm. In some firms, large and small, the turnover rate is high.

From a psychologist’s point of view (and these thoughts are influenced by the writings of Dr. Martin Seligman, father of “positive psychology,” who has addressed himself to depression-promoting aspects of the lives of lawyers), if someone running a law firm wanted to keep the firm’s associate(s) happier and more productive, and to retain more of these newer lawyers for a longer period once they have learned the ropes, one might do some of the following:

• Provide actual mentoring, not just oversight. Take some time, even one uninterrupted hour a week, focused entirely on the associate’s questions, concerns, and ideas. The time you invest will likely pay for itself in the associate’s increased productivity, flowing not only from the concrete information and advice that you can provide, but also from his or her increased effort in response to sensing your support and interest.

• People are generally more productive (and happier) according to Seligman and others, not to mention common sense, when empowered to have a say in what they do (what he calls “decision latitude). That suggests that your associate will do better if there is some discussion about what s/he will do and how, and if the associate has a voice and choice in determining how their time will be spent. That is likely to include a chance to master certain kinds of tasks before plunging into others.

• Different associates are likely to have different strengths, based not only on past experience/learning but even more on personality and native talents. You can utilize a win-win strategy by noticing and capitalizing on their particular strengths, increasing their sense of efficacy and optimizing their contribution to the firm.

My sense is that such efforts will pay off in productivity, retention, interpersonal atmosphere, decreased conflict, etc. Meantime, LCL remains a consultative resource for those (at any level of the hierarchy) who find their work environments a source of stress and dysfunction.

Integrity Among Lawyers (and Others)

2010-03-04T11:00:00.005-05:00

[The following thoughts arose out of discussions of some of the struggles endured by members of the LCL Solo Practitioners Forum that I facilitate.]

There is no greater delight than to be conscious of sincerity on self-examination. (Mencius)

A legal task took less time than you expected. Although ample funds are sitting in the client funds account, you bill only for time actually spent.
A practice that is profitable but ultimately irresponsible has gained momentum in the law firm that employs you. To the extent that it is improper, responsibility for it is spread across the whole firm, including those in positions of greater power than yours. Despite that, and the fact that raising the issue may have a negative impact on how the partners view you, you speak up.
You find yourself burning the midnight oil, putting an inordinate amount of effort and diligence into a family law case on behalf of a client who you know will probably never pay you; but you do it anyhow, even though you wish you’d never met this client.
You find that you can board a Green Line train to work from a rear door by merely waving any card, and you watch others do so and take their seats. You bother to walk to the front of the train and pay the $2, by which time no seats are left.
A fellow lawyer, you observe clearly by her behavior in his office and in court, is in rough shape, not firing on all cylinders. Though you hate to intrude into someone else’s business, you can see that she is on a path toward harming clients and her own career. You express your concern and offer to go with her to LCL for a confidential assessment, knowing full well that the suggestion may well elicit an angry, defensive reactio

Nothing is at last sacred but the integrity of your own mind. (Ralph Waldo Emerson)

Issues of integrity arise (whether or not consciously acknowledged) in all our lives every day – perhaps even more so in the lives of lawyers, who on the one hand sometimes find themselves representing the interests of the dishonest and vile, and on the other hand operate within an intricate foundation of laws that would seem to require an honorable respect in order to remain standing.

Fear of discovery, punishment, humiliation, etc. is, of course, a major help in making responsible choices in the face of all the short-term rewards of cheating. That’s a major raison d’être for institutions such as the auditing wing of the IRS, or the Office of Bar Counsel. But it has not stopped the Bernie Madoffs or Bernie Keriks of the world (no offense to people named Bernie), or those who ignored construction standards in the Big Dig, or those scientists and pharmaceutical companies who publish only studies supporting their (profitable) propositions and ignore contradictory evidence, or … well, you know all of this. And the fact that so many people, so much of the time, ignore social values and go for quick profit (even your personal trainer who demands to be paid in cash) makes it all too easy to rationalize doing the same.

But there is an upside to behaving ethically, responsibly, and maintaining personal integrity. You go about your life without fear of being “caught.” You do not carry the burden of guilt, or go to great lengths to escape awareness of that guilt. To the extent that “what goes around comes around,” you are ready for what comes around. Your friends and associates come to trust you, and with reason. Your knees don’t shake if you get a letter from the BBO (at least not as much as some other lawyers’ knees). If you believe that the purpose of life is to amass the most money or fame in the shortest time, you may be disappointed. But, as they say, you can look at yourself in the mirror. Your clients, coworkers, bosses, and friends may never notice, may never thank you. But inside, where it counts, integrity must be its own reward.

This above all; to thine own self be true. (William Shakespeare)

The Many Demands of Solo Practice

2010-01-30T18:27:00.002-05:00

The other day I was telling a colleague about the lives of the lawyers who attend our monthly Solo Practitioners Forum. In the process, he and I both realized that running a solo practice requires a surprisingly long list of skills. Some of them are:

· Legal/Intellectual – this goes without saying, and calls upon much of what you learned in law school and in subsequent reading and continuing education, but no one can know it all. A major problem arises when lawyers, not recognizing their limits, fail to ask for guidance from someone who knows more about a particular subject.

· Accounting – unless you have paid staff, you have to log your time spent, bill your clients, and keep track of where your accounts stand. I can’t tell you how many lawyers I have met who are months behind in billing. For some of them, it’s because they are uncomfortable asking for money, especially from clients they know are far from well off. (Naturally, this is easier when someone else asks on your behalf.) They may feel a degree of shame for billing for services that were, perhaps, not delivered in a timely fashion. Or they may just have a brain that is allergic to columns, rows, and figures.

· Marketing – there may have been a time when just being a competent lawyer would eventually create enough word-of-mouth referrals, but that is no longer enough. Aside from CPCS as a ready source of (low-paying) referrals, the solo practitioner must figure out ways to get business. For most, it’s uncomfortable and oh-so-avoidable to contact people asking them to send business your way, or, for example, to do public speaking or spend a bunch of money on ads.

· Interpersonal – a slew of interpersonal skills are required to know how to deal with a variety of clients with different personalities, not to mention legal adversaries, judges, clerks, etc. – each of whom calls for a different approach. It helps to be able to read body language, discern unspoken agendas or expectations, etc., and to consciously manage your own reactions to individuals who “press your buttons.” Some practices call for evolved skills in negotiation or persuasion. And some clients behave in ways that require diplomacy in the form of clear limit-setting so as to avoid burning out or losing your temper.

· Organizational – in order to make a living, any lawyer has to be relatively efficient and productive. Most clients would not care to pay for your hours spent in reverie, even if you are finding parallels between their case and your readings of Proust, never mind Facebook. So you need to schedule yourself, keep yourself motivated, keep on top of deadlines, and prioritize tasks by importance, urgency, etc. Those who work at law firms have others around, and to whom they answer, to notice if their noses veer from the grindstone, or if they are putting undue work into matters that don’t demand it, or if they are taking too long to get back to clients, but those in solo practice must be their own overseers.

I’m sure that there is much more, but it becomes obvious how many skills and tasks must be juggled in order to carry on a solo practice. In order to thrive, and stay out of trouble, it is important to be aware of how you are doing on each dimension – few people could be adept at all of these functions. Identifying real deficits in any of these areas calls for action, such as delegating some tasks or getting further training or coaching for yourself. Those who attend our Solo Practitioners Forum use the opportunity to clarify, vent, brainstorm, and seek solutions. But that group is not always the right option for the lawyers who come to us for assessment; sometimes the thing that helps most is a referral to, for example, an organizational coach, mentor, or counselor. We also frequently refer to the Law Office Management Assistance Program (LOMAP), which is funded by LCL. It makes sense for practitioners to make use of such resources when you realize just how demanding and multifaceted a job they face.

Universal Coverage? Not Exactly

2010-01-04T18:25:00.001-05:00

On occasion, the “universal” health coverage system initiated in Massachusetts during the Romney administration and sustained in the Patrick years has been pointed to as a model of what might be accomplished on a national scale. As the various kinds of “public options” seem to be fading away, it looks even more similar – adding a requirement for all citizens to arrange coverage, without any substantial renovation in the system (e.g., there is clearly no appetite for adopting the kinds of systems found in most other countries, even though many of them reportedly offer better care at much lower expense). It is quite understandable that the idea of losing our familiar forms of medical coverage triggers anxiety in most of us. The Massachusetts plan does have a kind of “public option,” but it has not made coverage truly universal. The problem, and I am not claiming to have the answer on its solution, is that many citizens, having no way to pay for the mandated coverage, continue to go without it. [Let me be clear that I am taking no political side here, since there are clearly drawbacks in any approach that has been proposed – my concern is strictly for those who need care that they cannot get.]

Personally, I was very pleased when the Massachusetts plan came along, because I had been able to present few treatment options to lawyers who came to LCL (or others who consulted with me elsewhere) in need of therapy or medication but with no means to pay for it. Publically subsidized clinics and mental health centers had long since become unable to offer truly low-cost services (probably since the end of the Dukakis administration), so the main option remaining was to refer people to community-oriented hospitals drawing upon a statewide “free care pool.”

Little did I suspect that I would be faced with a significantly larger number of uninsured lawyers after the advent of “universal” coverage here in the Bay State – and virtually nowhere to send them (since the free care pool subsequently diminished or disappeared).

I don’t think that the advent of expanded coverage itself could have caused an increase in numbers of uninsured middle class citizens – that must be a reflection of the economy – and I’m sure it has reduced the number of uninsured citizens in dire poverty. [I don’t have evidence that the trend toward more uninsured even extends beyond lawyers who come to LCL, but there was no mistaking it among those I saw there.] Aside from imposing state income tax penalties on those without coverage, the new Massachusetts plan brought about two main changes in coverage options: (1) private insurers began making some more affordable plans directly available to consumers and (2) the state began offering its Medicaid plan, MassHealth, to a significantly expanded group of residents, under the name of Commonwealth Care.

But consider the case of an LCL client (or other citizen) with a spouse, 2 kids, and a combined family income of $70,000. The private insurers have developed stripped down plans, with less extensive coverage resulting in lower premiums for young adults -but not much lower for those who have reached middle age. So, what about the public option, Commonwealth Care? In order to qualify for Commonwealth Care (the application is somewhat cumbersome and processing takes well over a month), your income must be less than 300% of Federal Poverty Guidelines. For our hypothetical lawyer/consumer with a household of 4, that means under $66,168 – and he will still have to pay about $1200 a year in premiums. In order to get the least comprehensive plan and not pay premiums, the annual family (of 4) income would have to be under $33,084. An individual (family of one) would have to make less than $16,260 to receive fully subsidized coverage. (That individual can get Commonwealth Care with an income of under $33,084, but would be paying premiums.) Of course, just like private insurance, the plan also requires co-pays for office visits and prescription drugs (with an annual cap on out-of-pocket expenses).

Thus, more than one lawyer seeing me at LCL has demonstrated that, since s/he makes too much money to qualify for Commonwealth Care, there is no way to afford health insurance without giving up, say, food, the house, or the car. They can better afford the tax penalty. Certainly, hospitals will not throw them out on the street if they require emergency care. But for less urgent services, and certainly for most LCL referrals, consumers are on their own – “free care” is apparently difficult or impossible to come by. As the state’s coffers empty, the capacity to subsidize coverage may further erode. At LCL, we do what we can to help, but too often it is simply not possible to arrange the kind of treatment to which we would refer any of our insured clients. This may be the best that can be realistically expected in this place and time, but it is not “universal” care.

If you live in Massachusetts and currently lack health insurance, here is how to find out what you’re eligible for: Get on the internet (at the library if you don’t have it at home), and go to www.mahealthconnector.org. Click “Individuals and Families” or “Young Adults,” whichever applies, fill in the requested information (e.g., family size, income), and you will be led to either the opportunity to apply for Commonwealth Care or to a selection of private health plans, with information on their costs and benefits. If you are still left in the cold…. Well, let’s see what happens on a nationwide level…….

Taking on Depression: The Bottom Line: No Laughing Matter

2009-12-11T17:44:00.002-05:00

The need to make a change in order to overcome depression has been the theme of this series. The mind, heart/feelings, and body are the 3-in-1, highly reciprocal triumvirate of the human personality. Change the mind, and the emotions and body respond. Change the body, and the mind and emotions respond. Change the feelings, and the body and mind respond. Therefore, when it comes to depression, there may be a variety of access points to begin to leverage change.

If you are someone who struggles with mild to moderate depression, you may find the strategies described in this series very useful, enlightening, and effective. If you have a persistent moderate depression, and experience difficulty implementing and/or benefitting from these approaches, you should consider “hiring” a good therapist to help you support and focus your efforts to change. In some cases, the use of medication for a period of time can help you get some traction to the point that self-reinforcing behaviors begin to “take,” and for many the need for medication diminishes.

Depression is no laughing matter and should be addressed as early as possible, preventing a more severe decline in mood. A long-standing, severe and entrenched depression is often best addressed as a medical problem, and anti-depressant medication is often necessary, perhaps for an extended period. In such cases, symptom reduction via medication can make it possible to make better use of psychotherapy to address deeper needs, wounds, beliefs, and losses.

Fundamental to these deeper sources of depression are troublesome undercurrent human emotions such as fear and anger. When, despite the discomfort associated with them, fear and anger are consciously experienced and acknowledged, i.e., when you “own” them, as some say, they have less power over you, and offer useful information about your personal experience. You are then able to respond, rather than react, with constructive, responsible, decision-making concerning the situations/conditions that evoked them. In so doing, you are no longer victim; you reclaim and exercise your power.

One of the issues to be addressed in psychotherapy may be what I call an unconscious commitment to depression. Sufferers of long-term depression may be quite aware that they are depressed, may even be quite aware of many of the root causes, but they may be quite unaware that their depression has become a part of their identity, that they are unwittingly clinging to it, trapped by their grief, and by their vulnerabilities and fears of a fuller engagement in life with all its surprises, disappointments, and responsibilities. When this is the case, they may refer to their depression as “my depression,” see themselves as defined by their depression, and anticipate feeling quite lost without it. They may doubt their capacity to even imagine feeling truly good, truly alive. No wonder depression can be, for some, so insidious and tenacious!

Depression can have an insidious affect on loved ones as well, as the sufferer of long-term depression may also unwittingly hold and subtly communicate an expectation that others understand and be complicit with their limitations. However, for others to take responsibility for, or somehow participate in the depression, only serves to generate guilt and resentments that tend to feed and “spread” the depression. The challenge for family members and friends is to offer compassionate acceptance and support without infantilizing or buying into the loved one’s incapacitation, and to insist that the depressed person obtain treatment. To curtail their own enjoyment of life in any way, or succumb to guilt for being happy or having fun when their loved one may be miserable is a type of co-dependent behavior that serves no one, especially not the depressed person. It is therefore important that family and friends take care of themselves and allow themselves as full a ration of fun and enjoyment as possible.

There ought to be no shame in suffering from depression, and no stigma for seeking help. Depression is part of the human experience, and severe depression is now recognized as a treatable medical condition. Combination therapy that may include medication, psychotherapy, and use of techniques such as those offered in this series are generally quite successful and offer the participant valid hope for change and the prospect of becoming more happily and gratefully engaged again in life.

When you take on depression, you are taking on a challenge; the longer and deeper the depression, the greater the challenge. Whether you struggle with a low grade, a moderate, or a severe depression, you can overcome it with persistence, determination and patience. Strive for progress, slow steady progress, and take it one day at a time, employing at least one strategy every day, starting as early in the day as possible. Keeping it in the day, so to speak, can help free you from the failures or regrets of the past (and we all have them) and protects you from anxieties about the future.

For many, overcoming depression, whether accomplished through self-help strategies or with professional help, is a learning, letting go, and self-acceptance process: learning how to be happy, letting go of (or becoming reconciled with) those conditions or parts of yourself that have held you back, and embracing yourself with compassion and humor.

Taking On Depression: Part 5: Body Language

2009-11-19T12:12:00.001-05:00

Just as you can change the focus of your thoughts (the content of your mind) in order to change your mood, you can also elevate your mood by doing a variety of things with/for your body. The most immediate change you can make may simply be your posture. Most of us prepare ourselves for our reflection in a mirror by making little adjustments before we look. But I dare you to take a candid look at yourself in a full length mirror. What do you see? Do you need to tuck in your tush and your tummy, straighten your back, lift your chest and relax your shoulders, tuck in your chin? Having done so, do you feel even a bit more self-possessed? More dignified? If this is not your usual, commit yourself to making it so, and every time you become aware that you are slumping or slouching, tidy it up. You’ll look better and feel better.

How about your face? Many of us are surprised by what we see when we’re caught by surprise in a mirror. We may see a furrowed brow, grim mouth, tense jaw, protruding chin, or other signs of tension. Many of us do store tension in our faces, so while you’re correcting your posture, put on a happy face, or at least release the tightness around your eyes, your brow, your nose and cheeks, your jaw and mouth. If you’re not smiling at this moment, think a pleasant thought and smile. The way you now feel is your proof that even smiling to yourself can shift your mood. You can give yourself the further enjoyment of smiling at others, including strangers, and watching their mood shift along with yours.

Then there’s the matter of exercise. Everyone knows about endorphins, the body’s natural mood enhancers, which are produced by aerobic exercise. You may know from your own experience that regular exercise is energizing and boosts self-esteem right along with the immune system and general fitness. The endorphins help lift mood, and so does exercising the self-discipline to do something you know is good for you. If you exercise with gratitude for a body that is able to exercise, regardless of your level of fitness, and further, do so mindfully and respectful of your limitations, you ramp up the benefit even further.

So, even simple things that you can do with and for your body can improve your mood. Anthony Robbins, the hugely successful motivational speaker acquired his material from exhaustive research as well as from his own experience overcoming major depression. One self-observation he made is somewhat similar to the “fake-it-‘til-you-make-it” strategy, or acting “as if.” At a time when he saw himself as an utter failure, he realized he immediately felt better by simply carrying and presenting himself as he would if he felt great about himself, i.e., by carrying himself straight and tall, by looking others in the eye, smiling and showing some interest in them, all actions that typically elicited positively reinforcing responses. By taking a shower, donning clean and self-respecting attire, shaving and combing his hair, correcting his posture, and being willing to smile, he came to realize how much power he could exercise over his own life and sense of well-being.

For him, this was the beginning of his implementation of a daily routine of deciding and visualizing what he wanted for that day, including what he wanted to accomplish, how he wanted to interact with others, the attitude and mood he wanted to carry, and how he wanted to respond to annoyances and frustrations. This harkens back to the previous blog addressing what you want. It is obviously helpful, therefore, to engage the mind in a manner that supports what you are doing. So, if you find yourself thinking, “That may work for some people, but not for me,” then transform that thought to something like, “If it works for others, it will certainly work for me, too.”

Any discussion of caring for your body is incomplete without talking about “fuel.” It is common knowledge that a balanced diet low in sugar and fat is good for the brain and body and that both diet and exercise are critical to health maintenance and longevity. We all know the difference between good nutrition and junk food; we’ve been hearing the data and the warnings for years, decades really. You need not be a purist. I, for one, am a believer in the benefit of my daily dose of chocolate (rarely just one square). And I consider a slight excess of carbs to be one source of soul food. But without good nutrition, the amazingly adaptable and most forgiving body will begin to cause you problems and expense far greater than that of providing yourself good nutrition. Yes, it does take effort to budget the necessary time and money, but doing so is, again, self-empowering and helps lift and maintain a good mood.

Well, you may say, I can manage all these things quite comfortably when I’m not depressed. When I’m depressed, it’s more of a struggle to motivate myself and may even feel impossible. It is true that it may feel impossible, but it is not true that it is impossible. It may help to remember that you don’t have to do everything all at once. You can start by just doing one thing, even one very small thing, until it becomes routine, and then add another action. Do not permit yourself to be seduced by the feeling, but stay focused on what you want and what you are going to do, and then put yourself in motion. And don’t indulge in discouragement if results are not stellar at first. Persist and you will get your results.

Think about this: what impression would you like to create in the mind of someone meeting you for the 1st time, or even for the 1st time today? What do you want the “take away” to be from your encounter with another person today? Do you want it to be productive, useful, pleasant, fun? Do you want to relax and enjoy it and for both of you to walk away from it feeling at least generally positive? Imagine yourself engaged in such an encounter and then play it out in your interactions. If you can imagine it, you can do it, however much practice it may take. If you fear that making changes such as those suggested here will be too “out of character,” too noticeable to others, or evoke comments or compliments, don’t be deterred. In response, you can just smile mysteriously and say that you’re conducting a scientific study.

For some who are battling depression, the thought of having to make such an effort indefinitely may be overwhelming. Do it just for today. “Yesterday’s gone, tomorrow’s but a dream.” Commit to doing something just for today. Changing your behavior, i.e., your posture, your face, your care of your body, your energy, in some small way may produce an initially imperceptible difference, but the momentum builds. The long term results of persistent small changes can be huge.

Taking On Depression: Part 4: What Do You Want?

2009-11-09T10:15:00.002-05:00

Overcoming depression is about change. Last time I talked about changing your thinking by focusing on thoughts of gratitude in order to generate the energy to act, to make further changes, to get where you want to be. For many with depression, especially long term depression, thoughts about what you want may have become habitually secondary to what you think others want from you. Early childhood experiences that honed your vigilant attentiveness to others’ needs may have represented an instinctive and necessary, i.e., adaptive survival strategy. While sensitivity and responsiveness to others’ needs can be rewarding, maybe even lead to a career path as a lawyer that employs your valuable people skills, it can also become an impediment to your discovery of what you really want and need, to what will enable you to experience “authentic happiness,” not just win others’ admiration and approval, and perhaps a spurious sense of security.

A common manifestation of this impediment is what is increasingly referred to as “codependency,” a relationship of mutual dependency based on an implicit bargain in which “I take care of you and you take care of me,” in which both parties avoid having to take full responsibility for themselves. While self-sacrifice is a part of all healthy committed relationships (spouses and parents do it all the time), sacrificing oneself in order to avoid something difficult, or to leverage payback from the other is a form of avoidance or manipulation. Whether it occurs in a personal relationship or a professional one, it is somewhat dishonest, self-defeating and disempowering and inevitably creates resentments, disappointments, feelings of victimization, and possibly depression.

Some have never learned to give themselves permission to want and to dream, to know their own feelings and wishes, or have done so in a very limited way. Some may be very clear about what they want in one sphere of their lives, say the professional sphere, and much less so in their personal life, e.g., the successful lawyer who lacks close satisfying personal relationships. So, how do you begin to identify what you want? One place to start is to simply think about what makes you feel good, enhances your self-esteem, that employs your unique talents, that piques your interest or gives you enjoyment, that inspires, energizes, and excites you, that makes you want to get up in the morning.

If you haven’t felt any of these things recently, or experienced them in only one sphere of your life, think as far back as necessary to when you did. Pursuing the things that make you feel good is not frivolous self-indulgence; it is a participation in life, in the creative process. True creativity is implicitly positive, additive, contributing to the larger community and greater good in some way, however small. Do you like to cook and make pleasing meals for your family? That is creative. Do you like to read and share your thoughts with a book club? That is creative. Do you grow vegetables or flowers in a garden? Exercise to maintain your health and energy? Keep a home that is welcoming to others? Work collaboratively with others at home, in the workplace, in the community? Share your energy, time, or money with someone in need of it? Do you smile at strangers? Write programs, plays, books, pamphlets, songs, poetry, menus? Do you pray, meditate, praise, appreciate? It’s all creative.

What do you want? If you don’t know, then you must figure it out, discover it, keep asking yourself the question until you do. Be sure to ask yourself the right question(s). Do not ask yourself questions such as, “Why can’t I do this?” or, “Why can’t I be happy?” or “Why haven’t I accomplished more?” Such questions invest a subtle belief in an undesirable condition. The questions are pointless and will yield invalid, useless answers. Ask instead, “How can I do this?” “What makes me happy?” “What can I do to make myself feel good right now?” The amended questions create a receptivity to discover new possibilities, ones you may not have previously considered.

If you want to feel good, you must discover, decide, and begin to move toward what you want. It involves training yourself to think in ways that open possibilities, create new opportunities. Give yourself permission to explore what you want. Dream, visualize, fantasize, and then take a step. In so doing, you are beginning to change yourself, consciously and intentionally, from inside out and outside in. Your best and healthiest self is happy, alive, involved, and active. If you realize you have an interest in something, stay with it and nurture it with some action, however small, that moves you in that direction. You can change course at any point as you gain clarity about exactly what you want. If you don’t know what to do, seek the assistance of someone who can help you discover what you want and overcome inertia.

A helpful and inspiring read is Martin Seligman’s book, Authentic Happiness. He correctly notes that happiness is not something that one can pursue directly; rather, that happiness is a condition that ensues from the creative utilization of our given talents in a manner that participates in and contributes to the greater community – be it your family, your workplace, your neighborhood, or the world. Everyone, even you at your most depressed, has something to offer. I’ll go so far as to invoke Chaos Theory; the truth is you may never know how even an unreturned smile to a stranger will reverberate and magnify to your own or another's ultimate benefit, or how your holding the door for someone may improve the course of that person's whole day. Small consistent efforts at change can produce enormous results over time. The important thing is to act, to put yourself in motion and enjoy the results.

Taking on Depression: Part 3: Gratitude

2009-10-30T17:12:00.005-04:00

The “practice” of gratitude is one of the most powerful things you can do to overcome depression. Genuine gratitude includes both a thought and its emotional correlate. Thoughts usually carry an emotional valence: it’s a nice day, you feel glad; the partner likes your work, you feel competent; your child earned good grades, you feel proud; you’re going skiing, you feel excited; a snowstorm is coming, you feel annoyed. Because gratitude is a positive thought, it always carries a positive emotional valence.

Your thoughts and their emotional correlates do not occur in a vacuum. They occur in your body and influence biochemical processes. The mind-body connection is a well established fact. The most obvious examples are the connection between a happy, purposeful, socially connected life - and health and longevity; the connection between stress - and heart disease; the connection between the practice of meditation – and improved mood, concentration, and general health; the connection between the belief that you can’t do something - and attempts to do it that somehow fail.

You are energized or enervated by your thoughts. Prove it to yourself. Think back to a time when you felt really grateful for something. How is that thought affecting you physically right now? Do you feel a relief of tension? Increased energy? Greater lightheartedness? How about emotionally and mentally? Are you, even briefly, less anxious or worried? More hopeful? Happy? Joyful? More emotionally available? Prove it further: tell yourself right now, “I am grateful that I am loveable and competent.” Repeat it several times, letting the meaning sink in. How are your mood and your body responding?

Gratitude is as automatic for some as negative, depressed thinking may be for others. The automatically grateful perhaps have had life experiences that gave them sufficient reason to believe that they were good and deserving and that life would unfold favorably enough if they just did their part. Lucky them. For others, life experience may have tipped the balance toward less optimistic beliefs and expectations, against the odds of which they seem to continually struggle in order to achieve at least partial success and happiness. We are all somewhere on that continuum, and those for whom gratitude is not automatic may have to work harder, with real commitment and determined practice.

If you are not among the group of “automatically grateful,” how do you become more grateful?

· Commit yourself to practicing gratitude. (If you pray, pray for the gift of gratitude.) Making the commitment alone begins to change your energy and your ability to follow through. There are an infinite number of things, past, present and future, for which you can be grateful.

· Short-stop negative thoughts with statements of gratitude, ideally, a statement that reformulates the negative thought into a positive thought. Example: “I wish I didn’t have to get where I have to go by walking in the rain.” Re-formulation: “Thank you that I have two legs and the ability walk. Thank you that I can see where I going. Thank you that I have an umbrella and a hand to hold it. Thank you for water. Thank you for the way rain enriches the colors of nature. Thank you for the sun and its eventual return. Thank you for the opportunity to practice gratitude.” Another example: “At this rate, I’ll be broke before I find a job.” Re-formulation: “Thank you for the job I last held, and for all the jobs I’ve held previously. Thank you for all the knowledge and experience, friends or mentors I acquired through them. Thank you for all my opportunities for education and training, and for my many abilities. Thank you for the people who come into my life who contribute to my search. Thank you for the creative ability to make the most of what I have now. Thank you for ‘the sun in the morning and the moon at night.’”

· Reinforce gratitude by keeping a gratitude journal. Write down the things for which you are grateful (and notice what happens to your mood and body in the process).

· Make a mental list as you go to sleep of the things for which you are grateful that day (and notice how quickly you fall asleep). Do the same when you awake, before getting up. If you awake at night and have trouble returning to sleep, resume thoughts of gratitude, perhaps beginning with having a safe, warm place to sleep and the ability to relax into it and enjoy it whether or not you’re sleeping, for the ability to breathe unassisted, for a comfortable pillow, etc. etc., etc.

· Remind yourself to be grateful. One person (referenced in the very helpful book, The Mindful Way through Depression) did this by carrying a small smooth stone in his pocket to remind him throughout his day to think grateful thoughts, setting it next to his bed at night, ending his day and beginning his next day with grateful thoughts.

· Practice. It does take practice to develop any new habit, including a mental habit. Making a habit of gratitude is a great on-going, practically failsafe defense against depression; the two cannot co-exist for long. This “attitude of gratitude” is a key element practiced by 12-step program members who over time find themselves surprisingly and wonderfully transformed. You will, too.

The practice of gratitude is a deliberate mental practice that carries a positive emotional valence which helps correct negative thinking, relieves potentially damaging stress to the body and generates increasing levels of energy, enabling you to see and respond to new previously unnoticed possibilities. As it builds, with your continued practice, you will find yourself regaining and consolidating your power, and depression losing its grip.

Taking On Depression: Part 2: Change Your Thinking

2009-10-16T14:05:00.003-04:00

As I’ve stated before, in order to overcome depression something has to change. More accurately, you have to change something, because what you have been doing is clearly not working for you if you are depressed. One of the most important, effective, and perhaps most challenging changes you can make is in your thinking. What does your thinking have to do with how you’re feeling? Everything! While many believe that pleasant thoughts flow when you’re feeling good, the reverse is also the case: positive thoughts generate positive feelings. When immersed and perhaps feeling trapped in depression’s hallmark feelings of helplessness, hopelessness and worthlessness, you have first succumbed to thoughts that create a sense of helplessness, hopelessness and/or worthlessness.

I say ‘succumbed’ because you are unconsciously complicit with, or acquiescing to, negative thoughts, something easily done because they are often automatic, non-stop, and not usually subjected to our scrutiny. If we did examine them, we would find that they are also frequently unencumbered by reality and capital ‘T’ Truth. Our wakeful but unobserved thinking can carry a lot of mood deflating content consisting of fact-less opinions, invalid assumptions, skewed perceptions, misinterpretations, suppositions, pessimistic expectations, etc., aptly referred to by 12-step programs as “stinkin’ thinkin.” It is a disempowering, disabling cascade of subliminal thoughts that may begin with such phrases as, You never… I can’t…, I’m not…, I don’t…, If only…, which foreclose on all the possibilities lying just beyond worst case scenarios and a constricted imagination. Such thinking not only generates depression but shows up sooner or later in minor or major depleting, self-defeating, irrational, offensive or anti-social behaviors, and sometimes in quite significant emotional pain, as well. It can muck up our plans, screw up our relationships, interfere with our performance, and sink our mood.

But, just as 12-step participants learn to change their thinking in order to free themselves from their addictive behaviors, those with depression can do the same. You can exercise your option to become more aware of your thoughts, evaluate their truth and validity, and reject the distorted thinking that lurks behind and gives rise to every depression. And then you can substitute more accurate and positive thoughts that reflect reality, generate new energy, and inspire action.

Observing and changing what you think appears so simple and elemental a strategy that it may seem to trivialize the painful and debilitating experience of depression. However, simple does not mean easy. Anyone who makes the effort to change his/her thinking is quickly disabused of the belief that it is easy. It is a skill that is learned over time with practice, supported and reinforced by commitment and perseverance, and ideally, professional help.

Why is it so difficult? In order to begin to observe your thinking, you must slow down, quiet the noise and distraction, and listen to yourself. Part of the difficulty, therefore, lies in shifting one’s focus inward, and being willing to go against the grain of the dominant culture that values speed, productivity, constant stimulation, acquisitiveness, and conformity. Lawyer culture, in particular, emphasizes devoting precious hours to tangible productivity.

The other part of the difficulty lies in the nature of our thoughts and thinking. When not fully engaged in concentrated mental activity, or in a meditation practice, our minds usually roll along in subliminal, rapidly shifting, fragmented and unformulated thoughts, assumptions, opinions, wishes, memories, plans, often with attached feelings, much of which we are quite unaware of within nano-seconds of their occurrence, if at all. They are reactive to all forms of stimulation, may be habitual, and may represent components of defenses against unresolved painful emotional experiences. In addition, thoughts that seem particularly resistant to our efforts to change may be rooted in deep-seated false beliefs that were formed early, perhaps even at a pre-verbal stage of development.

In addition, becoming an observer of your thoughts eventually leads to also observing your behavior, augmenting the process of self-discovery that inevitably contains the good, the bad and the ugly, and sooner or later, a closer encounter with your own vulnerability. So, besides moving away from cultural norms, you risk seeing yourself through a wider angle lens. But the ensuing awareness and acceptance of your thoughts, feelings and beliefs form the springboard for volitional change, and the opportunity to lose the depression and feel more alive.

Here are steps you can take to become a better observer and manager of your thoughts:

Prime the pump by holding the intention to observe your thinking with objective interest and without judgment. This helps to summon, mobilize and focus new energies.
Journal. Frequently. The process of formulating unedited thoughts and feelings into more or less coherent words and sentences is clearly consciousness raising.
Tell it to someone. Speak your thoughts and feelings to a skilled and trusted therapist (or friend, or clergyperson) who functions as a sounding board, a source of feedback and perspective, an asker of questions you might not think to ask yourself. Scheduling regular appointments is one way to create a time and space for you.
Begin a daily spiritual practice, i.e., something that helps you slow down and listen to yourself. This may be a walk on the beach or stroll in the woods, attending church or temple or a good 12-step meeting, meditation (alone and/or in a group), listening closely to beautiful music or visiting an art museum, reading poetry or spiritually inspiring literature, journaling, drawing, or other solitary creative activity, etc.
Tag and correct negative thoughts. Substitute a corrected thought that specifies what you want. Reinforce the corrected thoughts with repetition, and don’t get discouraged when they recur; stay the course until they weaken and fade.
Identify and visualize what you want. Depression short-circuits thoughts about what you want and what you can do to achieve it. Begin to move toward “the unachievable” in little steps. Dreams can come true one little step at a time.
Cultivate self acceptance. “If your compassion does not include yourself, it is incomplete.” (Siddhartha Gautama) When you are feeling down on yourself, identify the reason/thought, e.g., for “I’m too depressed to get anything done,” use this “mantra” to re-focus yourself: “Even though I feel so depressed, I deeply and profoundly love and accept myself.” Say it repeatedly until you feel it. Modify it to suit other forms of perceived personal failings or troublesome feelings. (Notice that working this thought effectively demonstrates how positive thoughts generate positive feelings.)

Loving, compassionate self-acceptance is a condition for change and for beating depression.

Changing your patterns, especially well-established thought patterns, is challenging. Meeting that challenge means taking responsibility for your own well-being and is the antithesis of depression because it is proactive, empowering, and enlivening. Changing your thinking is a powerful strategy. Does depression ever gradually or spontaneously remit without your active participation? Yes. Agreeable external events may occur that restore confidence, a sense of personal worth, raise expectations, or inspire new positive thinking and behaviors. However, passive waiting for “things to get better” is much more likely to result in more of the same, i.e., continuing or worsening depression. When you take charge of your own journey and take charge of your thinking, expect to feel more alive. Depression and aliveness are mutually exclusive states.

Next time: What Do You Want?

Taking on Depression

2009-10-09T11:13:00.001-04:00

What do you do when you feel utterly uninspired? When your usual sources of joy and pleasure cannot rouse you from an immobilizing, listless dullness? When you may not have anything to feel bad about, but also can’t find anything to feel good about? When you can’t depend on your usual ability to focus and concentrate? When you are easily annoyed and generally irritable, or when you find yourself in a sudden outburst of anger that is just not you? When you’re tired but can’t sleep, or you sleep too much. When you’ve lost your appetite, or eat too much. What’s going on?

Those of you who have been there would recognize this description of depression, and in the absence of a diagnosable physical cause, that is probably what you’re experiencing. Depression can seem to strike suddenly, or it can be a subtle and gradual process that we’re barely aware of, if at all, until its persisting effect on health, job, relationships and general functioning is no longer tolerable to us and/or others, and we are forced to address it as the problem it is.

Most of us have experienced at least mild depression. It can be regarded as part of the human condition, a fact of life. Some are more vulnerable, some less, for reasons that can be biochemical, circumstantial, genetically determined, even socio-cultural. The triggers setting off an episode of depression are many and sometimes easily identifiable, such as an external event: a blow to the ego (a perceived slight ignites an old vulnerability); a major loss (of a loved one, a job, income, home; even a personally treasured object, a dream, or a social role); a personal or professional failure (divorce, failing the bar exam, losing an important case).

Sometimes the source of depression is not immediately apparent. We may feel awful, begin to realize we have felt awful for too long, and have no clue as to where this encroaching lethargy came from, and only with some (perhaps professionally assisted) digging and soul searching begin to discover a myriad of intersecting events, conditions, memories, unresolved losses and more that affect us at a core level, leaving us with those three major emotional earmarks of depression: feeling helpless, hopeless, and worthless.

Much has been written about what some authors call the “epidemic” of depression in this country, even among children. If the incidence of depression is escalating, we can suspect that something may be going on in the culture, even in the collective psyche, as well as in or within our own personal lives. Times like these, of unpredictable economic, political and financial events, fractures and polarizations in the sense of national unity, etc., can contribute to depression by diminishing our sense of control over our lives, eroding self-confidence, overwhelming one’s usual coping strategies and bringing on fear and doubt. To recognize that a co-occurring wider phenomenon may be taking place may offer a useful context and perhaps perspective. However, personal responsibility for one’s own sense of well-being still obtains.

Lawyers are disproportionately over-represented among the depressed, due in part, as many have noted, to the adversarial nature of their work, the constant stress of managing details, deadlines, and demanding clients (or partners), the need to present themselves as always competent, in control, and able to deliver the answers and solve the problem. Add to that the tendency to over-prioritize the clients’ needs to the neglect of, or even disconnection from, their own needs, and the burden reaches critical mass.

Lawyers’ struggles to meet such demands of the job, without adequate self-care, may be inimical to the very things that really count, that make life worth living, that give pleasure, and that support physical, mental, and spiritual well-being and balance, i.e., that prevent depression. Depression is a sign that balance has been lost and some action is necessary to restore it. The good news is the right actions will restore balance and vitality. Because depression can be so disempowering, enervating and immobilizing, discovering the source(s) of depression and identifying and prioritizing appropriate actions may require, or is at least expedited by, professional assistance. No matter how smart and savvy you are, negotiating the slippery slope of your own mind can be tricky, can amount to missing the forest for the trees. What is most helpful is someone who can compassionately mirror back to you what you yourself can’t (yet) see, and who can help you figure out what you are willing to do, so that you can make the changes necessary to feel better.

Overcoming depression is all about getting your power back - power over your own life, your own self, your own mind and spirit. Overcoming depression is not about controlling or exercising power over other people, places or things. Overcoming depression is not achieved by changing anyone but yourself, anyone’s behavior but your own, anyone’s thinking but yours. You may notice, however, that self-empowering actions you take to combat your depression may evoke positive and self-reinforcing changes in others’ responses to you. Self-change is where your true power resides, and as you begin to exercise that power with increasing confidence and skill, you need never succumb to debilitating depression again. Depression may recur, but you will be able to successfully deal with it.

Yes, you have to change, change your thinking and change your behavior. And you are the only one who can do that. What’s good about that is you don’t have to wait for anyone else, or depend on anyone else in order to make changes that will help you begin to feel better. That’s the good news. There is no bad news, unless taking up the challenge in your own behalf is not what you had in mind. Realistic expectations of professional assistance and family or close friends may be an important part of the process of taking up the challenge; for some it makes all the difference. Depression will not be remedied by magical thinking, longing, or mere wishing that things were different. It may require determined, persistent work, and in the case of certain intractable depressions that don’t respond immediately to your best efforts, the use of medication for a period of time may be very beneficial. The important thing is to never accept defeat, and never accept victimhood.

In subsequent blogs, I will suggest specific actions you can begin to practice to loosen the grip of depression.

Coping Mechanisms for Managing or Relieving Stress in the Wake, or in Fear, of Job Loss (4-Part Series) -- Part IV: Accepting Help, Giving Help

2009-10-01T12:26:00.003-04:00

Too often we turn away opportunities and offers of assistance when most needed because of some misguided, though completely understandable, sense of pride, shame, and/or embarrassment. If there is one positive thing that has come out of the nation’s economic crisis –if you can call any of this “positive” –it is the fact that because so many are experiencing layoffs at the same time, employers rarely dwell on the reasons for an applicant’s laid off status during the interview process.

Here are a few things to keep in mind, lest you turn away your next great opportunity:

· DON’T BLOCK THE BLESSING! Helen Keller once said, “When one door of happiness closes, another one opens; but often we look so long at the closed door that we do not see the one which has been opened for us. . . . " Too often we get so bogged down in our circumstances that we proceed through life with blinders on and miss potential opportunities that come across our path. Be conscious of when you feel yourself pulling in that direction and do an about-face. Don’t become so mired in the negative that you don’t hear when opportunity knocks. Maintain positive expectations and be open to possibilities.

· ACCEPT “THE GOOD” There is nothing to be embarrassed or ashamed about being laid off, especially in the current economic climate. Don’t let pride or shame lead you to turn away offers of assistance and opportunities. Identify and utilize all available resources to advance your goals. Similarly, now is not the time to decide to stop participating in your profession-related extracurricular activities, such as boards, task forces, committees, bar association groups and sections, etc. Now, more than ever, you want to cultivate and maintain those connections, which may prove useful in the end. This also ensures that you won’t give in to the urge to isolate yourself, or become disconnected from others. It can be quite beneficial to have fellow committee members see you “in action.” They would be able to comment on such things as your ability to lead, how well you work with others, whether you are a “team player,” your work ethic, and how well you get along with others. After all, you never know from where your next opportunity will come.

· SET UP YOUR OWN PERSONAL “DREAM TEAM” Your “dream team” is a person, or group of people, whom you trust to be there for you in a supportive role as you embark on this journey towards the next chapter in your work life. Some turn to people they’ve identified as mentors or role models, while others choose close, positive-thinking friends or confidants who they know will help to keep them moving forward. Ultimately, they should be people who know what your goals are and who are going to help you to achieve them by checking in with you on a regular basis to ensure that you are moving towards your goal and accomplishing tasks you identified for them during the prior call.

· PAY IT FORWARD. Helping others is not only good for the person you help, but also for your own soul. Remember also that good attracts good. Take the time to volunteer your services through pro bono work and public service. This has added benefits, including helping you to continue to practice and feel connected to the profession, advancing and honing your legal skills, networking and opening yourself up to other opportunities, as well as potentially exposing you to other practice areas. Additionally, if you were contemplating going into a particular practice area, but weren’t sure about whether you would like it, this is one way of making that determination prior to committing yourself via a long-term contractual arrangement. Contact your state and local bar associations, as well as your state’s legal aid office(s), to find out what pro bono and public service opportunities are out there. You can also simply pick up the phone and call solo, small, and/or mid-sized firms which specialize in the contemplated practice area and ask whether they could use some volunteer help in exchange for their willingness to allow you to be, in essence, an apprentice and shadow them. In today’s economy, with many firms being forced to significantly downsize in order to remain open, you are certain to find lawyers who will gladly take you up on that offer.

Even with these coping mechanisms, you may still need professional help with getting through your stressful situation, which may seem overwhelming and all encompassing. THERE IS NO SHAME IN GETTING OR SEEKING HELP, SO PLEASE DO SEEK PROFESSIONAL ASSISTANCE WHEN SUCH STRESS, OR ISSUES SUCH AS ANXIETY, DEPRESSION, SUBSTANCE ABUSE, OR OTHER TROUBLING BEHAVIORS PERSIST. For assistance, please contact us at Lawyers Concerned for Lawyers, Inc. (31 Milk Street, Suite 810, Boston, MA , (617) 482-9600, email@lclma.org, or visit our website at http://www.lclma.org/). Help can also be accessed through your: healthcare provider; local hospital; psychologist, psychiatrist, social worker, clinician or other mental health professional; or community healthcare center.See our web site Resource Page for a list of relevant stress resources.

Ms. Walcott presented this and other material in a program entitled, “Staying Positive in a Down Economy: Beyond The Group Hug” (June 30, 2009), which was part of the ABA’s Recession Recovery Teleconference Series. A download and course materials for this program are available online at http://www.abanet.org/cle/programs/nosearch/tspdmo.html.

Coping Mechanisms for Managing or Relieving Stress in the Wake, or in Fear, of Job Loss (4-Part Series) -- Part III: Using The Time to Your Advantage

2009-09-25T10:46:00.002-04:00

While you certainly did not want, and probably did not expect, to be laid off or between jobs, there are certain things that you can and should do now that you have the time. Not only will doing these things help you to present for your next career opportunity at your best, but there is the added bonus of helping you to feel better about yourself, thereby decreasing your levels of stress. The following are some examples of actions that should be taken during this period:

· USE THE TIME WISELY. Think about all the people, places, and things you may have neglected or overlooked in recent years, and use this time to reconnect with people and to tackle some of those projects. You will feel better for having done so, will feel a sense of connectedness which is important at this time when many are tempted to isolate themselves. This will also give you a sense of accomplishment whenever you complete a task. As an added benefit, you never know from where your next opportunity will come. One of those people you reconnect with may prove useful in helping you to determine next steps, to come up with contacts that you may not have thought of, or may have some great ideas or avenues for you to pursue or incorporate in your job search. You never know.

· WORK TOWARDS A NEW AND IMPROVED (AND MORE MARKETABLE) YOU. Take courses, learn new skills, update and hone old skills, in an effort to reevaluate what it is you want to do next (i.e., do you want to continue what you’ve been doing, or have you been secretly yearning, but putting off, doing something else). In the same way that the ABA Recession Recovery Teleconference series is offered free of charge, there have been numerous other offerings in recent months advertising free online courses aimed at helping people to produce better resumes and cover letters, state and local bar association programs designed to assist in assessing one’s marketability and putting together a career development plan, committees dealing with transition issues for lawyers, etc. Check out the ABA website, but also the websites of your state and local bar associations, as well as running a web search for webinars, and other free teleconferences and podcasts.

· KEEP TO A ROUTINE. No matter what, get up and do something aimed at helping you in your job search every day. At the end of every day, make a list or schedule of things to accomplish the next day, and tell someone what it is you intend to do. Somehow saying it aloud helps to give you a sense of accountability. You want to keep up a routine so you don’t feel as if you are aimlessly wandering from day to day, but instead have purpose.

· COMMIT IT TO PAPER. Identify and write down the largest sources of your stress. For many, this is financial. If this is the case, as an initial step, review the spending habits of yourself and your family and think of ways in which you can begin to cut costs. Once written, investigate ways in which to alleviate some of the financial stress and begin to look into them (i.e., with respect to mortgage issues, there are a number of repayment and other programs now available to assist in this effort, and a host of nonprofit entities ready to talk to you about them. With respect to credit card payments, some companies will entertain lowering your interest rates, so it’s worth it to call and ask. There are also reputable credit counseling companies out there to assist you.)

· EAT HEALTHY, EXERCISE MORE, AND LAUGH MUCH! It sounds basic, but it’s important to remember to take care of yourself. You need all your synapses firing at full throttle, and they won’t be able to if you aren’t getting enough rest or exercise, and are eating junk. It is especially important to avoid turning to self-destructive attempts at relieving stress, such as: drinking, drugging, gambling, smoking, and emotional eating, to name a few. Also, it’s been said that the mere act of laughing in and of itself has stress relieving properties. So, read a funny book, go to the movies and opt for a comedy, hang out with your friends who are the most upbeat and funny (and thus, less likely to bring you down).

Even with these coping mechanisms, you may still need professional help with getting through your stressful situation, which may seem overwhelming and all encompassing. THERE IS NO SHAME IN GETTING OR SEEKING HELP, SO PLEASE DO SEEK PROFESSIONAL ASSISTANCE WHEN SUCH STRESS, OR ISSUES SUCH AS ANXIETY, DEPRESSION, SUBSTANCE ABUSE, OR OTHER TROUBLING BEHAVIORS PERSIST. For assistance, please contact us at Lawyers Concerned for Lawyers, Inc. (31 Milk Street, Suite 810, Boston, MA , (617) 482-9600, email@lclma.org, or visit our website at http://www.lclma.org/). Help can also be accessed through your: healthcare provider; local hospital; psychologist, psychiatrist, social worker, clinician or other mental health professional; or community healthcare center.See our web site Resource Page for a list of relevant stress resources.

Ms. Walcott presented this and other material in a program entitled, “Staying Positive in a Down Economy: Beyond The Group Hug” (June 30, 2009), which was part of the ABA’s Recession Recovery Teleconference Series. A download and course materials for this program are available online at http://www.abanet.org/cle/programs/nosearch/tspdmo.html.

Coping Mechanisms for Managing or Relieving Stress in the Wake, or in Fear, of Job Loss (4-Part Series) -- Part II: Shifting One's Perception

2009-09-18T12:50:00.005-04:00

Losing a job, for whatever reason, is a life-altering event on many different levels –familial, professional, financial, behavioral, social (etc.) –and affects people in many different ways. For most, however, there are certain experiences that should be simply taken as givens:

1. There will be some degree of worry and/or stress.

2. There will be some level of interest in knowing who is (and is not) going through a similar experience.

3. There will be some people in your life who –for whatever reason –feel the need to constantly update you on how much worse things are than you thought. (I’ve lovingly dubbed these people naysayers, voices of doom, and town criers.)

4. There will be a point in time, however brief, when you experience self-doubt, lowered self-esteem and/or decreased self-confidence.

5. At some point, it will take more of an effort than usual to keep up the social and professional relationships you had when employed, and to continue in your professional extracurricular activities.

In moderation, all of these experiences are completely normal and to be expected given the circumstances (i.e., job loss). It is only when they get in the way of moving forward towards accomplishing your goals that it becomes a problem. The following are some examples of self-defeating actions which should be avoided at all costs:

· WORRYIN’ NEVER CHANGED ANYTHING, SO DON’T GET STUCK ON THE WORRY TRAIN. If you have a lot of free time with nothing to do, that also gives you a lot of time within which to stress or worry. Fretting, worrying, and being stressed or anxious are all normal. There’s nothing wrong with doing any of those things, for a time. Just don’t get stuck there – it’s self-defeating.

· STEER CLEAR OF NAYSAYERS, VOICES OF DOOM, & TOWN CRIERS. While there is certainly comfort in knowing that you are far from alone in this situation, be careful not to spend all of your time dwelling on the negative, as opposed to working towards a goal. Avoid those people who can’t seem to talk about anything other than the state of the economy, lawyer layoffs, unemployment, firm closings, decreases in available jobs, and the like. While I am in no way suggesting that you should avoid discussing what happened to you, I am cautioning against not being able to move beyond it. Also, there will always be those people who tell you all the reasons why you can’t do something, instead of supporting you in your efforts to make an attempt to accomplish your goal. Avoid such naysayers and surround yourself with supportive people.

· DON’T BECOME A SLAVE TO THE MEDIA. This serves no useful purpose other than to stress you out and keep you coming back for more. The media is more likely to give reports focused on the bleak, tragic, downtrodden, and hopeless (from its skewed perspective), than the positive, successful, hopeful, and victorious. That’s just the way it is. While you should absolutely keep abreast of what’s going on around you and what opportunities may lay out there for you, you can accomplish this by quickly skimming your media outlets for this information.

· ACCEPT THE SITUATION, BUT DON’T BE LABELED BY IT. It goes without saying that being unemployed is quite a humbling experience. Use it as a life lesson –absolutely –and if you come out wiser and stronger for it, then you have come out the victor. However, remember that being laid off doesn’t define who you are, or what you’re about. Indeed, it is no reflection whatsoever of your value. Nor is it an indictment of your worth. It’s merely a temporary place called unemployment, which you’ll soon depart.

· DON’T BE M.I.A. Very important: Make sure people know where you are and how to contact you! Often people give their work addresses to bar associations and others as their preferred contact method. After leaving a place of employment, however, they forget to update the bar associations with their new contact information, so they no longer receive notifications of any relevant and/or free course, program, and other bar association offerings. You don’t want to stop getting this information –stay connected. Be sure to also update your alumni offices (law school, college) of your whereabouts because some of them are offering programs as well.

Even with these coping mechanisms, you may still need professional help with getting through your stressful situation, which may seem overwhelming and all encompassing. THERE IS NO SHAME IN GETTING OR SEEKING HELP, SO PLEASE DO SEEK PROFESSIONAL ASSISTANCE WHEN SUCH STRESS, OR ISSUES SUCH AS ANXIETY, DEPRESSION, SUBSTANCE ABUSE, OR OTHER TROUBLING BEHAVIORS PERSIST. For assistance, please contact us at Lawyers Concerned for Lawyers, Inc. (31 Milk Street, Suite 810, Boston, MA , (617) 482-9600, email@lclma.org, or visit our website at http://www.lclma.org/). Help can also be accessed through your: healthcare provider; local hospital; psychologist, psychiatrist, social worker, clinician or other mental health professional; or community healthcare center.See our web site Resource Page for a list of relevant stress resources.

Ms. Walcott presented this and other material in a program entitled, “Staying Positive in a Down Economy: Beyond The Group Hug” (June 30, 2009), which was part of the ABA’s Recession Recovery Teleconference Series. A download and course materials for this program are available online at http://www.abanet.org/cle/programs/nosearch/tspdmo.html.

Coping Mechanisms for Managing or Relieving Stress in the Wake, or in Fear, of Job Loss (4-Part Series) -- Part I: Shifting One's Perception

2009-09-11T16:32:00.005-04:00

Almost everyone has a friend or family member who is contending with a layoff, between jobs, or who fears the same may be in their future. There is cold comfort in knowing that one is in the good company of others who share a similar fate, not by virtue of personal or professional shortcomings, but by an economy that has failed them. Even so, such a life-altering event can affect all dimensions of one’s life: finances, for sure, but also family and social relationships, self-esteem and self-confidence, energy, thought processes, and daily routines formerly structured and organized by work schedules. Losing a job, or delayed success in finding a job, is no small thing.
While stress in moderate amounts, or when adequately managed, provides motivation and drive, that is not the case when the stress is in excess. Stress has been described in the simplest of terms as resulting from the way in which one interprets and reacts to events. Accordingly, a person who changes her perception of a situation in a positive direction should, in turn, experience a decrease in stress. The following are suggestions for assisting in this perception shift, and ultimately for managing and relieving stress:
· THIS TOO SHALL PASS. Chances are you’ve been through worse times, and survived darker periods in your life, so keep it all in perspective. Reflect on some of those periods when you thought you just couldn’t make it through, and recall that in spite of everything, you did. You’re a survivor! The ability to cope or deal with adversity is not new to you. You’ve coped and adapted before in a myriad of situations, whether involving yourself or others –including clients! What would you do and advise if a client came to you with this situation? What would you say? It’s important to remember that transitions in whatever form are a natural part of our lifecycle, requiring adaptability and often, the ability to reinvent oneself. Some examples of life events triggering some form of reinvention include: becoming a new parent, divorce, dealing with a major illness (yours or that of someone close to you), having your child go off to college for the first time (empty nest syndrome), relocating to a new country/state/city/town, etc. No matter your situation, remember that things could always be a lot worse.

· CELEBRATE YOU! Reflect on all of your past accomplishments and significant experiences and milestones. Make a list of the things of which you are most proud and grateful. (i.e., birth of a child, wedding day, trial victory, high praise or compliments from colleagues on your delivery of a masterful argument, 1st time finishing a 5K race, watching your child take his/her first steps, the first time you hear your child say “dada” or “mama,” finally reaching the mountain top during a long and arduous climb, losing that final 5 pounds, graduating from college and law school, passing the bar exam, etc.). This should help to put things in perspective and remind you of just how great you are and how much you’ve achieved. Also, it will help you to remember that in the large scheme of things, this is but a blip on the radar. Whenever you feel yourself heading back towards the worry train, remember this list.

· FLIP THE SCRIPT! Rather than think of this as the worst thing that could have ever happened to you, flip the script and look at it as an incredible opportunity. Use the time to reevaluate where you are, both professionally and personally. In terms of the professional, are you doing what it is you really want to do? Too often, we become complacent in our day-to-day lives and forget about some of our dreams and goals. This is a perfect opportunity for you to reexamine your priorities and to take stock of where you are, and where you‘d like to be.

· THINK BABY STEPS OR SMALL, ACHIEVABLE GOALS –NOT LEAPS AND BOUNDS. When trying to lose weight, it is usually ill-advised to think in terms of how much you wish to lose all at once (i.e., 100 pounds). Instead, if you break down how much you want to lose into smaller, incremental portions (i.e., 10- or 20-pound increments), and then tackle it piece by piece, it’s much less daunting. This also allows you to enjoy periods of achievement throughout and it prevents you from having to wait a long time to celebrate an accomplishment. The same should be true of finding your next employment opportunity. If you break it up into small achievable goals, then it allows you to maintain momentum.

· BEEN THERE, DONE THAT. Try to remember that we, as a profession and as a nation, have weathered storms just like this one in the past, and we always get through it, just like we will this time. Nothing lasts forever –not even the current state of affairs.

Even with these coping mechanisms, you may still need professional help with getting through your stressful situation, which may seem overwhelming and all encompassing. THERE IS NO SHAME IN GETTING OR SEEKING HELP, SO PLEASE DO SEEK PROFESSIONAL ASSISTANCE WHEN SUCH STRESS, OR ISSUES SUCH AS ANXIETY, DEPRESSION, SUBSTANCE ABUSE, OR OTHER TROUBLING BEHAVIORS PERSIST. For assistance, please contact us at Lawyers Concerned for Lawyers, Inc. (31 Milk Street, Suite 810, Boston, MA , (617) 482-9600, email@lclma.org, or visit our website at http://www.lclma.org/). Help can also be accessed through your: healthcare provider; local hospital; psychologist, psychiatrist, social worker, clinician or other mental health professional; or community healthcare center.

See our web site Resource Page for a list of relevant stress resources.

Ms. Walcott presented this and other material in a program entitled, “Staying Positive in a Down Economy: Beyond The Group Hug” (June 30, 2009), which was part of the ABA’s Recession Recovery Teleconference Series. A download and course materials for this program are available online at http://www.abanet.org/cle/programs/nosearch/tspdmo.html.

Parity Time

2009-08-28T12:50:00.008-04:00

The world of health insurance and managed care is confusing, especially when it comes to mental or behavioral health coverage (interchangeable terms), even for the lawyers who compose our clientele at LCL. In fact, assistance in searching for adequate and covered treatment is one of the key reasons that lawyers come to LCL rather than seek help on their own. Right now, things are changing in mental health insurance coverage (largely for the better), though few consumers are up to date on these changes (which some insurers have not seemed eager to mention, e.g., in their on-line benefits information).

Mental health coverage has long been the “stepchild” of health insurance, partly because it is more difficult to evaluate or define these conditions with precision, or to determine a specific optimal treatment plan. That very vagueness has served as an excuse for inadequate coverage. When I was first licensed as a psychologist in 1981, before managed care, most people in Massachusetts had an old-fashioned Blue Cross Blue Shield policy. By law, those policies covered up to $500 a year in mental health coverage. Believe it or not (partly because, even then, the insurer gave itself a discount), that was enough for at least 10 sessions. Nowadays, coverage is generally defined by number of services (which helps accommodate inflation), and most people have HMOs, which require “pre-authorization” before subscribers can actually utilize these benefits.

In one form or another, insurers have set fairly arbitrary maximums in mental health coverage, even while there were no such maximums for coverage of most physical health conditions. Sick as you might be, even with severe mental illness, once you had used up your maximum for the year (or, occasionally, your lifetime), you were on your own. In 2000, more or less concurrently with a number of other states, Massachusetts passed its first Mental Health Parity law, which removed predetermined maximums from coverage for psychiatric conditions seen as largely biological in nature. These were:
♦ Schizophrenia
♦ Schizoaffective Disorder
♦ Major Depression
♦ Bipolar Disorder
♦ Psychotic Disorders
♦ Delirium and Dementia
♦ Obsessive-Compulsive Disorder
♦ Panic Disorder
♦ “Affective Disorders” (defined slightly differently by different insurers)

In addition, the 2000 law stipulated that, for most other conditions, the maximum number of outpatient visits per year could not be fewer than 24 for adults (thus every Massachusetts-based insurer began covering 24 visits), with no limits for children. Excluded from the law entirely were alcohol and drug dependence, which are often covered up to just 8 sessions per year. (I am not focusing, here, on the maximums for inpatient hospital stays, since those are virtually always kept extremely brief regardless of stated maximums.) It always seemed very curious to me that alcohol and substance dependence were handled this way, since the biological aspects of those behavioral disorders are so central.

What’s new is that, as of this past July 1, Mass. state law has added four more diagnoses (including chemical addictions) to the list of those covered without a hard-and-fast maximum:
♦ Alcohol/Drug Abuse and Dependence
♦ Eating Disorders
♦ Post-Traumatic Stress Disorder
♦ Autism.

This state law does not apply to (a) self-insured plans [where the money that pays the claims comes directly from the employer], (b) MassHealth, or (c) Medicare.

There is also a new federal parity law coming down the pike. It was actually bundled with the measure congress passed late in the Bush term to permit the massive bailout of financial institutions (in this case the “pork” going toward what I regard as a good cause). As of January 2010,

♦ No plan is required to offer mental health coverage, but if it does (which is mandatory in Massachusetts), the coverage for all legitimate mental health diagnoses must be equivalent to coverage for medical/surgical procedures.
♦ It applies even to self-insured plans, but excludes employers with no more than 50 employees.

When the state and federal laws are in conflict, the more consumer-friendly one generally applies.

Two caveats:
(1) Who can say how Health Care Reform (which I support in principle) may ultimately be worded, and whether, as some kind of trade-off, it will override these legislative measures. In any case, I assume it will not take effect before 2011.
(2) Despite the removal of automatic maximums, the insurers will continue to require pre-authorization—that is, HMOs will cover only those services that they have determined are “medically necessary” for an individual. That is a very slippery concept when it comes to mood and behavior problems. In truth, even with reform or with a “public option,” some kind of mechanism is needed to prevent wasteful spending on unnecessary health care. I do wish, however, that someone would come up with a better means of accomplishing that purpose than the cumbersome,(unpaid) time-consuming, and privacy-reducing forms that providers and their patients/clients often face.

In any case, if you are in need of assistance, now is a good time to look for the right therapist. LCL can help with that process if you are a Massachusetts lawyer, law student, or judge, or a family member of people in those categories. Understand that LCL itself does not use your health insurance – our primary service is to evaluate and refer (not to provide ongoing therapy), and is funded through lawyers’ annual licensing fees. We do, and must, take your health insurance into account in the process of our efforts to refer you for further services.

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Update Feb 2010: You may have noticed that we are not hearing anything about the federal parity law from our insurance providers. As a provider, I can tell you that when I look up new patients' eligibility on-line, there are still references to the 24-session/year maximum for diagnoses not on the Massachusetts list of parity diagnoses.

Based on some web searching, it seems that, although in one sense the federal parity law is already in effect, in another sense it is still in a non-final, feedback-gathering phase until July 1 -- so that may be the point at which it will really kick in.

In addition, while most interpreters of the law see it as applying to all mental health diagnoses (thus not just the ones that Massachusetts has deemed parity-worthy), some commentaries note that this only applies to coverage of conditions included in the plan. Although I have seen no evidence of this as yet, it seems possible that an insurance company could decide, for example, that they do not cover substance absue at all, or that they do not cover adjustment disorders at all. My impression is that they could get away with that gambit, because the law only states that whatever is covered must be covered equivalently to medical/surgical conditions, and that providing no coverage whatsoever, for a given condition, gets around that requirement. We'll see. In either case, we should be beyond the 24-session limit that is probably still being shown in your insurance provider's information packet. Caveat: I am a psychologist and not a lawyer or policy expert. My only expertise is that I've been dealing with health insurance claims, authorizations, and limitations (though a series of changes) since 1981 as a working clinician, and that I've taken the time to look up this information extensively on line.

ON LAWYER SUICIDES

2009-07-10T13:53:00.001-04:00

The recurrent issue of lawyer suicide has come to the fore recently with reports that lawyers at three prominent firms have taken their lives since December. In subsequent months, there has been a flurry of correspondence as to what kinds of programs can be offered to target the problem. The prevalence of unhappy lawyers, and the very high incidence of depression in the profession are, of course, not new findings. Despite repeated calls for humanizing and balancing the lives of attorneys, there seems to have been no way to stem the tide of ever-increasing stress, the emphasis on billables and bottom lines for those who work in large firms and the difficulties making ends meet for many sole practitioners and small firms. I see so many lawyers who wish they could find another way to make a living but feel trapped; it is always a refreshing counterpoint to visit with some of my college buddies who went into the law and are enjoying themselves.

Feeling trapped, of course, can readily lead to both depressed mood and suicidal thinking (an exit), especially for people who are predisposed, either biologically or psychologically, to depression. The risk is heightened in the presence of a disinhibiting substance (most commonly alcohol) and/or access to a gun (particularly lethal in response to an impulse).

The programs being contemplated may be very helpful in addressing the needs of the grieving survivors – those of us who have lost a colleague, friend, family member, or client to suicide. The normal sense of grief is, in these cases, often compounded by such feelings as guilt (“What could I have done?”), anger (“How dare he choose to take himself away from his friends, family, etc?”), and even fear of contagion (“He seemed no different from me… Will this happen to me, too?”). In addition, when a loss seems to come from out of the blue, it is difficult not to become more vigilant, seeing the world as a place where dire events can strike us without warning. Fortunately, for most of us these emotions fade over time as we gain perspective and talk it over with others, but if not, it’s a good idea to talk it over with a therapist.

Brief prevention programs, on the other hand, seem not to be very effective in reducing rates of suicide – no more than those one-shot high school drug education assemblies made a long-term difference in who would eventually use or develop an addiction. What is likely to make more of a difference are long-term, ongoing factors. To what extent does an individual feel connected to, cared about, and accepted by a community – of friends, coworkers, fellow congregants, etc.? To what extent do lawyers allow themselves to become overwhelmed with burdens (cases, finances, home life, etc.) and tell no one, because of a perceived need to always appear in control? And although in many cases we see no advance warning of a suicide, do we make ourselves available to listen when something seems amiss with a colleague, or do we feel that acknowledging human frailty on the job would be a faux pas?

These kinds of factors probably make a great difference in the path toward (or away from) the sense of entrapment or despair. Listening is a powerful antidote to the sense of aloneness and isolation, but it’s hard to come by nowadays. Primary care physicians, back in the days when they were known as “general practitioners,” had time to listen. Managed care, combined with the cost of maintaining their desired lifestyle, has made it almost impossible for physicians to take time with patients, as you may have noticed last time you went to the doctor.

Fortunately, the vast majority of lawyers, even the many who may have fleeting thoughts of suicide, never reach the point of readiness to take their lives. But at the lawyer assistance program, we often wish that people had come to see us sooner – before the onset of severe symptoms or the license suspension or the daunting pile of unopened mail or the drunk-driving arrest. People tend to put off reaching out for help, a feature especially prominent in lawyers (and also doctors) – those who feel they should be the “knowers” and not the “needers.” [Lawyer assistance programs, however, are not emergency services; if the danger of harmful action is imminent, the appropriate resource is an emergency room, or if slightly less imminent, a suicide hotline – shown for each state at suicide hotlines.com.]

I feel particularly heartened when a lawyer comes to LCL accompanied by one or two friends/colleagues who have prevailed upon him or her to see me for assessment. There is no need for the concerned party to diagnose the problem – just to recognize that something is wrong and to not turn away. Sometimes, of course, the colleagues are partners in a firm seeking to avoid losing a valuable lawyer – and that’s certainly a good idea. But at other times the only motivation is friendship and human concern, motivation of a higher order. Although some individuals, whose covert agenda is to avoid change, find ways to give lip service and evade my further attention and recommendations, some actually grab the lifeline and embark on a path toward health.

2009-05-15T16:55:00.003-04:00

Hello and Welcome.

We, the staff of Lawyers Concerned for Lawyers of Massachusetts, look forward to finding ways to increase our usefulness to the legal community through the medium of blogging.

At this location, you will begin to see a series of observational and informational postings about the human side of lawyering from the perspective of non-lawyers who have interviewed hundreds of lawyers over the years, usually for the purpose of assessing problems that are impeding their functioning (professionally or personally or both). We are excited about adding this means of communication to our existing toolbox, which includes, for example, the many articles and resources posted on our web site, our many types of presentations, our newsletter, and our Q&A column featured in Mass. Bar Association Lawyers Journal.