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.
Friday, September 30, 2011
Friday, August 26, 2011
Our Heroes
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.
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.
Friday, November 19, 2010
Another Look at Lawyer Suicide
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.
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.
Thursday, October 28, 2010
Counterpoint to Myself (re plight of new lawyers)
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.
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.
Thursday, October 21, 2010
Is the Legal Profession Neglecting its Young?
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.]
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.]
Monday, August 9, 2010
BEHAVIORAL HEALTH COVERAGE -- COMING BACK TO THE PARITY
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.
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.
Monday, June 7, 2010
Unsolicited Advice to Lawyers with Associates
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.
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.
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