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Bar News - January 18, 2013

Criminal Law: Secondary Traumatic Stress, Vicarious Trauma and Burnout: The Hazard of Working with Sex Offenders


Few client populations present as many personal and professional challenges as sexual offenders.

It is well documented that clinicians working with sex offenders can be significantly impacted by their work in ways that can produce disruptions in affect regulation and expression, interpersonal relationships, and sexuality, in addition to symptoms of psychological trauma, such as nightmares and intrusive imagery (Ennis, 2004). The term vicarious traumatization was coined by McCann and Pearlman (1990) to describe pervasive changes that occur within clinicians over time as a result of working with clients who have experienced sexual trauma.

In addition to vicarious traumatization, the syndromes of secondary traumatic stress and burnout have been described as psychological consequences to working with trauma victims as well as perpetrators. Secondary traumatic stress has been defined as “the natural consequent behaviors and emotions resulting from knowing about a traumatizing event experienced by a significant other” (Levin, 2008, p. 1). Burnout refers to the constellation of symptoms that flow from experiencing work as a heavy burden. These can include apathy, hopelessness, rapid exhaustion, disillusionment, and irritability (Pross, 2006). All three conditions have been found in clinicians working with sex offenders.

The extent to which these conditions are experienced in attorneys working with sex offenders is less clear. However, one may hypothesize that attorneys are similarly positioned as clinicians in that the risk factors for the development of psychological symptoms are present in the legal arena. This article will review the psychological conditions described in clinicians working with sex offenders as well the general studies examining psychological syndromes in attorneys.

The psychological syndromes of vicarious traumatization, secondary traumatic stress, and burnout are well-described in the psychological literature. Few studies have examined the psychological consequences of attorneys working with sex offenders. Jaffe et al surveyed judges in criminal, family and juvenile courts and found that 63% experienced symptoms of vicarious trauma (Levin, 2008). Prosecutors working with domestic violence and incest cases identified symptoms of demoralization, anxiety, helplessness, exhaustion and social withdrawal (reference 22 in Levin article). Levin et al. studied vicarious trauma in attorneys by assessing their responses to trauma questionnaires. Survey results demonstrated that attorneys experienced more symptoms of secondary trauma and burnout compared with comparison groups (Levin & Greisberg, 2003). The attorneys reported higher levels of intrusive recollection of trauma, avoidance of reminders of the material, diminished pleasure and interest in activities, and difficulties with sleep, irritability, and concentration as compared to the comparison groups of mental health providers and social service workers (Levin & Greisberg, 2003).

These studies establish the presence of all three psychological syndromes in attorneys. However, the studies do not specifically examine the symptoms experienced working with sex offenders and sex crimes. One can hypothesize that there are some general risk factors for the development of these psychological syndromes, but it is unclear to what extent attorneys experience the specific risk factors present in sex cases.

Literature from the psychological field suggests the following risk factors when working with sex offenders:

Risk Factors for Vicarious Traumatization, Secondary Traumatic Stress, Burnout:

  • Longer and more severe exposure to sex offender work (Catanese, 2010)
  • Working with more disturbing material such as child pornography, sexual homicide, videotapes of sexual assault, (Catanese, 2010)
  • Offender characteristics: difficult to work with clients (clients who are in denial, repeat offenders, non-compliant with supervision or treatment) have been considered a risk factor to the development of psychological symptoms. However, no study has examined the relationship between offender characteristics and symptoms of traumatization in sex offender clinicians.
  • Therapist characteristics: less training (Moulden & Firestone, 2007), poor coping strategies, history of trauma.
Research conducted on the influence of personal trauma history in victim therapists found a relationship between trauma history and vicarious trauma symptoms (Moulden & Firestone, 2007).

One may hypothesize that an extrapolation of the findings from the psychological studies could be of benefit in the legal arena. Studies have shown that attorneys experience similar psychological syndromes and syndromes as clinicians working with traumatized individuals. Given the nature of the attorney-client relationship, it is likely that attorneys develop similar reactions and feelings to clinicians. The psychological well-being of the attorney, like the clinician, is paramount to a successful working relationship with the client. As such, it is imperative that the attorney becomes familiar with his or her response to offenders, as well as ways to address psychological trauma or victimization.

Symptoms and Signs of Traumatization
  • lashbacks or intrusive thoughts of the case
  • Nightmares related to content of case
  • Hyper-vigilance related to situations, which are reminders of the case
  • Intimacy deficits with significant others
  • Decreased interest in sex
Symptoms and Signs of Burnout

  • Depression
  • Hopelessness
  • Sense of incompetence
  • Poor concentration
  • Low energy
The psychological research has identified mitigating influences of psychological distress as psycho-education, strong collegial relationships and social support systems, which may serve to offset the stress isolation and stigma of working with sex offenders (Kadambi & Tuscott, 2003). The literature contains a number of suggestions for reducing the effects of vicarious traumatization, including: specialized training to raise awareness and recognition of vicarious traumatization (Cunningham, 2003; Way et al., 2004), support and supervision which allow to address the effects of vicarious traumatization without fear of judgment (Cunningham, 2003).

Working with sexual offenders provides an opportunity to address public policy, challenge constitutional law, review the scientific data about the biology of sexuality, and understand the complexities of human behavior. Attorneys who work with sex offenders should be educated about the risks inherent in working with such a population as well as the ways to mitigate risk. Such a balance will allow for a successful, healthy career in such a challenging speciality.

A respected expert on the topic of paraphilia, Dr. Renee Sorrentino is the director of clinical services at the Boston-based Institute for Sexual Wellness, a clinic devoted to the evaluation and treatment of individuals with problematic sexual behaviors. She is also an instructor in psychiatry at Harvard Medical School. Dr. Sorrentino can be reached at


Catanese, S. A. (2010). Traumatized by association: The risk of working sex crimes. Federal probation, 74(2).

Cunningham, M. (2003). Impact of trauma work on social work clinicians: Empirical findings. Social work, 48(4), 451-459.

Ennis L. & Horne, S. (2004). Predicting psychological distress in sex offender therapists. Sexual Abuse: A Journal of Research and Treatment 15(2); 149-57.

Kadambi, M. A., & Truscott, D. (2003). Vicarious traumatization and burnout among therapists working with sex offenders. Traumatology, 9(4), 216-230.

Levin, A. P. (2008). Secondary trauma and burnout in attorneys: Effects of work with clients who are victims of domestic violence and abuse. American Bar Association Commission on Domestic Violence, 9.

Levin, A. P., & Greisberg, S. (2003). Vicarious traumatization in attorneys. Pace Law Review, 245.

McCann, I. & Pearlman, L. (1990). Vicarious traumatization: A framework for understanding the psychological effects of working with victims. Journal of Traumatic Stress, 3, 131-149.

Moulden, H. M., & Firestone, P. (2007). Vicarious traumatization: The impact on therapists who work with sexual offenders. Trauma, Violence, & Abuse, 8(1), 67-83.

Pross, C. (2006). Burnout, vicarious traumatization and its prevention: What is burnout, what is vicarious traumatization?. Torture, 16(1), 1-9.

Way, I., Vandeusen, K. M., Martin, G., Applegate, B., & Iandle, D. (2004). Vicarious trauma a comparison of clinicians who treat survivors of sexual abuse and sexual offenders. Journal of interpersonal violence, 19(1), 49-71.

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