Litigants Can Benefit From Counseling to Relieve Symptoms of Distress

Contemplating, undergoing, or having undergone a lawsuit is distressing and disruptive. Litigants who enter psychotherapy are seeking support and help in managing what can be a continuing crisis.

"The challenge for patients is to confront and manage the emotional burden of the process," said Larry Strasburger, M.D., an assistant clinical professor of psychiatry at Harvard Medical School and a counselor and past treasurer of the American Academy of Psychiatry and the Law. Strasburger was a corecipient of the Manfred S. Guttmacher Award at APA's 1998 annual meeting in Toronto.

Litigants who seek counseling may be experiencing multiple symptoms of distress, including sleeplessness, anger, frustration, humiliation, difficulty concentrating, loss of self-confidence, anxiety, and despondency. Defendants commonly experience a sense of being alone, isolated, and helpless.

Litigants are often further distressed as various members of their support systems burn out.

"The experience of giving testimony in a public forum can be exquisitely painful. Having a deposition taken is sometimes described as 'being stripped naked,'" said Strasburger.

Both direct examination and cross-examination may make plaintiffs feel that they are on trial, exacerbating a sense of vulnerability and victimization. This is particularly true for PTSD patients whose "psychological defense of avoidance is thwarted, causing a resurgence of intrusive traumatic ideation and increased arousal."

Plaintiffs and defendants are troubled by a sense of losing control over their lives, which is aggravated by issues of power and control inherent in the attorney-client relationship.

Transference of positive or negative feelings from the patient's relationship with the attorney to the therapeutic relationship can occur. The helpful attorney may result in an idealizing transference. "In contrast, the cynical, seductive, inattentive, or authoritarian attorney who demands unconditional trust and compliance can produce feelings of helplessness, rage, or despondency in the therapeutic relationship."

Feelings of countertransference must also be recognized. The therapist's interest in the legal consequences of the case may lead to an overidentification with the patient's cause, obscuring the focus of psychotherapy. The therapist may also have to cope with feelings of envy regarding the litigant's financial award.

Psychiatrists should also understand that even when there is a positive verdict, the successful litigant undergoes suffering. "Vindication does not necessarily restore the self-confidence eroded by the demoralization and isolation that litigants often experience," he observed.

On the basis of his experience treating litigants and consultation with colleagues, Strasburger made the following suggestions.

• Become familiar with the legal process. This will enable reality testing and provide clarification for the patient, who may have a distorted idea of what's occurring in the legal process.



• Remember that the statute of limitations may have rushed the patient into litigation before he or she was psychologically ready to face an adversarial proceeding.



• Recognize that litigation is a lengthy process and anticipate the patient's frustration with the amount and length of time required.



• Understand that the legal battle enables people to put their lives on hold, avoiding other significant aspects of their lives.



• Remember that the issue of divulging secrets will arise, particularly as the patient is required to disclose information through interrogatories or a deposition.



• Help the patient understand that an out-of-court settlement is not an admission of guilt.



• Recognize thatfriends, associates, and family may have been damaged by the litigation.



• Be careful about taking notes, which may be subject to subpoena. It's best to be discreet and avoid conclusory statements about causation.