Managing stress.

Do you think your legal career is too pressured and leaves little time for a fulfilling personal life? You are not alone. Many recent surveys have shown that a significant number of attorneys are dissatisfied with their lives. More than 70 percent of lawyers often complain that the main problem is excessive stress.(1)

Even more disturbing are recent data showing that because of excessive stress lawyers are more likely than most other professionals to develop symptoms of mental illness, such as depression and substance abuse.(2) High stress levels also lead to headaches, sleep disturbances, high blood pressure, and more serious physical illnesses.

Not only do these symptoms damage lawyers and their families, but they are bound to diminish the quality of services clients receive. The latest statistics suggest that more than 60 percent of malpractice cases and disciplinary actions against attorneys involve chemical dependency or stress-related mental illness.(3)

The causes of stress among attorneys are fairly well known. Some stressors are common to many professions today. These include time pressures, work overload, competition, poor relationships at work, and inadequate office staff.

Other stressors are indigenous to the practice of law. For example, the conflict-laden legal environment causes stress among lawyers by encouraging suspicion, hostility, and aggression. The requirement that lawyers be both officers of the court and strong advocates for their clients sometimes creates role conflicts, another common cause of stress. In combination, these and other stressors often make practicing law physically and mentally hazardous.

Even though a great deal has been written recently about stress among lawyers, there is little evidence that the legal community has taken effective steps toward change. On the surface, at least, what needs to be done is plain to see. The problem is that what is easy to see is not always easy to do.

Consider what it takes to lose weight and stay trim. Most people know that you should exercise, eat less, and eat the right foods. (This is also a great way to reduce stress.) Even the details are web known. For example, almost everyone knows that fat and sugar consumption should be minimized and that 30 minutes of aerobic exercise three times a week is ideal.

Why is it, then, that weight-loss services and products constitute a multibillion-dollar industry in our country? Because knowing what to do behaviorally about weight is not enough. It requires change at a deep psychological level, where powerful emotions are often at work. This is where most people need help.

So it is with stress management. Real change requires a reexamination of basic values and an ability to deal with self-esteem issues, fear of failure, and conflicting social pressures. It is doable and worthwhile, but not easy.

Steps Toward Change

Everything should be made as simple as possible, but not simpler

The first step is to understand stress-reduction techniques at their most elemental level. Reducing complex tasks to their most basic level makes them dearer and less overwhelming. At this level, the advice given may sound like ordinary common sense. But part of the problem with our society is that common sense is not so common anymore. Therefore, the advice warrants being repeated.

You can respond to stressful events, like other dangers, in three basic ways: You can surrender, flee, or fight.

To surrender, you passively accept your stressful circumstances as inevitable and endure their costs. With the other two options, the goal is to reduce your exposure to stress. When you flee, you take leave of stressful stimuli. When you fight, you confront the situation directly and alter it to make it less stressful.

You can leave a stressful situation physically mentally. Examples of physical leaving include quitting your job, getting assigned to a different office, taking vacations, doing community service projects, and working fewer hours. Some of these strategies rejuvenate your ability to endure stress when you return. All of them reduce your exposure to stress by simply getting you involved in other activities.

You can also get away from it all mentally without physically leaving your office. The best way to do this is to use relaxation techniques that involve breathing, muscle relaxation, and mental imagery exercises like yoga. Although not as effective, daydreaming is a natural form of mental relaxation.

In part, relaxation techniques work because they allow you to take a mental break from your stressors and focus your mind on something pleasant. Researchers have discovered that these techniques have powerful physiological effects as well. They reduce blood pressure and the flow of certain stress-related hormones that are harmful to your health.

Relaxation techniques are effective short-term interventions. They give you a greater sense of control and get you through emergencies. However, they are not designed to be a long-term solution to chronic stress.

Short of quitting your job, the only way to effect a more permanent solution is to confront your stressors directly. You can do this in two ways: manipulate the external environment or change the way you interact with the environment both mentally and behaviorally.

To work on the external environment, you can advocate systemic reforms (for example, streamlined legal procedures) or help bring about better working conditions in your firm (such as reduced work loads). One of the most powerful mental and behavioral changes you can make is to develop more effective time-management skins.

Once you understand stress management in a global way, you can then begin to

delve into the details. Surface-level advice generally doesn't work. Real change requires dealing with deeply rooted personality traits. By way of illustration, consider what it takes to develop better time-management skills.

Time Management

Unless we are careful, we tend to slip into an attitude toward time which is rather like that of a passenger who sits backward on a speeding train.

People often assume that effective time management is a quantitative skill by which you simply accomplish more things in the same span of time. This is a limiting way of looking at it. Consider these questions: Who is the better time manager? Is it the person who spends more time doing rewarding and meaningful things, or is it the person who is more efficient at doing a great many different things? Both quantitative and qualitative aspects of time management are important.

The primary time-management skill to learn is to prioritize tasks and do the most important ones first. This strategy is explored in a book by Stephen Covey entitled The 7 Habits of Highly Effective People. Covey divides all daily activities into four categories:(6)

Effective time managers try to fill their days with activities that are important but not urgent (quadrant II). Planning, crisis prevention, and creativity occur when you work on these activities, and long-term goals are achieved. To focus on this type of work, you must think of time management in both quantitative and qualitative terms. You must explore your basic values and determine what your aim in life truly is.

One reason so many lawyers experience burnout is that they live in quadrants I and III, where crises and digressions occur. Although some crises in law are inevitable, many of the activities that should be completed in quadrant Il wind up in quadrant I as a result of poor time-management habits, such as procrastination and ineffective delegation. Other important matters inevitably become crises when lawyers allow themselves to be distracted by such quadrant III activities as telephone interruptions and unnecessary meetings.

To become an effective time manager, you must determine what goals are important, prioritize them accordingly, and try to accomplish the ones that are on top of the fist before they become urgent. This rule has several corollaries: Don't manage by crisis, don't procrastinate, delegate effectively, and don't allow your day to be interrupted by unimportant activities.

As simple as these time-management tips are, many lawyers find them difficult to follow. They blame the environment: "You don't understand what my office is like," they say. "I don't have time to do long-term planning and figure out what is important to me." Those who are able to follow some advice do become more efficient and less stressed, but only for a short while. Soon they revert to old habits or take on so many more tasks that they become just as stressed as before.

Simple time-management tips, like weight-loss tips, are often ineffective. For example, it is not enough to advise someone against procrastination. Usually, procrastination results from an underlying fear that the task may result in failure and cause emotional pain.

Similarly, an inability to delegate tasks usually is related to underlying perfectionism and distrust of others. People who find it difficult to control telephone interruptions and other digressions often are motivated by a need to be universally liked and a fear of being abandoned and rejected. Until these thoughts and emotions are fully understood and modified, little progress will be made toward effective time management.

Learning to manage time effectively requires you to dig deep within your personality and figure out what you truly want out of fife. Doing this involves over-coming personal ambivalences about values as well as strong social pressures that pull you in opposite directions.

As painful as it may be, honest and thorough self-examination is the only way you cm move toward enjoying both the process and the outcome of your work.

What Works

It is easier to perceive error than to find truth, for the former lies on the surface and is easily seen, while the latter lies in the depth, where few are willing to search for it.

Once you are prepared to dig deeper the first and most important step you can take is to examine what is causing your stress or keeping you from making changes to reduce it. To start, you nee to recognize that every stress response you have goes through a sequence of four events:

(1) a triggering incident or stimulus causes you to respond;

(2) your initial response comes in the form of a conscious or unconscious mental appraisal;

(3) the mental reaction causes a physiological response that results in an emotion; and

(4) you exhibit an outward behavior.

For example, let us assume that the associate working with you on an important case brings you a less-than-perfect brief. Also assume that you have a perfectionistic personality; that is, you have by the rule that anything short of a perfect job is a failure.

When confronted with less-than-perfect work from the associate, your initial reaction might be to think, "You are incompetent. I need to be in control of everything or it will all fall apart." Such thoughts trigger emotions like anger and fear of failure. Your outward response might be to express hostility toward your associate and to take fuller responsibility for the work.

This reaction creates a vicious cycle. Your inability to delegate work to others and tendency to take it all on yourself creates more stress because it compounds your time pressures and leads you to make mistakes.

One of the best ways to become aware of the specific stimuli, thoughts, emotions, and behaviors that contribute to your stress is to create a daily log of stressful events. Din4de a blank sheet of paper into four columns and use it as you would a diary.

Generally, it is easier to identify the events and behaviors in a stressful situation than it is to connect them to their respective thoughts and emotions. Before you can make any changes, however, it is important to understand the contents of all four columns in the log. Take special care to dearly identify two types of underlying thoughts:

(1) the basic assumptions you make about yourself, others, and the world around you and

(2) the predictions you make about the future.

For example, underneath thoughts prompted by stress, a person often makes a negative assumption like "I am not really worthy of this job." Closely tied to these negative assumptions are negative predictions stated in an "if-then" form. Someone with low self-esteem, for example, might predict, "If I fad at this task then my colleagues will discover that I am truly not worthy and ease me out of the office."

After you have kept a log of your thoughts and emotions for a while, you will discover that they reveal a few common themes that are constantly replayed in your daily life. Generally, you will find that these patterns have a long history and are deeply ingrained in your personality. This means they are so habitual as to be triggered automatically and without much deliberation about their validity. You tend to rely on them as if they are scientifically proven laws of physics.

Finding Alternatives

This brings us to the next step you must take - namely, to interrupt your automatic mental and emotional reactions and evaluate each anew.

To accomplish this, you must open yourself to the possibility that there are alternative ways of interpreting the stressful events in your life. Doing this makes sense only if you recognize that stress is caused both by objective reality and subjective interpretation. The proof is that people differ drastically in how they perceive similar events.

Here is an example of one internal dialogue you might have. Suppose you are assigned a new case, and your immediate, automatic reaction is to say to yourself, "How can I find the time to do everything?" Almost as quickly, you feel frustrated, depressed, and even angry. Soon you may become irritable, lose your ability to concentrate, and work less effectively.

But if you recognize the sequence, you can tell yourself, "Wait a minute! Those are my automatic thoughts. Let me reevaluate their validity. What are the basic assumptions and predictions I am making when I say, |How can I find the time?' The underlying assumption is that I am incapable of finding a creative solution to my problem. In addition, I am jumping to the conclusion that if I can't handle all this work without making any adjustments to my already busy schedule, then others will think I am not up to the task."

You might then say to yourself, "Suppose I make the assumption that I am capable of solving this problem and that perhaps nothing will happen to me if I have to make reasonable adjustments to my calendar. Now, instead of asking my initial question rhetorically, I can ask it with a real question mark: |How can I find the time?'"

From then on you explore various answers to that question in a creative way.

Once you begin to develop actual solutions to the problem you're facing, positive emotions are triggered, and the behaviors that follow are more constructive. If you do this often enough, eventually your old patterns of thoughts, emotions, and behaviors are replaced by stress-reducing new ones that help you function more effectively.

This process is effective but difficult to put into practice. For many people, it is among the most difficult things they will ever do. Because of this, some choose to seek the help of a professional. If you decide to seek help, note that this approach is based on what is known as cognitive psychotherapy. Because the vast majority of lawyers place great value on their logical and analytical skills, cognitive psychotherapy seems a natural match for them.

Summoning Courage

Beware of easy-sounding solutions to the stress in your life. Of course, when they are implemented, they do work. The problem is that they, are always difficult to put into practice.

Real change requires delving into your personality. It means breaking through emotional resistance, and it takes courage. The good news is that courage builds self-esteem, which in turn leads to what everyone wants - happiness.

Wisdom for Workaholics

If you think you might be a workaholic, here are some suggestions:

* Stress management and exercise programs may help. Be careful not to substitute excessive exercise for excessive work. Stress management and mediation alleviate only the symptoms of overwork. These are only temporary solutions, not cures.

* Admit that you have an unhealthy attachment to work and decide to step back. Realize that too much time on the job can make you unproductive, affecting your judgment and making you a potential liability to your firm.

* Ask yourself why you work so hard. What is your mission? Are you looking for some reward? A sense of accomplishment? Who are you trying to please? If you don't have clear answers, you may not know what you are doing and why. You may be compulsive about work.

* Put strict limits on your workday. Decide to stay only until 6 or 7 p.m., then leave, regardless of what else needs doing. You don't have to complete everything that crossed your desk today. Some things can wait until morning, when you are refreshed and your mind will work more efficiently. Some "marinating" might produce better result.

* Before leaving work, take 30 minutes to think about the next day and plan your priorities.

* Make a commitment to spend some time with family and friends. Make real plans. Buy tickets. Make reservations. Send a deposit for a resort weekend. The people you care about can't be squeezed in between meetings and phone calls.

* Consider talking to a counselor or therapist. He or she can help you look at the causes behind your workaholism and help you to deal with its consequences.

Perhaps you aren't a workaholic. You're just overloaded, overscheduled, and overwhelmed. Here are some suggestions for lightening your load:

* Always leave at least 25 percent of your time unscheduled.

* Assign priorities to each task. Try to work on the most important ones each day.

* Break down big jobs into small chunks. Early in the day, try to finish something, even a small chunk.

* When you take on something new, give up something else you were doing.

* Delegate more. When you delegate, ask your subordinates, "Would you like to do this?"

* Face your problem. This is the biggest step to solving it. Some only get the word after a heart attack or a failed marriage.

Dr. Amiram Elwork is the director of the law-psychology graduate program at Widener University in Chester, Pennsylvania. He has a private practice in the Philadelphia area.

Gerald Le Van heads Le Van Associates, a Black Mountain, North Carolina, firm that counsels lawyers and others on quality-of-life issues. This list is taken from his book, Lawyers' Lives: Out of Control (1992).[C] 1992 Gerald Le Van.

Notes

(1) AMERICAN BAR ASS'N, AT THE BREAKING POINT: THE REPORT OF A NATIONAL CONFERENCE ON THE EMERGING CRISIS IN THE QUALITY OF LAWYERS' HEALTH AND LIVES (1991); AMERICAN BAR ASS'N, THE STATE OF THE LEGAL PROFESSION - 1990: REPORT OF THE YOUNG LAWYERS' DIVISION (1991). (2) G. Andrew, Benjamin, et al., The Prevalence of Depression, Alcohol Abuse, and Cocaine Abuse Among United States Lawyers, 13 INT'L J. L. & Psychiatry 233 (1990); William W. Eaten et al., Occupations and the Prevalence of Major Depressive Disorder, 32 J. OCCUPATIONAL. MED. 1079 (1990). (3) DONNA SPILIS, AN OVERVIEW OF LAWYER ASSISTANCE PROGRAMS IN THE UNITED STATES: RFPORT OF THE ABA COMMISSION ON IMPAIRED ATTORNEYS (1991); STANDING COMM. ON LAWYERS' PROFESSIONAL LIAB., AMERICAN BAR ASS'N, THE LAWYER'S DESK GUIDE TO LEGAL MALPRACTICE 105 (1992). (4) DONALD O. BOLANDER ET AL., INSTANT QUOTATION DICTIONARY 239 (1969). (5) ROBERT GRUDIN, TIME AND THE ART OF LIVING 9 (1982). (6) STEPHEN COVEY, THE 7 HABITS OF HIGHLY EFFECTIVE PEOPLE 151 (1989) (7) BOLANDER ET AL., supra note 4, at 259.