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In the introduction to the series, the role of connection to ourselves and others was offered as an essential practice to live out the philosophy of therapeutic jurisprudence that underpins treatment courts. But, how do we stay connected to ourselves and others?
Connection requires us to make conscious choices. Active listening, asking questions for understanding, and identifying a participant’s strengths are all examples of choices that can help us stay in connection with others. What keeps us from making these choices? How do we notice when we are in connection, and how do we sustain it? How do we notice when disconnection happens, and then, how do we take steps to reconnect?
The answers to these questions—and ultimately making deliberate choices—first relies on our capacity to notice what is happening in the mind and body. The quality of that noticing—how we do the noticing—is also important to balancing both effective communication with others and taking care of ourselves. The skill that supports us in this is called mindfulness.
What is Mindfulness? (And, What It is Not)
Mindfulness is paying attention to what is happening in this moment, without judgement or reaction to the thoughts, feelings, and physical sensations that arise (Kabat-Zinn, 1994). The practice invites us to adopt an attitude of openness and curiosity about what we are experiencing, with kindness towards ourselves, so that we are able to respond, versus react, to not only what is happening in us but also around us in the environment.
Said another way, mindfulness involves five A’s: attention, acceptance, allowance, attitude, and action (Lee, 2020, 2021):
Discussion of mindfulness is increasing culturally, which has resulted in the increased accessibility of learning and practicing opportunities. Yet, with the rise of attention to the practice comes, at times, misconceptions. These misconceptions include:
Why Mindfulness?
Research suggests we spend approximately 50% of our time lost in thoughts about the past or future (Killingsworth, Gilbert, D. T. (2010) instead of the moment-to-moment experience we are having.
Consider the consequences of not paying attention to at least half of the moments in your life.
While practicing mindfulness does not guarantee a particular “state” of being, noticing our experience with kindness and without judgement does position us to make more conscious choices. Those choices, if intentional, can better embody our values, meet our needs, reflect our knowledge, and allow us to exercise our skillsets.
So, What Could Mindfulness Look Like at Work?
We can practice mindfulness using formal practices (e.g., meditation) or informally through everyday activities. The purpose of formal practice is actually to support us carrying over what is learned to everyday life, both in personal and professional contexts. Everyday activities could include, for example, drinking your coffee in the morning at your desk. Using all your senses to bring you to the here-and-now, you may take time to notice its color, smell its richness, hear any noise it may make moving in the cup, and experience it through touch and taste when taking a slow sip. And, you can practice mindfulness when you interact with others.
Consider the following scenario: a participant has missed three sessions of a group treatment program you are running. What could be some of the automatic, habitual thoughts, feelings, and sensations that arise for you?
Let us say the following was your experience:
Thought: He doesn’t event care. So disrespectful. Why do I even try? I’m tired of working harder than he is.
Feeling: frustration
Sensations: heat in the body, increased heart rate
Now consider what reactivity to this internal experience might look like, remembering reactivity is not intentional, deliberate behavior but rather more automatic and habitual reactions.
Reactivity might look like:
Reactivity: assuming your thoughts are “true,” complaining to a coworker about the participant, being short the next time you see the participant, or failing to see the participant’s strengths due to ruminating on the “disrespectful” behavior
Were we to consider taking a mindfulness approach, how might you relate to the experience of the thoughts, feelings, and sensations outlined above? This might look like:
Certainly, many factors influence our automatic, thoughts, feelings, and sensations in response to the world around us. Perhaps our mood is low that day, we were just in an argument with a loved one two days before, the participant reminds us of a friend with whom we have a challenging relationship, or we have a pattern of interpreting participants’ absences as disrespectful to us personally—just as some examples.
No matter the explanation, we will experience automatic, habitual thoughts, feelings, and sensations. The key to being able to stay in connection with ourselves is to not abandon the experience we are really having. Connection with ourselves positions us to be able to take care of ourselves.
The key to being able to stay in connection with others is also not to abandon the experience we are having. Connection with others position us to make connective deliberate choices like listening, asking questions, and displaying empathy.
There is no greater sign of respect, no deeper signal of appreciation, no better gift than you can give yourself or others than you attention.
Each article in the Connection: The Essential Practice for Therapeutic Jurisprudence in Treatment Courts series will conclude by offering two features: Connection Questions to
Consider and Connection Calls to Action.
Connection Questions to Consider:
A Connection Call to Action:
This week, you are invited to engage in a connection call to action to try out using mindfulness practice to connect with yourself and others.
By design, the judicial system wields disconnection as a tool to gain compliance, police behavior, and execute punishment. Rules are standardized, personal histories often remain unconsidered, change is sought through punitive means, and people are, quite literally, numbers. Arguably, the dehumanization inherent in this approach perpetuates, at least in part, the very social problems it seeks to address.
As a movement, the treatment court model is itself an answer to the ineffectiveness of disconnection in promoting behavioral change for those who experience challenges with substance use and/or mental health. The philosophy of therapeutic jurisprudence, which underpins the treatment court model, emphasizes the potential for psychologically healthy outcomes when the legal system is structured as a “restorative, remedial, and healing instrument” (ISTJ, 2022; Kawalek, 2020, p. 2; Stobbs, 2019). Therapeutic jurisprudence is concerned with “the human effects of the law” and the promotion of practices to benefit the “emotional, psychological, physical, relational, economic, and social personhood” of participants (Kawalek, 2020, p. 1-2). Treatment courts offer an important opportunity to leverage the legal system to make meaningful changes in people’s lives.
Collaboration is perhaps the hallmark of treatment courts. In identifying best practices, the National Association of Drug Court Professionals (NADCP, 2018b) emphasizes the importance of an interdisciplinary approach as well as complementary treatment and social services. Best practice standards also underscore the need for predictability, fairness, consistency, and evidenced-based principles for behavior modification in the operations of treatment courts—practices that cannot be actualized without both interdisciplinary and professional-participant collaboration. The NADCP standards further acknowledge the critical nature of attention to equity and inclusion for participant success; addressing historical patterns of discrimination and inequity certainly requires sincere collaboration (NADCP, 2018a).
The thread of collaboration can be traced back even further to NADCP’s earlier efforts to outline key components of treatment courts. NADCP names the “non-adversarial approach” as crucial to encourage collaborative, coordinated efforts to support participants (NADCP, 2004, p. 3). Another essential component is “ongoing judicial interaction with each treatment court participant,” a standard that explicitly highlights the need for an “active, supervising relationship” in service of increasing the likelihood of participant success (NADCP, 2004, p. 15). Emphasis is placed on early engagement with participants, interdisciplinarity, and “forging partnerships among treatment courts, public agencies, and community-based organizations” (NADCP, 2004, p. 23).
Without question, intentional, focused, collaborative relationships are central to the mission of the treatment court model, and such meaningful collaboration requires connection.
While scholars within psychology offer various conceptualization, social connection may be simply described as a sense of belonging, which can be derived from the experience of acceptance, concern, empathy, and care (Seppala, Rossomando, Doty, 2013). Arguably, a uniqueness of the treatment court model is the opportunity for social connection including
between participants and direct service providers (e.g., case managers, therapists), participants and others professionals (e.g., defense counsel, probation authorities, judges), as well as among the entire team of professionals collaborating with the participant. Notable to the treatment court approach is another, albeit a less obvious, opportunity for connection for participants—connection with self. That is, mental health service provision as well as case management services offer participants pathways to cultivating a sense of belonging to oneself through self-acceptance as well as concern, empathy, and care for the self. Lastly, treatment court professionals benefit greatly from being in connection with the self, too, which is helpful for both their own wellbeing and positioning them to be present and skillful in working with participants.
Connection—whether it be with self, others, or larger systems—is the nexus of change.
When participants are connected with themselves, they are best positioned to understand the influence of the past upon the present, identify their needs and values, establish goals, and take meaningful, congruent choices to shape their lives. The connection between professionals and participants results in participants feeling seen, heard, understood, and supported—often catalysts to personal growth and change. A treatment court team member’s own capacity to stay in connection with oneself results in the ability to embody professional values, utilize knowledge from their training, and effectively engage with participants. Further, professionals do not operate in a vacuum; connected collaborations, systems, and institutions result in stronger collaborations, systems, and institutions. The practices, processes, and policies of these larger entities matter—they can either reflect an investment in connection or disconnection. The ultimate goal of the treatment court model is to reduce recidivism through substance use and/or mental health treatment, and the means by which this goal is achieved is, in fact, staying in connection—perhaps the most essential, yet most unrecognized, practice necessitated by the treatment court model philosophy.
If connection is the birthplace of behavioral change, five primary questions emerge:
In the Connection series, we will examine these questions as to untangle the rewarding, nuanced, and challenging aspects of working in treatment courts.
People who have experienced trauma can be easily and suddenly overwhelmed, hypersensitive to sounds, confined spaces and objects. They may reflexively respond to these as life-threatening and can’t attend to or remember essential court proceeding or treatment-related information.
The field of Environmental Psychology studies how the physical environment, such as building design, floorplans, signage, and other features of buildings impact our behavior. Designs that provide privacy and a sense of safety are ideally suited for people who have experienced trauma (Garcia, 2020).
Of course, few courts, probation departments, treatment providers, etc. have the luxury of designing their own buildings. However, SAMHSA and other collaborators (2013) compiled tips for treatment court professionals that can help prevent or offset negative impacts of these often-intimidating spaces and promote a sense of safety and respect in participants. They highlight aspects of the physical environment that treatment courts can consider without great expense or delay.
Does your courtroom have seating that provides easy access to aisles and exits? If not, can seats be reserved near aisles? Where does the judge sit? DO they loom above the court, making eye contact and respectful connection difficult? Are people placed in handcuffs and shackled where all in attendance can see? Are the bathrooms where drug tests take place well lit? Is there a space where people can get some privacy if they need a space to calm down? Is the signage posted respectful? OR does it just instruct people what NOT to do?
The article provides a table that describes potential triggers in the environment, the possible reactions of a trauma survivor, and a more trauma-informed approach that treatment courts may take. According to Garcia (2020), “The goal of trauma-informed design is to create environments that promote a sense of calm, safety, dignity, empowerment, and well-being for all occupants. These outcomes can be achieved by adapting spatial layout, thoughtful furniture choices, visual interest, light and color, art, and biophilic design.” It would behoove treatment court teams to assess the physical spaces where participants engage in program-related activities with a critical eye toward minimizing trauma.
Which clients in your treatment court have a history of trauma? How can you find out? Why does it matter? While the conversation about the prevalence and devastating effects of trauma has become increasingly open in justice settings, many treatment courts may be blind to it in their own programs or simply hope that good intentions will prevent further trauma. Perhaps now is the time to self-reflect as a treatment court and to take small, but meaningful actions right now.
According to SAMHSA, “Individual trauma results from an event, series of events, or a set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being, (2014a, p. 7).” Trauma experiences can diminish the ability of treatment court participants to engage in programs and long-term recovery. So, what does it mean for organizations to be trauma-informed? First, in order for treatment court programs to fully embody a trauma-informed system of care, all program staff must:
1. Have a basic realization of the origins of trauma and the impact this can have on individuals, families, groups, and communities.
2. Be able to recognize the signs of trauma in individuals.
3. Continuously assess the ways in which policies, procedures, and practices should be revised in order to allow staff to respond to individuals appropriately.
4. Resist engaging in action(s) that may result in re-traumatization.
In addition, SAMHSA (2014a) identifies six key principles that should serve as the foundation for developing your trauma-informed systems of care.
1. Safety (this is #1 for a reason) – above all else, participants’ physical & emotional safety should be promoted in all settings & through all interactions. Individuals (i.e., staff and participants) who do not feel safe will not fully engage.
2. Trustworthiness & Transparency – treatment court operations should be transparent and conducted with an eye toward developing and maintaining mutual trust between and among stakeholders and participants.
3. Peer Support – incorporating peer recovery support specialists into your treatment court program is an effective way for individuals with lived experience to assist participants in their recovery.
4. Collaboration & Mutuality – recognizing and acknowledging that all treatment court team members and participants have unique roles/responsibilities is key to developing collaborative relationships based on mutuality and respect.
5. Empowerment, Voice, & Choice – treatment court team members look for opportunities to empower participants to make decisions and have a voice in their recovery.
6. Cultural, Historical, & Gender Issues – the treatment court program provides participants with access to clinical and recovery support services that are responsive to their cultural, racial/ethnic, and gender needs.
A good place to start moving toward being a trauma-informed treatment court is to screen participants for trauma exposure to determine which individuals are in need of a more thorough assessment and trauma-specific services. Several screening and assessment tools have been validated with justice-involved populations; a sample list is attached. This is by no means an exhaustive list, and note that separate tools have been developed for youth (Collaborative for Change, 2016) and adults (SAMHSA, 2015). Many of these tools are free, while some charge a nominal fee.
To conduct a screen sensitively that will yield valid responses, it is recommended that programs “take the time to prepare and explain the screening and assessment process to the client gives him or her a greater sense of control and safety over the assessment process.” (SAMHSA, 2014b, p. 94). Be prepared to reassess individuals as they grow more willing to disclose information over time.
In the coming months, Beyond the Field entries will periodically highlight literature on trauma-informed practices for different components of treatment courts, including drug testing, courtroom set-up and structure, team dynamics, use of language, and providing participants opportunities to have a voice and make choices.
Associating the word “brand” with treatment courts may seem to be a mismatch. Taking a closer look at what branding is, however, opens up possibilities for how we talk about the work of treatment courts with professionals, clients, and the larger community. In communication studies and rhetoric, one of the most prominent scholars who explains narratives and story is Walter Fisher. According to Stache (2017), “In 1978, Walter Fisher proposed a theory of narrative communication, which advances the idea that humans inherently tell stories and like to have stories told to them.” The idea of branding and brands comes from this human need for stories. In the commercial, business-to-consumer sense, brands function as a way for humans to create relationships with consumer goods (Twitchell, 2004). We sometimes call these “brand narratives.” Organizations tell stories in order to gain their stakeholders’ attention and every communication interaction between an organization with its audiences has an impact. In addition, Fisher explains that stories ideally have narrative coherence and narrative fidelity. Narrative coherence means that the story makes sense, and narrative fidelity means that the story rings true to the audience’s experience (Stache, 2017).
What does this look like for treatment courts? It means that the responsibility for communication falls on every member of the treatment court team, because every interaction is an opportunity to create a new reality – a new story – that builds on the mission and vision of your program. Does this mean every interaction must be perfect? Of course not. That’s neither realistic nor human. However, it does mean that open, honest, and authentic communication that aligns with a program’s mission and purpose can create a strong brand story. This strong brand story also means that the inevitable messiness of human communication happens within the context of a coherent story with fidelity. The process of developing your program’s brand can also build goodwill and trust with your intended audience, which will serve you well in times of both crisis and celebration.
Innovations like NADCP’s Equity and Inclusion Tool make it easier for treatment courts to “Do Better” to determine if their policies and procedures reduce racial, ethnic, and cultural disparities. But what about therapies? Are evidence-based interventions, say motivational interviewing (MI), equally relevant and effective for diverse populations?
No. The field has been slow to address this problem, but researchers have attempted to adapt existing, effective therapies to make them relevant for diverse clients. For example, Karen Chen Osilla and colleagues developed a web-based MI intervention in English and Spanish to improve the outcomes of Latino first-time DUI clients, (Osilla et al., 2012). They used a strategy called formative iterative evaluation, a multistep process, to assure the MI intervention content and delivery were responsive to linguistic and cultural needs.
First, MI researchers and health literacy experts for Latino & Spanish populations created an in-person MI intervention tailored to first-time DUI clients. Next, they conducted focus groups with clinicians and clients to determine what changes were needed. Then, they adapted the in-person MI intervention to an interactive web format in both English and Spanish. Finally, they tested it again to gather more feedback about its usability and cultural fit.
The developers made changes, such as translating idioms (“getting high”) and adding examples of ways that drinking could negatively affect family and friends. They integrated feedback on social and family values-related themes, adding “drinking with friends” as a reason to drink, “being a good role model” as a reason to stop drinking, and “not meeting family responsibilities or disappointing family/children” as negative consequences of drinking (p. 197). At the final test of the web-based format, clients who spoke only Spanish (compared to English-only and bilingual clients) “reported feeling less embarrassment, shame and discomfort with the web-MI” (p.199).
A later study of the intervention found it was likely not long or intensive enough to make a lasting impact, at least on its own. However, the study provides a sound example of a systematic, collaborative approach to developing effective multicultural therapies. Clearly, treatment court staff and providers cannot afford to wait for intervention research to catch up with the demand for culturally relevant therapies. In the meantime, we can remember that treatments are not “one-size fits-all,” and ask clients–especially those from diverse backgrounds–whether they feel respected, a sense of belonging, and if the therapy is actually helping, throughout their treatment court experience.
How many hours per week do you spend in meetings? Is it time well spent? Do you leave meetings with a sense of a way forward? Frustration? Could your team use a meetings “tune-up”? Workplace meetings are a mainstay of all organizations. For treatment court teams, regular pre-court staff meetings are required as a Best Practice (NADCP, 2018). But teams engage other meetings as well, including those with community stakeholders, program evaluation and planning, and others.
The NADCP Adult Drug Court Best Practice Standards champion the use of evidence-based practices, based on the best available research. While research can tell us what models and interventions work, the how of their delivery is less often discussed. The most effective treatment court teams go beyond the “what” of their program’s offerings (evidence-based practices) and relate to participants in ways that support and promote recovery (evidence-based relationships).
A Task Force on Evidence-Based Relationships was formed by the American Psychological Association to analyze the best available research to identify the core components of effective therapy relationships (Norcross & Wampole, 2011). The Task Force concluded that the therapeutic alliance, empathy, and gathering client feedback are clearly linked to positive outcomes. The therapeutic alliance entails mutually agreed upon goals, agreed upon tasks, and a sense of collaboration and relational bond between the two parties. Multiple rigorous studies also indicate that therapists who can express empathy (understand and acknowledge the client’s perspective) and who actively monitor client’s perceptions and responses to treatment are more effective. Relationship behaviors deemed ineffective and potentially harmful include a confrontational style, therapist comments that are hostile or blaming, judging the person versus their behavior, and applying a one-size-fits-all approach that ignores individual and cultural differences.
Relevance to Treatment Courts
While most members of treatment court teams are not therapists, the Task Force’s findings detail what works and doesn’t work in relationships that target lasting personal change. The following can apply to every court team role:
Treatment court involvement is essentially a series of human interactions, so relationships between participants and the team are central to recovery. Substance use and criminal behavior can be viewed as rooted in disturbed relationships, disconnection and alienation, and treatment court professionals have the opportunity to make lasting impacts–not only via evidence-based techniques and operational models–but through meaningful, evidence-based connections.
How many hours per week do you spend in meetings? Is it time well spent? Do you leave meetings with a sense of a way forward? Frustration? Could your team use a meetings “tune-up”? Workplace meetings are a mainstay of all organizations. For treatment court teams, regular pre-court staff meetings are required as a Best Practice (NADCP, 2018). But teams engage other meetings as well, including those with community stakeholders, program evaluation and planning, and others.
Industrial/organizational (I/0) psychologists Joseph Mroz and colleagues reviewed over 200 empirical studies of meetings in their article “Do we really need another meeting? The science of workplace meetings” (Mroz, Allen, Verhoeven & Shuffler, 2018). They identify worthy goals and provide specific recommendations for conducting successful meetings.
Nationally, they note, the average employee spends 6 hours per week in meetings, and that half of those meetings are rated as “poor” by those who attend. For most organizations, there is a clear need to revisit current practices and consider improvements. Mroz and colleagues identify four primary purposes of meetings:
1) Information Sharing;
2) Problem solving and decision making,
3) to develop and implement organizational strategies, and
4) to debrief a team after particular events.
They recommend that care should be taken before, during and after meetings to facilitate positive outcomes. For example, before a meeting, attendees should have read the agenda, be prepared and arrive on time. The agenda should list clear goals and outcomes and be realistic in terms of allotted time. During meetings, leaders should make the meeting short, and relevant. Humor and laughter can stimulate positive behaviors, but complaining leads to poor performance. Leaders should also intervene when communication becomes dysfunctional or off-track. A clear agenda as described above can go a long way toward mitigating these issues. By the same token, leaders should attend to perceptions of fairness and encourage participation from all attendees. After meetings, effective leaders send out action items and minutes and seek feedback about how others perceived the meeting, to improve the process.
While many of these recommendations seem obvious, researchers have objectively analyzed the costs, interpersonal conflicts, and inefficiencies that arise when these recommendations are not followed. The authors describe a problematic dynamic noted in a study by Simone Kauffeld and Nale Lehmann-Willenbrock, that many readers may find familiar:
When one person starts to complain in a meeting by expressing so-called “killer phrases” that reflects futility or an unchangeable state (e.g., “nothing can be done about that issue” or “nothing works”) other meeting attendees being to complain, which begins a complaining cycle that can reduce group outcomes (p. 488).
This “cycle” is common among professionals in human services fields, and while realism and pragmatism are valuable, pessimism can be contagious and toxic. This is one of the major challenges in treatment court work—even when participants behave in ways that look like “giving up,” staff would do well to convey a sense of hope in how they conduct themselves in meetings.