Would you prefer a delicious piece of chocolate now or a whole chocolate bar tomorrow? A 3-day vacation now or a 7-day vacation in 5 months? To spend an extra/bonus $500 now, or put it in a savings account to accrue interest? Most people prefer immediate rewards over delayed ones. However, people with substance use challenges tend to find it especially difficult to imagine their futures and delay rewards. Research indicates that people with substance use disorders have a narrower “temporal window,” meaning their attention is focused on gaining near-future rewards, such as the next drink or next drug use opportunity. For example, studies show that when asked about their own future, the typical individual reports goals and activities about 5 years in the future. In stark contrast, people with heroin use disorders offered reports that extended only 9 days in the future, on average (Patel & Amlen, 2020).
Delay discounting is the term used to describe the rate at which future rewards are less valued over time. Higher rates of delay discounting are related to impulsivity and risky behaviors like drug and alcohol use. Research in Episodic Future Thinking (EFT) suggests that helping people to vividly imagine personally salient future events could help them learn to delay rewards in order to get a bigger payoff in the longer term (Bulley & Gullo, 2017). Applied to a treatment court context, clients could learn to forgo short term rewards such as relief from craving or feeling euphoric, in favor of long-term goals, like graduating from the program, freedom from probation, and regaining custody of children.
Several promising studies of EFT with people with alcohol dependence show positive results. For example, Snider, LaConte & Bickel, (2016) encouraged participants to expand their temporal windows by thinking about personally relevant future events and describing them in salient detail. Participants reported the most positive event that could realistically happen at each of 5 points in the future (1 day, 1 week, 1 month, 3 months, and 1 year). Researchers then probed: “What will you be doing?” “Whom will you be with?” “Where will you be?” “How will you be feeling?” “What will you be seeing?” “What will you be hearing?” “What will you be tasting?” “What will you be smelling?” (pp. 1160-1161). They also asked a comparison group of people with alcohol dependence to imagine PAST events in the same timeframes, with similarly worded probes. This method allowed researchers to assess the unique contribution of a future time orientation.
Each participant’s future or past personalized account was then integrated into a task in which they chose between hypothetical gains in money received now or after some delay (e.g., “Would you like $50 now or $100 in a year?” They also administered measures of alcohol use. They found that over time, people in the future-thinking/EFT group came to value future monetary rewards more highly and reduced their alcohol consumption. These improvements were also found in a study that involved a one-week, 4-session/practice protocol with people with alcohol dependence (Patel & Amlen, 2020). In addition to decreases in alcohol demands and delay discounting rates (i.e., they were more able to delay rewards), participants who had engaged in even 1 session also showed significant increases in mindfulness—an essential tool in supporting recovery.
More research is needed to determine whether EFT can effectively contribute to treatment of substance use disorders. But treatment court personnel and providers can easily incorporate these highly targeted, future-thinking questions to help clients visualize a future self that is healthier and more fulfilled. Repeated practice is essential to change, and the frequent contacts afforded to treatment court clients could provide ideal opportunities to engage them in this line of thinking.
Compassion is defined as “the ability to understand the emotional state of another person or oneself…and a desire to alleviate or reduce the suffering” (Engel, 2008). Given that treatment courts are an application of therapeutic jurisprudence (see Winick & Wexler, 2015) and seek to facilitate the rehabilitation process, all team members (e.g., prosecuting attorneys, defense attorneys, law enforcement representatives, case managers, probation/parole agents, etc.) should display compassion when interacting with participants.
We know that the work of treatment court practitioners can be both rewarding and challenging. On one had treatment courts facilitate change within individuals who may have repeatedly cycled through the criminal justice system. However, asking team members to embody principles of therapeutic jurisprudence generally and compassion more specifically may run contrary to previous schooling and/or training. For example, Norton, Johnson, & Woods (2016) highlight the challenges lawyers may experience given their law school training (e.g., Socratic method) and the structure of the legal profession (e.g., adversarial system). This reality underscores the need to be mindful of a phenomenon titled “compassion fatigue” (or secondary trauma). Compassion fatigue has been defined as “’the cost of caring’ for those in professions that regularly see and care for others in pain and trauma” (Grant, Lavery, & Decarlo, 2019:1).
Dr. Françoise Mathieu’s TEDx Talk “The Edge of Compassion” addresses strategies for sustaining both compassion and empathy for others.
In order to maintain fidelity to the treatment court model, it is imperative that all team members are operating in accordance with the principles of therapeutic jurisprudence and are mindful of how compassion fatigue (or secondary trauma) manifests itself and what it “looks” like. This level of awareness among treatment court practitioners will allow for course correction should they experience the “psychological and physical effects of exposure to the pain, distress, or injustice suffered by clients” (Norton, Johnson, & Woods, 2016:988).
The term “self-care” has been used by scholars and practitioners across many disciplines (e.g., social work, psychology, nursing, education, etc.) as an identified strategy for bolstering health, well-being, and resiliency among members of their respective workforces. Despite this and the increasing discussion of self-care within the larger society, minimal consideration has been paid to the role of self-care in providing these same benefits to practitioners within the criminal justice system and specifically treatment courts. This is an obvious oversight and an area in need of empirical focus given the nature of work performed by criminal justice system and specifically treatment court practitioners.
According to Lee & Miller (2013) “Self-care has been described as a process, an ability, but most often as engagement in particular behaviors that are suggested to promote specific outcomes such as a ‘sense of subjective well-being’, a healthy lifestyle, stress relief, and resiliency for the prevention of empathy fatigue” (97). They go on to describe two distinct, but inherently connected dimensions of self-care; personal and professional. Personal self-care focuses on holistic health and well-being of oneself, where as professional self-care “is understood as the process of purposeful engagement in practices that promote effective and appropriate use of the self in the professional role within the context of sustaining holistic health and well-being” (98). Lee & Miller argue that both dimensions of self-care must be cultivated in order to develop and maintain a healthy and resilient workforce.
So, what is needed in order to fully develop personal and professional self-care? What specific areas of one’s personal and professional life should be considered and supported? Lee & Miller (2013) identified several areas within both dimensions which are outlined in Table 1 below. A specific discussion of each area of attention and support is provided in the journal article. Go check it out!
It is widely acknowledged that therapeutic jurisprudence serves as the theoretical foundation for the treatment court model. This perspective “seeks to assess the therapeutic and anti-therapeutic consequences of law and how it is applied. It also seeks to affect legal change designed to increase the former and diminish the latter.” (Winick & Wexler, 2015, p. 479). Treatment court scholars and practitioners recognize that treatment courts stand in stark contrast to traditional criminal courts in how they are structured as well as how they operate. Winick & Wexler (2015) assert that “an important insight of therapeutic jurisprudence is that, how judges and other legal actors play their roles has inevitable consequences for the mental health and psychological well-being of the people with whom they interact.” (p. 481) One strategy for putting therapeutic jurisprudence into practice is through the practice of empathy. Empathy is defined as “the ability to see a situation from someone else’s perspective—combined with the emotional capacity to understand and feel that person’s emotions in that situation.” (Colby, 2012, p. 1945)
Drug Court Key Component #7 & Adult Best Practice Standard #3 highlight the critical role of judges in treatment courts and specifically the interaction between judges and participants during court review hearings. More specifically,
While judges are integral to the success of any treatment court program, less is written about the specific role of other interdisciplinary team members (e.g. prosecuting attorney, defense attorney, case manager, law enforcement, etc.) in adopting the principles of therapeutic jurisprudence in their work. It is vital for all treatment court team members to practice empathy when interacting with program participants. The below-listed multimedia resources provide some additional insight into how to practice empathy within your work as a treatment court practitioner. According to scholar Jamil Zaki “empathy is like a skill. It’s like a muscle. We can practice it like any other skill and get better at connecting with people.” (Young, 2020)
According to Knottnerus (2005) “. . . daily life is normally characterized by an array of personal and social rituals. Such rituals help create stability to social life while expressing various symbolic meanings that give significance to our actions” (p. 8). Both positive and negative behaviors are part of daily life and when practiced often enough become ritualized. Individuals in recovery often report that certain “people, places, or things” can elicit behavioral responses without conscious awareness or intention. This reality underscores the need for the recovery process and programming to include an emphasis on individuals recognizing negative rituals and replacing them with positive (or prosocial) rituals.
We know from research that this behavioral change must be predicated on a change in attitudes/beliefs, an increase in knowledge regarding the behavior and associated consequences, as well as ample time to practice new behaviors within a structured and supportive environment. Changing ritualized behavior can be a difficult process and feel very foreign no matter how positive the results may be. Researchers, Van de Poel-Knottnerus and Knottnerus (2011), assert that “. . . when patterned, ritualized modes of behavior are severely disrupted, this is a very difficult and problematic situation for human beings” (p. 108). To this end, understanding how ritualized behavior forms, as well as how it can be effectively changed, is central to the work of treatment court practitioners and researchers. Understanding the specific mechanisms by which programs affect behavior change among various target populations, and sub-populations, is crucial to success and sustainability.
We hope the below-listed resources encourage you to take inventory of the ways in which your treatment court program facilitates and supports participants in their work to replace negative habits with positive ones. Also, we hope this information provides you with ideas as to how your program can work to do more in this area. While Dr. Clear’s work is not specific to treatment courts, the ideas are very much applicable to the behavior change process that is central to the treatment court model. The article by Drs. Lanier and DeVall applies Structural Ritualization Theory to adult treatment courts specifically.
The importance of social connectedness among human beings has been well-documented. Researchers have found physical, emotional, and social benefits for individuals who are and remain connected to others. These same researchers have found profoundly negative outcomes associated with experiencing social isolation.
In these current times, the methods by which individuals connect with each other have taken on multiple forms (e.g., face-to-face, by phone, via cloud-based technology, etc). How is this notion of social connectedness relevant to the treatment court field? It is hoped that the information presented in the multimedia resources featured here will encourage you to examine the ways in which your treatment court program facilitates meaningful social connection between and among participants, team members, and the recovery community through program requirements (e.g., case management sessions, pro-social activities, court review hearings, etc.). It is vital that opportunities for participants to connect with others are maintained.