December 12, 2019 Article

Using Reflective Case Consultation to Battle Burnout and Secondary Traumatic Stress

Over time, we have seen a cultural shift in our office.

By Kim Cobb, Elise Melrose, Alison Stankus, and Alexandra Vargo

As advocates for children, we are “under pressure”: We are the voice for the most vulnerable in a vast and complicated configuration of systems. The issues we face as children’s lawyers are immense, and not ones that attorneys in other practice areas generally confront through their work on a daily basis. Each client’s individual experience illustrates our societal problems: poverty, substance abuse, domestic violence, severe neglect, mental illness, physical abuse, sexual abuse, human trafficking, and sometimes death.

Due to these experiences, the clients we represent often have complex trauma histories beyond the scope of what any child (or adult, for that matter) should endure. Just when we think we’ve heard or seen it all, there is another client who has experienced a situation that baffles, angers, and saddens us. We look into the eyes of our clients; we hear their voices recount the unimaginable and experience the hard truths of their lives. We revel when the protective factors for which we advocate bring forth resilience in our clients. We are discouraged and may feel responsible if our advocacy is not enough to mitigate the long-term impact of their trauma. As Laura van Dernoot Lipsky writes in her book Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others, we are “transformed” by this work—“the world looks and feels like a different place” as result of it.

Exposure to these issues through our work leads to secondary traumatic stress (STS) in children’s lawyers. In a fact sheet, the National Child Traumatic Stress Network describes STS as emotional duress that is a result of hearing another’s first-hand trauma experiences. STS is caused by “second-hand” exposure due to the work we do every day as advocates for abused and neglected children: hearing stories and narratives of traumatic events, reading case files, and eliciting testimony in court.

STS is unavoidable if we are immersed in our work with trauma-impacted children and families. It can develop into symptoms—such as hopelessness, hypervigilance, avoidance of clients, anger and cynicism, sleeplessness, chronic exhaustion, and guilt—that can mimic those of post-traumatic stress disorder. Further, STS and its symptoms can accumulate over time and lead to compassion fatigue and vicarious trauma, more than just burnout or general occupational stress. We can become desensitized toward our work, and STS can build up to become an occupational hazard. We chose to become children’s lawyers because we have a fervent desire to ensure children’s safety, well-being, and permanency. Yet, we likely didn’t fully understand the impact this work would have on us. How do we sustain ourselves in the face of STS to continue on our relentless quest to improve the quality and dignity of our clients’ lives?

What We Are Doing

The Office of the Cook County Public Guardian comprises three divisions—the Juvenile Division, the Adult Guardianship Division, and the Domestic Relations Division—that are devoted to championing the rights of children and adults with disabilities. In the Juvenile Division, our office is appointed as attorney and guardian ad litem for about 6,000 clients ranging from newborn to age 21 in child abuse and neglect proceedings in Cook County, Illinois. The division has some 60 lawyers and a multidisciplinary team of paralegals, social workers/case advocates, psychologists, investigators, and support staff.

Due to the confidential nature of our work in child abuse and neglect proceedings, it can be incredibly difficult to share the trauma that our clients experience (and that we hear or read about on a daily basis) with our normal supports, such as family or friends. Even when we can share generalities, we fear that our normal supports won’t understand, or we don’t want to burden them with more stories of injustice or suffering. We may also worry about “sliming” our coworkers—unloading our experience of a client’s trauma on them when they might already be experiencing STS themselves. But we must acknowledge that STS affects all of us, and to ensure that we continue to advocate zealously for our clients, we must address it.

The first step toward addressing STS was recognizing, as the saying goes, that it is an issue. In 2014, our office was approached by the Children’s Research Triangle, a Chicago-area mental health service provider, which had received a grant from the Bright Promises Foundation. The goal of the grant was to work with partner agencies to help further integrate trauma-informed knowledge and practice into the fabric of each organization. For our organization, clinicians from the Children’s Research Triangle facilitated a series of trainings focused on recognizing and developing foundational tools and strategies to cope with STS, compassion fatigue, and secondary trauma. These “cost of caring” trainings were mandatory for all staff in the Juvenile Division, from supervisors to our clerical support staff, and the sessions were tailored to an individual’s role in the office. For example, supervisors received training that incorporated discussions on the additional challenges of supervising attorneys affected by secondary trauma, while also likely experiencing STS themselves. Through the trainings provided by the grant, it quickly became apparent that STS was greatly affecting not just us as children’s lawyers but our staff as a whole.

After the grant ended in 2017 and our entire staff in the Juvenile Division had participated in and benefited from the trainings geared toward addressing the secondary trauma we all experienced, the four of us set out to carry on the tenets of the grant. Specifically, we wanted to ensure that our organization continued to recognize the effects of STS on our staff and provide an outlet to address it. With guidance from the Children’s Research Triangle clinicians and by adapting a model by Richard L. Hester and Kelli Walker-Jones from “A Reflecting Team Method of Case Presentation,” we developed and implemented the Reflective Case Consultation (RCC) process to address STS among attorneys and other staff in our Juvenile Division.

What we now call “RCC” is a one-hour reflective session designed to provide a safe space for lawyers and staff to share their experiences of STS. The process consists of four roles for participants: presenter, listening partner, reflective team, and timekeeper. The presenter volunteers to share his or her experience with the group and raises internal struggles, questions, and concerns—initially just with the listening partner and then with the larger reflective team. The listening partner asks questions of the presenter that focus on the inner experience of the presenter, rather than on judgment or supervision. The reflective team listens to the discussion between the presenter and the listening partner, and then talks among themselves about the presenter’s experience. The timekeeper is charged with managing the time and participates as part of the reflective team. The focus of the session as a whole is on the experience of the presenter—not supervising, fixing, diagnosing, or directing the issue or case.

We begin each session with a brief introduction to explain the process and discuss the ground rules—including that the forum focuses on support and encouragement of each other, rather than on judgment, and is meant to be a safe space. Next, the presenter and listening partner speak as if they are alone for 15 minutes about the presenter’s case, while the reflective team listens silently. After a minute of silent reflection, the reflective team then speaks for 10 minutes regarding the presenter’s struggles or concerns. The presenter and listening partner remain in the room and listen to the reflective team’s discussion. Following another minute of silence, the presenter and listening partner again speak alone for 5 minutes to process what they heard from the reflective team. Then, the entire group comes together—presenter, listening partner, and reflective team—to discuss each other’s experiences as they relate to the presenter’s case. The end of each session is dependent on the course of the discussion. At times, we have used silence or meditation to end the session, but for most sessions, staff have so much to share with each other that we run out of time and (without even trying) end on a positive note of shared experience. For more information on the process, see the "The Reflective Process—Guide".

We schedule RCC as a monthly opportunity for our lawyers and staff, and the management of our organization encourages staff to take the hour to process and address STS. In preparing for each session, we provide a related article or reflection for participants to read, and despite using a conference room, we try to make the room as tranquil as possible through air diffusers, portable fountains, and baked goods or treats.

We encourage staff members who attend to volunteer as the presenter, but we also come prepared to present. One of the four of us is always the listening partner—a role that we’ve sometimes found to be difficult, given that most of us are attuned to focus on solving problems, rather than simply listening and focusing on the presenter’s internal struggles. We also offer a list of suggested topics for presenters to help identify an issue or concern to discuss. Some examples of suggested topics are our experiences of our client’s or client’s family’s trauma; stressful issues as advocates in the child welfare profession; gender, racial, and cultural issues that arise in our work; and systemic competence issues, including engaging with other professionals.

Why It Works: The Impact of RCC on Our Staff and Practice

It is not always easy to introduce new projects, especially those that make individuals reflect and share. Many of our lawyers and staff were skeptical at first, and some probably still are. Some initially thought that the sessions were just for venting or complaining or that they were just another task on their to-do list. These initial responses to the project made clear that the first step toward having any success was to have internal support from our administration. Once we had this support, it allowed us to provide a consistent time and space for monthly sessions to be held. The consistency of the facilitators and the process at every session has been crucial.

Everyone in our office knows when the sessions are held and who will be facilitating. Though we have consistency, we never know how our colleagues’ days will go. Court hearings, meetings, client visits, record reviews, and phone calls can be filled with brand-new trauma exposure. One day someone might not want to talk about anything, and other days that person may be bursting at the seams to share. We try to make attendance as easy and beneficial as possible. Staff are welcome to attend the open sessions without signing up in advance, with no expectation of participation, and with an expectation of privacy. Those who attend may wish to present and share, listen and provide feedback, or just simply listen.

Sometimes merely listening to what our colleagues are experiencing can help us feel less alone. It can increase our awareness that our colleagues are also experiencing STS and dealing with or processing it in their own ways. Any level of participation allows us to be there for one another and to acknowledge that it is OK to talk about our exposure to STS and the fact that it affects us all.

One of the ground rules for RCC is that attendees do not talk about what happened during the session once they leave. We have worked hard to keep RCC a “safe space” where what is talked about in the session stays in the session. We have also worked hard to distinguish RCC from our regular chain of supervision, keeping the sessions focused on the experience of the presenter and the feelings the experience brought up for the presenter and the reflective team. We redirect our inclination as lawyers to diagnose, advise on, or fix those experiences, as that certainly has or will happen in separate meetings outside of the session.

We have been able to maintain attendance through word of mouth and by building a positive reputation. We have also been able to get new faces in the room and have consistent attendance by offering continuing legal education (CLE) credits to lawyers who attend. In Illinois, earlier this year we completed our first reporting period where one of the required categories of continuing education credit is “mental health and substance abuse,” a subcategory of our professional responsibility credit requirements. RCC qualifies for this specialty credit for lawyers who attend. We realize that some lawyers may attend because they need that hour of CLE, and that is fine with us—we believe that every single person in the room receives a benefit from the session, no matter their reason for attending.

Over time, we have seen a cultural shift in our office. Those who have attended often come back again and again. Providing a time and space for these structured sessions with support from our administration has allowed our lawyers and other staff to openly discuss how our work affects us. We have been able to acknowledge and reiterate that STS is not a sign that we are not cut out for this work or that we are not able to do our jobs well. Rather, through RCC we are slowly and collectively recognizing that it is OK to admit the presence of these symptoms not just to ourselves but to our colleagues and even our supervisors.

Evaluations are a required part of our course offerings to receive mandatory continuing legal education (MCLE) credit, and they have been especially useful to gauge participants’ true feelings and reactions to the reflective process. For example, it may be hard to tell how a participant who is not speaking as much as others is experiencing the sessions. Feedback from our sessions has included statements such as these:

  • “Words cannot express the value this training has added to my work experience.”
  • “Need more time! I love being able to ‘exhale’ in these sessions and not feel judged.”
  • “[T]his [session] far exceeded my expectations. The structure helped me more than I thought it would. At times, I had tears in my eyes.”
  • “We all went through processing the emotions—feeling the frustration and lack of control we all feel—in a very universal way.”
  • “[The presenter] was brave, and I think this is the start of something great.”
  • “Thank you for this outlet!!!”

Effects on the Profession

Even seasoned lawyers sat back after the initial round of grant-funded training and had an “ah-ha” moment of identifying with the experience and symptoms of STS, realizing “that’s why I’m feeling this way” or “that’s why I’m having this reaction.” While we may all vent about the frustrations of being a children’s lawyer, STS is more than that—and we don’t know that others are experiencing it unless we talk about it. Making the initial “cost of caring” trainings mandatory gave all our staff a common language to use when talking about how the work affects us, helping us identify symptoms of STS both in ourselves and in our colleagues. The RCC sessions also have helped to create an office-wide model of a safer and more reliable option for debriefing our work with colleagues.

Unfortunately, the legal profession overall has only in recent years begun to address wellness among its members. When Illinois announced in April 2017 that attorneys would need to complete CLE on mental health and substance abuse topics, it was one of only three states requiring attorneys to complete some form of mental health and substance abuse education. The Illinois Supreme Court Commission on Professionalism amended the MCLE rules to include this category to both address the profession’s lag in addressing wellness among its members and encourage course development on this subject. In the announcement issued on April 3, 2017, the Illinois Supreme Court found that “lawyers were not seeking out or cannot find continuing legal education programs that might offer meaningful help in addressing [their own issues or those of their colleagues].” Education is the key to reducing the stigma of STS among children’s lawyers and the legal profession as a whole.

Conclusion

We cannot do this work for very long—at least do it well for very long—without being affected by STS. We need to maintain seasoned children’s lawyers while developing new members of the profession who will want to stay and commit to this difficult work for their career. We have found that both experienced attorneys and new hires attend RCC and that they use the outlet of the sessions to sustain them. We also are beginning to implement the “cost of caring” material into our training protocol for new hires as well as hold initial reflective sessions for them. Our hope is that what has been a “cultural shift” for those of us who have been in the office through this journey will become the normative way of practicing for our new lawyers. We believe that RCC is an effective tool to battle burnout and STS and that it is an important tool in elevating our practice and our profession.

Kim Cobb is the director of the Caseworker Advocacy Unit at the Office of the Cook County Public Guardian in Chicago, Illinois, where Elise Melrose, Alison Stankus, and Alexandra Vargo serve as attorneys and guardians ad litem for child clients in the office’s Juvenile Division. Together they facilitate monthly Reflective Case Consultation sessions for Juvenile Division lawyers and staff.


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