November 01, 2014

Communicating with Youth Who Have Experienced Trauma (Part 2)

The views expressed herein have not been approved by the House of Delegates or the Board of Governors of the American Bar Association, and accordingly, should not be construed as representing the policy of the American Bar Association.

Effective communication is crucial for establishing trust and building a successful attorney-client relationship.1 Part one2 of this article focused on the importance of relationship when working with youth who have experienced trauma. It also outlined some challenges to building healthy relationships that follow from trauma’s effects on development. 

This part focuses on strategies for communicating with clients who have experienced trauma. 

Trauma-Informed Communication

Many resources are available on developmentally appropriate interviewing and counseling of children and youth. This article adds to that guidance by highlighting considerations that arise when accounting for trauma’s effects. 

Interviewing

When interviewing youth:

  1. Take steps to minimize triggering the youth’s trauma-related sensitivities, and 

  2. Use interviewing techniques that accommodate trauma’s cognitive impacts, including trauma’s effect on receptive and expressive language.  

The principles of the trauma-informed stance (described in part one)—transparency, client control, predictability, reliability, proactive support, and patience—can help inform your interviewing approach.

Interview location. Conduct interviews in a place where the client feels safe and comfortable to minimize the client’s vigilance to threat. Give the client a sense of control by empowering the client to make small decisions about the interview location, such as what room to use for the meeting, where to sit in the interview room, and whether to meet with the door open or closed.

Preparing the client. Because youth who have experienced trauma struggle with unpredictability and transitions, tell the client about the timing, location, and intended substance of the interview ahead of time. Avoid showing up unexpectedly to meet with the client, or pulling the client out of a preferred activity. To further ease the transition, start the interview by “meeting the client where she is”—for example, talking about an activity the client was involved in right before your meeting—and then come around to the topic of the legal case gradually.

Client control. Give the client a greater sense of control than she may have had in other interviews (e.g., with the police or with child protective services). For example, you and your client might jointly develop an agenda before the interview with topics you would each like to address.

A general strategy for increasing the client’s sense of control is to “flatten the perceived hierarchy” between the lawyer and client.3 Explain that the lawyer and client each come to the case with distinct areas of expertise—for the lawyer, knowledge of the legal system; for the client, knowledge of her experiences and needs. In the lawyer-client relationship, the lawyer is not the authority figure; rather, the lawyer needs the client’s expertise to do the lawyer’s job effectively and, when representation is client-directed, to help the client accomplish her goals. De-emphasizing hierarchy creates the foundation for a more collaborative relationship, which decreases the risk of the client being triggered by the interviewing experience. 

Note taking. Have a candid conversation with the client about note taking. Tell the client she can see your notes any time, and invite her to take her own notes if she wishes. Explain you are only writing down what she is telling you, or questions you may have, and if she doesn’t want you to record a piece of information, you will follow her wishes.4

Transparency. Transparency should be a guiding principle in client interviews. Often, you will come to the interview with information relating to the client obtained from third parties. Be up front about what you know, while allowing the client to correct that account and provide her own version of the events. One strategy is to use a rising tone in laying out what you have been told to highlight your open-mindedness to alternate versions, while explicitly inviting the client to correct you and add her own account.5 

Since young children, in particular, may be prone to suggestibility, take care in walking the line between transparency and inadvertently “feeding answers” to the client. At times, you may have sensitive information that is unknown to the client that is more appropriately disclosed through a third party (e.g., a trusted therapist). Even in such cases, err on the side of telling the client what you know at an appropriate time, as the client might view it as a breach of trust if she later learns you withheld that knowledge from her.6

Child’s understanding. Trauma’s impact on language and attention can affect the client’s understanding of the interview questions and the manner of the client’s responses. Recall that youth may have trouble tracking interview questions if their brains are in “survival mode,” and that they may pay greater attention to nonverbal than verbal cues. Even if the client is giving brief answers, she may not be processing the exchange. Regularly check with the client on her understanding of the issue at hand. 

Client narratives. Help clients construct clearer narratives. If the client gives very short answers, one cause (among others) may be difficulty with expressive language. Here, the legal field can learn from recommendations developed for educators working with traumatized youth in schools. Try brainstorming with the client a list of words to describe her experiences and feelings.7 To bolster the client’s sequential thinking skills, help the client break down her answers to organize chronologically the events under discussion. Written or visual sequencing tools can also help, such as working with the youth to draft timelines or create “before” and “after” drawings.8 Also leave more time for having these conversations, so you can patiently work with the client to understand her story as she needs to tell it.  

Information disclosure. Respect your client’s choices about how much information to share with you. Explain to the client why you are seeking particular information, and how it will aid your representation. This lets the client make an informed decision about how much to disclose and maximizes transparency and client control.9 For example, if you are approaching a hearing where placement will be determined, and your client has a position about where she wants to be placed, explain how knowing as much as you can about the proposed placement can help you anticipate possible barriers and build the best case to support it. In jurisdictions where you serve as a more independent guardian ad litem, representing the client’s “best interests,” be clear with the client that you are fulfilling your duty to do a complete investigation and make a report for the court. 

Remember that it may be difficult for some youth to take advantage of your invitation to become empowered agents—due to feelings of shame about their traumas, fear of reprisal or of betraying loved ones, or an impaired sense of agency stemming from early trauma. With appropriate client consent, engage proactive support, such as other trusted adults, to help you gather information, and be patient. 

Interview recap. At the end of an interview, re-emphasize the client’s control over the information she has volunteered. Remind the client that it is up to her how you use that information, and ask if there is anything she wants you to keep confidential. Where ethical requirements take control out of the client’s hands, discuss those limitations with the client regularly, before your interviews. Also ask if there is anything else the client would like to tell you or if there is anything you forgot to ask her. This shows you value the topics your client finds important. 

Counseling and Decision Making

Counseling youth similarly requires attention to how trauma can affect the way a young person processes information, focuses her attention, and thinks through problems. To facilitate the process, begin laying groundwork early for choices the client will have to make in the future, then build on those conversations over time. This enhances predictability and helps prepare the client to make key decisions. 

Information retention/processing. Consider developing strategies to help the client process and retain information discussed during meetings. Again, draw on strategies used by educators working with traumatized youth in schools. When explaining an important or complex issue, present the information to the client in multiple formats (e.g., verbal and written).10 Flow charts, role-playing, and diagrams can further enhance understanding and focus the client’s attention. Write down key points and give them to the client to refer to after the counseling session, since the client might remember little after a meeting.11  Frequent repetition of important topics will also be necessary.

Decision making. When the representation is client-directed, remind the client that your job is to help her achieve her goals. Consider brainstorming and writing down lists of available options—for example, placement alternatives—along with their likelihood of success, to help the client identify and understand her choices and ultimately voice a preference or decision. As discussed in part one, some youth who experience trauma struggle to see themselves as capable of mobilizing resources to obtain desired outcomes. To encourage the client’s sense of agency, work with the client to brainstorm resources (e.g. trusted adults, school-based resources) to help her reach her goals. To cultivate decision-making skills, use tools like pro/con lists, or write down “if/then” statements to talk through likely consequences of options you might pursue in the case.12 

Creating continuity. At the end of a counseling session, summarize your understanding of the client’s goals and the next steps you will take on her behalf, giving the client a chance for input. At the beginning of your next meeting, update the client on what you have done since the last meeting, to help build a sense of reliability and repeat important information the client may have forgotten. Also give your client a chance to raise developments she wants to discuss.

Preparing for Court Appearances

In preparing for court, a central goal should be to maximize predictability in an inherently unpredictable process. Even if the client has been to court before, remind her about the flow of the proceedings and participants’ identities and roles. Familiarize the client with the physical space by visiting the courtroom in person, reviewing photos, or drawing diagrams. If available, consider showing the client photos of key players, such as the judge or opposing counsel. If the client will be asked to participate—even to answer seemingly neutral questions from the judge—use role-playing to prepare the client ahead of time. 

Anticipating outcomes. Try to anticipate the range of surprises and outcomes that may occur in court, and discuss these with the client. Avoid making promises, even about likely outcomes. Explain to your client that you will follow the plan you and your client have discussed, but it will be up to the judge to decide the outcome. Also explain how other parties involved in the case might respond to the range of outcomes that might occur.

Client control. Many lawyers find tensions arise when it may be legally advantageous to address the client’s trauma history in court. First, we worry that hearing or talking about these experiences in a semi-public setting may upset the client. To the extent possible, give the client as much control as possible over whether and how to use her trauma history. Explain that you understand it may be difficult to talk about these matters in court, but you think it might help achieve the client’s goals. “To help you in court, I’m going to have to ask you a lot of tough questions. This is so I can build a case for x, which I understand is what you want.” To help the client make an informed decision about talking in court, know your jurisdiction’s rules regarding opening proceedings to the public and under what circumstances, if any, the courtroom can be closed or a minor may address the judge in private.

Coping mechanisms. Additionally, your client may have adopted coping mechanisms that lead her to resist portraying herself as a “victim.” Consider identifying the client’s coping skills for her and explaining the advantages of stepping outside that way of functioning for purposes of the hearing. Frame this as a way the client can control her outcomes. “I understand that you’re a strong person and that it’s very important to you how tough you are in the face of what you’ve experienced. But, I think I can do a better job [achieving your goal] if you tell the judge about your experience and how hard that was for you.” Be frank about the dilemma with the client, and maximize the client’s choice in deciding how to use her trauma history. Note that some clients will be too invested in their adaptive behavior or will lack necessary cognitive skills to take advantage of this structure.13

Talking about Trauma 

Addressing our own fears that limit communication. For many lawyers, the most daunting part of communicating with clients who have experienced trauma is discussing that trauma with the client directly, when necessary for the legal case. Lawyers fear that they will severely upset or even “retraumatize” the client. It is true that we cannot do our work without causing occasional distress, but distress differs from harm. In considering the distress we cause, remember that it may be equally or even more harmful to walk on eggshells around a client’s experiences than to approach conversations about trauma with clarity and compassion. 

If we wait for clients to bring up these matters when they are ready, clients may assume we do not care or simply cannot handle it—confirming their view that others are indifferent to them and their experiences or that they are “too badly damaged.”14 Further, by avoiding these conversations we may actually be avoiding our own distress. Seeking support and guidance on secondary trauma can help us manage our own distress and communicate more effectively with clients about trauma.

Strategies for discussing trauma. While we encourage lawyers not to shrink from conversations about trauma, it is important to develop strategies for: 

  • evaluating when the client may be more or less prepared to talk about her trauma history without a high level of distress; 

  • containing conversations about trauma to minimize the client’s distress; and 

  • when the client does become severely distressed, responding to the client and helping her return to her baseline level of functioning. 

Additionally, because many youth are more willing to discuss their experiences with someone they trust, working to establish a strong relationship from the outset will be invaluable to facilitating conversations about trauma when necessary for the legal case.

The Importance of Assessment

Evaluating when a client is prepared to talk about her trauma history requires consulting mental health clinicians trained to understand and interpret client functioning in ways that are usually not readily accessible to a lawyer. Ideally, each youth client who has contact with the legal system should have an assessment of her needs and strengths, and have access to appropriate, coordinated services to meet identified needs. Consult clinicians assigned to work with clients to help you: 

  1. understand the clients’ vulnerabilities and strengths; 

  2. distinguish when a client may be in unusual distress from the client’s typical state of functioning; and 

  3. develop strategies for when and how to approach difficult subjects with the client. 

Discuss these objectives with your client, and obtain appropriate consents to consult your client’s providers, explicitly limiting that consent to your agreed upon objectives. Explain to your client that, by consenting for these purposes, she is not losing all confidentiality in the patient-therapist relationship.

Containing Conversations about Trauma

In addition to consulting mental health clinicians, the following strategies may help minimize clients’ distress from conversations about trauma.

Client’s state of mind. First, know where your client is coming from when you meet with her. Has the client just come from a stressful event, such as a visit with a noncaregiver parent or a conflict with a peer at school? If so, consider waiting to raise sensitive issues with the client, as the client’s heightened state of stress may increase the likelihood of a negative response. 

Reading the client. When raising a difficult subject, Dr. John Sprinson recommends relying on your own ability to read the client.15 If it seems the client is becoming distressed, say so, and retreat when appropriate. “It seems like what we’re talking about is upsetting you. Would you like to take a break? Would you like to stop for today?” If your client becomes severely distressed or appears to be in a “triggered” state, the roadmap provided in part one of this article can help guide your response. Even if you don’t see any visible distress, check in with the client periodically, to make it a normal part of your interactions. This lays the foundation in your relationship for the client to notify you when she is becoming distressed. Again, rely on your ability to read the client and do not push her. While we encourage actively pursuing conversations about trauma, it is equally important to respect the client’s choices when it comes to talking about her experiences.

Client debriefing. Debrief with the client at the end of the interview. Check in on what the client thought about the interview and whether you asked anything that bothered her. If you noticed signs of distress that you did not raise during the interview, this can be a good time to check in with the client about specific things that concerned you. As always, remind the client that she is in control of her information. If you will need to revisit the subject that was distressing in the future, give the client advance notice.16

Entry and exit strategies. Use techniques to “contain” conversations relating to clients’ trauma experiences. Devise rituals with the client to bring her “into” the conversation and then enable the client to “exit” that mental space at the end of the meeting. 

One example used by mental health professionals is a “container exercise.” In one version of the exercise,17 after discussing trauma, you allow 10 minutes to close your meeting with the client. Have the client close her eyes if she is comfortable, and imagine a container. Encourage her to use any materials she likes, and to decorate and design it as she sees fit. Ask her to pay attention to details such as size, color, and texture. Suggest that she visualize holding the container in her hands, and moving it around to inspect it on all sides. Then ask her to open the container and imagine wrapping her memories, feelings, and experiences she has just shared in a wrapping of her choice, and placing this package inside the container. Finally, ask her to close the container and seal/lock it and place it on a shelf where she can come back to it at a later time. 

This exercise activates other brain functions, apart from the emotions that your conversations have been tapping into, and teaches important emotional regulation skills. It also highlights the difference between containment—talking about difficult emotional experiences when it is safe and putting those feelings away when it is not safe—from stuffing—simply avoiding or denying the emotions altogether. 

You may feel some discomfort conducting this kind of exercise, feeling it is outside the scope of your legal training or expertise. Nonetheless, our jobs compel us to talk about trauma with clients, and we have a duty to do so thoughtfully and to minimize distress where we can. While some lawyers are fortunate to work on multidisciplinary teams with mental health professionals who can help facilitate conversations about trauma (for example, in lawyer-social worker partnerships), many do not have such resources available in their practices. Where necessary, we encourage lawyers to seek appropriate training to build the experience and comfort they need to pursue conversations about trauma in ways that support and cause minimal distress for the client.

Legal time constraints. The time constraints inherent in most legal cases will complicate your ability to follow the above recommendations. It is common for lawyers to need information about the client’s trauma history for an impending court hearing, but when meeting with the client, the client becomes overly distressed or resists talking. At this point, it would be best to back off and revisit the subject later, but the court hearing is looming and your schedule is packed. To avoid this scenario, build in enough time for multiple meetings with clients to address trauma and related topics. This will be even more important early on when just starting to build rapport with the client, as a trusting relationship may help the youth feel more comfortable discussing her trauma history.

Conclusion

Being an effective lawyer for a youth who has experienced trauma requires you to adapt how you undertake even the most basic tasks of the attorney-client relationship. Research shows the cognitive, developmental, and psychosocial impacts of trauma can affect how the youth perceives and interacts with you and her ability to engage with and participate in her legal case. These understandings create a duty to respond by adopting a trauma-informed approach in the representation. This imperative goes beyond the ethical duties to be zealous and effective advocates: it values the fact that every positive relationship with a youth who has experienced trauma can be restorative, helping the youth change negative beliefs about herself, her relationships, and her possibilities.

Eliza Patten, JD, CWLS, is a senior staff attorney at Legal Services for Children, San Francisco, CA. 

Talia Kraemer, JD, was a fellow (2012-2013) at Legal Services for Children, San Francisco, CA. 

Special thanks to John Sprinson, PhD, and Gena Castro Rodriguez, LMFT, for their time and collaboration. John invested many hours training the staff at Legal Services for Children and reviewing our draft recommendations for trauma-informed legal services. Gena developed a trauma training for attorneys in the San Francisco Bay Area and also invested considerable time discussing and reviewing our draft recommendations. We also thank Susan Craig, PhD, Frank Vandervort, JD, and Jessica Feierman, JD, for their invaluable feedback. 

This article is one in a series produced under a grant from the Office for Victims of Crime, Office of Justice Programs, U.S. Department of Justice. The opinions, findings, and conclusions or recommendations expressed in this article those of the contributors and do not necessarily represent the official position or policies of the U.S. Department of Justice or ABA.

Endnotes

1. See Reitman, Karen A. Attorneys for Children Guide to Interviewing Clients: Integrating Trauma Informed Care and Solution Focused Strategies, 2011.

2.  Kraemer, Talia and Eliza Patten. “Establishing a Trauma-Informed Lawyer-Client Relationship,” ABA Child Law Practice, October 2014, 193, 198-202.

3. Dr. John Sprinson, Training at Legal Services for Children, Feb. 8, 2013 (on file with authors) (“Sprinson Training 2/8/13”).

4. Ibid.

5. Ibid.

6. Lawyers should also consult the ethical rules in their jurisdiction regarding withholding information from minor clients.

7. Craig, Susan E. Reaching and Teaching Children Who Hurt, 2008, 56.

8. Ibid., 28.

9. Sprinson Training 2/8/13.

10. Cole, Susan F., et al. Helping Traumatized Children Learn: Supportive School Environments for Children Traumatized by Family Violence, 2005, 64.

11. Vandervort, Frank E., Jim Henry & Mark Sloane. Building Resilience in Foster Children: The Role of the Child’s Advocate, 2012, 13.

12. Craig, 2008, 30.

13. Sprinson Training 2/8/13.

14. Ibid. For example, at a May 2013 trauma conference in San Francisco, one youth explained that she never told adults about the trauma she experienced at home because “nobody ever asked me.” 

15. Dr. John Sprinson, Training at Legal Services for Children, Feb. 22, 2013 (on file with authors) (“Sprinson Training 2/22/13”).

16. Sprinson Training 2/8/13; Sprinson Training 2/22/13.

17. This is an exercise used by Gena Castro-Rodriguez, adapted from Francine Shapiro’s EMDR work.