“Abi is slowly engaging, but I feel something is missing, and I could not wait for today to continue our discussion,” Roberto said to Karen, his supervisor, who has been helping him develop skills on how to effectively work with Abi, a justice-involved individual.
“You feel something is missing and you have also been seeing some progress, which is good. We have discussed the principles, which require practice and time. Let us take it to the next level. Tell me what’s going on with Abi,” uttered Karen, as she leaned in to hear Roberto’s narration.
In the first article series entitled, New Strategies to Working with Justice-Involved Individuals: 5 Reasons Why, I explained why it was crucial for us to possess the skills to effectively work with this population. In the second article entitled, New Strategies to Working with Justice-Involved Individuals: The 5 Principles to Master, I laid the groundwork for the concept, the law, and the understanding of how to best work with the justice-involved individuals. They provide a framework, a form of philosophy, and orientation, if you like. On the other hand, the techniques I will describe in this current article are the skills that we need to use in order to properly follow the principles of working with this population.
1. Encourage them to tell their story
“I used to cry on the way to work, at work, and on the way back from work. Now I am much better, happy and well, I feel more alive. This thing really works.” Shana articulated these words to Rodis, her doctor, who had urged and helped her to write her story after she lost her spouse in a fire. Storytelling has been cited by many as, “one of the most powerful medicines,” and the best speeches have been found to be the product of storytelling during or immediately after times of calamities. Like the rest of us, justice-involved individuals have a lot to tell, a lot to say, and a lot to explain; and if you simply encourage them to tell their story, you may end up handing to them, “one of the most powerful medicines.” Next time you sit with your justice-involved patients and clients, encourage them to tell their story.
2. Be genuinely curious and caring
As you encourage them to tell their story, you need to be genuinely curious and caring. If you are intrinsically and genuinely curious and caring, it will show, but there are also things that can unintentionally send the wrong message that we do not really care.
Knowing how to make eye contact, when to take notes, when and how to best ask follow up questions are skills that some take for granted and others barely know they exist. Next time you sit with your justice-involved individual, make a note to pay special attention to your body language, where and how you sit, your facial expressions, and your ability to mirror his or her emotions or affect. Take these findings, reflect on them, and learn about your degree of genuine curiosity and caring when working with this patient population.
3. Join in
In family therapy there is the notion and principle of “join the family system in therapy.” (This is a skill I gratefully attribute to a dear friend and mentor, Dr. Jill Harkaway and her team). This is a core concept in Structural Family Therapy, developed by Salvador Minuchin, an Argentinian-American physician, a child psychiatrist, psychoanalyst, and family therapist. I therefore borrow the concept of “join the family system in therapy,” to formulate the technique of “joining,” while my description of it is a bit different and goes beyond the confines of family therapy.
Encouraging your patients and clients to tell their story, and being and remaining genuinely curious and caring are some of the pillars to effectively join in with them. Joining also means you take the steps to connect with your patient and client; you become part of their story telling process, hence their progress, healing, and recovery.
4. Pay attention to Maslow’s hierarchy of needs principle
“You cannot learn with an empty belly,” my father often said. “You cannot heal from trauma as long as you do not feel safe,” is a core principle of trauma-informed care; and “you cannot learn well if you do not feel safe,” I do believe and often say. Paying attention to the Maslow’s hierarchy of needs principle is therefore not just the right thing but also the required thing to do. In a previous series of articles, on Social Determinants, I described the story of Dr. Davidman, the new clinic psychiatrist, who stated, “Until now, I had not given my full attention to the significance of my patients and clients having food available. It’s something so small, yet crucial; easy to miss, yet sine qua non for medication adherence.”
As I mentioned in that article, “In reality, patients and clients often fail to take their medication due to lack of food.” Paying attention to Maslow’s hierarchy of needs principle is a great way to join in, and begin the process of helping justice-involved patients and clients begin to feel safe enough, so they can build trust and work toward recovery.
5. Be and remain predictable
I often say that since the way we view the world is shaped by our relationships, relationship is therefore a great place for repairs to occur, and this includes our therapeutic relationship with our patients and clients. It is common knowledge that regardless of the type of treatment modality we use or the type of setting we work in, transference or countertransference will be part of and affect the work we do.
In the case of Abi, being and remaining predictable would entail Roberto explaining:
How they are going to work together;
How often they are going to meet;
What is likely to happen in the sessions (with some flexibility); and
When and how often might there be a need to focus on treatment plans, reviewing notes together, as part of collaborative documentation, and how would phone calls, emergencies, tardiness, or absences be handled.
In a patient population where chaos is the norm and structure takes place significantly in the form of punishment (jail or prison), framing the set of expectations and, more importantly, doing your best to follow through and remain predictable can be a powerful tool when working with the justice-involved individual.
“Abi is slowly engaging, but I feel something is missing, and I could not wait for today to continue our discussion,” Roberto said to Karen, his supervisor, who has been helping him develop skills on how to effectively work with Abi, a justice-involved individual. “You feel something is missing and you have also been seeing some progress, which is good. We have discussed the principles, which require practice and time. Let us take it to the next level. Tell me what’s going on with Abi,” uttered Karen, as she leaned in to hear Roberto’s narration.
Five techniques then followed, and Roberto learned the following:
Encourage Abi to tell his story
Be genuinely curious and caring
Pay attention to Maslow’s hierarchy of needs principle
Be and remain predictable
And as the Chinese philosopher, Lao Tzu, once said, “A journey of one thousand miles starts with a single step,” all you need right now is to take the first step to using the new strategies to working with justice involved individuals.
For more in this series of articles, check below!
Dr. Sidor is quadruple board certified in psychiatry, with board certification in General adult, Child and adolescent, Addiction, and Forensic, psychiatry. He also has additional training in public psychiatry, in several treatment modalities, in addition to his teaching, supervision, mentorship, coaching, and management, experience. Some of his passions are public speaking, leadership, entrepreneurship, and research, in addition to program development and project management. His overall goal is to empower all health care professionals throughout the United States and globally, towards ensuring the continuity of excellent patient care, while balancing the need to take care of themselves. Dr. Sidor is the main instructor for the SWEET Institute, and he is currently an Assistant Professor of Psychiatry at Columbia University. He is also the past-Medical Director for CASES (Center for Alternative Sentencing and employment Services), and he speaks and writes fluently in six (4) languages—French, English, Spanish, Creole, and has intermediate proficiency in Portuguese and Italian.
Health & Human Services. State Health Official Letter #16-007, RE: To facilitate successful re-entry for individuals transitioning from incarceration to their communities. April 28, 2016.
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Blandford, A. and Osher, F.C. A Checklist for Implementing Evidence-Based Practices and Programs for Justice-Involved Adults with Behavioral Health Disorders. SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation. August 2012.
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