Mental Health Counselor Marie Tsalughelashvili (left) and Clinical Coordinator Mary-Ann Louis.
You couldn’t function if you took time to process every emotion. But over time, I started numbing everywhere.
Vicarious trauma. That’s the trauma you absorb from working with traumatized people—especially in places like the justice system, which can be traumatizing in its own right.
Reducing trauma for all of our participants is at the core of everything we do. We do that in part by designing alternatives to incarceration—treatment instead of jail—and by working to steer people away from the system altogether.
But making those goals a reality relies on an abundance of staff on the ground: case managers, mental health counselors, peer mentors, violence interrupters—the list goes on.
And many of the people who deliver these vital services are navigating human suffering—trauma—on all sides.
Ruth O’Sullivan, Senior Director of Clinical Practice.
This special episode of New Thinking features an interview with Ruth O’Sullivan, our Senior Director of Clinical Practice. Ruth has made it her mission to confront the problem of vicarious trauma among our staff head on. That mission is informed by Ruth’s own experiences with trauma after a decade operating our Brooklyn Mental Health Court.
You’ll also hear a roundtable with two members of our staff. Mary-Ann Louis, a clinical coordinator with our Strong Starts Court Initiative, and Marie Tsalughelashvili, a mental health counselor with our Manhattan Justice Opportunities, talk about the urgency of their daily work, and the toll that work can take.
The following is a transcript of the podcast:
SOUND UP: So this, um, first quote that I have up here, I’ll just read it out: “The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water without getting wet.”
Matt WATKINS: Welcome to New Thinking from the Center for Justice Innovation. I’m Matt Watkins.
That quote you just heard was part of a training for staff held here at the Center. The subject was vicarious trauma.
That’s the trauma you absorb from working with traumatized people. Especially when both of you are inside of already traumatizing systems.
Treatment not jail; diversion from harmful system-contact; alternatives to incarceration. All of these urgent goals are at the core of this organization’s mission.
But making those goals a reality relies on an abundance of frontline staff: case managers, mental health counselors, clinical care coordinators, eviction diversion specialists…the list could go on.
And many of those staff, at our organization and at others like us, are navigating human suffering—trauma—on all sides.
In the second part of today’s show, a conversation with two members of our frontline staff…about the remarkable work they’re doing and about the toll that work can exact.
And in the first part, you’ll hear my conversation with Ruth O’Sullivan. That was Ruth’s voice you heard leading the training at the start of the episode.
Ruth is our senior director of clinical practice—that’s a new position for her, and for the Center.
Along with reducing trauma for everyone that we work with, Ruth has made it her mission to confront the issue of vicarious trauma among staff.
That mission was informed by Ruth’s own experiences. She spent a decade running our Brooklyn Mental Health Court. That’s a pioneering court offering treatment, not incarceration, for people with serious mental health diagnoses, often people facing serious charges.
I started the conversation by asking Ruth when she first realized how that work was affecting her:
Ruth O’SULLIVAN: We had a number of suicides. They’re very, very difficult to process, and I did recognize the impact that they had on staff and that they had on myself. And then I just noticed changes in people over the years. And I was pretty deep in it myself and we were just working incredibly hard.
I think it was a couple of months, maybe the year coming up to the COVID closure, that I had my first experience with burnout. And at that time, I did not know what burnout was, I just knew that I was bone-weary, exhausted, and just had to keep going.
There’s a lot of people relying on you, the importance of the work, and I think that’s what propels you to keep going. There are so many people in need, it’s hard to make space for yourself, it’s hard to think about yourself or your own needs. And now in retrospect, when I’ve done all of this research on vicarious trauma, I know that that’s an element of it is that you just become consumed with the work and your personal life gets a smaller and smaller piece of you over the years.
And then I think the last year I had an incident where I was in an office and a client lunged at me and I was cornered in the office. And that was pretty disturbing. And I noticed after that that I just started to get sick all the time. I was realizing then I needed to get out of there, I wasn’t at my best and I probably needed some space to recover.
So I started to look for other work. And I think I got this new job, and I was still there for an additional six months beyond that. And I think that was really when I started to decline. And I noticed when I finished the work, I took a week off, and when I came back, I got an email that a young man that we supported had died.
And he was very young, very close in age to my own son. And I went to the funeral. And I had been talking with a friend of mine who’s a therapist for a while and telling her I was very disconnected from my emotions, and I remember her telling me, “You really need to reconnect with your emotions.”
So I went to that funeral, I came home, I went to work the next day, I was okay. And when I got back that evening, I remember there was something on the news about two young boys were washed away in the Rockaways, and we loved the beach and the water, and I just broke.
I broke and I started crying and I could not regulate myself for several days. I was really struggling, and I needed to take some more time off. And that’s when I really started to look into what was going on with me. When I sat in silence with myself, when I sat in the peace and quiet of my own home, I started to realize that my body was going haywire, that I was having all of these physiological reactions. I’d get a message on my phone and my heart rate would go up and I’d have anxiety symptoms.
And I think I really started to recognize how hypervigilant I was. I remember taking my daughter on the train somewhere, she was maybe about six at the time, and I remember holding her hand and she just looked up at me, she’s like, “Mommy, my hand.” And I didn’t realize how tightly I was squeezing her hand, it was just—
WATKINS: Because you start to see the potential for catastrophe everywhere?
O’SULLIVAN: Everywhere. I started to see danger everywhere. I mean, the world is dangerous, but your worldview just shifts: how you feel in the world, how you believe people are going to operate in the world, everything changed. You’ve read the worst things, you’ve heard about the worst things imaginably possible that human beings can do to each other, and you just start to really distrust the world.
And then the other area where I really noticed it was, I started to see suicidality everywhere. After a couple of incidents where we lost clients to suicide, I started to really perseverate and worry, almost obsess, about people in my life becoming suicidal. I had a teenage boy at the time, he’s still a teenager, but he was a younger teenager at that time.
And I started to struggle to parent him because I couldn’t maintain boundaries because I would become obsessed that he was going to become suicidal if I didn’t turn on his phone or didn’t let him go somewhere.
I think as well, the numbing of emotions. There’s no way, you couldn’t function if you took time to process every emotion and the impact of every experience. But over time, I just started numbing everywhere. So I really wasn’t even feeling big joy in my life. I just wasn’t feeling emotions at all. I was very disconnected from my emotions.
Dissociating becomes a piece of it too, where you just emotionally check out, you lose track of time, your memory gets impacted. So I saw that, and I definitely saw people on my team where they started to struggle with attention. And I didn’t realize it at the time, I really wasn’t connecting it to trauma exposure. But in retrospect, I know now that that was how the vicarious trauma showed up because the brain needs a break.
The brain is very smart. It does everything it can to protect you from the enormity of those emotions because you can’t always have time to experience those emotions. And it wasn’t until I left there, and I took some time out and I recognized I wasn’t in really good shape, that I took time to sit with my emotions and just try to process them.
So that was pretty scary in that moment, I couldn’t think, am I going to get better? What’s going on? And I think for me, I like to read, I like to research, and just figuring it all out, oh, this was because of that, and this is what happens when you’re exposed—
WATKINS: It gave you some control, I guess, figuring out what was actually happening to you?
O’SULLIVAN: Exactly. I could put a name to it and I could make a connection to it. And I think the last six months of my time in Brooklyn Mental Health Court and the first six months of my time away from it, I really came inward, and I slowed down. I didn’t go out a lot. I worked, and I was able to continue to work, and I’m very grateful for that, but I spent a lot of time with my family and just figuring out how to regulate myself and get myself back on track.
And I went for a walk on Friday, I was thinking about all the stress and turmoil in the world, and I just thought to myself: “Wow, if there’s one thing I’m grateful for, it’s that I am where I am today and not where I was this time last year.” Because I don’t know how I would have managed that kind of enormous stress on top of what I was already going through.
So I know that I came a long way, and I know that people can recover and heal from it. So I feel really like it’s my job and my duty and that I can do some good in the world now by helping people to understand what these experiences look like and how we are impacted by the work. And just hopefully caution people to put some protections in place for themselves so they don’t go so far deep into it where they’re really in a bad state emotionally.
WATKINS: I mean, the people you’re now principally trying to help are our staff, I think?
O’SULLIVAN: Yeah.
WATKINS: You’ve been in this, what I think is a new role for the Center, the senior director of clinical practice, you’ve been doing that for a little more than a year now. I guess first, how widespread do you think it is amongst our social workers—using that term, social work broadly, that comprises a lot of people—but these experiences similar to what you have had of vicarious trauma, of burnout, of being overwhelmed? How widespread do you think that is?
O’SULLIVAN: I think there’s a lot of awareness of burnout. And I think burnout in this field is particularly dangerous because I think burnout is what makes us more susceptible to secondary stress or vicarious trauma. We work in situations where there’s great urgency: we work in the court system, we work in the community, where people are in crisis and in need.
It’s definitely not just social workers, I think almost everybody in this organization is exposed to human suffering and trauma: from our admin assistance to our security staff, to our case managers, intake workers, everybody is getting exposure, everybody is supporting people in crisis.
It’s really important to me, because nobody ever really had the conversation with me. Nobody ever really said, “maybe this is vicarious trauma, maybe the work is impacting you in a negative way.” And I think people are grateful when they hear that because it’s very isolating. I think in this work—
WATKINS: Well, there’s still some stigma, maybe less so you’re suggesting, but there still can be a stigma associated with it, right?
O’SULLIVAN: Oh, there’s absolutely a stigma associated. And not just in the mental health piece of it, just in the toughness and resilience piece of it. I think people come into the work and they’re so invested in helping people and doing good work, and then they start to experience a negative impact on themselves.
And they don’t want to acknowledge it because it makes them feel like they’re not tough enough for the work or they’re not resilient enough. And nobody else is talking about it, so maybe it’s just you. Maybe you’re the only individual that is experiencing this and there’s something wrong with you.
And I think that really creates a sense of isolation when people are afraid to name it and say, “actually, I’m struggling. Actually, that was a terrible thing that I was exposed to where I had to process, and I don’t feel good, and I need some time or I need to talk this through.”
We talk so much in the world of behavioral health about reducing stigma. And I think we talk about it all of the time for clients because we have a lot of communities that don’t trust the mental health system with good reason, but we’re trying to reduce that stigma and get support to everybody.
But I think our social workers are almost the last people that we have worked to reduce that stigma for. And I think it’s just a really essential piece of this.
WATKINS: Yeah, I want to talk some more about the kind of solutions, if that’s not too definitive a word for this, that you have in mind for this problem. But I feel like we should also address another big feature of this, which is somewhat out of our control sometimes, which is just caseloads, the caseloads that are on social workers’ dockets.
And that’s something I think every organization that is doing this kind of work is struggling with, where the needs are high and the resources are low—particularly right now. But I don’t know, can you talk about the effect that that has on our frontline staff, and what, if anything, we can do about that?
O’SULLIVAN: Yeah. I think the Center is a remarkable organization and the Center staff are just absolutely remarkable people, everybody impresses me so much. And I think, look, I didn’t know the negative impact of this work when I was doing it. But I do recognize it now and I’ve done an enormous amount of research on what are mitigating factors for secondary stress. And one of the big things is caseloads, overwhelming caseloads, and too many traumatized clients on caseloads.
So I think, to me, one of the most important things that we can do right now is really to elevate the value that we place on supervision because I think we haven’t, across the board, not just the Center for Justice Innovation, in nonprofits in general, and maybe even behavioral health organizations, we do not effectively train our supervisors.
So we ask our supervisors to do an enormous amount of work, but there’s a lot of things that supervisors can do to try to mitigate some of the impact of this work. And managing caseloads, managing caseloads is an enormous part of it. Every piece of the literature points to that.
So I think, especially in this moment in time, it seems like a pretty urgent moment to express that we can’t continue to do the same volume of work that we’re currently doing with fewer resources. That is a surefire way to burn people out, to decrease the value of the services that we offer, potentially harm clients, and then potentially expose people to increased secondary stress or vicarious trauma.
WATKINS: Especially as we’re now moving into dealing with people with more serious charges and we’re trying to push these diversion efforts into people with more serious charges who are sometimes going to be bringing more serious trauma and more serious histories of harm in their past?
O’SULLIVAN: It’s a really important time to take stock and see what is an appropriate caseload for people? What can people effectively manage? The drive in moments like this for many of us who are so compassionate and so worried about other people is that we could just work harder: “I’ll just work harder. I’ll just do more. We’ll just fill in the gaps and we’ll figure it out.”
And I think that’s a dangerous path to go down because I think people are already pretty burnt out. We’re seeing a lot of attrition. It’s difficult to hire and retain staff. People are not really coming into in-person work anymore, particularly in social work, they’re going directly into private practice. So the people who come into this work, we have to figure out how to support them and how to support them well.
WATKINS: Right. So we’re recognizing that all of our staff—including people in courts, I see where judges and prosecutors and public defenders too are also dealing with often unacknowledged trauma. So we’re recognizing that people are operating in environments where they just are saturated with harm.
O’SULLIVAN: Yeah, and I think you named a really important element of it. When somebody has a history of trauma, what happens to the brain is that it becomes too sensitive. And that’s what I noticed in the court system when we had clients who predominantly had histories of trauma, they weren’t showing up hypervigilant or anxious, they were showing up very emotionally dysregulated. The court in general is just a very traumatizing and triggering experience for people.
Our judges are exposed to a lot of trauma. Our defense attorneys are exposed to a lot of trauma. Our district attorneys are exposed to trauma. Our court interpreters. They recently did a study in the court on the court interpreters and they were explaining that when they’re interpreting on a case, they’re interpreting in the first person. So if somebody says, “I was raped.” They interpret that as I was raped. So the body doesn’t necessarily know the difference.
Even our housing department, you’re serving people who are potentially being evicted. What a crisis! You’re in a complete state of emotional crisis in those instances.
You know, Family Court, my goodness, some of the things that they’re exposed to. But in the criminal courts too, you’re just exposed to people who have no resources, no support systems, no money, no one to help them, who have just had horrific experiences. I remember some of the clients that we lost and what they had endured, and just trying to process their life experiences after the fact. And just thinking, how could anyone do better in that situation? People are really exposed to some horrific things.
MUSIC STING
WATKINS: That was my conversation with Ruth O’Sullivan. Ruth is our senior director of clinical practice.
MUSIC STING
WATKINS: Next up, a roundtable with two members of our frontline staff.
Mary-Ann Louis is a clinical coordinator with our Strong Starts Court Initiative, a family court-based program in New York City, and Marie Tsalughelashvili, is a mental health counselor with our Manhattan Justice Opportunities. It offers treatment, not incarceration, to people facing felony charges.
Here’s our conversation.
WATKINS: Mary-Ann, Marie, great to have you both here. Thanks so much for joining us today.
Mary-Ann LOUIS: Thank you for having us, Matt.
Marie TSALUGHELASHVILI: Thank you for having us.
WATKINS: I thought it would be great if we just started by giving people a sense of how you both got into this work in the first place—I mean, this work, broadly speaking, of helping people.
Mary-Ann, do you want to go first?
LOUIS: I think I’ve always had interest in working with people, in general. I consider myself to be a nurturer, and I think a lot of that comes out through the work. But more specifically, over the last seven, eight years, I worked as a school-based mental health provider working with children ages five to 11, and I needed to pivot and found myself back doing this work.
I had previously worked as a child protective specialist with the ACS.
WATKINS: That’s the Administration for Child Services, the child welfare agency in New York City.
LOUIS: Yes. And so prior to grad school, worked there for about 18 months and found that that work was very difficult for me. And so right after grad school, I transitioned into this school-based role working with young children and wanted to continue that work, that focus on working with younger children and learned a lot about the work at CJI and really just applied and was connected to Strong Starts, and that work has felt very rewarding.
WATKINS: That’s great. And Marie, a bit of your backstory, so to speak?
TSALUGHELASHVILI: Yeah, I think similarly to Mary-Ann, I also always knew that I wanted to be in the helping role, and I was very curious about mental health work since I was little because it was very taboo in my culture. I’m Georgian and it was not something that was ever discussed. And so I grew up being really curious about it.
And then I took some time off after bachelor’s degree, and then I went back to school for mental health counseling. And during my schooling, I did an internship at Safe Horizon as a mental health counselor and then one of my supervisors told me about Center for Justice Innovation. And so I applied, and I started working at BJI—
WATKINS: That’s Brooklyn Justice Initiatives.
TSALUGHELASHVILI: Brooklyn Justice Initiatives. I was a supervised release counselor there. And then after a year I realized I wanted to do a bit more clinical work, and I learned about Manhattan Justice Opportunities from my other supervisors. So I applied and I’ve been there for a year and a half, and I really love what I do.
WATKINS: Why don’t we start by talking a bit about what you’re each doing day to day. Mary-Ann, you started talking about this a bit, you’re a clinical coordinator with our Strong Starts Court Initiative that operates across New York City and a bit beyond, I think, and we’re talking about, unfortunately, thousands of infants and toddlers who are caught up in the child welfare system. And you folks work only with children from basically birth to age three.
LOUIS: Three, yes.
WATKINS: And that’s families that have either, the child welfare agency has taken their children or they’re under supervision, so obviously that’s families under real stress.
Can you just talk a bit more in detail about the work that you’re doing, what you see your role as being?
LOUIS: I should mention, I think one of the really important points with respect to our program is that it’s a voluntary program. The recommendation comes directly from who we refer to as our Strong Starts judges.
WATKINS: But the families can decide whether to participate. It’s not one more thing that they have to do.
LOUIS: No, it isn’t. And so once they consent, our assessment begins right there: we meet with the family, we complete an intake, and that’s getting a lot of historical background on the family. That includes a lot of their trauma history, but also—
WATKINS: Because a lot of these families were themselves wards of the state, or I mean, were foster children themselves. You see the system-involvement perpetuating itself.
LOUIS: Absolutely. And those are things that we help to highlight throughout the life of the case and through our engagement with all of these really important people that are involved with these families. We recognize that a lot of the parents who are now court-involved, similar to what you just said, were court-involved as young children.
Even in the youth, we have cases with youth who are in foster care, but who are also parents. And during the intake process is when we learn about a lot of the traumas that that parent has experienced and the assessment continues throughout the life of the case, but we then work with ACS to ensure that the service plan that the family has been mandated for, so to speak, to engage in, is appropriate for them.
Because typically, with any family that’s court-involved, they’re usually having to engage in a parenting class or—
WATKINS: Anger management, that kind of blanket…
LOUIS: Anger management, right, and it’s not always helping to meet the need of the family or helping to really target what brought them to court in the first place or address what brought them to court in the first place.
WATKINS: And your focus, your client, in a sense, the way I’ve heard it described, is the relationship—
LOUIS: The dyad.
WATKINS: …between the parent and the child, the dyad. Everybody has an attorney, but there’s no attorney for the parent-child relationship.
LOUIS: Yes.
WATKINS: And that’s where you come in.
LOUIS: Yes. And it’s really working to center that dyad in every conversation, in every meeting. What I’ve found is, especially as someone who was previously a child protective specialist, we’ve helped to increase a lot of the visibility around the experiences of the parent and child. And their experiences are considered in a way that it might not have been for families who aren’t a part of our program.
WATKINS: And then you’re trying, whenever possible, to keep that parent-child relationship together and evaluations show that the program is succeeding at doing that.
LOUIS: Yes, it has.
WATKINS: So it’s very emotional labor, it sounds like, and a lot of relationships to navigate and manage all at once.
LOUIS: It is. There’s a huge responsibility that we have with respect to ensuring that our assessment and our engagement with the family is one that is…That we’re too not contributing to possible harm that’s being caused.
You might feel connected to a case in one way or another, or a family or an experience. And through supervision, you’re obviously unpacking a lot of those, sometimes internal conflict that you might feel throughout the life of that case and engagement with the family. It’s a lot of different pieces to leverage.
WATKINS: I want to get into all of that. I’m also just struck by all the parallels between the work that both of you do.
Marie, you’re on the criminal court side, as opposed to the family court civil side. You’re a mental health counselor with what’s called Manhattan Justice Opportunities, which is a program we run offering alternatives to incarceration, which traditionally go to lower-level charges, but we’re trying to push it, and are successfully pushing it, into offering alternatives to incarceration for felonies: more serious charges, charges sometimes with serious harm associated with them, where people are getting treatment, not incarceration.
But you as a mental health counselor are helping to draw up these treatment plans and reporting to the court. Anyway, I’m stealing your thunder. Do you want to talk a little bit about what your day-to-day work is like and maybe anything that Mary-Ann has made you think about in describing her work?
TSALUGHELASHVILI: So, I work for the Felony Alternative to Incarceration Court and part of my job, I guess, is to, once a case or participant is referred to ATI for assessment, is to really get to know a person and to really learn about their strengths and wherever in life they may need some more support.
Then from there, create a service plan recommendation that they could engage in instead of doing any jail time. And if they are open to our recommendations, and if all the legal parties, including the judge, are open to our recommendations, then they do enter a plea agreement. And so part of my job is to connect them to all the right services and then really support them throughout their mandate.
So mandates can be 12 to sometimes 18 months long, and we have regular updates in the courtrooms. But my day-to-day: I’m talking to my participants, my clients, checking in on how they’re doing in their different programs, and also in life, and just really listening to their frustrations. Another part is talking to their service providers on a daily basis.
I think similar to what you were saying, how difficult it is to do all this work: we get two hours of supervision every week, and we sometimes have to talk about just our frustrations with sometimes the legal parties, sometimes the service providers, and sometimes the participants, because sometimes we have this different idea of what we want for them and we forget what it is that they want for themselves.
And so yeah, it can be a lot.
WATKINS: Well, it feels like you’re both operating in the middle of a lot of different systems and people, and even languages, jargon, and even timelines about how we think about how quickly recovery should happen or what healing is, and being in the middle of that—code-switching doesn’t seem like it would be enough of a term for what you’re trying to do sometimes.
That must be taxing.
LOUIS: It is! It’s very taxing. I think just what’s taking place in between court appearances, in my opinion, that’s where a lot of the meaningful work is being done, because all of that is part of an assessment that then gets shared with a judge who is reading a report and getting a sense of where the family’s currently situated.
And oftentimes, when I think about this work, we go on about our day-to-day, and these families are still really just confronted with the same stressors that brought them to Family Court.
And so when thinking about everyone who’s working closely with the family, sometimes there are frustrations because all of these different perspectives can go on to cause more harm.
I think more specifically for me, that might come in the form of working with ACS and this family is part of an “investigation,” and the term in and of itself is harmful. And so a lot of times there’s a bias, whether unconscious or not—
WATKINS: Well, there’s a documented bias, right?
LOUIS: Absolutely.
WATKINS: I mean, certainly a racial bias in the way these investigations are triggered.
LOUIS: Absolutely. Their first interaction with the family comes in the form of a report with words that are written about them that may or may not be true. And being on the other side of that and seeing what engagement with this family looks like and feeling like there are times where it’s not meaningful engagement, often, there are long-term decisions that are being made about these families and for these families in a very short period of time.
WATKINS: And I’m just struck by the emotional labor, again, that you both must have to do, I mean, to build trust with people as well. I mean, people who end up family-court-involved or felony-court-involved generally have been failed by a lot of other systems in their past.
I would not be prone to be very trusting of this latest representative, even if it comes from a happier-seeming nonprofit position.
Are there things, Marie, that you have figured out about how to try to build some trust in those situations? Because you’re working with people, as you said, often for a long time.
TSALUGHELASHVILI: Obviously when clients come to our court part, I am just another person in the courtroom and to them, and in actuality, I am a part of the system. And so it can sometimes be difficult to build trust.
I think that the way we try to achieve good rapport is being that empathy that they sometimes lack in the courtrooms and in the systems and really trying to paint a fuller picture of their life. And even in their updates, it’s not just like: “they attended this many of this many sessions and they missed this many sessions.” It’s more about what happened, what were the barriers and were they forthcoming and honest about the triggers if there was a relapse?
And so we really talk to our participants. We are very honest about what we are obligated to report. And so I feel like it does eventually build trust, because again, we’re not just talking about what are the court’s motivations, but what are your own motivations? What do you want to get out of this? And where do you see yourself beyond the mandate?
Because you’re not just your mandate, you are a human being, and you have hopes and dreams and we want to support you with that.
WATKINS: But for some people, I would imagine that’s the first time anybody operating from a system perspective has asked them anything like that.
TSALUGHELASHVILI: Absolutely. There are a lot of folks I find on my caseload that just don’t believe that anybody cares about them. So yeah, I find that that is the most fulfilling aspect of this job is just being someone that they can call if they have no one else to talk to. And I always make sure to make that space for them if they need someone to talk to.
LOUIS: A moment ago, you just shared that you imagine that it’s probably the first time that someone has asked these questions. And I find that that helps to really, really help me to build a rapport with the families that I work with because I’m asking questions that, they’re clinical in nature, but these are questions or things that they’ve also never had to think about or didn’t think maybe or consider were connected to where they see themselves now or how they see themselves as caregivers.
And we talked earlier about the patterns, and a lot of families don’t see themselves, or parents don’t often see themselves, in the experiences that are very similar to that of their children.
And so having those meaningful conversations and also being transparent about what my role is has really helped and recognizing that it takes time. I make it a point to let them know that I don’t have an agenda. I actually have had cases where, throughout the life of a case, the parent was not able to establish trust with me.
But that comes from a number of traumatic experiences that they’ve had in their lives that then impact how they interact, not only with anyone new, but someone who they perceive to be part of a system that’s caused harm.
WATKINS: Does that feel like a loss, though, for you? A loss that you have to absorb or it’s just—
LOUIS: No.
WATKINS: …it’s part of the day in some ways or?
LOUIS: I think that’s all useful with respect to just thinking about that family’s experience or that parent’s experience. It’s actually common. It makes sense that that would be the reaction that someone would have.
WATKINS: It makes me think, Marie, you told me about an experience where a client said to you, “You don’t really care about me, and when you go home, at the end of the day, you’re not thinking about me.” And if it had been me, I might’ve just quickly denied it and said, “That’s not true,” but you said you realize “I have to leave space for those thoughts.”
TSALUGHELASHVILI: I think that we’re not going to be able to build trusting relationships with every single client that we have. We’re not always a good match, whether we want it or not. And sometimes you have to give space and not force someone’s hand.
I have people on my caseload that I call them and they barely say two words to me, and it’s okay. They’re doing good in their mandate, and it’s okay that we don’t have great clinical rapport. But yes, I have folks that really, again, they don’t believe that anyone cares about them. And they’ve told me, “I know that you go home at the end of the day, and you don’t even think about me,” which is of course not true.
I’ve also shared with you, I have nightmares about my participants and my clients. It’s really hard to actually decompress after work. And there are all these ways that I’m trying to create a buffer between my workday and my real life, but everything has clinical significance.
Even the fact that she shared that with me is important, and she didn’t owe me that. Nobody owes us anything or any information. And so, all we can do is thank people for being honest and create space for them to maybe have those conversations in their own therapy, and maybe there will be another window of opportunity where we can talk about that.
WATKINS: Actually, could we talk about caseloads for a minute? I think people have sense now of how much is involved in each individual case that you guys are working with. I know Marie, for example, at Manhattan Justice Opportunities, they’re trying to get caseloads down to about 20 per mental health counselor. That’s not where they’re at right now. You’re laughing.
And I think there’s even a waiting list for people to get into the program, which is a sign that the program is working, and prosecutors and courts are referring people, but that leaves people working there with frankly, too much on their plate. Can you just talk a bit about the stress of trying to keep all these plates spinning in the air at once?
TSALUGHELASHVILI: Twenty? That’s news to me! I don’t think that there are conversations about that. Maybe 25, but even that would be, wow, that would be a dream. Currently, we’re capping our caseloads at about 30, and I am almost at my full caseload.
And yeah, it’s a struggle. It’s a struggle because there are some folks on my caseload that don’t have a lot of needs. Maybe we check in every other week. And then there are people on my caseload that I talk to every single day—almost.
That’s my favorite part of the job, talking to my participants and my clients and just talking about life and what shows they’re watching and some of the lighter stuff too. But it’s also the coordination and the getting information from their service providers. Sometimes folks will have anywhere from one to five service providers.
Maybe they’re in housing, they’re in inpatient, or they’re receiving outpatient services, mental health services, vocational services. Sometimes the more difficult part of the job is just corresponding with other service providers that are really overworked and really underpaid and maybe don’t have the bandwidth for your million questions, because they don’t have the same responsibilities that you do to report to the courts, and so they don’t understand why you’re asking so many questions.
There is never, at this job, a sense of, “Okay, I’ve completed all of my tasks for today, so now I can shut my laptop and relax and go on with my life.” I have not had a single day on which that was the case.
But it’s hard. Sometimes it’s really hard to turn off your phone after 5:00. It’s just the anxiety of: what if I miss an email, an important email.
WATKINS: I don’t think I’ve ever had two guests who do as much nodding along while the other person is speaking.
LOUIS: There’s so much overlap, and actually it’s so validating to hear your experience, because I don’t think I’ve ever had to think about self-care in any other role, in the ways that I do here.
And I think when I first started addressing some of the guilt that I felt from having to step away. Especially in a moment where it feels like this family is in crisis. It’s 5:00, it’s 6:00, and I need to step away to tend to things in my own personal life, but still, these families are in the back of my mind.
WATKINS: I mean, it must be overwhelming too, because you know can’t solve everything. No matter how hard you work, you can’t solve the affordable housing crisis in New York City, or the effects of intergenerational trauma, or racism.
Does that happen too, of just feelings sometimes of just despair?
TSALUGHELASHVILI: Oh, yeah.
WATKINS: Yeah?
TSALUGHELASHVILI: I think that’s the vicarious trauma. I often start feeling helpless, and that’s when you know need to take time off and step away. But even that’s difficult. You’re looking over your calendar like, “When can I squeeze in two days? But then all these people that have court appearances, I don’t want to leave them. I want to be there for their court appearances. I don’t want to just…”
But yeah, I have to remind myself also sometimes that I also can’t save people from their lives. These are just the things that, even after the mandate, they’ll have to deal with, as sad as that is.
WATKINS: Mary-Ann, for you, I mean, the obvious question is that you’re working with infants and toddlers. One would think there are joys associated with that that are unique to infants and toddlers, but it must also be very heartbreaking work sometimes. And you’re dealing with some very intense situations sometimes, so that must take a toll.
LOUIS: You have children who are unable to advocate for themselves when you’re thinking about the attachment relationship and that between them and their caregivers or parents and you’re working to preserve that or strengthen it, all the while assessing what the child needs and working with the people who are responsible for keeping them safe, to help to work with them, to recognize what that looks like as well. And it’s not a linear path.
So sometimes, if I’m being honest, I might come across a family or someone who I’ve had a very similar lived experience to, and it may not be through the courts, but again, through that assessment, you’re learning things about their lives that might resonate with you in a number of ways.
And so that’s where a lot of that work for myself, obviously through supervision comes in, where I have to always realize that it’s not about me.
And so yes, it can be very taxing, but I continue to go back to working to center the family. And whatever’s happening right now may not be long-term. We’re working to get the family to a place where they’re stabilized. And I see, in real time, ways in which our work helps to address that. Families are not leaving ACS supervision or having their cases closed in the same place that they did when they started. There’s been a lot of work done to help repair the relationship.
WATKINS: Yeah, I remember you told me recently that you had been too much in the trenches with one particular case and that was really wearing you down. I’m just wondering what that looks like, how you deal with that.
LOUIS: It’s calling out for help when I need it, and checking in with myself too, because sometimes, more specifically with that case, I had to take a step back and think about how I can be most helpful. And a lot of times it’s not by thinking that I can “fix it,” whatever the identified problem is, so to speak.
TSALUGHELASHVILI: What you can do is be the support but, at the end of the day, it doesn’t reflect on you, or the work that you’ve done. The outcome of the case doesn’t really reflect on you because sometimes I also feel super responsible for the outcomes of my cases. Sometimes it’s because it feels like, since we are the ones that are reporting the information, we’re reprimanded for something that isn’t going well, and sometimes we can forget that we’re there to support, but it’s really not up to us at the end of the day what participants choose to do.
LOUIS: That’s it.
WATKINS: But it sounds like, Marie, you have struggled with carrying this work home with you sometimes.
TSALUGHELASHVILI: Yes.
WATKINS: You’ve mentioned that nightmares about…where you’re just running through worst case scenarios with your clients or…?
TSALUGHELASHVILI: Yeah, I tend to have nightmares when I’m really burnt out. I just had this nightmare that I was in a car with one of my clients, we were driving somewhere, we were pulled over by the police, and a gun was pulled and I was running, and all these different aspects of my life were coming together.
I was all of a sudden in a different city. I don’t know. It was a wild dream. But that’s one of the ways in which my burnout shows itself. But it’s also, I experience compassion fatigue. I don’t have the capacity to really listen to other people’s problems in my personal life, whether it’s my partner, or my friends, or my family members. I ignore text messages. I don’t call my grandparents! And I don’t socialize, so—
LOUIS: I feel so seen.
TSALUGHELASHVILI: Yeah. I know. I know you know. Yeah.
LOUIS: No, I feel like I interrupted, please. I was just having like—
TSALUGHELASHVILI: No, you’re good.
LOUIS: …a strong reaction to what you were saying, because I am struggling with that very same thing. Often, I’m self-isolating, and I can tell I’m at capacity when I’m more irritable or I’m projecting outward in a way that is impacting my relationships. And really, community is what you need in this work. And you work really hard to cultivate these spaces that live outside of the workplace.
And so the thought is, for me at least, that you should be able to tap into them when you’re feeling like you need it.
But sometimes I feel so depleted, and it could be after a court appearance. And I went in there thinking…We have what’s called a clinical conference, and we convene the court based team providers, the family, all of these really important—
WATKINS: Foster parents—
LOUIS: Foster parents as well.
WATKINS: Everybody’s got a lawyer, a lot of people.
LOUIS: And we have this really important conversation about where the family is and any even barriers to engagement and services and so on and so forth. And you write a report at the end of that, and you submit it to the judge and you’re thinking everyone’s had an opportunity to come in and think about what the best approach would be for this family.
And everything just goes awry. And I don’t want to say you don’t see the outcome that you wanted, because you don’t want to have an agenda going in, but you feel disappointed by the system.
So I may not have time to hear about how someone else, the frustrations that they had at work when they work somewhere where things are just so low stakes. And it’s not to minimize the experience of anyone that I love and care about, but it’s like the work that we’re doing is really challenging.
And so sometimes I’m on the other end rolling my eyes, like, “I don’t want to talk about what you had for lunch.” That’s the first time I’ve ever heard anyone speak to the experience in a way that I can relate to, in such a way that feels so deeply connected to mine.
WATKINS: As an outsider to this, it feels like you need to have a lot of empathy in order to do this work, and that’s what draws you into it, but then you can’t feel too much or you’re going to be exhausted. And I just don’t understand how that balance gets struck. It’s a shifting line, I guess.
LOUIS: It is. And sometimes it takes maybe even someone else pointing it out. It’s interesting with respect to the empathy. We have a neutral stance on these cases and, more recently, I’ve found that I’ve been having this very visible reaction when things are evolving in court. And—
WATKINS: You’re not keeping your poker face…
LOUIS: Oh, no! Even, I mean—
TSALUGHELASHVILI: It’s hard.
LOUIS: It’s so hard! And I used to pride myself on being able to do that. And now I am like, “Oh, I’m really deep in the trenches here. I’m really, really involved and we’re in the weeds of it.”
TSALUGHELASHVILI: Yeah, it’s because I think you really get to know the people and you start to care for them on a different level. I don’t think that any of the other parties really have the perspective or the pleasure of getting to know the participants or clients the way we do.
And so it’s really hard to be neutral. Of course, that is what we’re supposed to be. But yeah, we start caring a lot about our participants, and we might not be able to hide our disappointment when things don’t go the way that we were hoping they would go.
WATKINS: Can we talk a bit about supervision, which is, I know, a real focus now for the Center on recognizing what staff are experiencing. I’m just curious what the experience for both of you has been of supervision, what those conversations look like, what the role has been for you in your jobs. I don’t know who wants to go first on that one.
TSALUGHELASHVILI: It’s first of all super helpful to really talk through some of the challenges that you’re having with a participant or a service provider even, and to really brainstorm ideas of how to pivot or how to approach a participant with your supervisor. I have two supervisions per week.
I have task supervision, in which we go through every single case and just talk about where people are in their mandate. And then we have the clinical supervision in which we just talk about, not just the clinical needs or the struggles of the participants, but also my feelings about everything. And it’s really the space for me to express frustration about the participant, about myself, or about stakeholders sometimes.
And sometimes I find that sometimes I actually avoid clinical supervision because, I don’t know, sometimes it can be like, “Okay, am I using this as my therapy? Should I seek a therapist?” But yeah, it’s super helpful to have two per week because we do need that many just because of the caseload. And then we have our group meetings every week in which we always just talk about our wins and that’s also super important for team building and just not feeling alone.
LOUIS: I know it would be very impossible to do this work without the supervision and the quality of the supervision that I have. And I think more specifically because, while I am talking about cases and how they’re evolving, I’m having an opportunity to really also think about how I’m bringing parts of myself into this work.
And also the support is there. You’re never alone.
WATKINS: Well, maybe to close out, we’ve spent a lot of time in the last little bit at least talking about the weight that this kind of work puts on you and what it takes out of you, which is clearly a lot, and as somebody said to me, if it’s not taking a lot out of you, you probably shouldn’t be doing it.
But I guess what keeps you both in it? What keeps you wanting to do this day after day?
Mary-Ann, do you want to go first?
LOUIS: I think the only reason I’m comfortable going first is because we actually, we had a conversation very similar in a team meeting several weeks ago and we discussed this, coming back to the why, why we’re in it. And I’m reminded of the small wins, and I’m reminded of the impact that we have on the lives of the families that we’re involved in. And that can look like establishing trust over time.
But it could also look like just connecting a family to a service provider to a service that they would really benefit from, or being able to collaborate with another clinician who is aligned with the assessment that you also have made about the family. And so, there are small wins, and it continues to motivate me to show up every single day.
WATKINS: Well, I mean, and keeping a family together must be—
LOUIS: Keeping a family—
WATKINS: …more than a small win.
LOUIS: …or even working towards that.
WATKINS: Well, thank you.
And Marie, what keeps you doing it?
TSALUGHELASHVILI: Yeah, the small wins, but also the big wins. This work keeps people out of jail. Maybe not forever—
WATKINS: And prison.
TSALUGHELASHVILI: And prison. Maybe not forever, but maybe at some point in their lives, my clients will have another contact with the justice system. I don’t know. But in this particular situation, it means that they won’t languish away on Rikers or a state prison, where they won’t have the services that they need. They won’t learn the skills that they need to survive. They won’t get better if they’re struggling with mental health or substance use.
And so, I have to remind myself: this is important work, and if not us, then who? And just there are also times when participants and clients and even service providers, because those are also important people, are so kind and so grateful and are able to really express how you’ve touched their life. And that’s just an amazing feeling.
WATKINS: Well, this is such important work that both of you are doing. So, first off, I just want to thank you…I’m honored to be your colleague, actually, so I want to thank you for the work that you’re both doing and for making the time to do this, as well, on a Friday afternoon here in rainy New York City.
Mary-Ann, Marie, just thank you so much—and I’m glad I got to introduce the two of you to each other, actually.
TSALUGHELASHVILI: Yeah, it’s so nice to meet you!
LOUIS: It’s so nice to meet you!
TSALUGHELASHVILI: It was so much fun.
LOUIS: It was.
TSALUGHELASHVILI: Thank you, Matt.
WATKINS: Thank you.
LOUIS: Thank you.
WATKINS: That was my conversation with Mary-Ann Louis and Marie Tsalughelashvili. Mary-Ann is a clinical coordinator with our Strong Starts Court Initiative, and Marie is a mental health counselor with our Manhattan Justice Opportunities.
For their help with this episode, my sincere thanks to my colleagues Kiran Malpe, Kate Wurmfeld, Joe Barrett, Michelle Pelan, James Brodick, and Julian Adler.
Today’s episode was edited and produced by me, with the indispensable assistance of our communications team. Recording was by the coruscating Bill Harkins. Samiha Amin Meah is our director of design, Emma Dayton is our V-P of outreach, and our theme music is by Michael Aharon at quivernyc.com.
