In some instances, sources cited in this article refer to women. However, menopause is a condition which impacts people of all genders. The issues explored in this article may also impact transgender people, non-binary people and others, who are an important part of this conversation.

At Communicourt, we are celebrating World Menopause Day and opening up the conversation about menopause in the workplace. As part of The RCI Group, we have taken the Menopause Workplace Pledge and hosted an awareness session for colleagues, by Emma Persand of Working with the Menopause, about the impact of menopause upon our working lives. The RCI Group is also introducing a new group-wide menopause policy to support people at work.

Rarely discussed in our professional lives, menopause is a significant life transition and physical change which will affect 51% of the UK population. The recently published House of Commons Committee Report ‘Menopause and the workplace’ has collated a wealth of information which illustrates the importance of more open discussion about the topic:

• 3 in 5 women experiencing menopause were negatively affected at work (CIPD, 2019).
• 900,000 women in the UK had left their jobs because of symptoms relating to menopause (BUPA, 2021).
• Less than a third of people experiencing menopause told anyone at work, citing privacy and the reactions of others as key reasons for this (Women and Equalities Committee, 2022).
• Over 25% of people who did not request adjustments for menopausal symptoms did not do so because they were “worried about the reaction” (Women and Equalities Committee, 2022).
• 14 million working days per year in the UK are lost due to menopause and related symptoms (Health and Her, 2021).

These statistics paint a clear picture of the impact which lack of understanding and adaptations around menopause has on individuals, workplaces and the economy as a whole. Evidently this is a health issue which can have a marked impact on people’s ability to work without adaptations, yet which few people feel comfortable raising in a workplace setting. As such, workplaces are losing valuable, experienced staff members. These are often people who offer years of expertise and perform vital functions such as mentor and role model to more junior employees.

Destigmatising hormonal change

Bringing conversations and understanding about the menopause into the workplace is clearly an important task. When workplace cultures understand the potential impacts of menopause (and become aware of the adjustments which are likely to support menopausal employees), organisations can start to retain more senior staff.

Open dialogue about menopause at work also encourages important conversations about the effects of other hormonal changes which may affect employees, including pregnancy and the use of hormones for processes like IVF or gender confirmation. Other health conditions which impact women, transmen and non-binary people, such as endometriosis, can also become part of this wider conversation about better support and inclusion.

Menopause in the workplace: The facts

When does menopause happen?

• Menopause typically occurs between 45 and 55 years of age.
• In 1% of cases, premature menopause takes place before the age of 40.
• Perimenopause takes place before periods stop (menopause). During this time, menopausal symptoms can occur, lasting for months or (in some cases) years.
• After menopause (the total cessation of periods) menopausal symptoms last for around four years after periods stop. In some cases, the symptoms last longer.

What are the most common symptoms of menopause?

• Hot flushes and night sweats.
• Disturbed sleep and sleep difficulties.
• Vaginal discomfort.
• Mood changes, including increased anxiety and low mood.
• Memory and concentration difficulties.
• Headaches.
• Heart palpitations.
• Joint stiffness, aches and pains.
• Reduced muscle mass.
• Recurrent urinary tract infections (UTIs).
• Reduced libido.
• Bone strength (increased risk of osteoporosis).
• Increased vulnerability to heart disease and stroke.

How can menopausal symptoms impact people at work?

• 65% of survey respondents reported problems with concentration.
• 58% said they felt more stressed.
• 52% reported feeling less patient when working with clients and colleagues.
• 30% reported taking sick leave due to menopausal symptoms.
• Of this 30%, only 25% were able to tell their manager their absence was due to menopausal symptoms (Women and Equalities Committee, 2022).

5 ways workplaces can support menopausal employees

1. Normalise conversations about menopause and hormonal changes in the workplace by participating in events like Menopause Awareness Day, setting up a regular employee support group and sharing information.
2. Allow flexibility around the working day. Some menopausal people may have sleep difficulties which may impact their work in the morning. Others may feel more physically comfortable working from home.
3. Provide desk fans or adapt office seating plans to make individuals experiencing hot flushes more comfortable.
4. Allow more frequent comfort breaks.
5. Allow alterations to workplace uniforms to increase comfort.

References

BUPA (2021), Written evidence from Bupa [MEW0046], accessed October 2022

CIPD, “Majority of working women experiencing the menopause say it has a negative impact on them at work | CIPD”, accessed October 2022

Health & Her Ltd (2021) A fact-based focus on Perimenopause and Menopause issues faced by women [MEW0054], accessed October 2022

Women and Equalities Committee (2022) Fourth Special Report of Session 2021–22, Menopause and the workplace survey results, HC 1157.

One of our intermediaries Holly talks about how to avoid the ‘do you understand?’ trap.

If I could wave my magical intermediary fidget aid and make one small change to legal proceedings, I would banish the question, “Do you understand?” from existence. Almost impossible to avoid, “Do you understand?” (and its close cousin, “Does that make sense?”) are very widely used in legal proceedings (particularly conferences). Even legal professionals who are notably adept in working with individuals who have communication difficulties frequently fall into the “Do you understand?” trap.

The problem with questions of this nature is two-fold:

1. The service user may just say “yes”. Many of us would struggle to respond “no”, if asked this question by a Crown Court judge during our oral evidence, while feeling flustered and overloaded in front of a full courtroom. This issue can be compounded when a person has a communication difficulty. People with communication difficulties are often skilled at masking their needs. Many will have done so throughout their educations and adult lives. There are many reasons why an individual would erroneously respond “yes”, when asked whether they understand. They may:
   
   • Feel embarrassed about not understanding.
   • Feel overwhelmed and simply want a situation to end.
   • Feel uncomfortable seeking support from unfamiliar professionals.
   • Have an expressive difficulty which makes it challenging to provide a more nuanced response.
     
2. The service user may think they understand. An individual may also state that they understand because they erroneously believe that they do. Misunderstandings frequently arise between individuals who do not have a communication need, resulting in two people having very different understandings of one piece of information. When an individual does have a communication difficulty (for example, difficulty maintaining attention, processing verbal information or understanding figurative language) the opportunities for misunderstanding can increase. A person with a communication difficulty may have entirely misunderstood information or partially misunderstood, yet still respond “yes” when asked whether they understand.

As an intermediary, I have endless examples of situations in which a service user has said they understand but, when their understanding was directly checked, revealed that they had not.

Case study: I assisted a service user with a mild learning disability. They presented with strong expressive communication skills, using a wide range of legal terminology correctly while giving instructions. The barrister mentioned to me that they were surprised the service user had been allocated an intermediary, based on their presentation. The barrister spoke rapidly to his client, using very low frequency vocabulary (eg, “Otiose”). It was necessary for me to check the service user’s understanding while the barrister was not present, then provide simplification. The service user explained to me that they did not feel comfortable speaking to the barrister.   In conference after the hearing, the barrister stated, “Well you understood all that, didn’t you? You know what VIG work is”. The service user nodded. I then checked their understanding by asking a direct comprehension question (“What is VIG work?”). They responded, “I don’t actually know”. I therefore provided a simple explanation of the term, which they were able to recap in their own words when understanding was re-checked.

How to check understanding

Direct, specific comprehension questions are one of the most effective methods of checking understanding and retention of information. For example, after an explanation of a Special Guardianship Order, ask: “What is a Special Guardianship Order?”, rather than, “Do you understand the SGO?”. This ensures the individual expresses exactly what they have understood, so that it can be checked and (where necessary) corrected.

Although this process is simple and often highly effective, in some cases it can be challenging to implement if:

The service user doesn’t engage with comprehension checking

Some individuals may feel patronised or put on the spot by this strategy. In these cases, there are lots of measures that can be implemented to assist, including:

• Explaining the rationale for the strategy (e.g., “It’s really important that your legal team gives you all the information you need. This is to check we have explained everything properly”)
• Adopting a more informal, conversational approach after building rapport (e.g., “What was all that about, then?”)
• Asking their opinion to open up the conversation in order to assess understanding (e.g., “What did you think about X?”)
• Feigning ignorance, to allow the service user to ‘fill in the blanks’ (e.g., “What did the judge say about X again? I missed it”)

The service user has expressive difficulties

If an individual has difficulty putting their understanding into words, it can be challenging to explore their true understanding using comprehension checking questions alone. It may assist to:

• Use more specific prompt questions (e.g., “What did the doctor say about X?”, “What does that mean?”, “Why is that important?”)
• Give multiple options, including a distractor item (e.g., “Does consecutive mean: One after the other, at the same time, or no prison time?”)
• This approach can be visually supported if the service user has a reduced auditory working memory capacity (e.g., using pictorial multiple choice questions)
• Use other visual aids to support their expression (e.g., if discussing court roles, use a plan of a courtroom to allow them to point to different areas and professionals)

Never assume understanding

Intermediaries and legal professionals should never assume “yes” means that an individual with a communication need has understood. There are also other presentations which we should not assume demonstrate understanding. These include:

• Nodding during explanations.
• Making sounds of engagement during explanations, (e.g., “Mhmm”).
• Echoing parts of the explanation (e.g., repeating the final clause, “Yeah, like the social worker said”).

Checking understanding more effectively can be a longer process but helps ensure that individuals with communication needs have the information required to fully understand proceedings. This can help them to make better informed decisions, give clearer instructions and feel more confident engaging with proceedings (among many other advantages).

Learn more about court communication from experienced court intermediaries on The Access Brief. A growing library of free resources developed for legal professionals working with clients who have communication needs.

Rhianna explores how trauma can affect communication skills.

“The physical trauma – or more precisely the memory of the trauma – acts like a foreign body which long after its entry must continue to be regarded as an agent that is still at work”. – Freud and Breuer

Trauma is a subjective experience which overwhelms a person’s ability to cope. It may involve an individual feeling as though there is a direct threat to their life, sanity, or safety. In an effort to survive, preserve a coherent sense of self, and process the traumatic experience, the brain seeks out various coping mechanisms.

The brain can make mistakes – and these coping mechanisms may leave enduring consequences on an individual’s ability to integrate their emotional experiences and process information. The shadow left by a traumatic event may affect how an individual presents, behaves, communicates, and relates to others.

Research into the understanding of trauma is developing. Increasingly, professionals and practitioners across many fields are shifting towards a trauma-based perspective when dealing with those who live with Post Traumatic Stress Disorder (PTSD). However, this has not always been the case. PTSD has only existed as a diagnosis since 1980. Prior to this, veterans and victims of abuse who were suffering, with what we now call PTSD, would be routinely misdiagnosed with a plethora of conditions, including alcoholism, substance abuse, depression, mood disorder, schizophrenia, or neuroses.

Whilst people diagnosed with PTSD may experience any of the aforementioned conditions (plus many, many more), trauma lies at the heart of the issue. The roots of trauma run deeply, the consequences and effects branch wide.

Fight, Flight, Freeze, Collapse

Our nervous system is ancient. Like all species, humans have evolved self-protective mechanisms to help us survive imminent danger. This system evolved to mobilise us away from very real threats such as, a predator, a landslide, or a fire. The complexity of modernity means, however, that the dangers we face are not always as concrete as they were historically. We may misinterpret safe situations, seeing danger where none exists. Before our rational brain can process and de-escalate the situation, our central nervous system has already sprinted into action.

Trauma survivors are often hypervigilant to danger. They may be far more likely to misinterpret situations, to feel like danger is imminent and inescapable, when in fact they are perfectly safe. Individuals with PTSD are effectively on hyperalert. Their fight or flight response has been hijacked, meaning that this chain reaction can be quickly triggered.

Once this chain reaction has been set off, the body is running on pure instinct. This is an extremely physical response. The amygdala (the stress centre of the brain) fires stress hormones called cortisol and adrenaline through the body. The pupils dilate, and we experience the phenomenon of tunnel vision. Blood flows to the major muscle groups such as the thighs, and arms, preparing us to run from or fight off an attack. The breath and pulse quicken, our blood pressure increases, and we are elevated to a heightened state of tension. The intensity of this physical response can have serious consequences for our ability to communicate, and we may struggle to articulate our feelings, to decipher meaning and to express ourselves coherently.

Courtroom environments can be extremely overwhelming, in particular for people with PTSD. The atmosphere is heightened and stressful, the pressure on the individual is intense, and the consequences are often life changing. Breaks from the court environment can interrupt the mounting anxiety trauma survivors may be feeling. Intermediaries can monitor the emotional presentation of service users and alert the court if it deteriorates. Taking some time and space away from the court environment can reset an individual’s anxiety levels and allow them to de-escalate their panic response.

The intermediary can assist further with this by implementing grounding exercises. These exercises may include guided deep breathing with a particular focus on the outbreath, as this stimulates an individual’s parasympathetic nervous system and slows their heart rate. The intermediary may also guide the service user through exercises to assist them to reconnect with their senses, for example, by asking them to name 5 things they can see, 4 things they can hear, 3 things they can feel, 2 things they can smell and 1 thing they can taste.

Feeling a sense of presence and connection with the earth can bring us back to the current moment, and the intermediary could invite the service user to feel the full weight of their body against the floor or chair. The path of the vagus nerve carries messages of panic through the throat, chest, and abdomen. Grounding exercises can help to direct an individual’s focus away from this system. Focusing attention on the hands, which lie outside of the path of the vagus nerve, can create physical sensations which can counterbalance the feeling of being out of control. The intermediary could introduce the use of fidget objects or offer the service user some paper so that they can draw, write, or shred. The intermediary may guide the service user through some gentle movement, such as tapping on the pressure points, or simple stretches. These exercises can help create space and movement in the mind, body and voice, which acts as an antidote to the frozen, paralysing fear we experience when living in a traumatic moment.

Speaking out and sitting down

As part of our instinctive panic response, a key area of our brain which is used for communication – known as the Broca’s area – completely shuts down. The Broca’s area is a key speech centre, and if this part of the brain stops functioning, you are effectively unable to articulate your feelings. This poses enormous challenges to individuals who are required to give evidence in court.

With an impaired Broca’s area, individuals in court will struggle to alert professionals when miscommunications occur. They may have difficulty recognising and advocating for breaks when they are needed. They may struggle to decipher meaning when presented with information which uses low frequency vocabulary (for example, the word, ‘instigated’ may be harder to process and understand than the word, ‘started’). They may also struggle to comprehend complex sentence structures, such as tag questions, or questions which contain multiple parts. Of course, all of these issues are only magnified if the individual already experiences barriers to their communication in their daily life. Any pre-existing communication difficulties will be exacerbated, at a time when effective communication could not be of greater importance.

When asked to give evidence in court, individuals who have PTSD may become so overwhelmed that they can barely speak. Their nervous system may be hijacked into a state of panic, rendering them unable to clearly articulate what happened to them. Their evidence may be fragmented, chaotic, confusing, or incoherent. Alternatively, they may try and recount the events of what happened to them in a way that prevents them from becoming triggered. This may result in their responses appearing evasive, minimal, or unreliable.

An integral part of the intermediary role is assessing the communicative ability of the individual service user and intervening to ensure that the questions asked of them in evidence are appropriate for their communication profile. At the assessment stage, the specific difficulties each service user faces will have been identified, and recommendations for effective communication will be set out in the intermediary report. However, the service user’s ability to process and understand language may fluctuate, and this will need to be constantly monitored by the intermediary. If a service user enters fight or flight mode, they may become far less able to process question types which ordinarily may not pose any issues.

The intermediary can alert the court’s attention to complex question types and offer suggestions for simplifications. Ensuring that language is kept extremely simple and that questions are short and easy to understand, will assist the service user to provide their best possible evidence to the court. If the evidence given by the service user lacks sufficient detail, the intermediary can also recommend the use of simple, follow up questions, such as, “Where did you go next?”, or, “What happened after that?”. If the service user is unable to understand or process verbally presented information, the intermediary can intervene and offer visual explanations, using simple visual aids. These strategies are not only effective when a service user is giving evidence, as the intermediary can continue to use visual aids and give verbal simplifications throughout proceedings to support comprehension.

Our nervous system is a powerful thing, and the intensity and regularity of the fight or flight response can have lasting consequences for how trauma survivors understand, process, and retain information. Over a prolonged period of time, constantly elevated stress hormones can have serious impacts on the memory of traumatised individuals and their ability to maintain concentration and attention.

The court environment was not designed with PTSD survivors in mind. In court, there is often large volumes of complex verbally presented information, which contains unfamiliar or court-specific language, such as ‘indictment’, or ‘threshold’. This can be extremely fatiguing for individuals with trauma-related communication difficulties to process. In addition to this, the court environment has an intensity which requires focused attention, and due to time pressures, breaks are not always factored in.

This is where intermediaries can assist individuals with PTSD to access and participate fairly in the justice system. Having a timetable or checklist of what is coming up within the court day can manage expectations and assist the service user to maintain their attention. Another key strategy which intermediaries may implement to support the retention and concentration of individuals with PTSD is enabling regular breaks. The intermediary can closely monitor the presentation of the service user, and if it is clear that the fight or flight response has overwhelmed their ability to participate fairly, then the intermediary can advocate for breaks and alert the court when they will be necessary. In these breaks, salient points from proceedings can be repeated and recapped to assist retention. Time should also be carved out within the break for the service user to have a complete rest from processing, which will then enable them to concentrate more effectively when they return.

Flashbacks

A common experience of trauma survivors is that of visceral flashbacks. These flashbacks are intense physiological experiences and do not operate in the same way that typical memory does. When an individual with PTSD is presented with images, sounds or thoughts which relate to a traumatic event, the amygdala lights up in alarm. Physiologically, their body reacts as though the traumatic event is ongoing, as though the danger is immediate and inescapable, even if their brain is simultaneously aware that there is no tangible risk of harm.

When a flashback occurs, the left hemisphere of the brain deactivates. This can have disastrous consequences for an individual’s ability to communicate coherently. Without the left side of the brain functioning, the individual may find themselves unable to name and compare things and understand how one thing relates to another. They may be unable to organize and sequence events, and whist being consumed with overwhelming emotions, individuals may have extreme word-finding difficulties. This can leave them feeling incapable of communicating their subjective experiences to others.

The court environment is rife with stimuli that could trigger a flashback or adverse reaction. When attending court, individuals may be required to publicly relive traumatic events. Some may be faced with seeing the perpetrator of their trauma. Individuals may undergo cross examination which may feel invasive, personal, or triggering. The subjects that are discussed in proceedings are often highly sensitive, and even if not directly related to their trauma, could nonetheless stir up distressing memories and feelings. In addition to this, the unique formality of the court environment, the stakes and pressure of the situation, as well as the anticipation and anxiety surrounding court attendance, could all act as further catalysts.

As intermediaries, we can implement various strategies to minimise the risk of an individual experiencing a flashback. If the service user is likely to be triggered by seeing a particular individual in a court setting, intermediaries can recommend the use of special measures, such as screens, to shield the service user from being visually confronted with the source of their trauma. If the court building itself could be a trigger, we could implement a familiarisation visit, to allow the service user to acclimatise to the environment in which the proceedings will be taking place. If this does not alleviate the service user’s anxiety, we could recommend that the service user attend remotely from another room in the court, or even a neutral building, such as a solicitor’s office.

Whilst attending court remotely certainly has its own complications, for some service users it can be a far less anxiety inducing experience and enable them to fully participate in their proceedings. Some individuals may find authority figures intimidating and could feel triggered by the hierarchical structure of the court environment. In some cases, a service user’s anxiety can be alleviated if certain court specific formalities and traditions are forgone. For example, it may be helpful to refer to traumatised individuals by their first name, or to allow them the opportunity to meet the advocates and judge prior to the court hearing. Some traumatised individuals may have a comforting object, or a person who provides emotional support who they may wish to accompany them to court. The presence of a reassuring object or individual in such an overwhelming environment may help to create a feeling of familiarity and safety.

Rapport and repair

Trauma is a rupture which can drastically alter how we view ourselves and interact with others. Those who have been traumatised may have great difficulty trusting new people. If their trauma was enabled by an abuse of power, they may find it particularly hard to engage with professionals and authority figures. It is for that reason that building a rapport is so fundamental to the intermediary role when working with trauma survivors. This rapport is the foundation on which all other assistance provided by intermediaries is layered. If the service user feels comfortable and relaxed working with the intermediary, they are more likely to express their lack of understanding or their need for a break. They may engage better with simplifications and explanations provided in court. In addition to this, there may be an increased likelihood of the intermediary being able to effectively assist with managing any emotional dysregulation.

Humans are innately social beings. When we feel under threat, we instinctually turn towards others to seek reassurance or call for help. If our distress is recognised and reassurance is given, this can go a long way to avoiding the stress response escalating to a fight, flight, freeze or collapse response. It may sound simple but acknowledging an individual’s emotions can be an extremely useful tool for de-escalation. Simple mirroring statements, such as, “I see you are very upset”, “I know what Mr X said made you very angry”, or “I understand that you feel very anxious about tomorrow”, carry a reassuring message: that the service user’s subjective experience is heard, understood, seen, and acknowledged. Having an intermediary in court can provide a soothing and steadying presence for those who suffer from PTSD. Whilst an intermediary is impartial, our purpose at court is specifically to assist the service user. For the service user, knowing that there is someone there who will be attentive to their communicative needs, and provide support when necessary, can be hugely beneficial in managing emotional dysregulation over the course of proceedings.

Trauma is complex and subjective. The ripples that it creates are far reaching and unique from individual to individual. With appropriate therapeutic intervention, traumatic experiences can be re-integrated and processed by the ever learning and adaptable brain. Left unresolved, however, trauma can permeate all aspects of how one interacts with the world. Individuals with PTSD who are required to attend court can feel as though they are being left exposed, vulnerable and at risk of re-traumatisation, if their experience is not adapted to meet their unique needs. Intermediary support can enable individuals who carry the complex scars of a traumatic past to participate fairly in a justice system which may often shine a light directly onto their wounds.

One of our Team Leaders, Rachel, reflects on what we have learned from sharing experiences and tips for managing stress.

The theme of this year’s Stress Awareness Month was ‘community’, which the Stress Management Society defines as more than just a group of people. It’s about having a sense of belonging and connection to others and feeling supported and accepted by them. This theme was chosen because a lack of support and lack of feeling of community can cause loneliness and isolation. This in turn lowers people’s wellbeing, impacts mental health, and can lead to mental illness. 

This month, some of our team members got together to reflect on stress awareness in more detail. We discussed what stress is, how it can affect the body, and aspects of the intermediary role that can contribute to feeling stressed. We shared our strategies and tips for dealing with stress and most importantly, how you create a keep a sense of community when you work on your own most days.

What we learned from Stress Awareness Month 2022

We approached the definition of stress using a visual aid, of course! The team found the bridge analogy to be handy when considering what stress is. When a bridge is carrying too much weight, it will eventually collapse. It is possible to see the warning signs before this happens, for example, the bridge would bow, buckle and creak, or you might see some cracks appear. When we apply this to ourselves, excessive demands and challenges placed on our bridges might create early warning signs. However, stress can creep up on some of us, resulting in an unexpected breakdown or health issues.

When reflecting on how stress impacts us individually, one thing that stood out in our discussions was that no individual is affected in the same way – parts of our job that one person found stressful for example, didn’t impact on another so much.

We thought about how this can make it hard to give advice to someone who is experiencing stress, because what might work for us might not work for them. It also makes it hard to identify stress in others.

The Stress Management Society highlighted three categories of change that might occur in someone when they are feeling stressed:

• Emotional, eg. moodiness, irritability, frustration, panic, anxiety, feeling overwhelmed etc
• Physical, eg. chest pain, rapid heartbeat, aches and pains, frequent colds, skin complaints etc
• Behavioural, eg. sleeping too little or too much, demotivated, isolating yourself etc

As a group, we decided how important it was to look out for these changes in ourselves and in others (friends, family and colleagues).

Community at Communicourt?

As intermediaries, we often spend a lot of time working alone. Even before the pandemic we were considered remote workers, travelling to courts and solicitors’ offices across the country without an office as a base. There are times when this can feel quite lonely, especially when you are on a particularly early or late train or are in a hotel away from home!

One of the main things we all took away from our group discussion is that we are never actually alone. We all share very similar experiences and stresses, and we all felt a level of comfort and connection in knowing that.

We reflected on whether we felt there was a sense of community in the workplace (despite us all living and working separately) and everybody agreed there was. We all believed that everybody does what they can to make others feel accepted, connected and like they belong, whether this was through informal Teams sessions, group chats, group challenges, team days, or just keeping in touch with our cohorts.

We also drew on the final aspect of the definition of community – feeling supported. We thought maintaining wellbeing lay more in the clear expectations we have of our roles and responsibilities. Having the opportunity to come together, if only virtually, for regular training and CPD sessions gives us an opportunity to share ideas and experiences. We have also been making a team effort to recognise and appreciate our colleagues more, and of course it is always lovely when we get appreciation from our service users.

Sharing some personal experiences of stress, and the strategies we used to overcome this, also gave us a feeling of being part of a community. We all left our group discussion knowing that it wasn’t ‘silly’ to feel stressed about something that could be perceived as being a small issue by others. We are feeling grateful for the opportunity to try a new strategy.

A big part of being an intermediary is about making recommendations for others, looking out for warning signs that might lead to emotional dysregulation, for example, and putting strategies in place to assist. Stress Awareness Month allowed us to focus on and consider ourselves, how stress may impact us and put some strategies in place for each other.

Our top tips for stress management:

• Talking to each other or the wider team
• Doing something creative in our spare time
• Colouring
• Exploring the different places we visit and stay in, e.g. taking a trip to an art gallery, museum or the zoo!
• Going for a walk or having a change of scenery, especially when working at home or when in the middle of a long piece of written work
• Laughing
• Breathing exercises

Effective communication requires a high level of language skills. When communicating with one another, people use a combination of both their receptive and expressive language. In this post, one of our intermediaries Miriam explores what these language skills are, and why many people don’t know the difference between the two.

Receptive language skills are important in communication as they allow you to have successful interactions with others. ‘Receptive’ refers to the understanding of language. These language skills are key to communication as they allow a reciprocal exchange to take place.

For example, if a person does not understand what is being said to them, they cannot give an appropriate response, which could lead to a breakdown in communication. Receptive language is more than just listening to someone. It can be described as the ‘input’ of the language. It is a person’s ability to comprehend spoken language that they hear or read.

If someone is asked to “pass me the salt”, this relies on their receptive language ability. Much of receptive language is inferring meaning from our experiences and environment. When children are developing, they are usually able to understand (receptively) more language than they can use (expressively). This is one reason why people’s receptive vocabularies are often larger than their expressive vocabularies.

Understanding is built on:

• receptive vocabulary – understanding of words
• receptive grammar – understanding meaning the grammatical structure of a sentence
• non-verbal communication – this level includes understanding non-verbal communication and drawing inference from language. You can learn more about pragmatics in a recent Communicourt post on how difficulties with pragmatics can affect our service users. 

In this post, we’ll be focussing on the building blocks of receptive language, receptive vocabulary, and grammar, as well as taking a closer look at expressive language.

There are a number of people who struggle with their receptive language. This difficulty can be harder to spot, as it is often hidden and not as obvious as an expressive language difficulty. Many people learn to mask their receptive difficulties, often by ‘nodding along’ and agreeing, without indicating that they have not understood. These individuals may find it hard when:

• following directions
• understanding questions
• understanding the meaning of words
• making inferences
• paying attention

Expressive language

On the other hand, expressive language is the ‘output’ of the language. This sort of language skill encapsulates a person’s ability to express their wants and needs through verbal or nonverbal communication. It is the ability to put thoughts into words and sentences in a way that makes grammatical sense and is understood by the listener.

Again, there are a number of people who struggle with their expressive language. These individuals may find the following hard:

• using words in sentences
• grammar
• sentence structure
• telling their side of the story

Receptive language in court

The courtroom environment poses a number of barriers for those with receptive language difficulties. Trials and hearings require individuals to demonstrate excellent attention skills, while rapidly processing information, comprehending different types of questioning and being able to listen to more than one person at a time.

Receptive vocabulary

Courtrooms are full of specialised vocabulary which is unfamiliar to the average person. Crawford and Bull (2006) conducted a study which investigated the understanding and misunderstanding of legal words by older children (aged between 12 and 15 years). This study looked at the understanding of 37 words typically used in court demonstrated by a group of school-going teenagers. Findings suggested that all participants identified difficulty with understanding even with words like ‘jury’, ‘defendant’, and ‘cross-examination’.

In another study, researchers were startled to discover that, when it came to key legal words and concepts, 17-year-olds were likely to be confused and mistaken, and only slightly more likely to understand than 13-year-olds – even after the words and concepts had been explained, and even among those who had previous juvenile court experience (Lavigne and Ryboreck, 2011).

Many of the individuals we work with have a limited receptive vocabulary. If someone finds it difficult to understand the words being used in court this will negatively impact their understanding of evidence, legal discussion and legal advice provided in meetings with their legal team.

Individuals without language difficulties are often able to recognise when they have misunderstood or do not understand legal language and therefore may ask their counsel to explain this further. However, individuals with language difficulties may find it hard to do this, especially in a courtroom where there is increased formality.

It is crucial to note that it is not just court vocabulary that individuals may struggle with. Someone with a receptive language difficulty may not understand words which we think everybody understands. For example, a lawyer once asked his client to indicate when he did not know the meaning of something. The client nodded. However, when the intermediary checked the client’s understanding of the word ‘indicate’, the client explained that they did not understand what this meant.

Receptive language

Being able to rapidly process and accurately retain syntax (the grammar of speech) is essential to understanding legal proceedings. Many people with receptive language difficulties process syntax incorrectly, resulting in poor understanding or misunderstanding. They may have difficulty holding words in mind in order to process and ‘decode’ them. Another common difficulty, for example, is switching reversible position words. For instance, switching the position of the names in the following sentence, dramatically alters its meaning:  “Cressida was screaming at James” vs “James was screaming at Cressida”.

People with receptive language difficulties may also have an impaired auditory working memory capacity. Someone’s auditory working memory capacity is the amount of information they can ‘hold on to’ whilst working out the meaning of the sentence. If a person is given too much information at once, this capacity gets overloaded. An example of overload would be when given directions, or a long list of things to buy at the shops. If a person has a low auditory working memory capacity, they will have difficulties following proceedings especially if the information presented is complex and delivered at a fast pace.

Much of the syntax used in a court setting is complex and formal. Legal professionals may speak rapidly, using multiple clauses and complex sentence structures. This can make it very challenging for an individual with a receptive language difficulty to process and retain verbal information accurately. Many people with receptive language difficulties will struggle to process verbally presented information. This difficulty is exacerbated if they are unable to understand the words which are being used in court (a reduced receptive vocabulary). Individuals may find it hard to retain key bits of information from what they hear in court and therefore may find it difficult to give instructions to their counsel in conference. 

Receptive language difficulties affect individuals with a range of diagnoses including Developmental Language Disorder (DLD), Cognitive Communication Disorder (CCD – often following a brain injury), autism, aphasia (often following a stroke) and learning disabilities.

What is DLD?

DLD is a type of speech, language and communication need which affects the way children understand and use language. People with DLD may struggle to interpret sentence structure and therefore receive message of the sentence inaccurately. In some cases, processing words in the incorrect order could alter the meaning of the information. For example, “I had my dog walked” has a different meaning to, “I had walked my dog”. Therefore, in court, this will have an effect on a service user’s overall understanding of the language being presented to them.

Giving evidence

Strong receptive and expressive language skills are required at all stages of legal proceedings. A service user’s evidence, however, can be one of the most demanding aspects upon their receptive and expressive language. When somebody is giving evidence, it is crucial that they are able to understand the question that is being put to them in order for them to have a fair chance of putting their side of the story across. However, the types of questions which get asked in a courtroom setting are often complicated in structure and content and can lead to people with receptive difficulties becoming confused or answering without a full understanding of the question.

Some examples of question structures which someone with a receptive language difficulty may struggle with include:

• Questions preceded by preamble

When a barrister asks a question, it often contains preamble and information which is redundant. If someone has difficulties with their auditory working memory, they are likely to struggle with questions which are unnecessarily long. For example, Questions that start with “I suggest to you that… I believe you told us that… Isn’t it a fact that…” are complex sentence structures and likely to be problematic.

• Interrogative statements

A typical cross examination approach is to put a case using interrogative statements, for example, “You knew he would be at the pub that night?”. This question type expresses a question as a statement and invites agreement.

Some individuals with receptive language difficulties will not always recognise that a response is required from a statement. Some individuals are particularly suggestible and therefore may agree with a statement. For example, ‘It was raining’ would be better rephrased as, ‘Was it raining?’

• Questions containing negatives

People with receptive language difficulties sometimes find questions containing negatives hard to process. These questions can end up being less reliable for getting accurate information. For example, “Didn’t he go with you?”, “I do not doubt that…” , can be rephrased as, “Did he go with you?.

• Questions containing tags.

An example of a tag question is, ‘It’s raining, isn’t it?’. These questions are linguistically complex and can be very difficult for people with receptive language difficulties. This question could be rephrased as, ‘Is it raining?’.

• Questions containing multiple parts.

Questions which are asked in court can often be very long. This poses a significant difficulty for those people with receptive language difficulties who have difficulties with their auditory working memory. For example, I worked with someone who was asked, “Did you go to the shops with Annie and then go to the cinema?”. The individual answered “No”. However, when this question was broken down to say, “Did you go the shops with Annie?”, he replied “Yes”. When he was then asked, “Did you then go to the cinema?”, he replied, “No”.

This person had been unable to hold all of the information in their head and therefore only answered one part of the question. They also required it to be broken down into separate questions before being able to answer this question correctly.

Expressive language in court

When someone goes to court, they are required to use their expressive language skills to give instructions to those representing them and to tell their side of the story when they are giving evidence. Within court proceedings, an individual is expected to be able to clearly communicate under significant pressure and answer questions in a way that also requires them to remember legal advice.

A study by Lavigne and Ryboreck (2011), conducted on criminal proceedings, found that language deficits limit a person’s ability to:

• provide their lawyer with vital background information and factual information about the case.
• convey important details.
• construct a narrative.

These expressive language difficulties can interfere with a lawyer’s ability to understand their client’s defence and any potential mitigating factors they need to put forward on their behalf. An American Judge called Judge Jack Weinstein recently said: “effective assistance of counsel is impossible unless the client can provide his or her lawyer with intelligible and informed input”.

Individuals may not possess the necessary vocabulary needed to express themselves. Individuals may feel the pressure of being in a formal environment and feel the need to speak ‘proper’. For example, using words and syntactic constructions which they are much less familiar with. This could result in them using vocabulary which they do not fully understand the meaning of and therefore could have a detrimental effect on their evidence. A person I worked with was once asked to describe his state of mind at the time of the crime he was being accused of committing. He stated, “I felt on edge”. When cross examined further, he was unable to provide more of an insight into his thoughts and feelings at the time of the crime because he did not possess the expressive vocabulary to do so.

Some individuals may find it very difficult to stay focussed when they are asked questions. Sometimes their answers may become very tangential, verbose, and lengthy. They may have specific topics that they want to talk about and therefore may find it difficult to answer the specific question. Conversely, some individuals may struggle to give detailed responses and instead provide one-word answers to questions. In both of these instances, listeners may have difficulty gaining the relevant information needed.

Narrative discourse refers to the ability to structure information units so that the story is told to a listener in a logical way. Being able to give a narrative is of significant importance in a courtroom setting as it means a person is able to tell their side of the story. It is closely connected to many cognitive and linguistic skills (Paul et al., 1996) and therefore, narrative competence is strongly associated with language competence. Research has found that people with speech language and communication needs frequently lack the ability to provide narrative information in a logical and sequential manner (Humber & Snow, 2001) and in a way that meets the needs of the listener (Snow and Powell 2005).

Another challenge people with expressive vocabulary difficulties may experience is with word retrieval, also known as a ‘word finding’ difficulty. This difficulty occurs when a person knows and understands a particular word but has difficulty retrieving it and using it in their utterance. It is similar to when we feel that a word (for example someone’s name) is on the tip of our tongue. These difficulties can cause significant challenges for someone when they are giving instructions. Word finding difficulties can typically be found in individuals who have aphasia. This diagnosis results from damage or injury to the language parts of the brain (e.g., stroke). However, it is important to note that word finding difficulties are not restricted to just those who have had significant brain damage.

How can we help?

Receptive language

If somebody struggles to understand figurative language, they may have difficulties with a phrase like, ‘in a nutshell’. This breakdown in communication can be avoided by using clear  language and avoiding figurative language where possible.

It is really important to be aware of the vocabulary used within a courtroom setting. Providing simplified explanations of unfamiliar legal or court-specific vocabulary and using simple and everyday words eg, ‘live’ instead of ‘reside’ will help to ensure someone is able to effectively engage in their proceedings. Visual aids can be used alongside these explanations to support someone’s understanding.

For those who struggle with retention and memory, keep your sentences short and imagine you are speaking in bullet points. Breaking down larger volumes of verbally presented information into smaller ‘chunks’ may help assist someone with receptive language difficulties as it reduces the volume of information that they need to process and retain at any one time. Conferences at the start of the day, as well as during proceedings, are a very good way of ensuring that a person is able to understand what is going on. They can also be used to recap key information heard in court.

It is crucial to monitor a person’s understanding of questions throughout proceedings, to ensure that they are following discussions and able to engage effectively within their trial/hearing. To help someone to process each part of what you are saying, speak slowly and allow the individual plenty of time so they are not rushed.

Expressive language

If a person says something unclear, clarify this information by repeating back your understanding of what they said to avoid misunderstandings. 

If a person presents with word finding difficulties, allow them extra time to form their responses, without interruption and encourage them to take their time. The intermediary can create a visual aid which may assist with these difficulties. For example, I once worked with a service user who had significant word finding difficulties. During a conference beforehand, we created a simple spider diagram (See below). The service user was able to take into court with her and use during conferences. This spider diagram had a space in the middle to represent the target word and lots of different questions round the side which would help prompt her to retrieve the word that she was trying to say.

Visual aids can also be used to help support someone’s ability to form a clear narrative. For example, writing down the current topic of discussion may help an individual to stay and topic and avoid becoming tangential. I once worked with an individual who found it very difficult to stay focussed. A helpful strategy I used with her was to use a clear visual prompt (eg, holding up a hand) and to remind her of the topic under discussion.

When individuals have difficulties adding details to their answers, it can sometimes be helpful to use simple WH prompt question (Where, What, Why) to support them in telling their side of the story.

I often ask people to clarify the meaning of a word that they have used if it appears inappropriate or out of context, to ensure that they understand what it means.

Keeping a clear chronology when asking questions as this will help assist people to provide an account in a logical and coherent way.

Putting the pieces together

Difficulties with language (receptive and expressive) eg, vocab and syntax, are only one piece of the puzzle and many other factors such as pragmatics, social communication, speech, and attention all come into play.

Receptive and expressive language are different. Competence in one should not be assumed because someone has competence in another. People with many different difficulties can have either expressive or receptive language. One particular way that people with these difficulties can be assisted, is through the appointment of an intermediary for their court proceedings, who can explore the specific difficulties they have and make recommendations to assist both the individual and the court to communicate with each other.  

References

Crawford E, & Bull R. 2006. Teenagers’ difficulties with key words regarding the criminal court process, Psychology, Crime & Law, 12:6, 653-667, DOI: 10.1080/10236190500489970

LaVigne M, & Van Rybroek GJ. 2011. Breakdown in the language zone: The prevalence of language impairments among juvenile and adult offenders and why it matters. UC Davis Journal of Juvenile Law & Policy 15(1):37–124. [Google Scholar]

Paul R, Hernandez R, Taylor L, Johnson Narrative development in late talkers: Early school age. Journal of Speech and Hearing Research. 1996;39:1295–1303. [PubMed] [Google Scholar]

Humber E & Snow P.C. 2001. The oral language skills of young offenders: A pilot investigation, Psychiatry, Psychology and Law, 8:1, 1-11, DOI: 10.1080/13218710109524999

Snow, P. C., & Powell, M. B. (2005). What’s the story? An exploration of narrative language abilities in male juvenile offenders. Psychology, Crime & Law, 11(3), 239–253. https://doi.org/10.1080/1068316042000209323

Intermediaries have to adapt their practice to accommodate the environment they are working in. Holly talks about the changing role of an intermediary.

The legal landscape has changed considerably over the past ten years, and the role of the intermediary has evolved since Communicourt was founded in 2011. Criminal courts are increasingly electing to assign intermediaries to support service users only during their oral evidence, while family courts make ever-greater use of intermediaries throughout proceedings.

In 2016, 81% of Communicourt referrals were related to criminal cases, and just 19% related to family proceedings. In August 2021, family proceedings accounted for 54% of our referrals, with 43% coming from criminal cases and 2% from other types of proceedings (e.g. medical tribunals and deportation hearings).

In every setting, the skills and strategies which intermediaries employ to improve communication and understanding are largely universal. Yet, in criminal and family courts, our practice must adapt to accommodate the very different legal arenas.

The early stages

In many criminal cases, a Ground Rules Hearing on the first day of a trial is the first time an intermediary will be assigned. In contrast, family cases more often have intermediaries allocated for a number of Case Management and Issues Resolutions Hearings prior to a Fact Find or Final Hearing.

Criminal court

Following assessment, our first interaction with a defendant and their case is at a Ground Rules Hearing. In Youth and Magistrates courts, a Ground Rules Hearing is typically rolled into the first day of trial and it is usually the case that the intermediary will be granted to assist during proceedings (often because the defendant is a child, or because the trial is due to take place over the course of that one day, for which the intermediary has already been booked).

In criminal proceedings, an intermediary is often granted on the first day of trial or booked to assist from the first day of a defendant’s evidence. With such limited time, the intermediary assigned will need to rapidly build rapport with the defendant and establish effective communication strategies, drawing on the contents of the intermediary report. At this stage there may be a number of barriers to contend with, including time constraints, limited access to the cells (depending on the court), limited conference rooms and higher levels of emotional dysregulation in the defendant (who may be facing their first day of trial).

In exceptional circumstances, an intermediary may be approved to attend conferences with the defendant prior to trial. These rare pre-trial conferences are often invaluable in terms of assisting communication. Here, intermediaries can start to build a working relationship with the defendant (away from the immediate stresses of a courtroom), assess their communication skills in an organic environment (rather than a supportive assessment environment), dynamically assess their response to intermediary strategies and collect crucial information to inform intermediary practice during the trial itself.

Family court

While the first hearing we attend in a criminal case is often the first day of trial, the first post-assessment appointment we attend in a family case is less predictable.

Often, we first meet respondents or intervenors at a Case Management Hearing (CMH) or Issues Resolution Hearing (IRH). In other cases, our first interaction with a respondent may be at a conference at a solicitor’s office.

Conferences may have been arranged to assist a service user to give instructions, to prepare a statement or to read through documents ahead of proceedings.

These preliminary hearings and conferences allow us to gain a better sense of the service user’s communication skills and difficulties, prior to a Fact Find or Final Hearing. This is in marked contrast to criminal proceedings, in which intermediaries typically must ‘hit the ground running‘, absorbing key case information, rapidly building rapport and swiftly identifying communication needs and effective strategies (albeit with the assistance of the intermediary report).

We take detailed case notes, adding to the understanding of the person’s communication needs and honing the strategies implemented for them. Meeting people in early conferences and hearings often allows intermediaries to build more effective rapport and trust, prior to any more significant hearings in the case. While the intermediary who attends conferences may not be the intermediary assigned to hearings, a wealth of helpful information can be gathered and shared during handovers, to maximise effective working with the individual. Although even short CMHs can be emotionally difficult for someone, at this stage in proceedings people are often more relaxed, allowing communication strategies to be explored more freely and helping the individual become more comfortable with receiving intermediary assistance.

COVID-19 has had a more marked effect on our early interactions with service users in family cases, than service users in criminal proceedings. In the majority of cases, early CMHs and IRHs are now held remotely. This impacts how intermediaries meet service users for the first time and affects our practice in the remote courtroom. The remote setting poses a particular barrier to rapport building, while also requiring the intermediary to liaise with the service user to establish a method of communication during the hearing (and any pre- or post-hearing conferences with counsel).

The Ground Rules Hearing

The experience of delivering a Ground Rules Hearing in family court is typically quite different to a Ground Rules Hearing in a criminal trial. While an intermediary may be questioned very closely regarding the necessity for intermediary allocation in a criminal trial, this is rarely the case in family proceedings. Similarly, questions regarding the intermediary’s qualifications and the necessity of specific measures are less common. While advocates and judges may still query the need for ‘meatier’ measures such as questions in advance at a family Ground Rules Hearing, the process generally feels more collaborative than adversarial.

Criminal

In Crown Court trials, the Ground Rules Hearing may take place at a separate hearing, prior to the trial. These hearings often include an application for the defendant to be assisted by an intermediary during the proceedings, whether that’s for the duration of trial or during their evidence. At this juncture, the intermediary is typically asked questions about the findings and recommendations of the report, to assist the judge in making a decision regarding intermediary provision.

If an intermediary is approved by the judge, they will often be required to outline the full recommendations of the report and request the adaptations to proceedings which were suggested by the assessor.

In Youth and Magistrate trials, the Ground Rules Hearing is more likely to be rolled into the first day of proceedings.

Family

Ground Rules Hearings in family proceedings are often less formal and more flexible than those held as part of criminal proceedings. As intermediaries often attend hearings prior to a Final Hearing of Fact Find, Ground Rules may be ‘sprinkled’ throughout early hearings, with intermediaries raising suggested recommendations as required. Some Ground Rules may need to be agreed early in proceedings (e.g. the frequency of breaks), while others may not become pressing until a Final Hearing (those regarding question style during a respondent’s evidence, for example).

In some cases, Ground Rules may already have been lifted from the intermediary report, agreed by advocates and written into the order. In other cases, an intermediary may provide a list of suggested Ground Rules for advocates to review and discuss in hearings, as necessary. On the first day of a Fact Find or Final Hearing, an intermediary may still be asked to deliver a more conventional Ground Rules Hearing. In fact, this is often a helpful step, particularly given the likelihood of changes in advocates and judge, as a hearing progresses. A dedicated Ground Rules Hearing at the start of a longer hearing ensures all parties are on the same page about measures and strategies to assist a respondent.

In the courtroom

During trials and hearings, our role becomes almost wholly focussed on the service user. For this reason, there are fewer differences between the intermediary role in criminal and family courts at this stage. This stage in proceedings is the intermediary’s ‘bread and butter’; where we use strategies from visual aids and live simplification, to comprehension checking and anxiety rating scales, in order to assist people with a very wide range of communication difficulties.

During a person’s evidence too, our roles differ little in family and criminal courts (despite the more formal atmosphere of a criminal courtroom). Here we must intervene when questions are likely to be confusing or overly complex for someone, monitor their attention, monitor their emotional management and make recommendations to the court (where appropriate) to assist them to give their best evidence.

If you’d like to learn more about the strategies an intermediary uses during proceedings with a service user, these recent posts offer some excellent insights:

• Forming a rapport
• Creativity at court (including ideas for visual aids)
• Collaborative working with advocates and interpreters
• A day in the life of an intermediary

Perhaps the biggest difference between criminal and family proceedings at this stage, however, is closely connected to COVID-19 and the increase in remote Fact Finds and Final Hearings.

While criminal trials are almost exclusively conducted in person, family hearings are now often held remotely or in a hybrid manner. COVID-19 forced the courts to become more agile regarding technology, which means that the majority of Case Management Hearings and Issues Resolution Hearings are now held remotely. Although courts are now increasingly encouraged to return to in person Fact Finds and Final Hearings, the recent learning curve around remote hearings allows courts to be more flexible regarding the format of hearings.

For some service users, in person hearings are essential to improving participation. In person, a service user can access live simplification (among other strategies) from an intermediary and direct communication with their legal team, sitting with them in the courtroom and conferences. In this setting, judges and advocates are better placed to monitor a service user’s presentation, while intermediaries can more easily intervene and communicate with other court professionals.

For people with mental health difficulties and difficulties surrounding emotional management, however, attending a physical courtroom can result in elevated anxiety, which often has a detrimental impact upon communication skills. In the latter scenario, the option of remote attendance can in fact benefit participation. Permitting service users to attend court remotely from a neutral location (such as a solicitor’s office) with the on-site assistance of an intermediary, allows them to receive direct intermediary support without the increased anxiety of court attendance.

In rare cases, intermediaries must work remotely from service users throughout a Fact Find or Final Hearing. This is perhaps the most challenging arrangement in terms of implementing intermediary strategies. Ideally, intermediaries will have a direct line of communication with the service user via a separate CVP interpreter room (which comes with its own limitations), an open phone line or a messaging app. Some of these methods are more useful than others, but all limit an intermediary’s ability to monitor a respondent’s attention, emotional regulation and understanding. In this environment, other key intermediary strategies including whispered simplifications, simple notes and visual aids during proceedings is often not possible. More frequent breaks and conferences are, therefore, essential.

Conclusion

The biggest differences between the intermediary roles in family and criminal proceedings relate to the practical considerations of each setting, the conventions of these different legal landscapes and their differing rules. The increased formality and (often) greater rigidity of a criminal courtroom often means intermediaries have less flexibility in terms of the strategies they can implement. In family settings, greater contact with the service user over a number of hearings often allows intermediaries to hone communication strategies to a greater extent.

The move to virtual hearings in the wake of COVID-19, however, has made a difference to how intermediaries operate in family and criminal settings, with remote working still prevalent in the early stages of family cases.

Overall, once the differing conventions and atmosphere of family and criminal courts are accounted for, an intermediary’s role and strategies remain the same – focussing wholly on measures which improve a person’s understanding of their hearing or trial, and assisting them to give their best evidence.