Survival 2

What took place in that ‘one to one’ work was rarely analysed , though it was in the early 2000’s in drug treatment services, and the results of this research were of great interest. This I will discuss in more detail in another place, but for now an important finding was that the researcher could identify only a small part of the client contact as delivering something that could be recognisable as a structured change intervention. Most of the time was spent on other often mundane or practical issues.

A number of things could be said about this. In particular, it seems to me to provide testimony to the power of clients to control their workers, to defend themselves. We are all familiar with this in ordinary life:

  • the patient who visits their doctor and manipulates them to define their problem as something that can be treated by a drug
  • the young person who persuades their parent that a few extra £s can make them happy
  • the old person who hides their growing helplessness behind a false independence.

And the closer that a worker gets to the trouble that the client is fearful of revealing, the more fearful and controlling the client can become. This dynamic can easily threaten to undermine the whole working relationship. Surely everyone in a helping role has experienced an interview / encounter in which a client let them get close to their distress only to find the client runs away from further contact.

 

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Surviving 1

I want to write a little more about the concept of ‘professional survival’. My views about this developed through my early years as a practitioner but informed me throughout my career. I referred to these ideas in an earlier blog.

The idea of ‘professional survival’ has not, I think, received much attention in social work or probation literature and training. Its importance as a result has been insufficiently recognised, perhaps taken for granted because of its apparent obviousness.

This neglect of the apparently obvious has been an all too familiar error in a probation service whose practice has been blighted by a preoccupation with quasi-psychological interventions such as cognitive behavioural programmes. (Though I have little direct experience of direct work with children and families, or with mental illness, I suspect a similar dynamic has been at work there.) In probation for example, any serious analysis of what has in practice actually been delivered to offenders would show that, for all the preoccupation with establishing credible and accredited change programmes, only a small minority of offenders ever attend them or are allocated to them in the first place. Most were subject to a similar kind of well intentioned support and ‘counselling’ that has always characterised mainstream probation practice.

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Intuition part 2

Secondly, following from this, an intuition must be subject to critical review and this means that it is best shared. Working in pairs is a great advantage for this purpose, if the pair have a trusting relationship or can use joint supervision to explore the issues. All sorts of questions can then be asked:

  • Can the point at which the intuition occurred to the worker be identified and does this suggest how the intuition arose?
  • Is there something in the worker’s own personal experience that could explain the feeling and if so how much light if any does it shed on the client’s experience?
  • If working in pairs, do both workers have the same intuition?
  • Was there anything in how the client presented, body language, facial expressions, eye movements, levels of emotion or suppressed emotion that provide evidence to validate the intuition?
  • Do support staff such as receptionists have experiences with the client that help to validate or challenge a judgement about a client?
  • Is there anything in the client’s past behaviour to support the intuition?
  • Were there issues avoided or things not said that support the intuition?

This is the kind of critical evaluation that can make intuition a valuable resource rather than a destructive prejudice.

Thirdly, this kind of critical evaluation depends on the quality of communication between workers. Judgements about risk for example are always safer if shared with and challenged / supported by colleagues, supervisors, managers etc. As will be discussed later, the quality of the organisation providing the service is the most powerful factor in determining the effectiveness of that service. Effective organisations will generate the kind of working atmosphere in which shared feelings about the work are freely shared and discussed, and in which the experience of all staff including support staff is valued and used. This is the context in which intuition is most likely to be a useful resource.

Intuition part 1

The ‘active’ technique necessary for family therapy, the sense of ‘letting go’ of familiar securities reflects the need to act ‘intuitively’, to trust intuitions. This is difficult territory – how do we distinguish between and intuition and a prejudice? In order to understand this, it is important to recognise that an intuition is not an inexplicable feeling. The person with the intuition may not be able to explain their feeling at a particular moment in time but that does not mean it is ‘inexplicable’.

There is no doubt that acting on an intuition involves risks. ‘Intuitions’ can lead to disproportionate numbers of young black men being subject to stop and search process. ‘Intuition’ can lead to disproportionate numbers of men being excluded from exercising full responsibility for the care of their children. ‘Intuition’ can stand in the way of women fully achieving their potential in their career.

Three things must be said about using intuition in professional practice. Firstly, it must be noticed. This is important both because it may be a significant insight and in order that it can be subject to critical evaluation. It is easy, as I’ve suggested before, to become preoccupied with being right and then defending oneself against real or imagined criticism. Once we realise that ‘being wrong’ is often helpful so long as it is open to challenge and exploration , intuitions become easier to use constructively. Being wrong in an interview with a client can be very helpful if it is done in a way that allows for correction – a client will often explain something about themselves to correct a worker’s misunderstanding , something they may never have said in other circumstances. Even a prejudice, if open to challenge, can open up something useful – it may for example be that your prejudice is one with which a client is all too familiar and therefore colours the way they relate to people. The dangerous intuition then is one that is not noticed, explored, challenged.

 

Learning from weaknesses

It may be that my anxiety about letting go of safety reflected a weakness in my practice, but I came to feel that we are who we are because of both strengths and weaknesses. Our weaknesses can give us assets in the work if we are not afraid of them and the professional job is to make the most of who we are, rather than trying to be some kind of ‘ideal worker’.

I did find however, that following this limited and difficult experience of family therapy, I became more confident about working with couples and family groups, and about managing ‘live’ conflicts within client sessions. This was useful, not just because it increased the flexibility of the way I worked, but because it attended to one of the risks of working with highly charged family or couple conflict. There were workers who tried to focus on reaching agreements in couple disputes, to the extent that conflict in sessions was firmly suppressed as a blockage to finding an agreed logical conclusion to the problems at hand. All too often in these cases, the intense conflict, suppressed in the formal meeting, overflowed immediately the worker was out of the way resulting in more entrenched bitterness and mistrust. Equally in individual work, fear of intense and often destructive or ‘mad’ emotions could lead to their exclusion from the helping process, leaving the client as isolated or frightened as before – indeed more frightened if the anxiety of the worker seemed to confirm their worst fears about themselves.

This is a familiar problem in managing suicide work where a worker’s hesitation and fear about open discussion of suicidal feelings can mean risks of suicide are missed or underestimated.

The ‘active’ technique necessary for family therapy, the sense of ‘letting go’ of familiar securities reflects the need to act ‘intuitively’, to trust intuitions. This is difficult territory – how do we distinguish between and intuition and a prejudice?

Worker as ‘Scapegoat’

Studying family therapy was then more helpful to me in its influence on how I thought about the work than in its practical application. I can instance a few aspects of this influence:

First of all, family therapy theory and training seemed refreshingly eclectic – there was a belief that all approaches, cognitive, behavioural, psychodynamic, systems theory etc., had a useful contribution to make, and there was no need to ‘take sides’ between these theoretical orientations.

Secondly, I was struck by the notion of therapist as ‘scapegoat’, articulated by Robyn Skinner.

http://onlinelibrary.wiley.com/doi/10.1046/j..1979.00475.x/pdf

Skinner was one of those able to articulate an integration of all kinds of approaches to helping people that fitted exactly with the stage that I had reached in my own learning. The ‘scapegoat’ integrated a notion of emotional ‘transactions’ with systems theory – in engaging with the family the therapist becomes part of a system of emotional transactions. (S)he is not just exchanging ideas with, stimulating new ways of thinking in the family, but is becoming part of the emotional world of the family in all its confusion. The worker does not then just ‘offer interpretations’ that might re-frame the family’s understanding, but (s)he models behaviours within t he family, engages actively in emotional transactions. It is this participation in the family dynamics that entails the more active style of work, and a letting go of some of the securities that support more reflective individual work.

Struggling with Family Therapy

There is a considerable literature about family therapy and I have nothing substantial to add to this. In any event, I am trying to give an account of a process of professional learning, not a dissertation on intervention techniques. Although I did do some specialist family therapy training, and had some albeit tentative, experience of family therapy, ‘tentative’ remained the right word.

I found that the delivery of family work required a very different approach from that I applied in the rest of my work. It also involved new emotional challenges to which I think I was not then equal. I acted these difficulties out in the very first formal family therapy session I ‘conducted’, in partnership with my professional supervisor. To my distress, I found myself incapable of uttering a word through the entire session. No doubt, trying to work with my supervisor (the first time we had shared a case) contributed to my paralysis – not only was he more experienced and self assured, but given the dynamic between us, I felt scrutinised and judged. But the heart of the problem, I later came to believe, concerned the way I brought my own family experience into the family therapy session. In my own family, I was the youngest and was hidden behind a noisier, more dominant (as I experienced it) brother. I tended to retreat into a sort of passive acceptance of my junior status, until I had to assert myself, and this would then involve a combination of grumpy adolescence – especially towards my mother – and periodic outbursts of rage – especially towards my brother.

Having then not found a secure adult presence in my own family, I didn’t seem able to find such a presence in the formal family therapy session and regressed to a silent passivity. I felt embarrassed and ashamed of this, and whilst I did continue to do some family work and found a way of being present and active with more experience, I had no enthusiasm for making family work a larger part of my social work practice. It is the case that leading family therapy sessions called for a more active interventionist style from the worker than I comfortably adopted. I was only just beginning to try out (other than in Court settings) more publicly assertive roles at that stage in my professional life, and I found family therapy work too uncomfortable a place to learn.