It may seem too obvious to say but we must not forget that if we are working with people in trouble to the extent that some sort of public intervention – medical or behavioural – is required, we are facing problems that involve extreme distress and fear. This can be taken as a given, however the client presents themselves. Indeed, those showing least overt distress or fear can often be the most frightened, too frightened to allow themselves to be in touch with the fear.
The survival of the professional relationship cannot therefore be taken for granted. In fact, if you examine the work of helping services from this perspective it is significant how often professional relationships do not survive, how few end with a shared sense of completion. There are many common forms that this failure to survive takes.
In voluntary helping services, failures to survive are often all too overt – the client drops out of the helping process. This is however not as simple as it may seem. In one of the family therapy cases with which I did work, the family ended treatment with one of the parents saying that, having discussed the sessions together, they had agreed they felt so awful they had decided they had to talk issues through themselves! It is unfortunately not always possible to know what the outcome of helping work is, but it is not unusual for positive endings to take place in this way. People can come to a realisation that they are looking for the impossible from a helping service and that an alternative way forward is possible. Such occurrences are therefore not always properly understood as a failure of survival in the helping process.
Client drop out often does reflect a failure of survival however. One of the salutary experiences of moving from the probation service, where clients were mostly obliged to report to me, to the voluntary sector was to recognise that clients would only remain in the work with me if what I had to offer were good enough. ‘Survival’ therefore required the kind of active listening that convinced clients that they were understood, and that our work offered some promise of positive change. It highlighted how easily we would blame probation clients for failure to attend appointments when the quality of what we were offering was not up to scratch.