Has anyone seen a NEET to WEEP for ?

Charles Sharpe writes, has anyone met a NEET ? NEET is one of the latest of a long line of acronyms to reify unique human beings. I won't bother to write out what NEET stands for because by doing so it would seem as if I was validating the notion. It is an acronym coined by wise people who I will call - at the risk of being hoist by my own petard - WEEPs, that is people who are it seems Wise, Educated, Earning and Pontificating on what others - specifically, younger adults - should be doing. According to WEEPs the very least we must expect from NEETs is that they should be getting a job, or getting an education or joining some imaginative project out of which a well sponsored WEEP will be earning a good salary.This is the kind of project which though it will pay NEETs nothing will enrich them in so many other sublime ways. I suggest that each and every WEEP should get in touch with an individual NEET and say not only am I going to make sure you get the education you want and that is relevant to you but also until this can be achieved and you get a job I am going to give you half my pay. This is the least and the greatest service a WEEP can provide for a NEET.

More Unpublished Letters to the Editors

Dear Editor of The Guardian,
In his article 'Revealed : 77 trafficked children lost by home' (The Guardian 06.05.09) Robert Booth says the immigrant children were placed in a 59-bed block. I question why OFSTED who are responsible for scrutinising our children's homes allow the London Borough of Hillingdon to keep this home open. Nationally accepted guidelines suggest that the optimum size for a children's home is 5 to 6 beds because any home larger than this is likely to de-personalise and institutionalise the child. Certainly no social worker that I know would place a vulnerable British child in a home of this size. Why are immigrant children treated differently ?
Yours faithfully,
Charles Sharpe

May 14th, '09
Siobain Degregorio responds
I was as appalled as the next person to learn of the trafficked young people placed at a 59 bedded placement. Outraged I might even say!
The problem seems to be to be a systemic denial of the issue of trafficking, from what I understand of the situation Immigration do not even accept these young people have been trafficked! Nevertheless surely it follows that someone must recognise the needs of these young people who are incredibly vulnerable ; surely they can be placed in stable placements with experienced staff. It would seem we cannot do this otherwise why is there only such a large establishment made available to them ?
Blame the social workers then for their lack of understanding and incompetence. But if this is a systemic problem as I have suggested we need to look at the whole system of which the social workers are just a part . How many times are we told that a young person's placement has to end due to lack of funding or a young person cannot be placed within the organisation identified as most appropiate to met their needs because of a lack of funding? Asylum seeking children are not afforded the same recognition of their needs as local young people {and we all know how difficult it is to secure funding for them!}. How then if there is no money can social workers place vulnerable young people in placements where there will be 'good enough' adults available to them? What is the Children's Commissioner's for Hillingdon view on this and indeed what about the Prime Minister. I was a little sceptical about the comments made at Prime Minister's question time, after all who is going to take responsibility for agreeing these young people have needs that we as a society need to pay for? How many votes will that win?
Finally, I ask what are we doing about lobbying for these young people's rights? Do we simply sit on the sidelines tutting about the state of social work today or are we to take a more proactive role? I say shame on all of us for allowing such a thing to happen not just to these children but to all those that have gone before.

Thoughts after the death of another protected infant.

I was glad to find myself agreeing with Harry Ferguson (To protect children we must first protect social workers – The Guardian, 13.11.08) www.guardian.co.uk/commentisfree/2008/nov/13/child-protection-social-care that social workers need training which is focussed more on developing the skills and insight needed to engage with the ‘complex relationships with families which doing the work involves’. I agree too with Iain Duncan Smith (The legacy of broken lives : dysfunctional families raise children whose destructive paths are set by the age of three – The Guardian, 13.11.08) www.guardian.co.uk/commentisfree/2008/nov/13/baby-p-dysfunctional-families that without earlier intervention with dysfunctional families to change their lives’ more and more children will be at risk of serious harm. Yet where is the notion of concern borne out of love in either of these articles ?
Harry Ferguson rightly suggests that training for those working in the child protection system is more focussed on procedure and less on providing social workers with the skills and attributes they need to make relationships with troubled families and vulnerable children. Procedures protect adults - not only parents but also those with a professional role in the care of children and young people – and in particular as the Laming Report in 2003 implied - they tend to protect senior managers more than the social workers who are directly involved in making concerned, helpful relationships with dysfunctional families. It is difficult for a social worker to show sustained concern if no one is showing a similar concern for her.
Children who are loved in a healthy way by adults are protected. I don’t just mean parental love but love which represents a concern a community should feel for each one of its members. There is I believe a consensus that all children need love. Yet as we protect our own children with love, we attempt to protect other people’s vulnerable children with procedures while professional and political leaders by making noises about how much they are doing in response to the latest publicised child protection scandal seek to justify themselves.
What is our communal difficulty with loving other people’s vulnerable children ? Certainly love is not a part of professional child care liturgy. Perhaps the nature of our work has caused us to confuse the healthy love of a parenting adults for their child with the notion of love as a sexual act. Perhaps in our evidence-based ‘neat solution’ world, love is not sufficiently scientific for us. It doesn’t tick boxes. Perhaps in our professional terror of being seen not to protect children we retreat to the safety of the professional fortress and thus resist taking the risk of establishing healthily concerned and loving relationships with the children we are charged with looking after. After all who will protect us if something goes wrong ? It can seem in our rigid adherence to procedure, we have created many more subtle ways to de-personalise the relationship between ourselves and the people who need our services.
The love children need is characterised by its tenacity. It is impervious to life’s vicissitudes and above all it must be cherishing. Some of us struggle with these elements in our own personal relationships but we – child care workers, senior managers, policy makers and politicians alike - should ask the question, ‘do vulnerable children need this kind of love from us ?’ It is a big ask, but we know the answer. If we cannot give this kind of love to vulnerable children whatever we put in its place will not be enough. If we do give it, it will inevitably mean risking giving up more of ourselves. Harry Ferguson suggests that ‘Re orienting the public debate as well as public policy’ is important, but only as long as that doesn’t mean ending up in the same place.

Ejjercayshun - my thots

by Charles Sharpe (age 62)

There seems to be a general assumption that the way most youngsters are educated in western society - that is in formal groups in a classroom with a nominated teacher who has professional training - is the right way to 'educate' our young. Yet I don't know of - and I may be missing something - any universal biological, or physiological law which states that children must be educated in this way or indeed if they should be educated at all.
One politically radical way of looking at this might be to say that schooling as we know it developed out of powerful families deciding that if their offspring were to sustain or build upon the dynasty's wealth they must learn a thing or two about how to be on the right side of their kind of god and how to count and defend the money as well as all the other things which flow from that. It then became more economic and self-protective for 'clan rich' to carry out this 'educating'in groups called schools which were eventually broken up into classes. This system also kept the little rascals out of their parents' hair. Those who might suggest that education developed in this way would also say that schools are institutions which are used to protect the status quo so that youngsters are educated to protect and sustain the powerful. Even when 'education for all' was deemed not too dangerous to allow, the schools rich kids went to were different from the schools poor kids went to. Know what I mean ? Some socialists may shout and wail about these things occasionally but in the end nothing much changes.
I am in a measure sympathetic towards this view of how education comes to be the way it is in western society, but I haven't yet fully thought out my position on schools or education. I can't say for definite whether education in schools is better than education in the family home or indeed than no education at all, but I have a view on the way children learn best though. I trained as a teacher in the early 1960s when teacher training was influenced by educationalists such as AS Neill who suggested that if parents get the emotional upbringing right then intellectual development and learning will follow naturally. Neill also suggested that children learn best and become more imaginative and creative if they are helped to learn through their own natural curiousity and their own discoveries and not by having a narrow taught curriculum foisted upon them. The trouble with children educated in the AS Neill way is that they become inquisitive, they question things - particularly the status quo - and though society might have time for a few oddballs doing this, it can't tolerate the majority questioning things like the distribution of power and wealth. This is why teachers trained in the 1960s were labelled permissive and have been condemned, certainly in England, as being solely responsible for damned near destroying the education system and thank goodness that nice Mrs. Thatcher came along and saved the nation from the fate we had in store for it. As I said, I haven't reached a stage where I think I've got a definite position on where and by whom children should be educated, but you will have guessed I do believe children learn better from a stable emotional base and OK, I'll admit - at the risk of being condemned all over again - I think children develop better when they are helped to learn through their own discoveries and, by being given a great deal of responsibility in choosing their own learning path.

Does "every child matter " ?

By Charles Sharpe

I was comforted by a letter written to the editor of The Guardian on May 6th ’08 from
the government ministers Jim Knight and Beverley Hughes who have a responsibility for children in which the ministers said that they did not believe schools should be responsible for solving social problems. I was relieved because this is the government’s responsibility.
Schools do have a significant role in the development of children’s wellbeing but first and foremost children’s wellbeing depends on the emotional and physical care provided by good enough parental figures. The all too neglected Scottish educationalist, AS Neill suggested that the social and educational wellbeing of children is assured if they are given the right kind of emotional support.
In a society where material acquisitiveness is encouraged and is seen as a mark of having succeeded in life it cannot be surprising that there are some parents stressed by their failure to acquire – often entrapped in inter-generational cycle of poverty and all that it brings – have proved unable to give their children the emotional support which assures wellbeing.
Mr. Knight and Ms Hughes fail to recognise that government funded initiatives to encourage the notional ‘included’ – for example those who work in the educational, health and social services - to do something for, or to, the problematical ‘excluded’ have not succeeded in significantly improving the wellbeing our most vulnerable children.
Better perhaps that the government fosters an attitudinal change in order to create a social climate in which those of us who have more than we need acknowledge and act on the idea that we are just as much a part of the overall problem as those who have less than they need. Taking such action would be courageous politics but in terms of the wellbeing of our children it would justify the government’s claim that ‘every child matters’.

How Can Life Space Work Gain the Professional Status It Deserves ?

By Charles Sharpe

Most professional disciplines, like medicine, law and education evolve by a collegiate process in which a formalised body is set up in order to define, promote, train and protect the profession. In this process membership of the profession is almost invariably limited to those with a qualification demanded by the profession’s overseeing governing body.

Rightly or wrongly, these professions are acknowledged as providing services which are available to those – who are the vast majority - who are seen as functioning members of the wider society. Because this is so they are powerful and can defend and develop their public standing.

There are some ‘professional disciplines’ which are less well defined, less unified, less informed, less qualified and are consequently much weaker and less politically influential than the more established traditional professions. They tend to work with those who are marginalised in our society. They work with the people who are generally considered a burden or a threat. They are a burden because they are seen to use up more than their fair share of the public purse and they are a threat because it is considered that their behaviour and the consequences of it are a threat to the general order of things. Those who work directly with these marginalised people struggle for recognition in the evolutionary process of the professionalisation. In England such is the case for life space workers. They have no collegiate membership or professional governing body. They form a disparate band which is never quite considered 'professional', not often qualified in any professional discipline and generally understood to be below the status of teachers and social workers whose ‘students’ or ‘clients’ they often share. Just as their clients are in relation to the wider community, so life space workers are very much marginalised by other professional disciplines. The life space worker has few champions.

This has meant that both historically and currently there has been and is no real and
committed investment in the recruiting and training of these workers of the kind which would enable them to carry out with some certainty of success the complex role of nurturing, supporting and looking after troubled children and young people in the life space. Little is said or done about their practice until something dreadful happens to a child in a children’s home or to a youngster in a youth project. Following such a tragic event an investigation ensues, new procedures are rolled out, a great deal of noise is made about carrying them out and then everything returns to what it was until the next scandalous or tragic event. I do not question the necessity of fully investigating events in which children have been harmed directly or indirectly by the actions of those who are charged with looking after them. I am equally adamant that there is less likelihood of such events occurring if those looking after vulnerable young people are properly trained. In my view life space work should be developed in a predominantly proactive way and not just in the reactive blaming atmosphere that is inevitably prevalent in the aftermath of a tragic event.

There are many good people involved in life space work but in my view we lose too
many of them because they feel unheard and undervalued and consequently
become to feel ineffective.

Include Me Out, Exclude Me In

By Charles Sharpe

In her article ‘I don’t blame middle-class parents’ Alice Miles (The Times, June 13th, 2007) disengages the middle- classes from any responsibility for the experiences of what she calls ‘disadvantaged kids’. Nonetheless she concedes that 'we have to admit' that in the United Kingdom ‘we have an underclass’. If we accept her claim – which for argument’s sake I will temporarily, though not in the way I suspect she would want me to - then the corollary is that we must also have an ‘overclass’ of which she seems a self-satisfied member bathing in the denial of the power and the responsibility this membership might place upon her.

The central issue here is the idea which those who advise governments have called ‘social inclusion’ and ‘social exclusion’. The ‘disadvantaged kids’ are socially excluded and Alice Miles and her kin are socially included. At this point I divest myself of my temporary acceptance of Alice Miles’ position because it is my belief that a society which consists of a group of people who see themselves as ‘included’ and defines another group of people as ‘excluded’ is a split dysfunctional society. Paradoxically this schismatic position is symbolised by Alice Miles when she suggests the middle-classes would be culpable for poverty if, 'now that we have all the evidence we need, we fail to seize our best chance of helping the most vulnerable'. Has the poverty and deprivation she speaks only recently become evident ? Has history anything to say ? Surely all the members of a functional society start from the premise ‘We are all in this together. We are all experiencing this together and we will not tolerate the material, social and emotional deprivation and suffering of any of us'. Such a society would not, in the way the one Alice Miles describes would, allow the evidence of deprivation to accumulate because such evidence could not accumulate.

This is not simply the confused philosophy of an idealist - the root and branch changes which my position implies present many problems - and neither is it merely a left wing jibe at the affluence of the notional ‘included classes’ - indeed deprivation and poverty are not necessarily solely related to a lack of material wealth - but it is more a cry of dismay directed towards the leaders and influential ‘thinkers’ of the health care, education, social work and social care professions, who - knowing it will fundamentally change nothing for those who are experiencing poverty - have sold, or bought into, the notion of the social inclusion/social exclusion construct because it pleases and curries favour with their political masters, gives them some marginal influence, and keeps them in jobs.

References

Miles, A. (2007) 'I don't blame middle-class parents' in The Times London

Bruce's Story : learning from my mistakes and my discovery of transference

By Charles Sharpe



This is in part the story of my relationship with a young man I taught when I was a young teacher. It is also an explanation of how I came by crude means to some understanding of the psychodynamic phenomenon known as transference. In my view it is a phenomenon which all those who work with children and young people should become aware. In recognising it and responding to it sensitively, workers can gain a deep understanding of a young person’s inner world which in turn can help in the development of a healthy therapeutic relationship.

When I refer to transference I am considering a notion introduced by Sigmund Freud. In relation to working with looked after children and young people transference is the young person’s re-enactment in his relationship with a care worker of his feelings towards another significant adult - usually a parent or a previous carer - from his past. The feelings evoked may be hostile and this is known as negative transference (Freud,1915).

When I refer to counter-transference I am using Paula Heimann’s notion that in counter-transference the care worker, by comparing the feelings roused in herself with the content of the young person’s associations and the qualities of his behaviour, has the means for checking whether she has understood or failed to understand the young person she is looking after (Heimann, 1950).


In the 1970s I was the headteacher of a school attached to a local authority observation and assessment centre - a large children’s home in which the needs of young people ( who for a number of reasons were currently unable to stay with their own families) were assessed for a period of 6 weeks.. During this short assessment period the young people’s behaviour was observed and assessed in social, psychological, educational terms in order that a suitable long term residential placement might be found for them. History now views this as a flawed system principally because the assessment of the young person was made without any consideration of the family dynamics which had brought about the young person’s referral to the centre. In short, adults were believed and young people’s views were not heard.*

The time Bruce and I spent together passed mainly in the group setting of a classroom, but a key episode in our relationship occurred in one of those impromptu situations which can occur when you work in a place where people live.
At that time I had no understanding of psychodynamic theory or its related therapy. I was employed as the head teacher not because I had any theoretical or practical knowledge of human development or relationships but because I was a qualified teacher and perhaps because I was a man and so, in the spirit of that time, I was considered more able to control children whose main problem was deemed to be their bad behaviour. All this may have to be borne in mind by any contemporary reader.


Bruce was 14 years old and came to us six months after his mother had died of cancer. Until his placement with us Bruce had lived at home with his father and his 18 years old elder brother. He had been placed with us because his father and brother felt that they could no longer cope with Bruce’s anti-social behaviour. According to his father this behaviour had first become evident soon after Bruce’s mother died, an event which coincided with Bruce becoming attracted to the punk movement. Bruce began to wear leather clothes festooned with chains and safety pins which were associated with the movement and. he became interested in the music associated with the punk movement and in the bands who played its nihilistic songs. Bruce’s father and his brother were embarrassed by Bruce’s appearance and they equated his new interests with social rebelliousness. They often chastised him for this, but his father thought that Bruce did not respond in the way he should have to this chastisement. Prior to his mother’s death Bruce’s school teachers had regarded him as a bright and well-behaved boy but following his mother’s death they became critical of him because he insisted on wearing his punk clothing rather than his school uniform After some weeks of this conflict with his father and brother Bruce began to truant from school and stay out late. On his return he would not give any explanation of his absence. Having failed to control his behaviour with verbal chastisement, Bruce’s father and his brother now felt impelled to chastise him physically. Bruce began to stay out overnight at the home of a girl he knew. The girl’s mother attempted to reconcile the differences between Bruce and his family but to no avail and when Bruce returned home one morning with safety pins pierced through his ears and eyebrows, Bruce’s father contacted social services. His father explained that all his attempts to control Bruce had failed to change his behaviour. It was his father’s representation to social services, which led to Bruce being placed at the centre where I taught.

Bruce was placed with ou centre for a period of assessment and so he attended our school. At first Bruce was quiet during my lessons though my two female teaching colleagues soon had a friendly rapport with him. After a few days Bruce began to refuse to do the work I set him. Initially I thought he did not like the academic subjects I taught and preferred the more practical and creative subjects my colleagues taught. When I asked him why he was not doing his work Bruce shrugged his shoulders and gave no explanation. After a few days I began express to Bruce my concern at his refusal to do his work. Whenever I did this he turned his head away and looked out of the window. I began to feel at a loss as to what I should do. I felt certain that the other young people and my colleagues would expect me to take decisive action on the matter. I decided for the moment to ignore him and work with the other young people. During the second week Bruce ripped up his exercise books. When I asked Bruce why he had done this, he shrugged and looked away. I told him he had wasted scarce materials and though I would replace them, he must not repeat this behaviour. I felt hurt by Bruce’s behaviour towards me. I could not see that I had been unreasonable to him. I accepted, and to an extent sympathised with his identity with the punk movement and I had not expressed any negative comments about his dress or his beliefs. Once more I decided to attend to the other students and I did not engage with Bruce any further on that day.

On the following day Bruce refused to attend my lessons, and would not give the residential child care workers who were responsible for his care outside of school any explanation for this. When I asked for an explanation he shrugged and leaning on his elbows, put his hands over his face. More to rationalise my failure to persuade him to join me in school rather than allowing him an opportunity to consider what was happening, I told Bruce I would not deal with his matters immediately but I would give him the rest of the day to consider what he was doing and what it might mean for his future. As I made this comment I was aware that it may have carried a vague threat that his continued place at the centre might be under question, but I let it stand.

The next morning Bruce was persuaded by the other teachers to attend my lesson. I was not pleased that others had been successful in persuading him to attend when I had not. After all I was the headteacher! When Bruce entered the classroom I gave him a new exercise book and said if he did not do his work, there would be no point to him attending school. Bruce immediately ripped the exercise book up. Without considering the implications of what I was saying - since I did not have the sole authority to exclude him from the school - I declared he would have to accept the consequence of his actions. Bruce stood up, spat on the damaged exercise book, pushed over his desk and shouted, “ Fuck your school, everybody hates it, everybody hates you, even the other teachers”. He stormed out of the classroom. Shocked and upset by Bruce’s response to me, I settled the other young people, asking a colleague to tend to them while I looked for Bruce. I was upset, not only because Bruce had said nobody liked me, but also because he made me feel hated. I could not understand how he could feel this way because he hardly knew me and though I had been in conflict with him I did not feel anything I had said or done really warranted this reaction. I felt also that I did not want to be hated. Soon afterwards I found Bruce curled up in an armchair in a small sitting room in the main house where the young people lived. I sat in an armchair quite near to him. I remained silent because I sensed he was still angry with me. After a few minutes he asked, “What do you fucking want?” In this setting with only the two of us present, I did not experience this question as aggressive in the way I had found his response to me in the classroom. I said, “ I don’t think we can go on this way. We need to get on better”. I noticed how without conscious intention my tone had changed from the one I had adopted in the classroom. Since he remained silent, I said, “I can’t understand why you’re so angry with me or why you hate me so much. We only met a few days ago”. Bruce remained silent and becuase I was now in touch with my unreasonable feelings about rejecting him, I said, "I’m not trying to get rid of you”.
“ Yes you fucking are. You’re just like my Dad” Bruce replied. “Everything you say has got to be right and anything anyone else says is shit”. I was deeply affected by this. I was overcome by a sense of guilt and I was suddenly aware that Bruce had more insight about our relationship than I had. I did not know there was a word for it. I had become aware of transference. Bruce was angry and upset with me because he was angry and upset by his Dad. My demeanour, and the way I spoke to him brought him in touch with these feelings. Bruce had been enabled to express these feelings because he sensed I too would reject him in the way he believed his Dad had done. He was right. I had experienced primitive feelings of wanting to “get rid” of him because of the threat I had felt he posed me. My wish to reject him - though I didn’t know it at the time - represented my counter- transference. He had made me feel that I was a bad father, something which as the father of two children I was not prepared to feel about myself.

I said, “I don’t know your Dad and I’m not your Dad”. After a short pause, I said, “I’ll remember in future what you said your Dad was like”. I apologised to Bruce if he found anything I had said had felt like I wanted to get rid of him and that I would be more careful not to give that impression in future. I asked him if he would return to the classroom with me. He was silent for a few moments and then said “OK”.

In the following weeks Bruce and I were able to work together better. There continued to be situations where I experienced his negative transference but it seemed that now I recognised his displaced feelings and had become able to deal with my fear that Bruce was a threat to me, a safe mental space had been created which made our relationship of student and teacher more acceptable, and so Bruce was able to make progress in the subjects I taught him.

Comparing my work with Bruce directly to a psychodynamic approach to care is a dubious if not spurious exercise. I had not been formally introduced to psychodynamic principles, yet the opportunity Bruce and I had to be together on our own allowed me to I listen - without fear for myself - to what it was Bruce was feeling about his father and indirectly about me. It also allowed me to respond to him as the kind of concerned adult that he needed at that time. My skills had not tangibly developed but my disposition had changed. More importantly it had introduced me to the importance - even if working principally in a group setting - of finding time to meet with people individually in order to assure them that they are valued as unique individuals.

Over the years reflection on my relationship with Bruce has provided further insight. I recognise now that the positive relationship which my female colleagues enjoyed with Bruce was a consequence of his positive transference towards them in that he displaced on them feelings he had for his mother. I believe also my female colleagues, unimpeded as they seemed by the anxieties and defences I experienced, were more able to be emotionally in tune with the huge loss Bruce had experienced and his need for time and space to mourn this loss.

Unfortunately during his time at the centre no work was done to address Bruce’s relationships with his father and his brother and so it was much later after Bruce had spent a number of fruitful years being cared for by a foster family that he was able to re-establish links with his family.

I use the word unfortunately because at that time there was little recognition, certainly not on my part, of the emotional impact the loss of a loved wife and mother had on these three men.


* Don't get me wrong, things have changed a little for the better but in general I still feel adults are believed and young people are not heard. For instance (and there are many other kinds of instances), a certain kind of meeting is often convened which is sometimes called a "professionals' meeting" which has the sole hidden agenda of excluding an 'awkward' young person from important decision making about his or her future.
References

Freud, Sigmund (1915) ‘Remembering, repeating and working through”. The Standard Edition of the Complete Works of Freud, vol 14 , pp. 121-145

Heimann, Paula (1950) ‘ On Counter-transference’, International Journal of Psycho-Analysis Vol. 31.


Charles Sharpe
January 2004

Families are not just for Christmas

By Charles Sharpe

This short article has been adapted from my introduction to the family module of the Eagle House Diploma Course in Child Development and the Care of Children and Young People. The article’s title may appear somewhat whimsical but there is a serious side to it. Over the years I have been aware of a significant tendency – though not by any means an overwhelming one – for those of us who look after children and young people who for a variety of reasons are not living in their family home to view some family as a saboteur of our therapeutic work with the young people. Yet however dysfunctional these families may seem to the care worker, they remain the only families the young people have and for me an important a long term goal of all our efforts with troubled children and young people is - wherever it is possible and safe - to encourage and maintain each young person’s relationship with the birth family. How helpful sustaining this relationship can be will depend on a number of factors, not the least of which is the nature of the young person’s place in the family in the past. From my own experience I know that residential child care workers and others with similar responsibilities often, for good reasons, take a critical view of contact between young people and their families, except that is at Christmas or when we ourselves wish to be with our families. At these times many care workers are understandably desirous of an escape from the pressures of looking after the young people. Cosequently at Christmas an impetus can build towards sending young people home to their families. I have also been aware of occasions when we as care workers, otherwise critical of a young person’s parents are so hard pressed to control certain behaviours of a young person that we are temporarily seduced by the idea of the relief a weekend’s ‘cooling off’ period at home might provide for a youngster and, though it is not openly acknowledged, the relief it might afford us. In addition to our own emotional needs the dilemma we have as care workers is that we know families are not just for Christmas but we also know that for some youngsters one day a year with their families can seem too much. I do not wish to be overly critical of child care workers. The feelings I describe are natural but I believe it is better for the young people and for the care workers to acknowledge these feelings rather than deny them. Indeed I have often been equally concerned by those workers who insist they always want to work during those holiday periods which have traditionally been seen as family occasions.

My notion of ‘families are not just for Christmas’ is only one example of many I might give which is representative of our ambivalence towards the families of the children and young people we look after. Given that we have these mixed feelings I thought it might be useful to think about what a family is and what it does. I thought it helpful as an introduction to this part of the course to think about what a family is and what it does.

To borrow a phrase of D.W. Winnicott, ‘family is where we come from’. The family kept us alive when we could not help ourselves. This is a lengthy period which can extend from birth to well into our late teens and beyond. As we grow older it is our family that contains us while we seek our own identity and look for our place in the world.

Even when we have left home it is often to the family that we look for emotional and practical support. If we start our own families, it is frequently our own parents’ child nurturing methods which we will use to rear our own children. It is from our parents that we will frequently seek support and advice as we encounter the various difficulties that inevitably arise in our lives as we look after our own children.

Eventually roles may turn full circle and it may be us who will look after those in our families who cared for us when we were young.

But what is a family? Socially and politically this question has become increasingly contentious. The structure of the typical family is less easy to define. As we know from our own multi-cultural society, from what we have experienced in our personal history, from what we read and see in the media, and of course from our holidays abroad, the idea of family can mean different things not only to different cultural groups, but also to each of us as individuals. We may for instance generalise that in one culture the nuclear family is largely predominant while in another culture the extended family may assume greater significance. Yet even within specific cultures individual families are unique and there are no hard and fast stereotypes.

There may be more general agreement about is in what it is - to use another Winnicottian phrase - a ‘good enough’ family provides. In what follows I have started to catalogue this provision. It is not an exhaustive catalogue. I am sure you can add to it. We are also aware from our own personal experiences, and from our work with young people who have been separated from their families, that families are not perfect. Some families are not ‘good enough’ and in our work we are all too familiar with the effect this has on the young people we care for, just as we are aware of how less welcome aspects in our own families may have been unhelpful to us during our own upbringing.


Some things a good enough family provides.

It provides children with at least one consistent, firm, caring relationship – usually the relationship between mother and infant which will last at least throughout the early years of the child’s life.

It provides the mother and child with some form of support to bring up her children.

It provides, first of all, parenting adults, and then children with a secure environment, in which they have a clear identity and a role to play.

It provides good role models for children to imitate.

It provides all its members with praise and warmth.

It provides a consistency of care giving.

It provides a consistency in attitude toward, and dealing with children.

It ensures that the child wants and needs are responded to on a sensible basis.

It offers an environment with sufficient stimuli and resources to encourage exploration, discovery and creativity.

It presents an emotional and physical space where children and parenting figures can play and explore.

It provides an emotional and social environment in which children can learn how to behave in a socially acceptable way.

In providing at various and appropriate times the qualities listed here, the family ensures that children are nurtured to the extent that they have an opportunity to enjoy childhood and to become reasonably healthy adults. In achieving these things it also provides for the future generations of the family and the community. If we accept this then it is chastening to think of the family experiences of many of the young people we look after and it defines to the enormity of our task in compensating them for what they have missed.

Charles Sharpe, September 2004
Revised March 2007

By Douglas Cameron



In this article Douglas Cameron,adds another unique view to one of this site’s recent major themes : the breakdown of placements in the public child care system. In reading Douglas’ unique analysis of the causes of the placement breakdown for children and young people in the care system in England and Wales, it is tempting to see it as an interesting polemic in which Douglas expresses the frustrations experienced by many of us who are charged with the care of young people who are no longer able to live with their families, but it becomes much more than this when the reader has to confront the experiences of Ian, the young man whose story Douglas tells.

Douglas Cameron spent most of his childhood in Nairn in the north of Scotland and after leaving school he had a number of jobs including a period as a chef and another as a security guard and it was while he was working for a private youth custodial service that he decided he wanted to work with young people but in a different way. He enrolled at the West Lothian College in Scotland and gained a qualification in social care. After this Dougas worked as a volunteer befriender before moving to London to take up his current post in which he works with young people who are preparing to leave the care system.


The causes of placement breakdown for children and young people in care: a personal view.

By Douglas Cameron


In this essay I have made a personal exploration of some of the factors which lead to the all too frequent placement breakdowns in care which children and young people in the care system experience. In a vignette of my work with a young man who was placed with the leaving care project for which I work I attempt to illustrate some of the issues I raise, and I highlight the significance building good relationships has - even in the face of resistance - on preventing placement breakdown.


Factors external to my own work which may lead to the breakdown of young people’s placements in care



Inconsistencies in the care system

In considering the breakdown of placements for young people who are looked after in the public care system and the wide range factors which cause them I do not wish to lose sight of the idea that it is the first real change for any child or young person - when they are removed from their family home - which must affect the child most. Such a change may in some ways bring immediate release from what may be an unbearable situation, but moving away from what they have always known must bring its own uncertainties and insecurities. What is of further concern is that in my experience so many of the young people who have been placed in care with the view to making them feel safer and to provide them with consistent care find themselves in a public care system which actually makes them feel less secure and less safe. Too many young people who are looked after in the care system find that it is only their behaviour and not the cause of their behaviour which is responded to by substitute parenting figures. Such was the experience of Ian, a young man I describe later. Young people like Ian are not responded to at a caring emotional level and all too soon their misunderstood behaviour is presented as the cause for a placement with foster parents or a children’s home to end. This is frequently the beginning of a domino effect which leads to the young people moving from placement to placement in a system which declares itself as one which seeks to provide consistency of care. It seems to me that in assessing these young people we label them trouble makers long before we begin to think whether what we are providing for them is suitable to their needs.
In a very short time such children and young people begin to feel alienated in unfamiliar territory within a society which is supposed to be their own! (See Sergeant, 2006) Living in a state of anxiety about what is going to happen to them next, it is no wonder that these young people can lack the trust to make connections and to build relationships.



Changes in social work personnel

Another and frequently overlooked externally imposed change in the lives of these young people is a change in social work personnel. For instance when a social worker leaves the local authority or a new social workers is allocated to a young person without any consultation or notice, may only serve to confirm in that young person previously engendered feelings of separation, loss and worthlessness.



Overloaded social workers

In my experience the lack of sufficient social work time has an impact on the consistency of care provided to troubled young people and it is my view that this has a significant influence on the frequency of breakdown in the placements of young people. All too often social workers’ caseloads are so high that it is inevitable that they fall behind in their work. Important meetings are delayed, vital information is not communicated, planning decisions are not properly worked through, and, in turn, all this means that there is insufficient time available for the social worker to build an effective relationship with the young person.


Poor Assessment

It should also concern us as that the service provided for a young person may not be the right one for that young person. In my view too many social workers and other caring professionals working with a young person lack information about the young person and so it becomes difficult to make a holistic assessment of their needs. Frequently I have found that local authorities withhold information about a young person because they fear the young person will no be accepted by the resource they are seeking for the young person. I have also observed that young people are placed not according to their needs but at a less expensive resource because there is insufficient funding to place the young people in more appropriate, and expensive resources. Placements made on the basis of what I described are clearly more likely to end in breakdown.
When this has occurred at the resource I work with we as staff are very soon aware of our shortcomings but since there is no prospect of the young person being placed where his or her needs would be more fully met, we have sought to find ways of looking after the young person as best as we possibly can.


Factors in my own workplace which may cause the breakdown of the placements of young people


Forming a relationship

When I turn to looking at the issue of placement breakdown in my own workplace I am increasingly convinced that it is the quality of relationship we the staff build with the young people which predicts the success or failure of our work.
Sometimes it can seem an impossible task to establish a relationship which is at the same time both professional and caring. In working professionally we are always seeking for improvement in the young person’s symptoms at the same time as working within professionally acceptable boundaries. In contrast to this, in the caring relationship there are boundaries but we as carers must carry within an acceptance of the young person and all that he or she brings to us – how they look, how they speak, how they act and how they feel. Added to this I would add that as both carers and professionals we have to consider and to analyse the imperfections which we, the caring professionals bring to the relationship. (See, Sharpe, 2005).
In our direct work with young people the first obstacle we have to face is young people’s resistance to making a relationship with us. We are often surprised by this and yet why should we be? Usually, the young people have not specifically asked for us to help them and more significantly their previous experience of relationships with adults who have had a responsibility to look after them has seldom filled them with a healthy sense of security.
This resistance to our care, which therapeutic theorists call transference (Ward 1998) is a process by which the young people unconsciously displaces feelings on to us which belong to a relationship with another significant adult figure from their past (usually a parent). This response can often be angry and aggressive. It is important that we do not interpret this as a response which is directed against us as individuals. If a relationship is to be established with a young person then we have to able to contain these responses until he or she begins to trust that we will not confirm their previous experience of adults who inappropriately retaliate to this behaviour and who inevitably reject the young person.

Often too we can find that some of the experiences the young people we look after stir up memories of painful periods in our own past which in turn can make us feel as hopeless and helpless as the young people. In such situations I have found it important to take time to reflect on why I am feeling what I am feeling in order to overcome my own anxieties and contain my own feelings so that I don’t fall apart in the face of a troubled young person. This has allowed me to stay with the feelings of the young people and contain them for him or her. It seems to me that it is this often quite extended period of containment that the young person and I can find common ground where a trusting relationship and working together can begin to take place. It is when professional carers do not feel able to contain a young person emotionally and when they feel that the young person is out of their control that the young person is at greatest risk of being rejected and moved on to another placement.
It should be needless to say that repeated rejection has a damaging emotional effect on anyone but it is dismaying that as professional carers we are frequently involved in the rejection of troubled youngster. Each rejection adds to a history which makes it harder for a young person to trust others and consequently makes it more difficult to form a positive, healthy relationship with an adult.


Staff changes

Any change in the staffing structure within a resource offering practical, social and emotional support to young people creates insecurity for both young people and staff alike. This is particularly so when a new regime changes routines and working methods. More significant than this is when a member of staff leaves at a time when both the worker and the young person may have begun to establish a trusting relationship. Even when such a situation is dealt with the utmost sensitivity, it is likely that it will arouse feelings of rejection and loss within the young person. In turn this may influence the way a young person feels to he extent that their behaviour changes for the worse. If this behaviour is not contained and recognised for what it is – an expression of rejection and loss – then there is a danger that other staff and the young person’s social worker may see the deterioration of behaviour as a reason for doubting the appropriateness of the placement. I am pointing out here that it is at times like this that young people are very vulnerable to over hasty rejecting tendencies in the adults who are looking after them.

There are other reasons why a young person in care may experience repeated placement breakdowns but my main thrust has been to I demonstrate the importance of relationships in a placement. If we choose to ignore this phenomenon – that a failure to engage in a real relationship with a young person will lead to a placement breakdown - then in my view we would not be doing our jobs satisfactorily. Forming relationships is an important factor in everyone’ psychological development. For the young people who we look after, forming a relationship is no longer as straightforward as it should be, and so we should be patient with them. In order to illuminate and summarise the views I have expressed, what follows is an account of work my colleagues and I did with a young man who came into our care.

Ian

Ian, a young person I worked with was 16 years old when he came into our care, had experienced two placement breakdowns before he came into our care. Since his birth Ian’s father had been absent from his life and his mother had not told Ian anything about his father. However when he was 13 years old Ian’s father returned to the family home but shortly after his return his father died. After I had got to know Ian he was able to tell me that he felt both feelings of confusion and loss at this time. His relationship with his mother broke down and his relationship with his father’s family was not good. His behaviour deteriorated and he became less and less welcome in the family home to the extent that he was placed in care when he was 15 years old. Ian took this rejection very badly not only did he miss being at home but he said the loss of seeing his little brother every day made him at times sad and at times angry. Before coming to us Ian had two different placements which broke down. One was with foster parents who found it difficult to cope with Ian’s anger and his unwillingness to join in the activities of the family. Ian was then placed in a children’s home but he failed to engage with the staff their and he was asked to leave because of his angry and aggressive behaviour towards the staff. Ian has since said that in neither of the placements did he feel he was given a chance and that every time he got into any sort of trouble he was told that if he didn’t improve his behaviour he would have to leave. It seemed to me that Ian felt (whether his judgment was factually right or not) that his placements were under threat as soon as he arrived at them. This threat to his need for emotional security combined with his feelings of loss, separation and rejection from his family home, in my view makes it becomes understandable that he might have feelings of frustration and anger. This should have been better understood by his carers.
When Ian was placed with us, a project whose function is to prepare young people of over 16 years of age for leaving care, he was moved into his own flat and I was appointed as his keyworker. To begin with he was very suspicious of me and the other staff, and was reluctant at first to accept our caring intentions but he seemed to settle down and the only serious problem we encountered was Ian’s poor relationship with his social worker. The latter’s unwillingness to meet with Ian on his own without a member of staff being present was not really conducive to developing a relationship. Ian’s reluctance to engage with his social worker appeared to stem from his anger with the local authority for taking him into care in the first place. After some weeks I began to feel, like the carers in his previous placements, that Ian did not engage with me and that I did not have a real relationship with him. I did not mention this but allowed things to remain as they were, yet making sure that I met with him regularly. At this time Ian became ill and was found to be suffering from a serious kidney complaint which required Ian to be in hospital for a number of weeks. Ian was alarmed at this prospect and was unsure why he had been placed in hospital. I spent a great deal of time holding his anxieties and trying to re-assure him. Nevertheless, Ian was very frightened about going into hospital. Here was another change in his life, but a change of a frightening kind that he had not experienced before. At this time I still did not feel I had made an effective relationship with but during a supervision session with my manager she mentioned to me that Ian had told her that I was a good keyworker. This really encouraged me and though all was not plain sailing through either Ian’s period in the hospital, or after he was discharged, I thought that for the first time Ian was beginning to be more sure of himself and his worth. Getting used to taking medication every day frustrated him but he managed to accept our help in establishing a routine to look after himself. He managed to adapt to staff sleeping over in his flat while his condition remained delicate. Around this time too his relationship with his mother improved and he was now welcome to visit the family home again. Furthermore his relationship with his social worker improved.
I do not wish to give the impression that a miracle occurred for Ian. He did not return permanently to his family home but he had re-established his relationship with his mother and his brother and has since been able to cope with that situation as it stands. He still finds it difficult to make relationships but he has found that in trusting my colleagues and I through what was a difficult period for him he found he was able to survive.


One of the most important things that I learnt from my work with Ian was the need to reflect on what I was bringing to our relationship. Like previous carers I had felt that Ian was not engaging with me and I had not thought about how much I had engaged with and affected him and without the observation of my supervisor I may have been influenced to deny my relationship with him and created a situation in which he might have suffered further rejection and a further breakdown.




References

Sergeant, H. (2006) Handle with Care: an investigation into the care system. London London Centre for Young Policy Studies pp 34-53.

Sharpe, C. (2005) ‘Residential Child Care Can Do With All The Help It Can Get’ in http://human-nature.com/free-associations/sharpe.html ed. Young, R.M. Accessed 8.1.07.

Ward, A. (1998) ‘Help and the personal response’ in Intuition is not Enough eds. Ward, A., and McMahon, L. London Routledge pp 34-35

Meeting the dietary needs of young people in children's homes may not be as simple as it first appears.

By Patson Musumali

In this article Patson Musumali considers the issues of difference and diversity which impact on the life of children’s homes by considering how dietary needs are met. In expressing his personal view, Patson demonstrates how even this seemingly straightforward issue raised questions about the consistency of care provided in a children’s home. This may be a controversial piece of writing but it brings to light some of potentially unhelpful if unconscious tendencies that can arise in a staff group in its determination to provide the right kind of care for an individual young person.

Patson Musumali is Zambian. After qualifying as a primary school teacher in Zambia at the Malcolm Moffat Teachers College, he pursued a gift for music and later graduated from the Sir Evelyn Home College as a music teacher. In Zambia Patson taught children from some of the poorest backgrounds in the world. Later, as a senior official of the National Arts and Theatre Association he worked with children at the Murundu Orphanage. One of his most memorable times with the children, was producing Ravossa’s ‘Only love is spoken here’.
Since coming to the United Kingdom Patson has worked in children’s homes as a teacher, a residential worker and now as a Care Manager. Patson hopes soon to write about how he uses music in his work with looked after children. He feels that music can be used as a language at those times when unhappy children find it impossible to say in words what they feel.

Meeting the dietary needs of young people in children’s homes may not be as simple as it at first appears.

By Patson Musumali.


All societies change and it seems to me in this age of increasing electronic communication that societies are probably changing more quickly than they’ve ever done. The relative homogeneity in ethnicity, culture and religion which existed in the United Kingdom 50 years ago is no longer evident. As a consequence of immigration in the intervening years, many more ethnic, cultural and religious groups co-exist here. Immigration of course is currently a very sensitive social and political issue. Few would argue that immigration to the United Kingdom has brought with it the development of isolated ethnic, cultural and religious groupings as well as some social interaction such as the marriages of people from these different groupings. Just as these phenomena are reflected in society so they are in the lives of those young people who are looked after in the care system. In my work in the London area as a manager in different children’s homes I have been surprised by the wide spectrum of backgrounds the young people I have looked after come from. In the life of a children’s home this diversity can bring with it advantages and disadvantages. In a positive sense it can bring tolerance that can lead to a healthy understanding and appreciation of different cultures. It can bring about an enriching fusion of cultural mores and attitudes. In a negative sense it can bring with it an intolerance that views culture as static and can lead to racism and sectarianism which sets groups and individuals against each other.

In this article, I want to explore how matters of difference and diversity impact on residential child care by looking at life in a children’s home in the London area where I worked. To give my argument focus I want to consider the issue of difference and diversity through the diet of the children. For the record I want to say that the cultural backgrounds of the staff in the children’s home quite closely mirrored those of the group of young people resident at the home.
First I’ll introduce you to the six young people between the ages of 13 and 16 years who lived in the children’s home. Three of them were girls and three of them were boys. Two of the girls, Khadija and Faran, were British from an Asian Muslim background, but did not practice their religion. Kelly, was from an Afro-Caribbean background, was of mixed heritage and in the current terminology was described as black British. (As an aside, I want to say that I would like to write at another time on the vexed issue of how we choose to nominate sets of people from different backgrounds since for me current descriptors raise more questions than answers). Although from a Christian background Kelly did not practice any religion. Two of the boys, Gerald and Frank, were white British and from a Christian background but did not practice any religion. The third boy, Mohammed, was from Middle-Eastern background. He was Muslim but he was not devout and practiced his religion solely by following a strict Muslim diet.

All the young people were consulted about the menu of the home and were able to choose their favourite dishes, but some had particular preferences when it came to eating meat. Khadija and Faran did not eat pork or any of its derivative meats but they did not mind eating any other meat which was available. Kelly ate pork and its derivatives and ate any other meat which was provided. Gerald and Frank
ate pork and pork products and said they didn’t mind eating halal meat if there was no alternative. Mohammed did not eat pork or pork products and ate only halal meat.
It is important to say here that the only child who was expected by his or her parents to follow their religion and its dietary requirements was Mohammed. Mohammed’s failure to meet these expectations had a great deal to do with Mohammed’s placement with us. At his statutory review meeting after his admission to the children’s home, Mohammed’s parents felt that Mohammed was not obedient to the values of their culture or Islam and said that they thought him an outcast and seemed to wish to disown him. They did not feel that his strict adherence to a Muslim diet was enough for them to accept him back into the family fold. For them his being in care was a humiliation for the family. It appeared to us, the children’s home staff, that the parents’ intransigence was one of the main causes of Mohammed remaining in care. I would like to make it clear that we understood this intransigence not to be related to Muslim tradition but more related to how Mohammed’s parents were as individuals.
When he first came to the home Mohammed was silent about his relationship with his parents but as he began to build a relationship with staff and in particular with his keyworker it emerged that Mohammed had been quite a well behaved boy at home and that his troubles had started when he began to meet up and play with Muslim boys who were not so strictly tied to their parents’ religion and he began to develop what his parents believed to be - what for want of a better term - unacceptable ‘westernised behaviours’ such as arriving home late or swearing.
You may wonder why I have dwelt on Mohammed’s relationship with his parents when I said I was going to write about diet. Well, it was evident that Mohammed remained emotionally attached to his family, however troubled that attachment might be, and we felt that his links with his family should be encouraged. One way of doing this appeared to be to ensure that Mohammed followed – as long as he wanted to - his strict Muslim diet. Staff determined that they would work hard to ensure that Mohammed would have all his traditional foods.
When food shopping for the children’s home had to be done, Mohammed’s needs were taken into consideration and pots and pans were labelled so that staff knew which utensils could be used for cooking pork and its derivatives and those which could not.
After a period of a few weeks, I started to sense that the wellspring of sympathy which we, the children’s home staff felt for Mohammed, when we considered his helplessness in the face of his parents’ rejection of him was taking us away from our work with the other young people. I began to wonder if in our focusing on the importance of making sure Mohammed had the right kind of food we were beginning - I am sure unconsciously - to be more concerned about his food than we were about the food of the other young people whose dietary demands were not so strict. When my colleagues and I reflected on this we acknowledged that there had been a few occasions when other young people had accepted eating halal meat when temporarily nothing else was available. Yet we agreed that had no halal meat been available in the home we would not have tolerated the situation because of our own need to fulfil our determined commitment to meeting Mohammed’s dietary needs. It occurred to us then that just as we were rightly proactive in ensuring that Mohammed had what he wanted to eat so we ought to have been as conscientious in meeting the individual dietary needs of each of the other young people.
I wondered also if our more dilatory approach to considering the dietary needs of each of the other young reflected a less sympathetic approach to responding to their emotional needs because these were less obvious than Mohammed’s.
In conclusion, we decided as a staff group that we would address our discovery by considering the dietary needs of the each of the young people in the same detail as we did Mohammed’s. Unfortunately matters beyond my control meant that I left the children’s home and I was not able to evaluate the consequences of our new policy. However my point has been to illustrate through the issue of dietary needs that responding sensitively and effectively to matters of diversity and difference in children’s homes is much more complex than adherence to overly simplistic politically correct measures. It highlights also the importance of ensuring that residential child care workers need training that is sufficiently informative and sophisticated to deal with the ever changing issues of ethnicity, culture and religion as they arise in the work of a children’s home.

Multiple changes and breakdowns in the lives of young people in care impact on our work to help them make healthy attachment relationships

By Nancy Mohindra

In the following essay Nancy Mohindra, an outreach worker supporting young people who are leaving care reflects on her own practice as she describes the unhappy childhood experiences of Angela, a young woman she is now helping. Nancy considers how the failure of Angela’s mother, her principal parenting figure, to offer her protection and consistent nurture together with Angela’s consequent history of broken attachment relationships with substitute parenting figures has made it difficult for Angela - and those working with her – to achieve the emotional and social growth necessary to make her future prospects more hopeful.
Nancy Mohindra has been living in the United Kingdom for three years. She graduated in psychology at Universidad Nacional de Colombia. In Colombia she worked as a Clinical Psychologist with adults and young people.
For the last six months Nancy has been working with young people who are preparing to leave care and she is a student on the Eagle House Graduate Diploma Course in Child Development and the Care of Children and Young People.




How multiple changes and breakdowns in the lives of children and young people in care impact on our work to help them make healthy attachment relationships.


By Nancy Mohindra


It should concern all of us involved with child care that we can become so inured to the poor life experiences of children in care that we seem to ignore the implications numerous breakdowns and changes in childhood have for the children we are charged with looking after. In this essay I reflect on this issue in relation to the children and young people who I help to look after. From this I begin to consider how children and young people from broken families might be better understood by foster parents, by residential institutions and by projects like the one I work for which offers support to young people who are leaving care. To do this analysis, I first consider the narrative of a young person preparing to leave care in relationship to a number of developmental theories but in particular attachment theory. I also consider how a young person’s disrupted life history impacts on the relationship between the young person and the caring adult. Finally I will draw some conclusions and make some suggestions for future practice. I have called the young woman Angela, which is not her name and have changed particular details of her life story to protect her privacy.


The story of a childhood

Angela is an 18 years old girl who lives a chaotic and unsafe lifestyle, which includes using illegal drugs and drinking alcohol to excess. When I first worked with Angela she had recently been engaged in prostitution and had frequently been the victim of violent sexual assaults. How had all this come to be?
Angela was born into a family which could not protect her. At the age of two Angela was sexually abused. Since that time although she has intermittently spent periods of time living with her family, Angela has been in the care of her local authority. During her time in care her placements with different foster parents and in different children’s homes have invariably broken down. The principal reason given for these breakdowns is Angela’s unmanageable behaviour. When these breakdowns occurred Angela did not return to her family because Angela’s mother and other family members felt they could not cope with her behaviour and because her social worker felt Angela was not safe in her family. Angela continues to be a very vulnerable young woman who places herself at great risk. Her peer group is delinquent. She misuses alcohol and other substances. Her lack of a consistent and emotionally stable family experience has meant that she has poor self-esteem and has inevitably adopted a negative attitude to what life may hold for her.
In the two years before she came to us Angela had been moved six times from different placements. The adults who have been charged with looking after Angela seem to have experienced her as a very difficult young woman and Angela believes that in some of the children’s homes she has lived in she has made a poor choice in making friends with other residents who have proved a negative influence on her. On the other hand Angela feels that in some of her placements she has fitted in very well but was made to move on to another place because her needs did not meet the criteria of the children’s homes and families with whom she was placed.
Angela has been supported by the leaving care project for which I work for the last nine months. Here Angela has been provided with her own accommodation and with our outreach support. She is working towards becoming able to live healthily and more independently in the wider community. There are however what can seem like overwhelming obstacles to achieving this goal. For instance she has recently had to move from one residence to another because she and her friends have been rowdily verbally abusing Angela’s neighbours. Angela’s and her friends’ anti-social behaviour are a consequence of excessive alcohol consumption.
Following these incidents it is possible to imagine why Angela has been rejected so many times. She can make those of us who offer her support fall in with her view that it will not be possible for her to have a stable life. Probably for Angela, being uprooted all the time has come to seem the normal way of life. What we can infer from all this is that her emotional being is fragile. It is as if an attachment to protective adult figures cannot be accomplished since in Angela’s mind the importance of her need for protection has been distorted.


The consequences of poor attachment; an unhappy past, an unthinkable present and a blurred future

It seems to me that the person who should have been Angela’s most important parenting figure has failed her. When her stepfather abused Angela, her mother did not protect her. It is my view that Angela’s mother, probably unconsciously, allowed her daughter to occupy her place in the relationship with her partner. Angela’s mother could not stop her partner’s abusive behaviour and possibly sacrificed her daughter in order to save her marriage. In this we can see a failure in the psychological structure of the family.

Ainsworth et al (1978) as cited by Fonagy (2003:12) explains that there are two types of attachment.

“Secure attachment implies representational systems where the attachment figure is seen as accessible and responsive when needed. Anxious attachment implies a representational system where the responsiveness of the caregiver is not assumed and the child adopts strategies for circumventing the perceived unresponsiveness of the attachment figure”.

We can see Angela swinging backwards and forwards between her family and her peer group. She is looking for love, protection, acceptance and belonging. Unconsciously, Angela may feel that her family have abandoned her, yet she still feels she needs them. Her family, especially her mother, do not know how to approach Angela. To Angela’s mother, Angela represents her largely denied failure as a mother and therefore the failure of her family system. Paradoxically it is Angela’s difficulty in recognizing the wound caused by her family which is the principal element that keeps Angela in her unhealthy style of living.

Angela has suffered a cruel wound to her self-esteem inflicted by her nearest and dearest. In addition to this, Angela’s feelings of belonging to a family have been betrayed. What has followed is that Angela has become lost and detached in a very unhealthy world, where the bad people – for instance her abusing stepfather - get away with wrongdoing. Therefore Angela’s self-esteem and trust in life are lost. She is not able to accept that there might be a better future or indeed that she deserves a better world in which she can live with confidence.


People who work with children and young people in care

Staff who work with vulnerable children and young people like Angela experience a great number of painful emotions. Sometimes, as a mechanism of defence, staff will minimise or ignore all the problems and difficult circumstances of the young people. As a result of this there are occasions when it is easier to pass the buck than to admit that we are not prepared to face the avalanche of feelings which the young people are throwing at us. Staff who are alert to where these feelings may come from can begin to identify psychological mechanisms which stand in the way of the process of engaging with vulnerable children and young people.
Once we recognise that our own defences work towards us rejecting troubled young people, we are then in a better position to understand the inner world of vulnerable young people. Thus, in understanding our own feelings, which on many occasions will be stirred up by a disturbed young person, we are beginning to get in touch with the feelings the young people are experiencing and we can become more able to hold them emotionally.

What happens between staff and vulnerable children and young people

In order to understand further the exchange of feelings between young people and staff Sharpe (2006) states:

“It is my experience that many of the young people who are placed in children’s homes cannot find the words, and so can’t always give meaning to their problems because they have recent and distant memories which are, for the time being, too painful to consider consciously”

If we accept this, then staff will be encountering a variety of feelings and emotions that the young people cannot name and in this frightening state young people will shout or scream instead of asking for help or they will withdraw instead of telling staff that they feel angry, sad, embarrassed or depressed.
At the same time, children and young people can distinctly recognise the feelings of insecurity coming from the staff. Menzies Lyth (1989) as cited by Sharpe (2001:33) points out this aspect when she says “insecure staff will make insecure children feel even more insecure, more anxious and inevitably, less predictable”.
As Barbara Dockar Drysdale, (1959) suggests “only if staff are aware of the dynamics of the inner world of each of the children” will they be able to provide them with a healthy resource which will help them to become reconciled with the world of the adults. (Sharpe, 2001:6)

In my work with Angela I have experienced those feelings of despair, powerlessness, insecurity, anger and many other feelings. My counter-transference when I have been with Angela has been about my fear and disapproval of the way she lives and relates to others. In disapproving I have sometimes forgotten that my role is to give her support and care. I have to remind myself that the reason why Angela has been placed in the care of the project for which I work is because her own sense of social reality has been distorted by her life experience in a way which does not help her. This does not make her psychotic (as my counter-transference sometimes makes me feel) but it has engendered in her anti-social and self-harming behaviour.

What sort of feelings might we find among staff working with a young person like Angela?

Human beings are highly complex and so are their coping mechanisms. As Jean Moore (1992) suggests the feelings of the people working with children and young people at risk are ambivalent. It is possible to come across feelings both of omnipotence and impotence. These feelings are two sides of the same coin. In the case of omnipotence, the worker wants to be sure that the young person in her care will be safe and away from any danger. Yet it is impossible to control all the variables of a young person’s life. Most important, it is not healthy to rule somebody else’s life to the point that we interfere with their choices, even though these choices can be wrong. On the other hand as carers we sometimes feel incapable of achieving any change in their lives. We are faced with feelings of impotence. On many occasions, staff are overwhelmed by the noxious circumstances of the young person’s family life, or feel powerless in the face of what they experience as a lack of support from their colleagues or other agencies.

The caring worker will discover herself struggling between feelings of anger or/and guilt. These feelings are in close relationship with the feelings I have described above. For example, if I feel as if I have done everything possible to alleviate Angela’s pain, why is she not responding? Here I stumble on my feelings of anger. The anger could be the result of my own feelings of impotence. In my mind I may have had an omnipotent fantasy of control over her life, seeing her as a passive object of my support. Unconsciously I may direct my anger at her failure to respond to my help when in fact I am in denial of my own failure. What I have forgotten here is that Angel responds with her own psychological resources to what life has to offer her and not mine. Even in that disordered way of thinking where to Angela her abusive friends seem better than none, I need to try to hold on to the idea that it is not my responsibility to cut off her choices but to help her reflect on them. In the same way, my own feelings of guilt come to the surface when I am faced with circumstances that are beyond everybody’s control or after realising that my intervention was not “good enough”, either because I was “tired” or too involved with Angela. For instance, I could be saying to myself “I should have been assertive and stopped the fight before it was too late”.

Finally there are two other feelings to explore and these are what Moore (1992) describes as depression and accusation. Moore offers a very good example of those feelings when she considers the worker who is involved with what she calls ‘a non-solution case’. Moore explains that at times difficulties arise when a frequently discussed and well known case within a particular agency ‘blows up’. All the staff know about the young person’s circumstances, but even though the keyworker and her colleagues have been trying to work towards positive changes in the young person’s life nobody, especially the keyworker has been able to achieve any positive outcome. Unhelpful feelings can be aroused within the keyworker when for instance a young woman like Angela behaves in a socially unacceptable way. I was deeply affected when Angela roused her neighbours into demanding that she vacate her accommodation and then when in response to this she absconded and went to someone else who while proffering immediate support was actually intent upon abusing her. Circumstances like these can cause the keyworker to become filled up with feelings of deep failure and perhaps imagined persecution. In consequence the keyworker facing this situation may tend to isolate herself from her colleagues and from the young person she is looking after. Alternatively, the worker’s reaction will be one of accusing or blaming. The worker blames a lack of resources, a lack of support from managers, lack of support from other agencies, government policies and so on. In my work with Angela I have run through at one time or another all the feelings I have described here. In these circumstances I have had to guard against the danger of our attachment breaking down.


Recommendations

In reflecting on what I have written I believe it is important to acknowledge the necessity of good supervision for staff who face a large number of demands both from the children and young people who are in their care and from other agencies who have an interest in them. Support given to staff will reduce the kind of emotional fatigue I described in the previous paragraph and will in my view increase their feelings of personal accomplishment.

In my work with Angela I have become increasingly aware of the need for staff who work with emotionally troubled young people to be provided with ongoing training in such areas as child development, group dynamics, the primary care of children and most importantly how carers and young people engage with each other.

In conclusion, I believe that when we face a child or young person who has been placed into care, we ought to be aware of his life narrative, the reasons for his admission into care, the number of times he has been placed in care settings, and the kind of care settings he has been placed in. In this way we can begin to get in touch with how the young person feels but also, if we have been properly trained, we will be in touch how a young person makes us feel and be in a position to engage in a caring relationship with him in which a compensatory kind of therapeutic attachment can take place.




References and background reading


Alexander, M. and Hegarty, J.R. Measuring Staff Burnout in a Community Home. The British Journal of Developmental Disabilities. Vol. 46, Part 1, January 2000, No. 90 [Internet] Available URL: http://www.bjdd.org/new/seitel.thm (Accessed 11th July, 2006)

Ainscough, C. and Toon, K. (1994) Breaking Free. Help for survivor of child sexual abuse. London: Sheldon Press.

Bridgeland, M. People and Places: Barbara Dockar-Drysdale. Planned Environment Therapy Trust Archive and Study Centre. [Internet] Available URL: http://www.pettarchiv.org.uk/survey-dockardrysdale1.htm (Accessed 23rd June, 2006)

Joseph Rowntree Foundation (2005) Barrier to Change in the Social Care of Children. Findings [Internet] Available URL: http://www.jrf.org.uk/knowledge/findings/socialcare/380.asp (Accessed 26th June, 2006)

McAlister Groves, B. Mental Health Services for Children Who Witness Domestic Violence The Future of Children: Domestic Violence and Children. Vol. 9, Winter 1999, No. 3, pp122-131

Moore, J. (1992) The ABC of Child Protection. Cambridge: Ashgate Publishing Limited.

The Open University (1994) The Foundations of Child Development. Milton Keynes: The Open University and Blackwell Publishers.

The Scottish Office. Protecting Children- A Shared Responsibility: Guidance on Inter-Agency Co-operation. [Internet] Available URL: http://www.scotland.gov.uk/libraty/documents-w3/pch-05.htm (Accessed 23rd June, 2006)

Sharpe, C. (2001) In Care, In Therapy? MA, Psychoanalytic Studies dissertation: University of Sheffield
Sharpe, C. (2006) Joining with young people in Play: The significance…, What makes a good children’s home? , Working in children’s homes : what do we mean by t...” [Internet] Available URL: http://goodenoughcaring.blogspot.com (Accessed 10th July, 2006).
Sharpe, C. (2006) Therapeutic Child Care. Psychodynamic aspects of…, Leading a Shift: Life in a Children’s Home…, The inner World of the Child in our Work with …, The Group as Therapy: Life in a Children’s Home…, Joining with Young People in Play… [Internet] Available URL: http://goodenoughcaring.blogspot.com (Accessed 10th July, 2006).
Sutton, C. and et al. (2006) Nipping Criminality in the Bud. The Psychologist. Vol. 19, August, No. 8, pp470-475
Utting, D. (1998) Most Authorities Neglect Duty to Recruit Independent Visitors for Children in Care. [Internet] Available: http://www.jrf.org.uk/pressroom/releases/200298.asp (Accessed 23rd June, 2006)

Children in care who experience multiple placement breakdown suffer the consequences for the rest of their lives.

By Lorea Boneke

Lorea Boneke's exploration of the consequences of a child's early poor attachment experiences suggests that there is a dearth of the kind of tenacious and consistent substitute parenting figures which looked after children and young people need. It is a moving plea to practitioners, senior managers and politicians to be alive to the way the child care system can, far from alleviating children's suffering, actually compound it.

Lorea Boneke has degrees in European languages as well as accountancy and finance but she did not take up accounting as a long term career because child poverty was always a big concern on her personal agenda. She decided she wanted to be more directly involved with vulnerable children and so she worked as a volunteer, teaching, counselling and mentoring vulnerable children and young people in England, Scotland and internationally. Later she became a senior residential child care worker in a children's home where she completed a graduate diploma in child development and the care of children and young people. Lorea is currently engaged upon a Master of Social Work course.




Children in care who experience multiple placement changes and breakdowns suffer the consequences for the rest of their lives: why we need to shake off the indifference placing authorities seem to have about these children

By Lorea Boneke

How do children and young people feel when they are separated from their parents and from familiar surroundings? What is it like to be a child in a foster family or in a children's home? Authorities seem to take for granted the multiple changes and breakdowns that young people experience. Society forgets the anxiety, loneliness, and despair of young children in hospitals, foster homes, and children's homes.
This paper deals with separation and loss in childhood but it is also an effort to explain the work my colleagues and I do to help children and young people in a children's home to help them overcome the consequences of separation and loss and it also highlights why these problems should concern us.


What does change and breakdown mean for us, and more importantly what does it mean for the young people going through breakdowns?
Looking at things historically, I have tended to take a very simplistic personal view that until perhaps the beginning of the 20th century how children develop has not been a major concern of society. It has seemed to me that until Freud (1905 ) came along with his then controversial theories of childhood, children were viewed as miniature adults who were potentially or fundamentally sinful and needed strong discipline. Parents raised their children according to traditional beliefs, which the children were expected to accept without question.
Turning to the present day it appears that despite all the complexities of the modern age for some inexplicable reason, most people seem to think that children that children will left to their own devices will naturally always be happy during their childhood, The fact that they might become emotional distressed if not given what the care they really need from their parents is something that is too often dismissed out of hand. Perhaps this denial is because some adults find the thought of children suffering physical and emotional pain too much to bear.
Nevertheless nowadays we do have some realisation that social relationships are so influential that not only do they largely influence who we become, but they are indicators of our achievements in the future and can even influence our level of emotional wellbeing throughout life (Fonagy,2003 ). As Charles Sharpe (2006) states,
' the process of socialization is continuous from birth but it is now generally agreed that an attachment bond to a parenting figure marks the child’s first step towards socialization'.

The way the parents and caregivers bring up a young person will affect all aspects of their lives, present and future. It is important to emphasize the significance of attachment in childhood. The attachment that is formed in childhood does carries over into adulthood and will have continuing generational influence. Our potential to attach is handed on to our children (Fonagy, 2001).
When an attachment bond breaks down, the effect upon children can be devastating. Often they don’t understand why they may feel angry, sad or helpless, or they may be scared about what is going to happen in the future. They may experience total confusion or feel lost.
It is important that children who have lost or been separated from significant attachment figures are given an opportunity to relay their fears and anxieties to someone who listens to them, who will understand how they are feeling and who won't take sides or apportion blame. We should also be aware that children react to changes and breakdowns in different ways. There are all kinds of scenarios where children become distressed.
I would like to explore further the things I have been talking about by considering the case of Natasha.


Natasha came into our care in the children's home where I work at the age of fifteen after being in care since the age of eight years old due to her mother’s neglect and emotional abuse. Natasha had previously had 3 different foster care placements and had been in two other children's homes. She was then placed into our children’s home. I'll call it Kestrel Lodge. Natasha found it hard to make relationships with staff. Any staff that she started to become close to she would, after a short while, be very abusive toward and she seemed to try to ruin the relationship.

Natasha’s relationship with the other young people at Kestrel Lodge was similar to that which she had with the staff.. As soon as Natasha had established a closeness to one particular male resident, she found an opportunity to become angry with him, acted out in an extremely violent way which led to the breakdown her placement, and of course destroyed her newborn attachment to another person


How could I understand Natasha's behaviour ? Unfortunately family breakdowns happen so often in our society that we tend to take them for granted. The circumstances that children may find themselves in - being suddenly moved from their home without explanation - are devastating. Being displaced from the family to a new place like a foster family or a children's home puts a child through huge emotional distress. As well as many other uncomfortable things, this strange new world involves the challenge of the risky business of placing trust in another set of adults who seem to have the power to reject. There is also a need to make new friends and all the consequences that this may bring. The changes whichh these children have to face are just a few of the things that society and the placing authorities take for granted. There seems to be a denial of the importance of a child's need for a consistent and healthy attachment to a caring adult.

Winnicott (1960) stresses how important the mothering figure's emotional holding is in the development of the child. He explains that when the child is in the early stages of development he is connected to the mother so that; in the infant's world, he feels as if he and the mother are one. Later as separation begins to happen and when the child is experiencing new anxieties it is mothering figure who will take these emotions and give them back to the child in a more manageable form. This is what happens when the mother says, “It’s ok, don’t worry, nothing’s going to happen.” and the child begins to learn to cope with new situations because his mother has given him the capacity to trust his world. If the child loses, or is separated from the mother or a primary carer then this unconscious ability to handle his emotions is also lost.. This means that the child is left with feelings that he can no longer control. For the child In care who is moved on from one carer to another feelings of trust beome much more difficult to develop until eventually the child can no longer believe again that “It’s ok, nothing is going to happen.”

Each new carer will experience a greater intensity of feelings - anxiety, fear and anger - from such a child. All this is a consequence of the frequent separations the child has experienced. The child no longer trusts his world. This lack of trust is often accompanied by emotional distress which is symptomised by extremely disruptive behaviour. These emotions and behaviours can become too difficult for some carers to cope with or contain and in turn can lead to the breaking down of each new attachment relationship and, in for instance as in Natasha's case will lead to another broken relationship and another enforced change of placement.. As Natasha has been moved on to yet another placement, and her feelings of loss and worthlessness have become more intense, more aggressive and less manageable and so each successive placement becomes less likely to succeed in helping her.

Charles Sharpe (2000) when he discusses separation and loss states, “The experiencing of such circumstances can mean that children become progressively numbed by each additional loss and so they become increasingly resistant to further adult efforts to attach to them. This resistance may be a conscious or an unconscious attempt to protect the self from feeling further psychic pain, based on a denial defence that loss cannot be experienced if you refuse to take ownership of any relationship which is offered”

This happened to Natasha and eventually meant that she was placed in our children’s home. Her experience of relationships by this time was so negative that she tried to break them down before they could be properly built. Natasha did not seem to able to bear yet again putting all her feelings into somebody who she thought was going to let her down just as everyone else had. This phenomenon was evident in all relationships that she made with staff and other residents.


“Scientific evidence shows that the brain doesn’t develop normally if there isn’t good enough parenting and attachment” Sharpe (2006)

It is also noteworthy that all the experiences that a child has during his development will form personality traits that he will carry on throughout his life. Fonagy (2003) found that that adults who have had poor attachment experiences In childhood become poor attachment figures as parents, and though Sharpe (2002 ) points out 'the experience of loss is part of the average child’s experience and therefore part of a healthy development'. For too many of the children I look after their frequent experiences of rejection, broken attachment, separation and loss have gone far too far beyond the experience of the average child.
Another reason why the experiences of children like Natasha should worry us is because each breakdown has consequences. Nowadays, one of the main consequences for looked after children is that these breakdowns are so traumatic that they begin to run away mentally and literally. In running away from life these children become extremely vulnerable. Some young people have run away not only because of their own experience of care but also when another young person's placement - usually a young person who has become a close friend or even sometimes a sibling - breaks down in a way which results in their sudden removal from the placement.
All this brings us to the importance of placement stability and continuity for children in care. It is essential for their personal development and achievement. “Children’s emotions and thoughts need to be considered more and they need to be part of their care”(Denise Platt, )


Concluding, my aim has been to share and discuss the importance of attachment in human life, especially in childhood and the distressing emotional responses, which arise when ties are ruptured.
I have witnessed myself the suffering of children separated from loved ones and other important figures for long periods of time and I have come to my own rather obvious conclusion. An intimate, positive relationship between child and carer is essential to the child’s person’s future stability and in a way I imagine it is important for the carer’s future stability.. The parent’s or carer’s consistent presence is as important to the child’s need is as great as her need for food. In a way they are the same thing.
It is borne out by research that securely attached people have good self-esteem, they feel socially competent, they have positive social expectations and therefore only get into groups that meet these expectations. In their teens young people who have had good attachment experiences will be more likely to stay away from drug abusers and build better relationships with people who are positive and good for them

I think it is important that there is a safe place that children can come where they have no one else to please and where there worries and conflicts can be contained - . a place where they can feel safe to say what they feel and be able to say that ‘this is my home’.

It is understandable that the child who experiences multiple changes of parenting figures expresses the unhappiness that their compounded feelings of loss and separation bring in either frozen, empty emotionlessness or in anger and resentment In either case, the damage is likely to be permanent and they will have become very vulnerable young people..
It can seem that local authorities who place children and young people don’t seem to worry so much about how the separation and loss affects young people. We should not be indifferent and not miss the signs of children becoming anxious and unhappy. Coming into care should mean a hopeful new start for as Bowlby (1969) said, 'How we start, we tend to go on'.




REFERENCES
Bowlby, J. (1969) Attachment and Loss Vol.1. London : Tavistock 1982
Fonagy P. (2001) Attachment Theory and Psychoanalysis.. New York.: Other Press
Freud, S. (1905) 'Infantile Sexuality' in vol 7. London : Penguin Freud Library 1977. pp.88-126
Platt, D (2006). Cited in CSCI website at: www.csci.org.uk
Sharpe, C. (2006) 'The Inner world of the Child' Course notes for the Eagle House Graduate Diploma of Child Development and the Care of Children and Young.
Sharpe, C. (2000) 'Attachment Theory, Separation and Loss : how Children Develop Attachments to Other People'. Course notes for the Eagle House Graduate Diploma of Child Development and the Care of Children and Young.
Winnicott, D.W., (1960) 'The theory of the Parent - Infant Relationship' in Maturational Processes and the Facilitating Environment. London : Hogarth Press and the Institute of Psychoanalysis
Berridge,D. “Placement Stability” Quality projects research briefings. Available URL:http://www.rip.org.uk/

The impact of culture and difference on my practice as an outreach worker supporting young adults who are preparing to leave care.

By John Fallowfield

John Fallowfield graduated in criminology at the University of Southampton and gained his first experience of working with young people in a criminal justice setting. For the last six months he has been working with young people in care. John is currently a student on the Eagle House Graduate Diploma Course in Child Development and the Care of Children and Young People. John feels that what he has learnt so far in his work with chidren and young people is that it is essential to listen, understand and to be with them as they search for their own solutions. In this essay he explores this theme through a consideration of the impact culture and difference has on his work.

The impact of culture and difference on my practice as an outreach worker supporting young adults who are preparing to leave the care system.

By John Fallowfield


When working with troubled children and young people it is very important that practitioners are aware of issues of culture and difference and how they impact on a young person, on the professional worker’s practice, and on the relationship that is formed between the two. In this paper I discuss how these issues have influenced my professional practice by considering two case studies and reflecting on how they might have been handled better.

Firstly I want to consider the concepts of culture and difference themselves. Culture is commonly defined as a way of life of a group of people (Kidd, 2001). When we examine what a culture consists of, we often think of the behaviour, dress, language, religion, rituals and beliefs of an individual or group of people (Jary, 1991). These characteristics group individuals together to create a culture, but since human nature is complex and dynamic there is a tendency to compare one person or one group to another, resulting in experiences of difference. In my practical experience working in child care I have observed differences of race, ethnicity, age, gender, sexual orientation, education, learning ability, parenting, upbringing and cultural practices such as language and religion. Due to the individual nature of people, difference will always be a part of the human condition.

Working in child care in or around a large multi-cultural metropolis such as London, the young people we work with reflect the diversity of the population. London has been reported as having 300 languages spoken and 50 non-indigenous communities with a population of more than 10,000 people (Guardian Unlimited, 21 January 2005). In the 2001 census, it was shown that 40% of London's population classified themselves as non-British, with 29% classified as non-white (Office for National Statistics). Therefore modern life in London is dynamic and groups of people or cultures increasingly live side by side to form what I would term a 'global culture'. In my experience the young people I work with come from a range of cultures yet they all have one thing in common: they are in care.
The young people in care are different from many of their school friends or peers because they are 'looked after' by the care system. Many of these young people have experienced bereavement, neglect, rejection, abuse and a lack of care. Winnicott (1960) who created the concept of 'good enough parenting’ highlighted how some young people are not cared for or loved and the effect it has on their development throughout life. This absence of care sets them apart from what many of us think of as the norm and I feel that recognition of this as a cultural difference has had an important impact on my practice.
For many of us, the time, care, love and attention our parents offer us is taken for granted. Compare this to the experience of many looked after children and their ‘seeming inability to tolerate the experience of being cared for in families in the community’ and 'a history of neglect, abuse or disruption in the biological family' (Kasinski, 2003).

In order to establish difference you must have something to compare it to. For the purposes of this paper it is relevant to examine how my own culture, upbringing and life experiences differ from the young people I have worked with and the impact on my practice.

When I began working with young people in care, I felt I had an appreciative, realistic and respectful view of other people. I had travelled the world and had been taught not to judge other people but to learn something of other cultures and respect difference. As I met the young people I worked with, I was aware of the impact that negative stereotypes may have on my judgement and the effect it would have on the developing relationship. However, in practice I found that difference can be frightening and although many of us do not like to admit it, it can be daunting when we meet a new person who has had such a different life experience to our own.

At a very early stage, my professional practice was impacted by negative stereotypes, and I dealt with this by consciously trying to be open to the experiences of others and having a positive expectation of the relationship. For me this was a preferable alternative to succumbing to the stereotypes and feeling anxious about how I would cope. At this time I did not fully appeciate the prejudicial stereotypes held in my unconscious were informing my intuition. This is a concept that was identifed by Sharpe (2006). Since I have become more aware of the influence of the subconscious, it has enabled me to reflect on my practice and adapt my behaviour accordingly.

For example, when I began keyworking Richard, a 17 year old young man, I found myself continually challenging his criminal behaviour as a means of earning money. This may sound like a perfectly reasonable judgement on Richard's way of life and as his keyworker I saw myself as tasked with providing an adult pro-social role model which would offer Richard an alternative perspective. Richard responded to my views with a challenge of his own, saying "why should I work all week for money that I can earn in one night?" or simply laughing and dismissing my opinion. On reflection I began to associate Richard with the yobs, thugs and uncontrollable youth so widely publicised in today’s media. Additionally, I thought how I would feel if a member of my family was the victim of such a crime. I also began to compare my own experiences of delinquency with those of Richard. In my mind I felt that my own behaviour was no more than 'boys being boys' and I judged that Richard had overstepped the boundaries of what is socially acceptable.

As a result, instead of getting to know Richard at a deeper level and understanding his actions through his past, I had a tendency to label him as someone who had no respect for others. My unconscious prejudicial stereotypes of young people 'like Richard' were manifesting themselves. As these thoughts entered the conscious I began to examine my own feelings and talk about them with my colleagues. I was able to identify my lack of understanding of Richard's past and analyse how my negative stereotype was preventing our relationship from developing. I focused my attention on how he must be feeling, having someone he has only known for a short time telling him that the way he behaves is wrong and unacceptable. When I met with Richard over the coming weeks I concentrated on getting to know him as an individual. I learned about his biological parents, foster parents, peers and his experiences in life. We began to form a relationship where Richard felt able to confide in me about his thoughts and feelings and he expressed that he felt he had no alternative to the way he was currently leading his life. Our relationship strengthened and I was able to help Richard understand the hurt he may cause to others through his criminal activity and identify his own self-worth. This example has allowed me to reflect and conclude that despite my best intentions to enter a relationship with a positive and open minded approach, when other people's attitude, culture or perspective differ to my own there is a tendency to split them off as 'one of them' and cast them aside.

Working with young people from a range of cultural backgrounds I believe there is a natural tendency for care workers to identify with those young people who they feel are similar to themselves. From my own experiences this is because we feel safe with 'what we know' and are frightened of the unknown. However, we may be naive in assuming that similarities based on colour, race, cultural background or upbringing allow us to identify with another person. In making this assumption we are failing to appeciate the unique nature of human beings and their own experiences and emotions. It is my intention to explore in this next example how issues of over-identification with a young person’s cultural background can impact negatively on the practice of a care worker.

In the relatively short time I have worked as a care worker, I have unconsciously differentiated between those young people I perceive I am able to identify with and those I am not. One particular young man, Graham, who is 15 years old, I perceived to have a similar cultural background to myself and I felt I was able to indentify well with his circumstances. Over time, we formed a good relationship and Graham seemed to appreciate the practical support I was able to provide as well as valuing the emotional support I could offer.

As an inexperienced care worker, I was happy with the success of the relationship that we had been able to form. However this changed when Graham experienced further rejection from his biological parents and began absconding and becoming very despondent. I offered emotional support to Graham and ensured he knew that I was available to listen if he felt he wanted to share his problems. However, he did not respond and I began to feel increasingly hopeless and despairing myself. Initially I struggled to understand why he would not allow me to help him through this troubled time and I began to feel rejected myself. I recognised that Graham's feelings were being transferred to me in what Freud termed 'the transference' (Freud cited in Bower, 1995). This afforded me some insight into Graham's emotions and put into perspective our relationship. Although we had formed a healthy relationship, it was still at a relatively early stage and I had naively over-identified with Graham in my own mind. I felt that I could empathise with him, but on reflection I was not able to understand the impact that his parents’ rejection had on his emotions. I had failed to recognise that my pre-conceived ideas and experiences had placed a false significance on our relationship. Just because there were a number of similarities, I had not given enough consideration to the differences. Graham and I continue to build our relationship and on more and more occasions he feels able to accept my support.

Both of the above examples illustrate how issues of culture and difference can impact on practice. In the first example, Richard’s attitudes and beliefs were in conflict with my own and my own pre-conceived stereotypes subconsciously influenced my approach. In the second example, it was illustrated how issues of culture and difference are often subtle concepts unique to every individual. When we think of different cultures we often think of race, ethnicity or religion but I hope I have illustrated how they can be less obvious but equally important. The very fact that these young people are in care demands a perceptive and thorough understanding of the unique nature of their lives.

I feel that it is incumbent upon care workers to identify and where neccessary rectify their practice in responding to cultural differences. This requires recognition and a better understanding of a child’s life in care and an ability to reflect on these different circumstances. This allows those that work with vulnerable children and young people to build a relationship that is appropriate to the needs of each individual .





References

Books
Bower, M and Trowell, J. (1995) The Emotional Needs of Young People and Their Families: Using Psychoanalytic Ideas in the Community. London and New York, Routledge.
Jary, D. and Jary, J. (1991) The HarperCollins Dictionary of Sociology
Kidd, W. (2001) Culture and Identity. Palgrave Macmillan
Ward A, Kasinski K, Pooley J, Worthington A (2003). Therapeutic Communities for Children and Young People. London and New York, Jessica Kingsley Publishers.

Journals
Sharpe, C. (2006) Working with Difference and Diversity. Graduate Diploma Notes

Internet
“Census 2001: London”. Office for National Statistics.
Available URL: http://www.statistics.gov.uk/census2001/profiles/H-A.asp (Accessed on 24 July 2006).

“Every race, colour, nation and religion on earth”. Guardian Unlimited, 21 January 2005. Available URL: http://www.guardian.co.uk/britain/article/0,2763,1395534,00.html (Accessed on 24 July 2006).

The concept of the therapeutic holding environment and how it has been implemented in the residential home for young people in which I work.

By Ariola Vishjna


One of the major concerns expressed about children and young people who are placed in foster care or in children’s homes is the frequency with which their placements breakdown as a consequence of their behaviour. Indeed in a recent radio broadcast Beverley Hughes, the Minister for Children claimed that the care system failed young people because it was not providing the resolute care which is given by a good enough parent. At the risk of put words into the minister's mouth, I believe and hope her intention was to suggest that the good enough parent offers a kind of tenacious care which physically and emotionally holds a youngster through the vicissitudes of childhood and into adulthood. In the essay which follows, Ariola Vishjna considers the approach residential staff take to provide an emotionally holding environment for troubled youngsters in the residential home in which she works. These young people are preparing to leave care but remain apprehensive about what the future holds for them.

In the interest of confidentiality the names and specifically identifiable details have been changed.
Ariola Vishjna who now works in England, is Albanian. She has a BA in Teaching English as a Second Language, an MA in sociology and she is currently a student on the Eagle House Graduate Diploma Course in Child Development and the Care of Children and Young People.
Ariola has been working with vulnerable young people for the last 3 years and works as a Senior Residential Support Worker in a home for young people aged 16 or over.




The concept of the therapeutic holding environment and how it has been implemented in the residential home for young people in which I work : how effective is it and how could it be improved.

By Ariola Vishjna

Our work as residential child care workers consists of looking after young people who have had difficult lives, have experienced some form of rejection, abandonment and abuse in their past, and are deeply troubled by these experiences. Therefore, the focus of our work with these troubled young people is helping them to make sense of their emotional problems and their past experiences and to enable eventually cope with their difficult feelings when they leave us. This is a major task that requires both an awareness of the child development processes, and skills which will enable us as workers to build a relationship of trust with the young people in order that they feel safe to open up about their feelings and past experiences. In the psychodynamic approach this is described as therapeutic work, which is a healing process, during which the residential care worker helps the young people heal their emotional wounds through forming a relationship of trust with them (Sharpe, 2006). An important concept in our therapeutic work is that of a “holding environment”, which according to Winnicott (1990), starts from the time the baby is held in the womb by the mother, continues with the holding and caring when the baby is born, and is extended from the holding of the mother, to that of the family and later on to whoever takes on the parenting role. This holding environment combines the physical and the psychological holding of the baby from the mother and later on any parenting figure. In an environment that holds the baby well enough, the baby is able to make personal development which eventually results in autonomy (Winnicott, 1990). It is described as emotional holding and involves the containment of difficult feelings which prevent the capacity for relationships, emotional growth and learning. Emotional holding, also means demonstrating to the young people that painful feelings can be tolerated, helping them to manage these feelings and gain some understanding of their meaning (Greenhalgh, 1994). I would argue that this is the most important aspect of our work as residential care workers. In this essay I will look at the provision of a holding environment in the context of therapeutic work in the children’s home where I work, how well this is working and I will consider how can it be improved. I will be using a case study from my work, and in order to ensure confidentiality, names and other details of the young people and places have been changed.

In order to illustrate how is the therapeutic approach applies at my work place I will use the case study of Paul, who was 17 when he came to our home. His parents were not married and he lived with his mum until he was 5 when he was moved away from her because she attempted suicide as a result of mental health issues. Paul went on to live with his father who has always been harsh with him and considered him “mad” like his mother. As a result, he received little nurturing and was treated differently to his siblings. His father had three main relationships during the time Paul was with him, which seem to have been difficult for Paul to deal with. Paul started to smoke cannabis and began to stop attending school. He was referred to the social services by his father who said that Paul was showing uncontrollable behaviour at home. Paul’s admission to care occurred two years prior to being admitted to our home. During this two year period he has been placed with foster parents, two children’s homes, and one semi independent project. All these placements broke down because of Paul’s behaviour. During this time there were not only concerns regarding his behaviour, but also his mental health and he was assessed under Mental Health Act and was considered not to be sectionable. However, he was put on medication because of these ‘mental health’ issues. From this brief family history it can be seen that Paul experienced a very unstable childhood and adolescence with little nurturing from either of his parents. When Paul was first placed with us, he was very withdrawn most of the time yet he became aggressive when he interacted with staff. Paul did not want to stay with us and showed a lack of care for himself which was manifested by disinterestedness in his appearance or health. He ceased to talk to anyone and stopped responding if he was addressed and would not look people in the eye if they were speaking to him. He showed no emotions at all, I found it very difficult as his key worker to engage with him.


To be able to talk about the effectiveness of the holding environment and therapeutic work in the case of Paul we first need to use some criteria. One of the aspects that one should consider when talking about effective therapeutic work is the environment it provides. When we talk about the environment we need to consider its physical, social and psychological aspects (Sharpe, 2006). As far as the physical aspect is concerned, it has to do with the location of the home, the way it is furnished, decorated and maintained. We have often had visits from social workers who have told us that they had a very homely feeling when they came into our home. The social aspect of the home has to do with how are things organised in the home, the roles of staff and young people, and the general atmosphere in the home. In my work place we have tried to organise things in a way as to make it more of a home and less of an institution. Staff respect the young people and each other and this is reflected in the calm feeling the home has, which is also remarked upon by visitors to the home. When considering the psychological impact of the home I am thinking about how the the young people feel in the home, and whether they consider it their home. One way of judging this is looking at young people's rooms. If you have a quick look at their rooms it can be clearly seen that they have personalised their rooms and put their touch in it, which means they feel comfortable and consider it their place. However, there are things that could be improved. For example, it is my view that the young should in be involved more in painting and decorating their rooms. We also have a very big garden in which I think encouraging their input would be therapeutically profitable. Another way in which our holding environment might be improved is helping the young people to become more involved in the running of the home. We have found it difficult so far to make the young people contribute to cleaning and maintaining the house and especially the communal areas. We need to find ways to achieve this for it is my view that the more the young people put into the home in these ways, the more they will feel it is not ‘the’ home, but ‘their’ home and they will begin to feel an integral part of a home where there is emotional integrity. On the other hand I also have to consider that my anxiety is part of the normal conflict that can occur between an adolescent young man and one of his parenting figures.

Another very important measure of the therapeutic work in a home is to the level of emotional holding it provides for troubled young people when they come to us. In the therapeutic setting this has been described as the primary care (Sharpe, 2000). I remember that in the beginning of my work with Paul, my keychild, I often felt frustrated, and not good enough as a worker because whatever I did, I did not get any response from him. He would not even say hello or thank you. As I gained a better understanding of what emotional holding meant in a residential home, through the continual support by my colleagues and in supervision, I came to know that therapeutic work is a long process that takes time and patient effort. I came to accept that the way Paul was behaving had to do with his experiences in the past. In the beginning I was not able to do keywork sessions with Paul as he would not communicate with anyone, unless he needed something. He was also testing the boundaries with different members of staff and this is where we worked well as a team. We communicated every issue to each other and tried to have a unified and consistent approach. So, at first my work with him concentrated in building a relationship with him, helping him to cook or preparing a hot drink for him, cleaning his room and other daily routine activities showing him that I was there for him. I also worked with him around issues of being aggressive, and demanding money by talking to him and showing him that there are better ways of getting what you want rather then being aggressive. The other team members supported me in this and showed him the same approach and nurture. I came to understand that his being withdrawn or aggressive were only defenses he was putting up in order to hide his feelings of rejection, fear, and anger. After a few months of a consistent work, we started to see the first signs of improvement. Paul was not aggressive any longer, he started to talk to staff and other young people, he was more interested in what was happening around him, started to look after himself more and seemed to have settled in the home. This is the time when I felt that we had been successful in holding him emotionally and containing his difficult feelings. I felt very happy to see the change in him and believe this change came about as a result of the nurture, understanding, and respect we gave to Paul. This is how the mother holds the crying baby, to use Winnicot's terms (Winnicot, 1990).

This is when I started to work more with him around getting him back into education and finding him a course that would interest him. At the same time our relationship had improved a lot, and Paul started to come and talk to me when he needed help and advice. I felt really good about the work I had done with him. I have learned that in therapeutic work it is very important to take your time and reflect on things and see how things will develop (Sharpe, 2000). Paul is very fond of music so he was happy when we helped him to get a place on a music producing course. He started to be more motivated and worked with me to prepare his CV, and started to look for jobs. Knowing how little nurture and encouragement he had received form his parents I always encouraged and congratulated him for every little step even things like waking up on time to go to college which might seem normal for other young people but which were an achievement for him. Reflecting on our work with him, there are still things to be improved. There are things about his past that he finds difficult to talk about regarding his parents, and I feel that as our relationship gets stronger I will be able to discuss them with him.

To conclude, when working in therapeutic child care for troubled young people it is very important to provide emotional holding and containment for the difficult feelings the young people bring from their past. In the home where I work we try to make the young people feel taken care of, understood, loved and held in such a way that they can grow as individuals and develop their potential. In our home we try to provide a sense of security and safety for the young people so that they trust us and feel they can count on us. We see the result of our work in the development and progress of young people like Paul, and in our (that is the staff’s) increasing openness to learning from the young people. In caring for our young people there is always room for improvement !


References

Greenhalgh, P., (1994) 'Emotional holding’ in Emotional Growth and Learning, Routledge, New York pp. 107- 137
Sharpe, C., (2000) What do we mean by therapeutic child care? Unpublished Paper for Graduate Diploma in Child Development and the Care of Children and Young People.
Sharpe, C., (2001) The inner world of a child Unpublished Paper for Graduate Diploma in Child Development and the Care of Children and Young People.
Sharpe, C., (2006) What makes a good children's home available on line at http://goodenoughcaring.blogspot.com/2006_07_01_goodenoughcaring_archive.html. (Accessed on August 14, 2006).
Sharpe, C., (2006) Notes from The Graduate Diploma in Child Development and the Care of Children and Young People
Paul's Home's Statement of Purpose, November 2005
Winnicott, D.W., (1990) Home is where we start from, 2nd Edition. London: Penguin Books

When things aren't going the way we want them to, how should we respond ?

When things aren’t going the way we want them to, how should we respond ?
An interactive exercise

One of the problems for those who work in a helping role with children and young people is how to respond to them when things are not quite going to plan. Below are six different responses to the same situation - the kind of situation which I know many workers have will have faced. I wondered if anyone would like to comment on these responses using the comment button at the end of this particular entry or by e mailing me at cws.sharpe@dial.pipex.com. I will publish them on the blog.


I guess Dave will take his time. It’s no use pressuring him. When he’s ready he’ll ask me for a keywork session. Until then I’ll just let him be


On 4 occasions Dave has refused to speak to me and he has also refused to attend his keywork sessions. It is evident from this that David is in denial of his emotional difficulties and will require more sophisticated intervention.


Dave has not been coming to his keywork sessions and sometimes he won’t speak to me. I think I need to find out if his difficulty is with me or if it is something else.

When you think of how far my colleagues and I have gone to accommodate him and to understand his problems, his not attending his keywork sessions is a real slap in the face. Horses and water come to mind here.

It feels like it’s make or break time for Dave and I. We were all right during the honeymoon period but it’s the same old story we don’t have a chance against the influence of the peer group or that matter the computer game.

He has blatantly ignored me and he kicks off when I mention keywork sessions. He needs to appreciate my efforts to support him, but on balance I don’t see how he will be able to do that.


Charles Sharpe 2006.

Therapeutic Child Care : psychodynamic aspects of residential child care

Therapeutic child care : psychodynamic aspects of residential child care.


The idea that a group setting is a fertile arena for therapeutic work has many advocates. One of its most insistent proponents, S.H. Foulkes suggested that group members can modify their extreme ways of coping by learning from and articulating their underlying feelings in the “network of relationships” . Foulkes suggests that the process which achieves this is a “working towards an ever more articulate form of communication” which “is identical to the therapeutic process itself” (Foulkes 1975 p11) This optimistic view of groups offers a positive starting ideal for a young person and of course a member of staff newly arrived at a children’s home.

The adverse criticism which residential child care has received in recent decades, and the emphasis which the social work profession has placed on “normalising” the experience of troubled children by identifying an over-riding need for them to remain in a family setting - whatever their individual predicament - either in their own natural family or in a substitute family, seemed to challenge the notion that residential group care could have any therapeutic value for emotionally troubled youngsters. Research has suggested that many of the children who were placed in residential care in the 1970s, should have remained in their own families or have been placed in substitute families. ( See for instance Milham et al 1986) The decline in the numbers of children placed in residential care brought about by social policies designed to support children in their own community, was influenced by what Haydn Davies Jones refers to, with some ambivalence, as the “rediscovery of the importance of family and community in the growth of the child” as a response to 'the Bowlby credo'. He also suggests that the subsequent numbers of children who have suffered multiple failures when placed in one substitute family after another indicates that the swing towards family placement has at times been indiscriminate. To counter this, he attempts to identify those children for whom group living may offer a helpful alternative nurturing environment. There are children he argues who, experiencing family breakdown in adolescence, are developmentally unable to take on a new family and find residential care with its opportunities for peer relationships, more congenial to their current needs. There are also those children who continually fail to respond to both family and substitute family care. They are the children who are the casualties of repeated family and foster family failure, and for whom the family has ceased to be the appropriate background for nurture. For Davies Jones these are children who are unable to respond to the intensity of relationships in families. In this latter group he includes those children, the victims of systematic physical, emotional and sexual abuse within a family setting, for whom family life has become too threatening, and indeed those children, who, notwithstanding the abuse they have experienced, retain emotional loyalties to the families from which they must nevertheless be protected. Davies Jones proposes that residential group care can provide these children with a nurturing experience which offers consistent primary caring, and what he calls the “exploiting” of the group living experience for positive therapeutic purposes. (Davies Jones 1981 p228)

David Challender places stress on the similarities of living in a family and living in a children’s home. Reflecting on his work with groups and dealing with their unconscious processes he observes that most children are brought up in a group setting, whether it be in the family, extended family, substitute family or in residential care. From the moment of birth most will experience close interaction with other human beings and will be progressively socialized by exposure to groups of other people, from family to friends and neighbours and then in playgroups and in schools. It is a lifelong process and adults rearing their own children will re-enact their own process of socialisation with the children entrusted to their care. (Challender 1999) Certainly psychoanalytic theory from Freud’s Oedipal propositions, through to Bowlby’s attachment theory emphasised the child’s primary need for attachment to another and socialisation. (Freud 1931; Bowlby 1976)

Young people in children’s homes are for the most part victims of a failure of this primary caring and socialisation process and life in a children’s home attempts to rekindle the process by providing a special primary carer, a role which will be considered in the next chapter, and by providing positive group experiences. (H. Davies Jones 1981)

Many kinds of group experiences take place in a children’s home. In some children’s homes therapeutic treatment groups, facilitated and led by specifically qualified therapists, are set up to achieve specific therapeutic goals, but in the ebb and flow of life in a children’s home there are always other groups forming, operating and breaking up. These are not specifically therapeutic groups, and though they can be formal as well as informal in nature, they are widely acknowledged as having therapeutic possibilities. (Aveline and Dryden 1988) These groupings represent the greater part of group life in a children’s home, and in a large measure define the context of all the group work in the vast majority of children’s homes. Since most of those who work in children’s home are not formally qualified to facilitate “group therapy” or indeed individual therapy, these non-specific therapeutic groups are a principal focus of this study. In addition to staff meetings, most children’s homes have regular formal meetings in which both children and staff participate. These have the function of organising living arrangements and responsibilities, reviewing recent events, sharing information and dealing with consequences of failed expectations and boundary breaking. In short, these meetings serve the purpose of achieving the institutional aims. There are also other formal meetings such as eating together at meal times, and, as in some children’s homes, attending class in the school room. There are groups formed in which only a small number of children and staff participate which may also involve others from outside the children’s home such as parents and social workers. Less formal sub- groups are continually assembling, dispersing and re-establishing for impromptu activity such as discussion or recreation.

It is this complex of groups which meets the child who enters a children’s home. Rose offers the reminder that the basic anxiety each child resident in a children’s home carries with him is triggered by the normal process that exists within any group. People leave, people arrive, and for all groups new problems are continuously being thrown up. (Rose 1990) However Dockar Drysdale suggests that children placed in children’s homes have not developed the repertoire of psychic responses that normal life experiences require. For them new arrivals are experienced as though they are actually displacing siblings, while familiar residents and staff leaving throw them back into their past traumas of loss and rejection. Consequently their reactions to these processes can be extreme. (Dockar Drysdale 1961) Nevertheless, as Rose points out, the milieu of a children’s homes is created in order to allow this to occur. (Rose 1990)

If one of the primary tasks of staff in a children’s home is to sustain the meaning and purpose of what seems such a potentially volatile group, can psychodynamic theory offer insight into how this might be achieved ? Freud, who did not differentiate between individual and group psychology, held that being a member of a group is a consequence of the group we are born into, or, have an attraction to, or an unconscious desire to be like the leader of the group. (Freud 1921) Fairbairn, in considering the development of social groups, suggests that such groups are sustained by libido and that the cohesion of a group is dependent on the extent to which libido is bound within the group, and the extent to which the group can exclude aggression from relationships within the group. For Fairbairn the roots of the social disintegration of a group lie in aggression. (Fairbairn 1935) Children resident in a children’s home are not living in their natural family setting and are rarely placed there because they are attracted by, or identify with the notion of living there. They are placed in a group care setting because their parenting figures have failed them, and consequently other adults have decided that they will stay there. These are pained, anxious, fearful, and at times, angry children. As Fairbairn suggests, these are elements which may not be conducive to a cohesive group and yet, as has been indicated, a primary function of a children’s home is to use the group setting to facilitate a child’s development from a state of emotionally painful anomie towards a position of identification with the home and the parenting it provides.

However, as Rose contends, while these overtly threatening elements can create a chaotic regressed infantile group, such a group is regarded as normal in a children’s home. Coping with this abnormal “normality” is the very essence of the therapeutic group task. Nevertheless, he suggests, even by those standards life becomes intolerably difficult, and that necessary solutions have to be developed, by clarifying so far unexpressed relationships, and attempting to begin to resolve the problems which arise from them. (Rose 1990)

Of course developing solutions in such an apparently chaotic environment is a problem for incoming staff, while a problem for established staff is to communicate a sense of purpose to new children as well as new staff. A great deal has been written about the efforts of those charged with developing a therapeutic group care setting to create an internal culture which facilitates personal growth and change among the members of such a group. (Balbirnie 1966; Bettelheim 1974) For the inexperienced residential child care worker, this helpfully speaks in practical language grounded in psychotherapeutic theory. Yet however well prepared a newcomer to residential group work with children may be at a conscious and rational level, the actual experience of the variance between the culture of the therapeutic group care setting and that of the wider community, is less easy to prepare for and to contain emotionally. Rose points out that a group of human beings rarely, and then only fleetingly, achieves perfection. The community of staff and residents in a children’s home is also subject to the rivalries which split families. He argues that the survival of a children’s home depends, just as the survival of a family would, on how it manages itself in the wider social context; how it responds to departures, separations, failures, betrayals, and human inadequacy. (Rose 1990)

It is not therefore surprising that for staff in children’s homes, the acting out behaviour which these issues engender in the resident group, seems to expend an inordinate amount of time and emotional energy. It can feel as if the children’s demands are endless and progress can seem non-existent. It may appear to be a child’s fervent wish to frustrate those who are most committed to his care, and to hurt those who persist in sustaining a caring relationship with him. In this state of conflict staff may experience what Shohet, in expanding upon the Kleinian concept, describes as “group projective identification” which may lead to “scapegoating”. In attempting to discard its frightening bad or unacceptable parts the staff group puts them into someone else. (Shohet 1999) Inevitably the question arises, “Can we sacrifice the needs of all the other children for the sake of one?” Clearly a negative response represents a failure of the holding environment.

If, as related literature suggests, the challenge for those striving to create and provide all that the children’s home should offer, is to create for children who have been emotionally deprived, a group living culture which they experience as emotionally dynamic and in which individual growth is encouraged to the extent that when on leaving the children’s home a young person is substantially able to cope with the vicissitudes of family or adult life, how will those entrusted to carry out the group care task be prepared and sustained in carrying it out?

As noted, Freud claimed that people are drawn into, and remain in groups because of emotional ties between members and that one of the principal processes effecting such an attraction is identification - the process by which a person seeks to be like his parents. Freud suggested that an individual introjects a preferred person or the qualities they like in that person, while at the same time projecting some of the bad or painful qualities of themselves on to others. Accordingly when each member of a group internalises the same qualities as the leader, they can identify with each other. (Freud 1921) Menzies Lyth, discussing the development of the self in children residing in institutions, suggests that it is through introjective identification that the development of the self takes place. In language which has a faint resonance of Social Learning Theory she contends that healthy development depends on the availability of appropriate models of individuals, relationships and situations for such identifications. While acknowledging that these models may be available to the children in the adults who care for them, importantly she stresses that the individual adult’s relationship with the children, together with the adults’ relationships with each other and the ambiance of the setting for care, are all also models for introjective identification. She recognizes too that a child’s healthy development may require the management of the child’s identification with inappropriate models, for example other children within the institution. She argues that children in the group living setting of an institution are likely to find the most significant models for identification within the institution as a whole, and in its sub-systems and in the individual children and staff. Like Bettelheim (1974), she sees this process as the basis of the concept of the institution as a therapeutic milieu whose primary task may be described as providing conditions for healthy development and providing therapy for emotionally damaged children. It follows then that all the child’s experiences in the institution contribute positively or negatively to the child’s development, not only through education, individual or group therapy or child care, but also by the more general features of the institution. Such an aggregate she argues, points to a need to take a wide view of an institution in assessing its effectiveness in carrying out its primary task. This assessment would include the whole way the institution functioned, its management structure, including its division into sub-systems and how these related to each other, the nature of authority and how that is operated, the social defence system built into the institution, and its culture and traditions. These then have to be considered in the context of how far they facilitate the provision of healthy models for identification, or alternatively inhibit the provision of such models. Although it is possible to regard the whole institution as the model, Menzies Lyth suggests that for the child the impact of the institution is in large measure mediated through its staff who are the individual models for identification. While individual staff have their own personalities with their differing strengths and weaknesses within the institution, she maintains that the extent to which individual staff are able to deploy their personalities, their different qualities, their strengths and weaknesses within the group care setting will depend on characteristics inherent in the institution. She maintains that due attention should therefore be given to the maximizing of the opportunities available for staff to deploy their capacities, and for it to be seen that children respond to them.
( Menzies Lyth 1985)

For Dockar Drysdale this symbiosis between the children and the staff can only be achieved by the staff having an awareness of the dynamics of the inner world of each of the children. (Dockar Drysdale 1959) A problem posed for the worker in a children’s home is how this awareness of the individual’s inner world can be separated out in a group setting.

Hinshelwood in his search to find out what happens in groups begins to explore this. He suggests that the group is “concerned with the transportation of stressful experiences between people”. This clause encapsulates life in a children’s home. He suggests that it represents a dynamic which can be understood as a “container” in the sense that projective identification, “the transportation of stressful experiences” towards another person is the phantasy that a part of one’s self has been removed to another who now contains it. Acknowledging this notion as Kleinian at source, but further elaborated by Winnicott and Bion he describes the construct as similar to the baby whose mental state is contained by the mother. (Hinshelwood 1987, p230)

Ganzarain elaborates upon this with a suggestion that the group can be experienced by its individual members as an entity representative of the mother and so in the group setting the individual may regress to an infantile interaction with the group, and since projective identification will be at work within the group this will also lead to the re-enactment of mother-infant interactions. Ganzarain suggests that as “internal objects are projected on to other individuals in the group in an attempt to force them into assuming desired roles, they are also projected on to the group entity”. (Ganzarain 1992 p205) As an embellishment of this concept it is also possible to view the group as a transitional object performing the holding function during the process of separation and individuation, in the sense that a transitional object is utilised to assist in passing from the state of being merged with the mother to being separate from the mother. (Winnicott 1988)

Bion developed a construct of the group performing a holding or containing function by describing the relationship between the container, (the group) and its contents, (the group members). He isolates three kinds of relationships. Firstly he describes a situation akin to an institution where there is a rigidly held social order, where the group as the container crushes its contents. Secondly he describes another akin to a revolutionary situation where an idea or a person destroys the established social order, and finally he describes a relationship in which the container and contents manage to accommodate each other so both are able to develop and grow. (Bion 1970) Hinshelwood suggests that while the first two relationships represent non-therapeutic containing, the third represents flexible therapeutic containing, in the same way as a mother, though pained by her child’s acute distress, holds the child’s feelings until her understanding is projected into the child so that he may grow as she does in the process. (Hinshelwood 1987)

Taking direction from Freud, Bion also proposed that the behaviour of an individual in a group is a critical indicator of the individual’s inner world. The inner world has dynamic processes, particularly fragmentation and integration. For Bion the defence mechanisms which individuals have, the denial of internal and external reality, splitting, projection and idealisation are evident in group situations. (Bion 1961) Robert M. Young appears to go further than this, by suggesting explanations of both group and social phenomena can be governed by the same principles which govern individual phenomena. (Young 1994)

It is possible to extrapolate from Bion’s work on groups certain principles which would inform the tension that exists for workers when they weigh up what is happening for the individual and what is happening for the group. Firstly Bion infers that the psychology of the individual is in essence group psychology. Each member’s behaviour influences the behaviour of others in the group. Secondly, if there is potential for a group to be released therapeutically, it is essential to recognise that the oscillating emotions of the group and its members have an impact on the apparently conscious expectations of each of its members. (Bion 1961) Young in describing his experience in groups communicates this process through what appears to have been painful personal experience. Remarking on the interaction and the amalgamation of the inner world of the individual and the inner world of the group, he infers that it is helpful for those who work in groups to be aware of the constant potential of a group to oscillate spontaneously from being a task oriented group to being a group “in the thrall of psychotic basic assumptions”. (Young 1994 p91) For all who work in children’s homes this resonates powerfully.

Bion observed how a group could swing from “work group mode” which, if sustained over a period of time offers the possibility of growth and development, to “group mentality” in which a connection is made to unacknowledged aspects – basic assumptions – of the individual group members. In this mode, time, growth, and task performance are lost. According to Bion each of the different basic assumptions which he specifies, throws up leaders who tend to be “elected” out of the operation of primitive group processes. (Bion 1961) Menzies Lyth saw these elections as arising as a consequence of a process of splitting off the unacknowledged facets of other individuals, and projecting them into the leader or an idea, agreement being reached rapidly and collusively as to which member or idea it should be. The individual who is “elected” is likely to find the natural characteristics which suited her for the role exaggerated by the involuntary acquisition of similar aspects by other members, until her own identity is almost obliterated. (Menzies Lyth 1989) This is a cautionary tale for workers caught up in a group and its processes, who find themselves engulfed in a situation where their role as both an externally appointed facilitator, and parental figure, with all the formal responsibilities these carry, may become confused by the role assigned them, or indeed to others, by the “group mentality”.
In a study which may to an extent be adumbrated by the behaviourist or cognitive quality of requiring an observable, and preferably positive result, Duffy and McCarthy, working with young women in a residential setting believe that the group processes described by Bion, if managed judiciously during the routine and ritual meetings of the group can encourage individual emotional growth. It is their view that development is possible in a situation where two conflicting messages, those of confrontation and support, are simultaneously experienced. When this occurs individuals become able to take more responsibility for their actions and sustain changes subsequent to the group. Though conceding that the group may be influenced by both adolescent energy and adolescent alertness, they argue if the staff group leader and the staff can contain the changing culture of the group by feeding it back immediately, so the group culture switches from “that of the streets, to the domestic, to the judicial court, much as in the same way as Bion describes his adult group switching from a theocracy to a playgroup” (Duffy & McCarthy 1998 p154 ; Bion 1961) For Duffy and McCarthy if these energies are held within the group by competent facilitation, then positive changes of atmosphere were evident in the overall life of the group. (Duffy & McCarthy 1998)

Just as there is a concern for residential child care workers - untrained and ill-informed as they often are about group dynamics, and forced all too frequently to fall back on what Ward describes as “intuition” that “is not enough” - carrying out the role of facilitator in both formal and informal group settings, in the same way there is also concern for the manager of the home carrying out her group leadership role. Ward notes the intense pressures for the manager to stay on task at the same time as staying in touch with the individual and collective anxieties within the home. (Ward 1998) Rose observes that though the pronounced reliance of children and staff on one charismatic leader has been viewed with concern in recent times, children and staff invest a great deal of significance in the person who is the head of the home. This is a phenomenon which is widely evidenced and of course would not have surprised Freud ! Rose however suggests that if the leader is too overtly significant then the staff may begin to feel less mature than before they came to the children’s home. Nonetheless, given that the leader can hold to the kind of position Duffy and McCarthy describe, for Rose it becomes important that the leader should not underestimate or retreat from the dynamic significance of her leadership role in the overall group, or the young people will cease to be held to the therapeutic task. At the same time he maintains the necessity for continual dialogue between the head and staff about the centrality of the leader’s role, for if this ceases, then individual members of staff begin to act out feelings in the ways that seem to imitate the young people, and where there is conflict between the staff and the leader, anxiety is fuelled among the children, excited by their early experience of parents in conflict. (Rose, M. 1990 p52-3) Menzies Lyth goes further and stresses that by entrusting responsibility to non-management staff, they are enabled to provide positive ego, superego and defensive models which are fundamentally important to emotionally disturbed children whose personality development is immature and damaged. The ego and superego strength of staff having been fostered by the delegation of management tasks allows them the opportunity to demonstrate it to the children effectively, who in turn, she argues, become more able to be involved in control over their own circumstances and are given less opportunity to consider themselves as helpless and victims of uncontrollable circumstances. Pertinently she suggests insecure staff will make insecure children feel even more insecure, more anxious, and inevitably, less predictable. In a regime which manages delegation of tasks efficiently, it is, she continues, possible to achieve consistency and to avoid presenting children with conflicting and confusing messages. (Menzies Lyth 1989)
.

In summary, if child care workers are able to acknowledge the therapeutic possibilities of the group - a group consisting of workers as well as children – and to recognize the complexity of the group’s dynamic, as indicated by the theoretical stances which have been explored, so it becomes possible for them to understand how the group’s behaviour mirrors the unexpressed feelings of its individual members. A worker’s recognition of this process might enable her to be closer in touch with each of the young people’s specific emotional needs and so help her become clearer about them.

A residential child care worker operates as a group worker in a special way. Her work cannot merely be seen as a timetabled task in a busy week, although some of it may take that form. It is much more a continuous involvement with a living group to which the worker and her colleagues belong, and which gives them opportunities to intervene for caring therapeutic purposes. Since workers are so much part of the children’s life they are experiencing the conflict which can envelop the group, and though at times life in a children’s home seems to be an endless round of quarrel and crisis, as a consideration of some psychoanalytic theory has shown, these conflicts often represent crucial issues in child development. Veiled in the projective petty bickering, shouting and acting out within the group, may be poignant questions concerning separation anxiety, identity, sexuality, social inability and other emotive issues. From this it can be seen that the worker’s task is to use these conflicts constructively, and in a paradoxical sense to welcome them because used skilfully they can be a means of helping children acquire fresh learning, better ways of coping and some self-awareness.

As has been seen there are dangers as well as opportunities in working with groups and it demands insight and skill from the worker. The dynamic of the group encompasses processes that can hurt and damage individuals within the group if they are not husbanded towards help and care.

© Charles Sharpe 2001
References
Foulkes , S.H. (1975) Group Analytic Psychotherapy : method and principles. London. Karnac Books. 1986. pp11-12

S.Milham, R.Bullock, K.Hosie and M.Haak. (1986) Lost in Care. Aldershot. Gower.
pp 129-142.

Davies Jones, H. (1981) “Residential Care - Some recent therapeutic perspectives” in Durham and Newcastle Research Review. Vol. IX No.46. Durham. 1981 pp228

Challender, D. 1999 “Working with unconscious dynamics in groups” in Loving, Hating and Survival. A. Hardwick and J. Woodhead. eds. Aldershot. Arena 1999 pp377- 393.

Freud, S. (1931) “Female Sexuality” in On Sexuality. Vol.7 Penguin Freud Library. 1977 London Penguin

Bowlby, J (1976). “The Making and Breaking of Affectional Bonds” in Making and
Breaking of Affectional Bonds. London Routledge 1995 pp126- 173

Davies Jones, H. (1981) “Residential Care - Some recent therapeutic perspectives” in Durham and Newcastle Research Review. Vol. IX No. 46 Durham. 1981 pp223- 232

Aveline and Dryden 1988, Group Therapy in Britain, Milton Keynes, Open University Press p2-4.

Rose, M. (1990) Healing Hurt Minds : The Peper Harrow Experience. London. Tavistock/Routledge. p 43

Dockar Drysdale, B. (1961)”The problem of making adaptation to the needs of the individual child in the group” in The Provision of Primary Experience. B.Dockar Drysdale. London. Free Association Books. 1990. pp168-169

Rose, M. (1990) Healing Hurt Minds : The Peper Harrow Experience. London. Tavistock/Routledge. p 43

Freud, S. (1921) “Group Psychology and the Analysis of the Ego” in Civilisation, Society and Religion. The Penguin Freud Library. Vol.12. Harmondsworth . Penguin 1991 pp 95-97.

Fairbairn, WRD (1935) “The sociological Significance of Communism Considered in the Light of Psychanalysis” in Psychoanalytic Studies of the Personality. W.R.D. Fairbairn . London. Routledge 1996. pp235-240

Rose, M (1990) Healing Hurt Minds : The Peper Harrow Experience. London. Tavistock/Routledge. p 43/44

Balbirnie, R. (1966) Residential Work with Children. London Human Context Books pp61-95

Bettelheim, B. 1974 A Home for the Heart. London. Thames and Hudson. pp62-90

Rose, M. (1990) Healing Hurt Minds : The Peper Harrow Experience. London. Tavistock/Routledge. p 53

Shohet, R.(1999) “Whose feelings am I feeling? Using the concept of projective identification” in Loving, Hating and Surviving. A.Hardwick and J.Woodhead eds. London . Arena. pp39-54.

Freud, S. (1921) “Group Psychology and the Analysis of the Ego” in Civilisation, Society and Religion. The Penguin Freud Library. Vol.12. Harmondsworth . Penguin 1991 pp 95-97.

Bettelheim, B. (1974) A Home for the Heart. London. Thames and Hudson. pp201-243

Menzies Lyth, I. (1985) “Development of the Self in Institutions” in Containing Anxieties in Institutions: selected essays. I. Menzies Lyth. London. Free Association Books 1988. (pp236-264)

Dockar Drysdale, B. (1959) ”Communication as a technique in treating disturbed children” in Therapy and Consultation in Child Care. London. Free Association Books 1993 pp30-31.

Hinshelwood, R.D. What Happens in Groups Free Association Books, London 1987 p230

Ganzarain, R. (1992) “Introduction to Object Relations Group Therapy” in Journal of Group Psychotherapy 42 (2). International 1992 pp 205- 223

Winnicott, D.W. (1988) Human Nature. London. Free Association Books. pp114-115

Bion , W.R. (1970) Attention and Interpretation. London. Tavistock. Cited in What Happens in Groups. R.D. Hinshelwood (1987) London. Free Association Books. p231.

Hinshelwood, R.D. (1987) What Happens in Groups London Free Association Booksp230

Bion , W.R. (1961) Experiences in Groups. London Routledge 2000. pp130-131 & p169.

Young, R. M. (1994) Mental Space. London. Process Press. pp89-91

Bion , W.R. (1961) Experiences in Groups. London Routledge 2000. pp130-131 & p169

Young, R.M. (1994) Mental Space. London. Process Press. p 91

Bion , W.R. (1961) Experiences in Groups. London Routledge 2000. pp 124-126.

Young, R. M. (1994) Mental Space. London. Process Press. P91

Bion. W.R.(1961) Experiences in Groups. London Routledge 2000. pp50-58

Menzies Lyth, I. (1989) The Dynamics of the Social. London. Free Association Books. Cited in “Working with unconscious dynamics in groups” D. C. Challender(1999) in Loving Hating and Surviving. A. Hardwick & J. Woodhead eds. 1999 Aldershot. Arena. p.383.

Duffy, B. and McCarthy, B.(1998) “From Group Meeting to Therapeutic Group” in Understanding Health and Social Care: An Introductory Reader. M.Allot and M.Robb.. eds. London. Sage/Open University. p154.


Bion , W.R. (1961) Experiences in Groups. London Routledge 2000. pp 119-126

Duffy, B. and McCarthy, B.(1998) “From Group Meeting to Therapeutic Group” in Understanding Health and Social Care: An Introductory Reader. M.Allot and M.Robb.. eds. London. Sage/Open University. pp145-154.

Ward, A. (1998) “The Difficulty of Helping” in Intuition is not Enough. A.Ward & L .McMahon, eds. London. Routledge. pp63

Rose, M. (1990) Healing Hurt Minds : The Peper Harrow Experience. London. Tavistock/Routledge. p 52-53


Menzies Lyth, I. (1989) The Dynamics of the Social. London. Free Association Books. Cited in “Working with unconscious dynamics in groups” D. C. Challender(1999) in Loving Hating and Surviving. A. Hardwick & J. Woodhead eds. 1999 Aldershot. Arena. p.383.

Leading a Shift : Life in a Children's Home

Leading a Shift: Life in a Children’s Home.

Children’s homes like all residential homes need to be staffed around the clock. This necessitates staff working in shift teams. This can present difficulties in maintaining a consistency of care and good communication during shifts and also at those times when one shift finishes and another starts. To overcome these potential difficulties, thoughtful, conscientious and well organised shift leaders are essential. It was with these things in mind that I compiled the following document as an induction aid for new senior residential child care workers who were preparing, as part of their induction, to lead a team of up to 3 residential child care workers over the period of a shift at times when a manager was not present. Since new deputy and assistant managers may also be required to lead a shift it was thought this would be a helpful document for them too. I hope it is a useful document for all residential workers but I am sure that there are other things that could be added to it. I would welcome comments on how I might improve it.
You will notice that I have assumed that there is always an ‘ on-call manager’. I think it is essential that the shiftleader has access to someone who she with whom she can consult if a serious issue arises during the shift or a critical decision has to be made.


Leading a Shift : a Guide for Managers and Senior Residential Child Care Workers


Preparation

It is always useful if about an hour before your shift begins you arrange for the current shiftleader to contact you and give you an overview of the previous shift. This may help you to be emotionally ready to lead the shift without being overwhelmed by the sometimes emotional and tired responses of the shift team which is finishing. It will also enable to you to cushion these effects when you and your team start your shift.
This contact can also help you to begin to formulate ideas for the forthcoming shift.
Before you start the shift think about each of the young people and what they will need from you and you team during this shift. Think about each member of your team and what they will need from you during this shift.
When you arrive at the home take the earliest opportunity to communicate with and make emotional contact with each of the young people. Let them know that you are thinking about them. If any are away at school make sure you greet them as soon as they arrive home. When you arrive at the home take the earliest opportunity to communicate with, and be in emotional touch with your team members. Let them know that you are both thinking about them and looking forward to working with them.


Handover meeting and shift planning

Before the handover meeting starts you and the current shiftleader should agree who is to be with the young people while the handover is going on. All other staff should attend the handover meeting and though it is preferable that the member of staff who is with the young people is from the team which is finishing its duty, but if a member of the oncoming team is asked to be with the young people, it is important to brief her on the handover immediately after the meeting.
Listen to the handover taking account of the tiredness of the staff who are finishing their shift. It is important not to take on any of their anxieties. It is also essential that staff start their work calmly no matter what the dynamic of the group may be.
Make a careful note of the tasks which the current shift say will need to be done, continued or completed on your shift.
Check the home’s diary for the next 24 hours and consider how you will allocate staff for any appointments which have been made.
During the last ten minutes of the handover meeting make your shift plan and organise for the afternoon, the evening and, if possible, for the next morning and allocate tasks.
Be prepared to be flexible about the shift plan. Don't refrain from asking your team members for advice, but ensure (discreetly) that it is understood that you retain the responsibility for decision making.
Make sure staff are allotted tasks and while you may wish to assist in enabling them to carry out tasks, only as a final resort should you do tasks allocated to a colleague, but you must ensure that all necessary tasks are carried out.
During the handover make sure that essential recording tasks are allotted, and time is given for them to be carried out. During your shift check that they are carried out These recording tasks will include:

Keeping the log book up to date;
Writing the continuation sheets;
Entering diary appointments;
Recording and checking the administration of medicines;
Carrying out and recording food checks;
Recording incidents in relation to health and safety;
Recording any sanctions;
Recording complaints;
Recording any serious incidents;
Recording the petty cash *

*The inaccurate recording of expenditure has the potential to engender feelings of mistrust within a team and so it is important that the record is properly reconciled. The administration and recording of petty cash transactions must be done by the shiftleader and it is the responsibility of both the outgoing and of the oncoming shiftleader to ensure that when the petty cash is handed over it is correct and the record is correct. Both shift leaders should sign the petty cash book to agree that this has been done. If this is not agreed, the oncoming shiftleader should inform the manager.

De-briefing at the end of a shift

When you are the outgoing shiftleader it is important to telephone the incoming shiftleader, (if she has not already ‘phoned you) to give her an overview of what has happened on your shift.
In the handover meeting the information you communicate should be given in a calm unemotional way in order not to create anxieties for the oncoming shift. This is not to say that you censor, sanitise or massage what you have to communicate but it should be communicated in such a way that the oncoming staff will feel informed to the extent that they feel enabled to contain the home. What you communicate at the end of the handover should not only make sense of what is going on in the home but also it should de-brief your own outgoing team so that they are able to make overall sense of what has gone on during the shift.
Before leaving you must ensure that all the recording and administrative tasks which were required of you and your team have been completed.
Make sure you say goodbye to each of the children before you leave the home and tell them when you will be on duty next. Thank each member of your team for the work they have done and for the support they have given you.


Decision-making and on-call support

If as the shiftleader you have uncertainty about any decisions to be made, particularly those which you think might usually be taken by a manager during the shift, seek telephone advice from the on-call manager. For example, unplanned requests for outside over-night visits where a young person's claims cannot be substantiated by written records confirming the agreement to such a visit by appropriate persons such as the social worker, or parents.
You should also seek advice from the on-call manager if attempts by you and your team to diffuse a dangerously confrontational situation have failed
In an extremely dangerous situation as a final resort call the police. Remember using police to control emergency situations may exacerbate these situations as well as calm them. Young people expect quite rightly that the police have responsibility to enforce the law, while young people expect residential child care staff to provide nurture in the children's home and therefore make the home a safe place to live. Careful judgement must be made in order that roles do not become confused, so that no one is put in an undeserved, unhelpful and vulnerable position - the young people, the police and the residential child care workers.


Primary care

As the shiftleader, it is your responsibility to make sure that all the young people are properly fed, and have the necessary and appropriate clothing to carry out any activities they are involved in. These are tasks which you may allocate to staff working with you, but you are responsible for the quality of this aspect of care.


Individual care

It is your responsibility to ensure that each of the young people is respected as a unique individual and to ensure that they all receive individual attention during your shift. Make sure that each member of your team engages with, and remains emotionally in touch with each of the young people during your shift.


The group

If you are uncertain about the mood of the whole group allocate any appointments and activities out of the children’s home to another staff member. Never send inexperienced, or indeed, depending on the circumstances, experienced staff out on an activity with a group if you have a concern that it will be unsafe.


Overnight

You should lead the staff in sensitively settling the young people down at bedtime. You are also responsible for assuring that the young people have settled down to sleep. If a young person is absent from your care you must make a judgment on the likelihood of the young person returning and whether you must stay up to welcome the young person on their return and to settle them down to sleep. It is important when making such a judgement to consider the best interests of the young person and of the young people who are asleep.
As soon as you are assured that the young people are settled, you must make a thorough external and internal check of the home to ensure that it is secure and that the young people are safe from the possibility of intruders.
You should lead the staff in sensitively waking the young people so that they are able to wash, dress, have breakfast and be ready to attend school on time.


Fire safety

Ensure that at least four times a year you carry out a fire drill on your shift and record the response in the appropriate record book.


Health and safet

Always be aware of the safety aspects of the environment in the home, in particular any which are potentially life endangering. Ensure that repairs are carried out immediately, or as soon as possible, and take immediate temporary action to isolate and make safe dangerous areas or equipment until permanent repairs can be made.


Absence from care

Ensure that any young people absent from our care are reported as missing to the police at the appropriate time.


Expenditure on shift

Monitor expenditure on activities and recreation to ensure that they are not being used as "sleeping carers” in order to buy silence for a few hours.


Professional ethics

You should always exhibit an exemplary and ethically professional approach to both staff and young people during your shifts.


Disciplinary responsibilities

You will also have a responsibility to challenge and deal with any professional misconduct of colleagues and report these immediately to the Care Manager.


Handover meetings involving the young people and staff

If the children’s home has its own educational provision and all the young people attend this provision, it becomes possible for an additional handover meeting to take place that firstly allows everyone to reflect on the issues which have arisen during the last twenty four hours (the usual duration of a shift) and secondly involves everyone in the planning for the next shift. The first part of this meeting should be facilitated by the outgoing shiftleader while the second should be facilitated by the incoming shiftleader. It is important for the shiftleaders to make sure that this is a consultative meeting and not merely one in which staff dictate the agenda. In homes where most or all of the young people go out to school meetings involving all the people involved in the community of the home have to take place at other times and the shiftleader at such a time should facilitate the meeting.

© Charles Sharpe 1997; revised June 2006; revised July 2006

The Inner World of the Child

The Inner World of the Child

In our work with troubled children and young people we are often drawn to wonder what accounts for how they act and how they come to think and feel the things which they do about their previous and present experience. Sometimes their thoughts and their behaviour can seem unpredictable. In turn or indeed at the same time they may delight us, puzzle us, makes us fearful for them and, for ourselves. They may invoke our envy, frustrate us and anger us. At times it can seem that the more we try to help them the more they appear to resist our help. If care workers are to have any chance of helping these young people and themselves enjoy a healthy relationship, it is in my view important that they need to think about what has gone before for the young people if they are to gain any understanding of how the young p[eople they are looking after have come to be the way that they are. In doing this they will be exploring what has been termed the inner world of the child. This is a world which has its beginnings in the pre-language stage of early infancy and in psychodynamic terms it is at the core of what it is to be an individual different from any others.

There are many theories of human development which have a specific focus on emotional development and the inner world of the child, including, if only considering some of the psychodynamic theories, those of Sigmund Freud, Melanie Klein, John Bowlby, Eric Erikson and Daniel Stern. These will be considered later but to begin with I want to consider the inner world of the child, through some of the developmental theories of the English psychoanalyst, Donald Winnicott. I have started with Winnicott because he was interested in the work of those, including residential child care workers, who helped emotionally troubled youngsters. This interest is evident in much of his writing and so his developmental model is a useful one in my view because it provides the child care worker with a straightforward starting point from which it is possible to compare other theoretical stances. It is my hope that this will help the reader build up her own general understanding of emotional development (Winnicott, 1960).

What is the inner world of the child ?

Winnicott contended that the child’s inner world begins to develop in the early stages of infancy and therefore if there is to be an understanding of how a child or young person has developed, it is necessary to look at the earliest days of the infant because he believed that for some young people things have started to go wrong before the development of their inner world (Winnicott, 1960). Winnicott held that what happened between mother and child during the infant’s first year was vitally important for a child’s healthy emotional development. Before considering Winnicott’s views on the development of the inner world further, we should take into account that though Winnicott thought that others, including the father and members of the extended family have emotional and practical roles in support of the mother-baby relationship, he invariably refers to the principal carer as being the ‘mother’. This kind of supportive structure around the birth mother is still strongly in evidence, yet society has moved on since Winnicott was formulating his ideas about child development in the 1950s and 1960s and the nuclear family no longer has a near monopoly as the accepted mode of child rearing. In a world in which it is clear that western culture does not have a monopoly of what the ‘right’ child-rearing model is or indeed the predominant one, we should be mindful that patterns of child rearing differ from one culture to another, and it is not only in western culture’s typical nuclear family – one which is now challenged even within that culture - that children can flourish. It is now more widely acknowledged that it has always been possible for a father, or the mother’s partner, or even more customarily, other family members to assume the maternal role which Winnicott assigned to the birth mother. Even taking all this into consideration, Winnicott’s views on the rearing of children and their emotional development are still influential and remain a corner stone of other subsequent child development theories, including attachment theory.

Winnicott’s principal premise is that if the newborn baby is to develop healthily, he needs someone, usually the mother, to provide the primary parental care. Winnicott understood the baby’s inner world to be a jumble of instincts, fears and sensations which the infant cannot think about and therefore cannot differentiate. In short during the early stages of his life the infant cannot distinguish himself from his environment (which includes his mother) and so he is at the mercy of all the internal and external sensations which beset him, in addition to the vacillations of pure feelings. For example, he will feel discomfort and pleasure. He will feel warm or cold, full or hungry. At first he won’t be aware of feeling cold or hungry. Things will simply be acceptable or unacceptable. Winnicott thought that all these experiences are often very frightening for the newborn baby unless they are held by the primary parental carer (Winnicott,1960).

Indeed in order to help the baby deal with these internal and external phenomena, Winnicott speaks of the primary parenting figure’s function as one of ‘holding’ the baby. He did not just mean holding the baby physically and providing comfort and nourishment, he also meant holding in another sense, that is having the capacity to ‘hold’ those feelings the infant seems to find intolerable. Winnicott also saw the primary parental role of holding as ‘managing’ or containing the child’s emotional experience until the child gradually learns to understand and contain his own feelings. At this early stage the child and mother are emotionally merged and as the mother learns to make sense of the child’s experience, she can begin to mirror this back to him so he can start to make sense of it himself. With the help and holding of the mothering figure, the child progressively begins to bring together all the disconnected parts of his experience to the extent that he can begin to hold ‘himself’ together. This according to Winnicott is the birth of the inner world. The child has developed an insight that there is a ‘not me’ part of the world. I would argue, that it is at this stage - when the baby relinquishes the omnipotence of its cry for immediate attention and becomes increasingly able to wait because he trusts that nurture will eventually be provided - that integration occurs and this, whatever else subsequently happens to him in later life, with the exception of extreme trauma, will give him a sufficient emotional base to survive.


Integration and ‘good enough’ parenting

Winnicott described this as the process of ‘ego-integration’. Here the term ‘ego’ refers to the capacity to organise and make sense of one’s own experience. As has been noted, Winnicott was arguing that babies are not born with an inner world - an ego - but develop one during the first year of life. He suggested that babies are born with an in-built tendency to develop and mature and that this tendency when matched with ‘good enough’ parenting, carries the baby through these confused early stages to the point where integration has taken place. For Winnicott the development of an integrated inner world of the child is the wellspring of imagination and creativity throughout life (Winnicott, 1960).

Most babies do receive ‘good enough’ parenting , do have good enough experiences, do achieve integration and so have the basis for healthy emotional development, even though they – and of course, we, the child care workers, because we too have been infants – may subsequently encounter all sorts of difficulties and develop various neuroses as childhood and adolescence take their course. Nevertheless a small but significant minority of babies have a much more difficult time and, for a variety of reasons, do not manage to make a satisfactory start to their emotional lives. The development of an integrated inner world , that is ego-integration, is according to Winnicott a very critical achievement.


Incompletely integrated and unintegrated inner world

If the development of an integrated inner world is not achieved at the appropriate stage, then there will be core emotional elements which will remain unintegrated. According to Winnicott, this inevitably means that there is a strong likelihood emotional problems will be evident throughout childhood, while others are being stored up for the future, for instance, at the onset of puberty.

The things which prevent the process of ego-integration occurring are usually linked with matters which have prevented the parents from providing good enough ‘holding’. For example when the mother or the primary carer is more pre-occupied by her own emotional needs to the extent that she cannot notice or respond to the needs of her baby, there is little chance of the baby feeling safely ‘held’. He is more likely to feel ignored, dropped and abandoned at a time when he does not have the capacity to think what it all means, or, to comprehend what has happened. If there is no one there to mediate and manage the baby’s chaotic experience, then the baby is left exposed to these primitive instinctual fears and anxieties such as the fear of going to pieces or falling forever. These descriptions may seem dramatic but they describe what appear to be terrifying experiences for the baby. To remain in the unintegrated state without the prospect of relief may be extremely fateful for the baby because it means he cannot achieve any sense of predictability, or any understanding of people in his external world and in particular of himself. The American psychoanalyst, Eric Erikkson, whose theoretical propositions we will consider in a later chapter, describes this unintegrated state as the failure of the infant to develop a sense of basic trust in his world. Erikson argued that such a failure is the very source of psychosis. (Erikson, 1950)

While Winnicott thought that most of us have received good enough parenting and were satisfactorily integrated, he did not argue that all the children or young people looked after by residential child care workers are unintegrated. He concluded that while many of them have experienced good enough parenting in some part of their early infancy, that at some time, or sometimes, the experience of good enough parenting had been taken away from them, and that their inner and external worlds, which had held so much hope for them, had as a consequence of subsequent traumatic experiences, had almost, but importantly not completely, been divested of this hope. These are children and young people experiencing a sense of loss. Something which they had been led to believe as a fundamental part of themselves – of their inner world - has been taken away. Often these young people can seem the most difficult to tolerate since they tend to express their sense of loss in extreme ways and yet for Winnicott these were the ones for whom most hope could be held since there was a part of their inner world which, as a consequence of their experience of good enough parenting, is inhabited with the potential to engage with and trust their external worlds. Such a young person is described by Barbara Dockar Drysdale, a child psychotherapist who worked with children and young people placed in therapeutic communities during the 1960s and 1970s and who worked closely with Winnicott, as the ‘archipelago child’. This was a child who up to now had experienced a disrupted childhood in which there had been islands of good enough caring broken up by periods of neglect and abuse (Dockar-Drysdale, 1993).

Residential child care workers also work with unintegrated children and young people. The unintegrated child does not have this sense of loss, because he has not experienced good enough parenting at all. What has not been put into such a child’s inner world in the first place cannot be taken away. The inner world of the unintegrated child has been unable to flourish healthily because his complete lack of good enough caring has not allowed him to build a structure, an inner world, strong enough to hold together all his primitive feelings in a way that will allow him to survive without the care and support of others. Barbara Dockar-Drysdale, described the unintegrated child as ‘the frozen child’, one whose apparent social adeptness masks a state of panic and rage which can erupt for what seems no reason. Such a child is unable to show remorse or any concern and lacks warmth because they are unable experience or internalise healthy emotional approaches from others because neglect and abuse have characterised their earliest engagement with parenting figures (Dockar-Drysdale, 1993).


The relevance of the child’s inner world to those who work with children and young people

Winnicott indicates that those young people whose inner world can be characterised as one of extreme anxiety and fear and who have been unable to develop and sustain a coherent and healthy inner world will be significantly influenced by poor and sometimes traumatic early nurturing experiences (Winnicott, 1960). Those who are involved with trying to help young people in the care system are working with the young people who are experiencing these fears and anxieties. They are the young people who Adrian Ward (1998) suggests may be out of touch with the level and nature of their fearful and sometimes angry feelings. Their inner world is barren or chaotic and they are unable to express themselves in the way that most young people are. It is particularly important for the care worker to engage with the inner world of the young person if she is to be any help to him. Ward suggests this can only be done if the care worker has insight of her own inner world. In doing this Ward argues it is possible for the worker to have some empathy for the child’s feelings yet he also points out that this empathy should not spill over into over-identification with the young person (Ward, 1998). In order to make a healthy engagement with a young person, the worker needs to have insight of her own inner world and to acknowledge that this brings something to her relationship with a young person. If this can be achieved I would argue that her relationship with a young person becomes a real one which will allow both people in the relationship to grow. The worker may then be doing something for the young person by being with him emotionally rather than doing something to him from a position of unquestioned position of authority.

Charles Sharpe 2004


References

Dockar Drysdale, B. (1993) Therapy and consultation in child care London Free Association Books pp. 99-100
Erikson, E. (1950) Childhood and Society New York Norton pp.65-66
Ward, A. (1998) ‘The inner world and its implications.’ In Ward, Adrian, and McMahon, Linnet (Eds) Intuition is not Enough London Routledge pp. 25-27
Winnicott, D.W. (1960) The Maturational Processes and the Facilitating Environment London Hogarth Press pp63-80

The Group as Therapy : Life in a Children's Home

The Group as Therapy : Life in a Children’s Home

Charles Sharpe 2006

In this article I explore the therapeutic possibilities of the group living setting of a children’s home. To begin with I focus, uncritically some might say, on what I believe should happen in a children’s home. This is not to say I see children’s home through rose-tinted glasses. Unhappy children are placed in children’s homes and so inevitably the work of staff in children’s home will be dealing with the internal and external conflicts which the young people are experiencing both as members of the group and as individuals. Nonetheless I do believe that there are children who can be helped by living in a good children’s home for a period of time and yet I am aware that a feeling for what the function of the children’s home is has been lost by the caring professions except perhaps for those homes who have a reputation for providing a very specialist kind of care. It seems to me that for some time children’s home have been generally viewed as a last resort not only because it seems placement in a foster family is seen as a panacea for troubled children who cannot live with their own families, but also because residential child care is seen as an expensive service.


Why should children live in a children’s home?

In a children’s home the group living setting is seen as a fertile arena for the therapeutic care of troubled young people. By therapeutic I mean the process of the development of trusting healthy relationships between young people and care staff in order that the young people can be helped to feel better about themselves and so become able to cope with the vicissitudes of adolescent and adult life. On achieving this, they can in turn start to feel confident about striking out on their own in the wider community, by becoming involved in further education, by getting a job, by making friends, and perhaps by meeting and sustaining a loving relationship with a partner. In this secondary sense therapeutic care can be seen as giving help and support to young people that will encourage and prepare them to join and to partake safely in all the types of social groups they will encounter throughout their lives. Before this is achieved however it is the primary purpose of the care and support provided by skilled residential child care workers in a children’s home to nurture the young people to a point where they do not have to rely so much on the socially and psychologically unhealthy defences which they have developed in order to stave off the painful feelings invoked by a disrupted childhood. The young people can then begin to feel safe enough to articulate their underlying feelings in the network of relationships within the group of young people and staff at the home.


Who are the children who would be helped by placement in a good children’s home?

The young people who could be helped by a placement in a children’s home are:

1) those who, experiencing family breakdown in adolescence, are developmentally unable to take on living in a substitute family and who

2) Therefore find group living a less threatening prospect;

3) Those who have continually failed to flourish in both family and substitute family care and who have become the casualties of repeated family and foster family failure to the extent that a family has ceased to be the appropriate background for nurture.


Common to the young people in both these groups is an inability to respond positively to the intensity of relationships. The reason for this is that they invariably arrive at the children’s home having experienced family or other care settings in which they have been - in some combination or another - the victims of physical, emotional and sexual abuse.
They are often young people for whom family life has become too threatening, and yet who, even in the face of the abuse they have experienced, retain emotional loyalties to, and have expectations of, the families from which they must nevertheless be protected.

It is my belief that for these young people, residential group care can be used to provide an individual nurturing experience, and that the group process can be used for positive therapeutic purposes.


Group experiences in a children’s home

Many kinds of group experiences take place within a children’s home. In the ebb and flow of daily life within a home, there are always sub-groups forming, operating and breaking up in the “life space” of the children. These are not specifically therapeutic groups, and though they can be formal as well as informal in nature, they are widely acknowledged as having therapeutic possibilities. Taking part in leisure activities together, having informal discussions, preparing to settle down for the night, sharing in domestic chores and joining in many other activities provide special opportunities for relationships and trust to develop. These groupings represent the greater part of life at a children’s home. More formal sub-groups include the regular meetings between children and their special workers, (often referred to as keyworkers), to discuss the progress of a young person’s care plans and to discuss live issues which are currently concerning the young person and those who are caring for him; staff and children learning together in a school room or a homework room; meetings with the young person, parents, social workers and residential care staff to review the progress of a young person’s care, and to make plans for the future, and of course there are staff meetings.

In addition to these, in many children’s homes regular formal meetings are held in which all the young people and staff participate. These have the function of organising living arrangements and responsibilities, reviewing recent events, sharing information and dealing with consequences of failed expectations and boundary breaking. They are aimed at involving everyone in the purpose of the children’s home, and, at allowing those young people who over a period time have become committed to receiving the care the home offers them, to reassure newcomers. During these meetings the newcomers’ anxieties about being a member of the group decrease, so they - with the help of staff and other young people - become able to find ways of replacing anti-social responses with the more socially potent responses built on reflection, negotiation and healthy assertiveness.

Eating a meal together is also a most significant group occasion in the daily routine of a children’s home. A great deal of significance is placed in preparing food and eating it together. Food is symbolic of nurture and is also the very stuff of nurture. Though meal times can be difficult for troubled young people because they often arouse frightening memories or feelings of earlier deprivation, they nevertheless provide opportunities for staff and more settled group members to give encouragement and to present positive models to the newcomers in the group.

It is this complex of group situations which meets the new child who has come to live in a children’s home. Each new admission can arouse anxiety in every member of the resident group, yet this is a basic anxiety that would be triggered within any group. The group of people involved in the life of a children’s home share features common to all human groups. People leave, people arrive, and with each change new opportunities arise while new problems are thrown up. A problem for many of the young people who live in a children’s home is that they have not yet developed as wide a repertoire of safe social responses to change as their peers in the wider community have. For them new arrivals are experienced as though they are actually displacing siblings, while familiar residents and staff leaving throw them back into their past traumas of failed or broken attachments, rejection, separation and loss. Consequently their reactions to changes in the group can be extreme. With this in mind, the milieu of a children’s home has to be tailored to allow these reactions to occur and to be safely contained.


Therapeutic group care: a four-stage model

Trying to contain these fears at the same time as encouraging healthy mental and physical growth in young people is a complex task and in order to make some sense of it, I have, with the help of many current and former colleagues identified four developmental stages which can be the experienced by young people in the group setting of a children’s home. I have found this helpful in trying to make sense of what goes on in a children’s home and helpful as a model for less experienced staff when they are faced with the confusing dynamics of the home which - compared with anything they have previously experienced - can seem very uncontained. Of course describing these stages to young people has also proved useful in helping them gain some insight of what is happening in their own internal and external worlds. The four stages drawn out here are not rigid - indeed they are fluid – and it is possible during his stay in a children’s home that a young person may from time to regress to an earlier stage and of course not all young people achieve what I have defined as the most developed final stage.


The preliminary survival stage

The first stage is one during which the newcomer is assessing the group and deciding whether it is possible for him to have a place, however tenuous it may seem, in the group. This stage may last from as a little as a few minutes to as much as four weeks.

Johnnie

Johnnie, who had been moved from his family home because he had been severely physically abused by his new stepfather, was a small, quiet 13 years old boy who arrived at the children’s home late one night just as the other young people were going to bed. He was both frightened and tired but after getting ready for bed he fell quickly to sleep. In the morning staff could not persuade him to dress or leave his room. Johnnie stayed in his room for a number of days and
staff had to bring his food to him. He said very little and seemed nervous of both staff and the other young people. He
did not go to the bathroom unless he was sure there was no one upstairs. On the second day Johnnie’s keyworker in an
attempt to engage Johnnie with the life of the home asked Mary a 16 years old young woman who had been living in the home for 2 years to take Johnnie’s food to him. She did. When
Johnnie’s keyworker took his midday meal to him, he asked him if Mary would be bringing his food to him again. His keyworker said he would ask Mary if she would bring his breakfast to him on the next day. Mary agreed. On the
following morning while she took him his breakfast she asked him if he would like to come downstairs with her when it was time for the midday meal. Just before lunchtime Johnnie asked one of the staff where Mary was. A few minutes later when Mary came to his room, Johnnie was fully dressed and he accompanied her downstairs and joined the others in the dining room.

Lizzie

Lizzie, a 14 years old girl bustled into the children’s home when she arrived at the home for the first time. She seemed noisy and brash, and apparently not at all over-awed by her admission to the home. She seemed to have landed as one member of staff said, ‘well and truly running’. Lizzie’s main pre-occupation appeared to be a need to tell everyone that at her last children’s home she had got a member of staff sacked and that she been chucked out of her previous home because she had beaten up another child because as Lizzie said ‘She thought she was harder than me’. This was a pretence on Mary’s part. She had been placed at her previous children’s home as an emergency measure in order to protect her from members of her family who had been physically and sexually abusing her. Her placement at her last home was a
temporary arrangement until a children’s home could be found that seemed better
able to meet her needs. Although some of the young people at her new home
appeared to be threatened by Lizzie and what she was saying, those young people
who had been at the home some time did not react to her loud behaviour but did
engage with her over the more mundane matters that were a part of their shared
day to day experience of the home. Within a week, Lizzie became quieter and did
not seem to feel the need to sustain her pretence.

The testing stage

Johnnie and Lizzie continued to have problems adjusting to life in the children’s home as well as with dealing with the emotional trauma of their experiences before they were admitted to care. but with the support of the staff and the other young people, both had within a period of a few days entered a new phase where they could feel, however that fragile that feeling was, that it was possible for them to survive living in the group. In the following stage the young person begins to test out this feeling as if asking, ‘ Just how safe am I here? how much do you care about me ? ’. During this period the capacity of the group, in particular the adults in the group, to contain the young person emotionally is challenged. The young person begins to exhibit the anti-social defences, which may have played a significant part in bringing about his placement at the home. It is as if the young person is attempting by seeking the group’s rejection - in particular rejection by the staff members of the group - to find out how valid his own feelings of worthlessness, engendered by abusive or failing parenting figures, are in his new setting. At this stage trusting and making a relationship with parenting adult figures can seem very threatening. It is a critical stage for a young person and for the group. Primitive, regressed acting out behaviour can seem to test the very existence of the group and its capacity to remain functional. Yet it can be a hopeful stage too. While the young person, like a screaming infant seems embroiled in unbearable feelings, he may also be screaming out because he is in touch with feelings of the loss of good enough care and love given to him at an earlier time in his life. In his anger and aggression he may be communicating not only his sense of loss for what has been taken away from him, but also demanding that what he had must be replaced. The young people going through this stage are so fearful and anxious that it is likely that they will not interested in using any of the supportive resources available to them in the home apart from the member of staff they choose to scream and shout at, or whom they pointedly ignore, or indeed from whom they steal. The member of staff chosen by the young person to receive this invective is invariably of great significance to him. It is important that this worker does not collapse in the face of this vituperation for she may well be the one the young person hopes and feels will be able to contain all his infantile terror. This will not be easy for such a young person will not only seem to be attempting to disrupt social, recreational and group activities, he may also appear to threaten the very existence of the group. This critical period may last for six months and beyond.

Luke

Luke who was 14 years old came to the children’s home following the breakdown of his previous foster family placement. A fostering placement breakdown was not unfamiliar to Luke. He had been placed with five different foster families since the age of 4, when his mother, who lived alone with Luke supported only by her frail and aging mother, had died. Luke seemed able to start well with his foster families but once he seemed to be settled, he would engage in a series of destructive actions directed either at members of the family or their property. Such action had precipitated his placement at the children’s home. Following a string of destructive acts in directed at his foster parents’ property, he seriously damaged the bodywork of the foster father’s new car. After this incident, his foster parents felt they could no longer cope with Luke. Luke settled into the children’s home well, although his attendance at school was poor. He and his keyworker Helen seemed to have built up a good relationship. About three months into his stay Luke began to direct remarks to Helen which suggested that she was a bad mother to her children. These remarks were invariably made when they were both in the presence of other young people and staff. Helen talked with Luke about these remarks during his keywork sessions but he insisted that he had never made them.
In supervision Helen talked about how upsetting and frustrating Luke’s remarks and his denial of them were for her. She was at a loss because she believed she had built up a good relationship with him. Although Helen was feeling discouraged, her supervisor persuaded her to stick with her task and pointed out to her that the young people and staff often commented on how protective and possessive Luke was of Helen as his keyworker during those periods when she was not on duty. Soon after receiving this advice from her supervisor, Helen took Luke out to a restaurant for a special keywork session. The session went well. Luke and she had agreed that they would both make a big effort do something about his irregular attendance at
school. At the end of the meal Helen left the table to talk to one of the restaurant staff whom she knew. She left Luke on his own looking after her shopping bag. On their return to the children’s home, Helen found that money was missing from her purse but more upsettingly a treasured photograph of her son and daughter when they were young was missing. When Helen talked to him about it Luke said he did not know anything about the missing money or the photograph. After Helen left at the end of her shift, Luke gave some of the other children packets of sweets. As he took sweets out of his pocket some pieces of a ripped up photograph fell out. One of the young people picked them up a realised what they were. A number of them were unhappy about what Luke had done and told him he should not have ripped up the photograph. The staff on duty were told about the discovery. On her return to work Helen was told about what had happened. She told the manager of the home that she felt angry and betrayed and that a part of her really felt like rejecting Luke. A staff meeting was called to discuss the matter and it was agreed that to reject Luke – a
rejection which it seemed he was in some way seeking - at this time, no matter what had occurred - would be to confirm his fantasy that he could not trust parenting adults to hold him and contain him because they adults either leave, like his mother, by her death did, mother or they would reject him like his grandmother and his foster parents. Helen accepted her colleagues' decision though she found it painful. Helen talked with Luke about what had happened but a further year passed before he could acknowledge that he had stolen the money and had destroyed the photograph. Nonetheless following Helen’s acceptance of her colleagues' decision to continue to look after Luke, his school attendance gradually began to improve and his verbal outbursts about her capabilities as a mother ceased.

The acceptance stage

Once the group has demonstrated to the young person that it can contain his emotions, a stage has been reached where the young person begins to feel that the group and the caring adults can be trusted. This is a time of reluctant acceptance during which the young person is increasingly able to live without fear or terror of his own feelings. This is what Luke began to feel once he discovered that neither the group nor Helen would reject him. He can begin to see a world beyond himself which he could inhabit. During this period disturbed behaviour may remain evident. There are things which have still to be worked through but it is a time when the young person becomes interested in what the group can offer. Tentative beginnings are made to participate more positively in group activities and education.


The committed stage

The final stage in this model is a committed one, in which the young person has trust in the group and is committed to what it offers to the extent that consistently socially acceptable responses have developed. During this stage the young person becomes able to demonstrate the purposefulness of the group to young people who are going through the earlier stages. He is able to help maintain the group’s capacity as a container of feelings. The young person can now tolerate most of what life throws at him and through acts of reparation demonstrates an ability to care for others in the way that Mary did when she assuaged Johnnie’s fears. This is not to say that such a young person will not experience the difficulties common to most older adolescents, as he struggles to find his adult identity, but now that he has worked through and grown through the group experience, he has built up personal resources which will help him overcome these difficulties.



The optimal size for a therapeutic children’s home

In my view the positive outcomes from group living which I have outlined here, can only be achieved if sufficient young people in the group have reached or are approaching the latter stage of the group experience I have described. These are the young people who trust in the relationships they have with parenting adults and who are committed to the care provided. These youngsters have achieved sufficient personal development to help them cope with the anxiety brought about by a change in the group. They are able to maintain the historical culture of the group and its role as the container and holder of fears and anxieties. These are the young people who along with the staff can cope safely with the changes to the group dynamic which newcomers inevitably bring. Newcomers can see that these young people have learnt to trust in their relationships with caring adults. It is my opinion, and I am aware this runs against the grain of current accepted wisdom, that in the fluid group dynamic of a children’s home too small a group cannot sustain group stability while too large a group diminishes the opportunity for more individual care. I believe the premium number for young people living in children’s home is eight or nine. Such a group is small enough to allow staff to give each of the young people the kind of relational engagement, which cherishes their uniqueness and respects their need for privacy. At the same time it is large enough to absorb and contain safely the anxieties created by, for example, two newcomers to the group who may arrive within a short time of each other.


Residential child care staff

The child care staff is the most important resource of any children’s home. The staff generate and sustain the caring and nurturing milieu. The symbiosis between young people and care staff which is necessary for a children’s home to be successful can only be achieved by staff who have an awareness of the dynamics of the inner world of the young people and of the dynamics of the group. They must be informed about, and have both intellectual and emotional insight of the part of a young person which carries harrowing feelings from earlier childhood experiences. These are feelings which may be too painful to talk about, to think about or so intolerable to the conscious mind that they are blocked off. The young people who are admitted to children’s homes often have good reason to be wary and distrustful of adults and are fearful of making relationships. Residential child care staff require the skills and patience to work through this distrust. They need to be able to demonstrate to young people that it is possible to have a healthy and consistent relationship with adults. Once young people have gained this insight, they will be well on their way to moving on from the children’s home because they have begun to develop the personal resources to help them face their approaching adulthood.

It is also my belief that the healthy self development of young people in children’s homes is in large part dependent on their introjection of personal qualities that are present in individual members of the staff group. Residential child care workers have to provide the young people with healthy models of making relationships and of coping with different social situations.

To achieve these ambitious but essential goals residential child care staff need to be provided with ongoing training in the child development, group dynamics and in the primary care of children. My own sympathies are such that I would advise that this training should be underpinned by psychodynamic theory but my reasons for believing this will be explored in a future paper. Nonetheless I would argue that any humane and sensitive approach to residential child care in a group setting - as long as it is carried out by a conscientious, committed united, informed therapeutic team of residential child care workers – is likely to have some positive outcome for the young people.


Some final comments on the funding of placements in children’s homes and its relation to the therapeutic task.

Group care is often considered expensive and the longer it is provided for a young person the more expensive it comes. I have argued that for some young people good residential group care offers the best hope for their futures. I am reluctant to say for how long children need group care of the kind I have described. I have given some rough indicators for each stage but every young person is unique and of course their needs are unique. My own view is that if it can be demonstrated that a young person is being contained and nurtured, then therapeutic child care should be allowed to take as long as it takes in order for the young person to feel truly better about himself. It took Luke over a year to begin to work through the feelings which lay behind his theft and destruction of Helen’s photograph. Yet I would argue that this ‘working through’ was necessary if Luke was to begin to really feel better about himself. I am aware that this elastic time scale is not a very attractive notion to those who manage what always appear to be the ever diminishing budgets of the local authority social services which finance child care. It is with a partially sympathetic nod in their direction that I have come to the conclusion that effective therapeutic group work with children and young people who for whatever reason cannot live in family care can be achieved - depending on needs of the individual young person - in a minimum of a year but is more likely to be successful over a period of two years, and sometimes even longer. Yet all too often I have been aware of local authorities who, in the name of financial prudence, and after a period of years of spending hundreds of thousands of pounds on the care of a young person, decide - for the want of a fraction of what has already been invested in the young person - to end the young person’s placement before the therapeutic task is complete. The likelihood then is that such a young person may well need to be supported by public funding in one way or another for the rest of their lives. This seems to me not only a waste of public money but more importantly a waste of young people’s lives.

To enable young people to make personal progress takes time. The emotional damage done over many years cannot be repaired in weeks or a few months. There is a need for children and young people in children’s homes to have enough time to regress, reflect, process and then develop.

Joining Young People in Play : the significance of play

Joining with young people in play: the significance of play


The following notes were written as a first step in preparation for a much more widely and deeply considered project about play which would form a part of the Eagle House Graduate Diploma in Child Development and the Care of Young People. In this piece I look at some of the developmental aspects of play and begin to think about ways in which care workers who offer help and support to children and young people can fruitfully involve themselves in encouraging young people to play. I have not dealt with play here as a kind of specific therapy, but I am thinking more about play in the life space of children and their parenting figures. Nonetheless playing safely is in my view very therapeutic for vulnerable children and young people as indeed it is for everyone ! I hope there are some useful ideas here for those involved in the care of children and young people.


I have often thought how impoverished my life would have been if I had not been able to play. Like everyone else I did not have a perfect upbringing but my parents gave me space and time to play and they also joined in my play. In so many ways the informal play within my relationships with members of my family, with friends and also with team mates or opponents in more formalised play have helped me on numerous occasions to tolerate what seemed like unbearable feelings thoughts and experiences which I have now come to understand are an inevitable part of life.

If being able to play is a fundamental part of life, then of course it is essential to the healthy development of children. It is a necessary means of exploring, expanding and representing experiences. It is a main avenue towards gaining access to the full richness of life. D.W. Winnicott, the renowned English paediatrician and psychoanalyst argued that the capacity to play shows that the child is capable, given reasonable surroundings, of developing a personal way of life and of eventually becoming a whole human being (Winnicott, 1971).

Play is a starting point for growth because it offers an avenue towards coming to terms with oneself, other people and the wider world. Play provides a space within which the imagination can work and move. It is in this space that each child’s individuality emerges and is nourished. During play children are safely learning to explore and investigate their environment as well as learning to begin to solve the problems it presents them with. It is a practice for life.

The Swiss psychologist Jean Piaget (1969) amplified this notion when he suggested that it is important for a child’s emotional and intellectual equilibrium to have an area of activity whose motivation is not adaptation to reality but a place where imitation represents an adaptation to the external world and is a gradual and bearable assimilation of reality to the self (Piaget, 1945). Play in the sense that Winnicott and Piaget mean here is describing the difficulties children face in moving from what Freud might describe as the pleasure principle to the reality principle (Freud, 1911). Like Winnicott, the English child psychotherapist, Barbara Dockar Drysdale, understood play as significant in the necessary transitional experiences of healthy personal development. She proposed that for the child, play engenders the capacity to represent symbolically, emotional experience which is being realised internally. This is the sense in which play is transitional. It is a safe space between fantasy and the real world. While playing a child does not control others, and neither is he a potential victim of the consequences of his own desires and instincts. (Dockar Drysdale, 1990)

It is in play too, that children become aware of symbolic representation and so begin to develop and internalise symbolic communication. Piaget argued that this advance facilitates the development of symbols and their use in metaphor which in turn helps the development of thought.


Those who support and look after children and young people who are experiencing emotional difficulties are all too aware that their charges are often unable or reluctant to play. Given the critical role I have argued play has in healthy personal development, it would seem important that opportunities to play are provided. If they are unable to play or have been denied the opportunity to play children and young people will be deprived in life. If we accept play as the forerunner of inner reality, and that play links the individual’s relationship with his inner reality to his external or shared reality then it follows that play can provide a framework for an initiation into relationships which have emotional energy and meaning.

Emotionally troubled young people struggle to make relationships which have positive emotional energy and meaning. This is not surprising. All too often important parenting figures with whom they should have had a healthy relationship, have rejected them, deserted them, failed to protect them, and almost certainly not allowed them sufficient physical and mental space to play - a space within which the imagination can work and move, where individuality and confidence can emerge safely.

Those who care for children and young people should encourage them to play and should join with them in play. As I have suggested, these young people may well baulk at the idea of play because they feel unable to play. It is all too easy for the care worker to feel she has failed even before a start has been made when a child is reluctant to join in what seems the natural activity of play. Yet play can take many forms. The relatively advanced stage of play which requires an amount of time to organise such as joining young people in recreational activities in anything from art to yachting (I couldn’t think of anything beginning with Z !) may be reached via the more basic forms of play which go on in safe non-verbal engagement or within every day conversation, as long as no one is left diminished by such experiences. It is in these exchanges with a special worker, that a youngster can begin to have the kind of primary experience, which they would have gained from play with their mother during infancy.


References

Dockar Drysdale, B.(1990)

Freud, S. (1911) ‘Formulations on the Two Principles of Mental Functioning’ in the Standard Edition of the Complete Works of Sigmund Freud vol. XII London Hogarth Press

Piaget, J. (1945) Play, dreams and imitation in childhood London Routledge 1962

Winnicott, D.W. (1971) Playing and Reality London Routledge 2005


Useful Further Reading:

Alvarez, A. (1992) Live Company: Psychoanalytic Psychotherapy with Autistic, Borderline, Deprived and Abused Children London Routledge

McMahon, L. (1992) The Handbook of Play Therapy London Routledge

McMahon, L . and Fanshaw, R. (1999) ‘Healing Play’ in Loving, Hating and Survival Hardwick, A. and Woodhead, J. (eds) Aldershot Ashgate Arena



Charles Sharpe, May, 2004

What Makes a Good Children's Home

What makes a good children's home?

I wrote this document in 1985 when I was asked by a woman who was considering starting a career in residential child care what I thought made a good children’s home. I not only found my mind filling with all sorts of ideas but I had to say to her that on the spur of the moment I could not give her a brief answer. I said that I would think about it and that I might be able to give her a clearer response in a few days time. Clearly my reply was not helpful because she never got back to me, but I was troubled that I had been unable to formulate an answer for her. I continued however to think about her question but every time I thought about it a kaleidoscope of images came to my head which I seemed to make no sense of except to come to the conclusion that the whole notion of a children’s home was very complex. I went back to thinking about what the woman had asked me and I imagined that she had been invited to visit a children’s home for a week prior to her interview for a job there and I thought about what she would see and experience. I was able then to think about the questions I would have suggested she should ask herself as she approached, entered and spent time in the home. I fancied that the answers she found to these questions might help her discover for herself what makes a good children's home. When I’d finished compiling my catalogue of questions I thought that if I changed the questions into statements I might create an interesting induction paper for residential child care workers. In the event other, what seemed at the time more important, projects took priority and I did not write the paper. I had forgotten all about it until a few days ago when I was searching an old floppy disc for another piece that I had written and I came upon it again. When I read it, it occurred to me that it would be more useful as a training document if I left it as a list of questions since this would allow readers - as I had originally hoped the woman would - to reflect on their own ideas of what makes a good children's home.

It is a long list with some questions which may now be outdated and have only a little historical interest, but I would argue that they still have something to offer those who have to think about what makes a good children’s home. You may notice some value-laden questions which echo some of the issues that were of particular concern to me at the time. You will also notice the absence of any references to minimal standards, risk assessment or health and safety, and yet I think these are implied in what I would argue is a more natural and dare I say it more homely way ? Please tell me what you think.

Charles Sharpe cws.sharpe@dial.pipex.com


What makes a good children's home?


General impressions

As you approach the children’s home do you see a building situated in a locality and community which gives all the signals of being sympathetic to the needs of children and young people who are looked after in the public care system ?

Is it close to good public transport services which will allow easy access to the home for the families of the young people living there, and for the young people to visit their families and friends?

Is it within easy reach of the local schools and other public facilities such as the library, leisure centre, parks and shops ?

If the home is for young people who come from an urban community is it situated in a residential area in an urban locality ?

Does the house look similar to others in its street ?

Does it appear to be the kind of house a family would make a home in ?

When approaching the house whether it be along a garden path or a courtyard is the aspect which meets your eye attractive to you ?

Is the front garden interesting and well-maintained, or if it is a courtyard is it furnished with flowers in pots or hanging baskets to give it colour to compensate for the lack of a garden ?

Does the house look well cared for ?

Is it in a good state of repair ?

Is the external paintwork in good condition ?

Was arriving at the front door like arriving at the entrance of a family’s home ?

Was everything about the entrance welcoming, well-tended, yet human ?

Did the door bell work when you operated it ?

When you arrived were you greeted cheerfully by a member of staff or young person who lives at the home ?

Was your immediate impression of the physical environment of the interior of the house one of spaciousness on a scale consistent with a feeling of family homeliness.

Were the communal rooms of a comfortable size, clean and tidy but not sanitised ?

Were the furniture, and fittings of good quality and in good repair ?

After you had given your name, explained the reason for your call, did a member of staff confirm your identity ?

Were you will be welcomed in and then enabled to proceed with carrying out the purpose of your visit?

Did your welcome make you feel you were in a happy, welcoming, informal but organised place ?


Did you think the young people seemed interested in being in the home?

Did they seem involved in the running of the home ?

Were there signs that they had influenced appearance of the home in a positive creative way ?


Education

Did you see signs that children were interested in their education and schooling ?

Did the staff show an enthusiastic interest in the education of the children and young people ?

Was time set aside for homework to be done ?

Was a place set aside for homework to be done ?

Did staff show an interest in helping the young people with their homework ?

Were their bookshelves with up-to-date reference books and works of fiction ?

Were the young people helped to organise themselves for the next school day?

Were the young people encouraged in their educational pursuits in sensitive yet proactive way ?

Did the young people have schools to attend or other full-time educational provision ?

Did the young people attend school regularly ?

Were educational concerns and worries of the children and young people attended to assiduously by staff ?

Were educational achievements of the children and young people acknowledged and praised by the staff.

Was their evidence that staff liaised and engaged with the teachers at childrens’ schools ?






Relationships

Like other human projects children’s homes are not perfect places, but if you saw any anti-social challenging behaviours were these being resolved, dealt with in a good parental way by the staff?

Did the staff respect the young people?

Did the young people respect the staff ?

Did the young people respect and acknowledge the leadership of the managers?

Did the managers respect the staff?

Did the staff respect the managers?

Was there warmth and friendliness between the young people and staff?

Was there warmth and unity in the staff team?

If there was mutual respect was this based on good relationships, or fear or authority roles?

Were the young people encouraged to sustain their relationships with their families ?

Did the young people have ready access to their social worker if they were unhappy about aspects of their care ?



Social climate of the home

Was the house noisy? If so, was it unduly noisy?

Would it have disturbed neighbours?

Was there a feeling of calm and easy control?

Was there mayhem, or chaos?

Was it out of control?

Was it clear who the young people could look to ensure they were safe in their environment?

Were the young people repressed?

Were they allowed to express their emotions, eg: anger?

Were they encouraged to express them in a safe way?

Did staff, male and female, take on authoritarian roles to maintain control?

Did they adopt stereotypical attitudes, eg: males - physically strong presence,
females - soft, gentle?

Did the young people have stereotyped attitudes towards the staff structure?


Nurture and Culture

Were the young people well clothed?

Were they clothed in a way typical of their total peer group?

Were there examples of them having been given a choice to maintain individual cultural and ethnic tastes and customs, in their clothing and in other aspects of their lives?

Were the young people bored or bright?

Did they look healthy in appearance?

Did their appearance reflect healthy self-esteem or did their demeanour suggest a low self-esteem?

Was care taken over meal-times by both young people and staff?

Did all the staff on duty make a point of eating with the young people at meal-times?

Did any staff or young people not attend meal-times? If so, why did you think that was?

Were meals strictly formal ? were they chaotic ? were they friendly but with the occasional altercation that may occur at a family meal?

Did young people and staff talk together at meal-times? Did they engage or did staff talk with staff, and young people only talk with other young people?

Did the young people help choose the menu?

Did the menu reflect their individual, ethnic or cultural tastes?

Was the food well prepared and presented? Or was it institutional?

Had the young people helped in its preparation and presentation (eg: assisted with cooking, setting the table)?

Were the staff interested in the food, its preparation and presentation?

Was there a feeling that food and meal-times were important ? that meals were an important family ritual, or were they something to get over with as quickly as possible?

Did the staff prepare the young people for bed times and did they settle them down sensitively ?

Did the staff awaken the young people sensitively in the mornings ?


Recreation

Were the staff interested in the recreation and culture of the young people, or were they indifferent?

Did they actively encourage and/or partake in such activities?

Did the staff take conscious actions to enrich the lives of the young people?

Were there materials, equipment, and information about local facilities made available to help enrich lives?

Was this availability ad hoc, was it dynamic ? ( that is, were new ideas considered)?

Were young people part of the debate about what is possible and what is not in the home?


Care Planning and the Direction of Care

Were the young people happy to allow staff to help counsel them on matters concerning their care, including family, peer, and group issues?

Did the young people seek out help on these matters ? were the discussions supportive?

Did the young people avoid seeking staff help on these matters?

Did the staff team seem well informed about the care of each of the young people?

Did the young people know why they were there?

Did the staff seem to know why the young people were there?

Did the staff feel they were helping the young people?

Did the young people feel they were being helped?

Did the young people have some hopes and targets for the future, or was this impossible because their social, familial and emotional situation was so chaotic?

If so, were the staff coping with this in a way that made the young people safe?

Did the young people appear to know why they were there and what was to happen to them?
Did the staff know what the purpose of the home was, why the young people were there and what their care plans were?


The morale of the staff team

Did the staff team seem enthusiastic or interested in their jobs? Did they want to talk to you about it?

Were they keen to spend time inducting you to the point where you understood each procedure?

Were they always happy to answer your questions?

Did they seem to know what they were talking about in terms of legislation, ethos, procedure?

Did the managers show willingness to spend time with you?

After your week did you feel that you had joined a supportive,
informed and protective team?


Ethos of the home

What was the ethos?

Were children and staff aware of the ethos of the home.

Were the staff appropriately open in their communications with the young people ? Openness of staff appropriate openness of the young people


Social centre of gravity of the children's home.

Did the staff engage with the young people in their life space in the communal rooms or did engagement take place at the threshold of the staff office?

Were the staff aware of where each of the young people were, and what they were doing at all times ?



Administration : recording, money, medicines and some other things

Were all the required written records kept up to date without them taking up undue time that might have been better used for engagement with the young people ?

Was pocket money given out on time and administered and recorded correctly ?

Was the administration of medicine carried out sensitively and recorded accurately ?

Were regular fire drills carried out and properly recorded ?


And finally what about you ?

Did the visit make you think about yourself as a person ?

Did you think about why you might want to work in a children’s home ? Have you explored your motives for this ?

If you would like to work in a children’s home are there things about you that you think you will need to develop before you do so ?



© Charles Sharpe 2006

Life in a Children's Home : what do we mean by therapeutic child care

Life in a children’s homes : what do we mean by therapeutic child care?


This paper is based on the introductory session of the Eagle House Graduate Diploma in Child Development and the Care of Children and Young People. It focuses on therapeutic work in children’s homes, but since one of its principal themes is concerned with the way caring adults develop nurturing relationships with troubled young people, there is much in it which readily transfers to the work of foster carers, outreach support workers with young people leaving care, social pedagogues, educateurs and all the other people who work in a caring and supporting role with children and young people.
For the purpose of clarity, care workers are represented as feminine, while young people are represented as masculine. No bias is intended by this.

That word ‘therapeutic’!

The question posed in the title of this introduction is a controversial and important one. There is a great deal of suspicion about the word ‘therapeutic’ in the field of social care and social work. One reason for this is that the adjective ‘therapeutic’ is used in front of the word ‘care’ to accommodate so many theoretic stances and practice approaches. The umbrella like quality of the word is just as evident when it placed in front of ‘children’s home’. Given the difficulties we face in being specific about the meaning of this it at times infuriating word, it is not surprising that it conjures up so many feelings of insecurity in child care workers. For many it seems to have an almost religious aura as if it describes a special knowledge and wisdom that can only be held or given by a selected, ordained few, and certainly not by the average residential child care worker. It can appear that the hands of the residential child care worker are too clumsy to handle the knowledge the term contains and too untutored to use it as a helpful tool. It is as if in the residential child care worker’s possession it becomes a dangerous weapon with which she might harm those for whose care she is responsible. It might seem I am labouring my point here but it is one which comes with official authority. The National Minimum Standards for Children’s Homes describe a therapeutic technique as one which is ‘intended to relieve a physical, social, emotional, behavioural or cognitive problem of a child which requires the skills or knowledge beyond the skills or knowledge normally expected of a parent, teacher or care worker’ (DoH, 2002, p67). Yet residential child care workers are helping children and young people whose problems and experiences are not within the bands we would generally accept as normal. They are working to help relieve the emotional and social problems of children and young people who have been rejected, abandoned and abused. All residential child care workers are working with children and young people whose care and education problems have already proved them to be ‘beyond the skills or knowledge normally expected of a parent, teacher or care worker’. The argument that residential child care workers going about their tasks in an effective way are not working therapeutically is one which will be challenged throughout this paper but if we are to begin to question accepted wisdom about who is or who is not qualified to work therapeutically, perhaps it would be useful to agree on a general meaning for the word ‘therapeutic’.
In a brief survey of the dictionaries and reference books on the shelves beside my desk I sought a consensual meaning for the word and I found that ‘healing’ was the word which sprang most frequently from the text. In my view ‘healing’ is a helpful term upon which we might agree as capturing the spirit of what is therapeutic in a residential child care setting. In so far as it relates to what goes on in a children’s home we would use it primarily as referring to the healing of emotional wounds more often than physical ones. (Though in children’s home it is not unknown for a physical wound to be a surrogate for an emotional one, and this is certainly true of self-harm).
Once the residential child care worker is able to take ownership of the notion that in working therapeutically they are trying to heal emotional wounds - that is, helping young people feel better about themselves - she is then faced with another question, ‘ How can I help to make a young person’s experience in this children’s home a therapeutic one?’ This is the question I am trying to answer here.

Providing a therapeutic experience

Before I begin to consider the provision of a therapeutic experience, I want to make two important qualifications. Firstly I need to make it clear here that the therapeutic approach I will primarily focus upon is based on psychodynamic theory and practice rather than a cognitive/ behaviourist one. I will not look at the differences between these approaches here but a deeper consideration of them may be found in ‘In Care, in Therapy’ (Sharpe, 2000). What I think I can say without being shot down by any authorities from different therapeutic fields is that the psychodynamic approach takes into consideration unconscious as well as conscious forces in human behaviour while the cognitive behaviourist approach focuses on using conscious awareness as a method for solving the problems of troubled young people. The reason for my prejudice towards the psychodynamic approach is complex. Putting it as simply as I dare - though I do believe a cognitive behaviourist approach is potentially helpful to troubled young people who have experienced long periods of consistent and good enough parenting in their lives - it is my experience that many of the young people who are placed in children’s cannot find the words, and so can’t give always give meaning to their problems because they have recent and distant memories which are, for the time being, too painful to consider consciously. This brings me neatly to my second qualification, which insists that in order to work therapeutically in a psychodynamic way, residential child care workers should agree that the emotional difficulties experienced by the young people they are looking after will have their source in the young person’s past and not infrequently in their infancy when they could not communicate in words. In consequence the young people who are placed in children’s homes may find it difficult to articulate their problems in conventional ways. It is their potential to be able to communicate more conventionally that the residential worker is striving to help to bring alive so that a young person can begin to experience healthy personal growth.
Before returning to our consideration of what can make the experience of living in a children’s home therapeutic, I want to stress again that the residential child care worker should accept that the way young people are when they first come to a children’s home is a consequence of what has happened to them in their earlier childhood. I have repeated this because I have often heard residential child care workers argue that they take children as they find them and that when a young person is newly admitted to the children’s home, the worker does not wish to be prejudiced by the young person’s past, and so is not interested in finding out about it. While this may seem a noble approach to adopt, it does seem to me a naïve one which I would liken to the worker who says they are blind when it comes to the colour of a young person’s skin. This is to deny the whole life experience of the child. We cannot, it seems to me, ignore personal history and its influence on a young person’s life, not only because of what the young person is experiencing now, but also because we should not ignore its influence on what the residential child care worker is experiencing now. Yet, at the start of the relationship between the young person and the residential child care worker, the latter has to reflect on the influence which the young person’s and the worker’s own pasts are having on this hopefully burgeoning attachment, at the same time as carrying out the immediate practical task of providing an environment which can both accommodate and engage this young person who is in the throes of experiencing a plethora of powerful, painful and confusing feelings such as rejection, abandonment, guilt, fear, anger and loss. In whatever way he presents these feelings in his behaviour - by being withdrawn, brashly accepting, angrily aggressive, or by being desirous to please - the young person will be, if any kind of self-esteem remains, in a state of extreme anxiety and feeling uncertain and insecure. It is essential if a children’s home is to be therapeutic that the staff provide an accepting environment which ameliorates these symptoms by making the young person feel safe. In psychodynamic terms this is known as providing ‘containment’. Here, the provision of a welcoming safe place to stay is symbolic of saying ‘no matter what you are feeling, however sad, anxious, angry, hateful, or fearful you feel, we can deal with it. We will hold you until you feel better’. This is exactly what the nurturing mother figure does for her crying infant.

Primary Care

A safe, containing and accepting environment is initially manifested to the young person by the physical surroundings of the children’s home and this includes how the home appears to the young person externally, internally and consequently culturally. Where a home is situated, what it looks like and how it is furnished as well as what the other children who live there are like and what the staff who work there are like tells the newcomer a great deal about the home. Of course the most engaging and emotionally containing attribute of a children’s home providing a safe and therefore therapeutic environment is the quality of the relationships established by the staff in their day-to-day interaction with the young people. This work is primary. It is primary because – carried out with the right kind of sensitivity - it replicates the nurture that all children should have been provided with at the beginning of their lives.
Primary therapeutic care in a children’s home is offered by staff who are using the every day routines, rituals and activities in the group living setting as instruments for engaging young people, and through time, developing healthy relationships with them. Success in the making of healthy relationships depends both on the ability of the staff to contain the young people emotionally and on how the social and emotional climate of the home facilitates each young person to become attached to the staff and home and all that this potentially has to offer. This requires staff who are capable of making attachments to young people whose attachment bonds have been disrupted in earlier childhood. This may mean being able to sustain a relationship with for instance, a youngster who in human development terms occupies a 14 years old body, has a mind which is described as intellectually above average but who, because of the severe tribulations of his life remains emotionally, an infant. Such a youngster is likely to have built up a powerful bank of what inevitably become unhelpful defences against a world which he has experienced as being populated by adults who are hostile, abusive and untrustworthy. It is the residential child care workers therapeutic task to help him feel safe enough to learn that trust between people is both possible and healthy.


Making and sustaining a relationship

Making and sustaining a relationship with an emotionally troubled youngster which will allow him to grow healthily involves the reliable and consistent giving of good experiences of primary care. This is an essential foundation of an effective therapeutic approach to caring but it is also a powerful means of promoting personal change and emotional growth. Yet the proffering of such services can often meet with virulent resistance. Young people who have had the disrupted nurturing experiences which are invariably the lot of those placed in children’s homes, have good reason to mistrust overtures from adults who promise better things. For too many of them there have been numerous new beginnings which invariably it seems, end in rejection. To be therapeutic, workers need to show resilience and transmit through their actions both sincerity and sustained commitment in the face of understandable - yet often experienced by the worker as unbearable -hostility from the young person in response to her friendly gestures.
In the group living setting of a children’s home if staff are to engage with the young people and are to offer them emotional containment in order that their personal growth is cultivated, another necessary element of developing and sustaining healthy relationships is intense adult attention to the unique individual needs of each of the young people. It is vitally important for every young person in a children’s home to know that at all times he is valued positively in the minds of all the people responsible for his care and particularly so in the mind of the member of staff who has a special responsibility for his day to day care. The young person who feels cherished has, in my view, an enhanced potential to make healthy stable relationships with others when he eventually leaves the home. I want to get over here the need for immense sensitivity, insight, and prolonged determination on the part of residential workers if they are to be therapeutic.


Time for reflection

By offering individual care programmes in which allowing time for reflection is just as important as planned action, it becomes possible to begin to meet the emotional needs of the young people. It is imperative too that if we are to prevent the young person becoming institutionalised, the individual care plan which we make for a young person while he is in our care is a part of a wider overall plan which takes into account all the aspects of the young person’s life. Furthermore any caring strategies within such a plan must be focused on the underlying reasons for the young person being placed with us and should not merely be reactions to current symptomatic behaviours. To make sense of all this does not require action alone, it also requires that time is set aside both informally, in day to day life space situations, and also formally within the planning process, to ponder of over developments in the young person’s life so that a safe platform is built from which new directions can be taken with a degree of security.


Tenacity in therapeutic care

For staff working therapeutically in children’s homes, talking about being therapeutic, or having a notional sympathy with what might be described as therapeutic principles is not sufficient. Therapeutic care does not materialise out of good intentions. Staff working therapeutically require not only an intellectual understanding of the therapeutic approach, they must also have emotional understanding of it. If their work is to encompass all the therapeutic processes implicit in the practice of the home, the staff must be the joint proprietors of the mission of the home and be clear about the policy and procedures which go along with it. This approach is also effectively underpinned and reinforced by staff who recognise the importance of being a harmonious but self-questioning team which has the ability to work together with a common understanding and purpose. The approach also brings out the need for workers to understand that they, as well as the young people, are affected by the therapeutic process. It is a process which can stir up feelings in workers about events in their own upbringing which need to be acknowledged if they are to sustain healthy relationships with the young people. I hope that I am implying to the reader that all this is easier said than done. Sometimes it can appear all too tempting to walk down the line of least resistance to gain a short period of quietude, but inevitably this engenders deeper and longer term problems and takes both the young person and the staff away from the therapeutic task. Adults must remain adults when the boundaries are tested and ensure that whatever happens the young person is left feeling that the worker remained a sensitive and mature caring adult.


The significance of the group

In any form of residential child care it seems axiomatic to say that the group and its dynamic is an important element of the care provided. Yet the National Minimal Standards for children’s homes (DoH, 2002) make no reference to the significance of the group in the work of children’s homes!
In therapeutic residential child care the group and its dynamics are used to foster the therapy. It is important that the group as whole, in this I include both young people and staff, is able to contain newcomers while they become familiar with their new surroundings. The group itself works as a small community, and can give a young person opportunities to work through and resolve the problems he faced when in the wider community before he came to live at the home. Staff need to become comfortable with the group ethos and with joining the young people as they use group meetings to solve the problems of the day to day life of the home. They should also be aware of the dangers of groups and be able to contain the unconscious processes such as scapegoating and merging which are an inevitable part of group life.


The role of managers in the therapeutic child care setting

Those members of staff charged with the overall management of the children’s home must have the resilience to withstand the pressures which act against the achievement of working therapeutically. These pressures are inescapable in a children’s home where young people experiencing intense emotional difficulties are brought together. To contain the young people in order that staff can help the young people work through these problems, managers too must have an understanding of what the young people are experiencing, but they are required also to have a capacity to contain emotionally both the young people and the staff as the therapeutic process of ‘working through’ problems is in progress. This level of informed, insightful awareness in the managers is essential if staff are to be fully supported in understanding and feeling the meaning of their work while at the same time being helped to cope with the anxieties it throws up for them.
Managers of children’s homes have also to concern themselves with containing the tensions within the home but also with the tensions created by the home’s external relationships. Conflicts tend to arise with other interested professional bodies, such as social workers and teachers, but also with both the local and wider communities who may have little understanding of the purpose and culture of children’s homes. This asks that managers have an understanding of what outsiders to the home may call ‘the real world’. Managers of children’s homes have a responsibility to reach and manage a tolerable balance at the point of engagement between the children’s home and the external world. This calls for discreet and diplomatic communication.

A children’s home which is making a genuine attempt to put in place all the elements of care which have been discussed here has made a start towards becoming ‘therapeutic’. Therapeutic residential child care has been shown to be helpful to young people when time has been allowed for all the stages of the therapeutic stages to unfold. Once embarked upon it is a process which has no short cuts. It is almost invariably the case when working therapeutically with a youngster newly placed in a children’s home that the symptoms of a young person’s underlying problems will escalate before the deeper problems can be resolved. An all too easy and devastatingly demoralising trap for those charged with the responsibility of looking after young people placed in a children’s home is to have the expectation that there is a co-relation between the provision of a safe therapeutic environment and an immediate improvement in the anti-social symptoms of the young person’s underlying problems. These symptoms are the harmful defences which the young person has mostly unconsciously developed over years to protect him from the anguish and the fear he has of the underlying emotionally difficulty. Inevitably at the beginning of a young person’s stay at a therapeutic children’s home, when staff slowly ease him towards the source of his pain, he is so fearful that he will not only exhibit his anti-social symptoms but almost invariably amplify them. It is only after being assured over a period of time while living at the children’s home that the staff and the resident group can contain him emotionally to the extent that he begins to sense that he can survive living in the home and survive dealing with his underlying difficulties.


The importance of having well-trained staff

I will have succeeded in my intentions if I have persuaded the reader that therapeutic work with young people requires care workers who are well-trained. I have argued that they do not need magical, esoteric knowledge to work therapeutically, but that they do need emotional as well as intellectual insight in relation to the young people they work with and in relation to themselves. They will need to have an informed understanding of human development, and to know about what can happen when a youngster has missed out on important developmental stages as a consequence of poor nurturing experiences. In turn it requires residential staff to use this understanding to exercise the tolerance and sensitivity which will be needed if they are to help the young people feel better about themselves – to feel they are healing - and begin to experience the satisfaction of making healthy relationships. This kind of therapeutic work cannot be done by anyone but neither does it need to be done or led by some revered guru. The important point here is that all staff in a children’s home, and indeed all those who work in the life space of deeply troubled youngsters, need to have training which is specific to, and effective for, this most sophisticated and complex professional endeavour.



In summary a children’s home offering therapeutic care should be judged by the physical environment it provides, the primary care offered by its staff, the understanding and insight of the staff concerning the young persons’ needs both as individuals and as members of a group, the staff’s ability to offer intense individual care, the professional authority of the home’s managers, the unified vision and the shared sense of purpose of the staff in carrying out the mission of the children’s home, and finally the team’s effectiveness in promoting a better and enriched future for all the young people in the home’s care.

© Charles Sharpe 2006

References
Department of Health (2002) Children’s Homes: National Minimum Standards: Regulations for Children’s Homes London The Stationery Office

Reber, A, ed. (1985) The Penguin Dictionary of Psychology London Penguin Books p769

Sykes J, ed. (1982) Concise Oxford Dictionary Oxford Oxford University Press p1110

Sharpe, C. (2000) In Care, in Therapy? MA, Psychoanalytic Studies dissertation: University of Sheffield.

Welcome and have a nice day! Some thoughts for those who work in children's homes

Welcome and have a nice day ! Some thoughts for those who work in children’s homes.


I remember the first time I went to a MacDonalds, I was very impressed by the welcome the staff gave to each new customer. They wore a name tag and so I immediately knew each of their names and they always smiled and asked how they could help me. Once they had served me they said ‘ Thank you for your custom and have nice day’. Now I’m sure this politeness was drilled into them and I am not sure how sincere they were but their welcome was a good deal better than the surly one I was accustomed to in many British cafés at the time. (By the way I think the latter have learnt their lesson and are much better nowadays).

It made me think also about how the staff in the children’s home I had just started working in welcomed new children and visitors. Sometimes, I thought, we did not reach the standard MacDonalds set. I was sure that we didn’t always smile at people when they arrived, or introduce ourselves by name, or immediately offer them refreshment. In other words we were not making them feel special or at home.

We started to look at this seriously and we decided to do the following things :

Always to prepare carefully for new children and prepare carefully for visitors when we knew they would be coming. This meant preparing the home for them, and thinking of all the things that we could do to feel that we were welcoming them and showing them that they were special to us.

Always be ready to give a warm sincere welcome to all visitors whether they are expected or not. Meeting them at the front door, smiling and introducing ourselves to them by name, (we didn’t think wearing a name tag was right for a children’s home), and after establishing who they were and the purpose of their visit taking them to a reception room where we offered them refreshment. We did all this before taking the visitors’ book for them to sign. We decided we should present the refreshments in an attractive way on a tray with attractive crockery (like many families having our best set of crockery ready for guests).

When they had finished their business with us we would accompany them to the door, thank them for their visit and say ‘Goodbye’.

Wherever possible we would involve the young people in providing a high standard of hospitality to our visitors.

Once we got going on our new policy we discovered quite a few things.

Firstly it made us start to adopt a more considered approach to other aspects of our work related to our care of the children and also our care for ourselves.
We found we became less cynical our work.
We became much more aware of all of the home’s environment and we became more concerned to make it all seem more welcoming.
Now that we were much more vigilant and enthusiastic about our welcome we became more aware of keeping our children and young people safe. We were careful to make sure our front door was not left open for anyone to walk in from the street. We were making sure that when one of the children rushed to answer the doorbell one of us was not far behind door for a visitor, not because the children did not in general welcome the guests but because there were occasionally times when the young people were uncertain or indeed indifferent when visitors came and so by being there we could assuage potential problems which might have arisien.

It seemed to me that our new approach was a morale boost to us all and we each took turns once a month at our staff meeting to briefly review how our guest hospitality was going.

I’m not saying that other people should do exactly what we did but I hope this gives food for thought. The food I’m thinking about here is not a quarter pounder with cheese, though that used to be my favourite

Thanks for reading this, and have a nice day ! (Written with a genuine smile on my face)



Charles Sharpe, June 24th, 2006