By Jane Benanti, consultant chartered psychologist
As a senior consultant psychologist who has worked in multidisciplinary teams in child and adolescent mental health services (CAMHS) as well as other NHS and private sector roles, I have been struck by the minimal emotional support offered to social workers I come into contact with. The needs of extremely disadvantaged service users they are trying to support and the issues they are facing make social work emotionally draining, even after years of experience.
Cases that ‘trigger’
It is not necessarily the very severe case of, say, child cruelty that triggers stressful emotions and consequently practitioners’ own painful memories. It could be an adult fighting for a voice within chaotic circumstances, or the caretaking child who puts the self-serving needs of a parent and the daily requirements of younger siblings ahead of their own.
This article is part of Community Care’s Stand up for Social Work campaign. We’re standing up for social work by being honest, offering support and providing inspiration.This last one is a classic example of family dysfunction, sadness and false hope that many in the caring professions will understand: the intrinsic, compulsive need to “save” others.
Clouded judgement
It is for reasons like this that clinical supervision is vitally important; emotions linked to difficult past memories buried deep in the unconscious will almost inevitably be processed during casework. This has a significant impact on practice – personal memories can suddenly “pop up” and cloud our judgment.
Our professional decision-making is affected when we emotionally cut off and reject a particular client (perhaps with that feeling of “this one particularly irritates me”), or when we are drawn into a collusive relationship with a parent and are not alert enough to the potential harm to a child.
Becoming detached
I have witnessed social workers and psychologists become emotionally remote and detached when overwhelmed by stress. This may help the professional survive toxic situations but it can damage our work with service users.
We are humans with feelings and failings. We have our own family stresses, professional difficulties with managers and even with our colleagues within the team.
Yes, other professions face the same challenge, but the difference is that they are not exposed to distress and negativity at work almost every day of their lives and expected to process it like an automaton.
‘If there is no distress, social workers are not needed’
Social work in many fields is about helping those who are distressed or struggling. All professionals deserve and should expect support to process these emotions, not least to help ensure continued good practice with service users.
So what type of clinical or therapeutic (as opposed to managerial/workload) supervision should social workers be getting? How should it be structured, who should deliver it and how often? I would suggest something along the lines of the model below:
- In my view, appropriate professionals to deliver this type of supervision are applied psychologists (counselling or clinical) who are some years post qualification or mental health nurses with a robust training in psychotherapy or counselling (for example, a counselling model studied and practiced for a minimum of two to three years). Previous experience of providing supervision is essential.
- Junior social workers should be offered a 60 minute session of clinical supervision fortnightly, in groups no larger than three. One or two of the group may have something substantial to bring whilst the remaining one observes and contributes.
- Other times, two or all three may want to bring cases and the time is divvied up accordingly. The session is structured so that the social worker decides which case(s) to bring, but the supervisor will ask why that particular case has been chosen over another.
- A more senior social worker may need an hour of clinical supervision per month where issues can be brought, whether related to complex social work cases or responsibilities within the team, as well as relationships with senior and junior members of staff. However, it should be clear that it is not an open forum to discuss personal life outside of work, unless in exceptional circumstances.
- At times, supervision may need to be scheduled ad-hoc following a difficult home visit or traumatic event but this could be by phone, outside the more formal face-to-face scheduled sessions.
Setting up the system
Quality assurance covering supervision will apply and the framework of the supervisor’s professional body, as well as the social worker’s organisation, should be adhered to. An audit trail will be needed to assess the added value as well as costs.
Initially, there may be some teething troubles but these should straighten out so long as the will to provide a better service is there, best practice is there, and quality assurance overarches all.
Getting support from the top
Experience tells me that challenges will lie at the top of the safeguarding tree, in the carpeted council offices, with people a million neurological images away from a neglected or abused child.
I would suggest that anyone in those top floor offices (senior management, councillors and the local MP) spends three days shadowing a junior social worker. This would demonstrate at least an attempt to understand the realities of practice and, I believe, show them how seriously clinical supervision is needed.
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While the premise of better, reflective supervision is a good one, I’m not convince that psychotherapy provided by someone without any professional experience of social work is the best option. What we need are people within the profession with the skills and the time to provide proper clinical supervision. The Freudian idea that we need to delve deep into our horrible repressed past has failed of 100 years of practice to provide any evidence of efficacy.
What we need are tools that help us to reflect on our experienced emotions now, and to resolve them (through being contained by our supervisor) in the now. If it helps to talk about an incident in the past in order to make sense of our anxiety, then fine, but often it is not really needed.
If we want experienced social workers to remain in practice and not suffer from burnout at the rate they currently do, then reflective supervision is obviously very important. I’m just not convinced that the willingness to provide the resource, or the people with a high level of skills, exist widely enough to make it part of our professional culture yet.
I worked as an IDVA and received clinical supervision as a part of that role as it was a requirement for CAADA (now Safelives) accreditation. My colleagues could not believe that social workers do not generally have clinical supervision considering the emotional impact of the role. I think that social workers generally find appropriate ways to deal with potentially distressing incidents and situations, but the emotional toll taken by constant high workloads and pressure from other professionals who expect social workers to have some kind of magic wand when it comes to safeguarding, is something that seems to be swept under the carpet. This is why I believe clinical supervision should be mandatory for social workers, and I find it quite frightening that it isn’t already.
As a social worker (now retired) the last thing I needed was more supervision. In my last (part-time) permanent post I was allocated three supervisors for monthly supervision! Supervision seemed more about hierarchical control and risk management than about what might be useful to the family or to myself as a social worker.
I have always argued that agency supervision infers a judgement about practice in terms of good/enough or more needed / right or wrong / etc., thus triggering the brain’s threat system. When feeling threatened social workers are not able to explore emotions and intuitions.
My high hopes about what Eileen Munro might achieve have been dashed. From what I have read recently, even consultant social workers and systemic practitioners working within the ‘Reclaiming Social Work’ model are being overwhelmed by exploitative and abusive case allocation.
Far better (IMO) for social workers to accept agency supervision as a management tool for agency control and to instead campaign to access independent/peer consultation and/or coaching for professional and personal development – if/when a turnaround in agencies’ complicity in the neoliberal capitalist agenda can be achieved.
In the good old days supervision used to include emotional support and help with processing events and looking at the impact the work was having on the social worker. Perhaps it still does in some areas although it does seem to have become very task and measurement oriented as far as some are concerned. Supervision training that I was involved in delivering as a SW trainer stressed the importance of this reflective and supportive element of supervision. Working with nurse colleagues on a Practice Teacher programme I was interested to find that this element of supervision was separate for them. The nurses were intrigued by our model of combining the two forms of supervision and felt this would be beneficial for them. Therefore I find it slightly ironic that a medical professional is now pushing their model onto us. And as for it being delivered by health professionals, well, she would say that, wouldn’t she. In my view, all SWs should have supervision from social workers, either within or outwith their team (if the team is managed by a non-SW). Case management could possibly be carried out by someone from a different profession but the ‘softer’ (but equally vital) elements described in this article should be delivered someone with a SW background, if necessary an external consultant. I do agree with Jane Benanti that SWs deal with difficult, intense and emotional situations and should have support to do this with additional counselling on offer if matters have been particularly traumatic.