From birth to death: seeing clients through their life can take its toll

By Elizabeth Rylan

One of the privileges of long-term case work is following clients and their families as they progress through their lives. Social work truly is a job which covers births, marriages, deaths and anything and everything in between. Sometimes we are witnesses as events unfolds, sometimes we are co-creators supporting people to make and implement their own decisions and sometimes we arrive in the aftermath of a life-changing event and try to negotiate the process of rebuilding.

Yet as well as being one of the most rewarding aspects of the role, prolonged involvement can also be one of the biggest challenges.

We work with complex people in complex circumstances – demanding at the best of times and relentless and overwhelming at the worst.

I have read various articles which identify the benefits to clients of having a consistent case worker.  I agree that stable staff input can make it easier to build and then maintain communication and trust with the person and their network. It also often means that a potential difficulty can be simply and swiftly addressed before it becomes a bigger concern, because the practitioner is familiar with the situation and different dynamics at play.

That being said, I feel it is important to acknowledge this can impact on the practitioner in a variety of ways.  Seeing the same name or names on your caseload list as the days, weeks, months and even years pass can take its toll, particularly if there seems to be little in the way of tangible progress and reward.

So how to stop the occasional sigh, or thought of “what now…?” from turning into compassion fatigue? There are some techniques I have found useful in my practice, which I hope by sharing will support you in yours.

1 Acknowledge the timescales

Make a chronology to capture the main dates of the first visit, assessments, key meetings and any particular sticking or turning points. This can also help you identify whether there are any patterns to when crises tend to occur, for example, at certain times of year or at certain intervals.

Identify a time when something has gone well – what factors contributed to it being positive? Can you pick out any changes, even small ones, that have occurred over the past few months or year – or if not, then is maintaining the status quo an achievement in itself?

When you are working on a case day by day and month by month, the time can pass really quickly and even though you have been doing active work very regularly, you suddenly realise the last assessment is 18 months old and it can be beneficial to pause and revisit this as a foundation.

2 Define your remit

When you are doing odd bits of work here and there, or constantly fire-fighting, it can be easy to lose sight of your overall objective. Take some time to sit down and reflect on why you are involved and what the overall aim is for that involvement. This may or may not be the same as when you were first allocated, and it is important to recognise that situations, and the nature of professional input, does change.

Consider whether your aim matches the client’s expectations. Perhaps this is an opportunity to check what it is they are seeking from statutory services and what they see as your ongoing role.  This is also a way to confirm that involvement is still necessary, and that there is a purpose behind there being an active, allocated social care representative, rather than it drifting or being seen as the norm. Set a goal, no matter how small, associated with your redefined remit to help provide some clarity and structure for you to work towards. Depending on the nature of the situation, can the client also set a similar goal for themselves?

3 Seek support from others

I feel it is important to remember that while I may be the named worker, ultimately the client is a client of the wider service and not my sole responsibility. I am part of a team and therefore there are multiple people whose knowledge and skills I can draw on. It has been especially beneficial to me to complete joint visits and ask for feedback afterwards. I have found it doesn’t tend to matter who is accompanying me – someone of another discipline shadowing for the day, a student, colleague or supervisor – more that there is another person there.

It can act as a mini ‘test’ to myself to provide a synopsis of the situation, to outline what my role and purpose is and to confirm that I do still have a clear focus and rationale for intervention. The discussion afterwards can either help affirm my understanding and approach, or the person may ask a question or offer a different insight which then makes me stop and reconsider. The added bonus of asking a colleague to join you on a visit is that you can both reflect on the peer review and include it as evidence of your CPD.

Or perhaps there is a student who could complete a time-limited, focused piece of case work under your guidance? Not only would this provide a measurable and worthwhile intervention for the client and learning opportunity for the student, it could give you the breathing space to step back, even just for a short period, to rest, regroup and regain motivation.

4 Know when enough is enough

Sometimes the worker/client relationship does reach the end of the road and this outcome does need to be considered and planned for. This isn’t to be unexpected – all relationships go through changes whether it is in our personal lives, with our employer, or in other scenarios, and there is no reason why the dynamic between a client and a professional is any different.

If despite all efforts, you are continuing to feel stagnant, overwhelmed or reaching the point where your empathy is rapidly depleting then a change may be necessary. If so, then the most important thing is to raise it with your supervisor or manager, explain the steps you have taken to seek a resolution and, unless they can offer an alternative solution, request either a break from the case or for it to be re-allocated.

I have heard people comment that there is little point in doing so because all workers are as overloaded and over allocated as each other, however, unless you take ownership and ask, you will be unaware of what the options may be. For all you know, another colleague could be experiencing a similar difficulty.

It may be that you can negotiate a ‘case amnesty’ and swap, which would support you both and ensure continuity for the clients.

Alternatively, discussing documents such as your chronology and summary of key points of intervention with another person could lead to new ideas being generated and support to re-focus the situation. Either way, you will have evidenced that you are a conscientious and reflective practitioner and are seeking the most effective and appropriate outcome.

Elizabeth Rylan is a pseudonym for an adults’ social worker based in a local authority in the south of England