By Professor David Shemmings
Zoe – a social worker who’s recently completed her ASYE – is coming back from a visit. She rushes into the office in a fluster. Her colleague Tom notices she’s in a bit of a state and asks, ‘You forgotten something?’ ‘No’, says Zoe, ‘just my brains when I decided to become a f****** social worker!’
‘What’s happened?’ replies Tom. Zoe sounds irritated and sad at the same time: ‘That father…he’s a bully. I know he’s harming his little boy … he’s only three for goodness sake … and he’s emotionally tormenting his wife but she’s too scared to do anything and won’t let me help. I just don’t know how she copes quite honestly. Do you know …’
Tom interrupts to advise her: ‘You can’t let it get to you Zo; this happens all the time.’ He says he has to go out on a visit but that she should talk to her team leader.’
Zoe is apprehensive about visiting the father again. She finds him a bit creepy and aggressive towards her. She’s conscious that she’ll probably have lots of cases like this during her career and doesn’t want her team to think she can’t cope. But she finds herself thinking about him and running through scenarios in her head at different times during the day. She has difficulty sleeping; when she does, it’s fitfully and he’s always in her first thought if she wakes in the night … and she can’t stop thinking about the boy … and his mum …
‘Intrusive thoughts’
These are some of the classic signs here of an individual experiencing post-traumatic stress disorder (PTSD): unwanted and intrusive thoughts, difficulty sleeping, oscillating between shutting down one’s feelings and becoming drowned in them.
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Being a social worker does not (usually) involve the same stresses as, say, a firefighter or other first responder. But social workers can experience vicarious or secondary trauma from working alongside people who are suffering and in emotional pain, but who can also come across as being difficult to work with by appearing hostile, rejecting, or threatening.
Experiencing this kind of trauma can lead to decision-making being impaired as a result of ‘hot cognitions’ (in other words, the ability to think clearly is impeded by powerful, unprocessed feelings) and can result in social workers quickly becoming burned out.
This is why growing numbers of social care organisations are recognising the need to become ‘trauma-informed’. I’m working with a number of local authorities in the field of family support and child protection that are reviewing their supervisory, management and leadership practices to incorporate an awareness of how trauma impacts practitioners.
‘Facing the feelings’
I start by inviting social workers and managers to think about the difference between ‘event-based’ and ‘relationship-based’ trauma. We then discuss how trauma can affect the way we make sense of our emotions, how we think and how we can become more resilient by facing the feelings rather than repressing, suppressing or even denying them – this is OK in the very short-term but doing so doesn’t work for very long. (It’s always worried me the number of practitioners and supervisors who think that emotional resilience means ‘not showing your feelings by keeping a lid on them’.)
We talk about how colleagues deal with unprocessed emotion in the workplace: do they talk it through, act it out, end up having to take some time off, become grumpy with friends and family?
Or do they have ways to regulate the powerful feelings they are experiencing, thereby re-centring their emotional clay to offer the families with whom they work the safe haven and secure base they need? Anyone who’s tried making a clay vessel on a potter’s wheel will understand what I mean here: you have no control over the clay unless and until you centre it on the wheel
Organisational culture
What we find – and this is borne out in many studies in this field – is that it’s the culture of the organisation, rather than the actions of individuals, that determines how successfully practitioners will address these questions. And sometimes a ‘supervisor’ is not the best person to offer ‘supervision’, because they might not at the time possess ‘super’ … ‘vision’ (literally, better sight!) when it’s needed. Sometimes one’s colleagues are better placed to do that.
But whoever offers it, it doesn’t necessarily take a long time. A couple of minutes, to say how you (really) feel and then be listened to quietly, intently and with interest and kindness by a co-worker who, at that point doesn’t offer advice – that may be needed later – is often all at that’s needed to set you back on track. Rest assured, we’re not talking about a 30-45 minute counselling session here!
You will no doubt already recognise something in this idea: this is exactly what good relationship-based social work involves!
Our understanding and conceptualisation of ’empathy’ is going through the mincer at the moment as a result of a recent book by Yale psychologist, Paul Bloom, called Against Empathy. He cites quite a few research studies claiming that ‘feeling someone else’s pain’ can sometimes make us ‘unwell’, not just physically but emotionally too. This is why Peter Fonagy’s notion of ‘epistemic trust’ – knowing that we have been demonstrably and verifiably understood (‘episteme’ is Greek for ‘knowledge’) – is starting to find resonance in the field of ‘relationship-based practice’.
The role of social care leaders is to help create the conditions for the organisation to become more ‘trauma-informed’, to cultivate a culture in which it’s OK to be sad about the people with whom you are working; and it’s OK to be angry, or have any other feeling … but it’s unwise to leave these emotions unprocessed and unregulated because then they can fester and erupt unannounced and unexpectedly.
When organisations get it right, a virtuous cycle starts to turn. And, anecdotally at this point, I keep hearing powerful messages from social workers who tell me that, when the circle rotates, the various innovations they are trying out – such as Signs of Safety, systemic approaches, motivational interviewing, attachment-informed approaches, strengths-based approaches, solution-focussed work and so on – are applied with more fidelity to their theoretical bases, and with more confidence too.
David Shemmings OBE PhD is professor of Child Protection Research, University of Kent and Royal Holloway, University of London
David is one of a number of expert trainers, practitioners and leaders speaking at Community Care Live London on 26-27 September. Register now for your free place.
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Hi just read this article and feel like I’ve been hit by a thunderbolt. This is just how I’ve been feeling and recently unable to make the smallest of decisions even in my personal life.
Child Protection is extremely busy at the best of times but now with a lack of staff and higher case loads it’s becoming unmanageable.
If you ask for help there isn’t any apart from the superficial pat on the shoulder and a cup of tea. Organisations need to look after their workers have they not yet realised that good workers who are fully committed can only take so much and if support, understanding and recognition isn’t acknowledged then we leave.
I completely identify with what is being said here. Social work practitioners need to look after one another and offer support to other practitioners going through challenges in casework. As a social worker for 9 years, I am conscious that I have taken on the trauma the children and parents are dealing with as well as challenges in my own life. It is vital that we have counselling and trauma support and it is a significant deficit in the service that needs to be changed. Just yesterday a colleague broke their heart over a young person they are working with and a traumatic experience they have been through. The social worker was distraught about their young person. I sat and listened and suggested using our services listening service. I felt I was able to help the practitioner offload but ineffective in helping them move forward. Trauma support is offered in other professions such as to police and paramedics but as social workers this is something we don’t utilise but we should. This article has inspired me to read more about trauma support and put myself forward as a team member to offer that support to colleagues and train as a counsellor.
New buzzwords for old concepts..
eg in lieu of ‘trauma’ try using words like ‘worry’, ‘listen’, ‘feel’, ‘understand’, ‘respect’, ‘limit’. ‘humanity’ etc .Would’ent be nearly as ‘ground-breaking’ as ‘trauma’ though.
Social work is becoming increasingly difficult with limited resources, increased caseloads and more complex cases. To offer a few example from adult services:
1. A case of self-neglect
The person is refusing to accept help and support. There is a long history of abuse and neglect going back to early childhood and the Social Worker is concerned that this is impacting upon the person’s ability to make decisions. Most agencies believe that the person has capacity to make most decisions however, specific capacity assessments have not been conducted, as the person will not engage in anything other than small talk. The house is filled with clutter and the physical wellbeing of the person is rapidly deteriorating. Fire risks and risks to others have been addressed and so the concern is for the person themselves. All parties believe that the person is likely to die without intervention. Mental Health services have closed the case, due to lack of engagement. Safeguarding meetings have been conducted, assessments and recording of why agencies feel the person to be capacitated recorded. The person refuses all therapeutic intervention and will not answer the door to any medical professionals. The ethical question is at what point does the multi-agency team consider this to be an autonomous decision made by the person to end their life and to provide care and support with limited intrusion? Most medical practitioners find this decision difficult with empirical medical evidence about the diagnosis and the autonomous choice of the person. In this scenario little of this can be achieved. Often one practitioner is left worrying about the person and desperately trying to engage, potential violating a Human Right to private life.
2. A case of sexual exploitation
The person is twenty one and has been raised within the looked after system. She is an adult who appears to be making capacitated decisions and choices to drink and engage in sexual activity or someone affected by sexual abuse as a child, grooming and coercive and controlling behaviours that are not considered an intimate relationship for domestic abuse purposes. The Social Workers sees that she is increasing substance misuse, increasing drug abuse and is often distressed by what happens to her. Sexual exploitation is clear to all professionals however, she appears to be choosing to do this.
I could continue with a raft of similar scenarios that Social Workers tell me about on a daily basis. When working with people identified in the scenarios above, do we need to look at the impact of abuse and neglect on a person, their self-esteem, self-respect and self-efficacy. When people are abused and suffer trauma as a result of abuse / neglect they can become suspicious of people and services who have let them down in the past. The trauma mode of the brain does not create chronologies of events, so they are not credible witnesses. Their ability to plan and prepare is impaired and so they do not make / keep appointments. Services close down to them and eventually some people are blamed for their behaviours, stating that it was choice. Is it a choice to self-neglect or be sexually exploited?
The Social Worker can become exhausted, stressed and distressed trying to break down these barriers of oppression and discrimination, trying to engage the person, trying to change the negative impact of events on the person’s self-esteem and being pressured to address other cases where something can be achieved. The anxiety increases as they are told that they must preserve life, they have a duty to care, that this will result in a Safeguarding Adults Review and they need to do something.
The trauma experienced by Social Workers needs to be not only supported in a culture of discussion, multi-agency responsibility for decision making and more effective supervision, but also through strategic intervention and planned responses to barriers, decision making, legislation and ethics in cases where there is multiple abuse, or high risk potentially resulting in death.
Thanks for this insightful and well expressed article. I invite your readers to take a few moments to watch the trailer to our documentary about compassion fatigue and staff resilience and to learn more about this important topic at http://www.caregiversfilm.com Please feel free to contact me with any questions at viccompher@comcast.net.
I have this in my team, which is why I stay in my team.
My team is the epitome of what this article suggests, however, it is unfair to place this responsibility entirely on our colleagues. All employers should implement reflective supervision and offer a councelling service for both front line workers and managers, and practitioners should not be judged for accessing this support. A lot of these articles I read about “new” or “innovative” ways of thinking and approaches is not rocket science – we just need employers who value us enough to introduce common sense solutions to every day problems.