Chapter 36 – Des Mooney (D2SOP13)

Introduction 

This chapter sets out to explore the theme of professional relationships in social care practice. As professionals we do need to be mindful that at times there can be a blurring or misunderstanding of relationships in the workplace. Using the themes relationships as process, integration of theory to practice, communication, power, supports and teams, this chapter will explore some of the complexities involved in our work. While we work with the most vulnerable in society, we need to be mindful of the impact of this work on our professional relationships. Using a case study, the chapter will explore how difficulties in one area did impact on other areas. We will also look at how, through good communication and supports, relationships were strengthened with better outcomes for all involved.

Professional Relationship as a Process 

Given that much of our work is driven by relationship-based practices it is incumbent on us to understand that how we act and react, our use of language and manner, and our actual practice, both with our colleagues and our clients, is very important. The bonds of trust between service users and social care workers are tenuous at the best of times and one false word or deed can significantly impair a previously positive working relationship.

We need to be mindful throughout our work that we understand the world and our experiences in a different way from many of our service users. The idea of trust has been shattered for many of them, so that any action or word can be interpreted differently from what was intended. As we form a professional relationship with a service user, we explore the ways in which the service user communicates and responds to messages. We work within the parameters of their understanding, not ours. We need to be kind and careful. It is important that when we impart information the service users completely understand what we are communicating. This could be important information relating to their care or placement; or it could be a joke. How we relate to our service users, our tone and body language are equally important.

I spoke to Blossom about how I felt she had made an error, that she had thought she was in a ‘friend’ relationship with Judy, where loose language could be tolerated, that her boundaries were skewed, that the mantra ‘friendly not friend’ was absent, that, while being friendly, the social care practitioner had to maintain a professional relationship with the service user at all times – not sometimes. I asked Blossom did she think she was going to be sitting at home, PJs on, glass of wine in hand, watching Ant and Dec’s Saturday Night Takeaway with Judy? Blossom replied with horror, ‘Of course not.’ I replied, ‘Why, then, did you speak to her like she was one of your mates?’ We spoke for a time about whose needs were getting met by the dynamic within the social care practitioner/service user relationship. We also talked for a while about how Blossom imagined Judy saw the relationship. Blossom thought about this for some time and then spoke of Judy really looking forward to ‘me coming in’; of Judy smiling and waving when she entered the building and of Judy getting very upset when Blossom greeted someone else before she greeted Judy. I asked Blossom what they talked about. Blossom responded ‘everything’, but could not be specific about anything they had talked about.

Integration of Theory with Practice 

Laura Steckley writes of students and practitioners of social care struggling to meaningfully integrate theory and practice ‘with concerning gaps between what is being espoused in the literature and what happens in the field’ (2020: 2). Phelan in Steckley (2020) notes ‘the immobilising sensory overload experienced by students on placement and newly qualified practitioners’, describing how they instead turn to ‘“common sense” explanations and approaches’ (2000: 2); of a sense among some students that theory is a university requirement rather than an aid to practice. ‘This lack of integration or even rejection of a theoretically informed basis for understanding and decision making has concerning consequences – not only for the development of the workforce, but for the care experiences and outcomes of children and young people’ (2000: 2). While Blossom understood the importance of maintaining a relating approach in her relationship with Judy she had not adequately reflected on what was in fact taking place. The ‘immobilising sensory overload’ Phelan notes is a very common place for students and people new to social care. At times they are fooled into thinking that what we do is simple, when in fact they are not quite grasping what is taking place. At other times it can be overwhelming.

Cameron notes the difficulty in breaking down communication into a skill set and of producing meaningful criteria for assessing its quality, while also noting how safe and appropriate practice to service users has a moral and ideological dimension. ‘Therefore, it is important to give trainees the opportunity to discuss – and reflect critically upon – the beliefs and values that underpin judgements on communication in care settings. If they are presented as simply common sense, there is no way to resolve the problems and contradictions which may arise in real world situations’ (2004: 71). The ability to reflect upon practice through positive working relationships, supervision and other supports gives us practitioners the opportunity to unravel the complicated messages we are experiencing all the time. Over time it became clear that Blossom was not reflecting on her relationship with Judy, rather was taking a ill-considered common sense approach and not thinking in a deeper way about how one dynamic might support another and how these in turn might reflect in better outcomes for Judy. The cup of tea remained ‘just’ a cup of tea and not an opportunity.

Power within the Professional Setting 

Grainger notes power differences: carers, though themselves not a powerful group, presenting ‘their own definition of reality as more valid than that of a confused elderly patient’ (1998: 54); carers entering into patients’ ‘confused fantasies’ ‘because this made it easier to secure co-operation with routines’ (1998: 55). Seden notes the importance of communication; of a process involving thoughts, feelings, ideas and hopes being exchanged between people. Seden also notes how important it is to respect the values and beliefs of others and for carers to be consistent in their professional authority and function. ‘Meanings must be checked carefully, and in each exchange, care needs to be taken to be aware of, and reduce, the blocks to communication that can come from the many differences between individuals, such as authority and power, language, ability and disability, personality, background, gender, health, age, race, class’ (2004: 214).

Clearly Blossom needed to be more aware of what she was saying and how it might be understood by the service user, and, of the power dynamic on display. On the face of it there were two people sharing a cup of tea. Judy clearly enjoyed her afternoon tea with Blossom. It appeared to me that Judy was in control of the relationship and understood that Blossom, a staff member, took her out for a treat every time she came in; while Blossom appeared to think something else, that she was engaging in important work with a client (she was, actually) and that this in some way involved befriending her. Sometimes you don’t have to chase the work; it is right in front of you and you don’t have to tamper with it. If Blossom had done nothing at all maybe Judy would have enjoyed their time together more. By being overfriendly with Judy, Blossom made Judy feel uncomfortable; so uncomfortable that she made a complaint. The relationship already existed between social care practitioner and service user.

It was evident that Blossom had been engaged in some good work with Judy, and she definitely thought she was doing good work. Perhaps when Blossom made the remark Judy sensed a change in the power dynamic; from one where she was comfortable to one where Blossom was ‘in charge’. This prevented the relationship from progressing to one where practical social care issues could be addressed. It is often said by social care workers, ‘I get lots of work done in my car.’ I take this to mean a situation where a social care worker and their key person (for example) share a journey where gentle conversation, space, time and lack of intrusion from others allows firmer foundations to be created for stronger relationships, trust to be built and further work to take place.

The Dance (Part 1) 

Some might argue that Blossom was lucky to keep her job, that she had made a big mistake. However, on reflection and in conversation it became clear that the agency had some responsibility in this matter also. The concept of a team doing a ‘dance’, perfectly in step, where said and unsaid are understood, where higher thinking practices are normal, and empathy, listening, understanding others, the ability to wait and kindness are the norm is one I hear about in social care circles. Krueger writes, ‘like modern dancers, competent workers study, practice, and develop the knowledge and skills that allow them to be in their experiences with youth in the most effective and responsive way. These workers sense, as well as know, when to intervene or not intervene, move close or farther apart, raise or lower their voices, and increase or slow the pace’ (2005: 22). Krueger also stresses the importance of relationships when promoting development. In his 2005 study of youth work as a contextual, interpersonal process of human interaction, Krueger identified four main themes – presence, rhythmic interaction, meaning making and atmosphere – as contributing not just to positive relationships but also to the development of appropriate interventions.

Myer (2017) writes of social carers having varying levels of knowledge and experience within the social care system. It is a combination of experience, knowledge, maturity of personal and academic qualities and an ability to critically reflect, and self-reflect, that supports this social care ‘dance’ that we do. But significantly it is about relationships, understanding the difference between personal and professional relationships, and being willing to explore and reflect and change attitudes where necessary. Lalor (2013) writes of the quality of the practice environment, training, professional supervision, the philosophy of one’s peers, the ability to self-reflect, the ability to turn criticism into best practice, research and advocacy as ways in which a social care practitioner develops. All of these are done in the context of relationships.

One of the biggest learning curves a social care practitioner makes is when the concept of professional working relationship is ingrained into their practice. This, however, is a process. If I am asked how I would explain social care practice, my response is that it is all about relationships. Without positive working relationships, the work we do is stymied by miscommunication, suspicion, stress and weariness, by functions and form, by judgement and fault finding. It is not that the job doesn’t get done, it is just that it is exhausting, and no joy is gained from it. And it is where bad practice occurs. There is quite a blend of personal and professional relationships in social care, especially given the amount of time we work together and the sometimes stressful nature of the work. With positive working relationships the atmosphere is better, more creative, there is more sharing of information and ideas, people support each other and are honest with each other. Criticism is turned into better practice rather than personal offence and natural learning opportunities are rife. And people are kinder to each other.

Supporting Relationships in Practice

As a social care practitioner, I have my ‘go to’ people when I need advice. These are people who will tell me when I mess up and offer honesty and care. They will also support me at times of stress and worry. And they will celebrate with me when appropriate. This is important.

Three significant things happened when I started as a social care practitioner. One was that I had regular supervision from the time I started. This immediately meant I had a relationship in work even if I did not understand much about it. My supervisor did, thankfully, and over time I came to understand the value of reflecting on practice and acknowledging areas of learning. This includes making relationships with other staff members, making relationships with the young people in my care, the links between the staff team and the collective multi-disciplinary network and the macro/micro system of relationships that occur within this. I listened to the way people spoke to each other and to the people in our care. I watched as people created structured and boundaried environments for our young people to act out their own relationships with their world. I took risks and it worked, or it didn’t, and I brought this back to supervision and discussed the hows and whys. I watched how people work. I saw how different approaches work with different people. I watched as people displayed great bravery and no little honesty and yet at the same time they did not dominate situations, leaving room for the young person in our care to express themselves, and not be overloaded. And I talked about this in supervision. I watched as a group of 15 people, different personalities, with different approaches to the work, some loud, some quiet, some sporty, others artistic, some unassuming, others a ‘force’, action men, admin angels, kitchen devils, specialists, comedians, therapists, provocateurs, slackers and completists, all seemed to gather together under an umbrella of care and single-minded ambition; to try to make the tomorrow better than the yesterday for the people in our care. And I talked about where I might fit into this brilliant human machine.

I began to make relationships within the wider staff team. With some people you would be up until the wee hours talking about everything, not just work; with others it was function, get the job done, it’s late, time for bed. Some people came in with a ‘bag of tricks’ in the form of ideas, or activities, and sometimes I wondered if I would ever get a look in; other times I was glad because the ‘bag of tricks’ was so full of good stuff. Some were real talkers and I found out a lot about people’s families or relationships; others were full of questions and, depending on the friendship or mood I was in, I would tell all about myself. Some were funny, others were brilliant at getting you to say what was true, about yourself and others. ]

Some challenged my practice. This was uncomfortable but it was honest. Over time I understood that this was part of ‘the process’. That we weren’t going to get the job done by being nice all the time. This created fractures and at times there were tears and upset, and sometimes I took this terribly personally. Over time I realised that to challenge someone’s practice appropriately is a good way to help them to learn, reflect and shape their practice when necessary, to meet the demands of the task. Through experience and watching and listening and getting braver I learned more about controlled emotional involvement, theories of practice, listening, responding, sharing and recording information and workloads, and the importance of the team. I learned not to be afraid to look at myself. We ask so much of our service users. In some ways we have to ‘go to the well’ ourselves at times. When these difficult times occurred I still had other relationships within the team where I could discuss my dilemma. And when the learning was done we regrouped and moved forward. And I am more than willing to have my practice questioned and more than willing to question others’. The goal is the best care for the people in our charge.

I also began to make relationships with the people I worked with, in my case a group of teenagers in residential care. One was leaving soon, wanted nothing to do with the ‘new’ person. Her time was up. Making a new relationship just might have been too painful, or maybe she just wasn’t interested. Our relationship was one of respect, but I can’t say I got to know her well at all. Another ‘toyed’ with me; they were there a while also and knew how to play new staff; nowadays I look at how the young people look at new staff when they first meet them, what do they have in store for them? And will they survive? Two other young people were curious, and I began to get to know them. Between play, shared experiences, events, accidents, incidents, talking and listening, and time, relationships formed.

The next step was key-working a young person, being their advocate at meetings with the multi- disciplinary team, at reviews, listening to their ideas about how they wanted to be, making sense of challenging behaviours, empathising and being part of their holding environment. A very significant professional relationship but one with huge personal investment. The very fact that you know every detail about a young person you are key-working is in itself a personal investment. Trying to support them as they come to terms with their past, present and future can have quite an impact on the person. This is the place where wider team relationships become crucial, where the support network, both silent and obvious, becomes essential. Some moments become easier to understand, others become more bearable, when shared. Since then there have been many kids who have come and gone. We remember every one of the young people who pass through our door and we celebrate them and thank them for the collective learning they have bestowed on us.

Learning from Experience 

The first thing that irked me when I spoke to Blossom was that she reported that supervision was not happening regularly. Proper and regular supervision with an experienced supervisor will support better practice and also identify many of the issues Blossom was presenting with: lack of boundaries; thinking that she needed to be a friend to the service user; the fact that she felt on some level that she was working alone; and the fact that her relationships within the team in general were not great. In addition, proper supervision would have enabled Blossom to form a professional relationship with her supervisor where good practice would be discussed and encouraged. That Blossom spoke of ‘not great’ relationships with the wider staff team also concerned me. Social care practitioners speak about ‘a lonely place’ where work is difficult and suspicion abounds, where mistakes are pounced on and good work overlooked, and where relationships within the team are at a low. These are among the toughest times in our working life.

In my role as Blossom’s college supervisor I made contact with Blossom’s employer and arranged a meeting. At this meeting a number of issues were discussed. The issue of supervision was resolved and Blossom now has supervision once every two weeks. It was explained to me that because the unit was so busy it was not possible to provide regular supervision up to this point. Blossom was also appointed a mentor and an arrangement was made where Blossom would fulfill a number of learning tasks each week and these would be monitored. Blossom would also attend team meetings regularly and would be invited to/included in any training or events the unit would be having. I would also check on how Blossom was doing more often with both Blossom and her employer/supervisor. Much more structure and detail supported Blossom’s understanding of the experience, even though it increased the workload considerably. I also spoke with Blossom about how she could improve relationships within the wider staff team. Very often it just takes time for a team to get used to a new member; at other times a new staff member must look at what they are bringing to the collective and see where that fits in.

Blossom is happier at work, is still making mistakes, but nowadays she is learning from them rather than being punished and not knowing why. She is also engaging in good social care practice and this is being acknowledged, and the learning is being recorded and noted. Blossom has also made strides in her relationships with the wider team and has developed a good working relationship with her mentor. In addition, Blossom has attended meetings and training days with the team and noted how beneficial they have been to her development as a team member. She jokes about the shared ‘horror’ of role plays at these events and the fun and engagement, as well as the learning. I have encouraged Blossom to contribute to the meetings she is attending and to listen to the way others manage themselves at these meetings. Blossom asks more questions and reads more. She is engaged in a supportive role in many projects the unit is involved in. These include links between the local community and the unit, social skills, COVID-19 awareness, art, and ‘dance’ classes. Blossom also has developed much better relationships with the service users and when she talks it is now with a much deeper understanding of boundaries and the nature of care. Blossom also has a much better understanding of her relationship with Judy, although for the time being they are not working together on their own.

The need for us to build and nurture relationships within a team is very important and is in my opinion a key component in working independently with service users. Blossom has now got a place to go where she can discuss the dynamic between herself and the service users in her care and an opportunity to regularly explore the finer points of practical work with vulnerable people. Blossom also has the opportunity to talk about the way work is impacting on her life.

Conclusion 

This chapter invites us to look at professional relationships under the gaze of the Standards of Proficiency – Domain 2 Proficiency 13; ‘Understand the need to build and sustain professional relationships as both an independent practitioner and collaboratively as a member of a team’. It sets out a scenario where Blossom’s inexperience, allied to an absence of good enough relationships within the staff team, leads to a situation where bad practice was evidenced. This proficiency acknowledges the significance of building and sustaining relationships in social care. This chapter outlines how we can do this in practice; through positive workplace relationships, effective supervision, mentoring of new staff, of an atmosphere where practice is discussed, ideas are floated and decisions are not made without consultation, where we watch for good practice from people, where we watch different styles of communication, and where we only do the work we are ready to do. Now that Blossom is more integrated into the wider team she can accompany others and work collaboratively and effectively. Soon Blossom will begin to work independently of others, while maintaining her team ethos and supports. This way Blossom’s potential is checked, and celebrated, her current learning is acknowledged, and further learning identified. Blossom now has a much better understanding of the role of the team and consequently has made significant progress in learning their particular ‘dance’. It is going to take time. But it does take time to learn new moves.

The Dance (Part 2) 

Some day, very soon in fact, Blossom will walk into a room and in an instant understand the ‘temperature’, and she will know how to respond to it. She will move at a pace that interrupts no one, she will feel no less and no more important than anyone in the room, she will listen and watch for cues, she will ‘hold’ herself, and she will wait, and then she will go to work.

References 

Barrett, S., Komaromy, C., Robb, M. and Rogers A. (eds) (2004) Communication, Relationships and Care: A Reader. Milton Keynes: Open University Press.

Cameron, D. (2004) Communication Culture; Issues for Health and Social Care. Oxfordshire: Imprint Routledge.

Cooper, F. (2012) Professional Boundaries in Social Work and Social Care: A Practical Guide to Understanding, Maintaining and Managing Your Professional Boundaries. London: Jessica Kingsley Publishers.

CORU/Regulating Health and Social Care Professionals (2012) Framework for Guidelines on the Standards of Education and Training, and Monitoring of Approved Programmes. Dublin: CORU.

CORU, the Health and Social Care Professionals Council (website), www.coru.ie [accessed May 2020].

Grainger, K. (1998) ‘Reality orientation in institutions for the elderly: The view from social linguists’. Journal of Aging Studies 12(1): 39-56. 

Hood, R., Brent, M., Abbott, S. and Sartori D. (2019) ‘A study of practitioner-service user relationships in social work’, British Journal of Social Work 49: 787-805.

Health and Social Care Professionals Act 2005 (HSCP Act 2005). Dublin: Dublin Stationery Office. Available at <http://www.irishstatutebook.ie/eli/2005/act/27/enacted/en/html>.

Krueger, M. (2005) ‘Four themes in youth work practice’, Journal of Community Psychology 33(1): 21-9.

Lalor, K. (2013) ‘Understanding Social Care’ in K. Lalor and P. Share (eds) Applied Social Care: An Introduction for Students in Ireland (3rd edn) (pp. 3-18). Dublin: Gill & Macmillan.

Myer, K. (2017) ‘Carers’ experiences accessing information on supports and services: Learning the social care “dance”’, Journal of Qualitative Social Work 17: 832-48.

Seden, J. (2004) ‘Counselling Skills in Social Work Practice’ in S. Barrett, C. Komaromy, M. Robb and A. Rogers (eds), Communication, Relationships and Care: A Reader. Milton Keynes: Open University Press.

Social Care Workers Registration Board (2017) Standards of proficiency for social care work. Dublin: CORU Health and Social Care Regulator. Steckley, L. (2020) ‘Threshold Concepts in Residential Child Care: Part 1, The Selves of Learners and Their Praxis’, Children and Youth Services Review. 112, 104594.