Chapter 70 – Teresa Brown (D5SOP9)

Dynamics

A consistent area of agreement in social care practice is the acknowledgement that effective social care revolves around relationships. The Social Care Workers Registration Board (SCWRB) defines social care as a relationship-based practice through which a planned and purposeful provision of care, protection, psychosocial support and advocacy is provided (SCWRB 2017). Despite this recognition, reiterated in social care policies and literature, a certain amount of ambiguity exists on how relationships are practised. It is my view that the dynamics of social care relationship, the actual doing of relationships, warrants more visibility and discussion in both academic literature and social care policies. Although consideration must be given to variables such as gender, sexuality, culture and class that shape the complex dynamic of the social care relationship, the argument put forward in this chapter centres on the importance of locating our critical understanding of this proficiency in the current social care practice environment.

The model of the dynamics of relationship put forward in this chapter endeavours to capture some of the visible and invisible individual and structural dynamics that impact on the relationship between the social care worker and service user. These include:

• The Practice Environment: Arguably the practice environment is an unexamined component in the dynamics of the social care relationship. It is the backdrop to our practice, the organisation culture, which includes such things as ‘attitudes and beliefs, patterns of relationships, traditions, the psychosocial context in which work is done and how people collaborate in doing it’ (Menzies-Lyth 1990: 466-7). The practice environment is also shaped by legislative, social and economic influences, unconscious assumptions, attitudes and beliefs about the work task – the unspoken shared attitudes, the unacknowledged anxieties, conflicts, as well as the work atmosphere. The practice environment also includes the dynamics of multi-disciplinary and inter-agency practice, all shaping the dynamics of the social care relationship.

• Doing the Relationship: An understanding of the dynamics of transference and counter-transference in the social care relationship provides us with insight into service users and our own inner world. Using our first voice (Weick 2000) we can highlight the complexities of ‘doing the relationship’, advocating a move to work in solidarity, moving away from a ‘them and us’ attitude.

Supervision and Support: Supportive supervision practice allows us to reflect, self-analyse and respond to visible and invisible dynamics operating within the relationship as well as the complexities of the wider practice environment. Social care workers’ experience of support and being supervised is crucial to them being able to develop the capacity to recognise transference and counter-transference, individual and structural dynamics and the complexities of professional relationships.

The chapter begins with a discussion on the backdrop to all relationships; the practice environment.

Practice Environment

Against a backdrop of rapid societal and organisational change in the social care practice landscape, engaging in relationship-based practice presents challenges. The central argument based on research on relationship-based practice (Brown 2016) is that a culture of fear and risk underpins the practice environment, shaping knowledge, permeating the everyday norms and practices within the sector; and manifesting itself in the ways that relationships between social care workers and service users are constructed, experienced and lived out.

Discourses around ‘risk’ and a ‘risk society’ create the context in which fear emerges. Emotional responses to ‘risk’ and living in a ‘risk society’, it is argued, are designed to minimise and negate risks (perceived or real). Douglas notes that risk provides a powerful ‘forensic resource […] a language with which to hold persons accountable’ (Douglas 1999: 22), making it difficult for workers to work in risk-enabling ways due to fear of blame or liability (Ellis 2014) and in turn being held personally accountable (Furedi 2006; Gharabaghi & Phelan 2011). This can result in social care workers feeling fear in their daily experiences of practice (Smith 2009; Howard 2012). These fears can contribute to a climate where ‘not taking risks is positively advocated’ (Furedi 2006: 71) and where risk-taking becomes viewed as irresponsible behaviour and accidents the result of risk management failings. Consequently, risk is understood as a form of governmentality that undermines traditional practices of relationship-building (Furedi 2006).

Arguably social care workers’ responses to risk can be underpinned by anxiety and fear. The consequence of these fears and anxiety are manifested in relationships between social care workers and service users, where the main focus is often primarily on self-protection as the prelude for any professional interactions. In other words, staff and organisations have come to take their own safety as the starting point for ‘professional’ interactions (Steckley & Smith 2011: 84). It could be argued that this orientation has shifted relationship-based practice into a subsidiary of safe practice. In the context of daily professional practice where the relational aspects of the child-adult relationship, for example touch (Soldevila et al. 2013), have become the subject of regulation, constraint or have resulted in worker avoidance for fear of an allegation or complaint regarding improper, inappropriate and/or over-familiar contact. Steckley (2012) refers to these as the ‘damaging cultures of “no touch”’.

There has, and continues to be, much commentary in the literature on the impact of these regulatory and prescriptive procedures on professionals’ practice and the associated high levels of anxiety (Littlechild 2008; Brown 2016). Although the need to protect service users through improved regulation and inspection is viewed as a positive development, my research found that social care workers ability to develop and maintain relationships was constrained by bureaucratic requirements and the regulation of the relational space between workers and service users. Similar to recent criticisms in the literature (Smith 2009; Munro 2011; Howard 2012) reveal that regulatory responses were often in conflict with social care workers’ professional values and views on relational engagement. In some sectors of social care practice, relationships are now conceptualised in a way that is for utilitarian purposes of compliance (Murphy et al. 2013). This is where we can see the dynamics of the relationship between the social care worker and service user. In a national consultation with young people in care, ‘Listen to Our Voices’, one participant noted, ‘after the social care worker played a role in me being arrested, it was difficult to understand the relationship, as the next day they would be nice to me’ (McEvoy & Smith 2011: 18).

Maintaining relational engagement while following procedure-led practice can frequently undermine and impact on established relationships of trust; in fact, procedure-led responses have often reinforced and contributed to the escalation of challenging behaviour. The focus on managing behaviour primarily through procedure-led responses with no space for professional discretion and professional judgement can hinder the development of positive relationships. Despite an increased awareness of the need for organisations to create a relational-oriented culture, criticism continues to be levelled at adherence to a bureaucratic culture with regularised systems taking precedent over relational-oriented practice.

Multi-disciplinary/Inter-agency Practice

The challenge and complexities of multi-disciplinary and inter-agency practice have been consistently highlighted in the literature (Ferguson & Kenny 1995; Horwath & Bishop 2001; McWilliams 2006; Duggan & Corrigan 2009). The complexities of multi-disciplinary practice are evident in the daily experiences of workers, impacting on the dynamics of the relationship between social care worker and service user. In addition, the relational dimensions of social care can often place heavy burdens on service users, who are required to navigate relationships with a number of professionals. Navigating these relationships can be challenging, particularly when they experience poor inter-agency and multi-disciplinary practice. An example of poor inter-agency communication was noted in Buckley’s (2009) research: service users stated how they had to give the same information over and over again to different professionals whom they considered should be more connected to one another (Buckley 2009). Arguably, these kinds of experiences add further to the challenges service users are endeavouring to deal with.

Organisation structures in social care reflect an established hierarchy which is reflected in the way decisions are made. A number of social care workers feel their role and contribution are judged as lower in the hierarchy, and not sufficiently recognised and acknowledged in inter-agency working relationships (Brown 2016). The lack of shared responsibility is exacerbated by what Buckley (2003) calls the ‘exaggeration of hierarchy’. This refers to the privileged position afforded to the views of higher professionals such as psychologists over those of the workers who are in closest contact with children and families. The notion of the ‘closer to the child, the further from the decision’ was reiterated in the Brown (2016) study. Despite the regulations and official ideology emphasising the importance of professionals working together in meeting the needs service users, for some workers it is experienced as a discourse rather than a practice (Houte et al. 2013). It is argued that effective collaboration will only be achieved if efforts are made to articulate challenges, both long-standing and current. It is further argued that these challenges, if left unspoken, will continue to manifest in professional relationships and in the dynamics of relationship between service user and social care worker.

The poor quality of multi-disciplinary practice, or its failure to occur at all, has been identified in every inquiry report to date. Buckley (2009) highlighted that failings within multi-disciplinary practice reflect the dynamics between professionals and the tensions between and within agencies. She posits that these issues will not be solved with regulatory measures; they need to be addressed by supervision and capacity building within a supportive framework (Buckley 2009). With the reconfiguration of services, efforts have been made to promote multi-disciplinary practice with the establishment of collaborative structures and systems. However, as advised by Horwath and Morrison (2007), collaborative structures do not necessarily guarantee the realisation of collaborative activity; it is the informal relationships that are pivotal in inter-agency work, but they need to be supported by more formal linkages and acknowledged as an essential component of inter-agency practice.

Transference and Counter-transference

 

 

 

 

Counter-transference is described as the inner emotional reactions of a social care worker to the service user’s transference. It can be a conscious or unconscious emotional reaction experienced by the social care worker. Counter-transference also refers to the social care worker independently transferring their own feelings to the service user. In our practice, we may encounter service users who have gone through similar experiences to us, for example the loss of a parent at young age. This can evoke emotional reactions in the social care worker, leading to counter-transference in practice.

The social care worker’s counter-transference reaction may manifest in certain types of behaviour, e.g., feelings of sadness on days you are engaging with the service user, becoming tearful when you thinking about the service user’s situation. The challenge for the social care worker is being effectively engaged with the service user in the moment, while also being sufficiently detached to identify what is happening in the transference or counter-transference as it emerges. This dynamic can often be difficult to understand and manage and social care workers can, in turn, find themselves reacting unconsciously.

In teaching students about transference and counter-transference, van Breda and Feller (2014: 470-1) utilised Sedgwick’s (2013: 108) idea of ‘cup hooks’ through the following analogy.

First Voice

A key question is how we get beyond this to a position where the dynamics of the social care relationship are explored and understood at both micro and macro level. While the relationship has been broadly discussed in the literature, there is a need for further discussion on the dynamics of relationships; in a knowledge vacuum, relationships are considered a ‘largely empty word’ (Smith et al. 2013: 12). Arguably, because relationships do not sit neatly in an evidence-based intervention, and neither can they be scientifically measured, this could explain the lack of critical analysis on the conceptualisation and dynamics and reflect a view that relationships between workers and service users evolve organically. In conceptual and policy terms, positive relationships are recognised and valued; however, a current critical understanding is largely absent. Weick’s (2000) advice to social workers to avoid using their dominant professional voice and instead use their first voice, is relevant to the social care relationship. Within the social care field, excellent practice is not hard to find (Flynn 2020), but we need to make this visible. We need to continue to work in solidarity with service users, and distance ourselves from the ‘them and us’ attitude.

Furthermore, qualities and skills that make up relationship-based practice often remain invisible for fear of being negatively labelled as ‘over involved’ or ‘unprofessional’. It is this lack of fundamental recognition for all the elements that make up relationship-based practice (that is, use of personality in acts of individual and spontaneous kindness, humour; use of body through touching, hugging, comforting; and use of self as a social subject in the exercise of individual judgement, for example) that needs to be challenged and changed. In using our ‘first voice’, as workers we may move away from feelings of alienation and gain visibility and recognition in the wider context of practice. (Lack of visibility was particularly noticeable during COVID-19, with little acknowledgment in the media regarding the social care profession working at the coalface during the pandemic).

Part of the responsibility of social care workers in asserting their voice is not only to assert their experiences and views regarding best practice, but also to use their voice to challenge and change society’s perceptions of service users. We need to highlight that many of the challenges service users experience have origins in inadequate systems of support, e.g. education, housing. Inequality can manifest itself in different forms and impact a myriad of fields, such as employment, housing discrimination, education. For many service users whose trust has been abused in the past, either by a neglectful family or by a system that has failed to take their needs and wishes into account, ‘relationships are not easily constructed’ (Millham et al. 1986: 118). Past experiences of relationships often influence how we engage in current relationships (Cashmore 2002). These factors shape and influence the dynamics of the social care relationship.

There is one serious omission in the writings and reports on service users, despite the adversities they have experienced in their lives; they have an inner strength and sense of humour, which needs to be recognised in the literature. Professionals need to draw attention to their wisdom and resilience and policy makers need to learn from their lived experiences. Our recent Olympian champion Kellie Harrington’s brother encapsulated this when he stated that the area his family live in, although considered disadvantaged, is ‘one of the richest areas in the country because it is rich in support, camaraderie and community values’.

Going forward, it would be helpful if changes in the educational landscape could be effected to bring to the forefront, in training and teaching, themes such as ‘use of self’ and reflective practice, dynamics of transference and counter-transference within the wider ambit of relationship-based practice. A particular practical example of this, and following on from Anglin’s work (2015) on training, is to make workers aware of their own pain-based anxieties in order to be responsive rather than reactive. This will require course delivery that centres on tutorials and individual contact with the aim of increasing the level and quality of contact. Another way of enhancing training is through multi- disciplinary training, particularly on accredited courses. The training would require a strong focus on the ‘emotional dimensions of practice’ (Munro 2011: 91), which is probably best achieved by a combination of tutorial input and professional practice input.

Support/Supervision

Working in systems governed by processes that are procedural, bureaucratic and have the tendency to enforcing regulations, emotional support for staff is identified as a prerequisite for the positive development of relationships (Trevithick 2014). The importance of social care workers being afforded reflective spaces and opportunities for reflective practice (Ruch 2007), in a supportive practice environment, cannot be over-emphasised. However, inadequate levels of support and supervision for front-line workers has been highlighted in every inquiry report to date. Within the context of supervision, in recent research by Keogh and Byrne (2016), social care workers articulated feeling a lack of emotional support, mainly from the wider organisation, with ‘supervision … never or only sometimes provided by management for the majority of social care workers’ (2016: 75). This is particularly concerning because regular professional supervision for social care workers is a statutory standard inspected and monitored by the relevant authorities.

A theme emerging in the literature is that supervision appears to be become skewed towards policy and procedural imperatives, rather than towards reflection and professional development (Jones & Gallop 2003; Ruch 2007). Policies and guidelines clearly articulate the importance of regular supervision; however, there is a tendency in the literature to focus primarily on providing regular formal supervision. The relationship between workers’ engagement at supervision in terms of their feelings of value is given insufficient attention. This can mean that unexplored fears and anxiety that can manifest in the day-to-day practice of relationships remain unexplored, thereby affecting the day- to-day effectiveness of relationship-based practice. It is argued that the emotional climate (Ward 2010) needs considerable attention to enable workers to process feelings (Sharpe 2008), understand the dynamics of transference and counter-transference and embrace the emotional elements of practice (Trevithick 2014). We need to create a practice environment that is characterised by respect, safety, trust and openness, which we can mirror in our relationship with service users.

Conclusion

The pivotal argument in this chapter centres on recognising and addressing the contextual factors at the organisational levels (practice environment) that impact on the dynamics of the relationship between social care worker and service user. Social care’s remarkable strength as a profession is our persistence and commitment to relationships in practice environments that can be challenging and complex. We need now to create openings and opportunities to ensure that we are no longer at the periphery and contribute to a practice-based body of knowledge on the dynamics of the social care relationship.

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