Chapter 38 – Des Mooney (D2SOP15)

Professional Relationship – Lexi’s Story 

This chapter uses a case study (Lexi’s story) to discuss the role of relationships with professional colleagues and other workers in service delivery, noting the various relationships Lexi has in her life now, and how the dynamics between these impact on Lexi’s life. The chapter makes the argument that the relationships we have with service users are also a measure of the type of relationships we are looking for us as professionals and how respect, empathy, love, accountability, teamwork, integrity, organisation, nurture, self-regulation, harmony, initiative, and partnerships are enacted in our professional lives.

Interdisciplinary and multi-disciplinary are terms used to describe the links between the various professionals involved in people’s lives and the roles they play. Interdisciplinary teamwork involves a number of people across a staff team sharing their skills, knowledge and expertise, with a common purpose; to set goals and boundaries, make decisions, share resources and responsibilities. The multi-disciplinary inter-agency team approach to care refers to the significance of how agencies and individuals communicate with each other; and how mutual trust, respect and professional responsibility can lead not only to a creative working environment but much better outcomes for service users. One definition offered by Linden (2002: 7) states, ‘interagency collaboration occurs when people from different organizations produce something through joint effort, resources, and decision making, and share ownership of the final product or service.’ This collaboration refers to family caseworkers, social workers and social care workers, mental health providers, teachers, support workers, policy-makers, managers and legal experts. The team members focus on specific areas of care and these in turn are brought together in the form of an overall care package or plan. Linden further notes that better understanding by each member of the multi-disciplinary team of the others’ roles in the case, of their actions and perspectives, will only lead to better outcomes for the service users.

Respect 

This chapter uses a case study to look at professional relationships, and how actions in one area impact on others. Throughout this chapter we will be reminded of Lexi and how people like her are affected directly by our actions and decisions. When you look at Lexi’s story, think of the many and complicated relationships she has through many disciplines, and how sensitivity, communication, kindness and honesty are essential to helping her realise her true potential.

When you consider the number of people working on Lexi’s behalf it is quite daunting. Directly or indirectly, I can count 28 people who are working for or with Lexi. These include the staff team at the centre where Lexi lives, the social work team, support workers, doctors, therapists, teachers and her recently appointed guardian ad litem. It is important that we all have a good sense of what the others are doing, but more important is that we respect what it is we are all doing. From the social care worker who wakes Lexi up for school, gives her breakfast and sits with her as they discuss the day ahead – or anything, really – to the teachers, therapists, social workers and decision-makers, a level of understanding and respect for the roles they play, and for the tasks within these roles, for each other and, most important, for Lexi, is essential, not only for clear communication but for producing the best outcomes for her. It is difficult to have a clear understanding of the term respect in a professional setting. Do you respect someone you don’t like? Do you respect someone who can have a huge influence (positive or negative) over the life and welfare of a service user? Do we respect those who have unacceptable goals, such as lapsing addicts? Do you respect a colleague who appears to have a limited focus on events and appears to you and others to have formed an opinion of a service user and is then acting according to this view, to the neglect of others’? How do we address these dilemmas?

Definitions of respect include links with dignity, moral obligation, human rights, respect for cultural differences, reflection on professional relationships, ethics and the culture of respect (Hicks 2011; Beach et al. 2007; UN 1948; Gostin 1995; Hargraves & Page 2013; Paasche-Orlow 2004; James 2018). Dictionary definitions include: ‘a feeling of deep admiration for someone or something elicited by their abilities, qualities, or achievements’; ‘due regard for the feelings, wishes, or rights of others’ (Oxford Dictionaries); and, ‘Respect is a way of treating or thinking about something or someone … People respect others who are impressive for any reason, such as being in authority – like a teacher or cop – or being older – like a grandparent. You show respect by being polite and kind’ (vocabulary. com). To my mind these definitions fail to recognise what respect is; neither do they note differences between people and ideas. Perhaps one of the better definitions might be: ‘Respect means that you accept somebody for who they are, even when they’re different from you or you don’t agree with them. Respect in your relationships builds feelings of trust, safety, and wellbeing. Respect doesn’t have to come naturally – it is something you learn’ (Kids Helpline); this definition identifies difference and notes that respect is a learning event.

Beach et al. (2007) explore the concept of respect as having a twofold meaning; the exercise of ‘personhood’ and a moral obligation. They note the autonomy of service users but add that  respect is independent of a person’s characteristics, and therefore ought to be accorded equally to all. They argue that there is a cognitive aspect – respect acknowledges ‘value’ in others; and a behavioural one – which impels us to act in accordance with this belief. This moral duty is not to be reduced to politeness, honesty or deference to a service user’s wishes. Personhood, meanwhile, is described as ‘an essential characteristic of the human species’ that ‘gives to the human individual a universal worth and an exceptional standing’ (White 2013). Warren (1973) listed six criteria for personhood: consciousness, reasoning, self-motivating activity, capacity to communicate, presence of self-concept and self-awareness.

The role of relationships with our professional colleagues could perhaps be a mirror of sorts of the relationships we have with our service users; our attention to detail, for example, or how we respond to situations. The value we hold for the service user or colleague might impact on how we respond, and we need to be mindful of this. In my professional practice I can see how sometimes judgement of others, if not checked in supervision or with ourselves, can impact on professional relationships. How we communicate is very important. While social care workers by nature can be very expressive, our greatest tool is our ability to listen and to identify important information. Within this listening space we can identify not only what needs to be done for the service user, but also something of the person delivering the information, and how much they are involved with the case. We may disagree with something, but healthy professional relationships are not mutual agreement committees, rather platforms where debate can happen and progress can be made. Respect is central to this. Acknowledging another’s difference is another way to see their individuation, self-identity and personal identity. Mutual respect and trust are also nurtured through consistency of approach, by reliability and by how we are seen to behave towards others. The value we attach to others, and its reciprocation, creates a space where respect can be shared. Self-awareness allows us to respond in a timely and mannerly way. Self-awareness also allows room for difference, in personality, approach, work style and delivery. Constant reflection and learning will only increase our ability to acknowledge and show respect and to create spaces where our shared goals can be achieved, and for great work to be done.

Empathy 

Among the most important skills a social care worker can possess is the ability to communicate effectively, and it is important that healthcare professionals understand people’s feelings, experiences and perspectives in order to assess and identify the needs of that person. ‘Empathy among health care users and professionals significantly contributes to how both groups behave as well as to their therapy and overall well-being. The development of empathetic skills constitutes an important priority in the education of health and social care students’ (Moudatsou et al. 2020: 6). Sympathy and empathy are both acts of feeling, but with sympathy you feel for the person; you are sorry for them or pity them, but you don’t specifically understand what they’re feeling. ‘Empathy is understood as a more complex interpersonal construct that involves awareness and intuition’ (Moudatsou et al. 2020: 2), and can best be described as feeling with the person.

In the day-to-day shared experience with service users the use of empathy can yield positive results, among them improved relationships, creativity, trust and more harmonious living and working experiences, as challenging behaviour is better understood and responded to. In addition, a consequence of empathy can be a greater willingness by the service user to take risks in education, the community or life in general, as well as a greater chance of making the necessary changes that might lead to recovery from past hurt. In my practice with Lexi I am informed not only by the person in front of me but by information garnered from all available sources. I cannot help but be moved by her plight and how through her behaviour she re-enacts old wounds. My understanding of her case, and also my understanding of my relationship with Lexi, is significant; but more important, it is my ability to empathise in those moments where Lexi takes risks and lets us see her pain, or her dreams for her future, that are the building blocks for future progression and development. To catch these moments, and to bring them to our colleagues and advocate for Lexi, is a kernel of our mission as social care workers.

There is much written about the professional-service user relationship and the use of empathy. However, the use of empathy among professionals in their relationships with each other is not written about so much. It seems that if empathy is a tool for understanding the perspective of the service users it is not one that we choose to recognise often enough when working with each other. Within interdisciplinary teams I witness empathy between people and I see the types of skills people use with the service users in evidence between us professionals. People who understand the professional/personal situation someone might be in are less likely to judge but not afraid to engage around areas of care. These skills would include communication skills, but what is also notable is that one professional has a good knowledge of the other, as a person and as a professional.

The situation between social care workers and the multi-disciplinary teams is less empathetic. Social care workers can be mistrustful of social workers and other professionals who, as they see it, only see the service users a fraction of the time social care workers do, while apparently wielding far more power. As a result, social care workers can feel not listened to, while complaining that they are in the perfect position to effect change. Social care workers have also been criticised in studies: for their inability to deal with children’s problems (Clough et al. 2006; Hayden 2003); for being more reactive than proactive (Colton 2002; Berridge & Brodie 1998); and for at times assigning too much blame to the system for their problems (Smith 2009, cited in Brown 2016: 65). Brown further notes that, given these criticisms, it is inevitable that residential workers experience a long-standing inferiority complex (Gharabaghi 2008) and lack of confidence in their work (Howard 2012, cited in Brown 2016: 65). Brown notes that ‘the realignment of the role of residential social care workers and cognisant disciplines needs to be re-configured in a way that acknowledges the pivotal role of residential care workers in the child welfare system’ (2016: 70).

Social workers meanwhile have increasing demands placed on them as caseloads become larger, more rules are implemented, and they face greater expectations around performance (Wacek 2017: 5). Studies also note the level of stress and burnout among social workers (Acker 1999; Egan 1993; Lloyd et al. 2002; Wacek 2017). Hohman (2012) notes that despite being noted as central to the role, social work practice was not characterised by empathy. Antonopoulou et al. (2017) ask, ‘is the social worker vulnerability to and experience of high level of stress likely to act as an inhibitor to the cognitive and emotional processing of empathy in conversations?’ (cited in Lynch et al. 2019). Perhaps more work needs to be done to address the different roles each professional is playing in service delivery. A better awareness could lead to a more empathic understanding of the perspective of each professional. This in turn could lead to more trust and better working relationships, and consequently better outcomes for our service users. To support this idea, joint think tanks could be created where open discussion could take place and differences and difficulties could be aired. More professionals’ meetings and better explanations of decisions will bring about better understanding of each other’s roles and how it is a combination of all our struggles that produce quality care and better outcomes. This is discussed in more detail later in the chapter.

Labour of Love

In her article ‘Care Work, Capitalism and the Labour of Love’, Erica Lagalisse argues that ‘because “care” is implicitly presumed to be not work – but rather an act of love – […] one [needs to] put the word “work” after it to suggest its productive and strenuous aspect’ (2019: 1). She further argues that that relative assumptions in society about what is productive, of economic value, and what are ‘natural’ socially enforced activities, has led some to see ‘care’ and ‘work’ as separate activities. ‘In short, it is only because “care” is imagined as the natural activity of women that it is not automatically conceptualized as work … The woman who expects (better) financial pay for the activity of caring for others in hospitals, elderly care facilities and pre-schools is also suspect: She should be drawn to this form of employment out of her natural feelings of care for others – which do not therefore constitute a “skill”. The man who expects (better) pay for the activity of caring for others in the commercial sector is also misguided – he is only doing (unskilled) “women’s work” after all’ (2019: 2).

Anecdotally, social care workers will tell you of being asked, ‘Just what is it you do?’ and of people having no real understanding of what social care work is actually about, other than ‘caring’. ‘Misconceptions abound, and in many cases practitioners are not afforded the recognition or status they deserve’ (Lalor & Share 2009: 3). Byrne-Lancaster (2014) writes, ‘Lack of recognition is perceived as one of the blocks to professional identity … and … this is particularly evident in Irish Social Care’ (2014: 2). Lalor and Share note a ‘dearth of authoritative written material or academic research related to the area. Social care syllabi have tended to draw on elements of knowledge from social work, sociology, social policy, psychology and a broad range of other disciplines’ (2009: 5). This situation is slowly changing as the last few years have seen several books and articles devoted to the practice of social care with much of the material written by practitioners themselves.

Byrne-Lancaster writes of a lack of recognition among health and other professionals: ‘One of the major barriers to Social Care recognition by other professionals lies not so much in Social Care’s diverse areas of employment, but in lack of clarity associated with Social Care’s “outcome”: what is the outcome of a Social Care Worker being involved in a service user’s life’ (2014: 2). She notes that CORU’s definition of social care – ‘a profession where people work in partnership with those who experience marginalisation or disadvantage or who have special needs’ (2012) – suggests a social justice element and a political dimension. To this she adds her own definition of social care. which recognises both the day-to-day shared experience with ‘more productive coping mechanisms and prosocial behaviours and a political element being introduced to the Social Care Worker role’ (p. 7). She writes: ‘Social care is a profession with the purpose of supporting the holistic growth, societal and political engagement of vulnerable people which is underpinned by partnership, advocacy and professional accountability’ (p. 7).

Byrne writes of love in the context of practice and notes that in ‘Irish “professional” social care, to feel love for a client is considered inappropriate. It is a blurring of the professional boundary’ (2016: 155). ‘The bizarre irony is that as Fr. Mc Verry explained, if you want to get a job in Irish social care, the one thing that you have to show is a sense of compassion for vulnerable people. The question then is; what is the difference between love and compassion?’ (2016: 155). Byrne notes passion and compassion as being ‘essential qualities for a social care worker’ (2016, p155) and reminds readers that one of our tasks as social care workers is to provide love and security to troubled people, within a safe ‘professional’ relationship.

The fact is that social care work is a very skilled job. It involves complete commitment and skills many do not have; patience, communication skills, research skills, the ability to interpret and reflect on large amounts of often conflicting information, to set boundaries, to challenge, to write, to attend meetings, to advocate, to make dinner and help with rooms, to sit and hold broken people and to tell them that you will not ignore them. It involves a mixture of domestic, sensory, practical and creative skills, and yes, it’s very hard to describe. I sometimes wonder if our fellow professionals have a clear understanding of what it is that we do. It is not ‘women’s work’; it is not unskilled labour; and no, not everybody can do it; and yes, we bring a lot of ourselves to the role, which is why most of us can say we love the people we work with. In our work with Lexi we seek at all times to hear and interpret the child’s voice. We talk with Lexi about her care plan and placement plan, careful to put this into language she can understand. We discuss the environment she lives in and changes she may want; from the decor in her room to where she wants to go on holidays, the clothes she wants to wear, to what clubs are available to her within her community, to education and access arrangements, and we discuss the reasons why we might make decisions she may not like. We also encourage Lexi to talk of what is hurting her at any given moment and try to help her make sense of some of the wrongs associated with her life up to now. We do not seek to fix everything, but we do seek to give Lexi opportunities she has not had in the past.

We are acutely aware of the impact on Lexi of marginalisation and disadvantage, and we address this through advocacy and representation at meetings with our fellow professionals. We also acknowledge the political dimension noted by Byrne-Lancaster (2014) and indeed in the National Standards for Children’s Residential Centres (HIQA 2018), which state: ‘Each child experiences care and support which respects their diversity and protects their rights in line with the United Nations (UN) Convention on the Rights of the Child’ (Theme 1, Standard 1:1). I am hopeful that over time and through statutory registration, increased accountability and improved educational opportunities social care will have a much clearer professional identity, and that our role in relationships with our professional colleagues will be better understood. Improved understanding and respect for the roles each of us play in the life of our service users can only be of benefit to all.

Discussion 

In this chapter I am using the Lexi case study to discuss our understanding of the role of relationships between professionals. My work with Lexi is very varied. I play chasing and football and go for cycles with her. I also watch a lot of children’s TV and discuss the merits of various rap and pop music she listens to. I help her clean her room sometimes, but she prefers the ‘girls’ to help her with this. I cook with her and I also sing stupid songs that make her laugh out loud. I sometimes tell her off for some misdemeanour and she sometimes tells me to ‘fuck off’ because she doesn’t like what I said.

I also write daily reports of her life at the centre. I write weekly reports to her therapist (at the therapist’s request), regular keywork reports and fill in all the logs associated with her care. I monitor and maintain the care plan and the placement plan in conjunction with the social worker, the staff team and the management. I also have regular phone calls with all the professionals in Lexi’s case and attend weekly staff meetings where I report and advocate for Lexi. In addition, I attend regular supervision where I reflect, gain support and garner ideas that will further support the work we, Lexi and I, are doing; and indeed, all the work I am doing with the other young people at the unit. In addition to this I also attend two group consultations per month, facilitated by the centre and involving the staff team, where the work we do with all the young people and the impact on us as people and professionals is discussed. I do maintain and enjoy good relationships with the other three young people at the unit and spend time and do activities with them as well.

I came into work one day and Lexi was running around the centre screaming and crying. The only sensible thing I got out of her was that she didn’t know why this was happening. I took her in my arms and held her for some time. This was not a restraint. This was a hug. She cried and held on for a while. When she was a little calmer, I suggested she have a bath, lots of bubbles, and relax for a while. I asked that a female colleague of mine sit outside the bathroom and not move for the duration of the bath Lexi was going to have, and she did this. I also told Lexi what I was going to do so there were going to be no surprises. Lexi sat in the bath and talked non-stop for about forty-five minutes. Most of the talk was about nothing at all, certainly not about the reasons why she had got so upset and frightened earlier. After her bath, Lexi spent time in her room with my colleague talking and listening to music. She never told me why she got so upset that day.

The role I have with Lexi is hard to describe, especially to someone who does not work where I work. It must be difficult for other professionals to understand this too. I also do not fully understand what the social worker does, or the therapist, or any of the other professionals in Lexi’s case. However, I trust they are good at their jobs and I have good relationships with them overall.

One of the things that bonds us as a ‘workforce’ and strengthens professional relationships is the nature of the work we do and the adversity we sometimes encounter. We social care workers need to get support from our colleagues so that we may in turn have the fortitude to give this support back to our service users. The building of relationships within the group we work with, the expressions of support, love and empathy, have helped create a very resilient team; and one where trust and respect are very evident throughout our practice. Many of us come to social care from very different places. Some of us have natural people skills but lack the academic skills this industry is asking of us. It is important that opportunities are provided for social care workers to increase their knowledge base in a way that does not overload them. Brown writes, ‘Development of training on therapeutic models in the United Kingdom has proven to significantly improve residential care practice’ (2016: 46). Access to supervision, outside supports and continued access to academic resources will also support our ability to practise at the highest level.

With the imminent statutory registration of our profession and its emphasis on mandatory continuous professional development (something most of us do anyway through reading, attending training, supervision and reflecting on practice), audits of practice and a professional code of practice and conduct I would hope our profession will be seen in the same light as others whose professions are regulated (such as nurses, midwives, medical doctors and pharmacists) and that the sceptics will have a better understanding of social care work.

There is a need for all those involved in social care practice to understand the roles of the multidisciplinary teams better. One idea to support this increased understanding is for the establishment of groups, or ‘think tanks’, set up to study social care. Think tanks are invariably not-for-profit organisations and engage in research and advocacy in a range of areas such as social policy, politics, economics, security, the environment, science and technology, “Think tanks share a common vision to improve their respective spectrums, as well as being sources of new ideas and research” (University of Oxford 2021). There are already good frameworks available through colleges, Social Care Ireland and some social media groups dedicated to social care. Perhaps more harnessing of common ideas throughout these would be a great way to start.

The use of study and focus groups could further help support our understanding of the many relationships and working practices that exist throughout social care. Regular analysis of changes in attitudes, thinking and practice would be easier to notice and respond to where necessary. Additionally, more sharing of reports and increased use of professionals’ meetings will give each member of the multi-disciplinary team the opportunity to discuss their role with each service user. They could also be forums for understanding different perspectives involved in the decision-making process, of the risks involved, and, for the questioning some of these decisions.

Training events can be seen as opportunities for formal and informal contact with our colleagues. Perhaps more sharing of training events and within these more sharing of viewpoints would contribute to more trust and mutual respect among professionals. This happens already in many areas such as Children First training, challenging behaviour and more recently understanding trauma training days. Furthermore, the invitation of professionals from one discipline to address another team directly would greatly support better understanding of their work with our service users. At the centre I work in we have invited therapists and others to address the team and discuss the nature of their work. This type of training and shared experience has greatly helped our understanding of their role and consequently increased our respect for what it is they are doing and, indeed, has guided us as to how we can approach different situations in a new way.

Conclusion 

This chapter discusses how each of the professional relationships contributes to Lexi’s overall care plan. It lists the number of professionals in her case. The importance of respect and empathy and how understanding others’ perspectives is key to better outcomes for Lexi is also discussed. The chapter also maintains that the kind of relationship I have with Lexi, where respect, the ability to listen and communicate appropriately, attention to detail and effort can be a mirror to the type of relationships I need to have with my fellow professionals. This chapter also looks at the different ideas and misconceptions people have about social care work. The elements of social justice and political dimensions that are now becoming more significant are also discussed. The concept of love in the context of practice is also discussed and I have noted the irony that some people feel it is inappropriate to show love to a service user and yet the job spec asks us to be passionate about the task and compassionate about the service user. In an effort to further understand relationships within the multidisciplinary team, I outline suggestions for how they could be improved or nurtured in the Tips for Practice Educators section. These include strengthening of relationships using think tanks, focus groups and training days; the use of professionals’ meetings and the invitation of different professionals to address the staff team and discuss their work with young people. And we would be happy to do the same if we were invited.

This week was interesting for Lexi. She saw her father at a bus stop. This was the first time in six years that she had seen him. He ‘didn’t look too good’ was what she said. I will inform the social worker and anyone else who needs to know. We will mind Lexi and encourage her to talk – she might, or she might not – about how she feels about it all. When she is ready, she will.

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