Take better care of the emotional needs of social workers and they'll take better care of clients
Monday, March 21, 2011
Working in child protection services is arguably one of the most stressful jobs. It is not easy to relax after work when contemplating what might be happening to a child at home. Add in the worry that you may eventually be blamed, even lose your livelihood, if something goes seriously wrong and the stress becomes unremitting.
The pioneering work of psychoanalyst Isabel Menzies Lyth demonstrated how individuals and organisations protect themselves - by denial and repression - against anxiety when the primary task is unrelentingly full of anxiety. Another worrying consequence is seriously impaired judgment and decision-making - what Professor Eileen Munro has referred to as "errors of reasoning".
I saw a powerful example of this a couple of weeks ago. I am developing with a colleague, Dr Jane Reeves, innovative ways to develop social workers' skills using virtual reality and filmed scenarios of complex family situations using actors. We visited the clinical skills unit at the School of Medicine at Imperial College, London, where trainee surgeons are prepared for the difficult situations they face in A&E departments. One scene involved an actor taking the role of an aggressive patient (the trainee surgeon does not expect this). The trainee's task is to insert a drip into the patient's arm. To do this safely involves performing a number of key procedures, such as taking blood pressure readings and sterilising the entry site for the drip.
The unsuspecting trainee enters the cubicle to find a "patient" swearing, because she claims she has been waiting for two hours. The trainee is flummoxed and spends the next few minutes telling the "patient" that it is not his fault and she needs to stop swearing before he can proceed. Eventually she calms down and the drip is put in place.
The trainee's bedside manner is rated by the "patient" and a number of experienced surgeons who have watched the scenario on laptops. The trainee is asked to rate himself on his competence on each of the key procedures. But he is completely thrown at the end to learn he didn't actually perform any of them. He was so eager to calm her down that he completely lost sight of all hygiene and safety factors.
Child protection social workers routinely face situations that are considerably more emotionally taxing than an aggressive patient and they often have to undertake more complex procedures than administering a drip. The implication is that ways need to be found to manage the stress, otherwise the consequences will not be restricted to the usual suspects: stress-related illness, alcohol dependence, comfort eating, excessive superficiality, derogation of family members, and so on.
The solution? Powerful emotion needs to be processed in supervision, the meaning of which is contained in the term Super Vision: the ability to see better, which is best provided by an individual who is not involved in the nitty-gritty of the case and, hence, can see the wood for the trees.
Too often I am told by practitioners that supervision has become an exclusively managerial activity that ignores the emotional side of the work. While accountability is essential, supervisors need to rebalance their focus to strengthen the quality of the work undertaken. Thoughtful supervision that pays attention to the human dimension can produce immediate improvements to practice.
David Shemmings is professor of social work at the University of Kent and director of the Assessment of Disorganised Attachment and Maltreatment project.