Promoting therapeutic and relationship-based approaches in social work

Bristol Balloons

Social Work Story #1 Liz’s Story

Liz's first story from practice

I look back to a conversation with a young girl in a residential children’s home where I worked before I trained to be a social worker.  It taught me something profound about myself, something I need reminding of when I slip into unreflective practice.

I’ll call the girl Sarah. She was 13, and came into care when her mother couldn’t keep her safe.  Both had experienced organised exploitation and trauma from early childhood.

Sarah was on 24 hour monitoring, and required a female worker at all times. Without close supervision, she would run off, self-harm, and seek out older males.  At intervals she would be considered safe enough to be allowed a 5 minute curfew where she could leave the watch of the female staff and be in another part of the house.  Success in this would involve praise and small rewards, increases in her unmonitored time and the ultimate plan would be more autonomy and less supervision.

Our manager was Tavistock trained, ran on psychodynamic principles, although I understood very little of what he said, and wasn’t always rota’d for team meetings.  I could also recognise behavioural thinking from a psychology course, and assumed they were part of the same approach.

I was new in post, and keen, but the female staff were particularly tired and fed up from constant work with Sarah.  They said couldn’t wait to be rid of her, and a couple spoke about her with something close to disgust and hatred.  They said things like she was ‘too damaged’, that ‘she sapped the strength from you’, that ‘she would likely be dead by the time she hit 20’.  I pretended to be analytical about this – saying, ‘why has it come to the point that you dislike her so much?  But inside I was outraged.  This poor girl, everything she’s been through.  I wouldn’t give up on her; I’d make it work; I’d help her believe in herself.

One day, I came in to start my shift with Sarah, perhaps her curfew migh be extended to 20 minutes? The ‘handover’ informed me that she ran off yesterday, came back with some packs of cigarettes and a disclosure of sexual assault.  She was back on 24 hour monitoring. I let off the other female member of staff who had been with her for 36 hours.

Sarah did not want to talk and I felt a little annoyed that she was not confiding in me.  She stared at me and asked ‘What’s with the face?’

‘What do you mean, what’s with the face?

‘the face, your face, what’s that all about?

‘There’s nothing going on with my face?

‘Yes there is, don’t lie’ and this went on for another minute or so.

Staring straight at me, she said ‘Go look in the fucking mirror then and you’ll see the face’.

So I did.

And there was ‘the face’.  A slightly furrowed brow, staring, jutting jaw, head a little to the side, thin lips, questioning and wounded.  Looking at my face rather than Sarah’s, I was confronted with feelings that I recognised from my teenage years: a response to hurt that I could not speak of, but communicated non verbally.  Unlike my colleagues who were able to share their thoughts and feelings about Sarah, I was too ashamed to consciously feel these, and too scared to verbalise them, but they were embodied none the less.

I could have denied them, composed myself in an instant, but Sarah’s challenge prompted me to do something else. I thanked her for showing me something about myself that I hadn’t been very aware of.  I apologised for being dishonest with her.  I said something like, ‘the face was disappointed, but it wasn’t so disappointed at you.  I think it was disappointed at other things and it all got a bit muddled up.  I’ve been a bit silly, forgetting how tricky this big change is for you, but you have just reminded me about that too, so thanks’. I laughed, and asked how the face looked now.  She said ‘better, nice’.

I became aware of my ‘self’, but also of my role.  Realising my feelings were ‘out there’, they could be identified, named and moved on from.  We could get back to her. My managers message about Bion and containment made a little sense now.  Carers had to think about feelings and help them become thoughts.  I could continue with my own feelings and thoughts later, but right then, my job was to support Sarah translate her feelings into thoughts.

With ‘the face’ better, we joked about how others would react to ‘the face’.   Knowing that I was now ‘ok’, and she was safe to express herself, Sarah spontaneously listed feelings that a child might feel, if the child’s mother or another carer looked at them with that ‘face’, and indeed other ‘scary’ faces.  She talked about what made little girls feel unloved and unlovable – she was talking about the behaviour of her mother, and the female staff.  She drew simple faces and I had to write their meaning – ‘you aren’t worth shit’ said one of them.

With her agreement, I took the ‘faces’ to our team meeting.  The manager used the material to consider Sarah’s anxieties about rejection and abjection. We considered what our behaviours were communicating to her.  The female staff found words to explain our feelings about being exploited and isolated; about our working conditions (24 hour waking shifts with Sarah) no breaks and infrequent supervision.  Our depletion meant we defaulted to old faces, and we then lost sight of her  needs.   Some of the psychodynamic points made were lost on us, but perhaps triggered some anxieties because I noticed quite a few ‘faces’ around the room.

This informed and motivated my practice, but for all of us, it still slipped frequently, but Sarah did develop ways to tell us, and rightly accused some of not listening to her.  Some of us were able to point out ‘a face’ on each other at first, but it was never discussed as a staff team again.

I left the role a few months later.  I wrote a goodbye card with some little faces of the ‘before and after’ me’s.  I drew some faces to show her the many future faces she could be.

‘The face’ Sarah showed me appeared less frequently.  I learned communication skills and more about the self during my social work training, and in my personal life, I found ways to identify feelings, to articulate frustrations and hurt.  I’ve also since accepted by expressiveness as a valid part of my cultural background.  When I go home to Glasgow, faces move and change faster, and often the expressions enhance communication rather than confuse it.

I have discovered others, more ‘grown up’ versions of the injured adolescent: the disapproving parent, the morally outraged practitioner, just two that I have to monitor.  I often stop and ask, especially before a difficult intervention, ‘what would Sarah see right now?’, wonder what its about, give thought to the feelings and consider how to use them well.  This is a reminder to check in with my feelings, but occasionally, I’ve had to sneak up to a mirror to catch them.  I smile and laugh, almost shaking my head, accepting they are all part of a messy self, which continues to need attention even after 2 decades of social work.


Social Work Stories
Posted by:

Hannah Pepper

GAPS Coordinator