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Wednesday, August 4, 2010

Relationships are vital but why aren't they working

Recent research has affirmed what many social workers have known for years. The relationship between the worker and the client is the most crucial element of effective case work – including in child protection. Certainly there are clients who make the relationship very difficult as they resist working with anyone connected to child protection. In a few cases, this can be a severe enough resistance that intervention cannot work and the child cannot be protected within the family. As well, there are parents whose behaviors are so dangerous that, even when they engage with services, cannot be with their children until real change is well underway. However, for the vast majority of cases, a good working relationship with a case worker is vital to supporting their change efforts that are genuinely motivated to make their parenting better.

Telling people what to do and how to do it is not typically effective. Complex families in particular are often so stuck in their ways that they cannot trust the worker to begin with and will see prescriptive efforts as just another example of people in authority interfering in their lives. It talks time to get into these families in ways that cause them to believe that the worker really is trying to support something worthwhile. Remember that for many of these families, what we see as going wrong is both normal and likely inter-generational. Even if the family feels that what they are doing isn’t working very well. It may be so normal that they lack the capacity to see that it can be any different because it has been that way in the family for so long – and not just in a nuclear family sense but in the broad extended family.

Where some of the reasons for poor family function are also ecological, the family may feel that change is something that is so remote a possibility that they can see no reason to try to do something different. Consider the housing project full of families struggling with the economic realities of life, surrounded by crime, violence, substance use. In other words, they are surviving in an environment that they can afford to be in but may not want to be and without the means to live elsewhere. The social influences are massive and beyond the direct control of the family.

And then along comes what they believe is little miss goody two shoes from another world telling them what they need to do – it feels like a Martian arriving from some other world. Without the relationship, how can the family be expected to take anything seriously?

We tell the parents that they need to react to their child differently, calmer with more nurturing behavior. Yet, these are behaviors that are foreign. The majority of abusing parents themselves grew up in environments that created disorganized attachments in which nurturance, support, emotional regulation were typically unseen. A social worker coming in with power to tell parents should therefore not surprisingly result in anger, resistance, and other features of a power struggle.

To overcome this takes time – something that budget oriented management approaches make difficult. It may well take weeks to achieve even the beginning of a relationship and many months before real change is occurring. This is long term work that is further complicated by the reality that the sooner we intervene in a child’s life the better. Neuroscience and attachment research tell us that the neural networks of relationship are strongly in place from within the pregnancy to about three years. These attachment patterns have lifelong implications for how well we relate to others and manage our own emotions. Indeed, most of the parents we will work with have disorganized attachment – thus the intergenerational nature of child protection work.

We are torn between needing to get in early, do intense relationship building and then model different ways to parent in families with high levels of resistance and complexity while at the same time needing to show results to budget oriented mangerialism. However, that may not be the biggest hurdle but it may be the work environment itself. If relationship building is so crucial to this work, then the workers need to stay around. Yet, we are seeing high turnover rates in child protection throughout the Western world.

If I am the resistant client, I probably know enough about the system to know that you will go away to be replaced by some other worker, wet behind the ears, that I can also outlast. This is one of the reasons why we see files being re-opened time and again. Families may even show some progress from file opening to file opening but cannot sustain it because the interventions have not been intense and long enough to overcome the attachment patterns, for example.

If we cannot keep workers, how can we expect these families to trust us? The relationships just aren’t there.

As in all of these posts, there is so much to discuss and no post is really thorough enough to cover it all – but hopefully it is stimulating the kind of thinking that our profession needs for a healthy debate about where we are going.

An excellent review of some of these issues can be found in the recently published book out of the United Kingdom:

Barlow, J. & Scott, J. (2010). Safeguarding in the 21st century – where to now. Dartington: Research in Practice.

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