The worker with disturbed young people

Hyatt Williams

The earlier in the life of the person at risk that the remedial measures begin the better the outlook. Human beings begin by being plastic like clay but they set like rubber; so that after adolescence is over, though they respond to further experiences, the yielding is mainly temporary and when left by the therapeutic person, they quickly rebound and like rubber resume their previous shapes.

Changes of the person in charge are ill tolerated. The deprived and damaged person continues to behave in the way which characterises young children from six months to three years old and somewhat later, who depend on their mother or a suitable person standing in the place of her for their emotional well being. Growth and development continue to be unimpaired only in such a setting. This was all highlighted in the work of Bowlby and Robertson from studies and films.

Three roles
There is often a confusion of roles of the worker and it might be helpful if we attempt to delineate three main roles : namely guardianship, caring and continuity. These terms are intended as working instruments and there is no magic about them. The guardianship role consists of ordering, setting limits and boundaries and acting as a leader with whom the adolescent finds it possible to identify, to feel protected by and in some way controlled by. It is a masculine role, a paternal one. Examples are headmasters, prison governors etc. The carer, on the other hand, is a person who takes, receives and contains the communications of the adolescent. It is desirable for the carer to work upon what he or she takes in, and relay it back to the patient. Ideally the patient is thus enabled to handle, deal with, cope with what has been returned in somewhat improved form, and go on with the work, thus enabling psychic digestion and metabolism to proceed.

If the carer is unable to work upon the communications sufficiently or if the patient is unable to deal with what is returned from the carer in the form in which it is returned, that particular unit of therapeutic transaction has failed. There may arise a situation in which either the worker or the patient or both become frustrated. This pattern of the breakdown of progressive interaction and growth will be likely to follow the original path by which the young person became a patient. In understanding that pattern the therapeutic situation may still be salved because one area of the unconscious compulsion to repeat what has happened before will have been re-experienced in a transference setting and worked through there.

The role of carer it will be seen is more feminine than that of guardian and derives from mother/child relationships. This is true despite the fact that as often as not the carer is biologically a male. Not all males are guardians and not all females carers. The female role is that of a container but if there is no ability to work consciously or unconsciously upon that which has been taken into the self by the worker, the content remains un changed. There has been an unloading and the transaction is one of psychic toilet only, the carer acting as a lavatory and the therapy being simply a disburdening. Underlying many cases in which the adolescent patient becomes disillusioned and develops denigratory attitudes towards the therapist is the hidden failure of the therapist to work sufficiently upon that which has been communicated to him, or the failure of the patient to accept back his own content somewhat modified by the pre-digestion of it carried out by the therapist.

A major cause of the non-acceptance of the return of the content is the paranoid fear that it will be bad and that it was bad stuff which was originally put into the therapist. The prevalence of projective mechanisms at work must never be forgotten. Also there is likely to be the unconscious or even conscious expectation that history will repeat itself and events in therapy necessarily follow the precise course followed by events in the previous history of the patient. The task of the carer is complicated and involves the ability of the carer to cope intellectually and emotionally with that which she is called upon to take in, work with, and relay back to the patient. There can be no dissembling. He is forced to use himself as the therapeutic instrument. He brings to the task the weaknesses and strengths which stem from his own history and ability depends not upon intellect or formal learning experience entirely and certainly not upon intuitive gifts entirely, but upon an articulated balance between all three.

The continuity figure may not have a very direct role, in contrast with that of the carer. The family parallel which springs to mind is that of grand parents. This is perhaps because there is not a major disciplinary role in the continuity figure. But this makes the continuity figure more of an ego ideal upon whom the person needing help can depend for identification than a conscience figure whose pressures are much harder to tolerate. The continuity figure can help to give coherence to the developing ego of the young person. In some ways the continuity figure is passive, rather like an animated version of the transitional object described by Winnicott. There is a wide range of continuity figures from prison visitors to pop stars. It is important that they should be reliable and not corrupt.

The roles of guardian, carer and continuity figure of course can be carried out by the same person. They often are in schools for maladjusted children and in other residential settings. What is important and what impressed me so much at Shotton Hall is the consistent application of certain basic principles. These are: i) the telling of the truth to young people. ii) reliability of those in charge. iii) patience in the face of acting out of hitherto locked up aggressiveness, querulousness and resentment. Sooner or later there is nearly always a breakthrough followed by more integrative processes leading at least to some degree of maturation. Even so newly achieved development is flimsily held and the staff, in relationship to the young person at risk, have to be ready for the collapse of an eggshell or piecrust stability. After many a crisis however, more in some than in others, there is usually a growth of a more solid and durable adjustment, and though fate relapses are not at all uncommon, they are often of short duration, and the better situation is restored relatively soon. This is especially so if the caring forces are able to cope with the problem without any rejection or seeming rejection of the individual at risk.

An understanding, non-rejecting, long term, over many years, relationship with at least one person is essential. Desirable, however, is that there should be in addition to the one person a few others relating to each other in a place, a container, known and felt to be a home and growing place. It is a cross between a sanctuary and an incubator. It is a small portion of friendly territory inhabited by people who are important to the young fledgling, formerly maladjusted, youth. The acceptance, the understanding and the tolerance together with the incorruptibility of the workers make this kind of foster-home into something better than most homes peopled by the restricted family of the maladjusted child.

I noticed that Shotton Hall had built in self-righting mechanisms. Also what impressed me was that no demand made by a child or young person was ever rejected but with the yielding to the request or demand there was a counter request or demand for the child to do something for the worker or on behalf of the home. This militates against a greedy, devouring over-dependency.

This feature: Williams, H., Lennhoff, F.G. and Lampen, John. (1972). Thoughts on Aggression. England: Shotton Hall Publication. pp. 18-22