NUMBER 209 • 18 FEBRUARY 2003 • CRITICAL THINKING
INDEX OF QUOTES
Staff were more confident and skilled operating in areas that had previously been seen either as threatening, or even as falling within the domain of work previously regarded as properly belonging to a ‘high status’ professional. Critically, the process of being involved on a daily basis with mental health professionals and thinking about mental health issues allowed front-line staff to work through some of their own anxieties about working with needy and disturbed children.
The psychodynamic ways of working by the mental health team focused on providing an environment where staff were supported in thinking about the issues that made them feel anxious, rather than having to act them out. For instance, rather than getting angry with a child and then rejecting them, they were supported in thinking about why they felt angry in that particular situation, with that child, and about just what might be going on, including the possibility that the child might have engaged the staff member in re-enacting a situation of a parent rejecting a needy and frightened child. Such work facilitated residential care staff to manage the broader anxiety born of the move from institutional models of practice to smaller scale, but also more intimate, models, where it was more difficult for them to avoid working with disturbed and very needy children who often made the staff feel bad. Such children, some of whom had suffered terrible abuse, at times could only communicate inner distress by a primitive process of trying to make a staff member working with them feel, inside them, some of the pain and confusion that the child her or himself suffered but was unable to put into words, and therefore could nor work through by thinking and talking about it. What was required in such situations was for staff members to try to think about, and put into words, the distress generated inside them by working with a particular child.
An important component of the work here was to support a way of working where staff were encouraged to puzzle and think about what was going on without always having to have an answer, to have the child in mind, and to come up at times with surprising insights. This supported the authority of the front-line care staff group who, when working in large institutions, had been used to a more hierarchical way of working where definitive answers to problems were given by people in authority, but in a way that was not always in tune with what was happening on the ground. This was particularly pertinent in the looked after environment, where the high prevalence of attachment difficulties meant working with acting out children who, at times, made any kind of thinking very difficult. Not thinking about the inner distress of a looked after child could leave such children feeling even more rejected and therefore even more likely to act out their distress.
None of the front-line staff saw the mental health service primarily or exclusively as being about the treatment or management of presenting problems, although they valued the practical insight and support that allowed them to manage young people’s care on a daily basis. All saw the process as a longer-term-intervention that would impact on the outcomes for young people in later life.
MICHAEL VAN BEINUM et al.
Van Beinum, M.; Martin, A.& Bonnett, C. (2002). Catching children as they fall: Mental health promotion in residential care in East Dunbartonshire. Scottish Journal of Residential Child Care. Vol. 1. pp. 19-20