No. 1904

Helping together in Group Care Settings

I have previously (Ward 1991: 46-7) identified the defining characteristics of the group care context in the following terms:

1. an emphasis on the co-ordinated use of time through rotas, routines, shiftwork, etc.
2. a particular focus upon 'opportunity-led' work arising from the extensive everyday involvement between staff and clients
3. the close interdependence required of the team
4. the complex network of relationships between the team and the group of clients
5. the public or semi-public nature of much of the work
6. and the planned use of space and the physical environment

These characteristics, or some version or combination of them, will be found in all group care units, whether or not the unit has an overtly 'therapeutic' task and I have explored the general implications of these characteristics for group care workers in more detail elsewhere (Ward 1993a). The central implication is that, to be effective, group care workers need to keep in mind the various elements of the context as outlined above while keeping a clear focus on the task in hand with any given individual or group, and to be able to move between different areas of preoccupation without undue confusion or anxiety.

For those units which do have a therapeutic task, these characteristics impose a special context on the methods which may be used towards achieving that task. In some respects this may be experienced as a context which inhibits the therapeutic endeavour because, for example, it may appear harder to maintain what are traditionally seen as the appropriate boundaries around the therapeutic relationship. Thus, the worker may feel, 'How can I possibly remain clearly focused on helping this particular child when so much else is going on around me?'. On the other hand, if the context can be understood and harnessed towards the endeavour, it can provide a greatly enriched environment for therapeutic work. Now the worker may be able to say, 'What I am attempting with this child has parallels and overlaps with other things which are happening here — if these efforts can all be brought together we may stand a better chance of overall success'. Part of the task of management in such units will be precisely this business of promoting an understanding of the complexities and potentials of the system as a whole and enabling the team to maximise the potential. This management task has become more urgent with the decline of local authority children's homes and the burgeoning of foster care and would-be therapeutic residential units in the private and voluntary sector and simultaneously with the exponential growth of family centres, including those identified within the Children Act 1989 as 'therapeutic family centres'.

When people attempt therapeutic work in such units — even if they intend to confine the therapeutic work to (for example) planned individual sessions in 'special' playrooms, they are entering an intricate pattern of powerful relationships. At the heart of any therapeutic work will always be the relationship between a worker and a child: this is a relationship which, of course, is likely to evoke strong feelings in both parties, as seen in Chapter 2. In the child there will be a range of transference feelings connected with the child's experience of other significant relationships, especially his relationship with his parents or carers, where considerable stress, confusion, ambivalence or anxiety may be located. For the worker, in addition to being on the receiving end of this range of feelings from the child, there will be the range of counter-transference feelings both 'personal' (in the sense of associations which she as a worker may bring to any such piece of work from her own childhood or other experience) and 'diagnostic' (in the sense of feelings generated from this particular relationship with this particular child and which may indirectly tell her important things about the child's own inner world). These relationships occur in all therapeutic work and have been clearly documented in respect of clinical work: for the most part, clinical workers can focus exclusively on the experience of this individual therapeutic relationship without having to attend simultaneously to the broader context in which the work is set.

On the other hand, the therapeutic child care worker in a group care context will additionally need to attend to a much wider range of feelings, including those generated in the other children in the unit who may or may not be present during some of the significant interactions which she has with this child, as well as those feelings in her colleagues who again may or may not be present at key moments. Meanwhile she will also sometimes be party to other children's interactions with their 'key' or 'special' people and to children's comments to each other about their experiences and about the staff who are attempting to help them, as well as witnessing interactions between the child she herself is involved with and some of her colleagues, managers or supervisors. In addition, the worker may have to put this child to bed later that same day, or, in a family centre, escort that child back home with his mother and may subsequently have to complete a late shift or sleep-­in duty! Furthermore, in settings such as family centres, the child's actual parents may be present in the next room, or witness to or part of some of the communication between child and worker, child and other children and so on. Some of these parent- child-worker interactions may be apparently trivial, some of them deeply significant; some of them may be conducted in verbal and rational ways, others in less direct and conscious ways and others again may be enacted in physical and other ways, even including threatened or actual violence at times. Such family dimensions will be familiar to sessional family therapists, just as some of the group dimension described above arises in the context of sessional group work: my argument, however, is that it is only in the group care context that all of these factors may arise together and interact with each other.

For example, in a family centre Julie, a senior worker, observed that Peter, a four-year-old attending with his mother and baby sister, frequently became agitated shortly before the end of the day.

For no apparent reason, he would often begin racing around the building towards the end of the afternoon, avoiding contact with grown-ups as far as possible before eventually colliding with a smaller child or tripping over a toy on the floor and collapsing in a heap, crying. This behaviour was in marked contrast to his apparently subdued and compliant behaviour at other times and Julie also noticed that Peter's mother, Ramona, would not intervene during his disruptive behaviour but would eventually shout angrily at him when he had fallen to the floor crying. Other children and parents, as well as staff, were affected by this behaviour but nobody intervened. There is often some confusion in family centres as to who is responsible for the children's behaviour, but normally Ramona seemed to have clear control over Peter and staff would not need to intervene unduly. After the third similar occasion, Julie asked Ramona why she thought this was happening but obtained little response. She consulted the rest of the team at a team meeting, especially with Carole, who was holding weekly sand and water play sessions with Peter. These sessions were intended to help Peter to express his feelings more, particularly in relation to his confusion about his father, who had suddenly left the family twelve months before, shortly before the birth of Peter's baby sister. Carole herself had noticed that in recent weeks Peter had tended to become agitated towards the end of his sessions with her, but she was not clear of any specific reason for this development.

Eventually another member of the team made a connection with a recent occasion when another child had referred to one of the drivers who escorted families home at the end of the day as 'Peter's daddy'. It emerged that this was a new driver and that on his first day, Peter had mistaken him from a distance for his own father and had naturally become very distressed when he realised his mistake. This incident had gone almost unnoticed at the time except by this other child and by Ramona, but it had reawakened some of Peter's distress about his father and caused great anxiety to his mother, who preferred to think that Peter had actually forgotten about his father.

Out of these realisations it was then possible for the play-worker, Carole, to pick up this theme with Peter in his subsequent play sessions and for the senior, Julie, to spend some time talking with Ramona about her response to Peter's feelings about his absent father and indeed about Ramona's own feelings about her absent husband. A few days later, at the weekly meeting of all the families and centre staff, a comment was made by another parent about Peter's difficult behaviour and Julie found an appropriate and supportive way to help Ramona explain to the rest of the group something of what had been happening for Peter recently. This helped to re-establish understanding between Peter, Ramona and the rest of the children and parents.

In this way, a potentially confusing set of apparently disconnected incidents and feelings were pieced together by the team and the resulting pattern was used as the basis for future work with different members of the family and eventually with other families attending the centre.

To an inexperienced group care worker, such situations might be something of a nightmare, apparently at risk of spiralling out of all control into an unproductive chaos: how can we possibly create something positive and therapeutic out of this melee? To an experienced worker, on the other hand, the potential within such scenarios for productive therapeutic work may be quite evident and the ways of achieving this potential relatively clear, if still challenging. The key to unravelling the situation described above was teamwork: observation and deduction on the part of different team members and the use of the team meeting to assemble the pieces of the jigsaw so that team members could then use the emerging pattern in their future work.

ADRIAN WARD

 

Ward, A. Helping together: Using the group care context to reach the inner world. In Ward, A. and McMahon, L. (Eds.) Intuition is not enough: Matching learning with practice in therapeutic child care. London and New York: Routledge. pp. 41-45.

References

Ward, A. (1991). 'Training for group care', The Teaching of Child Care in the Diploma in Social Work, London: Central Council for Education and Training in Social Work.

Ward, A. (1993a). Working in Group Care: Social Work in Residential and Day Care Settings. Birmingham: Venture Press.