Needs of Staff, Needs of Clients
Introduction
I have known and worked with Peter Millar since we worked together at the Cotswold Community from the mid 1970s. When I became Principal in 1985 it was obvious and natural, that Peter would be the Vice-Principal. When I left the Community in 1999 Peter became the Acting Principal. In 2000 Peter became the Consultant Psychotherapist to the Cotswold Community, working primarily with the staff teams, as Paul Van Heeswyk and Barbara Dockar-Drysdale had done before him. Peter is now a practicing Jungian analyst in the Cirencester area.
John Whitwell
Needs of staff, needs of clients – a balancing or a juggling act?
Peter Millar Therapeutic Communities (2000), Vol. 21, No 4 © The Author
ABSTRACT: In thinking about nourishing body, mind and soul we have to consider the needs of both the client and staff group. Drawing on the work of a residential adolescent community, this paper examines some of the tensions and conflicts that arise in this context and explores their impact on, and in relation to, the task of the community.
Introduction
In the Winnicottian „good enough‟ environment the infant is adapted to by the primary carer who becomes attuned and preoccupied with the infant, for a time often at the expense of their own needs (although at some level perhaps other needs are being fulfilled). Through the creation of a safe space where the infant is shielded from too much external impingement, where physical needs are responded to appropriately and where anxieties are contained, made sense of and ultimately explained, the infant begins to develop its own capacities for making sense of its world, for dealing with anxieties and for developing relationships. Through the internalisation of its experience, the infant is able to move toward a relatively healthy personality development and thus become as normally neurotic as the rest of us.
The boys
The task of the particular community that I will draw material from is the treatment of unintegrated boys, aged between 9 and 16 years. Unintegration is seen as a point in early emotional development prior, to the consolidation of the ego, to the capacity to relate as persons, or to be able to experience concern and guilt in relation to another. The individual‟s world is still filled with part objects which are exploited and used, often mercilessly. The fact that these young people are still at this stage of development or predominantly occupying this mental state, is as a result of early breakdown in the emotional holding, containing relationship between infant and primary care giver (usually the mother) and compounded by abuse – physical, emotional, sexual, mental – for some, over a prolonged period. I believe the case histories of these young people are not dissimilar to those adults who would now be assessed or diagnosed as having severe personality disorders. At the heart of these individuals is a core of deprivations.
Prior to referral this experience is expressed by the young people in their repeatedly failed attempts (and the attempts of those charged with the responsibility for their well-being (most often social work departments)) to find what is missing. Thus there is a succession of failed placements, failure at school, involvement in delinquency, and embarkation into appropriate and often abusive relationships. One might consider this as the young person‟s continued quest to find that place or space where the nurturing and nourishing of body, mind and soul can occur.
The task and the kinds of demands on staff
The task of the community is to create and provide an environment in which they will feel safe enough to explore the possibility of relationships with adults, whom they may begin to trust and through this to receive a quality of nurturing that has the essence of what was missed in early life.
Their need is to experience a relationship that will survive their ruthless attacks and accept their feelings of awfulness. Through skilled work, empathy and attunement by the carer, the young person may get to experience a sense of maternal preoccupation or reverie that was absent, or interrupted prematurely; they may receive though the provision of an adaptation (usually a small, specific, reliable experience involving food) some form of experience that in essence symbolises the missed early experience that is an essential building block to any future emotional and mental health.
Such involvement means staff become highly preoccupied emotionally with the boys they look after, work long hours in what can feel like a sea of emotional chaos, often face enormous destructive fury in the young people expressed verbally and at times physically, and can be made to feel totally ineffective and useless. As Winnicott has said, the key word is survival, not just for oneself but to give the young person a chance to grow.
Working with intense deprivation – what this means for staff
How do staff learn the skills and acquire the knowledge needed to undertake such a daunting task as that described above? It can conjure up a scenario in which, on one side one has a group of very deprived, needy, demanding young people and on the other a group of staff whose job it is to nourish them. In this picture it can look as if one group is to a large extent receiving and the other to a large extent giving.
In rising to the task of meeting the needs of deprived young people, of providing a nurturing, stimulating and growthful environment, of being able to share existential moments with young people, staff are often thrown headlong into areas of their own personality development, encountering perhaps aspects of their own deprived selves, possibly for the first time, the need to explore their own projections, and to face their own shadows. So what do the staff get, and who sees that they get it?
How the community tries to nourish
At a practical level staff receive a salary and have reasonable holidays although this is in relation to working a 60/65 hour week. They are also availed of very reasonably priced rented accommodation on site, this having been a condition of employment for many years. There is supervision, training and access to consultants to discuss the work, individually and as part of a team. The Community has developed and continues to refine a three year training programme for staff which gives a thorough grounding in psychodynamic theory as applied to individual development and group and organisational dynamics. It is also exploring how the NVQ Level 3 in Child Care will fit into its structure, this being a government requirement for all residential staff in the near future.
Evocation of deeper deprivation in themselves
It should come as no surprise that given a very needy, deprived boy group and given what we know and understand about processes such as transference and counter-transference, projection and projective identification, it is inevitable that some of the feelings of the former are going to be expressed by or through the staff.
Although as a community we have been careful, in various ways, to build in provision for staff (and in fact this is seen as intrinsic to their carrying out the task) the extent to which the environment is perceived as nourishing is something that is in constant flux. Some days for some staff it may be felt as supportive and nourishing, on other occasions this may be quite the contrary.
In addition staff may have been drawn to work with this particular sort of client group as a means of meeting a number of needs in themselves. At one level it is probable that people come, for example, wanting to explore working with young people, or to further their career, or gain experience in a particular field prior to some further training. From our own experience we know that many people who arrive at the community are also looking, although it is not so conscious initially, to work through some sort of personal issue. Some have a sense of this from the outset, others discover it along the way. It has been heartening to see over the years how many staff reach a point where personal therapy, separate and distinct from work, is explored, and personal responsibility taken for all those things that begin as projections and basic assumptions about the community, the clients/residents, or the senior staff and consultants.
How it comes – the locus of neediness
So despite the range of provision for the adult group just outlined, other areas of need get expressed in more indirect ways, appearing perhaps as criticism, dissatisfactions, the wish to change things and so forth. Over the years of listening to such communications by staff, there is a theme or two that resonates with those of the young people.
Feelings arise for example to do with food, paying for it, the quality of it (cooked by staff themselves), numerous issues to do with accommodation, lack of maintenance etc; lack of support, missed supervision, lack of understanding by senior managers or consultants, lack of support by the managing organisation, now a children‟s charity, previously a county council social services department.
Examples
By way of trying to illustrate this I would like to offer a few brief examples, related to working patterns and food. Both areas can be the locus for a myriad of feelings.
1. Working patterns/hours
The exceptionally long hours worked by people at the community has generally been thought to be necessary to carry out the sort of work the community is engaged in, and for the most part staff understand and accept this, despite it being tough at times. Periodically, for various reasons it has been necessary and appropriate for the hours question to be reviewed and changes have taken and continue to take place.
Some years ago there was a lot of pressure being expressed internally about the hours. Rather than take the approach of saying “that‟s the way it is – get on with it”, or making an instant adjustment by cutting the hours, it was decided to create a working party comprised of new and experienced staff to look at the issue and whether the hours could be reduced and what the impact of doing so might be on the work. What eventually emerged was the realisation that what felt difficult, what was stressful and stirring up deep feelings, was not so much the number of hours being worked but that a way of off-loading, de-briefing, handing over of feelings and thoughts related to work at the end of the day was missing, or had become lost in the need to complete masses of paper work. These feelings and anxieties then got taken home, disturbed sleep patterns and played on people‟s minds the next day, especially if it was their time off, very much affecting the quality of that person‟s own time.
The group proposed that at the end of the day people working should sit and talk over the day and share anxieties or particular issues and pass on practical information before going home, rather than writing up innumerable case notes in boys‟ individual books.
Through this process the feeling in staff shifted from one of feeling isolated, fed up and having impossible demands made on them, to feeling heard and supported. What had been experienced as an increasing impingement on one‟s personal life, and therefore a deprivation, evoking feelings of being exploited and not cared for had shifted by identifying a problem in the way people working together were relating (or not relating). It highlighted too for staff just how much from the day „got into‟ them through the boys and how without appropriate unloading the only way to cope with it was to attempt to create more of a compensatory space. What actually helped was the creation of a different sort of thinking space.
A more recent review of the working week linked to the European directive, again by a mixed group working party, produced a range of responses with a number of staff feeling that they would like to continue to work the longer hours during the time boys were resident but to have the whole of the holiday period clear for regeneration and their own recreation (which satisfied the European Working Time Directive at the same time).
A recurring area of statement that I have encountered from some staff is an issue about the short holidays and that they were not told this when they came for interview (a process which involved a number of visits including a three day period when they lived in the Community and went through the daily routines with a group). This complaint was often accusatory and I usually felt personally responsible and that for some unknown reason I must have omitted this essential bit of information. The feeling was that they had been tricked into coming and that had they had this vital bit of information they would never have dreamed of or agreed to incarcerate themselves in this place.
The first time this happened to me I fell into the way of thinking that they must be right. However as the same issue popped up periodically I began to wonder what it might be a statement of. Comparisons made with ordinary schools highlighted the fact that our staff had two weeks summer holiday whilst they had six. Being with colleagues from other establishments stirred up envious feelings, the community was felt to be depriving them of a holiday and placing impossible demands on them. One might speculate too that these feelings arising before a long summer break, in which boys were to be away for three or four weeks, could also be linked to feelings they had about being sent away, about being rejected and deprived of their time at the Community. This may evoke feelings of guilt in staff which become expressed through the feeling of not being given enough holiday oneself. Becoming a way of locating the guilt somewhere.
2. Food
Over the years food has been another recurring area for debate. A number of years ago staff elected to pay for their food, being billed weekly by a team member who held particular responsibility for the overall provision of food in that household. The move came at a time when the community was decentralising from a centrally provided service and each of the four households began catering for themselves, purchasing, preparing and cooking all their meals. The feeling was that it put staff in a dependent position in relation to the organisation, that there was something potentially institutionally delinquent about using the money paid by local authorities for boys‟ placements and treatment to pay for adults‟ meals.
Subsequent generations of staff who inherited the structure increasingly questioned its validity, some to the extent of protesting by not paying. Recently the system has been scrapped and now staff who are at work over a meal time have their food provided, on the same basis as happens within the education and other systems where there is an understanding or agreement that „staff on duty‟ have their meals free.
Prior to this change, feelings at times became focused on the notion that staff were having to subsidise the boys‟ food by paying for it, that being forced to pay for food one did not like was wrong. The quality of the food was another matter. What did polarisations such as one staff member describing the same food as disgusting and another saying they enjoyed it mean? Feelings about the menu, whether it was boy centred or catered for adult tastes, and who was determining this have founded heated statements.
What could not always be explored was how perhaps the innate and inherent greed of the young people got inside the adults. Very powerful feelings are generated around the meal table. One can feel sick, that one is not going to have enough to eat or that one is going to make sure one gets one‟s share (and seconds if possible). Both complex and subtle feelings in this realm need to be thought about and considered as an aspect of the dynamics of deprivation.
Negative feelings about food may well carry an indigestible component, a reflection of how difficult and painful it is trying to digest the needs and demands of the young people. Feeling in competition for the food with the young people may arise in relation to experiencing their greedy impulses and identifying with them. This might be a direct reflection of their experience or arise from an anxiety that staff are going to be physically depleted through the voracious demands made on them from the young people and so have to strengthen themselves. It may be too that they are reminded and put in touch with some past deprivation of their own.
What is the task for Manager/Consultants?
Being at the receiving end of these sorts of communication is, I imagine, something that many people here are familiar with. Often this may be experienced as frustrating and distracting and can at times be felt to be tiresome or anti-task.
In some ways we might see these types of complaints as being about a deprivation, or a statement of deprivation of some kind. If this is the case how do we respond, do we leap to action and provide what was missing – more supervision, further training, additional pay, shorter hours, longer holidays, or perhaps sweep it aside with a clever interpretation?
Perhaps the importance of framing such communications in terms of the theme of deprivation is that they can then be thought about in a way that integrates them into our notion of task. In other words these statements by staff can be thought about as important communications coming from what one might think of as a collective psyche – an amalgam of the staff group, client group and the institution. Whilst at times the personal elements may appear stronger and require a more personally oriented response and solution, nevertheless it may still be helpful to consider this as a manifestation of something from the collective.
There is, I believe, particularly in communities working psycho-dynamically, a danger in interpreting complaints or grievances by staff in a way which they feel guilty or attacked and not heard – that there may be a real or practical issue behind the individual complaint and that it might need attending to. This is rather like seeing all illness as psychosomatic and therefore an emotional/mental problem rather than a physical one. There is a tangible illness or condition, which may need some form of medical intervention or treatment, which may emanate from an underlying psychological problem that also needs to be considered. Conversely the beginnings of an illness may give rise or produce an emotional reaction that becomes the focus of attention.
The immediately perceived solution to deprivation and need isn‟t necessarily the answer. One needs to guard against hiding behind psychological interpretations, reactive provision and instant gratification. It seems important to keep in mind the high level of deprivation and need in relation to the boy or boys we work with and that this will at times suck staff dry.
Creating space for thinking and reflection is essential, as is perhaps being able to consider the essence or nature of the content of the communication. In doing so we might gain a greater glimpse of the core of a deprivation as it moves around the institution.
Conclusion
So a task for those of us managing or consulting within communities is about holding a tension or keeping the balance between meeting the needs of the deprived client group and responding to the statement of deprivation in the staff group (which may be their own or may be the counter-transference response to being so intimately bound up with the task of meeting the needs of young people).
Keeping things in balance may, I think, be a healthier way of managing the situation than juggling. When juggling there is always something in the air, perhaps lost from sight or out of control, certainly out of touch, it looks impressive and the more things one can juggle with the more impressive it looks, until the whole lot comes crashing down around one.
However, keeping things in balance requires an awareness of the forces at work, a sensitivity to respond by making adjustments, something subtle, and keeping the whole in mind. There is a margin of tolerance where one side or the other can move up or down without dropping permanently to the floor. If we can achieve this in relation to the boys, the staff and the institution as whole then that „good enough‟ environment may go on existing, that nourishes body, mind and soul.