Speaking out for Social Work Sheffield , July 6 th 2016

1. ‘Holding it together despite it all’Andrew Cooper Tavistock Centre and Centre for Social Work Practice Speaking out for Social Work Sheffield, July 6th 2016

2. When times are hard…. …and there is not enough to go round, we may fight among ourselves, compete, fragment, and blame. Austerity…and now Brexit…. Or we may succeed in forging some solidarity, but even this may involve an ‘us’ against ‘them’ dynamic. Who are the real opposition? Is there a strong position somewhere between fight and flight, compliance and protest, passivity and rebellion? Holding it together may not be easy….

3. THE NEW DEAL Low tax Who is paying and how? Low welfare Just about everyone in this room, and our patients, service users, colleagues, children, parents…

4. Who is paying? • People with disabilities • Children and adults with mental health problems • Children vulnerable, in need and at risk • Asylum seekers, immigrants • Older people needing social care • Working people on low incomes – including many social care staff • The NHS • The health and caring professions • Local authority services • The third sector

5. Holding it together after Brexit… Two labour politicians, one identified with Corbyn and the other with the PLP, on Newsnight. The presenter says: ‘We’ve agreed you’re not going to fight!’ I am thinking – ‘How can they not fight? It’s an impossible situation…’ Some of the ‘veneer of civilisation’ has been stripped away…some of the conditions providing political containment have been fractured. Deep divisions in our society are more exposed and their toxic potential threatens to be unleashed… Events such as a referendum put tolerance to the test,” explains political psychologist TerezaCapelos. “Ironically, tolerance begins from a negative starting point. You have an intention to share benefits with others even when you don’t like them. Everybody dislikes somebody, but if you believe that others have rights and you engage in a society, which is open, you accept this. If you feel marginalised you may have weaker civic values. A spark can encourage you to see another human being as ‘the other’. You dehumanise him or her. They are ‘not like us’.” Some on the margins of society feel betrayed and don’t know who has betrayed them so they turn on “the other”. “That’s why politicians, journalists and academics have such a responsibility for the narratives they develop.”

6. And so… Events such as a referendum put tolerance to the test,” explains political psychologist TerezaCapelos. “Ironically, tolerance begins from a negative starting point. You have an intention to share benefits with others even when you don’t like them. Everybody dislikes somebody, but if you believe that others have rights and you engage in a society, which is open, you accept this. If you feel marginalised you may have weaker civic values. A spark can encourage you to see another human being as ‘the other’. You dehumanise him or her. They are ‘not like us’.” “Some on the margins of society feel betrayed and don’t know who has betrayed them so they turn on “the other”. “That’s why politicians, journalists and academics have such a responsibility for the narratives they develop.” Yvonne Roberts, The Guardian, July 2, 2016

7. The importance of ‘thinking’ • These divisions, and the associated toxicity, are directly relevant to us as social workers in our daily lives, experience and encounters • ‘Thinking under fire’ whether it’s professional or political in nature (Bion) – first open yourself to the emotional experience, and allow yourself to know it. Then allow time to assimilate its complexity and perturbing impact. Find some thoughts, that seem to capture experience in a truthful way…some words that might help you, and others, make sense of things. Speaking them may be a way of changing things. ‘Action’ may need to follow, but action without this kind of prior ‘thinking’ is likely to be reactive, panicky, create further anxiety….

8. HOW ARE WE PAYING? A SHORT STORY… As I go into supervision I am filled with dread as I know my to-do list is not even a quarter complete…All my manager is interested in is are timescales met, are plans completed and up to date, are core groups up to date, are core assessments completed, rather than asking me how I am and how are or who are the children on my caseload. He gets out my caseload list and asks me what cases can close? I respond saying none of them and he tells me that there must be. I try to explain why and he responds that he has to get caseloads down and we just cannot keep hanging on to cases. This starts to increase my stress levels as I feel that more work is needed on my cases, more support required to meet the families required needs… Supervision carries on in this manner, going through each case briefly, recording timescales and my manager telling me when assessments must be completed by so the case can close. I feel that all my manager cares about is getting cases closed and timescales, which irritates me as I know that if they are closed, they will soon be re-referred as the issues have not been addressed efficiently. I just wish I could be allowed to do my job effectively.

9. After work I quickly pop by the supermarket to get some food shopping and at the checkout I feel like its being in supervision, everything is rush, rush, rush. I take everything out of my trolley and place it on the conveyor belt; this is done in no particular order as I can see the checkout lady looking at me which makes me speed up. She is passing the items through at a fast pace, faster than I can bag them and I ask her to slow down, but this is ignored. As soon as she has finished scanning them, she immediately asks for payment even though I have not bagged all the items yet. I make her wait and I can see her getting agitated whilst I feel myself getting flustered and annoyed as I rush to bag the items and pay. After I pay and before I leave the checkout I notice that she is already scanning the next customer's items. Surely she could have waited another 30 seconds to give me time to leave, I think to myself.

10. How are we paying? With the emergence of an industrial / efficiency model of service organisation and delivery Ten years ago I wrote a book with a colleague - Borderline Welfare: Feeling and Fear of Feeling in Modern Welfare. This described how the quality of our services was becoming ‘thinner’ and more proceduralised as inspection, audit and performance management regimes, and risk aversion moved into the space once occupied by professional autonomy and discretion. The book developed the idea of the health service and ‘welfare state’ as a necessary social container for the adversity, suffering, conflict, mental pain of citizens. Services provide a response to people in need, but also protect the rest of the population from too much anxiety and responsibility for complex care. But a true ‘container’ is receptive to suffering and mental pain, and shapes itself around these experiences. The ‘contained’ changes the nature of the ‘container’ One clinical theorist described two alternatives to a ‘concave’ , receptive container – a ‘flat’ surface that doesn’t let much in, or a convex one which actively pushes the pain and need back into the subject. What kind of social container do we think we now provide in the UK? Or, for some, is it a case of no container at all?

11. We are paying… • In ourselves. With our professional and personal integrity - who in this room sometimes thinks their ‘true’ professional self has to stay in hiding these days? • With our own mental health – who in this room has been off work with ‘stress’, or been close to it, or resigned and moved on, or lives in some fear of redundancy? • With the quality of our services • With the quality of our organisations and ‘systemic’ deterioration in relationships between front line staff and managers

12. Why is it happening? To pay for austerity? To keep people in power? To open the way for privatisation? To create a society that is divided, but still politically manageable…. Britain is not the USA, (yet) but here is how one American commentator sees it:

13. David Simon on the USA now And that's what The Wire was about basically, it was about people who were worth less and who were no longer necessary, as maybe 10 or 15% of my country is no longer necessary to the operation of the economy. It was about them trying to solve, for lack of a better term, an existential crisis. In their irrelevance, their economic irrelevance, they were nonetheless still on the ground occupying this place called Baltimore and they were going to have to endure somehow. • That's the great horror show. What are we going to do with all these people that we've managed to marginalise?’

14. Constricted spaces? Government Statute, Policy, Statutory Guidance ‘Risk’ and ‘vulnerability’ The Service users Professionals and carers Child Protection, Adult Safeguarding, Fostering and Adoption, End of Life…. the practice space

15. Open spaces? Impoverished, marginalised, invisible, undocumented, scapegoated, populations and communities The t Social Work New social movements and social care and anti-austerity campaigns Social workers know about the lived experience of invisible, marginalised and impoverished populations…but we need a ‘movement’ to support us, protect us if we are to advocate and campaign on the basis of this knowledge… Reclaiming a different social work?

16. A Trial for Change: the FDAC model Service users The Family Court Professionals Judge Goal defined and time limited therapeutic work bounded by a collaborative agreement among all 3 parties a bounded but negotiative therapeutic practice space

17. Learning, development, supervision…How it should be / sometimes is…. The worker The task ‘Above the surface’ The nature of the work Experiential learning and reflection ‘Below the surface’ The emotional impact of the work A deepened capacity for difficult emotional experience in our work

18. Anxiety and Containment in Organisations – a short history Rationing Anxiety Performance and Audit Anxiety Partnership Anxiety Professional Anxiety Survival anxiety …Austerity The task The organisation as container of anxiety Senior management Coal Face

19. The professional self in hiding Performance and survival related (persecutory) anxiety Fears for the survival of the self Resonance True professional self Unprocessed task related (depressive) anxiety Fears for the well being or of harm done to patients

20. Spotlighting “Why is that system in place that 3 people need to check it? I don’t understand, isn’t someone competent enough to be able to check that report once, sign it and send it off? Because it’s making the whole process even longer than it needs to be, because ideally you’d want your court work done a week before. It’s impossible.” Social worker, Longer Term Team These defences resonated with a number of those identified by Menzies Lyth regarding decision making and checking with seniors, they also had an obsessional aspect to them... Taken together they represented socially structured defences against anxieties about carrying out important and risky work in contexts characterised by lack of time, resource, complexity and ambiguity, but importantly also in the shadow of an omnipresent inspectorial ‘management system in the mind’ that was not the sole product of task related anxieties or defences against these. (Cooper and Lees 2014)

21. However…some signs and spaces of hope: Engaging with children’s experience… In an East London children’s centre, a psychoanalytically trained social worker welcomes a dozen children who arrive in various groupings with their foster carers. The children are members of three sibling groups, all of them in local authority care and in the process of being adopted or placed in long term foster care. The adoption worker had noticed something which no one else had registered – that large sibling groups are routinely split up when they enter the care system, and then planning for the futures of sub-groups proceeds on separate lines. Professionals ‘forget’ the wider sibling system, and cease to consider its meaning from the children’s point of view.

22. Carrying the message across boundaries The series of groups she facilitates brings the sub-groups back into connection, and then helps them say goodbye, but now in the context of a system that ‘remembers’ their relationships and will enable future contact. Sometimes this has led to revised permanency decisions. Her work was fiercely resisted at first by her managers, by judges, by Children’s Guardians. They all voiced the same reaction – this process would be too painful for these children and the work would harm them. But she won them round, helping them discover that this response was mostly about the pain evoked in them at the prospect of these meetings and mournings

23. Boundary spanning This worker is doing more than just advocating for the needs of a specific group of disadvantaged children. She is doing the work of a ‘boundary spanner’ (Williams 2012), conveying thickly textured emotional and social intelligence from one domain to another in search of a more attuned and grounded policy response rooted in authentic recognition and understanding of lived experiences. She is insisting that the policy process must begin from such understanding, shape itself around such complex realities, and forge solutions that are negotiated between these different domains and systems. Psychoanalytically, she is asking the social ‘container’ to relate to, incorporate and digest the quality of experience of the ‘contained’ before it delivers a solution or policy response. (Cooper A. 2015, Comfort J. – unpublished)

24. However (2) A worker keeps her head… ‘… I was concerned that an image of this family was being presented to me before I had even had any opportunity to connect with them. I was being invited to be fearful and defensive before I had even met the family, as if a state of mind that may have belonged to the hospital staff was being projected into me. I decided to make contact with the father before the arranged visit because I felt that if effective work was to take place with this family, an atmosphere of fear and anger needed to be avoided as much as possible. When I phoned father and spoke to him, my impression was of a man who certainly was angry but also expressed a lot of vulnerability. In my countertransference I did not feel afraid of this man, but concerned for what the family including the mother and the two year old were going through this major life changing trauma.

25. I think with hindsight this initial phone call and the feelings that I got from it that contrasted with the feelings I was being invited to have by the hospital professionals, was crucial in developing an effective therapeutic relationship with this family. It was as though I was able to then treat them as a family suffering as opposed to a family on the attack, and they were more able to welcome me in to the family as a potentially helpful figure.’ After introducing myself, father asked if I knew what happened. By this it became clear that what he meant was how the hospital had let him and the family down in not being informed about the disability of the baby before birth. He said, “You killed me, you killed my family, we are dead”.

26. At that point I was clearly part of “the system” undifferentiated from the hospital staff who he felt let down by. I reflected and acknowledged his anger and said: ‘You seem to be very angry, feel let down by everyone and might wonder if I will let you down too?’ The latter part of my comment addressed the man’s lack of trust towards me in the transference in a direct way, which may have helped him feel that at least I was not going to avoid painful and difficult feelings. The sense of unknown was very powerful and included my own feelings of facing the unknown with this family, and I used this to say something about how hard and powerful it is to be suddenly faced with such an unknown painful experience as suddenly having a disabled child.’

27. A baby keeps his parents…. The number of hospital staff involved in my various meetings with them was always surprisingly high. The hospital child protection nurse who chaired the meeting outlined their concerns and there was particular emphasis on father’s verbal violence to hospital staff and his lack of bonding with baby. From the outset all the hospital staff spoke with one voice. They were also concerned about mother not visiting during day time or staying at night. The idea of the baby being taken into care was put forward as the solution from the very beginning. On reflection, it was as though hospital staff had made up their minds about what should happen, and my role would have been to implement their decision. By contrast, I fed back to the meeting my views about the home visit, agreed that father was clearly very angry but thought that such a big decision might be premature for a family who are still at early stages of coming to terms with very traumatic event. I said “We have to give this baby and her family a chance”, and that placing the baby even temporarily in care would harm the bonding relationship rather than help it.

28. That challenge to the overriding opinion of the meeting seemed to permit some other professionals to break away from the fixed idea that placing the baby in care was the best option, and I received some support for my suggested course of action. We ended the professionals meeting deciding that there needed to be further assessment and observation of the parents’ interaction with the baby and agreed to meet the next day.

29. What can we notice about this story? The worker is: Under immediate pressure of anxiety from others But says steady, thinks, takes her own authority Receives and contains the father’s anger, then finds words to empathise Recognises his response as possibly part of a grief reaction, a response to the loss of something…. Meets the anxiety of the hospital system steadily and finds a way to collaborate (think) with them Makes relationships in all directions – which makes the difference

30. However (3)….A CEO tries his best Our turnover and running costs have quadrupled in four years. This expansion has necessitated the introduction of a raft of policies, procedures and job titles to satisfy the needs of funders and the Board of Trustees…I became CEO in 2011 because my great friend who filled that role became unwell. She stood down; I took her job, and she took mine. I had been working very happily as a housing advice worker and advocate. As the organisation grows, I have super-imposed all sorts of management conventions retrospectively. I pay lip service to line management, supervision, and being a psychologically informed environment (a place where staff have an opportunity to reflect on the impact their interventions have, not just on others, but on themselves – a reflexive space).

31. So, in my head, there is a split. There is the charity that exists on paper in the funding applications - the sleek, streamlined, efficient organisation that meets targets and satisfies funders, and there is the organisation into which I dive every morning – the group of people who do great work, but muddle through, cut corners, lie about their feelings, sometimes watch the clock and long for the weekend. Clare feels confused about who to talk to about her anxieties. She describes the organisation as now being neutral since the hierarchy was imposed and she doesn’t know who it is safe to talk to or what it is safe to talk about. When I took over initially, I used to meet her almost every morning and we would have an informal chat about her mental health, her emotional state and her recovery. She says “I miss our little chats in the morning” (This makes me very sad. I feel a sense of loss and I wonder if we can ever return to that sort of relationship). She goes on to identify two organisations; the remnants of the old informal group when we all chatted together, and the new outcomes obsessed, project based (split) machine. She feels a little lost about where to find the common ground and still get the job done (So do I).

32. Flying apart under conditions of tension

33. Relating under conditions of tension

34. The ‘take home message’ (every presentation must have one…) Do you have organisational conditions that help you keep moving towards, rather than away from, the areas of pain in your work? How much of such a capacity do you feel you have in yourself? Do you have help and support with developing these conditions and capacities? Can you ask for them? The nature of the primary task isn’t so different from what it’s always been. The conditions in which we operate are different. ‘Solidarity’ emerges from talking about our painful experiences and struggles. From thinking first and acting later. It’s that simple and that hard….