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Hostile relationships in social work practice: anxiety, hate and conflict in long-term work with involuntary service users

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Hostile relationships in social work practice: anxiety, hate and conflict in long-term work with involuntary service users

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Hostile relationships in social work practice: anxiety, hate and conflict in long-term work with involuntary service users

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ABSTRACT
While recognition that some service users do not want social work involvement has grown in recent years, little research has explored what relationships between social workers and 'involuntary clients' look and feel like in practice and how they are conducted in real time. This paper draws from research that observed long-term social work practice in child protection and shows how relationships based on mutual suspicion and even hate were sustained over the course of a year, or broke down. Drawing on a range of psycho-social theories, the paper adds to the literature on relationship-based practice by developing the concept of a 'hostile relationship'. The findings show how hostile relationships were enacted through conflict and resistance - especially on home visits - and how anxiety and other intense feelings were often avoided by individuals and organisations. Much more needs to be done to help social workers recognise and tolerate hostility and hate, to not retaliate and to enact compassion and care towards service users.

At the heart of social work is a value base that urges practitioners to strive for relationships with service users that are empowering and based on mutual respect. However, some relationships in social work are not like that but are transacted through mistrust, fear, hostility and even hate. One reason social work places such an emphasis on achieving empowering reciprocal relationships is because it is assumed that service users are voluntary and want a service (Barber, ). While social work literature and policy stress the importance of 'user engagement' and working in 'partnership', 'the reality is that most social work relationships are involuntary' (Smith et al., , p. 1462) because the person receiving the service does not freely enter into it.

We even lack an agreed language to refer to people who don't want a service (McLaughlin, ). With respect to people experiencing mental distress and detained through the use of compulsory powers, Beresford () suggests the term 'service refusers' might be more appropriate. As people who have no desire to use a service are not 'service users' in any meaningful sense, the term 'involuntary client' seems a more honest, accurate way of representing the relationship. Recognition of involuntary clients and the complexity of such work has grown in recent years (Calder, ; Rooney, ; Trotter, ; Tuck, ). High profile cases where children were harmed or died despite extensive professional involvement have heightened awareness of what Laming () called 'resistant and deceitful parents'. Sudland () shows how working with 'high-conflict' parents and families is enormously emotionally and practically challenging. Some research suggests that in such high-risk cases intimidation and physical violence towards social workers by family members are quite common (Littlechild, ; Stanley & Goddard, ). Verbal aggression and threats have been found to be commonplace and have detrimental consequences (Robson et al., ), while significant numbers of workers have felt that the impact of the violence and parental hostility on them was minimised and mismanaged by their managers and this adversely affected their practice and the quality of protection that children received (Hunt et al., ). Notions such as 'respectful uncertainty' (Laming, ) have been coined to try and capture the delicate balance of trust and doubt that social workers need to achieve. Strengths-based practice models such as Signs of Safety include techniques for advancing such work (Edwards & Turnell, ; Turnell & Essex, ). Within the literature on relationship-based practice (Ruch et al., ) there is recognition of the complexity of working with strong feelings and dealing with aggression and hostility (Cook, ; Smith, ). Turney () argues that recognition, respect and a degree of reciprocity are key elements of an ethically grounded relationship-based practice with involuntary clients.

However, what is mostly absent from the literature is attention to what 'involuntary' relationships look and feel like in practice and how they are actually conducted in real time. Much more needs to be learned about how relationships based on mutual suspicion are sustained over time, or break down, and how the feelings generated by tense, often conflictual and sometimes frightening encounters are dealt with and the implications for keeping children safe. How professionals can have a relationship with someone who does not even want to be involved with them is one of the most difficult, important and yet under analysed dilemmas in social work.

This paper seeks to contribute to filling this gap in knowledge by drawing on an ethnographic study that used participant observation to explore how social workers establish, develop and sustain long term relationships with children and parents in child protection cases and how this is influenced by organisational life, staff support and supervision. Fifteen months of fieldwork were spent with social workers, the first three months of which were used to identify a sample of 30 cases that were then shadowed for as long as they were open for up to a year (Ferguson et al., ).

The research found that different kinds of relationships became established between social workers and families in long-term casework. Some were cooperative from the start, and therapeutic, or became that way having begun with the service users not wishing to have social work involvement (see, Ferguson, Warwick, Disney, et al., ). Some parents were opposed to child protection involvement and this type of relationship was often hostile and remained that way. It is the latter kind of work and 'hostile relationship' that is the focus of this paper, which has two aims: to draw on case-studies of long-term casework with 'involuntary' clients to show what it looks like, feels like and involves for both social workers and service users; and secondly, to add to the literature on relationship-based practice by developing the concept of a 'hostile relationship'.

The paper draws on a range of psycho-social theories to show the complex dynamics of hostile relationships, the emotional demands they place on social care staff and service users and the impact on individual workers, teams and organisations of working with or avoiding such hostility (Holway, ).

Researching long-term practice and relationships

The 15 months of fieldwork were conducted simultaneously in two Local Authorities in England and the research team spent a total of 402 days in the field. We had no way of knowing at the outset how long the 30 cases (15 at each site) we sampled would be open for and in the event 12 were shadowed for the full 12 months, one for eleven and 22 were shadowed for at least eight months. A total of 271 practice encounters between social care staff and service users were observed, 146 of which were home visits. Fifty-four staff supervisions were observed and 54 interviews took place with families, some of which involved up to three interviews with the same families over the course of the year. We also extracted data from social work case files about the total work that was done over the year (Leigh et al., ). Mobile research methods were used so we could travel with practitioners, interviewing them on the way to and from home visits and other places where children and families were seen (Disney et al., ). The practice encounters between practitioners and service users were observed and audio-recorded. Similar close attention was given to observing and recording encounters between staff in the social work offices, soaking up atmospheres and organisational cultures. A case study method was adopted by bringing together all the data on each case and this provided 30 very detailed case studies of long-term social work practice. Due to the large size of each case-study and the insights they give into the detail of practice the paper is focused around a small number of cases. The chosen cases are what Wengraff () calls the 'focal' or 'gold-star cases' within qualitative research samples that deserve attention because they not only tell their own story but illustrate the general research findings particularly well. The research was funded the Economic and Social Research Council and ethically approved by the participating social work agencies and universities. Professionals and families were only shadowed and interviewed if they gave informed consent. While the case examples used here reflect actual events and findings, details have been changed to protect the anonymity of the families, professionals and research sites.

The approach to participant observation that was adopted enabled attention to be given to the senses, emotions and lived experience of face to face practice and organisational life over time (Ferguson, ; Pink, ). This involves the researcher staying close to participants' experience and writing in ways that intertwine events and emotions as they were experienced in real time, ensuring accounts of practice maintain their 'aliveness' (Holway, , p. 123). In presenting the findings key scenes from the data are selected that typify what was said and done and the atmospheres of encounters and experiences over time, their smells, sounds, moods, emotional textures - in essence, how the work and relationships felt. This qualitative longitudinal approach (Neale, ) enables the drawing out of key patterns of relating between social workers and service users and how they were influenced over the course of a year by the ebbs and flows of what was going on in the family and the organisation - what we have elsewhere called the 'seasons of social work' (Ferguson et al., ).

In facing head on the difficult experiences and emotions that hostile relationships involve, the paper draws on social theories that are helpful in thinking about such emotional and relational complexity. The power social workers have to intervene into people's lives must be understood in terms of the lack of social power and status service users typically have. The persistent stigmatising of the poor and of black and minority ethnic communities make them into marginalised 'others' who provoke fear and contempt (Tyler, ). Service users in child protection cases have increasingly been framed through such discourses as disgusting 'others' (Warner, ). While social workers are trained to understand marginality and how fear of the 'other' is socially constructed and to counter it through anti-oppressive practice, at a psychological level direct contact with people from such social groups can still provoke anxiety and be experienced as a threat to the integrity of the self. This is exacerbated by how at a social level the social work profession is constructed as a 'bad object' into which the media, politicians and the general public project their rage and attack it for perceived failures in keeping children safe (Valentine, ).

Freud's work and psychoanalytic theory as developed by Klein (Salzberger-Wittenberg, ), Winnicott () and Bion (), argues that professionals' capacities to think clearly about and relate to the service user (referred to as 'transference') is particularly influenced by the level of anxiety the professional experiences and what the service user projects into them (referred to as 'counter-transference'). To care about someone and be helpful requires a capacity to become emotionally attuned to their experience, to think about why they present in the ways that they do and to not retaliate when they are angry and upset. This is extremely difficult for professionals to do when they are constantly under attack by service users and rage and hate are projected into them. As Winnicott () showed, feelings like hate are experienced and acted out unconsciously by professionals and not just service users. This analytical approach also sensitised the research to how not only individuals defend the self from unbearable feelings, but entire organisations erect defences that impede thinking and reflective practice (Cooper & Lousada, ; Whittaker, ). Developing Winnicott's work, Kahr () uses the metaphor of hostile clients throwing 'bombs' into encounters with professionals, causing 'psychological shrapnel' that workers and clients have to find ways to survive. Professionals are liable to retaliate and throw some bombs of their own into relationships and are involved in a struggle not to be hateful and punitive towards the service user. That struggle is at the heart of this paper.

Involuntary relationships

Within the sub-sample of cases where service users did not want a service there were different degrees of resistance and discontent. Some families reconciled themselves to the inevitability of statutory involvement, were not overtly aggressive towards social workers and tried to make the best of circumstances to promptly get workers out of their lives. In other cases parents were extremely unhappy, often hostile and remained that way. As will be shown however, this hostility was not simply a result of parental attitudes or personalities, it was also relational and a product of social worker attitudes and how the interactions between families and professionals developed into hostile relationships.

Twenty-five encounters took place between social work and the 'Jones' family over the year and there would have many more if the parents had permitted it. The concerns surrounded neglect of the three children, aged 6, 8 and 10. Social workers always undertook joint visits and the 11 encounters we observed were characterised by anger, acrimony and frustration. The parents attempted to take charge by interrupting, shouting and making accusations - that social workers are untruthful, inconsistent, hypocritical and 'in cahoots" with other professionals. Social workers at times raised their voices, argued with and talked over the parents. After a period of involvement, things got so bad that having let the social workers into the home the parents walked out and hovered around the front door. The practitioners tried to relate to the children in the home and saw them at school, but the parents soon blocked that too. The awkwardness of these encounters was painfully obvious; contempt and hate filled the air. When interviewed during month seven of the research Mrs Jones was scathing:

it was uncomfortable and it has got worse and worse the longer it has gone on. We felt like we were being judged obviously, which we are, nothing has properly been explained to us. We have been lied to actually from social services, blatant lies to our face so there is definitely no trust or anything there. They seem very aggressive, and very argumentative and sometimes patronizing ... From our point of view it seems like they are trying to pull the whole family apart. All of the experiences so far have been very bad and they keep coming round and saying, "well, we are here to help". Well, no, you're not because you're just causing problems and making everything a lot worse and worrying people and stressing people out rather than actually doing anything to help anyone. It has caused a load of stress, headaches, made us sort of feel ill in ourselves.

The social workers meanwhile, regarded the parents as being responsible for the lack of cooperation and saw this as further evidence of their problematic parenting. In child protection work with involuntary clients what constitutes fair, proportionate and respectful practice is inevitably contested.

This can also be seen in the case of the 'Lewis' family. They were seen 24 times by social care over the course of the year - they too prevented/avoided more visits - and we observed 15 of these encounters. There had been significant concern for the two children aged 4 and 5 from early in their lives due to their father's drug abuse and violence towards their mother. The social worker, who had known them for over two years, was so used to the family pretending not to be in that she no longer waited for them to answer but would knock and immediately walk into the house. The parents - Ron and Angela - didn't like it, but it enabled the worker to see the children with whom she had a good relationship. In Month 3 of being shadowed, there was yet another incident of the father being found to be in the home, despite being told he was too big a risk to be there, and the social worker Rebecca made a home visit:

Although there was a polite greeting there is an intense atmosphere. Rebecca in particular seems really angry with Angela and Ron, she doesn't hold back as she notes Ron's presence and the complete lack of engagement with the Child Protection Plan. Ron barely acknowledges the conversation initially, although it's largely aimed at him. Angela obviously does not see the problem with having Ron in the home. Both deny it and Rebecca threatens to do spot checks in the middle of the night. Ron leans back, puts his arm behind his head and splays his legs. Angela continues to have her feet up, snuggling into the sofa. There is a remarkable contrast between Rebecca, who sits rigidly and tensely upright on the sofa, and Ron and Angela who give off an air of not caring. Rebecca raises her voice to talk over them, she talks about the concerns of nursery. Ron, who was so placid and uncommunicative earlier, begins to seethe. He demands to know what the nursery workers are saying about him, complaining that there are never any concerns when he pick ups [youngest child]. Ron begins to raise his voice, he waves his hand around in a gesture of frustration, raising his voice louder still. Rebecca tries to bring it back to Angela and Ron's relationship, but they don't understand what she means ... Ron paces around, in and out of the kitchen and living room. You can feel the anger coming off him, anger with Rebecca and her manager for how he feels he's being described, anger with Angela for seeking to go back to court and complaining no one helps him.

In forcefully challenging the parents, the social worker did not disguise her annoyance with the lack of progress and ongoing risk to the children and she just about maintains her composure in the face of the father's behaviour. In working with on-going hostility, social workers face huge challenges in maintaining their professionalism by having empathy for service users' fears and not retaliating. While the above examples illustrate how social workers may consciously channel their anger into challenging parents, the danger is that they unconsciously return the hate service users have projected into them and become punitive but are not aware of it. This is what Winnicott () called 'hate in the counter-transference'. All the parents we interviewed who were involuntary clients felt social workers crossed the professional line and were punitive and persecuting. The threat by Rebecca the social worker to do spot checks in the middle of the night expressed her commitment to checking on the children's safety, but because it was so unrealistic it can be construed as retaliatory. Nothing changed and by the end of the research the children had been removed. These skirmishes, the anger, threats and walk outs, all delivered in highly personalised ways, show how incredibly emotionally and intellectually demanding these hostile relationships are for everyone concerned. But because of the child protection concerns, neither families nor social workers can walk away, and somehow a relationship based on hostility has to be sustained.

Sustaining hostile relationships over time

Having shown some general features of social workers' and involuntary clients' experiences, the paper will now develop these insights by exploring in-depth how hostile relationships developed and were sustained over time. This will be done by focussing on one case-study, which makes possible the kind of in-depth analysis necessary to show how the casework was done, the dynamics of hostile relationships and the ebbs and flows of the social worker - service user encounters and organisational life over the course of the year.

'Roberta Dixon' had two children, who were not in her care but resident with their relatives for the past two years, and she saw them occasionally. They had been on child protection plans due to concerns about physical abuse. Roberta was now pregnant and described in the referral as having a history of violent and abusive relationships where she was at times suspected to be the perpetrator. In the 12 months there were 68 face to face encounters between social care and the family. Some 30 of these were done by social workers and their managers. The Family Support worker based in the team also made eight home visits, while the intensive family support service (external to the local authority) made 21 visits in a short period at the end of the year of casework we shadowed. Most of this work was done in the second half of the year. Despite her overt hostility to social care, Roberta consented to being part of the research. Twenty-one of her encounters with social care were observed by the researchers (12 social worker home visits, two family support worker home visits, three child protection case conferences, two inter-agency 'Core Groups' and two court sessions). Practitioners were interviewed numerous times about the case, both in situ as events were unfolding and in formal research interviews. Roberta was interviewed for the research on three occasions: in Months 6, 8, and 12.

The initial social work response was to ring Roberta who responded by saying she does not want anything to do with social workers and would not meet with them. She told the worker they were being rude and that she would search their name on the internet and then hung up. Soon after, Roberta rang the office twice to tell the team manager (Olivia) she was angry with her, and the researcher could hear her shouting a barrage of abuse at Olivia and demanding a complaint form. Because Roberta's two children were not in her care, it was treated as an 'Unborn' referral and not urgent. So it was seven weeks after the initial referral that face to face contact was made with Roberta on a home visit. While this lack of contact could have been a relief to Roberta, it may also have triggered feelings of abandonment and meant that the opportunity to intervene early to try and build a relationship was squandered.

The first home visit was done by the team manager, Olivia, due to the social worker Susan's unavailability. From the start social workers always visited in pairs because Roberta was regarded as dangerous. Roberta showed her feelings as soon as the two social workers arrived and were parking up, by standing on the doorstep and then forcefully slamming the door to her house. The atmosphere of the visit was extremely tense, as typified in this scene:

Olivia mentions the assessment document and goes through the different columns of the assessment and acknowledges it was filled in without having met Roberta. Olivia is good at asking Roberta to help her fill it in - it is an attempt to involve her in the process and address power imbalances. ... Seven minutes into the visit Roberta taps the pen in her hand against her pad of paper irritably while she talks; it feels like she is very angry. The atmosphere feels incredibly tense. Olivia still seems nervous, she talks quietly. Roberta is much louder and really dominates the room. ... Roberta asks for the document that Olivia is writing on, she takes it and nods as she reads through it, but she does so irritably and the atmosphere, which was better, starts to become tense again. She disputes that she has harmed her children. She sort of laughs dismissively when she looks at things. She tries to gain control of the meeting. She hums a bit while she reads through things, and writes things down on her own pad of paper. Olivia remains largely still, except for nodding to her occasionally. ... Roberta questions the 'history of drug use' [even though she did agree earlier that she had a history of drug use]. Olivia scratches her face absent-mindedly and then moves her hair out of her face. Otherwise she remains largely still while they talk.

In a staff supervision session a few weeks after this visit, Olivia and the social worker, Susan, agreed that Roberta was preventing the pre-birth assessment by refusing to cooperate. They were alarmed by her aggression, mental health problems and history of alleged violence and concerned that Roberta may hit the (as yet unborn) baby:

Although Susan had some telephone contact with Roberta, she had not yet met her face to face and it would be another two months before she does. The social worker and manager both used this supervision to offload anxiety and fears about Roberta, which served to cement her identity as dangerous. Whilst Roberta's behaviour was frightening, if one function of supervision is for managers to support workers emotionally and in being critically reflective about parent-child relationships (Davys & Beddoe, ) it didn't happen. It is striking how these two colleagues wound themselves up into a kind of frenzy about Roberta's dangerousness, including imagining and enacting the 'whack!' of her assaulting the baby. But Olivia had been on the receiving end of Roberta's anger and was already deeply emotionally enmeshed in the casework, which prevented her from achieving the kind of detachment necessary to critically reflect and think clearly about the work.

It was nine weeks after the first home visit when the next face-to-face contact with Roberta occurred, at a multi-agency 'Core Group' meeting. Prior to the birth, two case conferences took place, at the first of which Roberta expressed huge anger towards all the professionals and her unborn child was placed on a child protection plan. The decision was that it was highly unlikely that she would be allowed to keep her baby and Roberta stormed out before the end of the meeting.

In Months 5 and 6, a pre-birth Parenting Assessment was completed by an independent social worker that involved four home visits and over the same period two home visits were undertaken by the family social worker. As time passed, Roberta became more cooperative with professionals and was seen in a very positive light by the independent social worker. The statutory social workers recognised that Roberta seemed different - as Susan put it, 'she's a changed woman' - but their narrative remained negative, that she was manipulative, hadn't really changed and that it was 'disguised compliance'. This use of the notion of disguised compliance was highly problematic because it placed the service user in a lose-lose position where they could never prove their sincerity or worthiness as a parent (Leigh et al., ). The social worker and manager were very annoyed by what they saw as the independent social worker's overly positive assessment, implying that tough questions about Roberta's anger and alleged violence had been avoided. The independent social worker's report had a significant impact on the second case conference and the decision was that Roberta would be allowed to keep the baby, who would remain on a child protection plan.

It is possible that Roberta was showing a capacity to respond to the empathetic approach of the independent social worker, whose report did indeed give limited attention to the risks represented by her. Statutory social workers on the other hand, by seeing Roberta through a lens of dangerousness, did not relate to the caring, loving side of her. Following the work of Klein () there is evidence of psychological 'splitting' occurring here, which is a defence mechanism for dealing with intense anxiety and other unbearable feelings. Cooper (, p. 32) describes how individual professionals and whole systems can 'lose their heads' with anxiety, become reactive and stop thinking and how 'case dynamics become split very quickly'. A 'bad' object is created into whom unbearable feelings are projected and a 'good object' becomes the recipient of positive evaluations, respectful loving feelings and is idealised. From the outset the child protection social workers internalised a view of this mother as a 'bad object', which was the lens though which they made sense of her. Meanwhile the independent social worker who completed the pre-birth parenting assessment related to the mother as a 'good object' and could see nothing of the danger others were preoccupied with. This splitting into love and hate was also evident in Roberta's narratives when interviewed for the research as she expressed her complete admiration for the independent social worker and her intense dislike of the statutory social workers, Olivia in particular. When such splitting occurs, relationships and the work suffers because sound assessments and decision-making require practitioners and the whole system to be in touch with as many dimensions of the emotional dynamics as possible and connected to the complexity of being human - the 'good' and the 'bad' in us all (Cooper, , p. 32).

Roberta's baby, Amy, was born in Month 6 and very regular social care visits began. Four home visits were made by social workers in the first few days after Roberta and Amy went home from hospital, after which in Months 7 and 8 the pattern settled into weekly home visits, which were either announced, ie Roberta knew when they were happening, or unannounced, when she didn't.

The initial couple of home visits by Olivia after mother and baby went home were quite harmonious, as the following typical scene illustrates:

Roberta talks about how she has changed as a person - she was only 16 when she had [first child]. She says it's important for her that Amy and her other children have a relationship. Roberta does sound quite different - she gives off the impression that she understands she did harm her other children. She wants to show us photos of them, she retrieves them from the sofa next to me. I help hold open the box so she can grab the photos as she is also holding Amy ... There is a much warmer and comfortable atmosphere suddenly. Olivia has responded so well to the photos, smiling and saying how lovely they are, how nice the children look.

A visit that Susan and Olivia made together later in Month 6 was more typical of the pattern of relating that became established:

Susan took the lead, knocked on the door and Roberta led us into the kitchen. Amy is in a car seat under the sink in the gap where a dishwasher or washing machine usually goes. Roberta is cooking. Susan tells Roberta how gorgeous the baby is. Olivia and Susan ask Roberta lots of questions about the practicalities of baby care. Seven minutes into the visit Roberta moves forward and picks the baby up. Susan moves to her right to allow this and suggests they move to another room. This move is engineered by the social worker who leads the way despite Roberta saying there are no seats in the sitting-room. Eight minutes into the visit and everyone has moved into the sitting room where Roberta sat on a stool. There is in fact a settee and other chair but they are covered in stuff, so Olivia and Susan remain on their feet and stand for the entirety of the visit. The social worker offers financial help while benefits are being sorted to take account of the baby's arrival. Susan has a powerful tone of helpfulness in her voice, really encouraging Roberta to accept help and conveying the genuineness of the offer.

Here Susan was meeting Amy for the first time and while she made genuine efforts to recognise the baby's presence, she did not get physically close to her, which we had observed her doing on visits to other infants. There were occasions when the relationship between Susan and Roberta seemed better, however this didn't last. During Month 7 another social worker co-worked with the family with Olivia because Susan was unavailable, and this is a scene from their first/introductory visit:

Roberta leads the social worker into the sitting-room. There is nowhere to sit and after 2 minutes the social worker gets down on her hunkers. She gives a minimal explanation as to why she is getting involved and where Susan is. Roberta tries to get more information from the social worker about Susan but is given a vague reply that this new social worker will be coming to visit for a while. Within five minutes the social worker tells Roberta to be careful to hold the baby's head so that it doesn't flop and Roberta responds angrily that she knows how to care for a baby. The social worker is very emotionally flat. She shows no excitement or pleasure at meeting the baby. In fact she does not actually properly meet the baby at all in the sense of going up to her and attuning to her by, for instance, looking into her eyes, making noises. Amy was awake when we arrived and the social worker kept a significant physical distance from her and her mother for the duration of the 21 minute visit. To the worker she seemed to be merely an appendage to her mother.

The new social worker's withholding of information about where Susan was, her lack of attention to the child and disrespectful approach to the mother felt punitive and made a difficult situation and hostile relationship even worse.

Social care then began to worry about an apparent downturn in Roberta's mental health and other agencies also expressed concerns about her well-being and capacity to care well enough for Amy. Due to this, nine social care visits occurred in the first half of Month 10 alone, mostly by Susan. The difficult, tense, conflict laden dynamics of these visits replicated those above. The pattern was for social care workers to ask Roberta questions about baby care and other practical things like housing, but there was little attention to her feelings about and relationship with the baby. On most of the visits Roberta sat on the stool holding the baby and there continued to be nowhere for practitioners to sit, which meant they mostly stood for the entire duration of the visit, or spent it crouched on their hunkers, which they repeatedly described (to researchers) as awkward and painful. When interviewed for the research around the time these encounters were happening Roberta admitted she deliberately covered the seating to prevent professionals from sitting down, orchestrating discomfort. There is nothing surprising about families who do not want social work involvement using such tactics to keep them at a distance or drive them out. What is striking is that social workers did so little to try and work through these barriers and defences. It seemed like their anxious state of mind was such that unconsciously they colluded in their own distancing, because they did not want to be there.

Then, in Month 11, at a meeting Roberta aggressively challenged everything Olivia said and - as Olivia put it - 'exploded' with rage and threatened her. Olivia was shadowed in the office for the rest of the day and said she was not happy with how she handled the meeting because she felt stressed due to pressure of work and enough attention wasn't given to Roberta's views and feelings. After this meeting the professionals feared that Roberta would act out her anger on her daughter. Olivia was very upset by Roberta's threatening behaviour and cried at her desk. In talking about it, it is notable how she brought up other times when Roberta was really aggressive towards her and others. Many of the social workers in the team had worked closely together for several years and the researcher established that it was extremely rare for one of them to openly cry in the office. Olivia said she was more worried about the administrative staff seeing her upset than social work colleagues and it being seen as a weakness. She was also trying to contain her emotions to undertake the several phone calls and other tasks now required to ensure this child is safe. She practiced what Ferguson () has called 'suspended self-preservation', where social workers consciously suppress reflection on and acknowledgement of the depths of their feelings to help them get through the work they have to do and protect themselves and colleagues from their suffering.

On a home visit a few days later Olivia was still feeling traumatised by Roberta's attack, couldn't stop crying, felt ill and stayed in the car while Susan and the researcher went into the house. Olivia was observed in supervision that week with her senior manager, who recognised that she was upset but did not pursue this with her, instead moving on to address other high risk cases and staff performance issues in the team Olivia managed. This was discussed with the senior manager in a research interview straight after the supervision:

Researcher: Olivia said she didn't want to talk any more about what happened in that situation with Roberta because she'd only get upset again. What were you thinking when she said that?

Senior manager - supervisor: I was thinking we'd spoken about it earlier in the week and she had got upset then and I'd heard the story, you know. So, and she, I felt, chose, and it seemed OK to come to the supervision and she didn't want in that setting to be upset and ... so I sort of thought, well maybe that's OK, I don't want to press her on that. But yeah it's a hard balance between, and then you're just avoiding it and let's move on and that's not intelligent, that's just kind of colluding with shutting that sort of discussion down and that emotion down. So, yeah, it's hard and there's, you know, a limit to how much you can get involved in the in-depth of one case when you know you've got another 60 to, to make sure get covered and so on too, really. I mean, you know, there I am talking about that emotion at the beginning of the supervision, half way through I'm talking about, "right, how are you going to a get a grip with this member of staff?" It's quite tough to balance.

The manager is aware of the importance of providing emotional support to staff in Olivia's situation and in order to protect her had ensured the case was now transferred to a new team. Ultimately however, the emotional support provided was compromised by the manager's regulatory role and their need to address issues such as staff performance, timescales and targets for completing work. The opportunity for reflective, emotionally supportive supervision was sacrificed to the organisational imperative to comply with government-imposed performance indicators that are inspected by the regulatory body, Ofsted. Audit requirements and the pressure for performance data over-rode the need for attention to what was occurring emotionally and viscerally for the workers, mother and baby, alongside analysis of what was going on in the relationship, especially below the surface. This echoes Smith et al.'s (, p. 1474) finding that while managerial regimes often advocate a sensitive focus on service user's needs, in reality they 'act against its meaningful realisation by eroding the social work relationship in favour of bureaucratic, procedural systems'.

When interviewed after the supervision, Olivia said she was hesitant about accessing her distressed feelings and reluctant to show vulnerability because she feared judgement. She felt that managerial responsibilities were what mattered most to the organisation and defended herself from unbearable feelings accordingly. Once again, 'suspended self-preservation' was regarded as the safest course, but it only really works as a healthy long-term strategy if the attention to the emotional impact of the work that is being postponed is provided as soon as possible. And it never was. This lack of attention to the emotional dynamics and effects of the casework contributed to social workers' relationship with the child remaining detached. As the social worker Susan explained at the end of the year of research, this was the first baby she had worked with in several years as a social worker who she had never got close to, touched or held as part of forming a relationship. This shows how even in long-term work where such children are regularly 'seen' by practitioners, they can be kept at a physical and emotional distance (Ferguson, ; Winter et al., ).

By month 11 of the fieldwork the cumulative concerns about Roberta and her parenting resulted in the local authority trying to remove Amy from her. This was averted in part by Roberta agreeing to the intensive family support service working with her. In her final research interview at the end of the research fieldwork (month 12) Roberta still had custody of her daughter but expressed how she regarded the attempt to remove her as a persecutory, punitive response. While there is no doubt that Roberta could be a frightening person, and that she and her child were vulnerable, the possibility that she was right and that at an unconscious level this was a retaliatory act cannot be ruled out.

Discussion

This paper has presented what the research shows about the nature of hostile relationships in social work and how enormously difficult it is for all concerned to begin, develop and sustain them over time. It has sought to convey the lived experience of being involved in such casework, the struggles over space and the rights service users have, or don't have, to refuse professionals access to their lives, the tactics of resistance that get played out and the deep emotional effects of such work. Many of the parents in the study began by disliking, fearing and even hating social workers. Through empathetic, strengths oriented practice and skilful use of relationship-based practice, some of these parents were helped to transform ambivalence and hostility into a capacity for cooperation, care and love and they and their children thrived together (for extended examples, see Ferguson, Warwick, Disney, et al., ). But in the 12 months of casework we observed where hostile relationships persisted professionals and parents remained deeply mutually suspicious of one another. It is vital to understand the mutuality of this dislike. It is service users who typically are characterised as 'hard to reach', 'resistant', 'difficult', but the social care staff were also often emotionally detached and unwilling or unable to tolerate and 'reach' the parents and children.

As Brett Kahr () shows, when Winnicott () first published his work on 'hate in the counter-transference' there was considerable resistance to it within psychoanalysis and the idea that therapists sometimes hated their clients, but this is now a fully accepted part of psychotherapeutic knowledge. The same cannot be said of social work however, which urgently needs to face the harsh realities of hostile relationships, the risks of abuses of power they contain, and the enormously difficult feelings they bring up for service users, social workers and their effects on the emotional life of whole organisational systems. The dynamics of how hostile relationships occurred and their implications will now be drawn together on two levels: practice experience and the organisational, and we will focus further on the Dixon case in particular for what it reveals about the impact of trying to sustain hostile relationships over time.

The embodied nature of practice and limitations of home visits

As has been shown, on most occasions interactions between social care and families went on in the home. Visits to families where there were hostile relationships were consistently fewer, more infrequent and shorter than in the other more cooperative long-term casework observed in the research, which in some cases typically lasted up to an hour (Ferguson, Warwick, Cooner, et al., ). The longest home visit to Roberta Dixon lasted 45 minutes and was the very first, as Roberta angrily sought explanations for why social care needed to be involved. After the birth of the baby social work visits lasted between 18 and 33 minutes, which given the high level of concern was short. This can be explained, in part, by how uncomfortable workers felt in the home having to face such anger and aggression (see also, Henderson, ; Sudland, ). While, as we have seen, some parents, like the Jones's and the Lewis's, sometimes walked out of their own home for some of the time social workers were there, Roberta's resistance was more subtle in how she made sure there was nowhere for practitioners to sit, which left professionals having to awkwardly stand, crouch or sit on the floor.

Workers so often having to stand contributed to an atmosphere that felt like they had not properly settled into the visit. Professionals towering over Roberta merely emphasised their dominance and power - precisely that which she most feared. Social workers told us they were aware of this dynamic and the need to, as they put it, 'get down to the service user's level', which (it was assumed) would create a greater sense of equality in the relating and enable conversation to flow, which was why they crouched for as long as they could physically bear it. It is crucial to recognise however the role the service user played in placing the professionals either in an upright, standing position, gazing down at her, or crouching or sat on the floor with her gazing down at them. For Roberta, workers standing over her did not simply signal professional dominance, but because she engineered it, her taking back some power from those she regarded as persecuting her. She told us she took pleasure in their discomfort. However, ultimately for Roberta it was the professionals who had the power, and she felt strongly that they misused it:

(Roberta - final interview)

Being 'squared off' with was in a variety of ways at the heart of how parents saw their experience of hostile relationships. With Roberta Dixon, for instance, some critical thinking and use of good authority by practitioners could have resulted in 'clear the air' conversations and firm but respectful requests to clear seats to enable them to sit down and an overall much more open, negotiated approach (Ferguson, , chapter 12). Its absence arose from how fear and anxiety cause the self to become defended, which stops reflection in action and how this is compounded by the absence of help with critical reflection afterwards in supervision (Ferguson, ). Nor did it seem thinkable that sometimes these involuntary clients could be seen somewhere other than in their home, whereas this did happen in some cases we observed that involved cooperative relationships as parents and children were seen in community centres, parks, cafes, or in cars (Jeyasingham, ). The emotional impact of hostile relationships paralysed workers and organisations, restricting their minds and actions, confining them in highly constricted spaces where they and parents effectively enacted pathological relationships, taunting and punishing one another. The consequences for parents and children could be huge.

Organisational life and the psycho-social dynamics of hostile relationships

Trying to sustain these torturous hostile relationships is incredibly emotionally demanding. The challenges involved were all the greater because typically social workers had several such cases at the same time and team managers had to provide support for their entire team's caseload of involuntary clients. This was on top of their many other duties. On one occasion when parked outside Roberta Dixon's home the team manager Olivia spoke of how exhausted she felt having the day before responded to 180 emails and covered home visits for social workers who were on sick leave. She felt at breaking point. Such pressures made giving children and families the full attention they needed and maintaining a capacity to think clearly about them and the dynamics of the relationship enormously difficult.

The workers were conscious that they were, in their own language, 'monitoring' Roberta Dixon's mothering. However, they were not really aware of the primitively anxious nature of their surveillance, the splitting and framing of the mother as a dangerous 'bad object' and the effect of this on the mother and baby. There was genuine fear for the baby's safety, however, a contradiction was that no actual evidence of harmful parenting was discovered by social care. The perceived risk lay in the mother's dangerousness and explosive nature.

Roberta explained vividly in research interviews how she felt persecuted by the surveillance, how she would be watchful at the sitting room window wondering when they were going to call unannounced again and also fearing the announced visits. This mother internalised the anxious surveillance by social care, experiencing it as persecutory anxiety, which in turn made her even more defensive and anxious about their involvement and her capabilities as a mother. It is very possible that the nature and style of the social work surveillance contributed to the worsening of Roberta's well-being and it certainly contributed to her reactions to professionals.

In their encounters with families, social care staff brought with them a highly pressurised organisational space which made maintaining a capacity to think analytically about what was occurring in their relationships with service users very challenging, especially at unconscious levels. The reason workers lacked awareness of these dynamics was because there was so little help with getting it. The social work team manager was deeply immersed in the case and had been on the end of Roberta's rage from the start. Thus in supervisions, social worker-manager interactions were fuelled by deep anxiety which at times built up into a frenzy of fear for the baby, and also for their own safety. This left no space for thinking that could help them become aware of the transference and counter-transference, the pathological nature of the relationship and communication and how they could negotiate things like having a place to sit on home visits and having meaningful relationships with children, where they were held as well as seen. As Cook () argues, it is crucial that the risks arising from the complex emotions experienced on home visits and elsewhere are brought to awareness and made into a resource for insight and thoughtful practice.

The nature and depth of organisational defences employed was particularly evident after Roberta 'exploded' and attacked Olivia. She did not want colleagues to see her crying and this avoidance of showing the impact of traumatic experience was compounded by her senior manager not enabling her to express her emotions, so that the managerial goals of improving staff performance in compliance with targets and audits could be achieved. This demonstrates how standardisation and neoliberal governance can impact on social work organisations and influence manager's and worker's experiences (La Rose, ). Social work practitioners and managers walk a very delicate line between acknowledging how emotionally demanding and sometimes deeply distressing the work is and not showing that distress and the effects it has on them. They protect one another from the painful realities of the work even whilst deeply immersed in enduring it - feeling it yet not showing it. The teams where the casework with involuntary clients occurred that we have featured in this paper were not uncaring. We regularly observed a culture of attentiveness and mutual support amongst staff and relationships were collegial. They were often helpful to children and parents and many families confirmed this in research interviews. But this must not be taken to mean the teams and their organisations were comfortable with acknowledging the very difficult feelings the work cultivated. Somewhat paradoxically these were not workplaces where sadness, fear, anger, guilt and other painful feelings were easily or openly expressed. There was a deep investment in not showing or fully feeling what was there deep down to be felt. The net result was an entire workforce fleeing from painful feelings. The basis for this was pragmatic in that feelings were suppressed and 'suspended self-preservation' practiced due to the need to keep going to ensure the work got done; and it was psychological, unconscious and defensive arising from the need for organisations as well as individuals to defend the self from unbearable feelings (Cooper & Lousada, ; Whittaker, ).

The research on the other hand did gain some access to the deeper emotional life of individuals and the organisation. The longer we were in the field the more participants revealed their interior worlds and distress to us. This is exemplified by a social worker we shadowed on several occasions who, as he talked about the deep emotional effects the work had on him, cried, shook and sweated so profusely that his shirt became soaking wet. This finding is supported by O'Sullivan's () research, where she used psycho-dynamically informed work discussion groups to reach the deep emotional experience of child protection workers. These are the 'suspended' feelings social workers were not getting help to deal with, which because they remain repressed can easily be unconsciously acted out against service users in retaliatory ways and that ultimately traumatise workers and burn them out.

Conclusion

Involuntary clients and hostile relationships have a very powerful presence in statutory social work. Acknowledging this and the presence of difficult emotions in the dynamics of hostile and avoidant relationships is a very important way to begin to overcome them. Anxious surveillance infused with persecutory anxiety is clearly not an effective way to deal with the primitive fears such work and relationships bring up. Practitioners and managers need to be provided with supervision that goes below the surface and enables them to recognise how they are really thinking and feeling about children and families and identify the effects of fear, anxiety, and defences such as splitting and the dangers of hate and retaliation (Trevithick, ). Professionals need much more training to help them learn strategies that defuse these potentially explosive relationships, recognise their role in co-constructing the hostility, and how to work through resistance and engage with children and parents in respectful, reciprocal ways (Smith et al., ; Turnell & Essex, ; Turney, ). Much greater awareness of spatial dynamics is required and the value of seeing service users in places beyond the home, at least some of the time (Jeyasingham, ). Providing parents with advocates who can support them and processes like family group conferences (Mason et al., ) can help to re-balance the power dynamics of vulnerable parents, often lone mothers, coping with constant visits by two social care workers. Parental allies can provide a person who has lived experience of the child protection system, who can offer emotional containment, genuine understanding and enable parents to feel valued, not just 'bad objects' (Tobias, ).

Creating supervisory practices and cultures where these deep feelings, unconscious processes and states of mind can be accessed is very difficult. In attempting to help social work managers provide a model of supervision that could include emotional thinking, Turney and Ruch found that for supervisors it was 'a significant challenge to hold thinking and feeling, process and task together' because they were so used to providing case management orientated supervision which precludes attention to detail and more open-ended conversations (Turney & Ruch, , p. 134). Meeting emotional needs and enabling critical thinking is more likely to happen if the reflective, analytical aspects of supervisory practice ('clinical' supervision) is provided separately from 'administrative' supervision in which managers address performance and audit issues and targets. The more opportunities workers have to reflect on and analyse their feelings and relationships with involuntary clients, the less chance there is they will become hostile relationships and the surer they can be that their work and major decisions (including to remove children) will be done ethically and free from hate and retaliation.

Acknowledgments

We are grateful to Marta Bolognani, Linda Cooper, Simon Haworth, Claire Mackinnon and Liz Salter for their very helpful comments on earlier drafts of this paper and for the feedback of the two anonymous reviewers.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The research on which this paper is based was funded by the Economic and Social Research Council [Grant Number ES/N012453/2].

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# data[].attributes.attachment_link.title
Hostile relationships in social work practice: anxiety, hate and conflict in long-term work with involuntary service users

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ABSTRACT While recognition that some service users do not want social work involvement has grown in recent years, little research has explored what relationships between social workers and 'involuntary clients' look and feel like in practice and how they are conducted in real time.

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It was more difficult than we thought: a reflection on50 years of child welfare practice Olive Stevenson

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It was more difficult than we thought: a reflection on50 years of child welfare practice Olive Stevenson

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Deconstructing Disability and Neurodiversity: Controversial Issues for Autism and Implications for Social Work

# data[].attributes.headline
Deconstructing Disability and Neurodiversity: Controversial Issues for Autism and Implications for Social Work

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Deconstructing Disability and Neurodiversity: Controversial Issues for Autism and Implications for Social Work

# data[].attributes.attachment_link.title
Deconstructing Disability and Neurodiversity: Controversial Issues for Autism and Implications for Social Work

# data[].attributes.attachment_link.description
Disability is a socially constructed concept that can be viewed from either a medical or a social perspective. Autism, a developmental disability, can be viewed from the medical model of disability...

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The Crisis Facing Older People Living with Neurodiversity and Their Aging Family Carers: A Social Work Perspective

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The Crisis Facing Older People Living with Neurodiversity and Their Aging Family Carers: A Social Work Perspective

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Reconceptualizing Autism: An Alternative Paradigm for Social Work Practice

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Reconceptualizing Autism: An Alternative Paradigm for Social Work Practice

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Reconceptualizing Autism: An Alternative Paradigm for Social Work Practice

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ABSTRACT

Autism is a complex, often misunderstood condition. More than a neurological disorder, autism can also be viewed as a different cognitive style or an alternative way of perceiving and reacting to the world. As more individuals on the autism spectrum are making themselves known, social workers must be open to using new paradigms to meet the needs of this unique population. This article explores how horizontal diversity and neurodiversity can be used to expand the ways social workers conceptualize autism and, consequently, how they work with persons on the autism spectrum and their families.

# data[].attributes.attachment_link.title
Reconceptualizing Autism: An Alternative Paradigm for Social Work Practice

# data[].attributes.attachment_link.description
ABSTRACT Autism is a complex, often misunderstood condition. More than a neurological disorder, autism can also be viewed as a different cognitive style or an alternative way of perceiving and reacting to the world. As more individuals on the autism spectrum are making themselves known, social workers must be open to using new paradigms to meet the needs of this unique population.

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Celebrating Neurodiversity: An Often-Overlooked Difference in Group Work

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Celebrating Neurodiversity: An Often-Overlooked Difference in Group Work

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Celebrating Neurodiversity: An Often-Overlooked Difference in Group Work

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Celebrating Neurodiversity: An Often-Overlooked Difference in Group Work

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For many years I worked in a children's mental health center, supporting children and youth with learning disabilities, and their families. To qualify for services, the children and youth had to be...

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Blogs about a neurodivergent social worker

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Blogs about a neurodivergent social worker

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Podcast about neurodivergent social worker

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Podcast about neurodivergent social worker

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Listen to The Neurodivergent Social Worker on Spotify.

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068 | Neurodivergence & the Social Work Field, with Mandalyn

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Podcast about neurodivergent social worker

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Podcast about neurodivergent social worker

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068 | Neurodivergence & the Social Work Field, with Mandalyn

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Listen to this episode from The Neurodivergent Magic Podcast on Spotify. Today we're talking to Mandalyn, a licensed social worker, soon-to-be a licensed clinical social worker, all about neurodivergence in the social work field. They are neurodivergent themselves, and in our interview, we talk about some of the barriers they faced when getting their degree.

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Listen to this episode from The ADHD Adults Podcast on Spotify. In Episode 6 James and Alex discuss how ADHD is a protected disability in the workplace, how to go about engaging with your employer for 'reasonable adjustments, and personal reflections on when and how ADHD made their jobs difficult.

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Episode 17 (S4). Autism and Social Work (feat. Jenni McCabe)

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Episode 17 (S4). Autism and Social Work (feat. Jenni McCabe)

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The influence and impacts of dyslexia on social work practice

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Dissertation about the impact of Dyslexia on social work practice

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Dissertation about the impact of Dyslexia on social work practice

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Summary of the research

The role of a social worker is dynamic and complex in supporting individuals, families and communities. Therefore, the interventions required are wide ranging and involve many skills, such as assessment, reading and writing. All these skills can be impacted by the condition of dyslexia.

A general literature review highlighted that there is an absence of an agreed definition of dyslexia. This impacts workplace relationships and support (Fitzgibbon and O'Conner, 2002). Secondly, dyslexia is not fully understood theoretically or in practice (Moody, 2010). Thirdly, despite an increased interest in the field of dyslexia within research literature, there is a gap in research surrounding the impacts and influences on social workers and their day-to-day practice.

The findings are based on ten semi-structured interviews of qualified social workers, working throughout Scotland and who work in local authority and third sector services. The study explored individual experiences of how dyslexia impacts and influences their practice. This included an exploration of the support they received and what they thought could be done differently in the future.

Findings

Findings highlighted that there was a lack of understanding of dyslexia. Participants consistently reported that their initial understanding of dyslexia was based on negative connotations and stereotypes: dyslexia meant you were slow or lacking intelligence. Participants related these initial negative connotations to ideas they had encountered earlier in life. As a result, they illustrated how societal views around dyslexia could impact a dyslexic person's perception of their condition.

Furthermore, participants described challenges and frustrations surrounding their current situations, including the inability to express their knowledge, the speed of information processing, their experiences of their challenges and other people's attitudes. Some participants experienced exhaustion because of the impact of dyslexia.

The challenges had various and numerous impacts on social work practice. These included the inability to recall information or instructions received, such as when on a duty call or in a meeting, some of which was exasperated by using virtual platforms because of the COVID-19 pandemic, and name recall. Some ethical dilemmas occurred because of the challenges with short-term memory.

McLoughlin and Leather (2015) argue that organisations have taken a positive approach to support those with dyslexia in the workplace. However, the majority of participants highlighted that workplace support was very minimal. Some felt this was adequate for their needs, whereas others felt they needed more but were not sure what support was available. The support experienced in the workplace was practical (e.g. reading software, different coloured paper or overlays, one-to-one administration support). Little emotional support was offered.

In summary, the findings indicated that participants had a positive association with their dyslexia, recognising their strengths and being aware of the challenges, as well as a range of personal strategies to mitigate these. However, there was less clarity about employers and managers' understanding and knowledge to support practitioners.

Completed: May 2021.

About the author

Sam Hepburn has lived in Scotland all her life. Having completed an undergraduate in childhood and youth studies she went on to study a Masters' in Social Work at the University of Edinburgh.

Sam holds her own diagnosis of dyslexia and has lived with the stigma of poor academic performance, which is associated with dyslexia It was not until she failed an essay in her Masters that she realised the stigma was still impacting her academically. She set about changing that, going on to achieve a Masters with distinction and bringing her learning to the workplace. Sam continues to influence understanding of dyslexia and how it's supported in social work practice.

Copyright © 2021 Sam Hepburn. All rights reserved. The author has given permission for this work to be downloaded and shared in the attached format for educational purposes only. For other permissions, please contact the author.

Contact: Sam.Hepburn@fife.gov.uk

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The influence and impacts of dyslexia on social work practice

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Research that explores how dyslexia is understood and supported in practice.

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First and last and always: Streetwork as a methodology for radical community social work practice

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First and last and always: Streetwork as a methodology for radical community social work practice

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Community Social Work: A Theoretical Perspective

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Community Social Work in Ukraine: towards the Development of New Practice Models

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Autism spectrum disorder and the science of social work: A grand challenge for social work research

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Clinical supervision: An interdisciplinary review of literature with implications for reflective practice in social work

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Clinical supervision: An interdisciplinary review of literature with implications for reflective practice in social work

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Self-reported patient psychosocial needs in integrated primary health care: A role for social work in interdisciplinary teams

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Working on treatment teams: Educating social work students to function as addiction specialists within interdisciplinary groups

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Working on treatment teams: Educating social work students to function as addiction specialists within interdisciplinary groups

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The nuts and bolts of including service users an

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The ‘nuts and bolts’ of including service users and carers in the recruitment of health and social work students in an English university—An interdisciplinary critique

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Casting Light on the Distinctive Contribution of Social Work in Multidisciplinary Teams for Older People

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Casting Light on the Distinctive Contribution of Social Work in Multidisciplinary Teams for Older People

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 20498675 Critical and Radical Social Work It s more than confusing our b s and d s a commentary on the lack of understanding of the needs of social work students who have dyslexia

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‘It’s more than confusing our b’s and d’s’: a commentary on the lack of understanding of the needs of social work students who have dyslexia

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‘It’s more than confusing our b’s and d’s’: a commentary on the lack of understanding of the needs of social work students who have dyslexia

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Neurodivergent social workers 'exhausted' from lack of understanding at work

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Neurodivergent social workers 'exhausted' from lack of understanding at work

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A lack of awareness and support at work has cultivated a climate of fear and exhaustion for social workers with neurodiverse conditions such as autism, ADHD and dyslexia.

A pilot study on the experiences of neurodivergent social workers has found that, of 60 responses, 34 participants reported they had received no specialist workplace support. Around 14 of those said this had been the result of a fear of speaking out and asking for help.

According to Deb Solomon, chair of the British Association of Social Workers' (BASW) neurodivergent social workers group and part of the team behind the study, managers' and colleagues' lack of understanding of neurodiversity has played a big role in that.

The peer support group was set up in summer 2021, inspired by the attention an article of Solomon's detailing her struggles as a newly diagnosed social worker during lockdown had received.

In the past year, Solomon has found new members have often reacted tearfully on first meetings, once realising they are not 'the only one'.

"It's really quite emotional," she said. "Nobody talks - nobody dares to talk - and it's really sad. That comes across every time."

Solomon, who was diagnosed with ADHD in October 2020, attributed that fear to the stigma around the diagnosis of a disorder and the subsequent external and self-imposed doubt around the social worker's ability to do their job. "[It's a feeling of], 'people are going to think that I'm now incapable, that I've got challenges, that I am less'," she explained.

"I've had a mental health social worker say, 'Oh, I didn't know autistic people could be social workers'," she added. "There's a real lack of empathy, real lack of understanding, and that makes people not want to speak."

Neurodiversity and possible struggles in the workplace

Neurodiversity is an umbrella term that refers to the existing variations in neurocognitive functioning and behaviours among people.

Neurodivergent people often live with neurological or developmental conditions that mean their brains function differently and their behavioural traits differ to what is perceived as 'normal'.

Some examples of neurodivergent conditions are autism, attention deficit hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), dyslexia, and dyspraxia.

According to 2016 research by industrial relations body ACAS, an estimated one in seven adults in the UK is neurodivergent.

The struggles a neurodivergent employee might face in the workplace differ depending on their condition and the severity of its impact on them. Among others, they could experience sensitivity to sound or light, issues with memory, note-taking or organisational tasks, or difficulties with equipment.

A guide for neurodiversity at work created by the Chartered Institute of Personnel and Development (CIPD), the professional body for HR staff, listed bright office lighting, noisy open-plan environments, and equipment (including bright screens, desks lacking personal organisation items, lack of visible instruction on equipment such as printers) as some factors that employers should consider addressing.

'The effort it takes to appear functioning becomes exhausting'

Neurodivergent social workers who took part in the pilot study listed lack of confidence, anxiety, and feeling 'resigned' as the main side-effects of the current work culture.

"People often say to me, 'How can you possibly have ADHD and say you struggle with executive functioning and organisation and time when you're organised to a T?'" said Solomon.

"And it's like, 'yes, but that's why'. I actually can't function throughout the day if I haven't put all of that time into doing that. I'm lost. It takes me probably an hour before I can even start working to just get my head around what am I doing."

Because of that, and not being able to 'function' at certain points during the day, in the past she would work three or four hours more "just to try and keep up".

"It's exhausting. We might be functioning and perfectly fine, but it took a hell of a lot to get there before we've even left the house. I can get to a point at the end of the day sometimes where I've just run out of words."

'I'm less open and honest with how I feel about what my needs are'

Solomon's experiences were echoed by a social worker from South East England, who, since becoming qualified in 2018, said she has received "mixed responses" to her dyslexia and dyspraxia diagnoses from managers.

Due to her conditions, Megan*, who works in child protection services, sometimes has trouble remembering instructions or learning a new IT system. She also gets overwhelmed by high-pitched sounds and sudden, noisy or intense lighting.

"There's one phone in our office that has a really high-pitched scream when it charges," Megan explained. "That can literally stop me dead in my tracks, it can give me tension headaches." She also uses a purple filter over her screen to help her concentrate and is often unable to sit in front of a computer after a stressful day.

During a work day, Megan is careful to explain her conditions to the families she visits to make for a smooth collaboration.

"I clearly explain I have sensory needs," she said. "If it is too bright in the house, I might wear sunglasses. And if it is too loud, I might ask that we go into a quiet room. I just really kind of lay it out from there because, if I can't give them my best or if I am kind of feeling overwhelmed by sensory stimulants, it could transfer on to the way that I work with them."

However, Megan has found barriers when attempting to communicate her needs with managers.

In her final placement, her practice educator had requested a meeting with her university - without Megan knowing - to discuss her learning needs. The educator's verdict had been that local authorities wouldn't be able to make reasonable adjustments to accommodate her needs.

"I wasn't asking for anything particularly massive," she said. "I was asking for things to kind of be followed up in writing, just the kind of extra care and attention that you'd expect for a student."

The experience made her fearful of revealing her diagnosis in her first workplace for months, only relenting when learning there was another dyslexic colleague in the same body.

Years later, when interviewing for her current job, Megan once again struggled to get the adjustments she needed.

Having informed the organisation in advance of her diagnosis and her need to bring notes and to take notes during the meeting, she found herself on the day being refused those adjustments because it would give her "an unfair advantage against other candidates".

"That should have been the biggest red flag, but my judgment was clouded because I really wanted to be here," she said. "I said to myself, 'It could be different once you're there'. But when I started working there would be comments like, 'Oh, isn't everyone a little bit on the spectrum', or 'I think I'm a little bit dyslexic, or dyspraxic'. It really made me feel small, unseen."

As a result, Megan became wary of being open and honest about her needs and of advocating for herself.

Now it is her colleagues that are making the necessary adjustments for her - making sure that one phone charges at a time due to the noise or being aware of bright lights or which items make high pitch sounds - instead of her employers.

The shift happened after another neurodivergent colleague opened up to her about their own diagnosis. Over the next few months, they begun having conversations about their needs, experiences and diagnosis more openly in the office.

Overhearing the interactions, fellow colleagues slowly started to join in the conversation and offer to help make the office a more comfortable place to work in.

"It makes me feel a lot more healthy," she said. "But it also means that they are probably having to do more work that isn't their responsibility."

'Working with individuals to understand their specific needs'

While not relating directly to Megan's situation, employers told Community Care that they need to be made aware of neurodivergent employees' needs in order to respond to them accordingly.

A Cafcass spokesperson said the organisation urged any neurodivergent social worker to inform it of their condition, to enable it to understand their needs and make the necessary adjustments to help them do their job.

"By doing so, it enables us to work with the individual to understand their specific needs and make the adjustments that would help them succeed in their role," they said.

The family courts body also acknowledged the contributions of neurodivergent social workers, stating that their input is key in raising awareness of conditions and improving the experience of both service users and fellow colleagues.

"Our staff also have access to a growing range of health and wellbeing resources to enable them to fulfil their role, such as guides, handbooks and webinars covering key areas of wellbeing, including neurodivergent related topics such as dyslexia and mental health," it added.

Training and awareness at all stages

According to Solomon, what neurodivergent social workers need is not necessarily equipment to help them with tasks, but simply "understanding" from line managers.

"I might need to go and work somewhere quiet sometimes," she said. "Or I might need to wear headphones because I can't cope with all of the distractions and the noise; when I'm reading something and somebody comes in disturbing and talking to me, I am going to probably forget what I was doing. I'm going to need to start again. Or I am going to need things in writing - because if you've given it to me verbally, I'm not going to retain that."

The pilot study she helped put together urged that, to achieve that awareness, there needs to be some systemic changes made. According to Solomon, those include:

Awareness training around what neurodiversity is for students, educators, and line managers.

"A clear path" as to what the process is to access support as a neurodivergent social worker

Altering recruitment processes to be inclusive towards neurodivergent applicants -"It could be just something as simple as giving that person the questions five minutes before an interview for example".

Ensuring there is access to equipment to support neurodivergent needs.

Encouraging workers to form peer support groups.

"I think peer support is huge," she added. "We learn a lot from each other, like coping strategies, and nothing works better. We're talking to someone else who gets it, and giving the space for people to be able to do that is really important.

"And then what that does is it allows these groups of people to be able to influence things like, 'Hang on, actually, your policy really doesn't reflect what we need'."

Employers' responsibilities under the law

According to the Equality Act 2010, any impairment - which includes neurodiverse conditions - that has a substantial and long-term adverse effect on a person's ability to carry out normal day-to-day activities is a disability.

That means that when an employer is made aware of their employer's disability, they are required by law to make the necessary adjustments to accommodate their needs.

According to the government's website, these reasonable adjustments include, among others, adapted equipment, altering the recruitment process, making physical changes to the workplace, training and support for people the new employee works with, and allowing the person to work somewhere else that is more comfortable for their needs - e.g. a quiet place or the ground floor.

Research from employment law firm Fox found that, in 2021, there were 93 tribunals for employees who had allegedly been discriminated for their neurodiverse condition - up from 70 the previous year.

Dyslexia accounted for 40 employment tribunals, autism for 28, Asperger's for 21, ADHD for 19 and dyspraxia for 12.

Solomon also recently helped pass a motion during the British Association of Social Workers' (BASW) in June that aimed to raise awareness and support for the neurodiverse workforce.

While the work is still in early stages, the motion will have BASW and the neurodiversity special interest group working with local authorities, universities, and regulators to introduce inclusive training, co-produce a neurodiversity policy, and celebrate good practice examples.

"At the moment for neurodivergent social workers there's no concrete support," she commented. "There's nothing out there that says 'This is how you get supported', and I guess that's what we're trying to create.

"Sometimes it feels like it's such a huge mountain to climb, and it's knowing where or how to do it. We're trying to get examples of good practice at the minute for one of our campaigns - and it's hard to find them."

She went on to explain that it is often "hit or miss" with managers, but if they don't have the knowledge, "it's not necessarily their fault".

"They're not purposely discriminating, but they just don't know how to support."

John Pearce, vice president of the Association of Directors of Children's Services (ADCS), welcomed "efforts to raise awareness of health issues" and recognised that a lack of support is a vital issue for neurodivergent social workers that can affect their mental health and wellbeing and their work with children and families too.

"It is vital that social workers can operate in an environment where great social work can flourish, enabling the children and families we serve to flourish too."
*Name has been changed for anonymity

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Neurodivergent social workers 'exhausted' from lack of understanding at work

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A lack of awareness and support at work has cultivated a climate of fear and exhaustion for social workers with neurodiverse conditions such as autism, ADHD and dyslexia. A pilot study on the experiences of neurodivergent social workers has found that, of 60 responses, 34 participants reported they had received no specialist workplace support.

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Developmental Dyslexia: Disorder or Specialization in Exploration?

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Developmental Dyslexia: Disorder or Specialization in Exploration?

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Our 'lived experience' is not in the past - it's a 'living' thing

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Our 'lived experience' is not in the past - it's a 'living' thing

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Our 'lived experience' is not in the past - it's a 'living' thing

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Dominic Watters may be responsible for bringing a new term into existence within social work. Instead of describing people as having 'lived experience' he refers to 'living experience'

The aim is to underline the immediacy of the situations people are facing and that their experiences are not a passive event of the past, but happening now and urgently need addressing.

For Dominic, this isn't just a distant theoretical concept too - it's based on his actual experience of being a social work student living in poverty.

"It's what I see every day," says the single father who lives on a council estate in Kent with his 15-year-old daughter.

"I see my neighbours are struggling financially. Speaking as someone living in poverty who is on pay as you go gas and electric and finding it hard to feed myself as well as my daughter, I feel it is such an important issue. I experience the debilitating effect of poverty and how that can dim someone's aspirations."

Dominic has spent the last two years studying for a Masters in social work. During that time, he has turned his passion against injustice into a campaign around food insecurity.

Last year, he launched Food is Care, a concept and a campaign to increase understanding of food poverty in social work. He wants to see it recognised both within the Professional Capabilities Framework and in England regulator Social Work England's professional standards.

Together with the Social Workers Union Campaign Fund and the Campaign Collective, he has recently carried out a survey that found two thirds of social workers are concerned about families being unable to feed their children.

This year he wrote to education secretary Nadhim Zahawi asking for a meeting to discuss food insecurity. He has also written to the Prime Minister in support of England footballer Marcus Rashford's campaigning on free school dinners.

"When I first started speaking about this people said it was a concern of public health and not in the social work arena," says Dominic.

"It is through the campaign work I have been doing, coupled with people who are giving it attention in the media, that it is more accepted that this should be a concern of ours."

Studying to become a social worker has also raised Dominic's understanding of the structural inequality that he and others experience in society. It has motivated his campaigning work which he sees as part of his professional identity.

"I have a deep sense that injustices should be challenged," he says.

"I don't speak about things I haven't experienced. When you are living the inequality you are discussing it's hard for it not to be personal.

"In a capitalist society you feel like a failure if every week you are experiencing food insecurity, having to feed your daughter while you go without.

"It doesn't make you feel extremely successful but at the same time it has given me the fuel to do the campaign work and come up with the concept of Food is Care.

"I was on a placement where I saw the children in care in semi-supported living experiencing this. They were surviving on food donations and food banks and I would go home thinking 'this is what I am going through' and realise that it is a shared disadvantage that some of the most marginalised people experience in society."

A year ago, Dominic published a book supported by PSW featuring essays written by social workers, academics and people using services highlighting the inequalities of Covid.

Called Social Distancing in Social Work: Covid Capsule One, it is now on the reading lists of several university social work courses.

He is currently in the process of reissuing an updated version of the book in light of the current cost of living crisis and is looking for more contributions from social workers.

"There is a lot of attention on this cost of living crisis, but for people like me living in poverty have been in a cost of living crisis for years now," he says.

"It is only now that it is hitting the middle classes who have a voice that is listened to that it is being given this focus."

Dominic recently met with the UN's food special rapporteur on the right to food Michael Fakhri and today, 14 April, he is due to meet representatives from The Food Foundation charity and End Child Food Poverty to discuss seed funding for his campaign work.

If successful, he plans to use this to continue pushing for food insecurity to be recognised within social work practice.

"I have had a meeting with the regional representative for Social Work England," he says.

"She was really encouraging about my work. Apparently for them to review the professional standards it has to go to Parliament. The long-term objective of Food is Care is saying the government needs to review this, perhaps with a judicial review about why food insecurity isn't included in terms of wellbeing in law."

To enquire about contributing to the Social Distancing in Social Work book email Dominic at notetodominic@gmail.com

#FoodisCare

Dominic can be found on Twitter @SingleDadSW

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Our 'lived experience' is not in the past - it's a 'living' thing

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Dominic Watters may be responsible for bringing a new term into existence within social work. Instead of describing people as having 'lived experience' he refers to 'living experience' The aim is to underline the immediacy of the situations people are facing and that their experiences are not a passive event of the past, but happening now and urgently need addressing.

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Scars on Healing Hands: The Role of Lived Experience in Social Work

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Scars on Healing Hands: The Role of Lived Experience in Social Work

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Scars on Healing Hands: The Role of Lived Experience in Social Work

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Why do you want to be a social worker?" That was one of the first questions I was asked by a staff member at the state hospital that had taken me on as a practicum student. The person asking was a security guard. I reached into my naïve, likely still developing brain and found an answer: "I want to help people." His response sounded more practiced. "You're going to find out that a lot of people don't want help." I smiled politely and left the conversation at that.

What I didn't say was that I knew this defiance very well, and that I also knew it to be partially false. Before going to college, I had already had interactions with more helping professionals than I could count. I spent a good deal of time dodging their questions, their advice, their "recommendations," and above all, them. I saw them as agents of society, or agents of my parents. I didn't think they could help me. I didn't trust them to help me. Still, on my own I was hurting. I desperately wanted help. There were people whose kindness eventually reached me. I realized the power of that kind of help, and it is what I have made my mission to give back. I am in recovery from a mental health condition. That is my reason for wanting to help.

My story is unique to me. However, the tradition of the once injured moving forward to give back is not. The prodigious psychiatrist Carl Jung reflected this in his archetype of the "Wounded Physician" (Jung, 1951) or Healer, which was described as an individual who has struggled-particularly in health-who has returned to help those still hurting (Benziman, Kanni, & Ahmad, 2012). He wrote of these healers as learning from their own experiences to relate to the suffering of a fellow human being and to guide a partnership in treatment (Jung, 1951). In ways, Jung himself could be called a wounded healer. He sometimes spoke of visions and may very well have walked through some of his own challenges (Dunne, 2000). With this intimate knowledge of the mind, he was able to contribute an abundance of health-giving perspectives.

Mental health surveillance research suggests that as many as 25% of Americans may live with some kind of mental health condition (Reeves et al., 2011). By these statistics alone, it can be estimated that among those represented include a number of individuals in the helping professions. Indeed, in a survey of personal statements by potential social work students, quite a number indicated a personal experience in their reasons for choosing social work as a profession (Regehr, Stalker, Jacobs, & Pelech, 2001).

Formal education, reading, and practice can grant insight into an array of elements related to mental health and the needs of individuals living with mental health conditions. Still, what cannot be taught by ordinary means are the intimate details of how it feels. Without having walked through extreme states of mind-such as psychosis, mania, and panic-social workers can at best learn from second-hand testimony of what these look like from the inside. Social workers and other "helpers" who have had experiences such as these have access to this less common understanding, and a number of these individuals have done fantastic work. Among those most notable helpers who have overcome overwhelming difficulties is Dr. Kay Redfield-Jamison (1997), a psychologist who has studied and written about Bipolar Disorder, and who also lives with the challenge herself.

Beyond this, social workers who have had contact with systems of care hold a degree of knowledge of how it feels to seek out services. An understanding of what can make the mental health system easier to navigate, specifically for a person living with mental health symptoms, and what can contribute to a stigmatizing, comforting, depowering, or empowering treatment session, can be incredibly useful for service providers.
Scars Can Look Like Scarlet Letters
Social workers wearing scars often feel driven to hide their scars, in fear of judgment and professional consequences. This fear is not unwarranted. Until recently, those living with mental health conditions were discouraged from entering any aspect of the mental health field, including social work. For many years, mental health conditions were viewed as chronic, incurable illnesses to which individuals were victim. With this in mind, social services would seem a dangerous career path for those who have been touched by mental illness, given the weak-minded nature of those affected, susceptibility to relapse under stress, and constant presence of symptoms. This stigma is well alive in the minds of society at large, as well as within the mental health profession (Nordt, Roosler, & Lauber, 2006).

Today, more consumers and professionals alike are recognizing that it is possible for individuals to move beyond this impact and recover to lead meaningful lives.

With the advance of models that embrace reintegration of those living with mental health conditions and promote the concept of recovery, the voices of individuals with "lived experiences" have been given a growing role in all aspects of the mental health field. This has spread so far as for there to be an effort to seek out the skill of people with lived experiences in a peer-professional role as peer support specialists and recovery specialists (Davidson, Chinman, Sells, & Rowe, 2006).

In the same way, having a mental health challenge has become more accepted among those practicing in more traditional areas of social work. At least one agency providing substance use and mental health services has gone so far as to encourage potential applicants of this variety by adding statements such as, "Current or former consumers of mental health or co-occurring services are strongly encouraged to apply," and "Welcomes applications from qualified applicants with Recovery experience." (Chestnut Health Systems, 2014) to their job postings. This is a bold step toward encouraging the strengths and unique viewpoints these individuals can bring.

Although sharing one's story to ignite hope and to model appropriate coping strategies is key to the work of peer-staff, the place for self-disclosure is murkier for social workers in traditional roles. This kind of disclosure is sometimes discouraged or even forbidden in some capacities. Although service users might find it encouraging to know that a social worker has had experience with his or her own challenges, excessive or untimely disclosure has potential to take focus away from the client and to be detrimental to social work goals. If and how much a social worker chooses to share is a very individual decision.

What Helps

Students and young social workers who have survived significant difficulties could be at greater risk for specific troubles, such as a triggering of traumatic memories (Zoskey, 2013) and over-identification with clients. Those involved in areas that correspond with our own personal experiences may be at especially high risk (Regehr, Stalker, Jacobs, & Pelech, 2001). For these reasons, supports and mentorship may be particularly significant for growing social workers with their own "scars."

Support can come from a recognized source, such as a counseling office or supervisor. However, it doesn't have to. In a survey of social work students who self-identified as living with a mental health condition, many reported that they were more likely to seek out the support of a friend or family member than a professional (Reid & Poole, 2013). In an academic setting, opportunities for peer support and mentorship may allow a safe means for this needed support to take place.

Reid and Poole (2013) also found that a number of the social work students they surveyed referred to their own coping strategies and self-care efforts, such as walking, as key supports for them in their work and studies. Social workers are known to be masters of compassion and giving care to the needs of others. We owe ourselves the best of our own abilities.

A chief way in which social workers can support those with scars might simply be to acknowledge individuals living with mental health conditions as an oppressed group and extending the same anti-oppressive attitudes to them as they would to any other. The stigma that all individuals living with mental health challenges fight is ever-present. With an open door into the profession and recovery-oriented policies, wounded healers can flourish and lend a valuable perspective to the field.
References
Benziman, G. Kanni, R. and Ahmad, A. (2012). The wounded healer as a cultural archetype. Comparative Literature and Culture, 14 (1),

Chestnut Health Systems (2014). Southern Region Employment Opportunities. Available online at http://www.chestnut.org/Employment/SouthernMetroeastIllinoisArea

Davidson, L., Chinman, M., Sells, D., & Rowe, M. (2006). Peer support among adults with serious mental illness: A report from the ﬁeld. Schizophrenia Bulletin, 33, 443-450.

Dunne, C. (2000). Carl Jung: Wounded Healer of the Soul. Morning Light Press.

Jamison, K.R. (1997). An Unquiet Mind: Memoir of Moods and Madness. Vintage.

Jung, C. (1951). Fundamental Questions of Psychotherapy. Princeton University Press.

Nordt, C. Roosler, W. Lauber, C. (2006). Attitudes of mental health professionals toward people with Schizophrenia and Major Depression. Schizophrenia Bulletin, 32 (4), 709-714.

Reeves, W.C. Strine, T.W. Pratt, L.A. Thompson, W. Ahluwalia, I. Dhingra, S.S. Mcknight-Eily, L.R. Harrison, L. De'Agelo, D.V. Williams, L. Morrow, B. Gould, D. Safren, M.C. (2011). Mental illness surveillance among adults in the United States. Morbidity and Mortality Weekly Report, 60 (3), 1-32.

Regehr, C. Stalker, C.A. Jacobs, M. and Pelech, W. (2001). The gatekeeper and the wounded healer. The Clinical Supervisor, 20 (1), 127-143.

Reid, J., & Poole, J. (2013). Mad students in the social work classroom? Journal of Progressive Human Services, 24, 209-222.

Zoskey, D.L. (2013). Wounded healers: Graduate students with a history of trauma in a family violence course. Journal of Teaching in Social Work, 33 (3), 239-2o50.
Jennifer Gerlach received her MSW in 2015 from Southern Illinois University Edwardsville. She takes great joy in supporting individuals seeking recovery from mental health challenges, and does so often in her work as a crisis worker as well as in sharing her own story of recovery. She welcomes email at jgerlac@gmail.com

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Scars on Healing Hands: The Role of Lived Experience in Social Work

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Social workers who have had contact with systems of care hold a degree of knowledge of how it feels to seek out services. An understanding of what can make the mental health system easier to navigate can be incredibly useful for service providers.

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The role of lived experience in social work practice

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The role of lived experience in social work practice

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The role of lived experience in social work practice

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One of the reasons I wanted to become a social worker was to help others who may have had similar experiences as myself. I have been able to access good therapists, and learn skills in self-reflection and I can quite honestly say, these have saved my life. The most helpful people were those who genuinely cared about my wellbeing and who shared their stories. They didn't launch into huge life stories, nor were they over-emotional (either of which would not be appropriate in that role) but it helped me to know I was not alone, and I could get through it. It gave me hope.

My experiences are just stories to me now; if they still brought up raw feelings I wouldn't ever mention them, and to be honest I hardly ever do, but the understanding I have of human beings and our capabilities in the circumstances we can find ourselves in, have been my most valuable tool in working with people. Sometimes just saying "I get it, I've been there" is enough.

Sharing lived experience is a highly personal choice, and you have no idea what can trigger people. My utmost role is a duty of care to my client and I take this very seriously. There are some good guidelines I found on self-disclosure in Social Work and these have been useful .

I have had two different experiences of the role of lived experience in social work. One was with a Maori run NGO and one was with a government agency. The Maori NGO had core principles of Whakawhanaungatanga, Manaakitanga and Rangatiratanga. Through the workshops and trainings, the staff were invited to disclose personal stories. There were trainings on suicide prevention, drug and alcohol addictions, mental health, sexual abuse so you get the picture. There was no judgement if you did or did not share, and confidentiality was emphasised. It was part healing for some and served to work on our own potential triggers; it helped reduce shame and stigma and importantly, it built bonds between colleagues.

It is seen in other organisations: Changing Minds only employs those in recovery from mental health or addiction issues, and the Jungian archetype of the Wounded Healer has been around for a while. This is where supervision is so important within social work, and having an experienced supervisor that has had some therapeutic training will add to the quality of that journey.

On my second work placement at a government organisation, my supervisor asked me why I wanted to work for them. I told them I shared some of the experiences of their clients (it was on my CV, this was no surprise) and I was met with "don't share that with anyone in the office, and certainly not your clients". What did they mean by this? They talked about not wanting to trigger the clients, which I completely understand, and they were concerned that I would become a topic of gossip in the office. This kind of culture compounds stigma and shame which are two things we should be striving to eliminate. I found an article detailing white therapists experience of self-disclosure to Mexican-American clients. The author found that this actually helped to break down barriers in the client/ therapist relationship. You can read the article here and is also relevant when working with Tangata Whenua.

Maybe we have become too risk adverse, and think if we share we have had suicidal thoughts that everyone is going to run around topping themselves. Or that those struggling with addiction will relapse if you say you understand the cravings and they will pass. Framing my response to a person in an emotional state has taken a lot of practice, mainly on my friends and family over the years where mistakes can be a little easier managed, (sometimes!). Sharing stories has taken away the isolation. Compassion, to me, is relating to the feelings: you don't have to relate to the circumstances that brought those feelings to surface. Ruwhiu and Ruwhiu (2005) say that social workers need to be at peace with themselves before being able to have peace with the practice, something which I experience as true for me.

In the spirit of social work in Aotearoa New Zealand, there is a lot to learn from whakawhanaungatanga. As Ruby Wax said in a podcast with Russell Brand, both of whom have suffered from depression and anxiety, "We're so alone, and no one is comparing notes." I believe it is possible in the right circumstances, that my lived experience can help others to see we are all human and there is hope.
References
Brand, R (2017). Madness and Meditation. Under The Skin with Russell Brand and Ruby Wax. Retrieved from https://www.youtube.com/watch?v=2uhpc_FsMAM

Danzer, G., (2017). White Therapist Self-Disclosure in Multicultural Contexts. Society for Psychotherapy. Retrieved from: https://societyforpsychotherapy.org/white-therapist-self-disclosure-multicultural-contexts/

Dunne, C (2013) Carl Jung: Wounded Healer of the Soul. Retrieved from: https://www.youtube.com/watch?v=oZTG-tCEFv4

Ruwhiu, P. T., & Ruwhiu, L. A. (2005). Ko te pae o te atua mai i nga whakaaro hohonu nei, hei oranga mo te ira tangata. Te Komako 17(2), 4-19. Retrieved from https://anzswjournal.nz/anzsw/article/view/330/387

Vaz, G. Boundaries of Self Disclosure. Ethical Social Work Practice. Retrieved from: https://ethicalsocialwork.wixsite.com/ethicalsocialwork/boundaries-of-self-disclosure

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The role of lived experience in social work practice

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By Naomi Smith One of the reasons I wanted to become a social worker was to help others who may have had similar experiences as myself. I have been able to access good therapists, and learn skills in self-reflection and I can quite honestly say, these have saved my life.

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The 'community' in 'community social work'

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The 'community' in 'community social work'

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https://gusvassell.wordpress.com/

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Monday, 18 July 2022An open letter to the social worker who wrote my case notes

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Monday, 18 July 2022An open letter to the social worker who wrote my case notes

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https://unbound.com/books/free-loaves-on-fridays/updates/an-open-letter-to-the-social-worker-who-wrote-my-case-notes

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An open letter to the social worker who wrote my case notes | Unbound

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Dear Tara*, Before I wrote this letter, I double checked the spelling of your name just to make sure it was correct. I know how jarring it can be when the basics are not quite right; you misspelt my name almost one hundred times in the case files you wrote about me whilst I was under your...

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A researcher-practitioner with lived experience @ZahraPsych

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A researcher-practitioner with lived experience @ZahraPsych

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One of the key strengths of the study was that it was led by a researcher with lived experience of receiving and living with an EUPD diagnosis. Whilst, for reasons outlined in the reflexivity section, this could also be seen as a limitation, it is likely (from participant responses) that this increased the willingness of participants to take part and increased the richness of their responses through enhanced trust in the researcher and less potential for feeling judged.

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Commanded to be ill accused of being well a lived experience led qualitative investigation of service user perspectives on the impact of emotionally

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Care Experienced SW Book: Editor @RebekahPierre92

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Care Experienced SW Book: Editor @RebekahPierre92

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https://t.co/oI3JOa13m9

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Hoarding and mental capacity: key points for social workers

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This article showcases excerpts from a guide on Community Care Inform Adults about working with adults who hoard, written by safeguarding trainer Deborah Barnett. The full guide covers types of hoarding, assessment tools and supporting someone to change. Subscribers can read the guide on Inform Adults.

What is hoarding?

Hoarding can be described as the collecting of, and inability to discard large quantities of goods, objects or information. Hoarding may involve neglecting aspects of the home and/or self, resulting in poor sanitary conditions and social isolation which eventually impact on the person's physical or emotional wellbeing.

Hoarding is characterised by:

An intense emotional attachment to objects that are not regarded as having the same value or worth to others.

The person feeling a sense of loss were they to dispose of the object.

The person perhaps seeing other value in the object such as environmental recycling use, or intrinsic value, for example, seeing the object as a thing of abstract beauty such as pebbles, stones, driftwood or artwork.

Issues of capacity

Working with a person who hoards is likely to raise issues of whether the person lacks mental capacity to make particular decisions. This may particularly be the case when the person is reluctant or refusing to accept help for their hoarding, and practitioners may question whether the person has the capacity to refuse.

The first three principles of the Mental Capacity Act 2005, set out in section 1 of the act, support people's right to make decisions where they have the capacity to do so:

A person must be assumed to have capacity unless it is established that he lacks capacity.

A person is not to be treated as unable to make a decision unless all practicable steps to help him have been taken without success.

A person is not to be treated as unable to make a decision merely because he makes an unwise decision.

The third principle is perhaps particularly relevant to working with a person who hoards.

Section 2(3) of the act also makes clear that a person's lack of capacity cannot be established simply by "an aspect of his behaviour, which might lead others to make unjustified assumptions about his capacity".

However, the Mental Capacity Act code of practice states that one of the reasons why people may question a person's capacity to make a specific decision is "the person's behaviour or circumstances cause doubt as to whether they have capacity to make a decision" (4.35, MCA code of practice, p52). Arguably, extreme hoarding behaviour meets this criterion and an assessment of capacity should take place.

Under section 2 of the MCA, a person lacks capacity to make a decision if they are unable to make the decision at the material time because of an impairment or disturbance in the functioning of the mind or brain. As set out above, this is likely to apply to a person who hoards because it is often a symptom of a mental health condition or can be seen as a disorder in its own right.

Under section 3, a person is unable to make a decision if they are unable to:

Understand the information relevant to the decision.

Retain that information.

Use or weigh that information as part of the process of making the decision.

Communicate their decision, whether by talking, using sign language or other means.

Any capacity assessment carried out in relation to hoarding must be time specific, and relate to a specific intervention or action. This may include decisions about where a person should live, their tenancy agreement, care provision, healthcare or more generally accepting support for their hoarding.

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Hoarding and mental capacity: key points for social workers

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This article showcases excerpts from a guide on Community Care Inform Adults about working with adults who hoard, written by safeguarding trainer Deborah Barnett. The full guide covers types of hoarding, assessment tools and supporting someone to change. Subscribers can read the guide on Inform Adults. What is hoarding?

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Multi-agency Protocol for Working with People with Hoarding Behaviours | Cambridgeshire and Peterborough Safeguarding Partnership Board

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Cambridgeshire and Peterborough Safeguarding Partnership Board | Safeguarding children and adults at risk from Abuse and Neglect

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Multi-agency Protocol for Working with People with Hoarding Behaviours | Cambridgeshire and Peterborough Safeguarding Partnership Board

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Download Table of Contents 1. Introduction This protocol offers clear guidance to staff working with people who exhibit hoarding behaviours. It sets out a framework for multi-agency partners to work together, using an outcome focused, solution based model. This protocol has been developed in partner…

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Experiences of adult social work addressing self n

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Supporting people affected by hoarding disorder

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How to find local services

Knowing what services are available in your area can help you coordinate the best care for a patient's individual needs.

On this page, we introduce the wide range of services that exist for adults living with a terminal illness. Not every service will be available or operate in the same way in every area of the UK.

You can find more information about Marie Curie services on our Patient services page. You can also contact our Support Line on 0800 090 2309.

GPs

For people living at home or in a care home, their GP is responsible for their medical care. GPs work with other healthcare professionals, such as district nurses, community matrons, hospital teams, physiotherapists, dietitians, palliative care clinical nurse specialists, as well as community pharmacists, to provide the best care for each person.

These are some of the things that the GP can do:

Assess someone's symptoms and prescribe medicines and other treatments.

Prescribe Just in Case medicines before a patient's symptoms get worse. We have information for patients and the public about Just in Case medicines.

Seek expert advice from specialists.

Provide information on the patient's condition and the support services available.

Liaise with the district nurse regarding care at home.

Refer the patient to local hospice services.

In Northern Ireland, multidisciplinary teams consisting of physiotherapists, mental health specialists and social workers are being embedded in GP surgeries. This allows patients to access a wider range of services in their GP surgery to better meet their needs.

Community pharmacists

If you have a community pharmacist in your area, they may be able to provide additional support. As well as dispensing and advising on medication, community pharmacists are becoming more specialised, reflecting the needs of the community. For example, they may be able to advise on local palliative care services and connect you to these.

District nurses

If a person can no longer leave their house or care home for appointments or treatment, a district nurse can help to arrange care where they are living. District nurses can provide medical care such as monitoring skin conditions, administering medicines, changing dressings, managing symptoms and ordering equipment. District nurses can also arrange certain equipment to make caring for patients at home easier. For example, they can arrange for a hospital bed or a commode.

District nurses also coordinate other services that the patient might need, but whether they're available will vary from area to area. These can include community nurses, healthcare assistants, care workers, Marie Curie Nurses, palliative care clinical nurse specialists, or other care agencies. District nurses work with the patient and those important to them to prepare a personal care plan. They can then refer them to the best services to meet their individual needs.

District nurses often play a key role in supporting independence by providing and coordinating palliative and end of life care so the patient can remain in their own home.

Marie Curie Nurses

If someone is being cared for at home, they might get help from the hospice care at home service. This service is provided by registered nurses and healthcare assistants. The patient's GP or district nurse can refer them to the Marie Curie hospice care at home service. The patient does not need to live near a Marie Curie Hospice for this, but the hospice care at home service is not available in all parts of the UK. You can check if it's available in your area.

Marie Curie Nurses and Marie Curie Healthcare Assistants usually provide overnight care for a shift of eight or nine hours when someone is in the last weeks or days of life. In some areas, they also provide a rapid response service when someone is in crisis to help them remain at home rather than being admitted to hospital. Rapid response services are typically available overnight and at weekends. Marie Curie Nurses have specific training in end of life care. They will make sure the patient is comfortable, and can also offer advice, support and brief respite for the people caring for them. They can also assess the patient's needs and inform the district nurses of any changes so they can plan for the kind of additional help they should receive.

Marie Curie Healthcare Assistants do not have a nursing qualification but have received specialist training in caring for people at end of life. They can help with washing, dressing, mobilising, pressure area care, support with medication and can give emotional support to the person and those important to them.
Find out more about the different types of support available from the Marie Curie hospice care at home service.
Specialist palliative care team

A specialist palliative care team might involve many health professionals, including doctors, nurses, occupational therapists and physiotherapists. Someone may be comfortably managed by their GP and district nursing services at the end of their life. But if they need any extra support, the palliative care team can help to manage pain and other distressing symptoms and can offer emotional, spiritual and psychological support to the person and those close to them. Specialist palliative care teams can provide care in hospital, in a hospice, in someone's own home or in a care home, alongside the person's usual healthcare team.

Macmillan nurses and other specialist nurses

Macmillan Cancer Support funds a wide range of professionals to support people affected by cancer. A Macmillan nurse can help with pain and symptom control and provide information about treatment. They do do not carry out routine nursing tasks, but they may call or visit you to check on the patient's symptoms. Some specialise in palliative care and managing symptoms, while others specialise in cancer. To get support from a Macmillan nurse, a person needs to be referred by their GP, their hospital consultant, a district nurse or a hospital ward sister.

If the person does not have cancer, they may get support from specialists who are experts in their illness such as motor neurone disease (MND), multiple sclerosis (MS) or Parkinson's disease. They can be referred through their GP or they may already have support through a hospital team.

Hospice care

Hospices provide free nursing and medical care in a friendly and comfortable setting, as well as emotional and practical support. Some people stay in a hospice as an inpatient when they need specialist care. Some hospices provide services in a patient's own home. Hospices can be fully funded by the NHS, but most are run by various charities, including Marie Curie.

A hospice may also provide day services for people who are living in their own home. These include support groups, exercise programmes, art therapy, music therapy, complementary therapy, counselling and spiritual support.

Read more about Marie Curie Hospices or call our Support Line on 0800 090 2309.

Social care

Social services can organise non-medical care - things like having meals delivered, home adaptations, and help with washing, dressing and eating.

A social worker or another trained professional can assess someone's suitability for this type of care and help organise it. They usually work as part of the local social services department (social work department in Scotland or health and social care system in Northern Ireland).

If someone wishes to live at home, then they or a member of their healthcare team, or a family member, can request an assessment of their needs. Depending on their needs they may be able to get support from social services.

Social services can also help when someone needs to move into a care home.

If someone has a family member or friend looking after them (an unpaid carer), social services might be able to help them to get support as well. They can talk to them about their own needs. Support might include putting them in touch with local support groups, help with taxi fares if they don't drive, and getting someone to take over caring for a while so they can take a break (this is sometimes called respite care).

Paying for social care

The local council, authority or health and social care trust may pay for some or all of the person's social care. But the person may have to pay for some or all of it themselves. Whether they have to pay might depend on what care they need, where they live and how much money they have.
Read more about getting nursing and personal care at home.
NHS continuing healthcare

NHS continuing healthcare is social care funded by the NHS and can be provided in a variety of settings outside hospital, including the patient's own home or a care home. It is somtimes called fully-funded care. To be eligible, the person will need to be assessed by a team of professionals − a multidisciplinary team. A person's eligibility for NHS continuing healthcare is based on their assessed needs, and not on any particular diagnosis or condition.

If someone has a rapidly deteriorating condition that may be entering the terminal phase, they may be able to access a fast-track pathway to get this care in place more quickly.

NHS continuing healthcare is available in England and Wales. It may be available in Northern Ireland but is more difficult to access.
We have more information for people and their families on how to be assessed for NHS continuing healthcare.
NHS continuing healthcare is not available in Scotland, which has a different system. Instead, the councils' charging policies apply for social care, meaning the person may have to pay some of their costs towards their care.

Private care workers

The person or their family could employ a paid care worker directly or through an agency to help during the day or overnight. Payment will need to be made to the care worker or the agency by the person or their family. Care workers can help with preparing meals, washing and dressing and taking the person out and about.
Read the information we have for the public about getting nursing and personal care at home.
Unpaid carers (family and friends)

A carer is someone looking after a partner, friend or family member who is not able to manage by themselves. Each caring role is different but carers might help with many different aspects of care, including washing and dressing, giving medicines, cooking and cleaning, taking the person to appointments and managing finances.

For many people, looking after a terminally ill partner, friend or family member at home is "just something they do". They do not think of themselves as the person's carer. But recognising that someone is a carer can help them to access support from the NHS and other organisations who may describe them in this way. You may find it useful to share our information on getting support as a carer.

Companion at home service

Marie Curie has trained Companion volunteers who can provide practical and emotional support to someone living with a terminal illness. The person will be matched with a Helper (according to their needs and interests), who will spend up to three hours a week visiting them at home or speaking to the person over the phone.
Find out more about the Companion at home service. Other local organisations such as faith groups, community groups and charities may provide similar services.
Charity organisations

Charities play a big role in supporting people with a terminal illness, their carers, friends and families. We've listed here just a few that may help anyone you care for find more practical advice, information, and emotional support:

Good communication

As end of life care tends to involve a lot of healthcare professionals, good communication between everyone who is involved is essential. This ensures that everyone is aware of the patient's wishes and preferences, and can act accordingly.

Sharing information

It's good practice to speak with the other professionals involved in the person's care regularly. Every local area should have a system that allows professionals to share information for each individual receiving end of life care. This might include a summary care record that you can access securely online, or notes and care plans in the home if the person consents to having their information shared in this way.

Advance care plans

In some areas, there are systems which record specific information, including advance care plans that are accessible to professionals. An advance care plan is a way for someone to express and document their preferences about how they wish to be cared for as their illness progresses. You can read the inforrmations we have for the public about advance care planning. The person's GP should know if this type of record is in place.

Ambulance services

The local ambulance service may also have a record of what to do in case of an emergency. For example, in emergency circumstances, this record might tell paramedics whether the person wants them to attempt resuscitation or not. The Do Not Attempt CardioPulmonary Resusciation (DNACPR) form can be completed by the GP, or hospital or hospice doctors and should be regularly reviewed. The form is kept in the patient records and should be accessible to everyone caring for the person. In some areas of the UK, the DNACPR form has been replaced by a ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) form .

Message in a Bottle

In some parts of the UK, the Message in a Bottle initiative allows people to store a form with important information about themselves and their condition in a small plastic bottle for emergency services to retrieve. This is usually stored in the person's fridge, as this is where emergency services are trained to find it.

GP meetings

Some GPs hold monthly meetings with the district nurses and palliative care teams to discuss people known to their services who are approaching end of life. As a professional involved in the care of someone at end of life, you could find out whether your patient is known to the palliative care team and if you are able to attend their meetings to learn more.

Useful resources

The Daffodil Standards is a free, evidence-based, structured approach to help GP practices consistently offer the best end of life care for patients.

Hospice UK has information on hospices across the UK.

You may find it useful to share our Being cared for at home booklet with people you're caring for and those around them. It includes information about the care and support that's available for someone living at home.

Macmillan Cancer Support's Your Life and Your Choices booklet provides detailed information about the ways someone can plan ahead and make choices about their future care specifically if they live in Northern Ireland.

Beacon is a not-for-profit organisation that provides expert advice on NHS continuing healthcare. As well as chargeable casework, it is funded by NHS England to provide 90 minutes of free advice by their trained staff on any aspect of NHS continuing healthcare.

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A guide to end of life services | Information for professionals

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A guide to end of life care services across the UK, including GP, district nurses, social care, specialist palliative care, Marie Curie Nurses and Macmillan nurses.

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Learning from those who are dying: the key to good palliative care social work

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By Gerry Nosowska

Three weeks into my social work training I started a placement in a hospice. During the 50 days that I worked there, almost everyone that I worked with died. I started off wondering what social work could offer to people who are dying. I finished the placement wishing every social worker had the chance to learn from people facing death. Their experience of loss and resilience, and the opportunity to find ways to be alongside people in those situations, goes to the heart of what social work does well.

I have just been involved in a remarkable working group which has produced a new resource for social workers: The role of social work in palliative, end of life and bereavement care. This resource aims to ensure that people benefit from good social work at the end of their life, and that those close to them are supported during this time and into bereavement.

Lived experience

The resource has been jointly produced by social workers and people with lived experience of end-of-life care. Throughout, it shares those experiences and these highlight the ways that social workers can make a difference when working alongside people who are dying or bereaved.

Here are some of the key messages from the resource for social work practice, alongside the voices of those with lived experience:

1. 'I want health workers to be positive and express what is going on in the right way without being negative. I am very positive about my life.' (Phone interview with woman who uses a drop in centre). Social workers can recognise people's need for acknowledgement and for someone to listen to them. We can show confidence and sensitivity in finding the right time to talk about death and dying, so that people can be in control, plan ahead and achieve what is important to them.

2. 'It will be my wife who makes decisions for me, when I'm no longer able. But I have it all written down, things of importance to me. It's all written down.' (Man in his eighties attending a hospice day centre). Social workers can support people to make decisions, advocate for, and challenge with and on behalf of people. Where necessary, we can use the law to enable people to be in control.

3. 'Enabling people to live their lives exactly as they want - it's more than the medication, it is something aside from treatment. Comfort? Peace of mind?' (Bereaved man in his sixties). Social workers can ensure that someone's experience is at the centre of what happens. We can use evidence, law and systems to enable people to live the lives they want.

4. 'I don't want sympathy, just support. I don't like people feeling sorry for me. It's just some support, I suppose, practical support.' (Woman attending a drop in centre, age unknown). Social workers can assist people to realise their own abilities and mobilise their own resources, provide information and practical support, coordinate services and negotiate solutions. Where necessary, we can deal with bureaucracy.

5. 'I do not like it, when people who have not been ill say to you 'Oh you are so brave!' I hate that. I just want to be treated as me. Just see me as I was and forget the cancer. It's not all that I am.' (Woman in her sixties/seventies in a hospice day centre). Social workers can help people to maintain their identity despite change. We can help people to gather memories and to leave memories behind.

6. 'It has been hard to ask for help, I didn't want to and I couldn't ﬁnd the words. But now I am coming round. I know it is terminal and I know I need help now.' (Woman in her sixties/seventies in a hospice day centre). Social workers can embrace diverse needs and develop alternative ways of supporting people. We can explain how care will work and help people know how to access urgent support.

7. 'People need to know how bloody tough this is going to be. We shouldn't protect people. This isn't going to be easy. It's going to be bloody tough.' (Bereaved husband in his sixties). Social workers can help people close to someone who is dying to get the support they need. We can help people deal with practicalities after death and follow up with people who are bereaved in the way that works best for them.

Vision for palliative care social work

Our vision for social work in palliative, end-of-life and bereavement care is that: people will have access to a palliative care social worker with the capabilities and resources to help them when they need it, and that all social workers will be able to help people, their families, and those close to them to realise the value of what they can do and give to each other at the end of their life and during bereavement, and to get the support they need.

Here is what some of the social workers we spoke said about their role:

1. 'Tom had an impact on the whole staff team and I organised a reﬂective space the following week for staff to share memories and thoughts of their work with him and his family. It was well attended and enabled us all to express our feelings. Rest In Peace Tom.' (Palliative care social worker). Palliative care social workers are a source of expertise and support for other professions and agencies. They can raise awareness, mentor and provide advice to others. They can undertake research and gather evidence of what facilitates a good death.

2. 'We work holistically, combining emotional and practical skills, to enable people to achieve what matters most to them. We are active in improving things, we are ﬂexible and adaptive, and we are at our best as enablers when we are least conspicuous.' (Resource working group). All social workers need to be ready to support people who are dying, experiencing loss or bereaved.

The social work contribution

We hope that the resource will be used by palliative care social workers to raise awareness of their role and the contribution they can make, and by people who are dying and those close to them to ask for social work support. We hope that social workers will use the resource to review their practice, and to identify the support they need to develop their knowledge and skills.

Employers, leaders, commissioners, funders, colleagues from other professions and educators can use this resource to recognise the contribution that social workers can make, and to identify how to support and develop this area of practice.

Most importantly, we hope that the accounts of people's experiences will enable social workers to strengthen our ability to support people at this difficult and profoundly human time.
'The Story Of My Life? Somebody knows something about me. I existed.' (Woman in a hospice day centre). The resource was written by the Association of Palliative Care Social Workers in collaboration with the former College of Social Work and Making Waves Lived Experience Network/OPEN FUTURES Research, with support from the British Association of Social Workers and Hospice UK. Making Waves Lived Experience Network/OPEN FUTURES Research interviewed people who were willing to talk or write about their lived experiences of approaching death, caring and bereavement and what mattered most to them. We are grateful to all those people who were willing to share their stories.

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Learning from those who are dying: the key to good palliative care social work

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By Gerry Nosowska Three weeks into my social work training I started a placement in a hospice. During the 50 days that I worked there, almost everyone that I worked with died. I started off wondering what social work could offer to people who are dying.

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Unheld Child: Social Work, Social Distancing and the Possibilities and Limits to Child Protection during the COVID-19 Pandemic

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Abstract

The COVID-19 pandemic changed dramatically the ways social workers engaged with children and families. This article presents findings from our research into the effects of COVID-19 on social work and child protection in England during the first nine months of the pandemic. Our aim is to provide new knowledge to enable realistic expectations of what it was possible for social workers to achieve and particularly the limits to child protection. Such perspective has become more important than ever due to knowledge of children who died tragically from abuse despite social work involvement during the pandemic. Our research findings show how some practitioners got physically close to some children, whilst being distanced from others. We examine the dynamics that shaped closeness and distance and identify seven influences that created limits to child protection and the problem of 'the unheld child'. The article provides new understandings of child protection as embodied, multi-sensorial practices and the ways anxiety and experiences of bodily self-alienation limit practitioners' capacities to think about and get close to children. Whilst social workers creatively improvised to achieve their goals, coronavirus and social distancing imposed limits to child protection that no amount of innovative practice could overcome in all cases.

Introduction

From its early 2020 beginnings, the COVID-19 pandemic brought new risks of infection from a potentially deadly coronavirus, resulting in 'lockdowns' of the population in their homes, forbidding visitors from entering and imposing two-metre 'social distancing' which effectively banned touch between people not sharing a household. Following the announcement of the first lockdown on the 23 March 2020, government guidance in England sought to limit the need for social care staff to enter homes, suggesting '[T]here are many ways to keep in touch with a child, young person or family without physical face-to-face contact' ( Department for Education, 2020). A key early strategy was for social workers to see families by making 'virtual home visits' using video calling technology ( Cook and Zschomler, 2020). Rapid risk assessments were made by managers and practitioners to ensure children on child protection plans and in complex need were visited at home in-person-inside the house, on the doorstep or in the garden-whilst children considered at lower risk could be seen virtually.

This sudden disruption of the taken-for-granted ways child protection was done raises vitally important questions about what could now be achieved? In this article, we present findings from our research into the effects of COVID-19 on social work and child protection undertaken over the first nine months of the pandemic. Our research asked: How can practices that have relied on achieving closeness keep children safe and help families in a period of institutionalised social distancing? One aim of the study was to provide knowledge to help social work organisations, regulators, politicians, policy makers and the public attain realistic expectations of what it was possible for social workers to achieve in a context of social distancing and the limits to child protection under such conditions. The need for such perspective has become all the more important due to public disclosure in December 2021 of the deaths of children in two families in England, six-year-old Arthur Labinjo-Hughes and sixteen-month-old Star Hobson. Both died as a result of horrendous abuse despite some involvement of social workers and other professionals.

Arthur and his father moved into his stepmother's home at the start of the first COVID-19 lockdown in March 2020 and as soon as April 2020, it appears, his wider family had reported suspected abuse; social workers visited, but he died in June 2020 ( The Guardian, https://www.theguardian.com/society/2021/dec/03/arthur-labinjo-hughes-timeline-of-events-that-ended-in-his). Star died in September 2020 meaning that key interactions between her, her family and professionals also went on during the early phase of the pandemic. Reviews of the practice of professionals in both cases are under way and aim to inform policy and practice nationally. It was striking how the furious public and political response to these tragedies underestimated or totally ignored the impact of the pandemic on social workers' capacities to keep children safe.

These cases increase the need for better understanding of the real possibilities and limits of social work and child protection in a pandemic. We have reported elsewhere on how social workers improvised to get as close as possible to children and support families by using video calling, messaging and walking interviews in fresh air spaces beyond the home ( Ferguson et al., 2022). We found that there was no single pattern to, or consequence of, the mandate for physical distancing, and it did not necessarily keep social workers remote from children and families. Children, parents and even objects like toys, became untouchable, whilst simultaneously physical closeness and touch were creatively used within nurturing responses to some children. Thus COVID-19 had complex effects that, despite-and even because of-social distancing, saw some practitioners getting physically close to and tactile with some children, whilst staying physically distant from others. We argue then that these interactions between social workers and service users are best understood through exploring the dynamics of closeness and distance, what influences them and their impact on the effectiveness of child protection. Our data suggest that COVID-19 and social distancing imposed limits to child protection that no amount of creative, innovative practice could overcome in all cases, leaving gaps that children could fall through.

We argue that these limits and gaps can usefully be explored through the notion of 'intimate child protection practice' ( Ferguson, 2011) and in terms of the problem of 'the unheld child' ( Ferguson, 2017). The latter concept encapsulates how effective social work is not just about ensuring children are 'seen' and heard but that entering the child's world involves getting down to their level, using physical closeness, play and where appropriate touch to learn about their experience and help them. The pandemic seriously disrupted the possibilities for achieving such intimate child protection practice.

From intimate child protection practice to the unheld child

The literature on social work and the COVID-19 pandemic is already extensive. A systematic literature review of publications during its first year identified 256 outputs ( Cheung, 2022). In the second year of the pandemic the literature grew significantly, covering COVID-19 implications across different countries, service user groups and all aspects of social work education, practice, staff well-being, ethics, inequalities and policy. Our focus here is on relational practice in child protection and studies of a key aspect of that, the digital and casework through video calls, show that some service users prefer this, whilst often social workers feel that their assessments are adversely affected by what they cannot see going on beyond the frame of the screen and the absence of the sensory experience of being in service users' homes ( Baginsky and Manthorpe, 2020; Cook and Zschomler, 2020; Pink et al., 2022).

Yet, there has been little research into these sensory experiences and the nature and dynamics of in-person relating between social workers and children and families during the pandemic, and the focus of this article is on the actual embodied practices that were engaged in and the lived experience of providing and receiving social work services. The literature on social work and relationship based practice largely leaves out consideration of corporeality, of the 'body' ( Green, 2017, 2021), especially as it is used and experienced in practice interactions ( Cameron and McDermott, 2007; Phillips, 2014). Kong et al. (2021) argue that COVID-19 has made visible social workers' 'sensuous bodies', concluding from their secondary analysis of survey data that social workers' bodies 'have been suspended, displaced and re-constituted during the first UK national lockdown'. Green and Moran (2021) argue that the pandemic led to a 'scientisation' of touch in social work where its emotional constituents and the actual practices of touch have been silenced under impersonal scientised terminology such as 'social distancing'. In going beyond such terminology, our data show how child protection social work must be understood as embodied, multi-sensorial practices that depend upon hearing, smell and touch, as well as sight, on movement as much as being still.

To understand the impact of the pandemic on child protection it is crucial to place it in the context of pre-pandemic practice. Prior to COVID-19 ethnographic research that observed practice showed that children were most commonly seen in the family home and effective relationship-based practice involved getting physically and emotionally close to them, especially on home visits ( Winter et al., 2017; Ferguson et al., 2020a). Different degrees of closeness to children and families occurred and in a minority of cases children were ignored altogether, despite being in front of social workers-they were not only 'invisible' but 'unheld' children due to an absence of tactile contact, play and holding ( Ferguson, 2017). Some encounters and relationships with children were close and intimate. A typical example is a case researchers shadowed for a year, where the social worker held the infant on all of the ten home visits she was observed on, regularly moving by getting down on the floor to the child's level. The worker's rationale was that touch was an important sense to use in relational work and as a way of checking children's well-being and safety. By getting physically and emotionally close to children such intimate child protection practice was central to creating a 'holding relationship' that benefited parents as well as children ( Ferguson et al., 2020b).

However, tactile closeness was not the only way that practitioners established intimacy that kept children safe. With older children emotional connection was achieved through talk, photos and other things in their bedrooms, encounters in the car, cafes, on computers and through mobile phones and social media ( Simpson, 2017). With younger children closeness from a distance occurred by workers speaking to them and connecting through smiles and other gestures such as clapping hands in unison. Such effective rapport and relationship building had an emotional feel, which in psychotherapy has been called 'non-physical touch, through energetic attunement' ( Bloom, 2005, p. 58). As we will show non-physical holding through energetic attunement had to become crucial to child protection work during the pandemic.

Methodology

The originality of our contribution lies in part in our qualitative longitudinal methodology. Between April and December 2020, we conducted interviews with forty-eight social care staff: twenty-nine social workers, nine family support workers and ten managers from four local authority areas in England. Forty-one were women and seven men and seven participants identified as Black, Asian or Minority Ethnic. Twenty-one social workers and six operational managers worked in long-term child protection and 'child in need' teams, whilst five were from initial assessment teams, three worked with children with disabilities, two were from children in care teams. A core sample of social work practitioners were interviewed seven or more times, approximately every month. Interviews were conducted through video calls and occasionally by telephone and we explored practice issues arising from the pandemic and also tracked social workers' experiences of working with a subsample of families over the nine months. We interviewed twenty-one parents and one grandparent, most of who (seventeen) were involved in these longitudinal case-studies. We also observed four video recorded interactions between social workers and parents. The data enable us to show the dynamics of closeness and distance in individual encounters and longer term relationships. All interviews were audio-recorded, fully transcribed and analysed using NVivo 12 Plus, identifying key themes across the interviews and the case-studies of longer term work with families. The study obtained ethical approval from the University of Birmingham research ethics committee and the participating agencies. All of the participants gave verbal consent to being involved. All information that could possibly identify participants and research sites has been changed.

Understanding the possibilities and limits of child protection in the fearful, anxious conditions caused by the pandemic requires a theoretical framework that enables understanding of embodied, sensory and mobile experiences and gathering data that explore what social workers and service users said and did and the atmospheres of the encounters, their moods, emotional texture, smells, sounds-in essence, how they 'felt' ( Page, 2021; Pink, 2015). The body can be understood as 'a "medium" or "mediator" between the reflective self and the world' ( Rosa, 2019, p. 83). The world exists in our consciousness only through our bodies, whilst consciousness itself must be understood as bodily. Our findings show how social workers' anxieties about COVID-19 and restrictions on movement and closeness caused experiences of what Rosa (2019, p. 105) calls 'bodily self-alienation'. Here, the body becomes an enemy or an unknown stranger and how it behaves runs contrary to our intentions by blushing, sweating, smelling, belching, refusing to move and so on, meaning we no longer feel comfortable in our own skin ( Rosa, 2019, p. 105).

Such bodily alienation is deeply connected to disruptions of social workers' minds, their use of the reflective self and how they are able to think-or not think-about service users. The theory of reflective practice holds that practitioners should reflect in action and then afterwards reflect on what they did and why ( Schon, 1983). It is a flawed theory, however, because it places no limits on what is it possible to think about and to feel when in the heat of practice ( Ferguson, 2018a). The 'self' therefore is conceptualised as an unproblematic entity that has an unlimited capacity to absorb emotion, that the worker goes into in order to connect to their feelings, thoughts, values and how they are relating to service users. Much more relevant to our research is the psychoanalytical concept of the 'defended subject' or self ( Briggs, 2005, p. 23). Here, the self is understood as being conflicted and principally concerned with maintaining tolerable, manageable levels of anxiety. We argue that in our study not reflecting in action was a vital strategy practitioners adopted to avoid them becoming overwhelmed by unbearable anxiety. Not thinking about the danger and complexity they were in whilst they were in it helped social workers defend the self and get through encounters with service users, especially in the riskiest COVID-19 domain of all, their homes, but this made it much more difficult to think about and hold children in mind.

Findings

Our data reveal seven key influences on the dynamics of closeness and distance that made child protection work more complex and prone to limitations than it was pre-pandemic: pandemic emotions; the complexity of the home as the key site of practice; 'frazzled', defended states of mind; untouchable bodies and things; hostile relationships and the home as a fortress; the effects of facemasks and social working in isolation.

Pandemic emotions and atmospheres of fear and danger

As levels of fear and anxiety have fluctuated during the pandemic depending on levels of infection and deaths, it is easy to forget just how frightening the initial emergence of coronavirus was. The first death from COVID-19 was recorded in England on 2nd March 2020 and by the end of that year 72,178 people in England were officially known to have lost their lives to cornavirus ( Public Health England, 2022). An intense atmosphere of uncertainty and danger existed at the time of the first lockdown between late-March and June 2020, when staying at home and away from others was held to be the safe way to avoid infection. Yet, social workers were still required to enter family homes, where the smallness of these spaces, taking in of residents' breath and contagion from surfaces, all in a context of no vaccines and low population immunity was regarded as extremely dangerous. This fear is typified by a social worker who undertook many in-person visits during the first lockdown:

I do worry driving home in my clothes, wondering what I am carrying. ... [a colleague] and me removed 2 children and they sat in my own children's car seats. You couldn't get closer to my family... we are potentially super-spreaders.

Using a car like this was only allowed in emergency situations. Because social work offices closed practitioners were forced to work from home and to return there from home visits to the intimate places like bedrooms that they worked from home in, putting at risk their own and their family's health. We heard frequent stories of workers on arrival home stripping in the hallway and going straight for a shower. Personal protective equipment (PPE) provision was intended to promote worker and family safety but its availability early in the pandemic was generally poor and policies directing when it should be worn were contested and confusing ( BASW, 2020).

Yet, the pandemic prompted a passionate commitment to social work values and selflessness which manifested in a powerful commitment to being helpful through home visits, even when personally anxious about the risks.

That's the drive: helping families, helping children, so for me to drop back I know in my head that there's this Covid that many ethnic minority people have. On the news we've been told that more of them have died, they've succumbed to this illness, but knowing that and then in my heart, the heart that I have to help is kind of overriding ... the knowledge about this Covid-19 and the risks.

Risks from COVID-19 were greatest for black and minority ethnic families and workers and this Black British social worker was here reflecting on the risks she was taking in the first lockdown.

We heard many stories about how impossible it was to maintain the expected two metre distance inside homes, because younger children did not understand it. Here, a social worker explains how a four year old girl 'likes to come and put her head on my knee, I think it is almost like a comfort thing, I think she slightly understands that I am there trying to help.' Social workers invariably reciprocated by providing the comfort children needed, revealing how closeness and actual tactile contact are a crucial part of the nurture and therapeutic help social workers provide for children.

Home visits are often calm, congenial affairs, but some are volatile and dangerous, whilst most are steeped in uncertainty and the unknown of what is behind the door ( Ferguson, 2018b; Page, 2021). From the start of the pandemic social workers reported encountering the unexpected, such as one who found a father who was not supposed to be in the home hiding in the bedroom behind a wardrobe, and in another case a man jumped out of the bedroom window on seeing the social worker. Another risky element was the threat of violence by some family members, but now with the additional risks of infection.

I think our risk ... remains the same, ... we are going into people's houses. I got a Dettol spray and every visit I do I spray myself ... [and] the physical risk of being threatened by parents, sometimes teenagers, I think that's still there.

As Page (2021) notes service users' homes are also sites 'of potential breakthrough, requiring work that is founded upon intuition and feelings as much as protocols and procedures.' The pandemic both intensified the feelings and made such breakthroughs harder to achieve. There were agonising examples of social workers on doorstep visits trying to establish whether children had been harmed.

On my visit the boy [two years old] had a bruise on his eye, mother was coughing away, I was on the doorstep, and mother went upstairs and left the child at the top of the stairs and I was trying to get him to come down the stairs, he didn't. She brought him down and put him in the hallway and I couldn't go in and get him because of the coughing and his older brother said he did it [the bruised eye] and I finally got to see him closer up. So that was farcical. ... I was a bit closer than 2 meters.

When asked how effective they could be at ensuring such children are safe the social worker told us 'it's not very satisfactory because you can't go as far as you usually would OR you have to go for a full medical. You've got to underplay it or overplay' and in the former 'you are waking up in the night and wondering should I have seen more, have I done enough?'

'Frazzled' states of mind and body

Thinking and reflecting in action in social work have always been challenging but COVID-19 made them considerably harder. An example typical of our sample involves a social worker we call Monica. The referral about the Martinez family concerned a twelve-year-old boy having a black eye that his mother allegedly caused, in response to being hit by her son. It was Monica's first time stepping into a family home during the pandemic and we interviewed her thirty minutes after the visit. She had spent just under an hour on the visit, during which she saw the other child of the family, a seven-year-old girl, on her own spending time in the garden, the sitting room, and upstairs in her bedroom so she could show the social worker her dolls. She thought the child had 'probably been prepared by mother for the visit.' Initially, the worker and child sat on the 'medium-large sofa, about a meter and a half apart, she sat at one end I sat at the other, I was perched on the edge of the seat. Then we sat outside briefly at a large garden table on chairs, approximately 2 metre distance, then inside around a dining room table, opposite each other.' When in the child's bedroom, the social worker 'knelt on the floor near the door way, she [the child] was about a metre or two away playing on the floor, she had her back to me most of the time.'

The twelve-year-old boy was in his bedroom and when the social worker entered he continued playing with his x-box. She saw he had a black mark on his eye, but he shrugged to everything she asked. The social worker, 'felt like I was trying to convince him what social work is about, ... he'd made his mind up he wasn't going to talk.' The boy was sitting on the end of his bed and she 'walked into the room, initially stood in the doorway and stood about a metre from him, as I needed to take a photo of his injury.' Mrs Martinez was quite open about what had happened, that she had hit him and showed the social worker 'the bad bruises' on her arms, caused by him.

Despite the barriers, the social worker managed to achieve at least some of her aims. She established some rapport with the seven-year-old, elicited a cooperative response from the parent, saw the mark on the boy's eye, but did not get him to engage. There was however a disoriented quality to the social worker's experience in the family home, as if part of herself and mind were absent. Directly afterwards she could not remember certain details that normally she felt she would have easily recalled. Her demeanour was weary and her thinking ponderous, as she stared into the distance on the video call and tried to make sense of the experience she had just had.

Funny I forgot the process, not big things, like where the children sleep, I can't remember if ... Funny because I was just so aware of what I was wearing. ... I took the mask off because the child was upset. ... It's true what colleagues were saying, you get really hot really quickly. ... You soon forget or I did anyway the social distancing, it all goes out of the window.

When we spoke to Monica again ten days after she did the above visit she began without prompting by awkwardly describing herself as having been in a 'frazzled' state when we spoke to her that late afternoon. Her unease and embarrassment spoke to a sense of disorientation that sometimes afflicted social workers during COVID-19, making thinking in action very difficult. Seeing families in their gardens was one way of gaining respite from the risk of the virus but this also became a place of unease for Monica because the neighbours were also in their garden and had a noisy aggressive argument which drove the social worker and the family indoors again. The social worker said the commotion next door was part of a series of things that 'threw off the visit'. Monica was interviewed nine times for the research and in December 2020 still spoke anxiously of having to wear PPE and 'maintain social distancing, knowing that I do feel time pressured, I don't feel as relaxed with children.'

This shows how precarious relating to children and families was, how interactions could be 'thrown off', but also how some connection could still occur. There was a heightened uncertainty and tension between connection and disconnection that very often caused a sense of a lack, of not being able to fully trust in what had been done to try and keep children safe. Monica experienced what she called 'forgetting of the basics'. Our analysis suggests two ways of accounting for this. The first is that it was due to the impact of anxiety on the mind and body. The sensation of the overheating body and feeling she had forgotten she was supposed to social distance were signs of 'bodily self-alienation' ( Rosa, 2019) and how the worker did not feel at home in or have control over her body. As another social worker Patricia expressed it in October 2020:

I never think about it [Covid] when I'm in people's homes. I think about it before I go in ... and when I go in I go into automatic pilot doing my visiting. You're talking to children, trying to find out how they are, Covid is not on the radar when you are in there.

There appears to be a contradiction here between social workers being afraid of the effects of COVID-19 whilst also claiming not to think about it once they were engaging with children. However, we see these responses as complimentary: Reverting to not thinking about COVID-19 when interacting with children was a strategy for managing the anxiety it caused. This is how we interpret Patricia's reference to 'going into automatic pilot' when home visiting.

What is evident here is how the limits to child protection were informed by the messy difficulties of implementing reflective practice when in the heat of the work. The findings show how during the pandemic social workers could think about some aspects of what they were doing whilst they were doing it, but there were limits to how far practitioners could reflect in action and sometimes chose to. The complex practical and emotional demands of COVID-19 and face-to-face work were so great at times that workers could not think about or allow themselves to feel that complexity whilst they were in it, if they were to be able to focus on service users' needs. Non-reflection and 'forgetting' arose from the self needing to defend the worker from unbearable levels of anxiety ( Ferguson, 2018a). Not reflecting in action was a vital strategy practitioners adopted, to a degree consciously, but more unconsciously, to get them through encounters with service users.

The second way of understanding disoriented frazzled thinking is through the concept of 'liminality'. A home visit involves stepping across a boundary into another world and liminality is an 'in-between' state that evokes a sense of normlessness from moving from one state to another ( Turner, 1969). The doorstep, hallway and porch straddle the threshold between public and private worlds, where they are neither in nor out and for this reason carry danger. Within them, we experience the world differently, not knowing where we stand. It is common for hallways to have mirrors to allow us to glance at ourselves to reorient to who we are ( Rosselin, 1999). Little wonder then that doorstep visits could be so challenging. What Monica described-and embodied-was how lockdowns intensified home visiting as a liminal experience, involving a state of disorientation that could last for the opening minutes of a visit or persist for its entire duration.

When Jeyasingham (2018) shadowed practitioners as they moved around the areas where service users lived, he found social workers often experienced these spaces as 'uncanny'. The uncanny can be the eerie feeling of a place being haunted, whilst for Freud (2003 [1919]) it was 'the jarring sensation that comes when something familiar is encountered in an unexpected context or vice versa'. It makes itself felt 'through a creeping sense of disquiet' ( Jeyasingham, 2018, p. 85). Home visiting was very familiar to these social workers but their experience of it had changed. Due to COVID their work now happened in uncanny spaces with a heightened sense of liminality, greatly increasing the risks of disoriented frazzled thinking that made it very difficult to think clearly and adequately hold children in mind.

Untouchable things and the sense of a lack

It was not just bodies but surfaces and all everyday things that were regarded as potentially contagious and could not be touched. This included pens and paper, which limited communication and:

if you are playing a game, that is not feasible at the moment because of the cross-contamination, like if we pick up the same pieces. So, that is tricky and in terms of our resources we are limited.

Social workers' freedom to move was also restricted. As one social worker put it, pre-COVID-19:

I would be all over: in the kitchen looking in the cupboards and holding stuff, and now we are being told that touch should be very minimal to prevent cross-infection. So, yeah, I find the way we are working now is restricting my practice compared to how I've practiced before. So, [pre-COVID-19] you'd sit by the table or on the floor with the child; you'd be close to them and doing direct work or talking to them, things like that.

How and where to sit so as to maintain physical distance and the role of touch had to be completely rethought. Yet, there were no absolutes. Some workers told us they 'would rather get in there and play and you know drive the cars around and ask them about their toys, like touching every toy', because they knew that play was an important way to enter the child's world.

This sense of a lack pervaded social worker's sensibilities and can also be seen in casework that had been effective. A powerful example is the relationship Sandra developed with the Williams family, who by the start of the pandemic she had known for five months. Three of their children had previously been removed from them into care. The pre-birth assessment for the new baby was positive and when she was born at the start of lockdown she was allowed home. For several months after the birth Sandra spoke to the parents daily, by phone or WhatsApp video. There was also frequent messaging and she visited them in person quite regularly. Elsewhere, we have characterised this practice as a classic form of hybrid digital and in-person social work that emerged during the pandemic ( Ferguson et al., 2022). The worker provided humane care to the parents and developed a relationship with the baby despite not being able to physically hold her. Sandra told us how 'In normal times I would certainly have had a cuddle by now and would try and get her to have a look at me and follow my facial expressions, she does recognise my voice now and mum and dad say she does recognise me. Were it not for the pandemic I'd be a bit more hands on, I'm a natural hugger.'

Wanting a hug emerged from the worker's 'natural' inclination to touch and her preferred 'hands-on' style of relating to children. She adapted to social distancing by attuning to and developing a meaningful relationship with the infant based on non-physical touch: through observation, voice, eye contact and being playful from a distance. Although the child was physically unheld, emotionally and energetically she was held in mind by the worker. By the end of our fieldwork in December 2020 the plan was for social work involvement to soon end.

Sandra had helped the parents to keep their child, yet for her there remained a doubt, a lack, relating to that unfulfilled part of the work where the child was physically unheld.

During lockdowns home visits were generally shorter and social workers saw children on their own, in their bedrooms for instance, much less frequently than pre-pandemic because this would have prolonged the time they spent inside the home and make maintaining distance from children more difficult. When schools were closed due the pandemic, except to vulnerable children, when parents did not send them as often happened seeing children on their own and for long enough was extremely difficult. The hybrid 'little and often' ( Kong et al, 2021) approach that emerged with relatively short in-person encounters sometimes complimented by video calls and messaging could be helpful to some families ( Pink et al, 2022). However, in high risk child protection situations where seeing the children and the family in-person remained the priority, practice generally lacked the immersive quality, the intimacy, that makes it possible to establish how safe children feel and are.

Hostile relationships and the home as a fortress

Whilst many families in our study were grateful for the thoughtful help they received during the pandemic, social workers also visited homes where they were unwelcome. Practitioners suspected some families pretended to have COVID-19 symptoms to stop them visiting. One example was social worker Linda's experience with the Stafford family. The children, aged nine and eleven years, were being home schooled and by August 2020 had not been seen by the social worker for five months, since the start of the pandemic. Refusing to let social workers in was not new, but COVID-19 lent it a new impetus. Linda finally persuaded the family to come to the office in October 2020, when she said: 'They wouldn't even sit down. Mother was very angry, she had the frown, I could only see part of her eyes, the glare felt much more intense over the mask.' The concern was about 'emotional harm by mum ... Even now we don't know what these children's lived experience is.' This was the kind of 'hostile relationship' that involves huge challenges ( Ferguson et al., 2021) to which COVID-19 added another layer of difficulty. There was not enough evidence to remove the children, for whom the limitations of child protection ran deep.

Disconnection and disorientation: The use of face masks

Another powerful narrative about the effects of COVID-19 was how mask-wearing caused 'disconnection' and 'disorientation'.

I hate wearing the mask, it's horrible, I feel frustrated and flustered in it, it does impact on my concentration, you get hot even if not wearing full PPE ... you want children to see your expressions. When sitting at a table or living room and facing down at work they are doing, they sometimes look up and catch your facial expression. ... I feel disconnected.

This could lead social workers to rush the work. As one exemplified it: 'With the mask I almost want to get the visit over and done with, when you take it off the visit feels much better. I feel disoriented, don't remember things as well. ... At times I get used to it but I usually feel more disconnected.' Some creativity was used to get around these barriers: 'I went to see a baby the other day and I was really trying to smile at him with my eyes.' However, mask wearing not only interrupted the normal 'facework' that goes on, it could affect workers' minds by causing flustered thinking, reduced concentration and bodily self-alienation in the form of agitated overheated bodies-disruptions that imposed yet more limits on child protection.

Working in isolation

Social workers consistently reported that many early help, health and therapeutic services either shifted online or were withdrawn. Whilst professional networks continued to meet online at case conferences and schools provided some in-person or doorstep support and the police visited in emergencies, during the first lockdown social workers were often the sole agency going into homes. Most health visitors were redeployed onto COVID-19 hospital wards and just one in ten parents of children in the UK aged under two years saw a health visitor face-to-face during the first lockdown ( Saunders and Hogg, 2021). This compounded how babies and pre-school children were unheld, increasing the danger of at-risk children being missed, whilst similar risks existed for older children whose parents did not send them to school, closing off a vital space where children could be seen alone. The capacity of social work teams to meet these higher demands was affected by episodes of staff sickness and self isolating due to COVID-19, larger workloads and at some of our sites increases in time-consuming court work due to more children being taken into care.

Working in isolation was exacerbated by working from home. In normal times the office and the team are a secure base within which workers can offload anxiety and difficult feelings ( Cook et al., 2020), but this could no longer happen in person during lockdowns. One social worker characterised this as 'missing the niceness of being around friendly faces that know what the work is like if you are doing something unpleasant. [With COVID-19] you hold on to more.' Some social workers spoke of a reluctance by managers to openly discuss workers' emotional and visceral experiences. Instead at some of our research sites managers anxiously insisted on extensive case recording in anticipation of inspection by the regulatory body Ofsted, even though inspections were suspended during the early pandemic phases. Front line workers felt the extra stress this caused during a global pandemic was deeply unfair. Whilst managers feared the shame that comes from a failed Ofsted inspection, such insistence on bureaucratic tasks involves the imposition of what Menzies Lyth (1988, p. 50) called 'ritual task performance' that occurs when anxiety becomes 'intense and unmanageable' and attention is displaced on to what can be controlled. Feelings were avoided for psychological, unconscious and defensive reasons arising from the need for not just individuals but organisations to defend themselves against anxiety and unbearable feelings ( Whittaker, 2011). At a time when workers' need for emotional support, containment and help to understand how they were thinking-or not thinking-and relating to children and families was never greater, the opportunities for them receiving it had literally never been so remote.

Discussion

The range of influences we have drawn out from our data shaped the dynamics of closeness and distance in child protection work during the pandemic. We are not claiming to have provided an explanation for how it was that children such as Arthur Labinjo-Hughes and Star Hobson died at that time despite social work involvement. At the time of writing, the circumstances surrounding attempts to protect them are largely unknown and are the subject of case reviews. What we are arguing is that the influences on the dynamics of closeness and distance we have identified provide the context within which the work was done and that must be taken into account in any evaluation of what it was possible for social workers to do and not do in keeping children safe during COVID-19. A strength of our methodology and analysis is that it captures how social work was done and experienced in real time, thus avoiding the pitfalls of hindsight.

Influences on closeness and distance manifested in different ways, either singularly or in combinations. The more of these influences were present and the more potent the interplay between them, the greater the potential limits were to effective child protection. So, in situations where social workers defended the self by suspending reflection in action and their thinking was frazzled, they avoided closeness and touching children, toys and other surfaces, they became rushed and sweaty due to facemasks and uncomfortable in and alienated from their own body, where home visiting was a disorientating, liminal experience, families were hostile to involvement, other things happened that 'threw off the visit' and there was limited organisational support to enable them to process their visceral and emotional experience and think clearly, the more likely it is that children could not be protected. Many children were left unheld, who in pre-pandemic times would not and should not have been. This does not mean that social distancing rules meant that touch was not used by social workers, but that it was engaged selectively, mostly when children initiated it. Babies and infants who are unable to walk over to and initiate contact with adults were at particular risk of missing out. Detached, disconnected practice was not the preferred approach of the social workers, who ached to get close to children and often took significant personal risks in doing so. As Green (2017) shows, the meaning and use of touch in social work is not fixed or static. The pandemic has created an intensified awareness of the centrality of touch and physical nurture to social work practice, for intimate child protection practice, and this learning must be taken forward. This needs to go hand-in-hand with a deep understanding of the sensuous nature of the body and its role in practice ( Kong et al., 2021).

To say some children were left unheld does not mean casework was never effective, that children were not kept safe, or families not helped. Many were and key to this was how the dynamics of distancing were minimised and the dynamics of closeness stretched to the limits resulting in relationships where children, whilst not proactively held physically, were held in mind through psychological holding and energetic attunement. This closeness-from-a-distance was achieved when social workers improvised in highly creative ways. Yet, fears from the virus and social distancing imposed limits to child protection that no amount of innovative practice could overcome in all cases, creating gaps that children could fall through, with-we now know-at worst tragic consequences.

Conclusion

Some limitations to the research must be noted. The most rigorous way to find out how practitioners relate to service users is to use an ethnographic approach to observe these encounters. Participants are not always fully aware of what they did and did not do and their interview narratives may struggle to convey the nuances of what occurred and how it felt ( Ferguson, 2016; Forrester et al., 2008). However, COVID-19 risks prevented us from getting physically close to practice. Our sample of four local authorities may also mean there were experiences in other places that our study missed. However, our frequent in-depth interviewing of participants over the nine month period meant that we did manage to get as close as it is possible to be to social workers' lived experiences without being there. This has enabled us to show that whilst child protection has always been complex, COVID-19 made it much more so.

The pandemic provides very important learning about the risks and complexities of child protection practice and new opportunities to conceptualise it, that we have taken here in terms of embodied practice. As O'Sullivan (2019) shows, keeping children safe requires that the embodied experiences and emotional and physical well-being of frontline workers, managers and leaders receives careful analytical attention in supervision and organisational support. Child protection whilst social distancing raises complex practical and moral issues and dilemmas. Children need protection. Vulnerable parents need support. And children's social care workers have the right to physical safety for themselves and their loved ones. Social workers need to know that when they cannot get as close to children and families in their practice as they normally would, that employers, politicians, policy makers and the public recognise their hard work, courage and skill, their achievements and the high risks they take and fully understand and accept the realistic limits to child protection during a global pandemic.

Acknowledgements

We are deeply grateful to the local authorities, managers, social workers, family support workers and families who allowed us to research their experiences; to the two anonymous reviewers for their very helpful feedback and to the journal editors Rea Ana Maglajlic and Vasilios Ioakimidis for their support.

Funding

The research this article is based on was funded by the Economic and Social Research Council, Grant Number [ES/V003798/1].

Conflict of interest statement. None declared.

References

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

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Unheld Child: Social Work, Social Distancing and the Possibilities and Limits to Child Protection during the COVID-19 Pandemic

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The COVID-19 pandemic changed dramatically the ways social workers engaged with children and families. This article presents findings from our research into the effects of COVID-19 on social work and child protection in England during the first nine months of the pandemic.

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David’s Harp: Bringing Healing Through Music

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David’s Harp: Bringing Healing Through Music

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Social workers who love incorporating music into their work might consider additional training in music therapy or therapeutic music. But even those not interested in such practices themselves might consider incorporating the services of such

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Social Workers' Sensual Bodies during COVID-19: The Suspended, Displaced and Reconstituted Body in Social Work Practice

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Abstract

After more than a year living with COVID-19 restrictions, the UK Governments have now published their 'recovery strategies' in which social care has been considered as key to plans for post-COVID-19 recovery in England and the devolved nations. Emerging literature has already explored the ethical and practical challenges facing social workers during COVID-19 and how social work practice has been re-created to embrace hybrid ways of working. To add to this discussion, a secondary qualitative data analysis was performed on a subset of data (280 responses submitted by 176 social workers) collected from the British Association of Social Workers' (BASW) survey on social work during COVID-19, to explore how social workers' sensual bodies had been responding to challenges arising from the pandemic. Drawing on sociology of senses and social work literature on tacit knowing and practice wisdom, we will present how social workers' sensual bodies have been suspended, displaced and re-constituted during the first UK national lockdown, leading to sensual compensation and sensual overload that impacted on social workers' practice. In striving towards a 'better normal', we offer key insights to implement hybrid social work practice and protect against the shortfalls that it might bring to the profession.

Keywords: COVID-19, digital practice, qualitative secondary data analysis, sensual body, social work

Introduction

At the time of writing this article (June 2021), the 'COVID-19 recovery strategy' had been published by the UK Government ( Cabinet Office, 2021). With the gradual roll-out of COVID-19 vaccinations in the UK, the number and rate of hospitalisations due to COVID-19 have reduced significantly despite the pervasiveness of the Delta variant. This turn of events provided some space for reflecting on the impact of COVID-19 including the restrictions for deterring its spread. The toll on the physical, social, psychological and economic wellbeing of people was evident, most notably 'women, migrants, forcibly displaced people, indigenous peoples, people with disabilities, marginalised communities, young people, workers in the informal economy and those with precarious employment contracts' who were disproportionately affected by the pandemic (UNTFSSE, 2020, p. 3). COVID-19 exposed the existing social inequalities and fragilities in our society which made each of us less resilient to the public health crisis and called the stability of our future into question. The United Nations Task Force of Social and Solidarity Economy (2020) posed a question to the world-do we want a new normal (back to where we were) or a better normal? This is also the question that social workers in the UK have asked during the pandemic ( Kong et al., 2021a).

Social workers were named as key workers at the beginning of the pandemic in the UK and in other countries ( IFSW, 2020), and remain pivotal to the post-COVID-19 recovery/transformation. In September 2020, Social Care Institute for Excellence (SCIE) published Beyond COVID: New thinking on the future of adult social care, suggesting three shifts to: (1) ensure respective Governments' long-term and sustainable investment in the sector; (2) enable the commissioning of preventive and community-based services and (3) empower social care workers through reasonable pay and recognition. The Department of Health and Social Care released a consultation, COVID-19: Our action plan for adult social care ( Department of Health and Social Care, 2021) which looked to improve the Personal Protective Equipment (PPE) provision to social workers, workforce stabilisation and the development of end-of-life care in England. These responses are partly reactive to the widening service gap (increase demand in social services and the decreased formal and informal services and care capacities) during the pandemic, but can also be considered as overdue acknowledgement of the impact that ongoing austerity measures have brought, specifically to the most vulnerable members of society.

Amidst this crisis, we started a collaborative project, 'Empowering Social Work during COVID-19' (funded by ESRC IAA and BASW), to bring social workers and academic researchers together to co-produce and consolidate the best practice available to social workers. The full report is available here. This paper is produced from the same project to examine how social workers sensual bodies changed as they coped with the challenges presented by COVID-19. Informed by sociology of senses, this paper examines social workers' experiences during COVID-19 as embodied and linked to gut feelings and body sensations that are sometimes 'sensible' and sometimes 'sensual'.

Social work during COVID-19

Throughout the first national lockdown, UK social workers continuously experienced a lack of PPE, unclear/contradictory guidance and inadequate supervision ( Banks et al., 2020; Kong et al., 2021). Many social workers voiced the increased health risks to themselves, their families and service users as a result ( Kong et al., 2021), and reported increased psychological distress. In the UK, 75 per cent of social workers reported feeling more negative about their work-life balance due to COVID-19 ( Community Care, 2020). Here, 69 per cent said their mental health was slightly (43 per cent) or significantly (27 per cent) worse than it was 1 year prior to December 2020 (Ibid). Greene et al. (2021) also found that, amidst COVID-19, over 57 per cent of health and social care practitioners reached the threshold for PTSD, anxiety and/or depression. Compassion fatigue, a sub-category of burnout, has been identified as a risk factor for the mental health of social workers, with practitioners supporting people in distress considered at increased risk ( Grant and Kinman, 2020).

Shifting to remote working, such as online meetings and telephone calls appeared to be a temporary compromise at the beginning of the pandemic. For example, in May 2020, NHS England issued legal guidance for medical practitioners and Approved Mental Health Professionals (AMHPs), of which 95 per cent are social workers, permitting digital assessments under the 1983 Mental Health Act. Given the clear departure from 'best practice', Devon Partnerships Trust sought clarification on the meaning of 'personally examined' in the case of the medics, and 'personally seen' in relation to the statutory duties of the AMHP. The High Court ruled that both phrases required the physical presence of each professional, citing one of six considerations in the decision that psychiatric assessments may involve a multi-sensory assessment ( Devon Partnership NHS Trust v Secretary of State for Health and Social Care, 2021. Despite this ruling, in many other areas of practice, digital working has largely been integrated into mainstream social work ( Ferguson et al., 2021b).

Social workers, especially in developed economies, have been able to embed technologies, digital skills, socially distanced practices and digital ethics in their everyday work life ( IFSW, 2020). Thus far, doing social work digitally by default has received mixed reviews. Social workers have expressed concern about missing non-verbal cues critical for identifying safeguarding issues; with the effectiveness of digital practice called into question for working with individuals who have severe mental health problems, learning disabilities, other health issues and communication needs ( Kong et al., 2021). Whereas some evidence has shown that digital practice can support more active engagement with young people ( Ferguson et al., 2021a). Cook et al. (2020) identified further benefits of remote working, including increased informal support with colleagues and reduced travel time which made practitioners feel more energised and supported as a result. Pink et al. (2021) acknowledged the positives of digital social work when employed as a 'hybrid, anticipatory and flexible practice' to bridge the digital and physical elements of child protection. This emerging body of evidence shows the dynamic and evolving nature of hybrid practice during COVID-19, and the need for contextualised appraisal of the utility of such practices.

COVID-19 presented unique ethical challenges to social work practice. Banks et al. (2020) conducted an international study to explore the ethical dilemmas that social workers had experienced during COVID-19 and raised concerns about digital assessments placing more risks to both the service user and social worker especially where safeguarding issues were present. The fusion of digital and socially distanced face-to-face practice still has the potential of compromising confidentiality, practitioners' health and wellbeing and professional boundaries ( BASW and SCIE, 2020). Banks et al. (2020) argued that the ethical dilemmas stem from the conflicting rights, needs and risks of service users and their families as well as the need for weighing up individual rights and public safety. The pandemic has also urged social workers to re-consider their ethical duties to social justice in terms of addressing social inequalities highlighted and exacerbated by the pandemic ( Garcia et al., 2021).

Up until now, with a few exceptions ( Ferguson et al., 2021a; Green, 2021; Green and Moran, 2021; Pink et al., 2020; van Rhyn et al., 2021), little research has focused on social workers' ways of seeing, hearing/listening, smelling, touching and moving into/out of/across practices and how these have been altered through the pandemic. Even less has been said about how social workers re-appropriated their body and re-configured their practice to ascertain social connections, empathy and social justice which are conducive to doing 'proper social work'.

Social workers' body in professional practice and research

The importance of the sensual body in social work practice is undeniable but debased. We have always known that social workers walk into people's homes, refuges, hostels and other health and care settings to make sense of how people live in their 'natural environment'. It involves social workers observing, smelling, touching, hearing and possibly even tasting the situation whilst making sense of these sensations through a professional lens. However, the 'body' of social workers remains largely absent in social work practice and research ( Mensinga and Pyles, 2021). When body is rediscovered, the focus is usually on professional burnout, fatigue, wellbeing and resilience ( McFadden, 2015; McFadden et al., 2015) or tacit knowledge and practice wisdom ( Imre, 1985; Fook, 2002; Martinez-Brawley and Zorita, 2007; Reinders, 2010).

Social workers' experience of an exhausted body is found to be linked to heavy caseloads, long working hours, low wages and ethical predicaments ( McFadden et al., 2015; Peinado and Anderson, 2020). As Mensinga and Pyles (2021) argued, the persistent concerns over social workers' wellbeing and burnout are proof of the violence against, and the marginalisation of, social workers' body in practice. In the study of social workers' burnout, fatigue, ill-being and need for resilience, there is a predominant focus on social workers' body as an atomised biomedical body that is self-sufficient, independent and able to recover through sufficient self-care. Rather than attributing the neglected and exhausted body of social workers to the prevailing instrumental rationality, reinforced through years of austerity and neo-liberalisation of welfare ( King et al., 2021), the emphasis on 'self-care practices' and 'personal resilience' further individualises social workers' bodily and mental experience.

The bio-medical body of social workers continued to gain attention during COVID-19 as medical science became the championed knowledge for navigating and managing the new health risks that the novel coronavirus brought to society. Social workers quickly developed strategies to reduce infection and increase protection of their health and others'. This included remote working, forming of staff bubbles, socially distanced walking and digital practice. Whilst these reactive practical strategies are forming and settling as the new normal, the less talked about issue is how these measures might have created different experiences for social workers' sensual body when practising. Green and Moran (2021) discussed how 'touch' is reconfigured through COVID-19 and the varying social distancing responses. 'Natural touch' and 'good touch' that brought comfort to the dying person and their family or to those who have fled the home where domestic violence occurred was reconstructed as 'contagious touch' or 'bad touch' during the pandemic. This echoes with social workers' worries, expressed at the beginning of the pandemic, about how social disconnection might turn into them delivering 'anti-social social work' ( Banks et al., 2020, p. 3). As the scientific advice on how to 'socially distance' varied, social workers' best and proper way to 'touch' people's lives also changed.

Alternative to the biomedical body is the sensual body which mediates sense-making of the world through sensing in the personal, interpersonal, social, cultural, historical and political contexts ( Green and Moran, 2021). The sensual body is therefore strongly linked to social work professional learning ( Imre, 1985; Fook, 2002; Reinders, 2010). Roberta Imre (1985) applied Polanyi's concept of 'in-dwelling' to link social workers' body to professional learning: 'It [social work knowledge] must be learned by doing, by discovering how to call forth the necessary processes from one's body' (p. 140). Irme emphasised the importance of understanding the very nature of how social workers produce knowledge beyond a focus on practice outcome-how their learning as well as their passion and imagination for understanding people (users, other professionals and researchers) are shaped by their experiences and interactions with others ( Fook, 2002; Reinders, 2010).

Social workers' sensual body is also central to the literature of 'practice wisdom' and 'professional intuition' ( Goldstein, 1990; Scott, 1990; Klein and Bloom, 1995; O'Sullivan, 2005; Martinez-Brawley and Zorita, 2007; Chu and Tsui, 2008; Cheung, 2016). These sets of literature commonly perceive social workers' sensual body to be key to professional development, with tacit knowledge more concerned about learning through doing (bodily experience), and practice wisdom and professional intuition focusing more on the practical utility (effectiveness in professional problem solving) of such knowledge. O'Sullivan (2005) made a distinction of the two by arguing that experienced social workers (with a lot of tacit knowledge) might not necessarily have a lot of practice wisdom, depending on their attitudes towards knowledge and ability to reflect.

Drawing on sociology of senses ( Vannini et al., 2012, p. 19), we frame social work as somatic work which 'refers to the range of linguistic and alinguistic reflexive experiences and activities by which individuals interpret create, extinguish, maintain, interrupt, and/or communicate somatic sensations that are congruent with personal, interpersonal, and/or cultural notions of moral, aesthetic, and/or logical desirability'. This analytical focus aligns with the sensory turn in social work research ( Morriss, 2017) and supports the examination of how social workers (re)build relationships with colleagues and service users during COVID-19 through sharing common (lack of) sensations and tacit experiences. For example, the absence of chit-chats and coffee mornings in the office space, socially distanced interactions with colleagues and service users and the inability to physically enter and move around the homes/care settings of service users. These relationships (re)developed through COVID-19 also serve as a site for 'shar(ing) common ways of using their senses and making sense of (and expressing) sensations' ( Vannini et al., 2012, p. 7). Joining the sensory turn in social work practice research, we place the bodily and sensual experiences of social workers at the centre to explore the making of social workers' body through COVID-19.

Methodology

Secondary qualitative data analysis of the BASW survey

In July 2020, Durham University and BASW started the project Empowering Social Workers in Challenging Times: Learning from Best Practice during COVID-19. It aimed to involve both practitioner researchers and academic researchers collaboratively in research activities to inform social work learning, improve practice, create desirable social change and promote social justice. The project set up the first BASW UK Social Work Practitioner Research Network in August 2020, through which social work practitioners and academics co-analysed data collected by the BASW Survey on Social Work during COVID-19 (the BASW Survey hereafter). Secondary data analysis (SDA) of qualitative data was employed to explore UK social workers' experiences and best practice during COVID-19. This approach has been used to study a range of topics, including healthcare, crime and deviance, childhood poverty and gender and masculinities (see the articles reviewed by Ruggiano and Perry (2019)) although it is still less popular than SDA of quantitative data. The collaborative analysis carried out by the Network has led to the publication of a full report, a practice toolkit and a professional magazine article. This paper is based on the analysis of a subset of data created to capture the bodily experiences reported by social workers during COVID-19.

The BASW survey, data processing and data analysis

The BASW Survey was launched on 16 March 2020 to collect professional experiences and views from the social work community. The survey collected 2,222 UK responses from different sectors of social services (i.e. adult services, children and families, mental health, criminal justice and other) and from different nations in the UK by the end of August 2020. The survey consisted of mostly open questions that collected qualitative data on the work experiences and views of social workers during the pandemic.

To deepen the understanding of social workers' body experiences during COVID-19, a subset of data, consisting of responses from 176 social workers, was created on NVivo2020 (see Table 1 for details). The authors devised search strategies to maximise the number of relevant data entries by individually searching the following words across the full dataset: bod* ( n = 44), face-to-face ( n = 585), hear ( n = 141), listen ( n = 60), sens* ( n = 92), smell* ( n = 6), speak* ( n = 106), talk ( n = 83), touch ( n = 78), visit* ( n = 1972) and walk* ( n = 20). Tast* and bubble* returned no results. Query results ( N = 280) were then individually assessed for relevance to the topic area and coded into 'disruption of senses' ( n = 102), 're-orientation of senses' ( n = 62), 'implications of disruptions' ( n = 52), 'impact on professional practice' ( n = 45), 'captured signs' ( n = 7) and 'missing signs' ( n = 12). Each of these codes were then further analysed by the authors.

Table 1.

Field of social work

Number of respondents (n = 176)

Children and families

78

Adult services

69

Mental health

20

Criminal justice

3

Multi-disciplinary

2

Social work student

2

Social work education

2

Primary role

Number of respondents ( n = 176)

Experienced social worker

100

Student social worker

18

Newly qualified social worker

17

Independent social worker

12

Manager

11

Other

9

Social work supervisor

8

Academic

1

Interpretive content analysis ( Drisko and Maschi, 2015) was performed to enable the authors, who were trained as social workers and have been collaborating with practising social workers in the ESRC IAA-funded project, to infer how the bodily experiences of social workers in the UK changed during COVID-19. Given the brief nature of the qualitative responses in the BASW Survey, their interpretation beyond the literal level was needed to enable an understanding of the how chaos, ethical challenges and professional transitions were experienced and mediated through the changing bodies of social workers and its wider impact on the profession. The brevity of the responses also puts restriction on making sense of the processes and contexts in which social workers acquire, reflect on and alter their body skills to realise their professional goals and values during COVID-19.

This study adopts an abductive approach to data analysis which intends to facilitate the development of new conceptual insights through continuous dialogue between existing theory with new research evidence ( Timmermans and Tavory, 2012). It was maintained by constantly comparing in vivo codes (bottom-up coding) with concepts borrowed from the sociology of senses and social work literature on tacit knowledge and practice wisdom as laid out at the beginning of the paper. This approach also shapes the writing style of the analysis which, differing from conventional reporting of results, incorporates concepts/theories that have informed the interpretation of data to increase accessibility to the abductive process.

Ethics

This study conforms to internationally accepted ethical guidelines and has been granted ethical approval by Durham University's departmental ethical review board before the project commenced (SOC-2020-06-15T14_47_46-plmb53). Participants' consent to participate in the survey was implicit to the completion of the survey itself. The transfer of dataset from BASW to Durham University presented no risk to individuals as no identifiable information had been collected. The transferring of the anonymised dataset conformed with both GDPR and their code of practice for data protection standards.

The changing sensual body of social workers during Covid-19

Social workers in the UK experienced three different phases during the first national lockdown (March 2020-August 2020) ( Kong et al., 2021). Commencing with chaotic change (March 2020), social workers then re-established new ways to continue practising professionally and ethically (April-May 2020). The creative practices consolidated through the rest of the year (June 2020 onwards) then served as the foundations for social workers to engage critically with the emerging 'new normal', characterised by a digital-by-default approach and a degree of social disconnection in professional practice. To understand the chaos, uncertainty and anxiety experienced by social workers we must first establish how practitioners' sensual body was suspended, displaced and re-constituted during the pandemic.

Suspended sensual body: the disrupted professional sensing and use of sensations

Social distancing as a measure to prevent/slow down the spread of the novel coronavirus abruptly suspended social workers' senses in their everyday work. Face-to-face conversations, home visits, supervised parental contacts deemed 'natural' to social workers suddenly compromised professional practice and became potentially dangerous. Social workers were caught in a constant ethical dilemma that lacking sensual engagement might risk missing 'cues' in assessment or resuming the usual sensual engagement might risk spreading the virus to vulnerable individuals and families, including their own. Williamson et al. (2020, p. 317) suggest that social workers may feel the 'profound effects of being required to perform already highly challenging duties in a more constrained manner' with the likelihood that many will experience a degree of moral distress ( Jameton, 1984) or moral injury ( Fenton and Kelly, 2017).

The non-verbal cues may include how an older adult or a person with disabilities eats, walks, showers and socialises in their own living environment, or how children relate to their parents or foster parents in their living space and how they address conflict in the family setting. Obtaining these 'cues' requires social workers to immerse their bodies in the environment and interactions where social workers/service users identify as being potentially problematic and to move around in the physical and social spaces to 'sense' how users 'feel about their situation'.

I need to assess with all my senses. I need a visual inspection of the fridge, bathroom, kitchen, where the bed is, whatever the bed is, what, sadly, is in the dustbins, what bills are unpaid, what the landlord has said, what substances are being used by whom and who is looking after the animals ... it is frustrating to be unable to properly assess, and nothing beats a proper home visit.

(Experienced social worker, Adult services).

Experiences of social workers performing home visits have demonstrated the importance of sensual body in social work assessment. Moving around and turning the gaze, as one hears, smells and touches anything that suggests the need for further attention, are integrated sensual experiences of social workers that enable fuller understanding of the service users' situation. Nonverbal communication or sensory language is understood to support social workers to overcome cultural or language diversity ( Nguyen and Larson, 2015) and enhance embodied knowing ( Sodhi and Cohen, 2012) and empathy ( Walter and Shenaar-Golan, 2020). The ability to interpret intonation, body language, timing in speech and interactions as well as the smell of the living environment is compromised, if not undermined, in remote working.

COVID-19, especially at the beginning of the national lockdown, created huge disruptions to home visits and suspended social workers' sensual body from the situations in which the service users lived. Social workers, at times, felt that they were not 'in touch' with the feelings and situations of their service users; and worse still were required to suspend and forbid human touch in their intervention. For example, suspending family visits to nursing homes whilst considered vital to preventing the virus spread was also dehumanising and demoralising to social workers, service users, their relatives and carers.

A lady's husband went to hospital, and she was unable to visit for 8 weeks and then was told he was being transferred to a nursing home for end-of-life care. She saw him once before he died and received poor treatment from the nursing home. I was unable to change any of this.

(Experienced social worker, Adult services).

Green (2021) argued that many types of 'good touch' are now considered as 'dangerous' and 'contagious' touch since the pandemic. Even when a person has come to the end of their life, the co-presence of their loved ones' bodies had to be avoided at all costs for public interests. Social workers' survey responses questioned if they were really doing 'proper social work' if they could not honour service users' rights to family lives and realise compassionate care in their practice. Rather than seeing the sensual body as a site for making sense of service users' situation, COVID-19 re-framed social workers' body as a source of illness.

We are currently staying away from the door on visits until the family have confirmed they are well and not symptomatic, we will then enter the home and wash our hands, we will then wash our hands before we leave ... We are encouraged to wash our clothes when we get home and I am antibacterial cleaning my steering wheel, gear stick and car door handles after visits.

(Student social worker, Children and families services).

The anxiety induced by this way of moving around in users' living space developed a new sensual process encoded in social workers' body during home visits. As the sensual body of social workers was suspended or restricted in practice during COVID-19, social workers were forced to concentrate their sensual focus into those senses that were available in remote practices.

Displaced sensual body: One body in many worlds

Reduced face-to-face contact during COVID-19 did not reduce the demand on social workers' sensual body in professional practice. Social workers' sensual body was displaced from the work environment of home visits and offices, and relocated to their own home and digital workspaces, which affected how social workers could sense and make sense of service users' needs.

My listening skills have been greatly enhanced and I cannot stress enough just how important active listening is at this time as we can rarely add body language, vibes, intuition or environment into the equation right now therefore every single word, answer, context and reaction is so valuable in providing support and comfort and for making decisions.

(Newly qualified social worker, Adult services).

Social workers were more likely to compensate for their restricted senses through increased reliance on their residual senses, which were majorly visual images, speech and hearing. Social workers talked about reading and listening between the lines and taking every single word seriously to help their assessment. This heightened use of listening for assessment and intervention can be considered as a form of sensual compensation. It required a lot more concentration from social workers which then made it very challenging for those with caring responsibilities at home.

The displaced sensual body also created situations of 'sensual overload' when social workers had to simultaneously deal with multiple realities that required very different ways of sensing, use of sensations and bodily responses. For example, social workers with caring responsibilities at home often talked about how they were torn by the multiple realities for working remotely on a phone/computer with children in the background. As seen below, the presence of practitioner's own children demanded a level of alertness and sensual focus, regardless of whether social workers chose to disclose their child's presence to the service user.

Be honest! I have a young child in the background and when making calls to families it is vital they know this .... On one call he lost a tooth, unexpectedly and panicked and screamed. I had to explain to the service user that I would need to call back once I had settled him.

(Student social worker, Children and families services).

Whilst navigating the digital workspace with limited senses, social workers' physical body was simultaneously immersed in the home environment. This required them to hear and watch out for potential dangers to their own children, placing many under more pressure and risking physical and mental exhaustion. The bodies of social workers were even more exhausted when faced with the realities of overworking, lacking protection, widening social inequalities and dwindling community resources during COVID-19, which contributed to the outcry from social workers for more government and management support ( BASW, 2021). Our data also showed that peer support was key to maintaining the morale of social workers, enabling sharing of good practice and 'bouncing ideas or queries off' colleagues ( Kong et al., 2021a, 2021b).

When you have difficult cases/phone calls etc your colleagues aren't around you in an office to speak to about it and get those emotions out. You end up internalising it when you work at home for a long period of time.

(Experienced social worker, Adult services).

When social workers were working from home, instant exchange of information or offloading of emotions became more difficult. Whilst social workers used phone calls, peer support WhatsApp groups and regular catch-up online meetings to enable communication of emotions with colleagues, the quality of these exchanges were not replicable to real life. The embodied and social nature of emotions means that emotions are not readily articulable ( Prinz, 2004) nor immediately understandable without someone participating in noticing, responding to and interpreting the bodily changes that indicate those feelings ( Turner and Stets, 2005). Practitioners appeared unable therefore, to achieve their desired level of emotional engagement with colleagues. The idea of 'internalising' the work emotion also tells us how social workers' bodies, after being exposed to multiple sets of sensual demands, could not easily shift back to sensing the home interactions and environment even when they were 'off work'.

The reconstituted sensual body for social connection, empathy and social justice?

The body is the site for the making of the social and the cultural. Through touch, movement, smell, voice, sight, the feeling of balance and its engagement with space, time and artefacts, human beings communicate and build connections with each other ( Finnegan, 2005). When social workers are given less sensual and bodily resources for building and maintaining social connections with their service users and carers, because of restrictions on face-to-face contact, they have to alter their way of sensing and utilising sensual engagements at work. Changing their intonation and the way they used their voice, appearing (digitally) more often in users' life and walking outdoors with service users rather than walking into their life became social workers' new sensual strategies for communicating care and empathy in the times of 'social distancing'. An experienced mental health social worker shared how they and the service user both felt 'more relaxed' walking in a park, and how the informal environment enabled them to use their 'instincts' to encourage sharing of key thoughts and engage service users as 'a person'.

Social workers also employed digital technologies to develop a 'little and often' approach to keep in touch with families and understand their everyday lives (Cook and Zschomler, 2020) and support digital intimacy ( Pink et al., 2021). For a children and families practitioner, this could mean 'seeing families more and talking more with them', but the impact of this way of working on the social workers' sensual body remains over-looked. The pandemic, at some level, brought new sensual and cognitive experiences to social workers. These new experiences enabled them to empathise with the sense of isolation experienced by their colleagues, service users and carers because of ill health, various forms of disabilities and poverty. Yet social disconnection also, paradoxically, created barriers for them to empathise and to feel empathised.

I feel we cannot always trust service user's family when they provide information because they often have their own agenda.

(Experienced social worker, Adults services).

Some social workers questioned the legitimacy of service users' realities whilst others were left feeling as though contact from their manager 'was lacking any compassion/empathy or support'. Practitioners also talked about how digital/remote practice made them physically inactive and strained from working long hours in front of the computer screen. To compensate for the physical tolls, a student children and families social worker felt compelled to complete 'a 15-30 minute workout to get the blood flowing around the body..to stay as fit as possible'.

Understanding how social workers' bodies have reconstituted through COVID-19 is also an issue of social justice. Whilst committed to anti-oppressive practice, adjusting to the new remote practices saw instances of individuals and institutions being less sensitive to the power issues embedded in the new ways of working. For example, for social workers with a hearing impairment, lip reading became very challenging online (especially with an unstable internet connection) and literally impossible when service users had their masks on.

I am hearing impaired. The prolific but necessary use of masks means I can no longer lip read and am struggling to understand people.

(Independent social worker, Adult mental health services).

Kong et al. (2021) also found that the new threshold for face-to-face visits developed during the pandemic risked undermining some families' chance to face-to-face engagement with social workers if they were not considered as being at 'crisis point'. The pandemic forced social workers to develop new body skills to practice without touching, meeting people and home visiting unless it is 'absolutely necessary'. The new threshold for face-to-face visits as well as the disappearance of early help during the pandemic caused worries amongst social workers, especially on whether they are implicitly endorsing a risk-avoiding approach versus a positive risk-taking approach to safeguarding work.

It makes me uncomfortable as a social worker as I feel powerless and can literally see the people I work with facing crisis situations in the next few weeks. Where is the early intervention, being creative and social justice, we advocate for? I feel like I have been living a lie... this goes against social work values.

(Experienced social worker, Adult services).

Therefore, social workers' new bodily habits of remote working must be examined to identify who is at risk of exclusion and marginalisation ( Smoyer et al., 2021); and to unpack the politics and power structure that underpin these emerging practices.

Discussion

This paper focuses on the changing sensual body of social workers in understanding social workers' experiences during COVID-19. It demonstrates that transitioning from the old normal to new normal is an embodied process. To enable the development of a 'better normal' for our future, rather than settling for whatever has come along, we must offer a critical reflection on whether the newly established and embodied practices are necessarily 'better'. For example, to what extent can(not) remote working be more useful for building social connections, fostering empathy and promoting social justice and whether social workers sense differently when infrequent home visits are combined with the 'little and often' approach using digital technologies. Pink et al. (2021) argued that creative use of technologies enabled social workers to develop digital intimacy with service users through more frequent contacts and informal exchanges. They further suggested that, looking into the future, we should seek an anticipatory approach to hybrid practice. Understanding the changing sensual body of social workers through COVID-19 offered insights into how social workers' bodies engaged with hybrid practice and were torn by sometimes incompatible and even competing sensual demands when working from home and how the 'little and often' approach might cause physical exhaustion which requires stricter body management to allow time for regular exercise in order to compensate the physical toll that digital practice might cause on social workers.

Although this paper is based on the data collected during the first UK national lockdown, when social workers were arguably still coping with the initial shock brought by the pandemic, the restrictions and demands that digital practice might have posed on social workers' sensual bodies are still relevant to future hybrid social work practices. In considering how to embed digital practices to enable the understanding of service users' everyday life beyond a snapshot approach ( Ferguson, 2006), we must contextualise the previously documented success of the 'little and often' approach ( Ferguson et al., 2021a) in social workers' efforts in managing increased and competing sensual demands. Added to that is the relaxed bureaucracy ( Ferguson et al., 2021b) that many social workers considered as a key condition for creativity and innovation in gauging their hybrid practice. As we move towards a 'hybrid digital social work' ( Pink et al., 2021) approach in the post-COVID-19 times, our paper emphasises that digital social work can be together sensually enabling, demanding and restricting.

This paper has also contributed to the discussion of tacit knowledge and practice wisdom as well as their distinction in the context of COVID-19. As social workers embodied new digital literacy and competency to control and adapt to the professional and personal risks associated with the pandemic, they also embodied the power relations and ideologies that shape and organise these digital and hybrid practices. Examining how social workers' body was re-constituted through COVID-19 offered unique opportunities to explore how little attention we have paid to disabled social workers' experiences in adapting to the pandemic, the continuous marginalisation of social workers' body and physical health when working remotely ( Kong et al., 2021b), and the normalisation of a risk-based approach, rather than a needs-based approach, in responding to families' needs. We argue that critical reflection on how social workers learned through sensing in the pandemic is a crucial step for transforming tacit knowledge into practice wisdom.

Social workers' vision for building a better normal for the profession and the society should not be circumvented by the UK Government's recovery narrative which positions social care almost exclusively in supporting hospital discharge and infection control ( Cabinet Office, 2021). A more transformative agenda for social work professional development demands efforts for distilling out practice wisdom from tacitly learned knowledge during COVID-19. By building critical awareness of how social workers' bodies have been re-constituted through COVID-19, we can unpick how the power relations and neoliberal practices (re)embed in emerging professional practices.

Acknowledgements

We would like to thank Angelic Quintana, Cherryl Pharoah, Diane Wills, Jane Shears, Kerry Sildatke, Wendy Roberts, Vyomesh Thanki, Evgenia Stepanova, Helen Charnley, Roger Smith, Sarah Banks and Susie Hawkes who collaborated with us in the Empowering Social Work during COVID-19 project and offered incredible insights into the lives of social workers in this trying time. Our gratitude is extended to those who completed the BASW Survey on Social Work during COVID-19. Without their contribution, our project and this paper will not be possible.

Funding

This project was funded by the British Association of Social Workers (BASW) and the Economic and Social Care Research Council Impact Acceleration Account (ESRC IAA) (RF900056).

Conflict of interest. No conflict of interest to disclose.

References

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Social Workers' Sensual Bodies during COVID-19: The Suspended, Displaced and Reconstituted Body in Social Work Practice

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After more than a year living with COVID-19 restrictions, the UK Governments have now published their 'recovery strategies' in which social care has been considered as key to plans for post-COVID-19 recovery in England and the devolved nations.

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Episode 18 (S2). The importance of human touch pre/post Covid-19

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Episode 18 (S2). The importance of human touch pre/post Covid-19

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Listen to this episode from The Social Matters Podcast on Spotify. Three friends that happen to be social workers discuss current social/social work issues from their front rooms (via Skype). Your favourite trio of social workers are separated by the lockdown but connected in the virtual realm!

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Episode 10: Make music part of care planning, w/ Grace Meadows from Music for dementia

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Episode 10: Make music part of care planning, w/ Grace Meadows from Music for dementia

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Listen to this episode from Social Work Sorted: The Podcast on Spotify. Grace is the campaign manager for Music with dementia and a music therapist with a passion for sharing the power of music.

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Listen to this episode from Helpful Social Work Podcast on Spotify. We continue our exploration of the use of self in social work by looking at the entwined senses of taste and smell. Though often overlooked in practice, these strongly influence our perceptions and our emotions.

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Listen to this episode from Helpful Social Work Podcast on Spotify. We continue our exploration of the use of self in social work. In this podcast, we look at how touch impacts on social work practice. We discuss the meaning of touch and consider the importance of being aware of the space we inhabit.

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Listen to this episode from Social Work Research Podcast on Spotify. Professor Helen Chatterjee from University College London discusses a review of nature- and culture-based interventions and their importance for our health and wellbeing.

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Using a Spiritual Model in Social Work Intervention. Student Connect Webinar 97

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Using a Spiritual Model in Social Work Intervention. Student Connect Webinar 97

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Concepts and theory of spirituality in social work

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Concepts and theory of spirituality in social work

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Dr. Canda's research and service address connections between cultural diversity, spirituality, and transilience in relation to health, mental health, and disabilities. Dr. Canda has taught courses on spiritual diversity in social work for more than 30 years. He is currently co-teaching a post-MSW continuing education course on spirituality and social work at New York University. His most widely cited books are Spiritual Diversity in Social Work Practice (Canda and Furman 1999/2010/ and with H. Canda 2020, Oxford University Press) and Contemporary Human Behavior Theory Contemporary Human Behavior Theory (Robbins, Chatterjee, and Canda, 1998/2006/2012/ and with Leibowitz 2019, Pearson).

Dr. Canda founded the Society for Spirituality and Social Work (SSSW) in 1990 at KU. In 2013, Dr. Canda received the Council on Social Work Education's Significant Lifetime Achievement Award for innovations on spirituality through scholarship and education. In 2021, he received the SSSW's Inaugural Edward Canda Award in appreciation for his leadership. He also received the Distinguished Career Award, The Ohio State University College of Social Work, Hall of Fame.

Professor Canda has been a Visiting Researcher or Professor in South Korea at Sungkyunkwan University and the Academy for Korean Studies and in Japan at Ritsumeikan, Doshisha, and Kansai Universities. He has about 200 publications and has conducted about 250 presentations in the United States and in many other countries, especially in East Asia and Central Europe. He is currently a research project consultant on spiritually sensitive social work at Palacky University in the Czech Republic.

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Dr. Canda's research and service address connections between cultural diversity, spirituality, and transilience in relation to health, mental health, and disabilities. Dr. Canda has taught courses on spiritual diversity in social work for more than 30 years. He is currently co-teaching a post-MSW continuing education course on spirituality and social work at New York University.

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Existential Social Work- Donald F Krill 2014

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The current post color is White.

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Belfast Met's Gerry Skelton - Interview on Spirituality

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Belfast Met's Gerry Skelton - Interview on Spirituality

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Out of Nothing with Gerry Skelton by Out of Nothing with Vivian McKinnon

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Out of Nothing with Gerry Skelton by Out of Nothing with Vivian McKinnon

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Vivian talks social work and spirituality with Gerry Skelton, Lecturer at Belfast Metropolitan College, after his experience of coming "Out of Nothing" post-Float at Hydro-Ease.

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Belfast Met's Gerry Skelton - Interview on Spirituality

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Belfast Met's Gerry Skelton - Interview on Spirituality

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The Spirituality and Religion Practice Manual

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Description

Spirituality, whether or not rooted in religion, is a core feature of what it means to be human. In this important practice manual, two very experienced writers and educators explain why spirituality and religion should be a fundamental consideration for the people professions, broadly defined - that is, professions based on helping people tackle their problems and fulfil their potential.

This is an invaluable guide to making sure that professional practice is 'spiritually sensitive'.
Endorsements
Despite our personal, interpersonal, and professional lives constantly being shaped by our values and belief systems, the common discourse on spirituality is often reduced to religion, with little exploration of its intricate dimensionalities and complexities. This practice manual provides an honest, informed, and in-depth discussion of the various constitutions of spirituality, while examining its intersection with religion for informing professional practice in the human services. It is long overdue and highly commendable, a refreshing, important and comprehensive addition to the literature; a volume that makes us think, reflect, and act upon our true north with conviction and determination.

Dr Andy Hau Yan Ho , Vice President, Association for Death Education and Counseling

This is not a textbook in the typical sense and use of the term manual should not suggest a functional "how to manual". The authors draw on their considerable expertise to challenge thinking, promote reflection and improve practice through a framework that takes complex concepts and makes them manageable and accessible. The values and knowledge of the authors shine through and suggest the integration of theory, practice, and values by promoting a "theorizing practice" approach. Importantly, the manual makes a compelling case for the importance of understanding people's spiritual needs as that which enables people to 'give expression to their worldview'. This thought-provoking approach is helpful and the use of 'moccasin moments' encourages reflection and understanding. The exercises at the end of each section require the reader to think and to apply that thinking to complex situations, thereby better understanding how our own values
inform what we do and how we practise.

Gerry Rice, Dean for Students, University of the West of England

The authors have identified an important area of professional practice, revealing an underdeveloped curriculum area, relating to spirituality and religion. They do not expect the manual to do justice to all religious or spiritual denominations, nor address the complexities of people-based practice across all faith, spiritual, religious, and cultural contexts. Their stated intention is to use a social justice and human rights perspective to consider religious and spiritual diversity by consideration of the practice context, using anti-oppressive principles. The manual provides a framework for students and academics to critically explore these topics, and it provides a reflective resource to interrogate knowledge and understanding in this critical domain.

Dr Paula McFadden, Senior Lecturer in Social Work, Ulster University
Notes
1. Free shipping is only available for UK book orders (excluding Pavilion publications). If you are based outside of the UK, please email [email protected] with details of your order. A member of our team will process your order manually and apply the appropriate shipping fee dependent on the size of your order and the country you are ordering from.

2. Price is discounted to £16 per copy for orders of 5 or more copies.

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The Spirituality and Religion Practice Manual

# data[].attributes.attachment_link.description
Spirituality, whether or not rooted in religion, is a core feature of what it means to be human. In this important practice manual, two very experienced writers and educators explain why spirituality and religion should be a fundamental consideration for the people professions, broadly defined - that is, professions based on helping people tackle their problems and fulfil their potential.

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Gerry Skelton s 2017 definition of Spirituality Ch8

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Social Work Reference Center Skill Biopsychosocial Spiritual Assessment

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What Does Spirituality Mean To Us A Study of Spirituality in the United States

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https://youtu.be/M7utPlqnXV0

Dr. Lisa Miller offers an insightful and brief analysis of her research and a recent book on why spirituality is a necessary means of addressing the new epidemic of suicidal ideation among youth.

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The Power of Poetry (David Whyte) https://davidwhyte.com/pages/writing

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From Cultural Competence to Cultural Consciousness Transitioning to a Critical Approach to Working 