Listen to thisI finished my column last month with a comment about the complex and demanding nature of providing therapeutic containment and how staff, as well as young people, need containing processes. One of the more accessible ways of understanding containment is by looking at its opposite, and I mentioned those recognisably uncontained kids who seem like they’re coming apart at the seams or about to come screaming out of their skins. And most of us have probably had such experiences ourselves – or at the very least, have experienced such strength of emotion that it has been difficult to think straight.
However, if much of the time we can handle what’s thrown at us on the floor, if it’s extremely rare that we feel we’re falling apart at the seams, then it would be reasonable to question need for containment processes for staff. While thinking about those extremely uncontained states, in young people or ourselves, is an easy way in to understanding containment theory, it’s important to be clear that these examples are at the far end of the spectrum – and understanding containment is better understood in terms of a spectrum than an all or nothing state. Containment also isn’t something one achieves (“I am contained!”); it is dynamic and shifts along that spectrum all the time (“I feel clearer and more together just now than I did last week”).
Another important aspect of containment theory is its illumination of the impact of anxiety on thinking. Often, uncomfortable, undesirable feelings cause the spin-off feeling of anxiety. We become anxious about these other feelings, or even about the possibility of them. Even low levels of anxiety can disrupt clear thinking, and this impact frequently goes unrecognised. Hindsight is twenty-twenty not only because we cannot predict the future, but because our sight is often clearer when we have had the chance to make sense of how we feel about a situation or event. If we don’t make such sense and the anxiety remains, our retrospective view can still be distorted.
If one is emotionally present and available, the work of residential child care will inevitably stimulate uncomfortable, undesired feelings. Working with kids who sometimes need to test us, who can be full of fury and who are expert at poking our vulnerabilities triggers our own self-doubts, anger or defensiveness – sometimes all three at once.
If you remember from last month, part of the process of therapeutic containment is absorption – staff absorb the uncontainable feelings that the kid cannot bear, and (hopefully) give them back in a more containable form. This isn’t just a metaphor for understanding an unconscious, often intuitive process. Our brains and bodies are impacted by young people’s feelings (and they way those feelings manifest). This can be obvious in situations where you feel the dump of adrenaline and stress hormones into your system when you’re going through a crisis with a kid. It’s no less real when the feelings you absorb are subtle, confusing or unrecognised.
Anglin's (2002) study of what makes for high functioning residential child care identifies the primary challenge of Child and Youth Care practice as responding to the pain and pain-based behaviour of young people. He coins the term pain-based behaviour to emphasise the deep-seated and often long standing pain that is manifest in challenging behaviour but is often glossed over – in practice and in the literature.
Even when we are not experiencing kids' behaviour as “challenging”, it can be hard to remain emotionally present with their difficulties. The concept of vicarious trauma offers insights into the effects of working with individuals who have experienced trauma; this concept has made its way into child care literature (Elsdon & Priest, 2000; Kostouros, 2006), though far too often it remains unacknowledged. The effects of vicarious trauma include pessimism, cynicism, hopelessness, distrust, alienation, victim blaming, and a loss of meaning in life or in one’s work. If we do not acknowledge vicarious trauma, it isn’t possible to address its impacts. Yet Anglin (2002) found that even in the highest functioning homes, staff rarely or never spoke of the pain triggered by working with young people who were experiencing such intense emotional pain.
For many of us there has been encouragement to suppress pain and other feelings about the work. Having strong feelings about a kid has somehow been associated with weakness or a lack of professionalism. Many have been told not to let kids “get to you”. And some feelings are seen as much more unprofessional than others, with some even being unspeakable. As with young people, this is more a form of “constrainment” than containment, and is more likely to lead to poor or even abusive practice. We can begin to see a parallel process here as well. If the work environment dictates that staff simply keep a lid on their own stuff related to the work, how would we expect the spaces between staff and kids, within that same work environment, to be different? Yet the feelings are there, nonetheless, and they often cause significant anxiety.
It isn’t just kids' pain and behaviour that makes the work complex and demanding. Part of residential child care’s complexity stems from its straddling location between the private/public divide. On the one hand, kids need experiences and closeness (or opportunities to learn to manage closeness) more often associated with private, family environments. On the other hand, residential child care is a public service governed by regulatory frameworks and continually perforated by the comings and goings of external managers, inspectors and various helping professionals,. Managing the resulting tensions is challenging at best, but when this complexity goes unacknowledged and unaddressed, staff are left to manage the related anxiety in isolation. Therapeutic relationships in this middle ground of the lifespace must travel an uncertain and ambiguous terrain. Staff are faced with situations on a daily basis that do not lend themselves to formulaic approaches, and the types of relationships that are likely to foster growth and healing are not well served by notions of professionalism that espouse impartiality and detachment.
All of this complexity, ambiguity and uncertainty is a significant source of anxiety, for staff and for their organisations. In Scotland (and the UK more broadly), residential child care is still reverberating from the crashing impact of scandals of abuse and an overriding focus on safety, which far too often gets translated into safety for the organisation and risk-averse, sterile cultures of care. So while an ability to tolerate ambiguity and uncertainty is necessary for the kind of openness and responsiveness that is necessary for good practice, some environments foreclose these qualities due to their preoccupation with avoiding abuse and other risks. Staff may have to contend with constant low grade anxiety wrought by a collective fear, just below the surface, of being seen as abusive. I would imagine that those of you working in other parts of the world have your own particular version of how attempts to avoid abuse and other harm to kids are impacting on practice.
In summary, then, it is not just the work itself that requires containing functions but the wider context within which that work takes place. Next month, I'll write about how these containing functions might be made manifest.
References
Anglin, J. P. (2002). Pain, normality, and the struggle for congruence: Reinterpreting residential child care for children and youth. New York: The Haworth Press.
Elsdon, I., & Priest, S. (2000). The same difference: Themes and experiences in Child and Youth Care practice. Journal of Child and Youth Care, 14(3), 17-25.
Kostouros, P. (2006). The curriculum of self-care for students in
professional career programs. Relational Child and Youth Care Practice,
19(2), 19-22.
