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Listen to thisChild care work is intense, disturbing, often unrewarding, and has a high staff burn-out rate. It involves child care workers in having to discover resources (new or old facets of themselves), which they do not always know are there, so as to meet the ever-new complexities encountered. The child care worker has to learn sometimes to act contrary to her instinctive or automatic reactions, and at other times to know that her gut feeling is her best guide. She has to admit that there are times when she does not know what to often does not have a specialised professional training with which to enter the job. What theory is known, is not always in harmony with practical day-to-day implementation in the practice setting. The hours of work and pay in relation to normal work expectations are a somewhat contentious issues. Despite all this, the child care service continues to render a creditable service. How is this possible? In this article the authors attempt to identify, from a child care worker's point of view, the factors which we believe help to explain this paradox. The two related factors we wish to discuss are relationships and play.
Therapeutic milieu
The therapeutic milieu conceptualised by such writers as Maxwell Jones
and Bruno Bettelheim has provided a much-needed practice framework for
child care. It is a structure and support system for both the child and
the child care team. The therapeutic milieu provides the child with a
space in which to 'act out' the torment, frustration and tensions which
besiege his life, a space with safe and containing limits. The child
care worker, to make the environment work for both her and the child,
helps the child to follow the general routines of the programme, as well
as the child's specific individualised programme. This
caring/therapeutic environment allows for a natural healing process for
the child. However, Whittaker points out that one of the key problems
faced by all child care workers is that of moving children through
routines and activities of the day. If the child care worker depends
solely on his 'authority' to move the children through structures of the
day, he soon finds himself making 'issues' over fairly simple rules and
getting into power struggles. So if the environment does not “work" for
the child, it becomes an added obstacle in his life, and his resources
and supports break down again. There are many dishonest and destructive
roles and ploys the child care worker can be tempted to use to make the
routine (which now becomes a closed system) work – for example, those of
buddy-buddy, manipulator, seducer, authoritarian, saviour, etc.
Furthermore there are the added dangers of inappropriate 'caring', for
example, getting hooked into the child's need and pathology; the pulling
off of scabs whilst destructively trying to open up the child; the
attempt to give the child all the love he believes is owed to him to
compensate for his hurt or loss. Two more problem areas of the
therapeutic milieu deserve mention. First, whilst in symbolic form the
therapeutic milieu is a 'therapeutic control', in practice the child
care worker does not always have the protection of a controlled and
structured therapeutic session, i.e. fixed consultation time, place and
duration. Second, the vital support from the team helps, but at the end
of the day (usually late at night!) the child care worker is alone on
the floor with the child and has to make decisions which she hopes will
be the best for the child and the situation, and then has to accept the
responsibility for those decisions.
The relationship
The relationship between child and child care worker is the medium which
will either ensure the success or result in the failure of the
therapeutic environment. The initial building of this relationship,
which will form the ground plan for all later encounters between child
and care worker, is the starting point. Remember when embarking upon
such a task, the new relationship is the child's prerogative. Only he
knows what his life history means to him. Whilst the care worker may
believe she is embarking on a new relationship, for the child it may
mean something quite different. The child feels different, he has
ambivalent feelings about himself and everything around him, and the
environment he now finds himself in, can be an ambiguous, dismembered
place lacking familiarity. So it is that underlying any attempt at
contact (relationship building) is the child's attempt and need to find
a safe space. The place to start a relationship is the place where the
child feels safe. If play and spontaneity are part of this initial
contact, then the first contact area is a safe area. However, whilst it
is at times apparently easy to assume a relationship in this manner,
particularly with a very needy child, the following should be kept in
mind:
Do not rush into a relationship;
An initial period of thorough observation is needed;
It is upon the small details and events that the relationship is built;
Allow the child to set the tempo;
Beware of inappropriate relating;
Avoid over-verbalisation in the initial period; instead allow for subtle non-verbal cues (e.g. eye contact) to act as indicators;
Respect the child's privacy;
Respect the child's vulnerability, particularly once he has opened himself up.
Trust
The relationship must be based on trust, and the building of trust takes
time. What does trust mean? It means to open yourself to your experience
with the child, and to what he experiences. The child cannot easily
understand how you are able to care, when the more important people in
his life have let him down. To accept this care from a less significant
other (the child care worker) means to recognise and attempt to accept
the lack of care received from the most important other (the parent).
Symbolically verbalised by the child, this could be “Why should you
care, when you have your own children?" With many deprived youngsters,
the challenge of a new relationship recalls anxiety associated with the
most fundamental of all developmental tasks. Erikson (1972, 241) states
that the achievement of basic trust in the infant “forms the basis in
the child for a sense of identity which will later combine a sense of
being “all right", of being oneself, and of becoming what other people
trust one will become". He goes on to say that in certain cases the “re-establishment of a state of trust has been found to be the basic
requirement for therapy".
It is at this point, when he opens himself to your care, that a relationship with a child can be said to exist. Now arises the question as to what form one can expect the relationship to take, and this depends on what the child brings into the relationship. Remember it is primarily his relationship, not yours. It is an authentic relationship, but it is a relationship for him, not for the child care worker, who is expected at this stage sensitively to receive, understand, contain and translate what ever the child brings to it. The time period is also totally random. It is within this phase that the child relives his past (regresses) and develops new and healthier perceptions of it which allow him to be himself without playing out some role. Said one child: “I tried so hard to be what I ought, that I forgot who I am". Another: “Now that I know what I don't want, I am beginning to know what I do want". The care worker is involved in a diversity of roles and it is here that her expertise and experience count, for few guidelines can be offered. Perhaps these boil down to only one: “Does it feel right?" Some contentious issues arise, such as socialising with the child, or opening up to the child, and these depend on the relationship. Remember each relationship is unique, and while at one level it may be an artificial, constructed relationship (and necessarily so), on another level it is very ordinary and human, subject to normal everyday experiences. In balancing these contrary views of the relationship, the important meeting ground is mutual respect. If the child has not come to respect himself and to respect you, then you have not yet succeeded. Your primary role is to teach the child how to live. Care worker and child are equal within this relationship, neither is better or worse, they just have different life experiences. Your role is not to manipulate the child into what you consider a healthy position, but rather to disengage his manipulations so that the end result is mutual respect between two human beings. This becomes a position from which other healthy relationships can grow.
To sum up, this stage of relationship-building is the trying period, the time you re-teach the child to cope with day-today events. However, any learning task, at the best of times, still has elements of frustration, and demands self-discipline. So it is that inevitably, in attempting to teach the child behaviours and the consequences of his behaviour, confrontation takes place. It is at this point that the courage of real caring is called for: “I care enough to fight you". As with all relationships, there is an end, a termination, goodbye, departure. Depending on how this is handled, whether carefully worked towards or occurring abruptly and unexpectedly, different emotions will be evoked. The child is confronted with what the relationship has meant to him, his feelings of loss, his anxiety about “going it alone" into the next stages of his life “its tasks and further relationships. It can be a sad and difficult time and, if not carefully handled, much of the work which has transpired can be undone. Furthermore, the care worker also has to work through her own losses.
Play
"A function of the ego is an attempt to synchronise the bodily and the
social process with the self." (Erikson, 1972, 190) Play is a safe
expression of the 'inner' in a non-serious or fun way while interacting
with the outer. The outer represents reality with all of its
opportunities and its unavoidable limits. The possibilities, together
with their counterposed limits, become an important opportunity for
learning. Play enables the child to master anxiety. In play the child
grows as a result of those experiences which help him to develop new ego
resources (coping strategies). “Just as the personalities of adults
develop through their experience in living, so do those of children
develop through their own play. By enriching themselves children
gradually enlarge their capacity to see the richness of the external
real world. Play is the continuous evidence of creativity which means “aliveness" (Winnicott, 1968, 144) Play develops peer-relating skills,
mastery of relationships, mastery of other skills, release of
aggression, the art of sublimation, for example, in artistic expression.
However, many children do not know how to play. They cannot entertain
themselves or even be left to their own devices. Alone, their own
histories and anxieties tend to preoccupy or immobilise them.
While most children have the spontaneity and insight to seize the moment to initiate play, others need help to do this, and this is where, in residential work with children, their own sake can be sterile and unhelpful. Ideally, an activity should attempt to meet each child's ego development level or be geared towards repairing ego damage. We often need literally to recreate trust and confidence, awareness and spontaneity or to build a foundation of positive and affirming experiences, and these are the goals of a recreation programme.
The nature of a recreation programme
Many youngsters involve themselves in extra-mural activities, which
suggests a positive development of ego resources. But for others, their
free hours are often aimless and unfilled. We should be aware, when this
is developmentally inappropriate, of those who sleep away the afternoon,
who sit with glazed eyes before the TV screen, who are loners. This is
not to say that the child care worker should watch a child's every move,
and it is appreciated that blank hours exist in everybody's life, but a
recreation programme offers a possible option for the child who cannot
motivate his own recreation or play activity. Freud spoke of
psychotherapy as the “talking cure". It is particularly at the point
where words are difficult, or are no longer able to express and
disguise, that the need for play and activity emerges. In play, hidden
feelings can be explored safely, tentative ideas tested, connections
made, meanings rediscovered. For the troubled child, this is the
language of play. Some practical formats for play and recreation are
offered:
Afternoon “outside" play can begin with fun activities with children, appropriate to their cognitive level. The children who can be engaged in this actively are often those who have a low level of mastery or competence. They are the institutionalised children who do not engage spontaneously in outside activities. These games should have elements of immediate gratification or else they will be sabotaged. This level of play is play for its own sake, with the emphasis being on intrinsic enjoyment rather than on any attempt to serve treatment goals. Because of anxiety or suspicion, and low levels of frustration tolerance, one should avoid at this stage undue rules, with limits being confined to those relating to personal safety. For example, games in which players are “out" or excluded for a time can be threatening or experienced as rejecting. From here they can move profitably into more formal games, e.g. a game of soccer or a swimming race. (A fitness drive is particularly useful amongst adolescents for it not only focuses a lot of physical energy, but also appeals to their self-concept.)
Afternoon “inside" play presents some more difficulties where more control may be necessary. The child outside has more room for expression, but inside can feel enclosed. These activities are more taxing on the care worker and require greater supervision and assistance, but are valuable as the child learns the inner controls of scaling his activities down appropriate to the room size.
Outings are powerful opportunities in which points of interest in the environment can open the child to exchange and dialogue. It is here that the over-used words “learn how to entertain yourself" apply. Many children remain oblivious to their surroundings, the sea and mountains, and prefer to go home to watch videos. The child in this environment is confronted with the need for active reception as opposed to passive reception. Few deprived children have the resources to appreciate the beauty which surrounds them. We have a great opportunity to share words and values with children when together we explore the wider world. Outings to social, cultural and civic events provide yet more complex learning experiences.
Activities with other groups. It is valuable to establish contacts for children outside of their own religious or cultural groups. Activities with other children's homes are useful in this regard, e.g. sporting or social events.
Summary
"In reality everything depends on the man and little or nothing on the
method. The method is merely the path taken by man, the way he acts is
the true expression of his nature" (C.G. Jung). We have explored two
common child care themes. The human relationships we establish with
children must paradoxically be real and authentic while at the same time
they may be instrumental and contrived, yet they are in a very real
sense the tools of our craft and therefore something child care workers
must understand and “do" well. But relationships are not made of vague
and vacuous interpersonal chemistry: they must have content, and so we
have introduced a discussion on play and activities which are methods by
which relationships can be made to “work" in assisting children over
developmental logjams towards positive growth.
Bibliography
Erikson, E. (1972). Childhood and Society, Penguin Books, Harmondsworth.
Whittaker, J. (1980). Caring for Troubled Children, Jossey-Bass, San Francisco.
Winnicott, D.W. (1968). The Child, the Family, and the Outside World, Penguin Books, Harmondsworth.
