By Ariola Vishnja
Date Posted: Tuesday, 22 May 2007
Ariola Vishnja who now works in England was born in Albania. She has a BA in Teaching English as a Second Language, an MA in sociology and she is currently a student on the Eagle House Graduate Diploma Course in Child Development and the Care of Children and Young People. Ariola has been working with vulnerable young people for the last 3 years and works as a Senior Residential Support Worker in a home for young people aged 16 or over.
The concept of the therapeutic holding environment and how it has been implemented in the residential home for young people in which I work : how effective is it and how could it be improved.
One of the major concerns expressed about children and young people who are placed in foster care or in children’s homes is the frequency with which their placements breakdown as a consequence of their behaviour. Indeed in a recent radio broadcast Beverley Hughes, the Minister for Children claimed that the care system failed young people because it was not providing the resolute care which is given by a good enough parent. At the risk of putting words into the minister’s mouth, I believe and hope her intention was to suggest that the good enough parent offers a kind of tenacious care which physically and emotionally holds a youngster through the vicissitudes of childhood and into adulthood. In the essay which follows, I consider the approach residential staff take to provide an emotionally holding environment for troubled youngsters in the residential home in which I work. These young people are preparing to leave care but remain apprehensive about what the future holds for them.
Our work as residential child care workers consists of looking after young people who have had difficult lives, have experienced some form of rejection, abandonment and abuse in their past, and are deeply troubled by these experiences. Therefore, the focus of our work with these troubled young people is helping them to make sense of their emotional problems and their past experiences and to enable eventually cope with their difficult feelings when they leave us. This is a major task that requires both an awareness of the child development processes, and skills which will enable us as workers to build a relationship of trust with the young people in order that they feel safe to open up about their feelings and past experiences. In the psychodynamic approach this is described as therapeutic work, which is a healing process, during which the residential care worker helps the young people heal their emotional wounds through forming a relationship of trust with them (Sharpe, 2006). An important concept in our therapeutic work is that of a “holding environment”, which according to Winnicott (1990), starts from the time the baby is held in the womb by the mother, continues with the holding and caring when the baby is born, and is extended from the holding of the mother, to that of the family and later on to whoever takes on the parenting role. This holding environment combines the physical and the psychological holding of the baby from the mother and later on any parenting figure. In an environment that holds the baby well enough, the baby is able to make personal development which eventually results in autonomy (Winnicott, 1990). It is described as emotional holding and involves the containment of difficult feelings which prevent the capacity for relationships, emotional growth and learning. Emotional holding, also means demonstrating to the young people that painful feelings can be tolerated, helping them to manage these feelings and gain some understanding of their meaning (Greenhalgh, 1994). I would argue that this is the most important aspect of our work as residential care workers. In this essay I will look at the provision of a holding environment in the context of therapeutic work in the children’s home where I work, how well this is working and I will consider how can it be improved. I will be using a case study from my work, and in order to ensure confidentiality, names and other details of the young people and places have been changed.
In order to illustrate how is the therapeutic approach applies at my work place I will use the case study of Paul, who was 17 when he came to our home. His parents were not married and he lived with his mum until he was 5 when he was moved away from her because she attempted suicide as a result of mental health issues. Paul went on to live with his father who has always been harsh with him and considered him “mad” like his mother. As a result, he received little nurturing and was treated differently to his siblings. His father had three main relationships during the time Paul was with him, which seem to have been difficult for Paul to deal with. Paul started to smoke cannabis and began to stop attending school. He was referred to the social services by his father who said that Paul was showing uncontrollable behaviour at home. Paul’s admission to care occurred two years prior to being admitted to our home. During this two year period he has been placed with foster parents, two children’s homes, and one semi independent project. All these placements broke down because of Paul’s behaviour. During this time there were not only concerns regarding his behaviour, but also his mental health and he was assessed under Mental Health Act and was considered not to be sectionable. However, he was put on medication because of these ‘mental health’ issues. From this brief family history it can be seen that Paul experienced a very unstable childhood and adolescence with little nurturing from either of his parents. When Paul was first placed with us, he was very withdrawn most of the time yet he became aggressive when he interacted with staff. Paul did not want to stay with us and showed a lack of care for himself which was manifested by disinterestedness in his appearance or health. He ceased to talk to anyone and stopped responding if he was addressed and would not look people in the eye if they were speaking to him. He showed no emotions at all, I found it very difficult as his key worker to engage with him.
To be able to talk about the effectiveness of the holding environment and therapeutic work in the case of Paul we first need to use some criteria. One of the aspects that one should consider when talking about effective therapeutic work is the environment it provides. When we talk about the environment we need to consider its physical, social and psychological aspects (Sharpe, 2006). As far as the physical aspect is concerned, it has to do with the location of the home, the way it is furnished, decorated and maintained. We have often had visits from social workers who have told us that they had a very homely feeling when they came into our home. The social aspect of the home has to do with how are things organised in the home, the roles of staff and young people, and the general atmosphere in the home. In my work place we have tried to organise things in a way as to make it more of a home and less of an institution. Staff respect the young people and each other and this is reflected in the calm feeling the home has, which is also remarked upon by visitors to the home. When considering the psychological impact of the home I am thinking about how the the young people feel in the home, and whether they consider it their home. One way of judging this is looking at young people’s rooms. If you have a quick look at their rooms it can be clearly seen that they have personalised their rooms and put their touch in it, which means they feel comfortable and consider it their place. However, there are things that could be improved. For example, it is my view that the young should in be involved more in painting and decorating their rooms. We also have a very big garden in which I think encouraging their input would be therapeutically profitable. Another way in which our holding environment might be improved is helping the young people to become more involved in the running of the home. We have found it difficult so far to make the young people contribute to cleaning and maintaining the house and especially the communal areas. We need to find ways to achieve this for it is my view that the more the young people put into the home in these ways, the more they will feel it is not ‘the’ home, but ‘their’ home and they will begin to feel an integral part of a home where there is emotional integrity. On the other hand I also have to consider that my anxiety is part of the normal conflict that can occur between an adolescent young man and one of his parenting figures.
Another very important measure of the therapeutic work in a home is to the level of emotional holding it provides for troubled young people when they come to us. In the therapeutic setting this has been described as the primary care (Sharpe, 2000). I remember that in the beginning of my work with Paul, my keychild, I often felt frustrated, and not good enough as a worker because whatever I did, I did not get any response from him. He would not even say hello or thank you. As I gained a better understanding of what emotional holding meant in a residential home, through the continual support by my colleagues and in supervision, I came to know that therapeutic work is a long process that takes time and patient effort. I came to accept that the way Paul was behaving had to do with his experiences in the past. In the beginning I was not able to do keywork sessions with Paul as he would not communicate with anyone, unless he needed something. He was also testing the boundaries with different members of staff and this is where we worked well as a team. We communicated every issue to each other and tried to have a unified and consistent approach. So, at first my work with him concentrated in building a relationship with him, helping him to cook or preparing a hot drink for him, cleaning his room and other daily routine activities showing him that I was there for him. I also worked with him around issues of being aggressive, and demanding money by talking to him and showing him that there are better ways of getting what you want rather then being aggressive. The other team members supported me in this and showed him the same approach and nurture. I came to understand that his being withdrawn or aggressive were only defences he was putting up in order to hide his feelings of rejection, fear, and anger. After a few months of a consistent work, we started to see the first signs of improvement. Paul was not aggressive any longer, he started to talk to staff and other young people, he was more interested in what was happening around him, started to look after himself more and seemed to have settled in the home. This is the time when I felt that we had been successful in holding him emotionally and containing his difficult feelings. I felt very happy to see the change in him and believe this change came about as a result of the nurture, understanding, and respect we gave to Paul. This is how the mother holds the crying baby, to use Winnicot’s terms (Winnicott, 1990).
This is when I started to work more with him around getting him back into education and finding him a course that would interest him. At the same time our relationship had improved a lot, and Paul started to come and talk to me when he needed help and advice. I felt really good about the work I had done with him. I have learned that in therapeutic work it is very important to take your time and reflect on things and see how things will develop (Sharpe, 2000). Paul is very fond of music so he was happy when we helped him to get a place on a music producing course. He started to be more motivated and worked with me to prepare his CV, and started to look for jobs. Knowing how little nurture and encouragement he had received form his parents I always encouraged and congratulated him for every little step even things like waking up on time to go to college which might seem normal for other young people but which were an achievement for him. Reflecting on our work with him, there are still things to be improved. There are things about his past that he finds difficult to talk about regarding his parents, and I feel that as our relationship gets stronger I will be able to discuss them with him.
To conclude, when working in therapeutic child care for troubled young people it is very important to provide emotional holding and containment for the difficult feelings the young people bring from their past. In the home where I work we try to make the young people feel taken care of, understood, loved and held in such a way that they can grow as individuals and develop their potential. In our home we try to provide a sense of security and safety for the young people so that they trust us and feel they can count on us. We see the result of our work in the development and progress of young people like Paul, and in our (that is the staff’s) increasing openness to learning from the young people. In caring for our young people there is always room for improvement !
Greenhalgh, P., (1994) ‘Emotional holding’ in Emotional Growth and Learning, Routledge, New York pp. 107- 137
Sharpe, C., (2000) ‘What do we mean by therapeutic child care?’ Unpublished Paper for Graduate Diploma in Child Development and the Care of Children and Young People.
Sharpe, C., (2001) ‘The inner world of a child’ Unpublished Paper for Graduate Diploma in Child Development and the Care of Children and Young People.
Sharpe, C., (2006) What makes a good children’s home available on line at http://goodenoughcaring .blogspot.com/2006_07_01_goodenoughcaring_archive.html. (Accessed on August 14, 2006).
Sharpe, C., (2006) Notes from The Graduate Diploma in Child Development and the Care of Children and Young People
Paul’s Home’s Statement of Purpose, November 2005
Winnicott, D.W., (1990) Home is where we start from, 2nd Edition. London: Penguin Books
|29 Jun 2007, Nicholas Williams writes|
|I am convinced by the way you describe your work with Paul, it sounds so genuine, but I wondered if this kind of work has been replicated with other young people or if this was a special case.|
|15 Jun 2007, Alex Mountain writes|
|I thought this was a wonderful article and I felt very much in touch with how you worked with this young man. I think it is so important to understand how such a troubled young person is feeling and to try to imagine the pain that he faces in beginning the process of building a trusting relationship.|