The nature of a residential child carer

Charles Sharpe

 

 

This essay  is written for all residential child care workers but more particularly for those who may be considering becoming a residential child carer or for those who may just have taken up the vocation and are becoming curious to know more of what it may be about.

 For simplicity I have used only the terms ‘child’ and ‘children’ and I have refer to a child as ‘he’ or ‘him’ and to a residential child carer as ‘she’ or ‘her’.

As to what I mean by the term children, well, I might include anyone up to their mid to late teens. This is not meant to infantilise or patronise anyone after all each of us can become a child again when faced fearful anxieties or become excited primitive playful pleasures are aroused. I believe my own adolescence only began to fade in my early to mid-thirties.

 There are so many different names given to those who work in residential child care and so to avoid confusion for those new to residential child care I refer to the adult carers as ‘residential child carers’ and occasionally as ‘carers’.

 

It has always seemed that residential child care is going through difficult times. In recent decades in the United Kingdom and Ireland there have been, major inquiries into alleged abuse in England, Ireland, Scotland and Wales (see for instance,Levy, Kahan, 1991; Waterhouse, 2000; Frizell, 2009 ). This is no less so than now when criticisms of poor and abusive practice continue to abound, it would seem important to consider those aspects of residential child care and in particular, where there is evidence that the work of the residential child carer, often carried out in  difficult and troubling situations, is of a great help to children, their families and the wider community.

Given the continual barrage of criticism – often unjust – that residential child care has faced, it can seem to many carers involved in the service that the standing of their vocation in the wider community may never have been lower. The residential child carer is left with little or no professional or vocational status, and no clear path to attaining a qualification or registration which is generally recognized. Training in the United Kingdom for residential child care workers is made up of an inconsistently provided national vocational qualification, a very limited number of graduate and post-graduate courses on the therapeutic group care of children based on psychodynamic principles and excellent though somewhat sporadic initiatives in the training of social pedagogues.

Since the late 1980s, residential child care has been seen as an expensive resource, perceived to carry with it a high risk of failure and hence unwanted public, media and political opprobrium and humiliation for providers; the provision of residential child care has moved away from being provided directly by local authorities and voluntary organisations, towards being a service principally provided by the private sector. While this has introduced many exciting new residential child care initiatives by thoughtful and creative organisations there is also well publicized evidence of private organisations who are more interested in the profit motive than the quality of the service provided. This has served to make a significant number of children vulnerable and open to abuse when, being in the public care, they should feel, and in actuality be, protected. In organizations like these the use of staff rotas which employ staff on an ‘as needed basis’ – commonly called the ‘zero hour contract’ system – has reduced the opportunities for residential child carers to offer themselves as consistent adult attachment figures and children are thus denied the nurture they need. In such a ‘profit before care’ environment working conditions for residential child care workers have in many instances deteriorated. Both pay and the opportunity for proper vocational training are severely reduced (Daniel, 2012).

A fair question may be, “Why in the current social climate do people continue to want to become residential child carers ?” There is a dearth of research on this matter but there are a range of considered thoughts which attempt to establish the nature of a person who becomes a residential child carer. These are worthy of consideration. This essay explores some of these in order to gain an impression of the nature of the residential child carer.

The children who are admitted to children’s homes often have good reason to be wary and distrustful of adults and so are reluctant if not fearful of making further relationships. They need adults who have the patience to work through this distrust, who can demonstrate to them that it is possible to have a healthy relationship with an adult. If children can gain this insight emotionally and intellectually they will have begun to develop personal resources to help them contend with approaching adulthood.

What is the nature of a residential child carer ? Is she someone informed by her reflection upon her own development from a child to an adult ? Is she practiced in providing children with their day to day basic physical needs for food, for clothing and shelter ? Is she informed by the study of theoretical propositions such as attachment theory, psychodynamic theory, life space theory, social pedagogic theory, cognitive behaviour theory and others? Is she someone who thinks life should be led by the principles of a specific religion, culture or social community ?

Whether or not she has been trained, qualified or assessed in any of the aspects described above, the residential child carer whether she likes it or not often has the label ‘therapeutic’ placed upon her and this implies the carer has gained specialized techniques, knowledge or insight that others have not, but in residential child care ‘therapeutic’ has a valid wider meaning. In the act of living with and engaging with children in a group setting the residential child carer is ‘therapeutic’ because her activity is associated with ‘healing’ in the sense of helping children feel better about themselves. This healing and feeling better refers, though not exclusively, to the healing of emotional wounds rather than physical ones (Sharpe 2007).

Defining the nature of the residential child carer

If the role of the residential child carer is considered to be to nurture children in a group living setting, certain insights, qualities and capacities may be necessary constituents of what a residential child carer should have in order to practice. As an aid to making sense of the nature of the residential care worker five elements of the residential child carer’s role are singled out here for further consideration, though these should not be seen as definitive, exclusive or discrete. These are : primary care, the mutuality of relationships, living with a group, shared experience and activity, and planned therapy.

 Primary Care

Authorities on the physical, social, and emotional development of children stress the importance of the early primary caring relationships in childhood (see for instance,Winnicott,1965; Bowlby,1998; Klein,1952; Fonagy,2001). Primary care processes are described as being concerned with supporting a child’s dependency, independency and expressive needs. Even in the hectic milieu of a children’s home the residential child carer remains aware of the critical place these primary relationships have in the lives of children coming into residential care who have been deprived of contact with their natural or substitute parents. The residential child carer is expected in large part to take the place of parents by being the adult who provides an environment capable of giving children good primary experience. This is a basic need whatever other therapeutic, social or educational objectives are set. The close and assured engagement of the residential child carer in the daily life of the children creates an opportunity to make good primary care possible.

Children in residential care are dependent. In the group residential setting as in family life children will frequently seek support with their daily living. The cry for help comes at any time, and it is important to have sensitive adults carers who are available to respond, listen and if necessary act at all times. Residential child carers are aware of the crisis times in the life of a children’s home and are present to contain them and to help children make sense of them. Meal times, because of the deep emotional significance of food and feeling are often occasions for the revival in the child of earlier insecurity and uncertainty. Getting up in the morning is a painful time for those who seek to withdraw in fright from what lies ahead. Bathing and going to bed signal in others the onset of primitive infantile fears. These may all be periods of much confused and disordered behaviour. They may give useful indicators to what lies below a child’s anxieties and fears and for the residential child carer they are also reminders that children may at any time desperately need the attention of a trusted supportive adult. The residential child carer’s skill and insight lies in recognizing the individual child’s needs for support (these may not be expressed in words) and in responding appropriately. To do this the worker must know each child well and enjoy a relationship which allows for intimate work of this kind.

The residential child care worker is able to demonstrate abiding support in other ways. The environment and social climate in which the children live should bear the mark of the residential child care worker’s concern.

Good physical care in itself is a measure of support. The worker’s deep involvement in the minutiae of living – in questions of food, furnishings, decoration, routines, privacy – make up opportunities to offer the underlying emotional support demanded by the child. There are times when physical care is the only vehicle available by which children may be helped. Where other demonstrations of care often evoke strong resistance, ‘love incognito’ is a necessary strategy.

Primary care also involves supporting children’s need for independence in those parts of their lives where they are ready for this. Children experiencing part of their growing up in residential institutions, as in families, need opportunities to look after themselves and to cut the metaphorical umbilical cord. Sensitive and caring workers will welcome each step forward taken by the child towards a greater autonomy and always their task is to facilitate the process. But development is not without its pitfalls and for many children self-reliance and independence from a background of recurring failure is strewn with pitfalls.   Their groping, hesitant steps tell their own story.

The residential child care worker recognizes some of the special difficulties that arise when they seek to support children’s independence needs within residential settings. If children’s homes are strictly disciplined and routinized, legitimate moves on the part of the child toward independence may be viewed differently. Institutions favouring order over creativity are not places where children can be helped to become independent. Supporting children’s need to be free is a major responsibility for the residential child carer.

A third component of the residential child carer’s provision of primary care arises from the needs of children to express themselves and to confide their thoughts and feelings to safe adult figures especially if these thoughts and feelings cause worry and carry threats. Growing children are often assailed by thoughts and feelings about death, the health of loved ones, personal adequacy, how others see them and many, many more fears and anxieties. The discussion and safe working through of these problems as they surface may save the child much emotional pain.

Finally, good primary care sees the child not only as the receiver but also as the giver of support. Children need opportunity to support others in daily living. Their active practice of caring will stem from their contact with both peers and adults. The residential child carer appreciates the value of this support to the child and to others. The carer’s task is to make sure that they are available and open to this help and that the emotional climate of the children’s home enables this to happen. This reciprocal component to primary care could be overlooked unless it is remembered how children help their parents and teachers, as well as one another. The socialization process describes not only how children are shaped by parents, but also how parents are influenced in their parenting by children.

Mutuality of relationship

 The residential child carer starts from the  position that any description, any explanation, any understanding of residential care acknowledges the mutuality within the relationships that go on in the children’s home. Just as a child brings his traumatic and other experiences, thoughts, feelings, prejudices, and fantasies to this relationship so equally does the residential child carer.  She does not understand herself as a superior all knowing example of the human species. Good relationships are mutual. They give satisfaction to both participants and foster the capacity to trust. The carer understands that any child-adult relationship she is involved in affects both the child and her. The relationship changes both parties to it. The residential child carer understands there will be times when a child may understand what’s going on better than she, the adult, does. It is possible for both to feel better or even more healed in the process of such a relationship. The carer understands that sometimes a bad experience in the relationship will transform over time to be understood as a good one. A mutual relationship as in all things human has an ever changing dynamic. In a group living setting where children and adults live together there is a labyrinth of relationships going on. In such a setting, vicarious processes – when one party in a relationship experiences something through the thoughts and feelings of the other party – are mutual and labyrinthine also.

A healthy relationship between a child and an adult is a dynamic, trusting, emotional and social connection which is built up over a period of time between a child and a residential child carer. The carer and the child understands this through their involvement over time in many different episodes, through their mutual occupying of attention, as through their mutual efforts to hear each other (Sharpe, 2008).

In understanding the mutuality of the adult-child relationship the residential child carer is always aware that she as the adult is the more experienced human being and from time to time may have to take decisions that will keep everyone safe.

Living in a Group

The residential child carer is not only involved with individuals in the way already described but also with a group of children and adults living together. Much of life in a children’s home sees residential child carers working and playing alongside numbers of boys and girls. Residential child care is in great part a group experience in which the children and adults are engaged with each other in a very special way. Here a group is not just a timetabled event fitted into an already busy week, although some of group meetings may take that form. It is more a continuous involvement with a living group to which both children and adults belong and which gives them countless opportunities for therapeutic and educational purposes.

Firstly, residential child carers share with others (children and colleagues) responsibilities for planning the routines and programmes of the home. Being aware of the significance of ritual and routine in the development of children gives the carers the opportunity to ensure that a proper balance is maintained between those essential experiences and the corresponding needs of children for spontaneous unstructured life, freedom and privacy. In the continual forming and changing of smaller formal and informal groups that takes place within a children’s home, the carers can help create spaces in which some children can achieve greater security and acceptance, while other children, feeling restricted in the roles they play in a large group can be encouraged to develop greater versatility.

Secondly, because workers are part of the children’s life they are engaged in those conflicts that periodically disturb the group of children and adults. At these times residential life seems to be an endless round of quarrel and crisis. The conflicts themselves are often imbued with crucial issues in the development of both the group and its individual members, adults and children alike. Hidden in what may seem petty bickerings will be poignant questions concerning sexuality, separation anxiety, identity, incapacity and others. The residential child carer’s task is to use these conflicts constructively and in a paradoxical sense to welcome them because they are an essential step in the group’s and each member of the group’s development. Dealt with using reflection and sensitivity they can be a means to fresh learning, better ways of coping and self-awareness.

Thirdly, a residential child carer is aware of, and uses, the potential of the group as a venue for peer learning.   Peer learning happens anyway without intervention from the adults, but the latter can facilitate the learning processes in a number of ways by ensuring that children share in many of the responsibilities for running the home, by genuinely valuing their contribution and so creating an open social climate which is conducive to these processes.

In recent times there has been less emphasis on using the group for therapeutic purposes. Regulatory bodies seldom mention group dynamics in the regulations and standards for residential child care which they publish as a guide to those operating residential child care facilities (see for instance Dep. for Education, 2015; Dep.for Education, 2011). This seems remiss given that the basic premise of residential care is that it is, with some rare exceptions, a group living experience as opposed to the more family based approach of foster care.

Residential child carers are aware of the possibility negative developments occurring as a result of insensitive engagement with the group of children. Among the processes met too frequently in residential life are gang pressures and rituals, informal powers systems, insensitive leadership by dominant individuals and scapegoating adults as well as children. Nevertheless the group work role of residential child carers is essential given its potential for providing opportunities for the emotional, social and educational growth of both the individual and the group.

Shared activity, shared experience

Laypeople may not be aware of the three aspects which form the nature of the residential child carer already described, and she is perhaps more readily, generally and correctly understood as a member of a group of adults who engage children in a whole set of interesting activities. These activities can extend from sports and hobbies to vocational and creative pursuits. However the observation that all residential carers are versatile ‘activity’ people, essentially ‘doers’, has been one stereotype which is unhelpful, especially since it seems to make the assumption that all residential child carers are essentially extroverted outgoing people. Nonetheless shared activities are important and the significance attached to them does not stem from the view that they will fill in the time, keep the children interested and thereby remove them ‘from mischief.’ After all activities like primary care and living in a group are fundamental to the child and residential child carer alike.

In the first place activities constitute a means by which carers and children acquire the shared life which makes possible primary care and group living. Growth is possible because the carer and the child have together a backdrop of shared interests and common identifications. Playing pool, manicuring nails, being in the same rock band, skateboarding, walking in the hills, shopping, playing computer games, talking together about any subject under the sun may not in themselves be highly therapeutic pursuits, but they give substance and meaning to the shared experiences which make good relationships possible in the residential setting the children and adults share together.

Secondly, many of the activities which children and adults in a children’s home share have developmental value. The significance of play, formal and informal, is widely recognized. In play children have opportunities to explore new areas of experience, experiment with fresh roles and work through safely in fantasy many of the personal problems that worry them. Alert to these opportunities the residential child carer helps in many ways by ensuring that time and resources for play are plentiful and more importantly that the whole environment, both its human and physical elements, is conducive to the activity. For the home to be a good place ‘to play in’ means much to the child. Even though carers may not be considered play therapists in the strictest sense they will relate the child’s play, to his general development and usefully interpret in that process his phases of emotional and physical growth.

The therapeutic significance of art forms, music and drama as well as their educational and recreational value, has long been recognized. Acknowledgment of the part played by the expressive media in the ventilation of feeling, tension and release, and the promotion of self confidence, explains the secure place these activities hold in the mind of the residential child carer who knows that a children’s home bereft of music and art are sad places.

Many children’s homes have used outdoor pursuits to expose children to new experience, giving considerable time to such activities as sailing, canoeing, camping, mountain biking and rock climbing. Residential child carers may be qualified to lead the small groups essential for these types of activity, but even if they are not, but are confident enough to learn with the children, they know these activities (when they are properly led ) and shared experiences can be used in a special therapeutic way. The challenges implicit in these activities hold real difficulties for some children who already have unresolved authority problems. Sharing in these kinds of activity with the children, the residential child carer uses their relationship with the children to help them resolve these problems.

 Planned Therapy

 The residential child carer is a reflective person, not only in considering the children she works with, herself, her colleagues and her relationships with them, but also in her curiosity about what underlies her endeavours. The presence of children in residential care with complex personality, emotional and social difficulties has led many residential child carers to seek ideas and principles which might inform effective methods of therapy.

During the 20th century the psychodynamic theories of Sigmund Freud, Melanie Klein, Donald Winnicott, the theory of groups as espoused by Wilfred Bion and attachment theory based on John Bowlby’s work have underpinned work in residential child care, particularly in therapeutic communities for children (Kasinsky,2003). Additionally, with its emphasis on the dynamics of the relationship that exists between a child and a caring adult, psychodynamic theory and practice has influenced the approach of residential child carers over a broad range of children’s homes in the United Kingdom. Currently the significance which is placed upon a child’s need for a significant adult figure with whom the child can enjoy a consistent healthy attachment relationship, has given an impetus to attachment theory in the sphere of social care training (Holmes, 2001).

In recent decades the therapeutic movement has found two more forceful expressions, both of which may be seen as a development from psychodynamic theory. These are life space work and social pedadogy.

The first of these is seen in the career and writings of Fritz Redl. Redl’s concept of the ‘life space interview’ and his substantial American practice during the 1940s and 1950s have been extremely influential in shaping the work of residential child carers in many parts of Europe. His central concept of the life space interview is based on Freudian principle but has offered residential child carers a less complex clarification of the therapeutic elements in the residential task.

The ‘life space interview’, now more often referred to ‘working in the life space’, is a term used to describe the interactions occurring between the child and a named significant adult figure who is part of the child’s natural living environment. The correct handling of the interview by the adult is of profound importance to the child because it draws from the child’s direct day to day life experiences and helps the child work through and begin to the resolve the issues which have resulted in him being in care (Redl, 1966).

Residential child carers may not consciously follow Redl’s ideas but as Ward (2002) suggests when he writes about ‘opportunity led’ work with children elements of Redl’s approach to residential child care form a natural part of their day to day relationships with children. Redl’s ‘emotional first aid’ is not only available when the carer tries in time of crisis to relieve the pain of anger, fury, guilt, separation, loss and their aftermath, but it is also there to develop a therapeutic intervention based on the relationship between a child and a caring adult (Redl 1966, Sharpe 2013).

In recent times a second stream of thinking and practice concerned with residential child care that has found credence with residential child carers is social pedagogy. This has its origins in post second world war Europe when there were a great many displaced families and children who needed immediate support (Davies Jones,1986). Since then social pedagogy has developed as a discipline and vocation which combines practical skills and social education with lasting emotional bonds. It ensures that each child has an adult who is responsible for them through their time in care and who keeps with them when they leave it and no longer need it. At the heart of social pedagogical relationships is the belief that children have the desire and capacity to grow, and the carer engages with the child to draw this out and so encourages healthy personal growth. Doing this may involve the adult carer holding back and waiting or maintaining a certain distance so that the child has the opportunity to act for himself. This quality might be described as watchful and thoughtful, using judgment about when to intervene and when to leave things as they are (Smith, 2009 & 2011).

Looking to the future

In describing the work of a residential child carer by isolating the five aspects of care described above: primary care, mutuality of relationships, group living, shared activity and experience, and planned therapy, it is not suggested that these constitute the entire repertoire of the residential child carer. They do however form a nucleus from which other vocational attributes be cultivated. It may have seemed too that the attributes drawn out to construct an idea of the nature of the residential child care worker focused on the residential worker in the singular. The reality is, which in many ways is implied in the text, that the residential child carer is first and foremost a member of a caring adult team within a group of children and adults who live together. Certainly this has significance. Regulations and standards set out by government departments about practice in England give little or no mention of the group aspect of residential care and leaves open the question, “Why place children in an group living setting if there is no official rationalization or consideration of the benefits of group care?”

The five elements proposed as in large part forming the nature of the residential child care worker have some implications for the future training of a residential child carer, and these can be drawn into one statement: that future training need not be academic though the curiousity to understand and to study ideas that underlie her endeavours would be a part of her nature, but most important would be her reflection both guided and spontaneous on all the aspects of her vocation, facilitated by experienced, reflective and thoughtful colleagues.

To conclude : some basic principles with which to start

Reaching the stage that she might want to achieve as residential child care worker may well take a long time and while on this journey she will have huge responsibilities. The healthy self development of children in residential care is in large measure dependent on children introjecting personal qualities present in residential child carers. Each carer will have unique personal qualities and this is important, for childen can learn there are different ways of being, and different healthy ways of relating to other people.

It takes a residential child care worker time to nurture these qualities and capacities but the potential to do so should be in their nature. In the mean time as they develop, there are some basic practical principles they might follow as they begin their journey. They offer an opportunity for the child and the residential child care workers to begin a relationship and to start sharing experiences. This is a very simple, practical, though not an exclusive catalogue which requires no previous practical knowledge. The principles are to :

  • demonstrate warm respect for each child cared for in the children’s home;
  • show genuine friendliness to the each of the children;
  • join with children in spontaneous play both in activity and conversation;
  • encourage and help children to look well and feel well;
  • show real care and nurture in the preparation and presentation of food for the children and show enjoyment in joining with them to eat together;
  • take care to respect the culture of children and work hard to make sure they are not isolated from it;
  • provide children with and join with them in a variety of cultural and recreational activities;
  • help children gain confidence in being a member of a group of human beings;
  • say “No” to a child’s unreasonable expectations;
  • encourage and help children with their schooling;
  • comfort children when they are unhappy;
  • help them when things have gone wrong;
  • be a good adult role model;
  • show the children that she has a warmth, a care and a respect for each of her colleagues.

By being or doing these and any number of other unsophisticated simple things with young people the new residential child carer can begin to build a trusting and loving relationship with them. On occasion the new worker may be rebuffed and on reflection this may help her consider her timing, to know when to do something, when to let things and begin to adapt to what each young child (and colleagues) respond to. With perseverance and with the support of colleagues the new carer will discover if she has the nature of a residential child carer.

References

Bion,W.R(1961) Experiences in Groups and Other Papers   London : Tavistock

Bowlby, J.(1988) A Secure Base : Clinical Applications of Attachment Theory London : Routledge

Daniel, E.(2012) “Residential Child Care : a view from inside the service” in The goodenoughcaring Journal Issue 11   Accessed at http://www.goodenoughcaring.com/the-journal/residential-child-care-a-view-from-inside-the-service/ on June 2nd, 2015

Davies Jones, H.(1987) “The Profession at Work in Contemporary Society” in  The Socialpedagogue in Europe – Living with others as a profession  Davies Jones, H. (ed).     Zurich :     Federation Internationale des Communautes Educatives  (FICE) pp74-108

Department for Education,(2011) Children’s Homes: National Minimum Standards Accessed at http://webarchive.nationalarchives.gov.uk/20130401151715/https://www.education.gov.uk/publications/eorderingdownload/nms%20children’s%20homes.pdf on June 2nd, 2015

Department for Education, (2015) Guide to the Children’s Homes Regulations including the quality standards  Accessed at https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/410021/Guide_to_the_Children_s_Homes_Regulations_including_the_quality_standards.pdf on June2nd, 2015

Fonagy,P.(2001)Attachment Theory and Psychoanalysis New York : Other Press

Frizell, E. (2009) Jointly commissioned report by the Scottish Government and Glasgow City Council of the Independent Inquiry into Abuse at Kerelaw Residential School and Secure Unit. Accessed at http://www.gov.scot/Resource/Doc/271997/0081066.pdf on June 2nd, 2015

Holmes, J. (2001) The Search for the Secure Base : Attachment Theory and Psychotherapy      Hove     Brunner-Routledge

Kasinsky, K. (2003) “The Roots of the Work” in Therapeutic Communities for Children and Young People

Klein, M. (1952) ‘On Observing the Behaviour of Young Infants’ in Envy and Gratitude and Other Works 1946-1963 London : : Vintage 1988

Levy, A; Kahan, B (1991). The Pindown Experience and the Protection of Children: The Report of the Staffordshire Child Care Inquiry. Staffordshire County Council.   Accessed at https://www.staffordshire.gov.uk/yourcouncil/dataprotectionandfreedomofinformation/publicationsscheme/The-Pindown-Experience-and-the-Protection-of-Children.pdf on May31st, 2015

Redl, F. (1966) When We Deal With Children   New York  :  The Free Press  pp35-67

Sharpe,C. (2007) “The Group as Therapy” in In Care, In Therapy? A consideration of the use of psychoanalytic theory for the care of young people living in children’s homes : Writings Accessed at http://www.goodenoughcaring.com/writings/in-care-in-therapy-a-consideration-of-the-usefulness-of-psychoanalytic-theory-for-the-care-of-young-people-living-in-childrens-homes/ on June 2nd, 2015

Sharpe,C. (2008) “Anyone can make a relationship?” in Writings Accessed at http://www.goodenoughcaring.com/writings/anyone-can-make-a-relationship/ on June 3rd, 2015

Smith,M . (2009) Rethinking Residential Child Care Positive perspectives Bristol : Policy Press

Smith,M. (2011) “Good enough social pedagogy’’ in Therapeutic Care and Social Pedagogy. Accessed at http://www.goodenoughcaring.com/therapeutic-care-social-pedagogy/ on June 3rd, 2015

 Waterhouse,R.(2000) Lost in Care – Report of the Tribunal of Inquiry into the Abuse of Children in Care in the Former County Council Areas of Gwynedd and Clwyd since 1974 Stationery Office Accessed at

http://www.julyseventh.co.uk/pdf/Lost_In_Care_Report-Formatted.pdf on June 2nd, 2015

Ward,A. (2002) “Opportunity led work: maximising the possibilities for therapeutic communication in everday interactions” in Therapeutic Communities (2002) Vol.23 (2) 111-124

Winnicott, D.W.(1965) The Maturational Processes and the Facilitating Environment London : Karnac Books(2005)