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"A home for research and discussion about therapeutic community"
Simon Peacock
“Holding On:
An Exploration of the Relevance of 'Holding' and 'Containment' to Field Social Work with Children”
27th June 1997
Submitted in partial fulfilment for an
MA in Therapeutic Child Care,
Department of Community Studies
This study examines the concepts of “holding” and “containment” in the context of field social work with children in care and argues that the process has become one of “brief encounters” rather than one of establishing long-lasting and reliable relationships.
Chapter One reviews the changes which have taken place in the professional culture of social work over the last thirty years. Chapters Two and Three attempt to define and distinguish between the different meanings and usages of the terms “holding” and “containment” in various settings. Chapter Four draws on the findings of the first three chapters and explores the relevance of holding and containment to the field social worker’s role with a child in care, using specific and contemporary case study material. Chapter Five considers the general application of the findings to field social work with children in care.
The paper concludes that the issues of holding and containment are even more relevant for the field social worker to be aware of and to use as effective tools in the long-term care of children in the present day culture of social work.
There are many people to thank for their help, advice and support, all of it given unstintingly in the preparation of this dissertation.
Firstly I wish to thank the staff of the Postgraduate Diploma/MA Course in Therapeutic Child Care at the University of Reading, Paul Cain, Theresa Howard, Dr. Linnet McMahon and Adrian Ward. In addition I must thank my fellow students on this course for their invaluable support and contribution to my learning.
Secondly, I must also thank my good friend and colleague Ian Foreman for his insight and understanding of social work, practice and psycho-dynamics, empathy and numerous informal consultations in the pub!
Thirdly I must thank the Planned Environment Therapy Trust which provided much needed financial support through their bursaries and without which completion of this dissertation would have been all the more difficult.
Finally, but by no means least of all, I must thank my wife Jo Meyjes whose unfailing tolerance of my bad moods, reading of many drafts, provision of advice, support, packed lunches, dog-walking and baby-minding has both held and contained things all together and made it possible for me to do this course and produce this dissertation.
I am extremely grateful to all of you.
Thank-you.
Simon Peacock
27th June 1997
Abstract i
Title Page ii
Contents iv
Introduction 1
Methodology 3
The Research 6
Chapter 1: Social Work 8
Social Work and Social Services 8
The Post-War Years 8
The 1960's and '70's 9
The 1980's 11
The 1990's 13
Surface and Depth in 1997 14
Looking After Children 15
Institutional Anxiety 18
Conclusion 20
Chapter 2: Holding 21
Winnicott and Holding 22
Physical holding 23
Holding Therapy 24
Emotional Holding 25
The Holding Environment 26
Conclusion 28
Chapter 3: Containment 29
Container-Contained Relationship 30
Containment within Ourselves 32
Containment within Families 33
Containment within Institutions 35
Conclusion 37
Chapter 4: Bobbie 39
Background History 39
Week 1: Containing Anxiety within Myself 41
Containment as Relationship 44
Containment of and within Bobbie’s Family:
Holding On and Letting Go 44
Holding and Containment within the Organisation 45
Two Years Later - holding on and responding to the actor 47
Holding and Containment for Bobbie 49
Still Holding On 50
Conclusion 50
Chapter 5: Conclusions: Holding, Containment
and Social Work 52 Holding and Containment 52
Social Work 53
In 1963 Donald Winnicott wrote of the role of social workers,
"Your function can logically be reviewed in terms of infant-care, that is in terms of the facilitating environment, the facilitation of maturational processes. Integration is vitally important in this connexion, and your work is quite largely counteracting disintegrating forces in individuals and in families and in localized social groups ... . For instance, think of casework as providing a human basket. Clients put all their eggs into one basket which is you (and your agency). They take a risk, and first they must test you to see if you may be able to prove sensitive and reliable or whether you have it in you to repeat the traumatic experiences of their past ... . Infant-care can almost be described in terms of holding, holding that starts off immensely simple and that steadily becomes extremely complex yet remains, jut the same, a holding. In other words, social work is based on the environmental provision that facilitates the individual's maturational process ... . Always [social work] has as its aim not a directing of the individual's life or development but an enabling of the tendencies that are at work within the individual, leading to a natural evolution based on growth".
(Winnicott 1963: 227-8)
In writing this, Winnicott had drawn upon his views of the therapeutic task and efficacy of ordinary, “good-enough” parenting. In the same way he drew attention to the task and efficacy of ordinary social work rather than to specific therapeutic sessions with clever, insightful interpretations made by an expert therapist. I was curious to discover whether Winnicott's likening of the task of social work to that of infant care remained valid thirty years after he had written about it. My curiosity stemmed from my experiences as a social worker working with children and families.
I am employed as senior practitioner in a shire county social services department working predominantly with children who are in the long-term care of the local authority and for whom the local authority holds Parental Responsibility. I also have experience of work in local authority residential care and in a therapeutic community for severely emotionally disturbed children, working within a psychodynamic framework.
In the course of my current work in local authority children's services I felt increasingly that I was spending a considerable amount of my time counteracting the disintegrating forces created by the organisation for which I worked before I could even begin to start on facilitating the maturational processes of the children I was working with. Ordinary, “good-enough” social working just did not seem possible any more. The most extraordinary steps seemed necessary to meet the most basic of needs and maintaining the status quo in terms of good-enough social work felt like an up-hill struggle in a head wind. As a consequence of this feeling I wished to explore the relevance of Winnicott's ideas about social work and "holding" to my every day work as a social worker. Unlike Winnicott’s view, my experience of "holding" a child as a field worker is that the process never starts simply. It always involves a degree of complexity. A large part of the work is one of directing the child's life because of the power inherent in the social work function and because of the often inflexible organisational and legislative frameworks in which I find myself operating.
The idea of "holding" is central to Winnicott's thinking. However, at the same time I was aware that the term "holding" is very often used in conjunction with the term "containment". Sometimes the words are used interchangeably and without definition, or one term is used to define the other. In other instances the words are used together so that the phrase "holding and containment" appears frequently throughout the literature as will be made apparent in reading this study. The concepts of "holding" and "containment" are used widely in psychotherapeutic, psychoanalytic and social work circles. I was curious to discover if a difference in the nature or usage of the terms could be discerned and if so whether any such difference was significant. Most crucially of all I wondered what, if anything, I held and/or contained for a child as a field social worker in my day to day work rather than in any specific therapeutic session.
It will be apparent that there are a number of very large areas of study contained within these questions. For example, an adequate review of the evolution and nature of social work in order to give some meaning to the context of the study would certainly require more space than is available here. Similarly, study of the concepts of "holding" and "containment" could very well occupy several books. Nevertheless, there is not a great quantity of material which considers these issues from the point of view of a field social worker and so this study is an attempt to widen the perspective of therapeutic child care to the every day task of field social work with children.
This study is firmly located within the framework of practitioner social work research and in particular a "state of the art review", (Broad and Fletcher 1993). It uses two techniques, a wide-ranging literature review and some case study material, in an attempt to bring together theory and practice from an alternative perspective, that is, from the point of view of a field social worker. A state of the art review attempts to describe what is going on at a particular time in a particular situation and within a particular context. In this case it is important to look not only at the concepts of "holding" and "containment" but also at the context of field social work with children in care. The principal analysis of the material to be discussed is in the drawing together of the various themes connected with holding and containment, as seen from different perspectives and in other contexts, and applying them to the context of field social work with children.
Wood (1980) points out that the difficulty with this kind of research is balancing "practice wisdom" and "empirical knowledge". The main question therefore, which could be raised in respect of the conclusions to be drawn from this study, is how generally applicable are the conclusions to the task of field social work with children? The principal criticism is that the conclusions may be relative only to the particular case described or to my own professional situation. The subjective element of the views I describe is therefore important to consider. I cite two reasons for giving some consideration to the general validity of my views.
Firstly, the subjective experience of social work practitioners does not automatically rule out the validity of that experience. Part of the art of social work according to England (1986) is that the practitioner brings something of him/herself to the task. From a psycho-dynamic point of view, issues of transference and counter-transference for example, if they are recognised and understood, help to inform practice. It is impossible therefore to eliminate or ignore the subjective component of practice from the professional task of social work and the conclusions to be drawn from the experience of being a social worker. The key is to try to be as aware as possible of that subjective influence and to look at it objectively. To this extent, my experience and that of Bobbie in the case example in Chapter 4 have validity.
Secondly, in relation to the general applicability of the study, my view of the context in which social work exists and the nature of social work within that context is supported in large measure by several authors. From a multi-disciplinary viewpoint in relation to Community Care implementation, Hadley & Clough (1996) confirm a view of the nature of social work in the field and the way it has changed and developed into the early 1990's as a process whereby a person in need is not seen or provided for in a holistic way. Hadley’s and Clough’s conclusions draw on the reflections and experiences of practitioners from both of their own and their clients’ points of view. Their view is supported in a paper by Downes et al (1996) who propose a training method for helping practitioners maintain their capacity for concern with their clients in a hostile social work climate. The motivation for their paper is clearly a result of their workers’ experiences of finding it increasingly difficult to maintain such a capacity for concern.
From therapeutic community points of view Whitwell (1994), and Campling and Davies (1997) in a hard-hitting opinion piece, describe the difficulties for specialist therapeutic communities surviving in the current social care climate. Campling and Davies argue that the concept of welfarism, of working together for the benefit of the individual and for the common good has been severely eroded in recent years and this is why such communities have struggled to survive. The value of treating or helping the whole person in the manner practised by most therapeutic communities is under severe threat by external market forces and the thinking which provides only short-term solutions to life-long problems.
The perspectives I have cited above tend to confirm converging views of the state of the art. The relevance of these views to this study is that the processes of holding and containment appear to be increasingly under threat from external cultural and economic factors. This can only be to the detriment of children who need to be seen in holistic terms.
A further criticism, of course, is that I and these other writers could all be mistaken in our views. One of the arguments put forward by Cheetham et al (1992) in discussing social work research is that it is complex. There are many more variables than the two cited by Wood (1980) above. For example, the contexts in which similar issues are examined can lead to a wide range of differing findings. The theoretical material in this study is derived from a wide-ranging review of literature which includes previously published case study material from a variety of settings, many of which reflect individual or group therapy situations, and these are considered alongside my own case study material. Because of the difficulty in measuring interventions and outcomes exactly in a profession which is exposed to the influence of so many variables, Cheetham et al (op.cit.:60) argue that at best the outcome of social work research is likely to be an "informed assertion" rather than a "confirmed causation". I will present the conclusions of this report as just such an informed assertion.
Throughout the paper I have used both he/she interchangeably and the use of one should not be taken as necessarily excluding the other.
Chapter 1 is a brief summary of evolution in the nature of social work. The nature of social work has constantly changed since Winnicott wrote his paper "The Mentally Ill in your Caseload" in 1963 and from which the quotation at the beginning of this introduction comes. The change has been one of shift from welfare to child protection, or from one of promotion of well-being to one of reacting to an absence of the promotion of well-being. The chapter describes some of the changes to the wider context of social work in the last three decades and concludes with a description of the current context of social work with Children Looked After in the late 1990's. "Children Looked After" includes those who are subject to a Legal Order as well as those who are Accommodated. In old terminology, those who are "in care" and those who are in "voluntary care". This study concentrates on those for whom a return home is not a possibility. Included in this chapter is a discussion of institutional anxiety which is influenced by and in turn influences the capacity of individuals to hold and contain anxiety.
Chapter 2 examines the concept of "holding" and attempts to separate out ideas of restraint, physical holding, holding therapy, emotional holding and the holding environment.
Chapter 3 looks at the concept of "containment" in terms of boundaries and in terms of relationship and in the contexts of the individual, families and groups, and institutions.
Chapter 4 contains some specific case study material which describes Bobbie, a ten year old child in care, separated form her birth family and with no permanent substitute home base. As Bobbie’s social worker I describe some of the instances of holding and containment which I feel are relevant to Bobbie’ situation, as well as the difficulties of providing holding and containment in the face of organisational anxieties.
Chapter 5 draws together the conclusions from the previous chapters and examines some of the general relevance of the concepts of holding and containment to field work.
The importance of this study is that the work of social services departments has changed. This may also mean that the nature of social work has changed. If it has, then the important question to be answered is whether Winnicott's (1963) comparison of the social work task to that of infant care is still valid. The answer to this question has major implications for social work practice and for the training of social workers. Most importantly, it has profound implications for the therapeutic care of disturbed children, where that care takes place outside a therapeutic context.
One of the main reasons for including this overview of the context in which social work takes place is that sometimes the notions of "holding" and "containment" can seem the province of specialist therapeutic work existing in isolation. The concepts of holding and containment were first proposed by Winnicott (1960) and Bion (1962) respectively, in the early 1960's, a period when the notion of welfare was still largely predominant following the creation of the Welfare State in the post-war period. Today, the idea of welfare is not always at the forefront of social work as I will show below. I will give a brief summary of the main social, cultural and political influences on the evolution of the social work task and role. The end result will I hope serve to illustrate the context of social work with children in care and in which holding and containment might take place today in the late 1990’s and into the next century.
The problem of defining what social workers do has occupied many writers over many years. The anecdotal evidence gleaned from colleagues in my own department and from those in other organisations is that Social Work is not what it used to be. While representing something of a truism such a statement also often carries with it an implicit message that social work once existed in greener, more fertile fields and was somehow once a more enjoyable, rewarding job to do. A short historical review indicates why this might be so.
The Report Of The Care Of Children Committee in 1946 (The Curtis Report), recommended that the scope of public care of disadvantaged children should be extended. Hopkins (1996) argues that this recommendation contributed to a greater influence by the "hands-on" practitioner within a statutory service framework. That is, there was to be a greater emphasis on personal service to children in need of care.
At its inception, social work was seen as being primarily altruistic in nature. The social work task involved helping people cope with the problems of poverty and disadvantage in society. i.e., the task was one of welfare and this was embodied in the setting up of the Welfare State in the post-war years. Parton (1996) lists a number of assumptions which characterised "welfarism". These were:
the best mechanism for maximising welfare in society was the provision of universal social services by the state;
the social services were created for benevolent purposes - meeting social needs; compensating disadvantage; promoting social justice;
social welfare functions were seen as "ameliorative", "integrative" and "redistributive".
Parton continues,
"Social work, in its modern emergence in the context of welfarism, was imbued with a considerable optimism ... . Social problems could be overcome via the state intervention by professional experts with social-scientific knowledge and technical skills ... . There seemed a consensus that social work was a positive development for all in the context of 'welfarism' ... . It was to be an essentially benign but paternalistic relationship... . Interventions which had therapeutic intentions necessarily had therapeutic outcomes".
(Parton 1996: 8)
During the 1960's and 1970's a challenge to the post-war modernisation of social welfare provision began with efficient administration becoming a major preoccupation. Social work method was seen as an incidental part of the administrative process and social work began to evolve into something other than pure welfarism and away from the early ideas of personal service. Butrym (1976) wrote in the mid 1970's,
"... social work has been vested in recent years with increasing power and responsibility in the realm of containment, control and alleviation of some of the major problems facing contemporary society".
(Butrym 1976: viii)
According to Butrym, social work in the 1970's emerged as a sizable and important institution but one which also gave increasing voice to the dilemma between how much of the task was "care" and how much was "control". In attempting to provide some definition to the task of social work Butrym highlighted the confusion of "models" and "theories" in social work which perhaps contributed to a lack of clarity.
Butrym was arguing strongly then that there was a need for Social Workers to refuse to “acquiesce” or “accept service by rote or numbers” at the expense of quality.
"Professional accountability cannot operate if professional standards of practice are lacking, and unless social workers accept such accountability and therefore assert the needs for standards they can be no more than bureaucrats".
(Butrym 1976: 133)
While not dismissing the need for efficiency in organisation and management in certain contexts, Butrym felt that effective social work could not be delivered through the medium of bureaucracy. The task required individual responses to events, changes in which could not be regulated by prescribed rules, and such individual interventions were ultimately the responsibility of the practitioner. Butrym questioned the assumption that "social work" and "the work of Social Services Departments" are synonymous and this is an important distinction to bear in mind because it goes to the heart of the dilemma and tension which exists for present-day practitioners who operate within bureaucratic organisations and yet who wish to practise their profession in a client-centred way.
Bureaucratic organisations for example, tend to serve themselves rather than their clients. Kennard (1986) writes that organisations which adopt a bureaucratic model for managing change have as a basic aim the directing of staff action by explicit procedures rather than by members of the staff relying on their personal feelings and judgements. The rationale for this approach, writes Kennard, is that the lack of a uniform service delivery exposes individuals to questioning of their judgement. In the short term, introducing rules and regulations can provide clear boundaries and thereby reduce the individual's anxiety about poor or variable service delivery by the organisation. The disadvantage of the bureaucratic model however is that there is little scope for learning and increasing skills and effectiveness so that competence depends on having rules to follow. The uniform approach fails to take account of individual differences.
Hopkins (1996) identifies the 1980's as the beginning of a demise of psycho-analytic based casework. The personal problems of clients were reframed to be seen as a response to present rather than past circumstances.
It is worth commenting here that the notion of reframing can also be seen as a process of denial as well as one of recognition. For example, if one looks at a major organisational change, some may view the process as an opportunity while others will experience a loss. Those who are unwilling or unable to acknowledge the pain and anxiety of loss in others or in themselves and who reframe the idea of major change only in terms of new opportunities I will argue as being in a process of denial. Hadley and Clough (1996) in their study of a multi-disciplinary group of professionals dealing with the implementation of community care reforms describe the phenomenon of “reframing” by managers occurring for several of their interviewees, most of whom experienced the reframed view as being a more negative representation of what they did. Challenges to the new view tended to be ignored, dismissed or countered with threats, both real and perceived, to the worker's position or continuing employment.
Hopkins' (1996) view of the demise of modernism and social work is that by the 1980's ...
"No longer impressed by the quality of dispassionate intelligence, the conviction politicians pursued their own radical agendas. In these circumstances representations by liberal professional intellectuals were more likely to be counter-productive than helpful. Representations by social workers on behalf of client groups were dismissed as whinging".
(Hopkins 1996: 30)
In the early 1980's the Barclay Report (National Institute for Social Work 1982) set out to define the role and tasks of the social worker within the wide framework of total Social Services Departments' activity. Put extremely simply, the report's findings were once again something of a truism in identifying a need to be clear about the character and practice of social work. The Report concluded that the matters were considerably complex but nevertheless in need of reform, although different views were put forward as to the direction in which such reform should be developed. There was some agreement on the necessity of social workers being able to provide "counselling" or "social casework", i.e., an element of personal service; but there were diverging views on how this should be achieved, e.g., through a community-based or neighbourhood-based model, or through an alternative model which effectively split the task of social care provision from the task of social casework. It is this latter option which has won out over the other during the past fifteen years. However, in respect of future social work training one of the respondents to the report stressed that the nature of social work knowledge,
"... is concerned not just with a depth of understanding of a specialised and narrow area but with a comprehension of some of the ways in which different areas interact with and affect each other ... The objective in view is the acquisition of a synthesis of knowledge which approaches more closely the totality of the client in his situation than any narrower approach can do"
(NISW 1982: 35)
England (1986), writing in the mid 1980's proposed a different and more sophisticated approach by abandoning the idea that it was possible to arrive at some single, all inclusive, scientifically testable definition of social work.
"There is no fundamental sense ... in which these maligned definitions of social work are wrong, and no fundamental sense in which they have failed to achieve an available precision ... . Indeed, far from being wrong their breadth and scope contains the richness from which social work should draw its substantial creative strength".
(England 1986: 7)
England attempted to bring thinking back to the area of what social work meant from the individual client's perspective rather than from the organisational or structural perspective. He identified three fundamental components of social work; "coping", "meaning" and "understanding". "Coping", according to England is the balancing of material help with practical assistance in the social work role and the making of judgements about how to best help the client with "not coping" in a given set of unique circumstances. In this sense the social work role is bureaucratic function plus personal service. But, the role is also about "meaning", the response the client makes to his or her experience and the meaning he or she gives to it.
An account of the task of social work, wrote England, must be,
based upon an account of perception, for social work is based upon the meaning people give to their experience;
always concerned not with problems per se, but with people's capacity to cope with problems. Social work is a personal service;
always to understand the meaning of experience and to communicate that understanding.
(England 1996: 17-21)
"Understanding" requires the use of empathy and a "client-centred approach", (Rogers 1951). The characteristics of understanding in social work include experience and related experience, the ability to communicate the understanding of meaning and intuition.
It is worth following England's ideas a little further because in my view he accurately predicts the direction in which social work has developed into the 1990's. The social worker, he wrote, needs to act purposefully and yet remain personally disinterested.
"In other words, helping in social work is not a different kind of activity, but the worker has to do deliberately and with maximum effect what others may do spontaneously and without responsibility ... . To do social work is to do purposefully and deliberately that which is primarily intuitive".
(England 1986: 38-9)
However, the intuitive, subjective nature of social work practice is often either denied or minimised and is not seen as the basis of the social work profession's knowledge and skills. The failure to recognise these attributes affects significantly the practice and structure of social service delivery because social workers' experiences are not validated and so that experience is not perceived to exist. In conclusion, England wrote that low morale resulted from the "schizoid conflict" between the different social work roles. That is, between the delivery of personal care using intuition, empathy and understanding, and the function of acting as the agent of an impersonal organisation making judgements and decisions and constantly being driven towards "positivist goals", (England 1986:59).
In the 1990's the drive towards positivist goals proceeds apace. Social workers find themselves acting more and more as the agents of impersonal organisations in areas of control such as the supervision of those with mental health problems who are now cared for in the community; the inspection and registration of homes for both young and old; and the protection of children who are likely to suffer, or who are actually suffering, significant harm.
Howe (1996) believes that the process has become one of "surface" rather than "depth". By this he means that shifts in politics and culture have led many social work theories and practices to become more analytically shallow and increasingly performance orientated. Howe says that the evolution of history means that contemporary society has become characterised by, "a strange mix of freedom and control; liberty and discipline; knowledge and responsibility", (ibid.: 78), and that social workers as a result switch from responding to the actor, to responding to the act. That is, a shallow, surface perspective - what the client/service-user does rather than why. At its extreme, writes Howe, clients will arrive without a history. It is what presents now that matters, not what went before.
Finally, of social work in the market place Howe concludes that the change of language and terminology affects the ways in which people think and act. The meaning ascribed to events and social work interventions begins to alter and by implication so does the reality perceived.
"Relationships between social workers and clients change their character from interpersonal to economic, from therapeutic to transactional, from nurturing and supportive to contracted and service-orientated. The relationship becomes a vehicle for market place dealings"
(Howe 1996: 93)
Paradoxically, despite the fundamental premise of the Children Act 1989 that there should be greater partnership between social services departments and families, local authority statutory social work with children in the 1990's has become much more of a social monitoring and policing function. In the field of social work with children Otway (1996) argues that the focus has shifted from one of child welfare to one of child protection.
In addition to the cultural, economic and political perspectives of the changes which have taken place in social work, there are academic and practitioner perspectives. These views include expressions of dissatisfaction with a perceived decline in social workers' knowledge of psychodynamic theory, (e.g. Kerr 1991; Payne 1992; Cohen 1995) with an accompanying loss of knowledge of valuable therapeutic tools for working with children. Others question changes in social work training (e.g. Trevillion and Beresford 1996; Clapton 1996) as both cause and consequence of such a decline of in-depth social work.
The introduction of the Looking After Children (LAC) documentation (Parker et al 1991) had three aims. Firstly, the measurement of outcomes for children Looked After. Secondly, the raising of local authority social workers' consciousness about areas of children's development. For example, see Stein (1997:51) in respect of educational outcomes for young people leaving care which are generally much poorer than for comparable groups of young people in the population who have not been in care. A third aim was the improvement of working partnerships with children, families and carers, (Parker et al 1991:137).
The lives of children in care are often characterised by disruptive experiences and lack of continuity. Parker et al (1991) advocated the use of the LAC scheme as a method of ensuring that what ever the disruption in the child's life, a level of continuity in the quality of care provided could be maintained.
"Perhaps its greatest advantage will be its ability to break down the complicated task of bringing up a child into a series of practical steps that can be undertaken at the appropriate times by whoever is acting as the primary carer, and regardless of other complications that may arise. Such an approach emphasises that outcomes in child care involve more than the resolution of placement difficulties, and enables active work to continue at all times".
(Parker et al 1991: 138)
I believe there are two fundamental faults in the proposal when it is applied to children in care. The idea of partnership with families and the idea of returning children who are accommodated to their families as soon as is possible are commendable and many of the LAC forms are geared towards this end-point in the short-term. However, for children in care long-term I think the proposal fails to take account of the importance of continuity and stability in relationships. I believe that the only effective way active and continuing work can take place with a child over a life-time of growing up is if one person holds their interests in mind. For example, Copley and Forryan (1987) in discussing the need for containment for children write,
“Children in care, or in a series of foster homes, need to find one adult who is able to set aside the need to take decisions or to find practical solutions, in order to talk to the child”.
(Copley & Forryan 1987: 18)
Not only is this need reflected in the protests of children who are required to move from foster placement to foster placement, it is also reflected in the wish of care leavers to have a single point of contact when they leave care. i.e., one person who can be concerned with their needs, (see Stein 1997; DoH 1997). For the child who experiences many moves in care there is in my view a fundamental need to link all of the practical steps proposed by Parker et al (op.cit.) together.
Secondly, the validity of the outcome measurements have been seriously challenged when those outcomes are seen in isolation from other important measurements.
"To raise professional or provider outcomes to a status above those of the child or family seems to put 'cart policy and design' before the horse".
(Huxley 1994:121)
I think the LAC scheme is in some respects a product of the shallowness, the denial by reframing and minimisation, and the drive towards positivist outcomes which I have discussed throughout this chapter. In particular the LAC Assessment and Action Records (Department of Health 1995) have the effect of reducing the social work task with children in care to the lowest common denominator. The outcomes measured are meaningless unless comparison is made on an ongoing basis with children who are not in care. A uniform approach it may be, but without the accompanying knowledge of how to adapt it to the individual it will be of limited use as Kennard (1986) predicted (see p.14). The task becomes one of ticking boxes and outcomes are a measurement of who has most diligently ticked the boxes rather than one of forming the continuity of a long lasting developmental relationship with a child. Entering into a conversation with the child in order to answer the questions on the Assessment and Action Record as the introductory notes on the form would urge does not in itself provide a child with holding or foster the development of a sense of self-containment.
The task of social work becomes depersonalised and the child ceases to be held, borne in mind or even remembered. All of the organisational anxiety about "corporate parenting" and the child's emotional pain becomes denied. Menzies Lyth (1959) writing over thirty years ago warned of the possible dangers of failing to recognise and work with institutional anxiety and defence mechanisms. Cohen (1995) writing only two years ago despairs of the failure to hold on to such valuable knowledge.
The implications for children looked after long term are considerable. The effect will be their increasing marginalisation in the battle for time and resources between child protection and child welfare.
In this context, for the relatively small but ever present numbers of children who are not able to live within their own families for what ever reason and who are the responsibility of local authorities long-term who must “corporately” parent them, the task of holding these children and providing them with containment is ever more necessary. The children who start life with failed parental relationships, and who then go on to suffer the absence of stable relationships with one social worker or one foster carer are those most in need of holding and containment as they are unlikely to have any relationship with which to anchor them in life.
The same can be said of social workers. A colleague described to me how when she first entered social work twenty years ago she had felt in tune with and connected to both the organisation (a local authority social services department) and to the task (child care). As time passed she said, she had become disconnected from the organisation but had remained in tune with the task. Most recently however in the light of the introduction of the LAC forms and the possibility of being made redundant because of reorganisation she felt disconnected from both the organisation and the task. She felt neither held nor wanted. Reorganisation has resulted in a fifth change of team manager in five years for both of us. The culture of rapid change has become not only one of constant and frequent change for children but one of constant and frequent change for social workers.
The concept of care for the new millennium promises even less with local authorities probably being limited to planning, purchasing and regulating services. It is hard to envisage what a child may make of a worker with whom he or she has only a surface relationship. Paradoxically it is for the child that history is most important because the child growing up without the continuity and links between experiences and life events which a relationship can provide is likely to have a poor concept of his history.
The phenomenon of institutional anxiety is relevant to this discussion because it hampers the processes of holding and containment. Much has been written about it already, most notably by Menzies Lyth (1959). In her classic study Menzies Lyth writes,
"In developing a structure, culture and mode of functioning, a social organisation is influenced by a number of interacting factors, crucial among which are its primary task, including such environmental relationships and pressures as that involves; the technologies available for performing the task; and the needs of the members of the organisation for social and psychological satisfaction and, above all, for support in the task of dealing with anxiety."
(Menzies Lyth 1959: 50)
Menzies Lyth goes on to say that a socially structured defence system is created over time as a result of unconscious collusion and agreement by members of the organisation. The defence mechanisms become a reality in the sense that the way in which the organisation operates requires both old and new members of that organisation to come to terms with the existence of the mechanisms and to adopt their use. The systems of defence are thus perpetuated. In the context of the nursing service in a teaching hospital which she studied Menzies Lyth identified a number of social defences against anxiety among which were the "splitting of the nurse-patient relationship" and "depersonalisation, categorisation, and the denial of the significance of the individual". These and the further examples she gives can be seen in other organisations.
In social services one can see the splitting of the tasks of “assessment of need” from the tasks of “provision of services to meet those needs” and hence a fragmentation of relationships. In Chapter 4 I describe how it is possible for me to assess one of Bobbie’s needs as being transport to and from school and of how it is possible for me to arrange to have that need met by someone else. I took the view however that the need was not only one of physical transport which could be met by the ordering of a taxi, but it was also one of emotional carrying which could only be met by the provision of a reliable relationship.
In the same way one can observe depersonalisation and categorisation in the language used. I always feel somewhat uneasy about the phrase "holding a case" and there is I believe a subtle difference between "holding a case" and "holding a child". As a social worker, in the first situation, you might have the image of being confronted by a desk with a large and bulging file, perhaps many such files sitting on it, as I was with Bobbie and her sisters. In the second situation you might have the image of cradling a child, holding a child's hand, teaching them to swim or to ride a bicycle. The distance which is placed between thinking about a case as a child, as a human being, and the immediate image of work involving paper and other inanimate objects and tasks is part of the organisational defence against experiencing and working with the pain and anxiety of the person involved, as described by Menzies Lyth (1959). Thus, in my social work example, referring to cases rather than to children both depersonalises and puts emotional distance between worker and child in a subtle way. Such a defence is perpetuated if social workers in organisations use "cases" rather than "children" as the common currency of language
Finally, the denial of the significance of the individual is perpetuated by a process which takes a shallow rather than an in-depth view of things. The primary task of the social services departments is no longer to hold and contain, i.e., to facilitate maturational processes and to promote growth and development. The emphasis is not on welfare but on protection from absence of the promotion of welfare. Downes et al (1996) write,
"In the days of more liberal provision [the psychodynamic perspective] reminded us that the very provision of material help could be used defensively to avoid the social worker having to bear with the client's unmet emotional need. In the culture of purchaser/provider it again points up the potential defensiveness of thinking about people in profound emotional distress as consumers."
(Downes et al 1996: 27)
Social work then has seen a shift from a culture of welfarism to one of consumerism and market-place exchanges. Relationships, feelings, anxieties are no longer openly the stuff of every day social work. Institutional anxiety and its accompanying defence mechanisms get in the way of working with the individual.
So what happens to these aspects of the work for children who have not experienced relationships of any duration or stability? How can their anxiety be held and contained? The next two chapters examine the issues of holding and containment.
Taking a purely semantic look at the word "holding" it is immediately apparent that it can mean many different things. Chambers Twentieth Century Dictionary lists over thirty different meanings including, for example, keeping, defending, asserting and continuing unbroken. The Oxford English Dictionary provides definitions such as restraining and maintaining an attachment to. Many of these words and phrases occur in examples of the nature of holding throughout this study and in the work of others.
Initially, when considering this study, I asked two or three of my social work colleagues informally what they thought was meant by "holding". Often the reply was something like, "What do you mean? Do you mean physically holding someone, like restraining them or do you mean emotional holding?" It is possible of course in the physical sense for "holding" to mean "hugging" or "embracing" or "cradling" for example, as well as "restraining". My guess is that within social work many social workers are concerned about issues of physical restraint in respect of the children for whom they are responsible even if they are not directly involved in physically restraining children themselves. The modern social work culture, as I have described in the previous chapter, is one concerned more with issues of control rather than with nurture. This hypothesis, together with recent and well-publicised scandals surrounding the physical ill-treatment of children in care, (e.g., Levy and Kahan 1990), may be why the idea of restraint featured so prominently in my colleagues’ replies. As a consequence of such scandals the issue of physical restraint of children in care is one which is rightly more clearly surrounded by rules and regulations and therefore I suspect workers are more aware of the issue.
I was interested that my colleagues perceived a difference however between physical and emotional holding, but in order to differentiate the two meanings, most of my respondents had to preface the word "holding" with the word "emotional". In an emotional sense "holding" may mean "thinking about", "remembering", "being concerned with", "listening to", "being preoccupied with" or "knowing" a child.
If the idea of a shift from in-depth to surface knowledge of a child as described in the previous chapter is accepted, one is perhaps less likely to immediately think of the child in the context of his or her life history. That is, having a notion of holding together the thread of individual events and transient relationships which, when connected together, make up that child's experience of life, of being valued, wanted and known about not only in the context of now but in the context of what has gone before and what might come in the future. The idea of having shared experiences with a child, of having gone through those experiences with a child so that they are held in a context for both adult and child is vital to the formation of the child's (and the adult's) sense of value and identity. These latter ideas are based on the work of Donald Winnicott and I will briefly summarise Winnicott's work before looking at physical and emotional holding.
The concept of holding was first described by Winnicott (1960) in his paper The Theory of the Parent-Infant Relationship. He wrote,
"Holding:
Protects from physiological insult.
Takes account of the infant's skin sensitivity - touch, temperature, auditory sensitivity, visual sensitivity, sensitivity of falling (action of gravity) and of the infants lack of knowledge of the existence of anything other than the self.
It includes the whole routine of care throughout the day and night, and it is not the same with any two infants because it is part of the infant, and no two infants are alike.
Also it follows the minute day-to-day changes belonging to the infant's growth and development, both physical and psychological".
(Winnicott 1960: 49)
Davis & Wallbridge (1981) write that the function of holding in psychological terms is to provide ego-support, especially before the child has developed sufficient ego-strength of its own or the ego has reached a state of "integration". That is, the child has developed a sense of "me" and "not me" and thereby a sense of his or her own identity as a distinct personality from everyone else. They go on to write (ibid.: 97) that reliable holding has to be a feature of the environment if the "line of life" is not to be disrupted. By this "line of life" they mean that the course of normal emotional development should not be arrested or distorted.
Holding in the sense of physical restraint is not the primary subject of this study and discussion of this issue can be found elsewhere. (e.g., Department of Health 1991a, 1991b, 1993; British Association of Social Workers 1993; Youdan 1994). Nevertheless, there are some links to be made between the communication of a sense of being emotionally held and the expression of that communication in a physical way.
For example, there are links between physical restraint and therapeutic child care. Winnicott (1960) identified the area of overlap between physical and emotional holding. Firstly, in the context of ordinary parenting,
"Holding includes especially the physical holding of the infant which is a form of loving. It is perhaps the only way in which a mother can show the infant her love. There are those who can hold an infant and those who cannot; the latter quickly produce in the infant a sense of insecurity, and distressed crying".
(Winnicott 1960: 49)
Secondly, in a professional context and in a slightly different sense,
'A correct and well-timed interpretation in an analytic treatment gives a sense of being held physically that is more real (to the non-psychotic) than if a real holding or nursing had taken place. Understanding goes deeper and by understanding, shown by the use of language, the analyst holds physically in the past, that is, at the time of the need to be held, when love meant physical care and adaptation."
(Winnicott 1988: 61)
Winnicott went to great lengths to explain his theory of holding in terms of it being a normal rather than exceptional process. i.e., the ordinary mother doing what comes naturally in being preoccupied with and caring for her infant’s needs. His series of radio talks encapsulated in his book The Child, the Family, and the Outside World (1964) illustrates this. A child may need to be physically held when in distress and the child himself may solicit holding and comfort by the parent in such circumstances.
For some disturbed children however, being physically held may be experienced as persecution or attack and simply recall previous abusive experiences. For adults, especially those acting in a professional capacity, the danger and fear of normal physical touching being misconstrued as abusive is an increasing risk and yet physical touch is essential for healthy development, (Ward 1990).
In particular, in the case of severely deprived and emotionally disturbed children in panic states there may be limited cases where physical holding in the sense of restraint is necessary but where it also requires careful, considered and limited use. (e.g., see Dockar-Drysdale 1981; 1983). Physical holding in a therapeutic context can range from holding a child's hand to restraint using reasonable force. It can be a spontaneous act or a pre-determined course of action.
Holding Therapy, based on the attachment work of John Bowlby (Bowlby 1969), is an example of a pre-determined use of physical holding and although much more commonly used in the United States of America, (e.g., see Tinbergen & Tinbergen 1983; Welch 1988; Cline 1992), it is being introduced into the UK.
Three groups of children have been found to benefit from the use of Holding Therapy. Those suffering from autism; adopted children, especially where there are emotional and behavioural problems; and thirdly with children who have behavioural problems such as Reactive Attachment Disorder. All of these groups show some form of distortion or deficit in their attachments and abilities to relate socially with others.
Even in normal circumstances such as a temper tantrum or when the child is angry he may solicit holding from the parent but then push the parent away when the parent approaches. This can create a dilemma for parents who wonder whether to hold the child or let him be. In Holding Therapy, and despite the child’s protests, the parent will hold the child closely but not aggressively until the child is calm again. The holding can be “scheduled”, i.e., provided at a time determined by the parent, or “unscheduled” in response to a behavioural outburst. The aims of Holding Therapy are firstly, an improvement of the security of attachment between an insecurely attached child and his or her parent and secondly, the containment of temper outbursts or disruption in a positive manner. Achieving the latter may in itself promote the former. The therapy is designed for use by parents or long-term carers, as its use by therapists on a short-term basis may be counter-productive for the child when the therapist has to leave for example and attachments are broken.
The idea of "holding" in an emotional sense tends to be used much more by professionals and in professional contexts where work/treatment/therapy is taking place with patients/disturbed children, etc.
Greenhalgh (1994) provides a description of emotional holding in his educational work with disturbed children and young people and summarises his view of emotional holding thus,
"... difficult, distressing and intense feelings can impede and get in the way of learning. The way in which we respond to such feelings is crucial for emotional growth and increasing children's capacity for learning. The concept of 'emotional holding' relates to the way in which we might pay attention to these difficult feelings... . Emotional holding is the holding and containment of disturbing feelings which are inhibiting the capacity for relationship, emotional growth, and learning; it involves demonstrating that distressing feelings can be tolerated, helping children to manage feelings , think about them and understand some of their meaning. Such holding is crucial to development: if I had to use one phrase to describe the most significant aspect of my own work with troubled children, it would be 'providing emotional holding' ".
(Greenhalgh 1994: 107)
In essence, Greenhalgh says, this means the adults participate in a process whereby the anxiety engendered by the child's disturbed or disturbing feelings is held and contained by the adult until the child is able to “hold and contain” those feelings for him/herself. Greenhalgh’s description provides a typical example of the dual use of ideas of holding and containment. In this context “contain” could mean “keep hold of”.
The characteristics of the process of emotional holding identified by Greenhalgh include providing a well-bounded container in which anxiety is contained while allowing some opportunity for autonomy; "consideration of immediate responses to projections", in other words counting to ten before reacting. This in itself demonstrates to the child that difficult feelings can be tolerated and understood. Lastly, it includes feeding back to the child empathically and non-judgmentally feelings of which the child might not be aware.
Greenhalgh gives many practical examples of putting emotional holding into use within the teaching and classroom contexts. Most importantly the process of emotional holding can only take place within a relationship with the child. He writes,
"Adults provide emotional holding through their relationships with children by making a well-bounded container for 'boundaryless' individuals, to create a meaningful space for all concerned".
(Greenhalgh 1994: 137)
Adequate holding requires the management of experiences which are part of a child's life in such a way as to ensure the child's passage through these experiences occurs without trauma. So, for example, ensuring that experiences have a beginning, a middle, an end and are complete, take account of both gains and losses and can be thought about, talked about and tolerated are essential aspects of holding. For the child, holding in this sense may be required at different times throughout life. As an infant a great deal of holding is necessary in order to facilitate healthy emotional development but even into adulthood at times of great psychological stress a level of holding or ego-support may be required. Holding in this context exists in both the psychological experience of the child and his or her main care-giver and the capacity of the carer to empathise is a vital component of effective holding.
A further important aspect of emotional holding is the provision of a "holding environment" according to Greenhalgh and a number of descriptions of the "holding environment" exist.
Shapiro and Carr identify two fundamental characteristics of the holding environment: "empathic interpretation and the tolerance and containment of aggression and sexuality", (Shapiro and Carr 1991:35-36). Empathy provides the child with affirmation of his or her sense of positive being while containment allows the child to discover that impulses and actions motivated by aggression and sexuality do not have to be destructive but can be managed. Shapiro and Carr add that the use of the term 'environment' directs us to think of the family as an open system rather than as a collection of individuals functioning in isolation, i.e., to consider relationships and interpersonal dynamics. Boundaries too are important and are seen as a developmental achievement arising out of and in addition to the mother-child relationship,
"The young child's parents provide the external family boundary. This boundary is not just a protective one designed to secure the family from intrusion. It is also an identity boundary comparable to the personal boundary of the young child. The development of individual and family boundaries allows sufficient self-identification to be able to negotiated - with others within the family and with the family's external world".
(Shapiro and Carr 1991: 37)
Stamm (1985) describes the "holding environment" in a hospital setting for children and adolescents. The main features picked out are once again empathy and containment and again within the context of a relationship between individual care worker and patient or between the care team and patient.
"The holding environment is not a therapeutic technique or process done to he patients by the staff. Rather it is an ambience or climate that the unit seeks to maintain. It contains a balance of qualities.
(Stamm 1985: 222)
Greenhalgh (op.cit.) describes the qualities and characteristics of a holding environment thus,
"In a holding environment the adults have the capacities to hold the anxieties aroused in themselves. There is a reliable provision of trust and affirmation, and stability of emotional climate ... . In providing a holding environment the adult strives to be reliable, to be attentive and sympathetically responsive to the child's explorations, and to see and feel the world through the child's eyes - to be empathic.
(Greenhalgh 1994: 108)
Stapley (1996) differentiates between the external holding environment which includes the formal, imposed or adopted sociological structures of an organisation and the internalised holding environment which each individual forms based on early psychological experiences. In one sense Stapley refines Stamm’s (op.cit.) point in arguing that while the holding environment influences the culture it is not the culture itself. The culture arises from the interactions individuals make with the holding environment, (Stapley 1996:39).
Physical holding has negative and positive connotations. It can be both "restraining" and "loving" and it is necessary for both control and nurture. In its restrictive sense holding is perhaps more about limitation. In its supportive sense it is more about emotional growth and development.
Emotional holding carries with it a slightly more receptive meaning, a reaching out by way of "bearing in mind", "remembering" or "being preoccupied with". In this sense it is about maintaining the line of life in an emotional, psychological sense rather than in a medical or physiological sense.
The holding environment involves the exercise of emotional holding not necessarily by one person but by a group, as in a school, a residential setting or a family. It is not a process but a culture in which empathy for and tolerance of aggressive and anxious feelings exists. It has boundaries which contribute to the formation of both individual and group identity as well as to the emotional and physical safety of those who inhabit that culture. Both emotional holding and the holding environment exploit, in a benevolent sense, the relationship between helper and helped.
However, all three of the above distinctions offer some form of protection from physiological insult, and in this sense they all involve the idea of containment which is the subject of the next chapter.
What does “containment” mean and why use this word as an alternative to or in conjunction with "holding"?
Chambers Twentieth Century Dictionary offers the following definition of containment: act or policy of preventing the spread beyond certain limits of a power or influence regarded as hostile, by means other than war. The Oxford English Dictionary suggests, holding (!), restraint, the action of preventing a hostile force etc. from expanding into other areas. In considering these definitions of the word it is apparent that most indicate some form of limitation or boundary. It is for this reason, I believe, that containment is more readily thought of in terms of physical boundaries (walls, fences, etc.) or in terms of proscribed behaviours or activities (rules, regulations, controls, etc.), than in other terms.
Instances of these uses of containment and probably their more common usage in residential social work with children for example, are those of setting boundaries (rules) around activities and behaviours, or of restricting liberty in the case of detention in secure units. Brookes (1991), however, identifies a similar limited view of containment in the worker-client relationship where she writes,
"It can refer to the necessity of firm and reliable boundaries to the relationship, and the need for a clear definition of the nature of the work in the mind of the helping professional. This sense of containment is only loosely linked to Bion's usage of the term, and has more to do with Winnicott's concept of a reliable and resilient enough 'holding environment' ... ".
(Brookes 1991: 137)
However, these are practical but limited uses of containment and it is not necessarily helpful to think of containment in such concrete ways. They do not convey the idea of a "relationship" which Bion (1962) proposed. In particular, Bion (1970) described a relationship between a "container" and that which was "contained" within the container.
Britton (1992) writes of how Bion saw the 'container-contained' relationship as pre-determined. That is, the first expression of this relationship was in the mother/infant relationship and its influence affected all subsequent situations.
"... the mother if she was receptive to the infant's state of mind and capable of allowing it to be evoked in herself, could process it in such a way that in an identifiable form she could attend to it in the infant".
(Britton 1992: 105)
In other words the parent was able to receive the projected anxieties, feelings and emotions of the child, tolerate them and communicate to the child that those feelings were able to be tolerated by the child himself. Bion's work was originally directed at the world of psychoanalysis. Britton argues that the benefit for psychoanalysis of Bion's work was, "... his notion of the transformation of experience through a process of 'containment', (Britton 1992:105). Britton describes how Bion thought that his patient,
“...took steps to give effect to his phantasy - e.g., that it was not the patient who was afraid, angry, helpless, despairing, impotent, or whatever, but that it was the analyst who should experience himself in that way ...".
(ibid.: 105)
A personal experience of this theory is that in the course of working on this paper, my newborn son at five weeks old went through a phase of crying, screaming and being generally very unhappy. I can remember feeling equally tired, angry, depressed and at times impotent in terms of dealing with those feelings in my son such that I could not tolerate those feelings in myself or help him with his. My inability at that moment to tolerate my son’s distress can be seen as a failure of containment.
Collie (1996) provides a similar account of projective identification and the containment of such projected feelings by workers in residential therapeutic settings with adolescents.
Britton (1992) utilises the word sanctuary to convey the idea of the "container" and the word meaning to represent that which is "contained".
Citing Bion (1962), Britton says,
"The 'contained' gives meaning to the context which contains it. The 'container' on the other hand gives shape and secure boundaries to that which it enshrines".
(Britton 1992: 104)
In this context there is a link with the task of social work. For example, England (1986) proposes in his view of the nature of social work cited in Chapter 1 that the social worker aims to understand the meaning of a person's experience and to communicate that understanding to the client. Britton, citing Bion's own description of work with a patient says,
"Meaning was felt by my patient to be something which would provide a desperately needed coherence to her thoughts, whose disconnectedness persecuted her"
(Britton 1992:103)
He goes on to say that if sanctuary is missing, i.e., there is no safety or security, then the patient has a sense of "falling for ever" or "that there is no floor to the world". If meaning is lost then there is internal fragmentation and incoherence. Clearly this is an image without limitation or boundary.
Britton describes two forms of the container-contained relationship. A 'symbiotic' relationship between the container and the contained leads to a mutually enhancing development of personality from new experiences. A 'parasitic' relationship means that the container is disrupted by new experience. i.e., the sense of continuity is disintegrated and subjectively experienced as fragmentation. So, Britton argues, in this second case in order to preserve some sense of continuity, "... all change must be resisted and no new experience allowed to emerge". (Britton 1992:112). An example of this phenomenon is that of Bobbie’s defensiveness against new experiences described in Chapter 4.
The result of such resistance Britton writes can be one of two 'catastrophic' alternatives - incarceration or fragmentation. The foregoing describes a “persecutory view” of containment. The alternative is an “ideal fit between container and contained”, i.e., perfect understanding.
Finally Britton writes, in reality there is tension between the container and the contained within ourselves, within our families, and within our institutions. This is what we live with. With reference to these three areas identified by Britton (ibid.:112) and using examples which move from the psycho-therapeutic to the social work context I will illustrate some of the relevance of containment to social work.
Schneider (1996) describes the arrival of a new patient with a 'borderline personality disorder' to a psychotherapy group. Schneider takes the view that the presence of a borderline patient can be both threatening and potentially helpful to the group. Threatening, in the sense that the borderline patient slows down the process of integration within the group and also often acts out what the more heavily defended patients feel but cannot express. Helpful, in the sense that the presence of the borderline patient may enhance the emotional feeling content and expression within the group by raising tensions and demands. All of these processes contribute to a raising of anxiety levels which can lead to patients leaving the group and therefore the disintegration of the group. Thus, the need for the group facilitator to manage these potentially disintegrating factors becomes crucial to the success of the group. Schneider describes how she needed to maintain a role as active leader of the group for a considerable length of time before the group was able to feel secure. She writes,
"This was done in order to contain and hold both group and borderline patient until such time as both felt sufficiently secure ... . (The) process whereby the group acts as the container did not come into play until much later. It was therefore left to me to provide the containing function during the first year".
(Schneider 1996: 128-129)
Throughout her paper, Schneider uses the terms "holding" and "containment" together. However, it is clear that she feels she performed a more containing function in the early stages of conducting the group and exercised a more holding function later on as the group began to contain its own anxieties. In ending her paper Schneider describes the establishment of a 'therapeutic environment' through a process of holding.
"Winnicott's (1960) theory of the parent-infant relationship offered me a framework in which to understand the consequences of my borderline patient's early childhood experiences and helped me to provide a corrective experience. His concept of holding enabled me to understand the need to create a safe environment, during the early phases, such that the group and the borderline patient can be held long enough for them to reach a point where they can take over the therapeutic containing functions".
(Schneider 1996: 133)
From this account, the containment which Schneider writes about was something she contributed from within her own individual resources at the beginning. Later the containment offered by the group for itself was much nearer to the idea of the holding environment described in the previous chapter. The initial process required establishing and sustaining relationships with the patient and the group.
Two papers illustrate the use of containment in work with families. Brookes (1991) writes about the use of containment in marital work and Johns (1995) writes about child protection work involving containment. In the first example containment appears to be more about the containment of destructive forces from within, while the second example is rather more containment in the sense of protection from external destructive forces. In both cases however the idea is one of an open system at work as was described by Shapiro and Carr (1991) in the previous chapter.
Brookes (1991) has written about her experience of Bion's (1970) concept of 'containment' and the 'container-contained' relationship in marital therapy. In her introduction Brookes describes a couple for whom,
"... their marriage was no longer working for them as a container in Bion's sense, and they wanted it held and thought about in the therapeutic container of marital work".
(Brookes 1991: 133)
Brookes goes on to say that there is a clear analogy between marriage and Bion's 'container-contained' relationship and she discusses the phenomena of "unconscious fit" and "shared fantasy" in the marriage relationship. In the first case, that of "unconscious fit", these are the attributes of the partner which match a need in the other partner but of which neither partner is consciously aware. In the second case, "shared fantasy", both partners perceive a particular attribute in the other which they believe will work well together for them. Both phenomena can exist side by side and each partner is seen as being able to contain and tolerate if not also modify destructive feelings in the other.
"Marriage ... can be a 'commensal' relationship in which both participants grow emotionally. Neither partner, but the marriage, the relationship between two partners, is seen as 'the container', which may, or may not have transformational qualities".
(Brookes 1991: 138)
However, if the unconscious fit and the shared fantasy fail to satisfy each of the partner’s expectations, anxieties result and the marriage relationship fails to contain those anxieties. Both partners can project destructive feelings into the other, as an infant may do with its mother, but in this case they are intolerable feelings. These ideas link with Bion’s concept of a “symbiotic” and a “parasitic” containing relationship.
In the second example of containment in family work Johns (1995) describes the case of a client with whom she was involved because of child protection concerns. Elsa, a young mother with four children under six, resented the concerns expressed by other parents in the neighbourhood about her care of her children. Elsa saw the expression of these concerns as "intrusions" into her life. She believed that her children should be allowed to grow up without any "interference" by their parents. In other words she had what Johns calls a laissez-faire approach to childrearing. Although Elsa's care of her youngest child was always felt to be "good enough" Elsa appeared to "switch off" from her older children when they started to exercise independence of thought and action. She also "switched off" from professionals who had tried to work with her on this problem, which they felt was contributing to neglect of the children and on several occasions exposing them to physical danger because of a lack of supervision and safety. An alternative to the notion of “switching off” might be that of “letting go” in an emotional sense.
"While Elsa appeared to 'hold' or 'contain' her babies, both physically and emotionally, during their early infancy, it seemed that as soon as they began to separate they were, in effect, dropped from her mind. This led to the situation in which they explored the environment without adequate supervision and were exposed to dangers. What for me was most perplexing was how and why Elsa suddenly stopped holding her children in her mind and became apparently oblivious to their needs for safety and containment".
(Johns 1995: 35)
Elsa's capacity to offer containment to her children was seen as being the result of her own emotional fragility and the lack of external family support. The lack of external supports merely reflected her lack of emotional resilience internally.
Applying the theory to the worker-parent relationship in this case Johns asserts that what Elsa clearly required was what Winnicott called 'holding' and what Bion called 'containment' in order that she might develop these capacities more effectively for her own children. However, Elsa appeared to have as much difficulty in allowing herself to be held as she did in holding her own children in mind and her ambivalence about the role of the social worker as a helper persisted. Elsa's level of trust in the social worker as a potential helper rather than a persecutor was built up only after a considerable length of time. In the end a sufficient change was established by Elsa to the extent that she could accept some support and so begin to support and protect her own children sufficiently.
Like Schneider (op.cit.) Johns argues that the change in Elsa arose from the long-term relationship she had established with Elsa, which provided her with containment. The relationship enabled Elsa to introject a benign sense of being helped rather than one of complete abandonment (falling for ever) or total intrusion (fragmentation).
Two papers look at the issue of containment within institutional settings. Parker (1989) describes the use of containment in a residential setting while Downes at al (1996) look at containment in the context of social work and training.
Parker (1989) uses the word "asylum" to describe the environment created in one therapeutic community for children, (New Barns). In its original sense “asylum” meant a place of refuge and protection from the external world and one can compare this with Britton's (1992) use of the word "sanctuary" which may represent more an idea of refuge than of active protection. Both, however, are similar. In the context of residential child care Parker focuses on containment in the sense of boundary setting as well as in the context of helping others contain anxiety and this aspect of containment he writes, is much nearer to the protective "father role" idea of Winnicott (1950). Parker (op.cit.) also writes of the community providing "holding" for the staff as well as for the children and describes the therapeutic community as providing containment "in a real sense".
"By this I mean not only the capacity to deal with an outburst or an explosion from the child but also the day to day provision of 'containing' or 'holding' experiences for the child".
(Parker 1989: 15)
Once again, the difficulty with this description is that it does not really distinguish between "holding" and "containment". Parker also describes some of the children who come to the therapeutic community as being "uncontainable". I prefer the phrase "in need of containment" as "uncontainable" has a rather foreboding sense of finality about it, as if nothing will contain these children.
The aim of the paper by Downes et al (1996) is to examine the relevance of "holding" and "containment" to the maintenance of successful engagement by practitioners with their professional task, with their organisation as well as with their clients in the context of major organisational change. Like Hadley and Clough (1996), Downes et al describe similar feelings of loss and change, as experienced by social workers and care managers, resulting from the Community Care implementation within their social services department. Downes et al (op.cit.) describe the setting up of a training module to assist workers coping with these feelings from which they could learn and make use of in their practice. The necessity of using containment as a mechanism for refuge and protection is apparent in this short extract from their paper.
"The notion that local authorities are now open to external market forces and central government financial regulations means that restructuring has to take into account the management of external uncertainty, as well as interdependence of staff within social services. The purchaser/provider arrangement internally, and collaboration with health services and the private sector are clear examples of this."
(Downes et al 1996: 26)
This quotation seems to imply perceived threats from both inside and outside the organisation. The local authorities are described as being "open to external forces" and yet set around by increasing "central government regulations" but the end result is one of "uncertainty" for those concerned. The external attempts at containment of the care management task through rules and regulations appear to demand more attention than the needs of workers' anxieties to be contained by their organisations. Drawing once again on Britton’s (1992) analysis, the anxiety of workers stems from fragmentation and a lack of coherence. Meaning is lost.
One of the views put forward by Brookes (op.cit.) is that the use of containment in a social work setting very often does not take sufficient account of the effects of institutional anxiety in its execution and I have made reference to this in Chapter 1. The splitting of the task into assessing, purchasing and provision inevitably means that no one worker and no single organisation or department remains in contact with the whole of the client's experience. It is difficult to imagine how this might be experienced by a client and especially a child. For those in long term need the emotional needs become obscured or denied. The totality of the child's experience is fragmented and uncontained.
Containment in a loose, practical and superficial sense can be about physical boundaries (walls, fences, etc.) and it can mean boundary setting (rules, regulations, controls, etc.). Boundaries are important, especially for boundary-less people, but they tend to be inflexible things when compared with relationships. Damaged relationships can also be inflexible as in the case example of marital work given by Brookes (1991) but normal, healthy, stable and sustained relationships allow for flexibility, growth and change.
In a therapeutic context containment is about a relationship. A relationship between the container and the contained or between the helper and the helped or the healer and the sick. The idea of containment as an open, fluid system or as a holding environment gives greater emphasis to its potential to heal damaged people and damaged relationships by creating coherence and tolerance. The “sanctuary” or “asylum” offered by the relationship is not a physical structure nor a rigid modus operandi but a reliable, continuing and uninterrupted emotional relationship - a modus vivendi.
The story of Bobbie is included here in an attempt to bring together the conclusions from the preceding chapters and to relate them to a real situation of field social work with a child. This example is not unusual in my experience, nor is it one with a clearly identifiable successful or unsuccessful outcome. Indeed it is rather a snapshot of particular events, as to describe the full situation in the space available here would be difficult. It is an ongoing piece of long-term social work with a child in care and reflects the impact of certain individual, family and organisational aspects of social work, holding and containment on Bobbie. The work is not yet completed and the relationship has not ended. Names, dates and locations in this chapter have been considerably disguised to protect the identities of those concerned.
In reading Bobbie's history below it is easy to be highly critical of certain aspects of the situation. For example, in terms of the placement and social work decisions made, I am only able to relate with the benefit of hindsight and case records those events which took place prior to my own involvement and while some decisions may be worthy of criticism I am not aware of all the circumstances and personnel who were involved in determining those particular courses of action. It is important, however, to set the context and to describe some of the events leading up to the point at which I became involved with the children. My own decisions are also open to judgement. However, the issue here is not one of a "post-mortem", but one of examining the ideas of holding and containment in a complex social work situation.
Bobbie, aged ten, is the youngest of three sisters. At the age of three Bobbie was received into local authority care with her sisters following physical and sexual abuse and neglect by their father, with whom they had lived. Bobbie's mother had left the family home two years prior to Bobbie's reception into care, having also suffered physical and sexual abuse from the children's father. She had had very little direct contact with Bobbie since then and had moved away. Bobbie's father, after serving a prison sentence, disappeared. It will be readily apparent that even at this early stage Bobbie had not enjoyed the benefits of ordinary good enough parenting and by implication no effective holding or containment in the senses described by Winnicott (1960) and Bion (1962).
Bobbie spent the majority of her first two years in care in a temporary foster family with her sisters. After legal proceedings were concluded Bobbie and her sisters were made subjects of Care Orders and contact with both parents was terminated. At the age of five, Bobbie was placed for adoption with her sisters in an area of the country a long way from their family home origins.
Sadly, after only nine months, this placement ended abruptly when Bobbie was physically assaulted by one of the prospective adoptive parents. Bobbie and her sisters returned to their home area and entered into a series of foster placements, each of brief duration. Bobbie was separated from her sisters at this time and they were placed in different foster homes.
After a further four months, and following further legal proceedings, Bobbie returned to the original foster family with whom she had first lived when she was received into care. This placement was intended to be re-designated as a permanent family for Bobbie and her sisters.
Bobbie and her sisters were by all accounts quite difficult to manage, disruptive at school and extremely demanding at home. Schooling had been severely interrupted for all three children and all were the subjects of Statements of Special Educational Needs. After a further year in the foster placement Bobbie was again physically assaulted by the foster carer. "Over-chastisement" was the phrase used; however Bobbie and her sisters were removed from the foster home and placed in a further series of foster placements. This time Bobbie was placed with her middle sister and the elder sister was placed separately.
Five years after being received into Care at the age of eight, Bobbie had experienced twenty moves of home and changes of carer. Her sisters had fared no better. Despite various pieces of direct, time-limited therapeutic work having been undertaken, the effects of the original abuse and neglect in her birth family continued to dominate her life and behaviour and the lives of her sisters, These disturbed behaviours were compounded by the further abuse, moves and changes while in care. Bobbie had also had five different social workers during this time.
Bobbie was by now extremely emotionally traumatised. Furthermore, she was needy, demanding and difficult for the ordinary, good-enough, committed and well-meaning foster parent to cope with. As I assumed responsibility for Bobbie her placement was looking extremely unstable with the foster parents saying that they could not manage Bobbie and her sister together and that she should be found another placement.
I was aware when I was asked to take over responsibility for Bobbie and her sisters from a neighbouring social services team that the previous social worker had been on long-term sick leave. I was also made aware by that team's manager that the children had been somewhat "adrift" within the system because their welfare had been dealt with on an ad hoc basis by a series of different workers filling in for the absent social worker.
My first feeling on being given Bobbie and her sisters to “sort out” was one of absolute horror. I was confronted in practical terms before I had even met Bobbie with a very large cardboard box containing all of the social services department files on Bobbie and her sisters. This box was equivalent to one full filing cabinet drawer for each child. My first thought was to take a photograph of this box to record the impact of it for posterity. I never did however and ended up leaving it in full view of all my colleagues on the floor of the office beside my desk for several weeks until I could acquire an empty filing cabinet. The unspoken message was loud and clear - look at what I am having to deal with!
During the first week several of my colleagues came up to me and asked what was in the box and I would explain. Their reactions varied from incredulity at the physical size of the paperwork given the ages of the children, to relief that it was me who had responsibility for the children and not them, or a mixture of the two. On the first day I did not even look beyond the top layer of files in the box. Pandora had nothing like this and I didn't want to know what was in there!
There is a serious point here however. Even now as I re-read this I realise I find the emotional anxiety of that moment is still difficult to contain and so I have made a poor joke of it in order to project it outwards for someone else to feel. The reputation of these children's difficulties which preceded them, together with the impact of the volume of case files, certainly increased my anxiety level and probably helped to shift anxiety from other people in the organisation on to me. A photograph might have symbolically contained this mass of work, a literal “reframing” perhaps, but I think in retrospect I felt somewhat unable to contain this load and so leaving it in full view enabled me to deny some of my own anxiety and try to shift it on to others. This shift can be seen in two ways. Displacing my anxiety about the children did not create any collective responsibility for these children within the department and in this sense I am clearly not describing a holding environment or a culture which was containing either me or them. On the other hand if I had stored all the files in an appropriate cabinet then not even the anxiety would have been shared. The children’s situation would have been mine alone and out of sight and out of mind for others and contained only by a process of denial.
After this initial phase of shock and disbelief I decided that I would attempt to get to grips with Bobbie's life by trying to familiarise myself with what had happened to her. This decision, enacted through the process described below, helped to contain my own anxiety in the sense that it was a movement from the unknown to the known. However, on another level this was also an avoidance of coming into immediate direct contact with Bobbie and her sisters.
The case records were unhelpful in the way that they were put together. Each of the previous social workers had carefully recorded their involvement and interventions but there was considerable duplication and no coherent chronology or history of events. I could not see at first glance what had happened to Bobbie in the context of her whole life. I should explain that each file contained sections recording elements such as medical events, educational events, statutory child care reviews, etc., but none linked these together to form a continuous history. That is, there was no single file which contained a complete and continuous history of Bobbie's education, for example. The elements of her education history were distributed throughout the many case files and this had contributed to much of the duplication in the files as bits had been copied from earlier files and inserted in later files, presumably in response to casework or administrative needs at the time.
I also performed a similar task on the files relating to Bobbie's sisters. Their earlier history was a little easier to construct as when they were together their histories were broadly similar. The importance for each of the sisters was that when they became separated their histories and their experiences were different. They needed to be seen as three individuals and not as a needy group of three.
It is worth considering exactly what is contained by the process of case recording. Using Bobbie’s situation as an example it is clear that her history was being allowed to be forgotten or was at least becoming fragmented and chaotic. Sadly this is a not uncommon occurrence for children in care. Administrative and organisational events may be recorded, but rituals, traditions, memories which may anchor the child at a point in time tend to be missed and are probably non-existent for children such as Bobbie who have moved around a great deal and for whom no one person holds a shared memory of those experiences.
My first decision therefore was to reorganise Bobbie's files. Three days were spent looking at every piece of paper relating to Bobbie and placing it in chronological order, grouped under different subject headings like education, placement moves, etc. At the end of this process I had reduced the volume of paper relating to Bobbie by the equivalent of two full files as I jettisoned everything which was a duplicate. I viewed this duplicate paperwork as unhelpful organisational baggage which obscured rather than added to my view of Bobbie's history. As I approached the earliest recordings of Bobbie's behaviour at school I was struck by how immediately similar they were to the current descriptions I was being given of her behaviour at school.
This slow and laborious process was something of a work of detection. On the one hand I felt somewhat depressed by discovering how little of this child had been held together in terms of her history, her identity and her emotional stability. On the other hand I felt quite pleased with my work because I was finally getting to know something of Bobbie. Practically I was creating some order where there was apparent chaos by reorganising Bobbie's files. In social work terms I produced an accurate chronological history and a comprehensive list of where Bobbie had lived, who she had lived with when she had lived there and for how long. This might be seen as the simpler form of containment, a keeping together, a limitation of the chaos. In emotional holding terms this was a reaching out to try and maintain Bobbie’s line of life. The point is, I could not have contained anxiety about what was happening on the surface, now, without knowing what lay beneath and in the past.
One might dismiss the idea of containment as a relationship at this point but at the same time as doing the practical task of sorting out files I was beginning to know something of Bobbie and my relationship with her had developed even before I had met her. I knew a large part of her history, what had happened to her and sometimes why things had happened. In a limited but already quite complex sense I was holding a piece of Bobbie in my mind - her history, but this history existed in isolation. I still did not hold any idea of Bobbie's personality or identity, her hopes, her anger, her anxieties, but by knowing what had gone before, I could begin to think about the present in an informed way. However, I did not know what Bobbie’s experience of this history was.
The idea of working with Bobbie without knowledge of what had gone before does not inform the way in which social work intervention might be most effective in the present. For example, if I deal with Bobbie's disruptive behaviour in foster placements without recognising the history of failed and non-existent relationships then this is a “surface” rather than an “in-depth” view. It is Howe’s (1996) “responding to the act rather than the actor”. The prospect of future placements needed to be fully thought about in the light of the number of moves, carers and experiences of abuse and failure which Bobbie had endured.
Throughout much of their early years in care previous social workers had endeavoured to keep the children together. A decision I had to take very early on was whether to attempt to try to do the same, or to take a different approach. There are strong arguments for keeping sibling groups together, (e.g., see O'Leary and Schofield 1994). In my view, and in this case, the right of siblings to live together seemed to be outweighed by their right to be viewed as individuals with myriad individual needs rather than as a needy group of three. My initial assessment was influenced in part by the pragmatic view that even if I decided to try and keep the children together, I was unlikely to find a foster family soon enough which would cope with their difficult behaviours and demanding needs. None of the three children was able to hold and contain anxiety for themselves let alone offer holding or containment for their sisters. My professional view was that I needed to separate the children and to try and meet their needs as individuals while retaining contact and links between them so that ultimately it might be possible for them to be reunited, or at least reach a stage in adulthood where they could enjoy and appreciate each other's company rather than be constantly competing with each other for every scrap of attention they might gain from those who cared for them.
The decision to separate the children should also not be seen from Bobbie’s point of view alone. Bobbie's middle sister Fran experienced the separation more painfully than Bobbie. Despite considerable discussion and explanation about Bobbie’s move with the girls, in effect Fran’s experience was one of having her sister taken away from her as she remained in the placement where they had been together. Fran tries to keep things together, writes letters and telephones her sisters and gets upset when they don’t respond. In this sense the link I maintain for Bobbie with her sister Fran is much more important for Fran than for Bobbie at present. It may prove to be as important for Bobbie as she grows older.
In making the decision to separate the children the impact of the exercise of this power was considerable and not a little troubling to me as the social worker. As an adult male in a position of authority relative to the girls with dual roles of advocacy and legal responsibility it is extremely difficult to be totally dispassionate in dealing with the mechanics of changes of placement and it is impossible to be unappreciative of the possibility of causing further distress to the children. This decision was both a directing of the children’s lives as well as having the potential for enabling growth tendencies, to paraphrase Winnicott (1963).
A second decision that I made very early on was that I would need a "consultant" external to my line management system with whom I could discuss issues without having to arrive at decisions necessarily. In other words I needed some holding myself if I was not to be overwhelmed by the practical and emotional complexity of the situation. One of my experienced colleagues agreed to perform this function. In this sense holding meant maintaining an objective view of my own line of life in my professional capacity and tolerance of my anxieties in dealing with the decision making processes for the children. A local authority social services department is not a holding environment. It is not a culture which contains anxieties well as I have indicated above but the need for workers to be held and contained is a crucial aspect of being able to hold and contain work with clients, (see Stapley 1996; Downes et al 1996).
One of the consequences of sorting the files into chronological order was that it quickly became apparent that there was a very large number of people who had been or were still involved with the children in professional capacities. For example, every time they had moved from one part of the county to another, a different educational psychologist had become involved. The third decision I made in respect of each of the children was to call a professionals meeting involving everyone who was concerned with each child. Foster carers, teachers, educational psychologists, etc. In Bobbie's case this was in order to gain some idea of how she impacted on different people in different areas of her life.
Many of the currently involved professionals felt a sense of indignation, anger even, at the state of things, a strong sense of being the only one keeping all of Bobbie's needs in mind and a need to save her from all of this chaos. Everyone had an idea of what needed to be done and it needed to be done quickly. The "do something now", "fix it quick" arguments carried with them an anxious imperative to “rescue” this child. That anxiety needed containing in order that a calm and considered approach might be taken because rescue would only mean directing her life without the possibility of enabling her own potential for growth. It was about something which could be done for her rather than with her. What Bobbie needed was "sanctuary" which would in turn begin to provide "meaning" to her life in the sense that Britton (1992) meant, (see Chapter 3). What Bobbie's life meant to her at this point I can only guess at in terms of emotional desperation, incoherence, disconnectedness and persecution.
Keeping the child in mind when others want to take decisions in the context of local authority care links particularly with Winnicott's, "counteracting disintegrating forces in individuals and in families and in localised social groups", (Winnicott 1963:227-8). I think it is useful to add to this the potentially disintegrating forces within large bureaucratic organisations such as local authorities as the different departments and specialisms become increasingly split from each other.
My view of Bobbie's needs in the early stages was that I should do very little except create and maintain some stability in her life. The task was to stop things happening to her, not to do more. To do this required resistance of the organisational and individual pressures to "do something", and containment of the anxiety about being perceived as "doing nothing". Providing stability enabled me after about six months to start thinking about Bobbie rather than about the things which were happening to her. In this sense containment was provided and all that was held on to was the maintenance of that containment.
* * *
Moving on eighteen months from when I took over responsibility for Bobbie I had achieved a relatively long period of stability in one placement and had managed to have Bobbie’s educational needs reassessed in the light of her deteriorating performance at day school. After another struggle with the organisation it was agreed that Bobbie should be provided with specialist schooling on a weekly boarding basis so that she could benefit from the much more containing regime of a special needs school and still experience a family life at weekends and holidays. Containing in this sense is not only about rules and boundaries but also about much more of a relationship for Bobbie with the teaching and care staff at the school. At the same time Bobbie entered what I would describe as much more of a holding environment, a culture which could tolerate her aggressive and disruptive behaviour.
My role as a field social worker remained as it had been previously but was thrown into a much stronger light and had a greater emphasis given to it because of the distance between home and school.
Two years later ... holding on and responding to the actor
I am now working with a ten year old girl who attends a residential special school on a weekly boarding basis in another county approximately 100 miles away. In comparison with her previous situation Bobbie is more settled. However, she still doesn’t have a permanent home base and is in a foster placement which has to end for reasons beyond my control. Last weekend the school sent her back home with nothing in her bag and I had to take her to an unknown foster placement with no clothes other than those she was wearing. So at 5.30pm on a Friday night I had the added anxiety of wondering what Bobbie was going to wear all weekend. This is the result of others at school not thinking ahead about Bobbie’s needs. I am furious. Bobbie is furious with me and the school’s staff.
By the next weekend the local authority has still been unable to find an alternative permanent placement and so in the meantime Bobbie spends weekends with a social aunt and uncle who have kept contact with her over the years. The majority of Bobbie’s clothes and belongings are in boxes in my house because there is no readily available storage space in the office and I cannot move her permanently into the social aunt and uncle’s home. I am still angry and Bobbie is still furious with me.
After a few weeks a new foster placement is found which is excellent. Things are looking up, except that I am told that the Education department transport will not pick Bobbie up from the new foster home because, “it's not in the contract”. The contract says pick her up from Town A and take her to school but not from Town B where she is now and which is a further twenty miles up the road. This means I've got to get up at 6am to pick her up at 7am every Monday morning to take her from Town B to Town A for 7.30am to meet her Education department. taxi to take her back to school. I do the reverse journey on Friday evenings. I haven’t the energy to be furious any more. Bobbie has.
Now when I say “I’ve got to do this”, it is not because I’ve been instructed to. I could quite easily have ordered a Social Services Department taxi to do the twenty miles from Town A to Town B and back. Parcel Force could probably do the job just as easily. What is important in this apparently minor piece of transport management is making a response to the actor and not the act. Bobbie needs a person who can carry her both literally and emotionally along the road from one part of her life to the next. I was making a tangible link for her but I was also making it with her.
The journey from school to foster placement mirrored the story of Bobbie's life. The anxiety about whether the two cars would meet up in the right place at the right time on each journey was quite extreme. The therapeutic reliability of ensuring that the cars did meet up in the right place at the right time on every occasion went a long way in demonstrating my reliability to Bobbie. It also demonstrated that the disparate parts of her life could be held together in me and by me. I believe it also demonstrated that I was holding her in mind and not just the task of getting her to school.
The numerous journeys to and from foster home to the meeting point for the Education taxi provided many opportunities for talking about things which were disconnected in Bobbie’s life and about how these could be brought together again. These discussions often centred around contact with her sisters and her mother. Given Bobbie's history of traumatic separations, re-establishing and maintaining links with her family and particularly her mother was important to her. One of the first questions that Bobbie and her sisters asked me when I became their social worker was could I find their mother and could I assure them that their father could not find them. Giving clear information about what I knew and what I could find out was crucial. After approximately six months of searching it was possible to trace Bobbie’s mother and renew contact. This can be so important because children like Bobbie who may return from their residential placements to their families or foster families need to be kept in touch with how the family has moved on (or not) if any process of re-acquaintance or re-unification is to take place, or even if only a sense of belonging is to be maintained. Cultural links may also be important to maintain for those who are members of ethnic or cultural minority groups. Holding on to Bobbie’s anxiety about where her mother was up to the point when she was found proved another important aspect of my relationship with Bobbie. This, coupled with her anger and my own anger about the placement and transport issues early on solidified a relationship which was experienced as being tolerant and containing by both of us. Bobbie developed an ability to be angry without being destructive and so began to contain for herself. Her previous defensiveness began to give way to extreme anxiety.
There has been nothing magical in the work I have done with Bobbie. Indeed it can be viewed as a very task centred way of doing things for her. However alongside the doing of tasks there has been a constant and long term relationship and I hope reliability for Bobbie.
When I am thinking about Bobbie, the energy put into thinking about the logistics of each weekend was emotionally quite draining. When compared with containment which might be seen as more reactive process, I believe holding as Winnicott described it is a more active, reaching out kind of process. It requires energy and can also be physically draining. This might be even more so for someone who is holding a child and thinking about a child in a professional capacity when compared with say, being a parent.
Bobbie told me early this year when we were waiting for her Education taxi to arrive with the radio on that her favourite song at the moment was "All By Myself" by Celine Dione. This was playing on the radio at the time and she started to sing along with it in a very out of tune manner. Greenhalgh (1994) (see Chapter 2) wrote that the idea of emotional holding is "the holding and containment of disturbing feelings which are inhibiting the capacity for relationship, emotional growth, and learning; it involves demonstrating that distressing feelings can be tolerated, helping children to manage feelings , think about them and understand some of their meaning". Bobbie recognised that this song had meaning for her. I said nothing. It did not require a clever interpretation from me. This was a moment of realization for Bobbie. Dockar-Drysdale wrote,
"Because realization and statement can make stress thinkable, i.e. containable (since through realization the underlying cause of the stress may become conscious), the insight gained may be available on later occasions".
(Dockar-Drysdale 1968: 3)
In this sense Dockar-Drysdale uses “containable” to mean “tolerable”. Bobbie’s realization was not the product of that moment alone but was a product also of the numerous discussions and angry rages she had had about being at boarding school and about why she could not live with her mother on our previous car journeys.
Two and a half years on Bobbie is at a stage where she has asked me for a list of all of the places and people she has lived with. I see this as a significant step forward in Bobbie’s capacity to begin to put things together for herself and to tolerate the previous uncertainties and traumas in her life. Although Bobbie still protests her anger on occasions, reports from those who live with her every day indicate a much steadier, recovering child. I see the same improvements although I remain constantly concerned about how her relationships with her sisters are maintained. There is a limit to what I can do however and on balance I believe it is good enough.
This chapter has attempted to illustrate some of the issues of holding and containment in an ongoing piece of social work with Bobbie.
In terms of containment there was a limiting of fragmentation and chaos in her life by sorting out her files. In halting her moves of placement there followed stability which offered sanctuary and which in turn began to enable Bobbie to construct some meaning to her life.
The image of Bobbie arriving back from school with nothing in her bag, unable to keep hold of anything or bring back anything of herself other than an image of an empty bag is a powerful one. Throughout, the process of containment was supported by a sense of reaching out to maintain the line of Bobbie’s life, keeping Bobbie in mind and offering her emotional holding. Once the task of holding things together for Bobbie was seen to be done reliably then she could begin an attempt at containing painful and anxious feelings for herself. The realization that the song “All By Myself” had meaning for her was one of the first steps. The later request for a list of the people and places she had lived in was a second significant step for Bobbie.
The element which is difficult to describe but which may be apparent in describing Bobbie’s story is that I have done a little bit of a lot of things. Containment appears in all its forms. Holding in terms of emotional holding is there. The Holding Environment exists in two separate forms for Bobbie - school and foster placement but I fulfil an element of the holding environment in ensuring the space for transition between the two is supported effectively and not just left as an uncontained or un-thought-about part of Bobbie’s life. My role as Bobbie’s social worker is perhaps not necessarily as the basket in which Bobbie has put her eggs to use Winnicott’s (1963) term but is perhaps more the wicker-work holding the basket together.
The concluding chapter examines what general relevance the issues of holding and containment have for the field social worker with children in care.
I began with three questions. Firstly, is there a difference between "holding" and "containment"? Secondly, if there is a difference, does it matter? Thirdly, what is the relevance of holding and containment to field social work with children in care today?
I have identified four different uses of the word holding. Holding in terms of physical restraint; holding in terms of loving or nurturing; holding in terms of emotional holding; and holding in terms of the holding environment. Holding Therapy is an example of the area of overlap between physical and emotional holding.
Containment I have identified in terms of boundaries, rules, social control and limitation; and also in terms of a relationship in which anxious or destructive feelings can be given meaning and validation through a process of tolerance and coherence.
The concepts of holding and containment are not easily separable nor are they easily distinguishable. The potency of the two concepts may lie in their equivocal nature. However, there are some further distinctions which I believe can be discerned. The paper by Schneider (1996) cited in Chapter 3 gives an example of this:
"As Miss X became more contained and less regressed, she required less holding".
(Schneider 1996: 131)
Firstly, Schneider writes that the group she was facilitating was required to be held before it could contain for itself, but that the group conductor was required to contain the group before any holding could take place. In this sense "holding" and "containment" are discussed as two separate functions and “containment” itself is viewed in two ways. There is a difference here between discussing containment in the sense of containing for oneself and in the sense of being contained by another. I think Schneider's view of "holding" is that it is a process which allows the development of a “self-container”.
The second difference which I would propose between the uses of holding and containment is that holding might be seen more readily as a receptive process, a reaching out to promote growth and development. Containment on the other hand might be seen as a more restraining, limiting function in the sense of offering protection from destructive forces. These two propositions can be complementary and so the linking of “holding and containment” in the same phrase would tend to support this idea.
The downside of the new social work culture is that as Hadley and Clough (1996) point out,
“Social services workers ... find themselves increasingly treated like industrial workers, their activities more and more tightly monitored and controlled, and their terms of service downgraded. Yet they are still expected to show the same kind of commitment and readiness to pick up the pieces when the system breaks down”.
(Hadley & Clough 1996: 194)
Picking up the pieces is just what I had to do not only in respect of Bobbie’s school transport problems and also in respect of her life history. There are also connections to be made between Bobbie’s feeling that she was all by herself with the numerous absences in her life, the absent social worker prior to my taking over responsibility for Bobbie, her mother’s absence and the absence of family relationships.
There has been a parallel experience for me in my workplace with frequent changes of manager and a common feeling of being on my own with Bobbie and her sisters. This is once again a sense of falling forever, unrelated or disconnected from others and this is also sometimes in the nature of long-term social work in a short-term, surface-orientated culture. It requires considerable emotional effort to resist such a culture and for children like Bobbie it needs to be done. I am not sure that I have any magic answers to offer as to how this can be achieved but I hope my consideration of what is involved in holding and containment together with the description of Bobbie’s and my own experience will give some indication of what is required.
I indicated in the introduction that the conclusions of this study could really only be seen in terms of an informed assertion and not in the absolute terms of confirmed causation. It could be argued that the work with Bobbie which I have described is just competent, reliable task-centred social work and indeed I am not dismissing the importance of holding and containment in short-term, time-limited episodes of social work such as in crisis intervention. I have acknowledged that everyone at times of great emotional stress may need some holding.
In a wider sense what I am arguing is that the socially controlling aspects of holding and containment are often applied inappropriately in long-term situations at the expense of the nurturing aspects of social work with children. The short-term-view invariably involves a directing of the individual’s life. What Bobbie has achieved is what Winnicott (1963:228) described as “a natural evolution based on growth”.
I believe the drive towards short-termism and task-centred social work leaves those children whom the care system is failing, adrift. There is no one task or series of tasks which can correct that. It is my belief that social work can also be therapeutic child care when a more holistic and committed approach is taken and when the organisational pressures can be successfully resisted. What is missing in my view is not only the long-term view but also long-term relationships. In the case examples given in Chapter 3 it is the presence of long-term relationships between social worker and client which are seen as crucial to providing successful holding and containment. Some useful questions to ask from time to time about these children as they move around the care system in addition to, “Has the statutory medical been done?” and “Has the Assessment and Action record been completed?” is “Who is this child in a stable relationship with?” or “Who is really preoccupied with and bearing all of these child’s interests in mind?”
In 1954, Clare Winnicott was able to write, “The main therapeutic experience for the child will not be in the relationship with the case worker but in his relationship with his foster parents”, (Winnicott 1954:11). This cannot be true for many children in care today. With a national shortage of foster placements and funding, who apart from a case worker will be in a position to form a therapeutic relationship? More importantly Winnicott writes that in using the word “holding” in social work this includes not only “acceptance” of the client and what he gives us but also what we do with what we accept, (ibid. 13).
In a short-term culture, long-term relationships are no longer seen as appropriate tools to use. Social work writers in the early 1960’s wrote books like Casework in Child Care (Kastell 1962); Relationship in Casework (Association of Psychiatric Social Workers 1963); and Child Care and Social Work (Winnicott 1964). All of these discuss the need for long-standing, reliable relationships with children in care. In the context of field social work with children in care today I believe that holding and containment as relationship need to have an increasing relevance. I do not think that agencies can offer this. I believe individual workers can. In the same way that I have argued that the process should be one of depth rather than surface, so it is one of attending to the process as well as to the task. This may be something of a repetition of an old message but it is this message of what is required to facilitate maturational processes which is being allowed to slip from social work training and practice. It is this message which must be held on to. As the Barclay Report indicated (see page 16) the task for social work training is about the acquisition and synthesis of knowledge which approaches more closely the totality of the client’s experience and of how the different elements of that experience interact and affect each other.
It is clear that many emotionally damaged children who may benefit from a therapeutic community type environment where a holistic approach might be taken do not get what they need, whether that is for financial or other reasons, (see for example, Beedell 1993; Whitwell 1994). I am not arguing that a therapeutic community type of experience can be provided by a field social worker but I do think that something more than good enough social work in today’s terms can be provided. This requires an individual energy and an appreciation and an understanding of the tasks of emotional holding and containment. I hope this study demonstrates that these concepts are very relevant to the task of therapeutic child care in a field work setting. Winnicott’s (1960) view of infant care is still relevant to the concept of holding and social work but in the modern social work culture it is clearly not universally regarded as being so.
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