Relationship-Based Social Work, Second Edition

Getting to the Heart of Practice

Gillian Ruch, Danielle Turney, Adrian Ward

• Publisher: Jessica Kingsley Publishers
• Year: 2018
• Print ISBN: 9781785922534
• eBook ISBN: 9781784505431
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

This comprehensive guide to relationship-based practice in social work communicates the theory using illustrative case studies and offers a model for practice. Updated and expanded, it now includes increased coverage of anti-oppressive and diversity issues, service user perspectives and systemic approaches in social work.

The book explores the ranges of emotions that practitioners may encounter with service users, and covers working in both short-term and long-term professional relationships. It also outlines key skills, such as how to establish rapport, and explores systemic issues, such as building appropriate support systems for practice, management and leadership.

• Section 1 •

SETTING OUT THE TERRAIN

Historical Trends, Conceptual Models and Frameworks

• Chapter 1 •

The Contemporary Context of Relationship-Based Practice

GILLIAN RUCH

Cathy glared across the courtroom to where Aisha stood in the witness box giving evidence against her. ‘Killing me with every word, you are’, she muttered, not quite under her breath. And louder: ‘Not happy with taking every child I’ve ever had, but now taking the next one too. Taking my future…’ She shook her head, banged her foot on the floor and fixed Aisha vividly with her eyes. Cathy’s solicitor put a hand on her arm to calm her.

Aisha continued, saying how, with real regret, she had to recommend that Cathy’s unborn child should be removed at birth and placed immediately for adoption. The history – which had been detailed in the reports and rehearsed in the court – was awful, indicating serious risk of physical and emotional harm if Cathy was allowed to keep the child. She spoke of her lengthy involvement with Cathy and the times she had had to remove her other children, but she also spoke about how Cathy seemed quite unable to change her behaviour with regard to her chaotic lifestyle, her drug habits, the severe neglect of her children and her repeated choice of dangerous and violent partners. At this, Cathy smiled wistfully and, with what might have been a nervous giggle of acknowledgement, she nodded her head, looked at her solicitor and nodded again, this time whispering, ‘She’s right, you know, the cow.’ But then she suddenly shook her head again and tapped her foot repeatedly on the floor.

The court eventually made its decision. The unborn child was to be removed to a place of safety and placed for adoption. Cathy had known this would happen and seemed both resigned and enraged, bemused and almost amused – in fact, quite lost in the formal processes and confused about this latest twist in her desperately unhappy life. Aisha came slowly across the courtroom to talk with her, half-expecting to be verbally if not physically attacked, and yet somehow also knowing that she would be able to carry on working with her, that Cathy was sufficiently in need of her support, and sufficiently aware of that reality, that the work would continue: in fact, Aisha was determined that it would continue. Sure enough, after a further vicious glare and shake of the head, Cathy said to Aisha with another wistful smile, ‘I suppose you’re happy now?’ but held her arm and led her away from the solicitors and court ushers, saying, ‘Buy us a cup of tea, will you?’ They walked out of the court buildings arm in arm and found a cafe. Aisha knew now that she would be able to retain her involvement with Cathy, supporting her in sustaining her access visits to her children in long-term foster care.

Understanding relationship-based practice

This real account of care proceedings might at first sight read as overly sensational and soap opera-like, but based as it is on the recall of a case with which one of the editors of this book was involved, it speaks powerfully to the complex, multi-faceted nature of the professional relationships social workers have to navigate on a daily basis.

The final twist to Cathy’s story may have a familiar ring to many social workers who have worked closely with service users in the greatest need and difficulty, balancing the requirements for care and control, yet somehow holding on to a working relationship with the very person who in many ways sees them as the problem rather than the solution. So what is going on here, and how has this social worker managed to retain (apparently) the trust and respect of Cathy, despite all that she has had to do?

At one level, we might imagine that Aisha is a particularly empathic listener who has engaged Cathy sufficiently so that she will still feel listened to despite everything, or that she has been especially persuasive in convincing Cathy that it is still in her interest to stay in communication with her social worker. But Cathy is, in most respects, a person whose life is in a state of permanent shipwreck – disaster, danger and loss have been with her for as long as she can remember – and she has fallen out with virtually every professional she has encountered. So how can we explain the persistence of this particular relationship?

It might also be argued, of course, that Cathy has a kind of dependency on the woman who is in reality her oppressor, or who at least has played a key role in removing her children, and that, instead of promoting this dependency, Aisha would have been better employed providing Cathy with better housing, with more support for her children and with stronger action against the string of abusive short-term partners. And yet whatever material improvement Aisha has managed to secure for Cathy seems to have made no difference at all to her capacity to regulate her own life and offer security and consistency for her own children. (If it had made a difference, Aisha might have been able to argue differently in court.)

On the other hand, we might look at what Aisha may think and feel about all this. She probably sees her key responsibility as not only ensuring that Cathy’s children are safe but also trying to provide ongoing support and containment to prevent Cathy from doing further damage to herself, perhaps resulting in a seriously self-destructive outcome. Aisha places a high premium on working ‘in the relationship’, against all the odds, as it sometimes feels. She wants to sustain the relationship, not only as a vehicle to offer support and, as necessary, an element of social control, but also in the hope that the experience of this continuing and unflinching personal commitment will enable Cathy to learn something which she has so far been unable to achieve by any other means: the ability to understand and regulate her own life and its pressures, and eventually to live a more fulfilled life. In other words, the relationship is not only the medium but part of the message: that it is possible to deal with life’s crises without panic, pandemonium and despair, and that positive human relationships are what makes this possible. Through the lens of attachment theory, Aisha might be seen as offering a secure base to Cathy, in the hope that over time Cathy will be able to use the experience of being in a continuing, honest and reliable relationship to reframe her own internal working model, which may enable her to live a less difficult life.

It is a complicated relationship: Cathy sees Aisha as a powerful figure but she has also been able to confide in her through some very difficult times and to talk with her about her own childhood experiences which were painful and abusive. Aisha, too, has very mixed feelings: at times over the years Cathy has been inconsistent, hostile and even abusive towards her (such that Aisha has at times had to take precautions for her own safety), but she also retains respect for the dogged determination with which Cathy clings on to the wreckage, as well as a personal liking for her humour and open manner. Aisha has excellent and detailed supervision on her work and has frequently used this to think through the balance of the working relationship with Cathy and to ensure that she remains on task and that she picks her way through the emotional minefield of Cathy’s existence without either making matters worse or losing her.

What is being described here is typical of much social work practice: demanding, confusing and paradoxical at times, and requiring of the worker the ability to stay with people in distress or turmoil and continue to provide a mixture of personal support and pragmatic guidance, largely through the medium of a reliable, engaged and constructive relationship. Such relationships are at the heart of good practice – and very often when practice goes wrong, it emerges that either there was not a solid helping relationship in place or that the relationship had become distorted or too tenuous to sustain the work, or sometimes that the social worker was too overloaded by other tasks to engage fully with the relationship.

The nature of the social work task

On a daily basis, social work practitioners are required to engage with difficult interpersonal situations and with distressed individuals such as Cathy. The individuals with whom social workers engage are experiencing social and emotional difficulties for which they need support and assistance. Within this context, the focus of social work practice uniquely straddles the intersection of the psychological and social contexts of people’s lives. Whether the service user is an older person, someone with a disability, a young person with an offending history or a vulnerable child, it is usually both the psychological and social factors impinging on their experience that are the focus of social work interventions. While attending carefully to the social context in which people’s difficulties are located, practitioners are simultaneously drawing on internal, often unconscious, dynamics to make sense of these professional encounters. It thus becomes clearer that working in relationship-based ways is complex and demanding. It also becomes easier to understand why it can be difficult to sustain the focus on the relationship and apparently easier to conceive of professional involvement in a more straightforward or simplistic way that prioritises, for example, form-filling and computer-based, as opposed to face-to-face, activities. Such professional behaviours may seem to make sense in the face of distressing, potentially anxiety-provoking, situations which are located in all too often resource-deficient welfare contexts.

This risk of minimising the importance of the relationship in professional practice provides a vivid example of one of the key concepts in relationship-based approaches – avoidant defensive strategies – explored below. The challenge social workers face in practice is to ‘defend and sustain complexity’ (Burke and Cooper 2007, p.193) and, in particular, the complexity of human behaviour, in the face of powerful pressures to oversimplify it. The emotionally charged nature of all social work encounters requires practitioners to reflect on how the work impacts on them and to draw on the understanding which reflection affords, to inform their practice. It is precisely because the bread and butter of social work is emotionally charged, and because resources to address the issues are often insufficient, that the professional relationship is so important as a key resource.

On a political level and in a climate of continuing austerity, this might sound like a cop-out, implying that an emphasis on relationships can be used to mask a shortfall in resources. Equally, it could be construed that if sufficient material resources (e.g. day centres, preventative child care packages, etc.) were available, then the professional relationship would not matter. Clearly neither of these positions is acceptable. The centrality afforded to professional relationships cannot be allowed to excuse inadequate resourcing of welfare provision, nor should material resources in isolation be considered capable of resolving all of the social and psychological difficulties which people may face. Certainly if resources were more abundant, some of the pressures on service users would be lifted, and this political dimension should not be disregarded. Featherstone et al.’s (2014) book Re-imagining Child Protection makes an important contribution to reasserting the significant part played by structural inequalities in the lives of families engaged with Children’s Services. That said, adopting a binary, either–or, individual–structural response to Cathy’s circumstances is not the answer. In Cathy’s case, gaining understanding of her own experiences, and their impact on how she behaves and utilises resources made available to her, is integral to any effective and sustained changes, and that is a longer-term task.

Bower (2005, p.11), referring to the potential benefits of the relationship in practice, comments that, ‘a thoughtful and emotionally receptive stance to clients can have therapeutic value without anything fancy being done’. Within this statement there is something of a paradox because, on one level, working ‘in the relationship’ is a straightforward and obvious way of practising. In reality, however, this requires practitioners to be appropriately equipped to understand the potentially complex dimensions of such relationships. If relationship-based approaches are to be taken seriously, they cannot be done on the cheap. To be a relational resource, practitioners need time and thinking space to develop appropriate professional understanding, and ongoing support to use it effectively, as we shall see throughout this book. Thoughtful and emotionally receptive responses do not, as Bower suggests, need to be ‘fancy’, but this should not imply they are undemanding for the practitioner concerned, as emotional receptivity and responsiveness require understanding of the intra- and interpersonal dynamics at work. Later chapters in Section 3 explore wider implications of relationship-based approaches, including how they can be embedded from the outset in social work education and training (Chapter 11) and be an integral part of the ongoing support provided for practitioners through supervision (Chapter 13).

One of the fundamental tensions that practitioners face is to balance the internal and external needs of service users – and to respond to both, or at least with both in mind. In essence, it is as simple and as difficult as that. Given the increasingly restrictive budgetary context of welfare provision, Bower’s claim for the impact of effective professional relationships deserves careful attention. In a paper that conceptualises the relationship between structural and individual factors shaping an individual or family’s life, Hingley-Jones and Ruch (2016) refer to the dynamics of relational austerity, an unintended outcome of financial austerity, and one which aligns itself closely with Bower’s position. If the creation of a meaningful professional relationship is as important as the provision of material resources, then it could be argued that, on grounds of effective practice and economic expediency, relational resources need mobilising as a matter of urgency. This is not to suggest they should replace other resource provision, but that they should be understood as an integral component of effective interventions.

In this book we will look at many aspects of professional relationships within social work: how they may start; the range of strong feelings which they may involve, including love, fear, sadness and despair; and eventually how they finish. Although the relationship between Cathy and Aisha is a long-term ongoing one, some social work relationships are very different in time, focus or content and may sometimes be only fleeting or fluid, even though they will still be important. Although all social work includes some element of relationships, our focus here will be on an approach known as ‘relationship-based practice’, in which much attention is paid to the detail and significance of the relationship: its dynamics or components, the factors which make it challenging or at times paradoxical. This approach also involves looking below the surface to make sense of the less rational or tangible aspects of the social work relationship: the unconscious elements which may have a critical effect on the work, such as the ways in which unspoken anxieties about powerful feelings, including fear or despair, may cloud the judgement of the worker or impede the progress of the work.

The main message of the book is that to be effective in relationship-based work the social worker needs knowledge and skill in the handling of the complex dynamics of helping relationships. In particular, the demanding nature of practice means that it is potentially fraught with anxiety: the dilemmas and difficulties which service users face may evoke considerable uncertainty and anxiety. Such anxiety – if not fully understood and addressed – may distort judgement and communication and seriously affect the outcomes of the work. How else do we explain the social worker who allows a young child to remain in a family home which she and other professionals are too scared to enter, or who...

Table of contents

• Cover
• Title Page
• Contents
• Foreword by David Howe
• Preface to the Second Edition
• Introduction
• Section 1. Setting Out the Terrain: Historical Trends, Conceptual Models and Frameworks
• Section 2. Working with the Relationship in Practice
• Section 3. Sustaining, Supporting and Developing Relationship-Based Practice in a Reflective Context
• Conclusion
• Bibliography
• The Contributors
• Subject Index
• Author Index
• Join our mailing list
• Copyright
• Of Related Interest
• Endorsements