Diana Hinings

Reason and emotion in social work practice: Managing relationships with difficult clients

Summary The authors argue that, in the course of its history, social work has oscillated between two contrasting views of human nature: that which views people as essentially rational and that which views them as predominantly emotional. Concentrating on the area of children and families, they show how current legislation and practice guidance are premised on the notion of people as essentially rational beings who are capable of discharging their social obligations and working responsibly towards agreed objectives. On this view, clients should be judged–and treated–according to their external performance rather than their internal motivation. The authors contend that this view of human nature is over-restrictive and often self-defeating. They argue that human nature is inescapably emotional and irrational, and that true justice can only be done to the human ‘raw material’ of social work practice through a psychological understanding of clients in the context of their own unique developmental histories.

Understanding attachment theory

In his early studies, Bowlby was intrigued by two findings in particular. The first arose out of his work conducted in the 1940s and 50s that looked at the long-term developmental impact on children who had either been separated from their parents for long periods of time (as war orphans or evacuees) or suffered emotional adversity in childhood (Bowlby 1944, 1951). Many of these children, Bowlby believed, went on to suffer a range of behavioural, emotional and mental health problems that he felt were in some way connected to their earlier upsets and losses.

Introducing protective mechanisms and processes

Within a relationship-based model of children’s psychosocial development, interventions are premised on the belief that the quality of children’s close relationships, particularly in the early years, profoundly affects their behaviour and development, and that, by changing the quality of close relationships, children can be helped to achieve their developmental potential. Practices that are culturally sensitive and family orientated, and foster support, can prevent problems and be cost-effective. Broadly speaking, interventions seek to modify the quality of interaction between children and their social environment (which includes parents, family, peers and other adults).

Secure and autonomous patterns

The majority of children and adults in all cultures show secure and autonomous patterns of attachment behaviour. It is the modal style. In normal populations, we might typically expect to see around 55–65 per cent of people classified as secure and autonomous. In broad terms, ‘felt security’ finds both children and adults holding a positive view of the self, other people and close relationships. Possessed of a positive approach to social life, individuals are generally able to acknowledge and deal accurately, appropriately and effectively with strong feelings, including distress, anxiety and anger. The ability to make sense of both the self and others in relationships increases people’s social competence.

Disorganised, controlling and unresolved patterns

The insecure disorganised attachment pattern is associated with those who have suffered and failed to resolve losses and traumas. The traumas vary widely from physical abuse to being parented by someone suffering a serious psychiatric illness or alcohol addiction. The disorganised pattern is frequently met by those working with behaviourally very disturbed children. Perhaps a little confusing at first sight, the disorganised-unresolved classification can be superimposed on one of the three organised attachment patterns of secure, avoidant and ambivalent, whichever ‘best fits’. This is meant to suggest that, when the individual is not immediately caught up in their fear and distress, an underpinning ‘organised’ attachment style operates. However, at times of stress and emotional low points, the disorganised interactional pattern predominates, adversely affecting relationships and the ability to cope.

Gathering information for assessment

One of the major challenges in incorporating attachment theory into a model of practice has been to take what seems to be a highly relevant and useful developmental theory for understanding family relationships and translate it into the practice frameworks within which child and family social work currently operates. The theory has to be made to work within the context of investigations, assessments and interventions in family support and child protection, and be persuasive in team meetings, child protection conferences and courts. Each of these practice environments requires workers to have available to them good, reliable and, above all, useful information about the family situation with which they are dealing.

The sites and focus of intervention

Interventions can take place in one or more of three prime sites: the family home ‘clinics’ or specialist centres key community locations (school, family centre and youth centre). Practice in ‘natural’ home settings, although difficult to control, is often more apt and effective.

Avoidant, defended and dismissing patterns

In normal populations, we might expect between 15 and 23 per cent of people to show avoidant-dismissing patterns of attachment. It is a pattern distinctive of those who feel anxious in the presence of strong feelings, either in themselves or in other people. As a result, there is a slight wariness and nervousness about entering close relationships — not that intimacy is not desired; instead, it is viewed with caution or even, in extreme cases, some incomprehension. So, at times when greater intimacy is expected, such as marriage or parenthood, dismissing adults may experience increased unease and discomfort, or increase their detachment. ‘Felt security’ is achieved by an overreliance on the self and an underreliance on other people.

Formulating the aims of intervention

In a sense, the aims in all cases will be the same: to ensure children’s physical safety and well-being, and to promote sound psychosocial development, or, in Werner and Smith’s words (cited in Fonagy et al. 1994: 231), to produce the child who ‘works well, loves well and expects well notwithstanding profound life adversity’. The assessment and analysis tell the social worker what factors are hindering and helping the achievement of these developmental goals. Thus, in short, the basic objectives will always be: to remove or ameliorate those forces and factors which appear to be hindering or threatening development to introduce and promote those forces and factors which appear to be aiding development.

Analysing, assessing and classifying the information

During the course of their work, social workers accumulate a great deal of information about individual cases. They know a lot about family members’ behaviours, concerns and relationships. Much of what is known is the result of direct observation — always a powerful source of information — in ‘natural’ settings such as the home, playgroup or school. The previous chapter outlined how such information can be gathered and collected systematically. However, information in itself does not help the social worker to explain or understand what is happening. Before facts can be used for explanatory effect, they need to be organised by theory. Developmental attachment theory offers clear guidelines on how to theorise facts. The theory suggests how information and observations might be arranged and ordered to help practitioners make sense of people and their relationships.