|
Introduction to Profiles ‘Profiles’ describes the work of our assessment unit from it’s opening in 1990 to the present day. It aims to answer the frequently asked questions regarding the nature of our work and whom we admit.
The nature of our work is very varied and our referrals may come from social services, from health authorities (particularly mental health) , or from the legal system. A number of our day cases attending for therapy may self refer or be sent by their parents or schools. The greatest majority of our cases however are referred as part of ongoing care proceedings and many therefore make first contact via the legal system. Cases fall into a number of categories with regard to the nature of the referrals. At one end of the scale we may have families or individuals where a considerable amount of social service intervention has already taken place, where there is a general agreement between family and professionals regarding what has happened, what has gone wrong and what needs to be done and the referral is primarily for rehabilitation and therapy to address commonly acknowledged concerns. These are the ‘easiest’ cases to deal with and the prognosis is good. The only proviso here is that sometimes the parents can have been quite cleverly deceptive and give the impression of being open, straightforward and wanting to work when really they feel that they can bide their time and show us how good they really are without having to work at it. Some do feel that a three month placement is just that - three months to sit back and just ‘do their time’. We have to be ready to challenge such a stance. At the opposite end of the scale we have highly uncooperative parents or young people who do not want to be here, have come under sufferance and feel ‘blackmailed’ into entering the unit - ‘I had to come or they would have taken my child’ - these are difficult to work with and attempt to disrupt the care of other people. They often manipulate the situation to force us to ask them to leave - making it look like a failure of the unit rather than a failure on their part to engage. Their attitude is that it is our fault for being there (otherwise they would not have had to come) they cannot see that if we had not been the chosen unit they would probably have gone elsewhere or have lost their child. It is an uphill struggle to get these type of parents to acknowledge their own responsibility in their plight. We need to somehow instil at very least a minimal degree of acceptance that - ‘I am here because I have problems parenting my children’ or ‘I have come to get help with my personal problems so that I won’t neglect my children again’ or ‘ I needed to come here to help protect my children from being hurt by my boyfriends again’ . … Just a little bit of ‘maybe it’s partly my doing’ rather than all ‘it’s my social worker’s fault … why doesn’t she just leave us alone’ or ‘it’s your fault with all your stupid rules and groups - I don’t need them!’ These are the resident cases. Even with a variety of approaches and attitudes to the unit prior to admission it is still difficult to accurately estimate the likely prognosis at the beginning of placement. The programme is intensive and personally tailored to each individual and aimed to confront and deal with many of the individual’s forms of resistance and denial. Hence even cases with an apparently poor prognosis can turn out better than expected and can do well. It is very important to deal with people on an individual basis - look at specific difficulties and specific attitudes and ways of coping rather than to make too many generalisations. Everyone needs a period of settling in and adjustment. They may then go through a period of denial and resistance, perhaps expressing anger and resentment at having to be in the unit or reacting against the fact that their therapy is beginning to bring out feelings and thoughts that they wished to remain hidden. This maybe be followed by a period of engagement in the programme and positive work. As residents begin to engage in the therapy process, they will go through a ‘honeymoon’ stage when they feel very positive about their groups and sessions - ‘I’ve never had anyone listen to me like this before’ …. ‘I never realised how I could change my life ..’ etc. etc. It is important to support patients through this phase and on through the following which is sometimes a rather cruel awakening to the fact that it takes time to make real changes and the harsh realities of life are still there. It is also important to avoid ‘false cures’ - getting rid of or helping people to deal with a ‘symptom’ such as not eating properly, relying on abusive relationships, self harming, rather than looking at the underlying cause - which is often rooted in early life and emotional development. A ‘false cure’ will only remove one symptom to allow it to be replaced by another. Parents who are attempting to deliberately mislead and pretend to engage in the treatment process will be able to maintain a false front for some time. These are the couples who can often keep up a deception on an ‘outpatient’ basis or when referred say for a specialist assessment at a hospital outpatients or paediatric or psychiatric clinic for example. However in the intensive atmosphere of a residential unit they often have difficulty maintaining their deception. This is a twenty four hour assessment in a ‘pressure cooker’ type of environment. Cracks soon begin to show and we may have to wait our time for this to happen. It is for these reasons that assessment and rehabilitation take time. Our initial referrals usually come for three months although we do cut this time short if it is clear that the parents have no intention of working or if features of severe concern arise leading us to believe that further work will be damaging to the children. Hurrying the process along to reduce time in the unit or misguidedly try to save funding that way - leads to a partial remission of problems which inevitably recur when the family moves back out into the community. Alternatively an assessment may be incomplete leading to the concealment of dangerous features or to the misjudging of a parent who is not given sufficient opportunity to show his or her good points. In both cases this is a great disservice to the children of the family who risk either being returned to an abusive household or of being removed by default from a perfectly adequate home environment. It goes without saying that it is imperative that we get the balance right - not be over cautious and remove children from possibly abusive households to help the professionals to deal with the probable level of risk - or to be over optimistic and push a family to care for a child that they for whatever reason, cannot cope with. - To quote from ‘Bonds and Boundaries’ (p9) ...
|
|
|