What Do You Do When There is Nothing You Can Do?

The title of this article, taken from a chapter heading in my recently published book, How Nurture Protects Children, refers to the daily dilemma that faces all those who work with children, young people and their families. But it is not a question we may feel easy about asking in an era when professionals are expected to have all the answers and, in any case, how can you tick the box that shows you have completed the task when you are not even sure what the task is?

What kind of environment do children and young people need to grow up healthily, emotionally secure, interested in the world around them, able to learn or to make and sustain mutually satisfying relationships with others? Whatever our favoured theoretical model for understanding such things, we would probably want to include in our answer words such as ‘safe’, ‘protected’, ‘stimulating’ and, dare I say it, ‘loving’?

All of these are primarily located in the relationships within which from the earliest age children are nurtured. They are the basis of the secure attachment relationships that we know are fundamental for healthy growth and development. They are the basis of experience from which later patterns of behaviour will emerge and the essential qualities of resilience and empathy are formed. We now know more as well about the actual physiological basis of human development; the complex relationship between the experiences of loving attention paid to a baby, including being touched and held, and the growth of the infant brain.

Many of the children ‘looked after’ by foster carers or residential staff will not have enjoyed the experience of a secure attachment, a safe and loving relationship in which their needs were met by adult carers who were able to be attuned to their emotional state and responsive to their cries for help or comfort. These are the children and young people who present as hostile to adult support, suspicious of attempts to care for them, inarticulate about their feelings but acting them out either through aggression or withdrawal. They are children who are anxious and hesitant around adults; they struggle at school, appearing unable to hear good things about themselves and on occasions can be seemingly vindictive in making hurtful allegations about the very people trying to offer them friendship.

The task of caring for such children and young people requires adults who are confident about themselves, feel positive towards children (even like them!), have some ideas about the difficulties confronting the children for whom they are caring and thoughts about helpful ways of responding to them, have access to resources for personal and professional supervision and training and feel they are working in an organisational context that understands the nature and demands of their work.

The Predominant Professional Culture

The hard question to be asked is whether the current framework for practice, built around the directives of central policy and the organisational priorities that follow these, provides the essential containment and support that practitioners need to work safely and confidently with vulnerable and troubled people.

The answer in so many important respects, sadly, has to be ‘no’ and the consequences for practitioners and for the children and young people with whom they work are serious.

So what are these concerns about how we are working with our most vulnerable children, young people and families? Professional activity in social care, education, youth justice and health services has been dominated for a number of years by policy directives that require copious forms to be completed, papers to be filed, boxes to be ticked, targets to be achieved and reports to be written, the latter usually in a formulaic style, with their conclusions already prescribed and sometimes even with helpful, prepared phrases ready for cutting and pasting, “Here’s one I made earlier!”

(Rose 2010:1)

The demands of bureaucracy affect not only social workers but extend across all areas of professional work. The impact of this can be seen not just in terms of reducing the amount of time front-line workers have to spend in direct contact with people, but in the corrosive way that the emphasis on recording shifts the focus of attention from reflective thinking about a potentially dangerous or abusive situation towards a state where the completion of a form becomes the professional task whose satisfactory completion is the measured outcome.

This is compounded by another feature of the predominant professional culture in which notions of the importance of reflective thinking and the use of professional judgment based on experience are devalued and discouraged. One of the frequently identified weaknesses highlighted in the series of reviews and reports that have followed high profile and tragic child protection cases in recent years is the failure of agencies to communicate with each other and to connect the disparate experiences of their workers in their dealings with the families of concern and thereby to construct a meaningful narrative of a series of unfolding and sometimes tragic events. In other words, a failure to think.

Organisations fail at a systems level because of the pressures under which they have to perform and show evidence of their ‘effectiveness’, whilst the individual workers within these organisations, faced with difficult and sometimes dangerous or frightening situations, are overwhelmed by inevitable anxiety. These workers receive little by way of supportive supervision that acknowledges the intensity of the feelings such work evokes and uses such feelings as a way of stimulating thinking about what may be happening in the families with whom they are involved.

Both victims and perpetrators use defence mechanisms to defend themselves psychologically against the effects of their actions or to what is happening to them – denial, projection, splitting – to name just a few.  It is also the case that workers who engage on a direct basis with challenging people have their own defence mechanisms that they use as a shield the impact of the truly awful things they must confront. The dynamics of these interrelating processes can create confusion and prevent thinking, which in any case is often the unconscious purpose of the client. How many times, when I worked in residential settings, did the fire alarm go off at staff meetings or the office door become an object for attack during the hand over?

If such processes are to be thought about, understood and responded to, then this can only happen in organisational contexts that are supportive of the task and that factor into their systems for supervision and case management appropriate ways for managing the anxiety that intensive work with vulnerable children and families generates. Is it too fanciful to propose that much of the current bureaucracy and its demands on workers’ time and attention are part of the way that organisations defend against the anxiety of having to face the horrors of what is happening in the lives of the people to whom they are offering services?

Risk of Fear and the Fear of Risk

Front-line workers need to be confident about what they do and how they do it. Foster carers and residential workers in particular work directly in the personal space of children and young people. They are there at bedtimes, in the morning, sharing meal times, and in the case of young children and even sometimes with needy adolescents they are around and may be involved with matters of personal hygiene. It is very much part of the job to share in these daily routines and to ensure that they occur with regularity and consistency. Knowing about the requirements of safe care practice is, of course, essential for these professional workers; but it is one thing to know about something and quite another, on a daily basis, to provide personal and genuine care to vulnerable children and young people in a way that both satisfies professional standards and yet has the spontaneity of genuine human contact and intimacy.

In what has been described as an increasingly risk-averse society the ever-growing fear of litigation and allegation – and concerns about what support will be offered if problems arise – overshadows the way workers carry out their duties. Foster carers are told to tell bed time stories through a baby intercom or to put a cushion between them and a child looking for the comfort of a cuddle whilst residential workers doubt their authority to challenge disruptive behaviour.

Such preoccupations with ‘safety’ restrict opportunities for genuine interactions between adult and child which bring an experience of ordinary human exchanges, essential for healthy growth and development. It is these vital experiences of being cared for by attentive, attuned adults that have so often been lacking in the lives of the very children who are now in danger of further exclusion from their enjoyment and benefit.

A professional culture that prioritises recording and box-ticking and in which the measurement of performance becomes an end in itself will never be able to provide a safe and supportive context for workers whose involvement with vulnerable and damaged children takes them into areas of high anxiety with the accompanying consequences of  inevitable risk.

Holding On and Being There

Relational approaches to all aspects of work with families, children and young people provide effective outcomes for disadvantaged and vulnerable people because they address their most deep-seated and real needs. ‘Science’ is now showing us how this is the case by clarifying and establishing the power of attachment relationships and the critical learning that takes place in the early years. This has become even better understood and supported by the growing knowledge and awareness that have come from studying human brain development through infancy and beyond.

To engage with people who are struggling in their lives, or with people whose behaviour is deviant or potentially violent towards themselves or others, is certain to create huge levels of anxiety. Learning to contain and manage this anxiety is an essential part of professional development for all workers. Of equal importance, however, workers must feel that they are free to practise their work in a management culture that understands, trusts and supports them, and that allows time for their work to progress and is not quick to blame if things go wrong.

 (Rose 2010:133)

Building the kind of trusting, open and genuine relationships that become the vehicle for change and growth requires time and support. In an age of short term interventions and brief therapy, where tasks have to be shown to have been completed and signed off to achieve pre-set targets, such approaches are hard to sustain. The expectations on professional workers to have the answers and deliver solutions become a pressure that is hard to resist. However, these expectations often run counter to a feeling that is commonly experienced in such work, the feeling of helplessness and sometimes of hopelessness that things will ever change. It is a feeling that comes from the helplessness of those with whom we work, victims and perpetrators, a powerful projection that challenges our sense of purpose and our ability to engage with or to challenge entrenched attitudes or patterns of behaviour.

And yet, as is known all too well by those who work with children or young people whose lives have been scarred by abuse or neglect, there are times when the best that can be offered is just to be there, to stay with a situation and allow time for the relationship to grow and deepen.  Sometimes there is nothing you can do, except resist the pressure to be over-reactive and make things worse. It is a matter of judgment, of using experience, of having time to think, even if that is just about what to do next.

Complex work requires clear thinking at a time when emotions are churning up and the stakes are high. The importance of supportive management and supervision, balanced with proper accountability and responsibility, is critical. The challenge for today is whether that balance can be achieved, allowing workers time and space to develop key relationships within an organisational and policy framework that identifies that as the task and understands its significance and meaning.



Rose, J. (2010) How Nurture Protects Children London: Responsive Solutions UK Ltd.

About the author:

Jim Rose has worked at a senior level in various social care settings since 1975, including secure accommodation. He was director of the nurture group network for five years (2004-2008) and  currently chairs fostering panels for an independent fostering agency. He has recently written a second book, How Nurture Protects Children, details of which can be found at www.responsivesolutions.org.uk

Leave a comment

This site uses Akismet to reduce spam. Learn how your comment data is processed.