Professional doctoral theses: D55

Who would be a residential child-care worker? An exploration of the motivation for entering and remaining in this role.

Whilst I was working in the sector, in a climate where residential child care workers had little professional status, were being expected to work with very challenging young people and at times blamed for the failings of the care system, I wanted an in depth understanding of what sort of people chose to take up this role and what, if anything, helped them to remain in post. To answer that question, ‘Why do we do it?’ I used the Biographical-Narrative-Interpretive-Method, (BNIM) to interview the volunteer participants as I wanted their narrative, which contains both conscious and unconscious material about their lives and work in residential child care.

I also placed a web-based questionnaire on the site, ‘Residential Child Care Network’, to get a different set of data. The data related to race, gender, age, length of service, qualification, ongoing training and number of establishments worked was set and compared to the National Survey. The narrative and other qualitative data was analysed twice. Firstly, using relevant psychoanalytical theory, defence mechanisms, reparation, oedipal situation and group functioning, and then applying French sociologist Bourdieu’s concepts of habitus, capital, field and practice.

I strongly believe that the use of the two theoretical frameworks led to a much richer and more holistic result as it enabled me to attend to both the inner worlds of the participates and the more sociological areas of family background, social

context and education. Although work is considered reparational in itself, I identified that the need to make reparation was one of the factors which led participants to remain and interestingly, some to leave.

A significant finding was that the type of organisations participants worked in was related to their own social status, in as much as the establishments they worked in had a similar status in the field of child care as they had in the field of social class.

Overall, the research identified that there were both conscious and unconscious process taking place when the participants considered entering this area of work as well as why they remained. Furthermore, it identified that homes with high quality staff support which promoted ongoing training and education had a better level of staff retention.

One of the recurring themes was that of disappointment in the participants lives prior to entering the work. This was either in their disappointment of the lives and opportunities they had had or in their disappointment of their internal parental figures. This was for many a motivation factor which led them into the work.

Another motivational factor was the opportunity to take on parental roles, whether to be better than their perceived parents, to surpass them or to replicate their experiences.

This study explores the experiences of trauma and transition into adulthood of African refugee and asylum-seeking care leavers in the UK. It aims to help practitioners better understand the impact of trauma on these young people and give them voice. Giving voice generates better research and develops the confidence of refugees (Temple and Moran, 2006).

These young people make perilous journeys to the UK and battle traumatic experiences with the challenges of transitioning in a hostile environment.

Supporting them is a challenge for local authorities. Despite these issues, there is little previous research interest about the experiences of trauma and transition into adulthood of African refugee and asylum-seeking care leavers in the UK.

Psychoanalytically informed Free Association Narrative Interviews (FANI) were used to explore six young people’s unconscious processes. Cross-case analysis identified similarities in their stories, but there were divergences and complexities in their trajectories. The young people felt relieved for telling their stories. Their mental health issues can be difficult to detect, and transition into adulthood could deteriorate if faced with restrictions and barriers. Immigration status could impact their trajectories. Premigratory trauma, separation from family and adaptation to a new system could exacerbate their trauma. They rated emotional support highly and felt that trauma could make them stronger. Their closeness or openness to the researcher is nonlinear.

The study concluded that the young people’s experience is complex.

Practitioners need to be attentive to their inner world and external circumstances to better understand and support them. A more open practice and development of a psychosocial approach is recommended – also, opportunities for the young people to tell their stories and be treated as individuals. It recommends future comparative study of the experiences and trajectories of young people coming to Western Europe from Africa with those from other continents, and between those from British and non-British colonies.

A bespoke MBT-informed psychoeducational programme emphasizing a novel tripartite model, comprising MBT, Attachment Theory and Regulation Theory was delivered in two hourly groups over twelve weeks. In addition to the provision of psychoeducational information, the groups incorporated a Tavistock style Work Discussion Group to support the participants’ applied use of MBT to one of their own cases.

The study aimed to explore the participants’ own experience of engaging with and acquiring a working knowledge of mentalization, its relevance, both personally and professionally, as well as garnering any learnings from this first attempt to research the provision of introductory MBT training to a group of social worker practitioners. Nine of the eleven social workers, recruited from a large metropolitan area in Ireland completed the programme.

Utilizing a thematic analysis in conjunction with a psychoanalytic lens, the transcriptions of the groups were analyzed within a critical realist world view, using Braun and Clarke’s six-stage model. The case studies were subjected to close scrutiny and reflexive considerations from which three central themes emerged for further analysis.

The study advances our knowledge by indicating a strong consensus amongst the participants that MBT was a relevant and beneficial theoretical and practice gyroscope to support the social work task. Participants warmly welcomed the new language and ‘Thinking Tools’ of MBT which supported their ability to conceptualize and articulate a level of complexity of their clients and their own intersubjective

process which they had previously struggled to enunciate. This novel tripartite model offers significant potential as a centralizing theoretical and practice framework. As such, it warrants further development and research. Future social work practice development could be beneficially advanced in light of these findings.

This was a study of the author’s practice innovation in therapeutic social work with siblings in permanency planning that started in 2009 and continues. Clinical and research supervision of the unfolding project facilitated a reflexive deepening and conceptualisation of the processes involved producing the practice model which this thesis introduces.

The practice intervention focused on the relational and emotional needs of sibling groups of children who all faced the inevitability of transition and potential separation from their own siblings.

The research process involved three key aspects: thematic analysis of data arising from the author’s group work with the children; conceptualisation of the author’s role as a boundary spanner, and the use of transformational conversations which contributed to changes in policy and organizational ways of thinking.

This thesis was underpinned by a psychoanalytic exploration of sibling relationships, group work and child centered play therapy leading to the development of a new form of practice for which the term Sibling-Centered Social Work is proposed.

Through studying the report of a public enquiry (the Report of the Committee of the Inquiry into the Personality Disorder Unit, Ashworth Special Hospital: DoH 1999a) and a detailed analysis of interpersonal processes in professional consultations with forensic practitioners through the ‘lens’ of a psycho-analytically informed paradigm, a critical link is demonstrated between clinical interpersonal processes with patients in perverse, antisocial states of mind and professional performance.

The study shows unconscious processes attacking reality and thinking – ‘nudging’ professionals into acting out of role in ways known to contribute to the emergence of critical incidents. It is grounded in an enquiry that effected changes in legislation, policy, clinical practice and the delivery of social care in secure psychiatric settings.

Social work is conducted within a social arena of contemporary concerns about risk and its prediction and management. When things go tragically wrong, events are scrutinised in the form of internal and public formal enquiries with emotive media commentary. Recent examples – Victoria Climbie, Baby Peter – demonstrate the way the public imagination can focus on perceptions of professional failings.

The explosion of private events such as these into the public domain results in changes to structures, processes and political understandings in relation to risk, danger and fear.

Such enquiries illuminate professional conduct with hindsight, foregrounding decisions that may appear misguided and are popularly held as evidence of incompetence. However, rarely do they ask why apparently ‘ordinary decent’ professionals appear to have acted in extraordinary ways and usually sensible people sometimes do foolish things. This forensic study suggests that a psychoanalytic paradigm is a useful means of achieving a depth of insight in this context. It proposes widely applicable understandings of the types of personal qualities and management structures necessary to delivering high risk, high profile, anxiety-driven services in a social climate of fear.

This thesis explores the everyday lives, life histories, hopes and dreams of young people (aged 17 – 25 years old) with irregular/undocumented immigration status.

The project grew out of 15 years’ experience of working with young refugees and migrants in an urban context and a desire to understand more about the lives of those without authorised status in the UK. Drawing on in-depth qualitative interviews with seven young people, the findings suggest that undocumented youth survive on a continuum moving between life and death, Their aliveness or closeness to death is impacted by multiple psychological and socio-political factors.

This thesis has three main objectives. Firstly, it seeks to document and honour the participants’ stories in ways which represent not only their struggles but also their capacity to continue living in the face of adversity and to hold hope for the future. Secondly, it delineates the ways practitioners in social care, health, education, youth and community work, might help this group of young people to construct their everyday lives safely. Thirdly, building on a psychosocial relational ontology informed by black feminism and decolonial thinking, the thesis looks to advance critical reflexive scholarship grounded in principles of respect, kindness and justice.

Overall, the results of this empirical enquiry confirm that individual lives cannot be understood through attending only to that which is spoken and speakable.

Rather, any attempts to understand lived experience must also consider that which may be unspoken or unspeakable. From this perspective, attention to emotions and a willingness to embrace embodied ways of knowing and learning can offer deeper insights into the lives of others. Interweaving participant testimonies, empirical research and theory, with poetry and prose, this thesis attempts both to represent the lives of young people with ‘no papers’ and to speak to the complexity of such an endeavour.

This is an exploratory study which critically examines the lived experience of Ghanaian trained social workers in child protection in England. The increased rate of child abuse in England has called for pragmatic strategies to achieve a better outcome for children and their families. One of the measures has been to increase the number of frontline child protection social workers to help plug the gaps in child protection services. Consequently, various local authority children’s service departments have recruited social workers from abroad to augment their workforce. Among these international social workers are Ghanaian-trained social workers.

Using the Free Association Narrative Interview method, my research focuses on a sample of 10 Ghana-trained social workers with a view to understanding what it is like to be a Ghanaian social worker in child protection in England. I also wanted to find out what informs their decision-making processes, with specific focus on the extent to which culture plays a part in their decisions relating to child protection.

The findings from this research clearly point out that the experiences of Ghanaian trained social workers in England are multifaceted and put considerable strain on their personal and professional lives. A significant finding arising from this research has been the pain and suffering the participants endured in their bid to work in this country. It emerged that the participants have traversed a long process of struggle with a good deal of injustice and discrimination in their journey. The phases of the journey could be traced to the lack of preparation, leaving their family/loved ones back home, poor knowledge of the child protection process in

England, the performance culture in the host nation, racism and difficult work environments among others.

The findings are contextualised in relation to social work education and practice in Ghana, Ghanaian culture and its implications for social work practice in England, difficult transitions from Ghana, and lack of knowledge on the policies/legislations and guidance that underpin social work practice here.

Most importantly, the study is underpinned by a theoretical perspective that relates to the work of the British sociologist, Anthony Giddens.

The primary aim of my research project is to gain a deeper understanding of the lived experiences of a group of first generation West African Black parents whose children have been subject to statutory intervention. My research focuses on the experiences of parents, their personal stories of immigration to England and journey to local authority children’s services intervention. BNIM interviews were completed with a group of parents and two focus group sessions completed with social work professionals.

Key questions posed to the process were: to offer a psychosocial account of the lives of parents who have immigrated to the United Kingdom; to learn from parents about their experiences of statutory intervention and the responsiveness of children’s services to the needs of the children and their families; to learn about the difficulties of working with this community – using carefully facilitated focus groups, comprising social work and social care practitioners to explore their experiences; to understand from the practitioners how they apply child protection policies; to facilitate a process of discovery about the needs of parents – how they have or have not been met, and might be better met in the future.

The emergent data from these two methods encompasses the intra-psychic, social and organisational aspects of decision making and practice. The overall findings from the research include: professionals’ unconscious/conscious bias towards parents formed from childhood experiences of physical abuse, difficult systems dynamics, biographical and cultural tensions in the experiences of parents and professionals, parents experiences of discrimination and racism, parents’

mistrust towards agencies, professionals’ inability to think about culture and the intersections of participants experiences, and finally, professionals’ defensiveness.

Recommendations includes: social work training to explore cultural knowledge of black parents’ parenting values, social work students to have spaces to address history of childhood abuse and experiences of being parented, reflective case discussions and sound knowledge of legislations and policies.

This study is an investigation into the new world of probation. For the past two decades the Probation Service has struggled to survive in a highly ambivalent social and political climate. During this period, the training of probation officers has separated from social work training and the service has adopted a more punishment-focused, coercive and managerialist stance in its work with offenders.

Using a mixed methods approach that includes semi-structured interviews and case discussions, my research focuses on a sample of recently qualified probation officers with a view to exploring their experiences and perceptions of their working lives, and to construct a picture of the occupation from a newcomer perspective. In particular, given the shift in the ideological framework of the service, I wished to learn about the professional identity of the generation of probation officers who are now entering the service through an examination of their motivation and practices.

Despite pressure to eradicate the welfare-oriented ethos of the service, a significant and unexpected discovery arising from my research has been the resilience of traditional values that are brought to the service in the aspirations and habitus of newcomers. My findings are contextualised in relation to the criminal justice system, the historical development of the probation service, the status of probation as a profession and my own ‘insider’ experience. In addition, the study is underpinned by a theoretical perspective that draws on the work of the French sociologist, Pierre Bourdieu.

This study analysed what encouraged or prevented creative thinking in three social work teams. They 1) supported people with disabilities in the community; 2) arranged care for people discharged from hospital; 3) helped homeless mentally ill people. Through observations, interviews and reflective thinking I gained insights into the teams’ preoccupations. These exposed the emotional meaning of the work for each team, the anxieties against which the teams were defending, and the unconscious contribution of the service users.

I identified five factors that influenced staff ability to function well: the coherence of policies, the degree of professional development among staff, the availability of support structures – both managerial and administrative, the level of autonomy allowed and the availability of reflective space. I found that teams with poor management or administration, lack of development opportunities, unsolved policy issues, or little professional autonomy, also had few opportunities to reflect on relationships and help more troubled clients. The research concludes that all five enabling factors are crucial for social work teams and makes practical recommendations for their provision.

This research studies five homeless people’s experience focusing on two key research questions – what is the place of faith and a faith based organisation in the lives and minds of people using the service and what does an in depth analysis of the emotional biographies of a group of homeless people tell us about the psychic, material and spiritual needs that they bring to the centre?

Each person interviewed was of no faith or a different faith to the host organisation. Using Biographical Narrative Interpretive Method and Grounded Theory the research generated in depth insights into the life experiences of some of the most vulnerable in our society, giving them a voice. Based on a single narrative seeking question, the interviews disclose long histories of personal and social suffering, and a connection between those histories and peoples’ pathways into homelessness, both external and internal. There are traumatised people for whom literal homelessness is not the outcome, but the path into homelessness for all the research subjects suggests a typical picture of people balanced on a knife-edge between a number of sets of pairings including meaning and meaningless, hope and despair and life and death.

To aid understanding I think of these subjects as distributed along a spectrum, with some occupying positions closer to hopelessness, despair or suicide, and some in more hopeful or connected states. All of this is both what brings people to

the host organisation, and what they bring into that organisation. The research findings enable better understanding of key issues affecting homeless people not only for faith-based organisations but for all that work with social exclusion and homelessness.

Noting the occurrence of similar emerging issues over each of the case studies what begins to emerge are a number of implications for practice. These include the importance of developing meaningful relationships; the need to meet service users higher needs particularly spirituality from the point of admission, the importance of a full knowledge of the housed history, the importance of giving the opportunity to explore important life issues and to be listened to.

A possible implication of the research undertaken relates to the organisation itself . The way the organisation does or does not respond , introducing the notion that it operates defences against anxiety and pain drawing on its own theological dogma, an ideology that functions as a defence against being over whelmed. The organisation’s position within the homelessness field is also consider ed. Finally there are the defences towards the inner projections of the residents. It is how the organisation responds to these elements that the research suggests assists or hinders the progress of the homeless person’s route out of homelessness.

Self-harm and suicide prevention remain a priority of public health policy in the UK. Clinicians conducting psychosocial assessments in Accident and Emergency Departments are confronted with a complex and demanding task. There is a paucity of research into the content of psychosocial assessments and the experiences of clinicians conducting psychosocial assessments in Accident and Emergency Departments.

This study examines the experiences of people who presented in an Accident and Emergency Department following self-harm or with suicidal ideation, as those are documented in the psychosocial assessments. Furthermore, the study explores the attitudes, feelings and experiences of clinicians working in a Psychiatric Liaison Team, as well as the process of making decisions about aftercare plans.

In order to achieve this, qualitative methods were employed. A sample of sixty- one psychosocial assessments was collected and analysed using thematic analysis. The coding of the data was done inductively and deductively with the use of the categories of the Orbach and Mikulincer Mental Pain Scale. Two focus groups with clinicians were conducted and analysed with a grounded theory oriented approach. Stevens’ framework was applied in order to analyse the interactional data in the focus groups. Key themes emerging from the focus groups were shared with service users who offered their own interpretation of the data and findings.

The study draws on psychodynamic theories to explore the experiences of clinicians assessing and treating patients with self-harm and suicidal ideation in an Accident and Emergency Department and to make sense of the needs of the patients. The findings are that suicidal ideation and self-harm were assessed and treated in similar ways. Difficulties in relationships and experiences of loss or trauma in childhood and/or adulthood were the two most common themes emerging in the psychosocial assessments. Decisions about aftercare plans were guided by patients’ presentation and needs in conjunction with available resources.

Clinicians were found to have various emotional responses to patients’ painful experiences with limited space to reflect upon these at work. Clinicians and service- users commented upon the therapeutic aspect of psychosocial assessments, which in light of the painful experiences reported in the psychosocial assessments could be used to generate more sensitive and meaningful approaches to the care of this population. Providing support and a space for clinicians to be able to think of their task and their responses seems important.

There is a general recognition that the role of the Looked after Children’s (LAC) nurse has positively influenced the health of looked after children. Yet, there is a paucity of literature available regarding the nurse, and specifically a lack of understanding of how the role of the nurse is understood and experienced by children and young people who are looked after.

The research adopts a qualitative, psychosocial approach to exploring and understanding how children and young people experience the LAC nurse. The Free Association Narrative Interpretative method (FANI) was the chosen methodology, as developed by Holloway and Jefferson (2010), used to interview three Looked After Children and three Care Leavers on two separate occasions. Their narratives were voice recorded and transcribed, then analysed systematically through the FANI method and further analysed using thematic analysis.

The findings are split into four domains, the young person, the nurse, the relationship and the system. The findings demonstrate the significance of how the young people relate to the nurse and centrality of the nurse in providing a maternal archetypal care to the young people and the role the nurse occupies in the system.

The significance of loss in the lives of the young people is a main finding along with the enormity of adverse childhood experiences (ACEs) being interlinked and interwoven in the young people’s experience. What develops out of these findings is a conceptualisation of a trauma informed model of nursing for Looked After Children. Recommendations are made for future practice and dissemination to interdisciplinary fields.

Whilst in recent times there has been an increasing interest in the popular media in families with gender variant children, there is still a paucity of academic research into the experience of parenting a pre-pubescent child with gender identity issues. Gender dysphoria in young children engenders powerful reactions in adults, involving the recognition of childhood sexuality, a subject matter considered taboo in Western society. As such, this research explores highly sensitive and intimate aspects of family life, requiring parents to talk and think about difficult issues.

This small-scale study adopts a case study design in order to explore how it might feel for families attending the Gender Identity Development Service at the Tavistock Clinic, London to parent such a child. Through acting as a ‘bricoleur’ (Denzin & Lincoln: 2000: p3) different and contrasting research methods and theories of gender identity development are explored in order to shed light on this under-researched and hidden area of parental experience.

Eight parents were interviewed and their narratives are presented as parental case studies which can both stand-alone as individual pieces of research, and be understood as a cogent group with over-arching themes. Psychosocial research methods of Free Association Narrative Interviews and photo elicitation were used in order to gather the data which was then coded and analysed drawing on the principles of Charmaz’ (2001) constructivist version of grounded theory.

Particular attention is also given to unconscious processes that might have been at play between researcher and interviewee such as transference, counter- transference and containment. Five key themes relating to the process of mourning emerged from the data: loss, uncertainty, ambivalence, being unable to think and acceptance. Recommendations for both social work and clinical practice and further research are also offered.

This research explores outcomes for 31 children in 17 families, from parenting assessment work undertaken by the author in her role as an independent social worker, for a local authority between 2006 and 2008. The data collected in the course of the work was used in order to identify themes and patterns across cases, to form an understanding of the common difficulties faced by families in complex child protection cases. The assessments were followed up with interviews with the social workers to find out what had happened to the child or family.

The themes arising from these two sets of data are presented as case studies, highlighting common themes about the psychodynamic factors affecting decision making in child protection work and the emotional impact of the work. The study describes a process whereby the social worker can lose sight of the child’s needs due to the overwhelming needs of the parents. The findings advocate a process of containment through a model of reflective supervision, which takes account of the emotional impact of the work, bringing the child back into focus whilst not losing sight of the parent’s needs. A process of reconnection with the tragedy behind the cases is also described.

This study demonstrates how difficult it is for one lone social worker to keep the parent and child’s needs in mind and therefore advocates for a team approach to complex child protection work.

Presentation and Intervention: My thesis examined hard to reach adolescents in respect of; the link between historical, contextual and familial factors, the young people’s inner working model and the manner of intervention with such young people and how one might understand what is most helpful.

Psycho-social case work with seven Black and Minority Ethnic (BME) adolescent boys in an area of high social deprivation and ethnographic study of the direct and wider environment was undertaken. This environment of trauma organised systems, within a community dominated by gang violence was impactful on the whole project.

The data was analysed by means of a case study approach using psychodynamic, attachment and neurodevelopmental paradigms. The findings suggest that early and ongoing adverse relational and attachment experiences impacts on four aspects of ‘hard to reachness’: Biological, Unconscious, Relational and Environmental. This includes neurochemical disregulation, excessive use of projective processes, emotional immaturity, difficulties with reciprocity and taking responsibility.

The four aspects of ‘hard to reachness’ correspond to four domains of intervention: Management and Safety, Therapeutic, Relationship and Social/External. The relationship is seen as central to successful intervention and the worker needs to be able to move between domains as required.

At the heart of this thesis is the wish to forge a better understanding of the lives and subjective experiences of severely learning disabled people in adolescence. Starting with the subjective, lived experience of the young people, the study explores their social and emotional worlds. This takes shape as a psychosocial investigation of identity development in the young people concerned with the study. Observation, informed by psychoanalytic theory and practice, is the chosen methodology.

The observer reflexively explores the relationships and emotions involved in the everyday lives of the young people concerned, within the social context of their families, enabling themes to emerge from which case studies are constructed.

Relational maps are formed for each young person by bringing together the idea of ‘becoming a subject’ with the unconscious defensive structures employed by parents in stressful caring situations. These are considered in relation to broader social factors: social class, culture & ethnicity.

Implications of the findings for policy and practice are described, highlighting technical and attitudinal issues. Relationship based practice and networking skills are indicated, to emphasise the nexus of care which is required by each young person and their family.

This ensures that the stressful aspects of dependency are acknowledged rather than denied within contemporary discourse which idealises independence. Finally, infant observation methodology as both research tool and as an aid to practice is thought about; its important contribution in helping to uncover the subjective experience of other vulnerable and ‘hard to reach’ groups stated.

This is an exploratory study which sets out to examine the practice experience of frontline mental health professionals, who provide care for service users and who have no recourse to public funds.

It considers the multiple layers of vulnerability which this client group faces, and that their needs are unique and more complex than most mental health patients in the general population. The frontline professional is therefore faced with a client whose condition is mediated by a complex mix of debilitating migration experience, mental health and lack of access to welfare support.

Using the Free Association Narrative method, the researcher conducted in-depth interviews on a sample of 7 frontline professionals with a view to understand their practice experiences while caring for someone who cannot access state welfare benefits because of their immigration status.

I also wanted to interrogate the extent to which they are able to deliver high- quality care (Health & Social Care Reg.9, 2014). Findings from this research indicate that frontline professionals face diverse anxiety provoking situations which they defend against. The study also shows that frontline professionals work in an emotionally laden environment where they are daily assailed with conscious and unconscious cues projected at them. Diverse hues of emotions were identified ranging from anger to self-deprecation and moral injury.

Another finding was that professionals experienced ongoing role conflicts emanating from different stakeholders around the workspace. In spite of all of these, frontline professionals enjoyed a significant amount of discretion in their work within the ambit of policies. Another significant finding was that professionals’ perspectives and practice orientations were influenced by other factors like ethnic and professional backgrounds, the work setting and the level of responsibility of the professional within the organisational structure. Paul Hoggett’s writing on Containment and Conflicts by Public Bureaucracies provided the conceptual framework to illuminate the findings.

My thesis explored the relationship between jokes, humour and social work. I argued that jokes are worthy sources of data in themselves to study, mainly because I wanted to do something I found interesting and found that everyone likes humour and its is intrinsic to social life. I interviewed social workers on their views of humour and gathered data from online discussion groups.

Social work has a contradictory relationship with humour (given the oppressive v liberating/ playful aspects of humour), so I used the contradictions to think about humour and social work which combined psychoanalytic and thematic approaches, in which “thematised meanings” were found across data sets.

I found that humour and jokes provide a transitional space which helps social workers manage the contradictions and ambivalences of their work. The jokes made about social workers reflect a profession under attack, and the humour and jokes made by social workers reveal the desire to convey humanity and to co- create relationships.

My research showed that whilst there is a risk to humour being used unethically, humour can help social workers attach to their teams and their colleagues, and help build resilience, as a culture of humour within teams can help to create a nurturing environment, with social workers who will be more likely to stay in the job.

Importantly as well humour can help facilitate relationships with service users, and become a tool for service users and social workers to bond.

This thesis highlights the domestic abuse of Pakistani/Bangladeshi women living in the UK and the constant challenge for professionals and agencies to protect those “hard to reach” sections of the community; a group of women who feel their circumstances are beyond the help of agencies.

Domestic violence is an issue in which there have been claims of progress in forms of funding, resources and advanced ways of working in recent years.

However there still remains a significant group of victims hidden behind a veil of unbroken silence. This qualitative study is an attempt to peak behind this veil in order to answer the rather elusive question of why victims of domestic violence do not leave their abusive partners.

Six women from the Pakistani community who felt passionate about the subject and had first-hand experience of difficult relationships took part in this study. The length of time taken to reach a decision was on average over a decade, which reflects upon the seriousness of the dilemma.

It is simply not in the Pakistani or some other eastern cultural make up to seek help from outside. Domestic issues are used to being kept in the family. Therefore

the usual time constrained Child Protection or Child in Need plan is unlikely to tackle an issue of this nature and complexity.

The main ideology of cultural psychology is that mind and culture are inseparable; people are shaped by their culture. Fiske, et al (1998). Some behaviour can only be understood by admitting to cultural devotion and embedded values. It is difficult to comprehend how a woman can not only allow her husband to have more than one wife but, in some cases, has taken on the role of matchmaker.

Agency Support and Domestic Violence Procedure: I am currently working as a child protection advisor and observed that often in cases of domestic violence, mothers as protective carers are expected to leave the offending partner. Although outside supporting agencies are available to these women, time and again they are not being used. Social Workers need to be aware of the sophisticated and delicate nature of the mindset.

This study was set within the context of child protection and safeguarding in an inner city local authority. Its main aim was to explore the unconscious processes experienced by organizational representatives when co-located to provide multi- agency partnership work in children services. It acknowledged that a lot has been written about the rational challenges to multi-agency work.

It then took a different dimension which focussed on the ‘beneath the surface’ issues in partnership work. The main research question was; whether an understanding and consideration of the emotional and the unconscious processes in organisations is the missing link in strengthening multi agency partnership working in safeguarding and protecting vulnerable children and their families.

Qualitative data from a two year ethnographic study is presented which was obtained using three research techniques; psychoanalytic informed participant observation, interviews and institutional documentary sources. The observations and narratives from the research participants provided a framework for exploring emotional experiences of being ‘an individual, a professional and an organizational being’ within an organization, interacting between and amongst others in a group and different subgroups.

The research unravelled and confirmed some interesting findings within the context of unconscious processes at work and the need for collaborative structures to foster boundary negotiation capabilities in order to sustain the survival of multi- agency partnerships. Realm framework

The aim of this study was to explore how Children’s Services Departments respond to inspections undertaken by the Office for Standards in Education (Ofsted) to improve performance.

The fieldwork setting for this study was in frontline Children’s Service Departments in two Local Authorities. Information referred to in this study pertains to the period when the two Local Authorities were going through a process of change in response to the Ofsted inspections. Information was obtained through qualitative research using ethnographic methods: psychoanalytic participant observation, interviews and organisational documents. A combination of a psychoanalytical theoretical framework and organisational metaphors was used to explore the conscious and unconscious process experienced by individuals going through a process of change.

This study has highlighted the complex issues arising from the inspection regimes and the impact of such regimes on individuals and groups in organisations. Within this, the unconscious processes play a significant role. The anxieties and the subsequent defence mechanisms deployed at an individual and organisational level influence the direction of the organisation. What was apparent in this study was the critical role leadership plays in determining the health and functioning of an organisation in implementing the primary task in particular during periods of organisational stress.

This study shows that to understand the journey of performance improvement in organisations and organisations’ relationship with the inspection institutions, it is important to understand the organisations’ culture and ‘organisation held in the mind’ of the workers. Organisation in the mind is what the workers perceive to be the organisation they are working for. It is equally important to understand ‘the inspection in the mind’ of the workers. The dynamics between the ‘organisation in the mind’ and the ‘inspection in the mind’ is crucial in understanding the responses of individual and organisations to inspections.

This study confirms that for any sustainable transformation to occur to improve performance, leadership needs to work through understanding the organisation ‘in the mind’ of the workforce before implementing any changes. The understanding of the organisation ‘in the mind’ should determine what change is required. Changing the mind-set of the workers and subsequently the culture of the organisation is paramount in effecting any sustainable organisational development. It is only then can real transformation take place when workers have a clear realistic view of their organisation and its function and the view of the internal and external institutions.

My Doctoral studies stemmed from a long term interest in the challenges of engaging with families often described as “multi-problem families”, who appear reluctant to engage with or are unable to access the complex professional systems that are put in place to protect and support children.

The research investigated complex relationships between parents and professionals involved in care proceedings, through detailed observations of network meetings – a practice developed in a Child and Adolescent Mental Health Service to engage with families and professionals in adversarial contexts. These take place at the border between the domain of court often dominated by structural preoccupations and the clinic valuing experience and relationships.

Six Meetings were recorded and observed by the researcher in the room. The methodology drew on a number of epistemological traditions to capture the complexity and multi-layered nature of knowledge and experience. The study evolved into an ethnography-inspired exploration of structures, relationships and emotions emerging in meetings and the context of care proceedings. The analysis of meetings identified some of the processes more likely to encourage thinking within the structures and constraints of the court.

In more successful meetings participants were able to navigate between the two domains (structure and experience) by encouraging dialogue and exploring differences while using the framework and authority of the court to brings a sense of urgency and joint purpose

Implication for practice: Being in the room together allows new information to emerge and a deeper understanding of the human stories behind these assessments. Participants can directly experience the complexities and unpredictability of change while acknowledging the responsibility and sense of agency that stakeholders need to move the system towards a satisfactory outcome for children.

Structure can be both enabling and constraining: Chairs/clinicians/practitioners have to work hard to manage the tensions between family and professionals by emphasising the need to work together with honesty, curiosity and courage in order to create a genuine space to think.

The analysis of network meetings showed the movements in the three stages of meetings from a structure dominated system (introductions) to more experiential, exploratory interventions from the chair (discussion) before a focus on planning brought back the authority and structure of the court in order to plan the assessment.

A three-phase approach to meetings and assessments can provide a level of containment to help clinicians move temporarily from the security of structure to take the calculated risk of entering the domain of experience in the knowledge that they will return by the end of the interview or meeting to the more linear outcome required of the social work/clinical role

We introduced regular reflective groups and adapted the systemic model described in the Reframing Social Work model (Goodman & Trowell 2012) to highlight the movements between structure and experience and create a safer space for the latter.

This study seeks to understand why some social workers seem to connect and engage openly with opportunities for continuing professional development (CPD) while others seem to have a more conflicted relationship with their learning.

Using psychoanalytically informed free association narrative interviews with eight social workers, the study explores the participant’s emotional experience of CPD. The data is analysed using an ‘Evolved approach’ (Cooper, 2014) in which it is examined for new ideas and organised into themes.

The findings suggest a clear relational dimension to learning for social workers and the researcher offers The Learning Response model as a product of the study. This is a biographical narrative model of the pedagogy of CPD which offers a way of understanding how social worker’s approach to CPD is influenced by the experience of learning facilitation in early life.

The model suggests that for some social workers, the script for future engagement with learning is set at this stage and they will repeat their early responses in their adult learning. But the study also identifies apparent compensatory factors and experiences and these seem to enable social workers to rescript their approach to CPD. For all however, the inner emotional voice created from initial experiences remains the same and it is this which replays and shapes social worker’s emotional experience of CPD.

The aim of this research project was to examine the impact of direct work on practitioners in the field of statutory child protection. The author’s premise was that this work was anything but straightforward and that surprisingly, given the intense scrutiny on Children’s Services following a child death, there was little research into the day-to-day practice of frontline staff. The aim was to explore whether psychoanalytic theory could be useful in understanding and making sense of the social work task. Data was collected through observation and semi-structured interviews in one Local Authority Child in Need team over a period of six months.

The findings indicated that practitioners experienced direct work with some individuals and families as profoundly disturbing and that this affected them physiologically as well as psychologically. These effects persisted over time and appeared very difficult for the workers to process or articulate. This could be expressed through embodied or non-verbal communication in the interview.

Practitioners appeared to be ‘inhabited’ by particular clients, suggesting phenomena such as projective identification were in operation. The intensity and persistence of the impact on the practitioners appears to be directly related to the quality, nature and intensity of the psychic defences functioning for the particular client. Significantly, the research indicated that when practitioners were dealing with the negative and disturbing projections from the (adult) clients it seemed from the

data that the focus on the child would slip so that the child appeared to recede from view.

Symptoms experienced by the practitioners were akin to trauma and research and theory on primary and secondary trauma were considered. Other issues raised included shame, which affects the clients, practitioners and the organisation and the meaning and implications of this are explored. Links between neuroscience and projective identification are addressed as well as the role of the organisation, particularly as a container for these toxic and disturbing encounters.

The aim of this study was to provide a sustained reflective space (Work Discussion Group) to Irish child protection social workers in order to closely explore the reality of their practice experience. This space became a site for structured engagement with case material as a method of reflective practice, underpinned by systems psychodynamic theory. Data from the yearlong study was analysed using thematic and cross case analysis.

Findings suggested that work with families is undertaken in a climate that is concerned with efficiency, certainty and the reduction of risk. This climate provokes anxiety; causes workers to distance themselves from families, and reduces opportunities for reflective and considered practice. Social workers habitually brought those cases that caused them deep emotional distress. Proximity to abuse, neglect, violence and deprivation, as well as being tasked with the making of crucial decisions in such cases are sources of significant anxiety.

The task of separating parents from children induced guilt and the operation of transference and countertransference caused the worker to doubt and resent themselves. A combination of task related anxiety and anxiety associated with making a mistake and being found out, left workers feeling frightened. In these instances, workers took up a position of psychic retreat (Steiner, 1993). This necessary defence enabled them to maintain some distance from the guilt and despair associated with the work, but offered no real security.

By participation in work discussion groups, workers came to recognise the inherent ability of a family in crisis to get into the worker. The absence of a robust theoretical model for this process to be made explicit in a way which is conducive to practice improvement became evident. This reduced the level of coherency across the professional network.

Sustained reflective engagement with the most complex aspects of these workers experiences shifted patterned ways of working with and thinking about families and professionals. The findings generated from this practice-near research study have implications for contemporary social work research and practice in Ireland and abroad.

This study focuses on what can be learnt from lived experiences of adult social care and social work practice in England in a policy context of personalisation. The concept of personalisation is increasingly a key driving force in adult social care policy with significant implications for social work practice.

In this study, psychosocial and participatory methods are purposefully combined, with lived experience and coproduction placed at the centre of a unique qualitative methodology. A reflective learning group with people with lived experience is a core feature of the research design. The findings reveal some important learning for social workers.

Firstly, a risk is identified that social workers working within a personalisation framework focused on independence and strengths might unconsciously collude with psychic defence mechanisms. Like those defences first identified by Menzies- Lyth (1960) they include individual and social defences against anxiety associated with unconscious fear and hatred of dependency.

The findings also highlight a phenomenon that the researcher characterises as depersonalisation – a social care system that appears unreal, detached and emotionally numb. The need for emotionally engaged social workers capable of bearing reality is a suggested response to such phenomena in adult social care. It is proposed that social workers have an essential role to play in perceiving and responding to such defences and countering the adverse effects of depersonalisation.

Drawing on Fairbairn’s (1952) concept of ‘mature dependence’, the author argues that the social work role should include facilitating the developmental achievement of mature dependence for people accessing adult social care. Secondly, the findings reveal the need for better integration of a form of personalisation rooted in principles of self-directed support and relationship-based practice approaches in social work.

Finally, a reorientation towards contribution-focused practice and an outline personalisation relationship-based practice model emerges from the findings. The draft model proposes that social work practice in adult social care in a policy context of personalisation should be focused on interdependence, choice and control, and reciprocity.

This research project examines the application of a bounded reflective group (RPG) when applied to a group of Approved Mental Health Professionals (AMHPs).

Learning through my own experience of an RPG’s ability to enliven and engage me as an experienced practitioner and manager, my curiosity as a researcher was piqued. Previous researchers have signposted the importance of good supervision for this challenging role, yet there has been no formal interrogation of such spaces (Gregor, 2010, and others).

As the manager, I introduced and led an RPG model – and simultaneously as a psycho-social researcher, I critically examined its application and impact over a twelve-month period. I have drawn on a blend of methodological approaches which included participant psychoanalytic observation and Free Association Narrative Interview (FANI).

I used three data sets; first, reflective group sessions, including case presentation, discussion and researcher observations; secondly, 1:1 interviews; thirdly, group interviews. Each set was methodically gathered via audio recording, subsequently transcribed by the researcher, and later, taken to supervision for interpretive analysis. I identified themes which emerged, and in turn these informed the research questions, helping to focus my field of enquiry. In addition, the paradigm of ‘thinking in cases (Forrester, 2017) was applied.

The research findings revealed how the RPG helped to strengthen and deepen the relationship to their professional selves and work with patients. The overlap of sole group leader and manager, while not ideal, richly conveys just how much there is to be gained by having a safe space to support the AMHP workforce with the emotional contagion of the work. It is hoped that these insights will inform social work practice, and future research is also discussed.

The purpose of this qualitative study was to explore the major areas of psychosocial concerns, individual anxieties and coping responses for fathers with testicular cancer. While numerous studies have been carried out with mothers with cancer, research from the perspective of fathers with cancer is sparse. This study attempts to identify and explore their specific concerns and priorities. The study was approved by the Royal Marsden Hospital (RMH) Committee for Clinical Research (CCR) and the Local Research Ethics Committee (LREC).

Men were recruited from the RMH Testicular Clinic. All of the men had two or three school age children and were from a range of ethnic backgrounds, professions and education levels. The Biographical Narrative Interpretive Method (BNIM) of interviewing was used and the Interpretative Phenomenological Analysis (IPA) method was employed to analyze the data. Psychodynamic concepts were utilized as the theoretical framework to develop interpretations for each participant. Theories of masculinity were also incorporated.

A set of themes emerged which was supported by the current literature. The psychosocial concerns included: lack of adequate medical information, concerns for children and wife and work concerns. The individual anxieties included: concerns around self-concepts and masculinity, physical changes and self-image, challenges to faith and finding meaning, fear of recurrence, fear of death and annihilation.

The participants employed specific coping responses including: intellectualization, minimizing, maintaining stoic façade and idealization which helped them to cope with the impact of their disease AND allowed them to maintain their sense of masculinity. This phenomenon was labelled “The Masculine Way of Handling Illness”. Additionally, the men split their cancer into the “good one to get”.

The findings suggest that men need more reliable information, preferably on a reputable UK site, about talking to their children, the physical effects of treatment and the options of having a prosthesis.

My research uses a psychosocial approach to reach a deeper understanding of the experience of those providing end of life care in on-specialist settings. It places this experience within the wider landscape of contemporary developments in care provision, with particular reference to the End of Life Care Strategy introduced by the Department of Health in 2008.

One intention of the strategy is to ensure that those at the end of life have greater choice about where to die, including the option of remaining in a homely environment. An initial hypothesis was that the End of Life Care Strategy does not appear to adequately address the psychological and emotional impact of engaging in the kind of care it proposes. More specifically the view that death is the subject that we are most defended against as human beings, particularly in contemporary western society, is based on psychoanalytic considerations of our relationship with death and has implications and consequences for the individuals and organisations concerned.

A free association narrative approach was used to gather data from a small number of carers from care home settings. The data is presented in the form of case studies, end of life stories and a cross-case analysis, revealing emotional complexity and the significance of the relationship each carer has with death and dying.

Identifying a range of unconscious defences in response to the carers’
close proximity to death and dying, I found evidence of a deep engagement with caring at the end of life, confirming personal and professional experience of a third tragic position elaborated within the thesis. Other findings include evidence of a strong vocational commitment to caring at the end of life, a powerful intertwining of personal and professional experience and a deep engagement with the emotional aspects of caring. The findings inform a number of recommendations.

My journey through the four years of the D55 was as much a personal journey into the personal and professional impact of unconscious processes as it was a research journey. Having joined the Programme with little knowledge of such theory, I left as a convert. I was particularly drawn to the work of Bion and Menzies, which provide such compelling rationales for many of the counter-intuitive behaviours displayed by Children’s Services organisations.

My thesis explored the contribution of unconscious processes to supervision practice. It detailed how the anxiety implicit in the social work task impacted the nature of supervision, and contributed to this schism between the rhetoric and reality of supervision practice.

Building on the learning from the first two years of the D55 Programme, the psychoanalytically informed research methodology was employed, drawn from the work of Skogstad and Hinshelwood (2000). It explored the emotional atmosphere of the supervision sessions, the anxiety present, and the collective strategies employed by supervision attendees to address this.

The subsequent data was analysed through a thematic analysis. Bion’s (1962) K and -K models of thought were employed to demonstrate how each group evidences a unique capacity to ‘think’ in light of its ability to contain the anxieties and frustrations implicit in social work. This demonstrated that when anxiety was

not contained, supervision attendees operate social defence systems against anxiety which stifle supervision practice, resulting in a denial of the reality of the social work task.

However, the study also evidenced how supervision characterised by negative capability, reflexive practice, a non-directive leadership style, and creation of containment can process anxiety. This leads to more thoughtful and effective supervision discussions, and more purposeful practice.

This is an in-depth single case study of a frontline social work team based in the third sector. The Bromyard Team provided comprehensive parenting assessments in care proceedings and safeguarding matters. This research is partly derived from the author’s own experience and makes use of ethnographic and psychoanalytically informed observations of ordinary day to day work processes in the professional team.

The study aims to identify, understand and conceptualize the variety of emotional forces and relationship dynamics that impact on first line managers in social work and social care settings in order to deepen and extend understanding of these demands, and the stresses and conflicts managed by professionals in these roles. The author undertook Management Consultative Interviews (MCIs) with the managers of this service, in which they were afforded space to think about their roles and detailed field logs of researcher/observer experiences were used to gather data. The emergent data identified four emergent episodes, these were analysed using aspects of thematic analysis informed by psychoanalytic theory.

The overall findings of the study are that the first line manager often finds themselves assailed from all sides: task related anxieties that filter through the front line workers, organisational anxieties and projections that trickle down from above, wider environmental anxieties that rock the stability of services and also impact on more senior staff, personal anxieties and projections that invade the professional space and organisational/systemic anxieties arising from inter-group, cross- boundary roll tensions.

The author recommends that rather than being left to cope with such experiences, front line managers need effective and robust support, which would

promote further understanding of the emotional and unconscious forces affecting their role.

The thesis describes a piece of research undertaken by a group of social work practitioners who experimented with different techniques and practices in their work-place in an attempt to include fathers. The research took place over a thirty- six month period in a Local Authority Children’s Service in London. The research was supported by senior managers within Children Social Care and by the Local Safeguarding Children Board.

The research asks why and how fathers have been excluded from children and family social work. The research goes on to asks what strategies, methods, conditions and techniques promote inclusive practice for fathers whilst examining the role of ‘the self’ as a researcher, practitioner and participant. The research strategy was based on the participation of practitioners in a co-operative inquiry supported by ‘a before and after’ case file audit designed to test whether the co- operative inquiry, which operated within a ‘front-line’ child protection service, brought about practice change. The aims of the research were; to design and implement a co-operative inquiry, instigate a range of inclusive targets to support the implementation of a father inclusive strategy across the whole system.

The research concluded that children and family social work is one of the few institutions to confront the perversities and abuses of traditional gender and power relations and this confrontation has led to ‘paternal alienation’. The work of the co- operative inquiry led to an increase in fathers identified and assessed. An increase in fathers attending meetings and reviews and an increase in fathers recorded as having parental responsibility and an increase in contact arrangements for fathers.

There was also a sizeable increase in social workers’ considering the father’s situation in ongoing planning for the child.

We learnt that we can include fathers if there is ‘a whole system and a participative approach’ which identifies how covert power and gender relations influence behaviour in practice. To achieve greater father inclusion social workers’ anxieties need to be contained through safety planning systems and quality reflective supervision. For fathers to be included senior managers must support the activity in the long term, (ten to fifteen years), collect data and set targets whilst strategically committing and realigning resources to meaningfully address domestic abuse.

The research identified that organisational change is possible if the conditions to foster emergence are in place, if the culture that operates in the organisation supports emergent creativity whilst espousing staff cohesion simultaneously championing social worker empowerment. This research adds to knowledge in the areas of; father inclusion, risk assessment in child protection, domestic abuse, management, gender and power relations, leadership, group work, participation and collaboration in achieving organisational change.

This psychosocial study examines some processes at work when commissioners outsource to independent social worker experts (from a black and ethnic minority background social work), assessments involving black and ethnic minority children and families in cases where there are serious child protection issues. Eight participants, (three commissioners, four independent social workers and one parent). were interviewed using the Free Associative Narrative Interview method (FANI). The psychosocial research method used values the subjectivity of the researcher, and the FANI method is consistent with this. (Holloway and Jefferson 2000).

Data was analysed using a blend of thematic and narrative approaches, supported by reflections on the researcher’s own emotional experience of the interview. The findings of this study centre on assessments of parents from black and ethnic minority backgrounds who had experienced structural inequalities, discrimination and in some cases racism. The independent social work experts have used a particular framework to undertake the assessments and this has assisted them in formulating recommendations. Anxiety and conflict have featured

heavily in the assessments. These anxieties are interwoven with the impact of racism on families, independent social work experts and commissioners working in modern social work organisations.

Alongside this the importance of anti-racist social work is considered. Anti-racist social work recognises that racism exists within social work and offers a framework to tackle racism within social work. However, currently antiracist social work appears to have slipped off the professional agenda and has been replaced by more ‘neutral’ discourses such as ‘diversity’. This allows one not to think about race and racism. It is a study of how anxieties are delegated to independent social work experts. My interest in this study stems from being a black, female, ethnic minority researcher and independent social work expert.

The key research findings are firstly, there are conscious and unconscious processes that have influenced the independent social work expert’s approach, which included being motivated and affected by their personal experiences with their own parents and families of origin.

Secondly, the way an assessment was presented by the independent social work expert was influenced by unresolved issues from their background. Thirdly, the independent social work expert’s biographical material is significant both in shaping their capacity to do the work sensitively and in depth, but also in creating blind spots for them.

There are significant implications for social work practice. There is a need for a different model and approach to supervision in social work, which is informed by a recognition of the impact of conscious and especially unconscious influences of a practitioner’s biographical material. The importance of intersectionality is considered. This is thinking about how family/emotional/biographical factors are interacting with the dynamics of race/ethnicity, and how anxieties about all these in commissioners and practitioners produce a complex psycho-social knot that has to be understood and worked with if we are to do justice to these cases.

This deep and complex biographical investment in this work is both a source of strength and vulnerability. It is evident that there is something professionally and personally reparative for the independent social work experts, and myself as the researcher, in engaging in the discussions and reflections that make up the data and the findings of this research.

Child protection conferences (CPCs) sit within a legislative and procedural framework responding to the most vulnerable in our society. Due to the intolerable feelings evoked by child abuse and maltreatment, the onus is not held by society. Instead, this sits with a specialist group of professionals.
MacAlister’s (2022) review of the children social care system has cited CPCs as questionable spaces. Within this study eight episodic interviews (EIs) were conducted with professionals, integral to the child protection system and associated conference.

EIs seek to capture perspectives of professionals through narratives, creating an experiential approach to understanding the reality of the CPC. Findings suggest that professionals enter the CPC with good intentions, seeking to respond to the task of protecting and supporting children to ensure effective family systems. This small scale study concluded suggests that anxiety runs like a vein through professional representations of the CPC, resulting in a cluster of social defences manifesting and obstructing the task and good intentions within the CPC.
Findings within this study suggest that, although anxiety cannot be eliminated, it can be reduced if the CPC is refocused. This small scale study provides evidence that the process of the CPC is intertwined with anxiety resulting in social defences eroding good intentions and diverting professionals from the intended procedural, and legislative task.

Recommendations propose how refocusing the task, as well as clarifying professional responsibilities and re establishing the power and independence of the conference chair, could ensure the CPC remains a place to ensure the effective working of family networks and the protection of children.

Several studies have evaluated the effectiveness of community mental health services by measuring economic viability and client outcomes. Whilst some surveys have emphasised the pressures experienced by mental health staff in the community, none have elicited details of these pressures, how they cope and what qualities and structures might be more or less effective. This study attempts to understand how mental health staff deal with the emotional impact of working with people suffering from severe mental illness in the community.

Observing staff visiting their clients followed by interviews with them and observing team meetings in mental health teams in the community were carried out. Using grounded theory, emerging themes were clustered together; and ideas drawn from systems and psychoanalytical theories were used to develop an understanding of how these individual and their teams worked and whether there were particular personal attributes they possessed which helped them carry out such work, and what organisational structures enhanced these qualities.

Although an important measure of the competence and efficiency of these teams is their impact on their patients, this study does not focus on patient outcomes nor does it scrutinise the overall effectiveness of the teams in detail; instead, it focuses on staff and attempts to explore what facilitates them to cope with the emotional demands of this work.

Three different types of community teams were studied; an Outreach Team for Homeless Mentally III people (OHT), an Assertive Outreach Team [AOT], and a ‘standard’ Community Mental Health Team (CMHT). Clients of the three teams varied in the severity of their illness and thus the intensity of their needs, and their ability to engage with services. The specific skills required to carry out the work within each team differed slightly. However, the significant finding was the importance of team structures and systems in facilitating individual staff to pursue the difficult task of supporting difficult-to-engage clients in the community.

At the heart of this study is the experience of caring for someone with a long term mental health condition and the relationship between mental health professionals and carers, who are largely family, partners or friends. The study has been conducted at a time when there is increasing awareness of carers but at the same time limited understanding of the day-to-day lives of people caring for someone with a mental health condition.

Using a psychoanalytically informed psychosocial approach seven carers and eight mental health professionals were interviewed using a free association narrative interviewing approach, which provided a framework for participants to share their experiences. In the next phase a combined focus group of 16 participants was held, comprising nine carers and seven mental health professionals and vignettes were utilised to facilitate discussion. Data from both methods was analysed using a reflexive and psychoanalytical approach which encouraged the emotional response of the researcher to be taken into account. Alongside, a thematic analysis was undertaken to enable cross-referencing.

The study found that the disturbing nature of mental health conditions directly affects carers and mental health professionals, and within this environment carers place high value on support that is built on a meaningful relationship with a mental health professional. However this is not always available as professionals seek to defend themselves from the distress that is bound up in the caring experience, and therefore they idealise carers and maintain professional distance, with the result that carers’ anxiety is not dealt with effectively.

Three implications are drawn from the research: firstly, that relational based support is developed based on the principles of ‘being alongside’ which includes: discerning those issues that need immediate response, and those that need time for a period of reflection, honesty about the nature of mental illness and what is realistic, agreeing respective expectations at the beginning of the work, and valuing seemingly mundane and everyday achievements that are often overlooked.

Secondly, that there is no such thing as a service user, only a service user in relation to their carer, and the two are a unit that must be worked with together by the professional.

Finally, that the framework of care in the community should adopt a different model in which the structures of an institution are utilised. Therefore each service user, carer and mental health professional form a mini community institution in which they all become members of the institution, and have a role in developing it.

In the UK, adoption and fostering panels play a key role in making recommendations about a person’s suitability to be an adopter or foster carer. In many cases, however, these recommendations lack the required level of objectivity. Why should this be the case?

There are several possible reasons, one of which is that panel members are influenced by conscious and unconscious biases which, ultimately, impact their judgements. The research described in the paper sets out to examine this hypothesis. Using a narrative research approach, together with observations of panels, it explores the ways in which adoption and fostering panel members’ biographies, attitudes and values influence their role and recommendations.

An analysis of the results showed a clear correlation between biography, as illustrated by personal values and beliefs, and professional identity, and that this impacted on recommendation-making. Further, while panels achieved their function of providing recommendations, they often constructed a collective narrative of being impartial and balanced which was not reflected in the conduct of panel members during the performance of their roles. In the light of these findings, recommendations for future practice are discussed.

This inspired the development of an awareness process called Effective Personal and Professional Judgement (EPPJ). A model for helping individuals improve the decisions and actions which they take about others, by understanding the effect of internal and external influences. The basic premise of EPPJ is

that increased personal awareness increases professional effectiveness. This enables individuals to become conscious of their own biases, and thus help them to make non-discriminatory decisions. The stance of the thesis is that, when an individual claims to be non-judgmental, they are denying the existence of both internal prejudices and external systemic inequalities.