Theme 4 The self in the work

The self in the work encompasses manifestations of participants’ personal selves in the work, primarily spoken about in relation to families rather than other professionals.

3.1.4.1 Sub-theme 4.1 Identification and passion.

Four participants described a personal identification with the parents, relaying aspects of their own lives and experiences that provided a foundation for empathy and a knowing that could make connecting easier and stimulate a motivation that “we can do more” (P2).

It helps me understand them, I feel like I have a better understanding of these ladies because of my own experience. P4

I felt like I was quite congruent with what it must be like for her in those moments and I could identify with it [...] I think that makes it so much easier if you can connect with something of the parent’s difficulty. P1

Relatedly, four described engaging with the work and context as having the potential to “repair some of my ruptures” (P2). Here, there was an awareness of the personal intertwined with the professional such that professional histories were also “a personal journey of understanding myself better” (P10). Two participants relayed instances whereby personal and professional selves were not necessarily harmonious and could even take different stances towards the parent and context:

It was really difficult because as a sister I can understand the motivations behind that but as a mother within the social care arena that’s not acceptable that’s not safeguarding the baby so I at times could completely feel the dilemmas but it didn’t counteract the risk. P2

It doesn’t sit comfortably with me but I would say that probably from the families’ points of view it’s about me being authoritarian, I do have responsibility for making some of those decisions. P9

Here, a personal self appeared to provide understanding and commonality, however, and linking with risk as the bottom line in the work, in these instances the personal self seemed to be relegated by the professional self. From a somewhat more distanced perspective, five participants described their passion for the work, which as illustrated below held a protective function against burn out and group demoralization:

I feel passionate about giving people every opportunity to do as well as they can […] it makes it more doable because if you haven’t got that you burn out much quicker. P5

The workers’ passion feels like a motivating force for me you know often people can get very demoralized and go into a no cycle but the workers have remained in kind of yes cycle about the work undertaken. P8

3.1.4.2 Sub-theme 4.2 Impact.

In contrast to the frustrations apparent in participants talk concerning the wider and inter-professional contexts, descriptors of the impact of the work upon the self alluded to states of anxiety experienced by participants. Nine participants relayed instances of being highly aroused with a sense that the work and levels of risk impacted on the physical body:

I feel completely highly aroused and over stimulated on a Friday afternoon because the work is so emotive […] I don’t think it’s making me sick but I think it could. P1

There was a weekend when I actually thought a mother was going to commit suicide and I didn’t sleep, I remember feeling highly anxious, it needed a lot of processing really a lot of processing. P3

There’s always a fear of am I gonna think it’s ok and it’s not, are we gonna make that mistake and somebody gets hurt am I gonna miss something, that’s always a fear. P7

For two participants, the local historical context in which a mother had committed infanticide and suicide remained a source of anxiety, that “reverberates through” (P9) cases with a similar context and issues, indicating how embedded and felt the work appeared to be for participants, for example giving one participant “goosebumps just talking about it” (P5). Less common but still prevalent, six participants described feeling pain and “immense sadness” (P8) at the removal of infants from their birth parents and at times of parental deterioration. Other instances included the “really emotionally draining” (P4) nature of the work, with three participants describing a process of having become less sensitized to the process of removals over time, “I’m not surprised by it anymore I don’t have as strong a sense of injustice as maybe I did when I was younger or less experienced” (P1). Although becoming de-sensitized may represent a necessary way of coping and distancing from the emotional context of the work, prevalent in the talk were instances where participants described feelings of inadequacy (seven participants) and a lingering sense of searching for what could have been different (nine participants). These seemed to indicate an on-going processing and impact of the work:

It was a very uncomfortable feeling, looking at myself wondering, lots of self- searching wondering how I could have done it differently. P10

I do wonder she (parent) probably wanted us gone the whole time and so is it just that she’s not able to say I’m ok I don’t want this anymore but it’s easier for her to just not engage. P7

For six participants, having boundaries either could have or did represent a way of bracketing and protecting the personal self in the work. As one participant described it, without boundaries, passion and motivation for the work could cause clinicians to go far beyond their work remit embarking on “a crusade if you’re not careful” (P5).

3.1.4.3 Sub-theme 4.3 Stance.

This sub-theme captures participants’ references to “something very important about what you as a therapist brings into that home with you that needs to be about more than an enactment of a series of techniques” (P1). References to being open (nine participants) seemed more than a professional act, involving using the whole self to receive the parents and infants:

We have to open ourselves up to those parents to do anything of any use, we have to open ourselves up to their experience and to get in touch with the damage that’s been done to them. P1

The space in my mind to be able to just receive what she’s (parent) saying, to be able to receive her without me having to compensate or rescue myself. P6

References to openness linked to consistency, with the latter enabling the former, for example, “being able to be consistent with a family makes the relationship easier, to be able to be free with myself in the visit, like open” (P7). As implied in these illustrations openness related to receptiveness and an ability to remain mentally present to the potential pain of families’ experiences. From this position, and linking with the importance of witnessing of moments of love and care, openness could also allow unique and bidirectional positive experiences for clinicians and parents:

Those moments of love between a mother and baby, when you witness it if you’re open to it, it’s unlike anything else in the world. P1

Nine participants relayed the importance of commitment, again with a sense of this being a personal and imperative stance, as one participant explained, “there’s a human element to traumas and sorrows that you can’t just ignore and walk away from” (P3).

Commitment and hope were essential in offering parents a perhaps altogether new experience of relating:

It’s important that no matter what they (parents) do you still keep going back so I’ve always described myself as a drippy tap because I just keep going because that’s how you engage, you don’t give up on them because everybody else in their life has so you have to show them that you’re not gonna give up and that you always hold hope. P4