Re embracing containment and holding environments a fresh take on a fundamental element of practice


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  • Ruch (2005) points to the need for containment in order for child-care social workers to respond to the complexity, uncertainty and risk in practice. She highlights how practitioners’ resulting anxiety is further compounded by the current risk averse and bureaucratic nature of steadily emerging technical-rational approaches to practice. These conditions impede the development and maintenance of reflective practice. Based on doctoral research, Ruch offers a model of holistic containment ; this model promotes the development of reflective practice in a way that integrates technical bureaucratic knowledge with knowledge that derives from more practical-moral sources.
  • Re embracing containment and holding environments a fresh take on a fundamental element of practice

    1. 1. Re-embracing Containment and Holding Environments: A fresh take on a fundamental element of practice Laura Steckley SIRCC/Glasgow School of Social Work Bringing Back Innovation and Creativity to Social Care Social Care Ireland National Conference 9-10 March 2011
    2. 2. Structure <ul><li>Concepts of containment and holding environments </li></ul><ul><li>Application of these concepts to social care </li></ul><ul><li>An argument for staff’s containment needs </li></ul><ul><li>How containment process might be achieved </li></ul><ul><li>Re-thinking some areas of practice through a lens of containment </li></ul>
    3. 3. Containment ≠ Constrainment <ul><li>Term is often (mis)used disparagingly to mean keeping a lid on or warehousing kids. </li></ul>
    4. 4. Holding Environments ≠ Holding Therapies <ul><li>Holding therapy is a controversial treatment modality. </li></ul><ul><li>Holding environments is a way of conceptualising the care environment. </li></ul>
    5. 5. Containment <ul><li>Notion first introduced by Bion (1962) </li></ul><ul><li>The infant projects the unmanageable feelings onto the primary care giver, who in turn reflects them back such that they become more tolerable for the infant. </li></ul><ul><li>Continual process of hearing and absorbing cries of fear, anger, hunger and discomfort and responding accordingly comprises early experiences of containment. </li></ul><ul><ul><li>Very strong parallels with processes of attachment </li></ul></ul>
    6. 6. Containment <ul><li>Early, ongoing experiences of containment enable the development of thinking to manage experiences and emotion. </li></ul><ul><li>When individuals’ experiences of containment are inadequate or significantly interrupted, cognitive and emotional development are affected. </li></ul><ul><li>Uncontainable feelings and experiences are normal and arise throughout the lifespan. </li></ul>
    7. 7. Emotional Holding <ul><li>Derived from Winnicott’s (1965) </li></ul><ul><li>Connection with child’s sense of being held during infancy, both in caregivers arms and in a safe environment. </li></ul><ul><ul><li>Makes possible emotional development. </li></ul></ul><ul><li>This whole experience of being physically and emotionally held by caregivers is referred to as the Holding Environment </li></ul><ul><ul><li>Within this the child develops trust, learns to identify thoughts and feelings, and develops the capacity to think, symbolise and play. </li></ul></ul>
    8. 8. The notion of holding is central to effective care giving relationships <ul><li>Holding environments: </li></ul><ul><li>Create reliably safe boundaries </li></ul><ul><li>Offer a protective space </li></ul><ul><li>Enable children to experience themselves as valued and secure </li></ul><ul><li>Is associated with a secure base </li></ul><ul><li>(Kahn, 2005) </li></ul>
    9. 9. Containment and Holding Environments <ul><li>Both Bion and Winnicott applied their respective models to the relationship between therapist and client, stressing the importance of metaphoric containment or holding as part of the process of healing and recovery. </li></ul><ul><li>These concepts have been subsequently applied to a range of relationships and settings, including education, social work and consultancy. </li></ul>
    10. 10. Containment involves: <ul><li>Caretakers ‘absorbing’ the experiences of those seeking their care to: </li></ul><ul><ul><li>Better understand ‘careseekers’’ needs and how to meet them </li></ul></ul><ul><ul><li>Contain parts of careseekers’ experiences, helping them to identify, verbalise, and make manageable those uncontainable feelings. </li></ul></ul><ul><ul><li>(Kahn, 2005) </li></ul></ul>
    11. 11. Containment <ul><li>This concept can also be applied to the more complex network of relationships amongst and between staff and children in residential child care. </li></ul><ul><ul><li>Involves directly addressing via verbal interpretation </li></ul></ul><ul><ul><li>Also involves the use of daily activities, transitions, leisure time, and even the physical environment towards the… </li></ul></ul><ul><ul><li>… development of a containing atmosphere in which children feel (over time) accepted, respected and understood. </li></ul></ul><ul><ul><li>(Ward, 1995) </li></ul></ul>
    12. 12. Containment— the role of a therapeutic milieu A therapeutic milieu can assist the client in holding or containing her painful emotions, allowing her to express internal conflict in a way that can bring about a greater sense of personal responsibility.
    13. 13. Containment <ul><li>Beyond literal containment, each young person needs ‘metaphorical containment’. </li></ul><ul><li>Containment is never static. </li></ul>
    14. 14. <ul><li>“ The complexity of the task of containment is great, given the scale, range and pace of issues arising in everyday life in residential treatment” (Ward, 1995, p.29). </li></ul>
    15. 15. Containment <ul><li>Challenges include: </li></ul><ul><li>Differentiating own feelings from those absorbed from young person </li></ul><ul><li>Counter-transference </li></ul><ul><ul><ul><ul><ul><li>Diminished energy, insight, </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>increased focus on control, </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>emotional unavailability, provoking </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>and/or punitive interactions </li></ul></ul></ul></ul></ul>
    16. 16. Containment for Containers <ul><li>Needed not only for the demanding and complex work of meeting children and young people’s containment needs, but to enable social workers to respond to complexity, uncertainty and risk… </li></ul><ul><li>… particularly in the current risk-averse, increasingly bureaucratic approaches to practice. </li></ul>
    17. 17. Unit Managers <ul><li>Pivotal role in providing containment </li></ul><ul><li>Increasing fragility of organisations due to continual restructuring and redeployment of staff </li></ul><ul><ul><li>Diminishes organisational containment </li></ul></ul><ul><ul><li>Increases pressure on individual managers as containers </li></ul></ul>
    18. 18. Containment for Containers <ul><li>Necessary nesting function of containment </li></ul>Containing relationships between staff and young people Systems of Staff Support Staff meetings Consultancy Supervision Other functions of management
    19. 19. Ruch’s Holistic Containment <ul><li>Holistic containment </li></ul><ul><li>Emotional containment </li></ul><ul><li>( feeling containment ) </li></ul><ul><li>Organisational containment </li></ul><ul><li>( doing containment ) </li></ul><ul><li>Epistemological containment </li></ul><ul><li>( thinking containment) </li></ul>
    20. 20. Rethinking areas of practice <ul><li>Relationships </li></ul><ul><li>Use of self </li></ul><ul><li>Child centredness </li></ul>
    21. 21. Rethinking areas of practice <ul><li>Managing challenging behaviour </li></ul><ul><li>Control </li></ul><ul><li>Touch </li></ul>
    22. 22. [email_address] <ul><li>Steckley, L. (forthcoming). Touch, physical restraint and therapeutic containment in residential child care. British Journal of Social Work . </li></ul><ul><li>Steckley, L. (2010). Containment and holding environments: Understanding and reducing physical restraint in residential child care. Children and Youth Services Review, 32 (1), 120-128. </li></ul><ul><li>Steckley, L. (2009). Therapeutic containment and physical restraint in residential child care [Electronic Version]. The Goodenoughcaring Journal , 6, n.p. </li></ul>
    23. 23. CYC-Online Monthly Column <ul><li>Steckley On Containment </li></ul><ul><li>November 2010 </li></ul><ul><li>December 2010 </li></ul><ul><li>March 2011 </li></ul>
    24. 24. References <ul><li>Bion, W.R. (1962). Learning from Experience. London: Heinemann (1967). </li></ul><ul><li>Deacon, J. (2004). Testing boundaries: The social context of physical and relational containment in a maximum secure psychiatric hospital. Journal of Social Work Practice 18 (1), 81-97. </li></ul><ul><li>Kahn, W.A. (2005) Holding fast: The struggle to create resilient caregiving organizations. East Sussex, Hove: Brunner-Routledge. </li></ul>
    25. 25. References <ul><li>Ruch, G. (2008) 'Developing &quot;containing contexts&quot; for the promotion of effective work: The challenge for organisations', In B. Luckock and M. Lefevre (eds), Direct Work: Social work with children and young people in care, London, British Association for Adoption and Fostering. </li></ul><ul><li>Rich, C.R. (1997). The use of physical restraint in residential treatment: An ego psychology perspective. Residential Treatment for Children & Youth, 14 (3) 1-12. </li></ul><ul><li>Ward, A. (1995). The impact of parental suicide on children and staff in residential care: a case study in the function of containment. Journal of Social Work Practice, 9 (1), 23-32. </li></ul><ul><li>Winnicott, D.W. (1965). The maturation process and the facilitating environment. London: Hogarth. </li></ul>