Why professionals are distressed by children’s distress

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The problem is how we can bring pain and anxiety back into the experience of professionals who work with children.”

Cover of 'Two Year Old Goes to Hospital'What fascinating words. They are calling for increases, rather than reductions, in the anxiety felt by professionals responsible for the care of children.

These are words spoken by James and Joyce Robertson in 1970.* When it comes to understanding the emotional needs of young children, the Robertsons were some of the most influential, bravest thinkers of the 20th century.

I am quoting them now because I think their words are as relevant today as they were 45 years ago. We are not anxious enough about young children’s needs. Another way of saying that is: we adults often find children’s distress so awful that we are unable to offer children the empathy and care that would allow them to recover.

It’s a strange thing for me to write. I talk all the time about the deleterious impact of fear. I talk about the limits of child protection policies. I talk about the need for us to challenge fear. Yet here I am now, joining the Robertsons in calling for more anxiety – or rather, calling for a different kind of anxiety.  Another way of putting this would be to call for more compassion, but the language of anxiety gives us a more useful purchase on the problem.

Why would I choose the language of anxiety? The answer is that our anxieties for ourselves are causing us to collectively deny the depth of children’s pain.  Children’s distress is too sharp for us, as adults, to risk feeling ourselves. So we tell ourselves, consciously and unconsciously, that it’s not ‘that bad’, that a child will get over it.  We tell ourselves, as professionals, that because we intend to do good, that is what we achieve. Way too often, though, we are fooling ourselves – and we are doing so at children’s cost.

The Robertsons said it more eloquently than me, all those years ago:

“Although there is everywhere good will and good intention towards young children… [progress in] work with children stagnates because the common defence against pain allows the acuteness of the problem to be dulled, as [if] by a tranquillizer.”

“The major obstacle to suitable care is neither practical difficulty nor lack of knowledge. It is that, whatever level of intellectual understanding may obtain throughout the professions, the appropriate sense of urgency and alarm is missing, or is dampened down.”

The fact that the Robertsons were courageous enough to say such things two generations ago gives me the impetus to renew their concerns today.

What sorts of things have I observed that fuel my concerns?

  • I think of the social work service manager who stood up in a recent training event and said, in front of her staff team: ‘Our social work policies are damaging children.’  How often do we hear a manager honest or brave enough to say such things publicly?
  • I think of the controversial public lecture delivered this month by Dr. Pat Crittenden, hosted by Children 1st to mark their 130th anniversary, in which she said we should stop fostering children and start fostering families, because removing children from parents always carries a greater risk of damaging them than we have realised.
  • I think of the teacher of deaf children who last week told a story of returning to work after an illness, to be met by a child who greeted him with a delighted hug, but who he pushed away out of alarm about what other people would think
  • I think of the massive response that a recent post on my Facebook page drew, when I said that a governmental aim to fund more hours of free childcare would damage the majority of children in Scotland, were that policy not accompanied by nationwide professional training in attachment.
  • I think of the child protection policies in place in so many nurseries that require two staff to be present while a child’s nappy is being changed – and the staff who have acknowledged that “it isn’t really child protection; its more like an adult protection policy”.
  • I think of Eunice Lumsden’s query, in Lisa Cherry’s latest book about the insanity of a care system that prevents itself from truly caring, about why it is “we do not learn from the messages we are given, using them to shape a different future”.
  • I think of the social worker (Deborah Matheson) who calmly and openly said straight to camera, in a brief film my team made in 2013 about attachment training underway with several thousand staff in Aberdeen: “Children in care have been through such traumatic circumstances that sometimes we social workers don’t want to think or feel too deeply about what they’ve been through, because we’re limited in what we can do for them.”

connected baby straplineIt is experiences like these that recently led my team to found a new initiative: connected baby.  The aim is to find creative new ways of disseminating the scientific information confirming that emotional connection is crucial to all human well-being. With this initiative, we are essentially trying to address the Robertsons’ query, now nearly five decades old:

“The problem is how to bring pain and anxiety back into the experience of professional workers, but in such a way that these are put to constructive use instead of being defensively sealed off by the constant pressure in all of us to escape hurt.”

What a tall order this is! We need not only to increase the levels of pain and anxiety felt by professional workers (and all other human beings as well). We also need to do that in some way that enables the anxiety to fuel us into action, rather than floor us into shutting off feeling.

I am impatient enough, outspoken enough, bolshy enough to think this is worth a try. I am also nervous. Do I really want to be this outspoken? Many people will not like me for articulating these things. They may mishear me, experiencing my concern as yet another instance of blame.

We have to stop blaming and start being curious. We have to ask why record-keeping has come to be regarded as a more important use of our time than relationship-making. We have to ask whether we believe that ‘caring professionals’ with caseloads of, say, 600 families have any real chance of caring. We have to ask ourselves what our purpose is.

I have not forgotten the “hurt”, “puzzlement”, and “abuse” that James Robertson described himself as feeling on release of his film in 1952, as medical staff accused him of slander and untruth. Remarkably, the reaction to a film about the emotional pain suffered by a two-year-old child in hospital was so angry that the decision was taken to withhold it from general release, until the medical professions had had time to come to terms with its content. Robertson’s visual evidence had not, as he had hoped, merely “pierced the myth” that children’s wards were happy places. He had unleashed an explosive meltdown.

Would I have been strong enough to handle such accusations? Would I have been as wisely grounded, able to remember that the vitriol was, as he described it, a “reflection of the very same repressed anxieties” that he was seeking to unravel.

Well, what other choice have we got, but to take brave new steps? The Robertsons charged that if professionals fail to bring a “sense of urgency and alarm” to our work, then we “endanger the well-being of children.” Endanger is a big, scary, troubling word. But there is a much bigger, scarier, terrifying idea behind it:  that well-meaning, well-intentioned professionals could be wasting the lives of so many young people because we were scared of a word.

We need to talk about this. I am only one of urging this. A collection of recent reports have, in their own ways, addressed this same theme. For example new guidance in some local authorities, such as Staffordshire, is trying to sensitise staff to the way in which basic professional language, including judgmental labels like ‘highly resistant families’, does not solve social problems, but often inflames families’ anger, frustration, and disengagement.  Martin Narey’s 2014 report on the training of social workers  concluded that their academic training does not equip them for the realities of the job. The 2012 report published jointly by CELSIS and Scottish Attachment in Action took an even stronger line. It concluded (pg 24) that the

“overwhelming experience of newly qualified social workers, of dealing immediately with several frightening and painful child protection courses and confronting the loss and hurt of looked after children, can undermine the learning and understanding achieved during the qualifying courses.”

This is a restatement of the Robertson’s astute 1970 observation that young professionals will “in time develop a ‘second skin’ against being upset by the painful sights and sounds of children’s distress.” It is inevitable. Professionals are human beings who must find a way to protect themselves from the onslaught of traumatizing experiences. The question I am asking is whether our understandable emotional self-protection is still yielding the unintended consequence of leaving children un-protected?

It is not just the front line practitioners who use emotional distancing as a strategy to protect themselves from terrible discomfort. The Robertsons stressed that managers and officers use it too:

“At more senior levels, those who are all the time associated with situations of stress for young children – the executive officers with absorbing administrative responsibilities, the child-care officer with a heavy case-load – may become distanced from the problem and lose the sense of urgency which goes with full awareness.”

If UK social services had had the capacity and willingness to take on board the Robertsons’ message, might we have averted the recent tragedies of Rotherham, Baby P, Victoria Climbie, and countless scathing care home reviews? Would that hold the answer to Christopher Booker’s question, published in the Telegraph in August 2014,  about what it is that politicians don’t ‘get’ about these tragedies? Ever more record-keeping and information-sharing will never solve the problem of compressed compassion.

I see the theme of resistance glimmering already in the embryonic activities of connected baby. The first contributors to our blog series, Stories of Connection, spontaneously reflected on the cultural encouragement that they had received to disregard human pain. Anne, a mother recalls the pressure she faced  to ignore her daughter’s crying, for fear of ‘spoiling her’.  John Carnochan, a police officer, recalls the disbelief that he encountered  when he began to argue that violence was not inevitable, but could be tackled by paying attention to how babies are treated.

We have a range of other contributors queued up to tell their stories in the coming months. Their accounts further illuminate this vein of resistance. Foster carers tell stories of the emotional safety ‘objects’ they send their traumatised children to school with, but which have to be hidden from the view of teachers and other pupils. Adults who were fostered as children describe what it is like to be abandoned by their ‘corporate parent’. These are hard stories, compelling stories, necessary stories. We must listen to them. It is only in hearing the pain – and the joy – they contain that we learn what it is our services need to do differently. (You are welcome to join the mailing list that will send you a notification of each fortnightly post, HERE.)

In the 2015 Film Nights series hosted by connected babywe plan to screen little-known documentaries that explore the power of human connection. One of those films will be that seminal film by James Robertson, A Two-Year-Old Goes to Hospital. A key purpose of the film, released in 1952, was to find a way of helping professionals to see the pain caused by their policies. It originated from hospital rules at the time, which prevented parents from frequently visiting their young children, because the visits ‘upset’ the children and prevented them from ‘settling’. It was extremely difficult to get doctors and nurses to recognise that their well-meant rules were causing long- term emotional deterioration in their young patients.

Of course the staff resisted such a threatening message! Who wouldn’t? Except that their continuing resistance blinded them to the reality that “systems of care that disastrously fragment relationships can operate in institutions busy with ‘child-oriented’ activities”.

I am suggesting there are areas of practice where we still harbor such resistance in 2014, where we are re-creating the “insidiously effective” but “deaf and blinkered” caretaking professions that the Robertsons warned of.  And yes, relationships can be fragmented innocently, even by an institution operating under the banner of child-friendly policies.

Just how serious are the consequences of fragmented relationships for young children?  Answer:  often life long.  That’s the point of attachment theory.  One of the best sources for understand the tragedy of that are the stories told by adults who had been patients in the children’s hospital wards in 1940 and 1950 (and yes, even 1960 and 1970).  In the course of my speaking engagements over the past several years, I have heard countless stories from adults who were once children caught in those regimes of enforced separation. They are gut-wrenching stories, not only because these individuals can still so vividly describe their childhood distress, but because so many of them attribute lasting emotional difficulties to that early hospital stay. In 2012, I wrote a blog telling one of those stories about a 65-year-old gentleman. That gentleman now plans to tell his story himself, in a future post in the connected baby blog series. We need to hear his story from his own lips.

We need to hear its rawness because I have begun to see anxious defensiveness popping up in more subtle ways. One woman who looked through the films scheduled for the Film Nights series said to me, when she read the description of A Two-Year-Old Goes to Hospital: “Oh, that one looks hard. I don’t know if I’ll be able to come to that screening. I might not be able to bear to watch it.”  That was precisely James Robertson’s point. We can’t bear to face children’s pain. So we turn away. I understand why we do that, why we want to protect ourselves from that distress. But I also insist, gently, oh so gently, but insistently, that we must stop this. We adults need to be able to look upon the pain that we force children to bear. It is only by looking that we have any chance of changing the pain we so unwittingly, casually cause to children.  It is the way we save ourselves from the guilt of realisation later on.

The launch of connected baby has already yielded one further lesson I had not fully anticipated. Professional defensiveness extends well beyond the childhood period. The first new resource we released, under the connected baby brand, is a book on how to connect with people with advanced dementia. One family member who spoke at the public lecture launching the book told the powerful story of watching her mother’s agitation fade away when staff were encouraged to engage by matching her bodily movements and sounds. One of the questions from the audience was: ‘If this way of working has been around for 10 years now, why hasn’t more been done by the NHS or governmental agencies to promote it?’

I thought immediately of the Robertsons, as the keynote speaker (Dr Maggie Ellis)  came back with her reply: “Maybe its because, ultimately, this way of communicating scares us. It makes all of us confront the fear that one day we too could be left lonely and agitated in a care home — just because people don’t understand how essential connection is.  Its easier to push that fear aside and ignore it.”

In the 21st century, we have gained so much scientific information that James and Joyce Robertson never had. We know more about how the brain operates and what the economic consequences of emotionally unattuned care are. We have more sophisticated technology for producing video footage. We know more about the astounding physiological transformations wrought by compassion, empathy, and attunement. Yet it turns out the Robertsons were right:

Without a sufficient degree of anxiety in the professions, there can be little improvement, no matter how much knowledge is available.”

* All Robertson quotes cited in this article come from their lecture delivered in 1970, entitled ‘The problem of professional anxiety’. The full text of the lecture can be found on the Robertson Films website: https://www.robertsonfilms.info. The lecture was also reprinted in the 1989 volume Separation and the Very Young, by J&J Robertson, Free Association Books.

7 thoughts on “Why professionals are distressed by children’s distress

  1. What a wonderfully constructed and thoughtful article. Thank you for taking the time to put this together and also for the mention too. We have so much knowledge and yet so much practice is not informed by it and it is very very sad. Keeping things as they are must serve the needs of someone but it is not the children and the young people who are in our care that’s for sure. As you so rightly say, why are relationships far less of a priority than writing notes for working with people who have suffered from trauma?

    Exploring this in terms of thinking about what adults can and cannot cope with, the limitations of our individual empathy abilities, is incredibly helpful and offers a chance for deeper reflection for all those working with vulnerable children, young people and adults.

    Thought provoking and honest. Thank you …

  2. It strikes me that a lot of this also applies to parents responsible for the care of children (not just professionals).
    In debates about childhood wellbeing and childhood developmental needs we often have a false disconnect between professionals and parents. I would say that in the same way as we strive for more integration between Health and Education we also need to think about parents and professionals as all being adults together in communities responsible for the wellbeing of children. Some parents will choose to provide care at home, perhaps attending regular toddler groups/singing sessions etc and others will choose community based paid care whilst they return to paid work. We need all these possibilities to be explored and respected and to build a system which enables parents to have choice and flexibility in how they raise their children and care for them.
    At the end of the day parents can’t cope with their child’s distress either (for example distress and being left for long hours in a setting that may be too much too soon for them, or distress because they can’t afford to heat water for a bath). But because of our socio-economic system parents have few choices and are struggling.
    So apart from the measures you speak of, we also need to build an economy that’s fit for family life – for example decent affordable housing, better pay levels and pay progression levels, fairer family taxation and allowances for people raising children. And crucially better understanding of the importance of family care responsibilities. We choose not to explore these difficult topics, not only for complex personal reasons, but also because we can’t believe there are any economic solutions – in other words the economic model doesn’t work for families and for ‘caring’ anymore – but we have no clue how to ‘fix’ it to make it better. Marie Peacock MAHM

    EXTRACT FROM YOUR PIECE “The problem is how we can bring pain and anxiety back into the experience of professionals who work with children.”
    What fascinating words. They are calling for increases, rather than reductions, in the anxiety felt by professionals responsible for the care of children. These are words spoken by James and Joyce Robertson in 1970.* When it comes to understanding the emotional needs of young children, the Robertsons were some of the most influential, bravest thinkers of the 20th century. I am quoting them now because I think their words are as relevant today as they were 45 years ago. We are not anxious enough about young children’s needs. Another way of saying that is: we adults often find children’s distress so awful that we are unable to offer children the empathy and care that would allow them to recover.

  3. Thank you.
    Your article has really resonated with me. I am a foster carer and I feel time and time again that professionals around the children are often paying no more than lip service to issues raised. Yes they are well meaning but do they really feel the pain and sense of urgency to make a different? Many professionals are very reluctant or unable to listen effectively and act upon concerns raised by those who really know the children and are living day to day with the children (the foster carers) and the people who are working with them daily at schools and nurseries. I wonder if this is through fear or through feeling they do not have the skills or time to make a difference? Many of the professionals seem very sanitised and even at times make carers feel inadequate for raising genuine concerns for emotional welfare of children in our care. They are looking for text book answers and are not asking the really in depth questions which would help them get to the root of the problem and start to help. Time and time again I feel that I am the only professional really fighting the corner of these children and the only one brave enough to speak up at meetings. All professionals need to be braver and willing to follow their instinct rather than following the crowd. I am constantly made to feel that there is always a child in more difficult circumstances than the child I am looking after. I don’t doubt that this is the case but the child I am looking after deserves to be heard and deserves professionals as you say to have a sense of urgency for their welfare and more people to really understand their pain. We risk failing so many children by waiting for the big issues to arise before we take any action, by which time it is far far too late.

  4. Thank you Suzanne, your article really resonates with me and backs up what I’m seeing in the area of work that I am involved in. It sometimes feels like social workers in many cases are so focused on ‘rescuing’ children, that they lose sight of what could be if they (as you quote) ‘foster families’, to avoid adoption being the inevitable outcome. I see many adoptions that break down in later life and the enormous emotional and life long impact on the children of being adopted. Not sure how to solve it all, but there has to be a starting point.

  5. Great. Just what we need in the care sector, and this extends not only to children and young people but to everyone. Vulnerable adults in care could use some empathy and genuine connection too.
    Have you heard of compassionate communication or NVC (non violent communication)? This model is all about a genuine connection. If only everyone related to each other in this way!
    Thank you.

  6. Absolutely yes to all of the above. I would also like to add that I have a noticed a real phenomenon of a blocking style of communication within the public sector and people dismissing (or may be just not understanding) distress. A real lack of the ability to be an empathic witness and so much cynicism and lack of authenticity.
    Maybe this is more noticeable now as levels of inequality and the gap between richest and poorest is wider, with people delivering services not living in remotely similar communities to the ones that they are “helping”.
    I think that this drives a level of frustration that causes people to come across as aggressive when they encounter this style of communication from these types of professionals.
    One thing I think that works well to counter this is more people from different backgrounds who have experienced adversity leading the way in solution finding.
    Different people at the table.

  7. I see workers on a daily basis in social work and Health extreamly worried, anxious and having sleepless night about children on their caseload. Some of these children remain at home with their families others are accommodated. The urgency and alarm they feel gets taken away from them by the numerous reports they have to write, the meetings that they have to be arranged, the waiting list for referrals and the descion of the judge! Now in Scottish Law a little bit of harm is ok. How much is a little bit of harm? Yes polices and procedures have to change, early intervention cannot be achieved in social work due to cut backs and staff shortages. I have seen an abundance of experienced sw staff leave the council in the past few months because the pressure is too much. Facing worry and anxiety every day but having to fight with managers and courts and having no resources and no time to do any real relational work. Everyone’s thresholds are different and this is a daily struggle. Things definitely need to change. From the area I am working in, things have got much worse over the last 11 years not better. The child does not appear to be at the centre.

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