By John Burton

John Burton’s forthcoming book Leading Good Care: the task, heart and art of managing social care due to be published by Jessica Kingsley Publishers on February 15th, 2015. John is a regular and generous contributor of articles to the goodenoughcaring  Journal. His book will be reviewed in our June 2015 issue.

 

Some notes on consultancy to children’s homes

I first became a consultant to children’s homes in 1980 after having led a therapeutic children’s home in the 1970s and completed the residential work “Advanced Course” at Bristol (Chris Beedell and Roger Clough) in 1978/9. While I was doing this consultancy, I applied for and got a place on the Tavi consultancy course which, then, was called the Advanced Course in Consultation and Training in Community Mental Health, and is now an MA, referred to amongst alumni and those “in the know” as D10. Since then, with some longer and shorter spells of employment including leading adult care homes and inspecting, I have consulted to various residential care organisations, homes and teams including several providers of care for children and young people.

At first my attitude to this lofty role as “consultant” veered between surprise and trepidation that anyone would hire me to do the work, and a defiant conviction that, having done the (real) work at some depth, I would be ideally fitted to the role of consultant. Of course, neither was – or is – a good starting point when engaging with your client organisation, and with age and experience, I have managed to come to terms with the role, and can cope better with my mix of knowledge and ignorance, competence and incompetence. I’m better at accepting that, often, I don’t know what’s going on, and that the role has at its centre the process of helping the client to find out; so that, even when I do think I know, it’s not always helpful to say so.

With the current state of regulation and inspection (CQC and OFSTED) most care providers are simply looking for consultants who will steer them through inspection, so there’s a lucrative living to be made from what we might call “compliance consultancy”. I simply can’t do that even if I wanted to, so those enquiries for my services never come to anything. I am also careful to check out – as far as is possible – what are the motivation and ethics of the organisation, because, as all readers will know, there are plenty of money-grabbing charlatans in this care business. So, with those filters on, I’m not inundated with work! But enough is plenty.

There’s much to be said – and written – about the consultancy relationship. When you boil it down, it isn’t surprising to find that, like care itself, care consultancy is a relationship. The work gets done in the talking, feeling, thinking, reflecting, relating process between people. And it’s different with different organisations. Working with a new organisation (or home) is very different from working with a mature organisation. In spite of what I’ve said above about staying with not knowing and encouraging the client to find out for themselves, it would be wrong to withhold information, experience and guidance if a client desperately needs them now, and is struggling without them. So, the role can have a strong teaching strand to it.

The consultancy relationship has a limited life: it can run its course and be ended and handed on, or it can get stuck but then repeat a course that has already been followed. The client or the consultant can find that, having done some productive work together, they are now out of sympathy. For me, one of the most interesting and engaging experiences is to go back to an organisation after several years’ break.

How often one visits, how feedback is given to whom and at what levels, who exactly is/are your client/s, how one combines reflective exploration with straightforward practical advice or guidance, the question of fees and clarity about contract, confidentiality, serious concerns, trust and reliability, and, of course, the values and theoretical base on which the consultancy relationship and work is based, are some of the issues that must be faced and worked out with your client. Having agreed some of the basics with a client, I usually make what I grandly call a “diagnostic visit”. If it’s one home, I arrange a visit starting at about 7.30 a.m. and ending around 6.30 p.m. I spend the next day writing a report to the client, and then we work from there.

What I offer here to illustrate the work are some selections from consultancy notes with one of the homes of a child care provider over a four year period – a provider with the best of intentions but little experience, so there’s a strong teaching element to the notes. The notes are in date order beginning in the second year. My routine was to visit the home every four weeks arriving at about 7.30 and leaving in the mid to late afternoon. I usually caught the morning handover, on to breakfast, off to school (or not), team meeting, consultancy meeting with team, and then consultancy with the manager. Usually within 24 hours, I emailed feedback notes to the manager, who then passed them on to the whole team.

 

In the second year.
1. Things are much calmer at the House. I put this down to your consistency and increasing cohesion as a team – your “COHESTENCY” as Arthur put it (a new word!).

2. This is paying off with the boys. They are beginning to feel that there is something solid to “hold” them. You are establishing a “culture”.

3. But NEVER let up. Old ways creep back in without you realising it, so you must be eternally vigilant and self-critical with yourselves and each other.

4. Although I wasn’t at the midday meal, I did hear that everyone was sitting down together which is very good.

5. I think the handover book/notes are good AND can be developed much further. The focus is rightly on the boys – but what about the boys as a group, and the life of the House? And there is still that tendency to leave yourselves out of the record – as if you were merely observers rather than principle participants!

6. Try to avoid institutional language/words such as “contact”, YPs, absconding. What’s wrong with “seeing your mum”, the boys, and “running off”? You can only abscond from an institution. Your children don’t “abscond” when they leave your home without your permission.

7. Don’t take anything at face-value. A developing and very positive relationship between one of the boys and one of the team means more than that the boy enjoys your company and the interest/activity/sport you are offering. The boy is looking for something special in this relationship – very possibly something that he hasn’t had or, if he’s had it, has destroyed (or been let down in) in the past. It is likely that he will soon test the relationship, or attempt to wreck it if it has deep meaning for him and touches difficult emotional areas. Doing constructive things with the boys that they enjoy is of course good in itself, but that is only a fraction of the potential therapeutic value.

8. Think more about using the “R&R” scheme in a more precise way: planning WITH the boys; helping them to achieve and to make and sustain relationships.

9. And think about how you might include the boys in the handovers and planning – and perhaps move to a community meeting type handover.

10. Good progress. Now to move up a gear!

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1. I arrived in the middle of the morning handover. A lot of good, detailed, discussion and planning.

2. The handover notes reflect further development of handovers – reviewing the day, thinking ahead etc. Also I noticed on several occasions during the day that staff were much more alert to the boys being at a loose end and then responding quickly by being with them and engaging them rather than letting them create destructive diversions. This was very good.

3. So, while recognising and applauding the progress made, there are a few critical observations about the day:
a. Whether they have to get up for school or not, the boys need structure. If they stay in bed until after 9 in the morning and then don’t actually have much of a programme for the day, they are under-occupied and under-stimulated. Your expectations of them are too low and you end up just following their demands.
b. I do think you should question your use of cars: your own dependency on them and the boys’ dependency on being ferried around at will. How does this help the boys to learn self-reliance?
c. The shopping – I have many questions about how this is handled: the money, involving the boys, what you buy, the use of time and transport, planning. Sometimes I feel that shopping is used as an apparently legitimate way of getting away from the home and the boys. If shopping is merely a matter of the supply of food, why don’t you order it on the internet and get it delivered? But if it is more than that, then make it part of the life of the home and involve the boys in every aspect of it. (Staff shopping on their own or in pairs is an extremely expensive way – and not just in money – of doing it!)

4. To establish a therapeutic culture, you have to build a therapeutic structure. (STRUCTURE AND CULTURE are interdependent.) On my last visit I observed that there was more cohestency – Arthur’s word for a mixture of cohesiveness and consistency – but much more is still needed. You are still inconsistent and as a team you lack cohesiveness. There are too many disagreements amongst you about the direction of the home. These need to be worked on until you are all clear about your shared direction. The “shift leader” role is beginning to work but is undermined by inconsistency and failing to carry out what you have agreed to do. Part of the structure is remembering that there is an order in which things are done. So, for example, the boys get used to the idea of “first things first” – you don’t get your pocket money until you’ve done things that need to be done. Pocket money is NOT a reward for tidying your room, but it does come AFTER you’ve tidied your room. For the boys to understand this, EVERYONE has to stick to it. Grown-ups who can be manipulated may gain short-term popularity but in the long run they lose respect and authority – and they are not reliable team members. Allowing the boys to manipulate you is not good for them.

5. Some good conversations with the boys during the day – grown-ups and the boys together. They want to be with you. You are very important to them. And the critical observation would be that you do need to learn to take more of a stand on some issues when you are talking with the boys. There is the feeling sometimes that you tolerate and even collude with attitudes (about crime, violence, race and women) that the boys hold (or are trying out) and that you need to make quite clear you do NOT hold. To get the message, the boys need to hear that all the team are together and support each other. But you don’t want to stop the boys talking ABOUT these issues (to just shut them up); the aim is to encourage them to think about the issues and about what they are saying. They are capable of thought and reflection but they have to be encouraged to discuss these issues with people (you) they trust and respect.

6. The House is becoming more and more MALE. This is partly, of course, because now there are very few women working there. But it is also because the men on the staff are lapsing into stereotypical male roles and attitudes. Maybe it’s just me! but I think there is something significant in the way the kitchen is treated. The kitchen represents food and nurturing. The boys throw food around and rip the door off the fridge. The kitchen is becoming less and less “homely”. This is the obvious location of “mothering” in the house. Most of these boys will have had less than satisfactory (or satisfying) early mothering. Have a look at some of Winnicott’s descriptions of the child and the mother. (Or look at pp 153-155 in my book “Managing Residential Care”.) If you consider what is happening for one of the boys (R) at the moment, think about his early infancy (“he was a difficult child”/possibly rejected by his mother), you can see that he is going through another traumatic period of separation. He rages against the “mother” from which he is separating. He destroys the good things on offer. He is at one time omnipotent and at another a dependent infant. His emotions and mental state are directly connected with what happened to him as a baby. The kitchen (as a symbolic location of mothering) is so important to him. So, although he tears the door off the fridge and destroys food, you, as the grown-ups, must treat the kitchen with due respect and try to make it worthy and functional as this location of good (enough) mothering for all the boys. So, for example, don’t sit on the worktops where the food is prepared! I don’t think women do that? Men need to learn about mothering!

7. I had a look in R’s file (for the first time) at what I could find of his early infancy and childhood, and I thought what a good job the House has done for him over the time he’s been there. When you are in the middle of this phase of his leaving, it is difficult to appreciate just how important and supportive the House has been for him, or to give yourselves (especially long-term staff) credit for sticking with him.

8. To start working in a consciously therapeutic way, you need to think all the time about the meaning of behaviour – your own and the boys’. For example, on one level J’s obsession and pride in his toilet habits is by turns disgusting, mildly amusing, and anti-social. But if you think of him as a toddler delighting in his shit, sitting on the potty and being congratulated for his production, and looking with pride at what he has made and what has come out of him (as toddlers do), I think it helps to understand what is happening for J at the moment. He seems to be getting a lot out of the House – and that is because of your good work and the relationships you are offering him. This disgusting habit of farting and stinking out the toilet and making everyone know that he’s just had a satisfying crap has other meaning and significance. (All this does not, of course, mean that you actually start treating and relating to the boys as if they were infants, only that you begin to understand that their behaviour has direct connections with their neglect and deprivation as infants.)

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1. Noticed the new planting outside the front door which I thought might have been done with the boys. Discovered it was done by the gardeners. Later I saw the vegetable plots in the back garden. Then there are the curtains and pictures, new doors and some new decoration. The House and the garden have the potential to be very attractive, and they have been at one time. You are trying and to some extent succeeding in getting the place looking good again. This is progress but it’s worth considering how you are going to maintain this progress and make it meaningful to the boys and the place. Generally those improvements that are just provided are unlikely to last but those that have truly involved the boys have meaning and may be more durable. One day this lovely house and garden may look really good again – but that is only worth having if it is part of the life and care for the boys. The garden could look so good but some of you need to learn a bit about gardening!!

2. But there is also the issue of building a culture of care for the place. Not so long ago the boys went round casually kicking and bashing furniture – they didn’t even notice they were doing it. I didn’t see that this time but I did see Ricky sitting on the small freezer in the kitchen and breaking more of the top off it. I think I drew attention in my last lot of feedback notes to the significance of destruction in the kitchen and the “maleness” of the place. A lot goes on in the kitchen. Some of the best conversations take place there. You notice how the boys want to be in the kitchen but also are destructive towards it. Try to imagine what is going on deep beneath the surface at a deep unconscious level. Once you understand the significance of the kitchen – of the food and the emotional nurture that it represents – you can then use the kitchen and the food as a central part of therapeutic work. You can also put the boys’ destructive impulses – the destruction of food and food containers, the throwing of eggs and squirting of ketchup and mayonnaise, the aggressive demanding and “stealing” of food – into a context that begins to tell you what’s actually going on for them at an unconscious level.

3. Arthur and I have planned for me to lead some team discussions to introduce therapeutic concepts and ideas again for new team members. What I’ve written above (about the kitchen) may be completely new and strange to some of you but if you can start discussing these ideas – even if it’s to say “What the hell’s he on about?” – it would get everyone thinking together.

4. You have made so much progress with J and A. J is really getting so much good, steady attention. This is work to be proud of. Just a little incident illustrates it: J outside kitchen door smoking – it starts raining – J asks if he can “run through the house” to be under cover outside the front door – he’s told no – he accepts it. J has developed inner controls and all you’ve been through with him has enabled him to do that. The boys are having proper conversations with you. They are relaxed and want to be with you.

5. You still habitually use institutional(ising) words such as YPs, contact, chores, and you use initials for the boys in the handover notes. “YPs completing chores” – what did they DO and HOW? Also, the handover notes, good as they are, need to go further. Consider WHY things may have been the way they were: “The house had a good feeling about it” BUT WHY AND WHAT WERE THOSE FEELINGS ABOUT? AND HOW ARE YOU FEELING? The boys pick up feelings from you and you pick them up from the boys. Then the boys hand them back to you and so it goes on. You need to reflect on and analyse where those feelings are coming from and why you might be responding/reacting in an angry/ hurt/ vengeful/ exhausted/ cold/ superficial/ detached/ controlling/ colluding/ frightened/ hateful/ or reliable, grown-up, loving way??? This is the key to therapeutic work. If you understand (or at least attempt to understand) what’s going on inside you, you will understand what’s going on inside the boys (transference and counter-transference).

6. For the first couple of hours of the day, the staff were cleaning and doing the “chores” while the boys remained in bed/asleep/playing with the games etc. Now, it’s of course good that the house is being kept clean, but think deeper about this. Are you well-paid cleaners? Are the boys guests in a house where the cleaning has nothing to do with them? There’s no right answer! But what might have been a really useful way of working a few months ago may not be suited to the current situation. The House has moved on. Don’t get stuck with outdated routines – comforting as they may be!

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Year three.

The House has maintained an excellent standard of work with the boys. Christmas is always a potentially difficult time and you seem to have not only survived it but made it work for the boys.

I think the family work that the House does is exceptional and there should be some way of that being recognised. Building your good reputation takes time but it seems that the word is beginning to go around.

You are working well as a team and you are so keen to learn.

The handover notes have made good progress though I think there is a section missing. You have “planning” and “reflection”, but where’s what happened? You tend to lump that into reflection but that’s meant to be a reflection on what happened. I must come to a handover meeting and see what actually happens!

One of the underlying themes for me on this visit was the difficult task of containing and tolerating conflicting feelings:
really liking and respecting your colleague, yet needing to tell them something that they won’t want to hear;
worries about disturbing the good feelings of a team working well together;
being envious of other people’s work, and wanting to support and praise it but also to undermine it!
letting go of the boys you’ve put so much hard work into, endured so much from, made such strong and important relationships with;
contemplating starting all over again with new residents – you know that it’s going to be very hard work, that things will go “wrong”. You doubt your own capacity to “succeed”; you are fearful about what lies ahead, yet you know that this is the job.

“Bad” feelings are better out than in, and the better you get as a team (and you’re pretty good) the more confident you will be in opening up and dealing with the inevitable bad feelings that you have to carry. Don’t forget that identifying these feelings and understanding that some will be coming directly from the boys (projection and splitting) and then supporting each other through them is an essential part of the work, and one of the tasks of the practice forum (the team consultancy meeting).

Arthur and I had a bit of a discussion about the rota. There is nothing that is more at the centre of a therapeutic “system” than the rota. Each alteration has the potential to affect everyone else on the rota. Your special request is someone else’s special accommodation to your special request. Amongst the photocopied pages from two of my books (that I left without writing the references on them – sorry), are a couple of pages on the rota. Arthur and I are going to do some more work on this. All rotas are compromises but the best put the needs of the boys and the House before any individual needs of staff.
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1. Good to see Julie starting and sorry to see Sally (housekeeper) going. Sally will be missed by all and especially the boys. It gives an opportunity to review the role that Sally took on, how it was used and how it might be developed keeping in mind its central therapeutic function.

2. It sounds as if Ricky’s move was well accomplished by all. Such a piece of work can never be perfect of course, but I think the planning and attention to detail was excellent (on the part of the House).

3. Anthony’s absence on extended holiday has had a deep effect on the home. The boys (esp. A) must worry, and miss him, and also be angry about being left. It’s just as well to bear this in mind. Even though as workers you have to attend to your own family/personal needs and demands, the boys have to cope with the knowledge that they aren’t always the most important people in your lives! The experience of your reliable care and attention (and attachment) is one they are not used to, so trusting it to any extent and then letting it go is hard.

4. One of the most difficult things to realise/come to terms with/act on is that the big issues that come up in the work and the everyday symptoms of those issues NEVER go away! You deal with them one day and they are still lurking there the next. In my notes for the introductory Practice Forum sessions, I think I called it “system maintenance” – meaning something like keeping the therapeutic system in good order. You create the system in response to the boys’ needs but if you think that, once built, such a system looks after itself, you’re wrong! It needs constant attention and vigilance. This is done every day – handovers.

5. I posed a couple of contradictory processes to be thinking about:
a. The therapeutic use of TV (watching WITH the boys and sometimes using what has been seen to talk over feelings, issues and events that the programme has evoked for them)
as opposed to the anti-therapeutic abuse of TV and computer/internet games etc. where the boys are left on their own to obliterate feeling or to escape into fantasy violence, aggression, omnipotence, sexual confusion.
b. The therapeutic use of the kitchen, food, cooking, and mealtimes (and there’s a lot more work to be done here?)
as opposed to the anti-therapeutic use of junk food and drink.

6. One of the themes in both the team meeting and the practice forum was authority – who makes decisions; who says no. Who can be depended on to say no when no is the right answer! As you develop further as a team, the authority will devolve. The boys will gradually understand that it is not only Arthur that makes big decisions, that individual staff and the team itself has solid authority. (I’m not saying this isn’t happening already.) It requires exceptional self-awareness and discipline. It requires anticipation – thinking ahead – what will this day bring for this boy and how are we going to support him? It requires excellent communication. It requires straight talking between colleagues and friends.
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Now there are three residents and – unusual these days – I was able to speak with both the boys that I hadn’t yet met before 9 a.m. The other resident, P, was still in bed and remained in his room until the afternoon. The feedback I got from the boys I spoke with was very positive and reflected the real qualities of the House.

The house is still looking good, and grown-ups and children are all thinking of how to contribute to enhancing the home in different ways (thinking about/ planning for the kitchen next). It was great to see one of the boys going out to feed the fish, and to see both the boys who were having breakfast sitting at the dining table and enjoying their food. The next step would be for staff to sit and have breakfast with them rather than standing eating in the kitchen.

While I was talking with M, I noticed what a variety of birds there was in the garden and started talking with M about them. He was interested and surprisingly knowledgeable, telling me of the birds he’d seen including owls and herons (after the fish). And then there was a discussion about the squirrels and the fish. Although M found the House a bit isolated, he recognised the positives of the garden and the semi-rural setting.

(Some practical advice . . . for a change! There were some funny noises in the building during the day and it struck me that it could be squirrels getting in somewhere and finding a warm place between ceiling and upstairs floor. This is quite common. They can be extremely destructive. It’s worth checking out before damage is done. And it’s not too late to plant bulbs – crocus, daffodils (go for small ones), tulips, hyacinth etc. are still in the shops and don’t cost much – and such plants as winter pansies. They’ll flower from Feb/March through to May. Wire them because squirrels dig them up.)

The team meeting was pretty positive on the surface but there is an underlying trace of despondency and hesitancy about commitment. People are on training courses; there are new residents to be engaged with and more to come; the house is now looking good – even the office has been decorated. But, people feel they are working too many hours, not being paid enough, not being cared for and appreciated. And the prospect of more extremely hard work and being asked to commit to these boys and more, and the always present problem for staff of the work/home life balance. Those with families and other dependents/partners do find their emotional resources stretched to the limit. Finding the balance is extremely difficult and testing. It is built into this work and cannot be avoided but it can be alleviated, shared, talked about, understood and somehow “managed”.

I think that the news of Anthony’s plan to leave is significant, not only because Anthony has made such a long-term commitment and given such reliable and authentic relationships to boys at the House over the years. But Anthony is going because he needs to concentrate on his family now, and others must be thinking the same. This extremely difficult choice and tug in both directions affects people in other jobs as well, but very few jobs require the same level and quality of emotional commitment and anguish for work as well as home. Many people do this job well for a year or two, and then go on to something else. They learn a lot and they give a lot, but they also take away a huge amount of personal/professional development that in the second, third, fourth . . . tenth year will bear fruit for residents and care homes in ways that “new” and relatively inexperienced staff can never match. My own first experience of proper residential work lasted only two years before I just had to leave (and go and drive a van for a few weeks to regain emotional equilibrium). The House has a great team and can (and does) do great work. Such a team is co-dependent and cannot be rebuilt in a short time.

In retrospect, we probably should have talked about this in the Practice Forum, when in fact we talked about the elements of the “therapeutic social ecology” – and this was triggered off by a question about whether a new TV and games console would actually add anything to the care of the boys. Perhaps I was (unconsciously) avoiding opening up the very emotional subject of work/home balance in the presence of an OFSTED inspector who would be unlikely to understand or appreciate that feelings that might be exposed were really important and talking together about such things was very much “on task” for a children’s home. (Perhaps you were also agreeing to keep such feelings under wraps in the presence of the inspector?)

You’ve obviously done well with the inspection, but these satisfactory, good and outstanding ratings are so false. It’s like you concentrating on the boys’ behaviour to the exclusion of what’s behind the behaviour, or having a brilliant piece of course work marked down because you’ve set out the heading in the wrong way. How can people make a judgement about an extremely complex “therapeutic social ecology” that they have no experience of and don’t understand? But, there we are, we have this inspection system and we have to comply with it to carry on the important work you do.

Sorry to pick out just one example of excellent work (of many available) but I was so heartened to hear about bedtime stories being read to one of the boys (and another showing interest). This is so good. And I’m so happy because it’s one of those things that I have always hoped may happen – and here it is: you’re doing it and it “works”!

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Weathering the storm

In thinking about the House over the last three years, this phrase “weathering the storm” comes to mind.
I’m no sailor but I’ve spent most of my life travelling by bicycle or motorbike, so I know what it’s like to just keep going, hour after hour, sometimes wet and freezing cold, whatever the weather throws at you. I’ve also been a residential worker for many years and know that feeling of putting my head down and carrying on through thick and thin.

The House is a place where storms – short, long and perpetual – are weathered. This is achieved by individuals, by the team and really by the place as a whole.

On this visit, I saw in the boys a month’s significant progress, enabled by some very skilled and committed work AND by weathering the storm.

It is very difficult for outsiders (who haven’t done this work) to understand how a good place evolves. It takes time, commitment and the resilience to weather endless storms. If you’re still there after each storm, you, the place and the boys will have moved on. And this is what the boys so desperately need and so desperately try to destroy.

On my last visit, the House was staggering under the impact of staff leaving in ways that must have communicated desertion to the boys. On this visit, the strengths, creativity and renewal of recently joined staff combined with the belief and commitment of the core staff have enabled the boys and the House to make progress.

A proper goodbye was given to Anthony. The boys were there and understood the significance of the occasion and were given the chance to say goodbye to someone important properly. Of course the occasion was important for Anthony and for his good friends and colleagues on a personal level, but it was very significant for the House and the work.

The House – building and garden – has such great potential. We talked about the kitchen again and its significance for the boys – and its potential. Alterations to the kitchen by themselves will not work. Any alterations should follow a build up of “demand” from the House, so that everyone knows what is missing, why it’s an essential part of the therapeutic ecology of the House, and how it will be used. The garden is similar but doesn’t involve such material/financial investment. This is a very good time of year to start “gardening” – highly therapeutic but can only get going when the enthusiasm and dedication are there. A garden “make-over” is just temporary and very depressing three months later when it’s been neglected!

Actually, the house looked a bit neglected when I arrived.

Always remember that there is no better “training” than doing it and learning in a good place with good management, leadership and supervision. Outsiders can present themselves as “experts” but you are the real experts and you have learned (are learning) by weathering the storm.

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There was an atmosphere of quiet, disciplined, purposefulness!

School had started. Everyone seemed to have something that they were getting on with. Planning had taken place. The team meeting started on time.

Team meeting
Again, an impressive, in-depth discussion of each boy. It’s not just the content of these discussions, it’s the really positive approach – working things through, thinking deeply, using different opinions and observations, noting details and understanding the significance of events, words, moods etc.

Some of the work is top class and you should be proud of it. And – for staff who have held on when it all seemed so difficult – this didn’t all happen in the last few months. During those exceptionally difficult times you were laying the foundations of this work and it couldn’t have happened without you.

So good that people (esp. new staff) raise difficult issues. Even the best of us/you have weak areas and we need to be reminded of them and helped to improve. New staff should keep their questioning, fresh, critical faculties sharp! Watch out for comfortable collusion! (The unspoken collusion is – “I won’t say anything about you if you agree not to say anything about me. We’re all fine – it’s the boys who are the problem.”)

I notice that there is still some hesitation and repetition about minute taking. Arthur still chairs the meeting. Nothing wrong with this but I think it’s a stage on the road. When you all start taking turns at chairing and minuting, you may develop more confidence about the boys meeting as a group. There’s a lot of room for progress in groupwork – understanding, managing, participating.

Practice forum
I think it went OK? Not so many people there – but there are some who’ve been to all three so far, and confidence and familiarity with the concepts are building up and you’re participating – more of a “forum”.

1. INTRODUCING THERAPEUTIC THINKING
2. HOLDING
3. NURTURING
4. (Next one) CONSCIOUS AND PLANNED ENVIRONMENT THERAPY WITHIN AND IN ADDITION TO HOLDING, NURTURING AND DAILY LIVING.

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It took me a long time to get in! The door bell still doesn’t work and I don’t think it’s worked for months. People were of course busy upstairs. Some visitors may find this a real problem, indeed some “insiders” may find it a problem but find other ways of entering the house – they ignore the problem by getting round it. Visitors will encounter a notice on the side gate telling them to go to the front door, and on the other side of the gate there’s a notice saying that it should be locked! But it isn’t. I do understand that this notice has been posted as a result of some inspector insisting on it. But things should make sense. Compliance very rarely equates to care. This may seem like a mere detail and I didn’t raise the issue during my visit, but I think it represents all sorts of important issues that are well worth thinking about and discussing.

Continuing with the theme of inspection, a school inspection had just been completed on the day of my visit, with a very good result and all concerned deserve congratulations for their hard work and commitment. Well done! BUT! Inspections can get it so wrong. So often inspectors – and the process they have to comply with – don’t really get to the heart of things. They measure you by the only measures they have. There is a saying that what gets measured gets done. So missing bits of paper, signatures, reports, etc. are the details that make all the difference to the result. This is not an encouragement to ignore inspections – because that would lead to the end of the House – but always to put them in perspective and to have the courage of your own convictions.

Increasingly, I see the development of truly therapeutic relationships with the three boys at the House. Visiting every four weeks as I do, I can see the progress – the way the boys are relating with each other and with grown-ups, the growing trust they have in the House, their conversations, their demeanours. If only outsiders (e.g. inspectors, placement officers, social workers) could see the quality of this work – the persistence, resilience, the commitment, and the educated concern and understanding of what is going on for the boys. It’s so good to see and I find it inspiring to know that there are places that are really doing “the job”, rather than presenting a flashy facade for external consumption.

We discussed the infatuation of one of the boys with one of the grown-ups, and how to deal with it. This is a common – none-the-less difficult – issue, but in this case it may have been further complicated, and suitable response and action inhibited, by it being a same-sex infatuation and the anxiety about giving a repressive message. Our discussion may have helped to clarify and to encourage the team to trust their principles and act on them, rather than dither or be “caught in the headlights” when confronted by something that strikes them as wrong. I think if this had been a heterosexual infatuation, the team would not have hesitated? Authenticity – the real you – is so important to the boys even if they don’t like it to begin with.
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The House is working well. For a long time now there has been progress, even though that means one step back and two forward. What the team has developed is the ability to use that backward step as a launching pad for the forward progress – learning from setbacks. Yet again a new team has formed around the core of the long-term team and leadership. And again people have been lost in the process but it’s always better that someone who finds themselves to be out of their depth leaves quickly rather than struggling on.

The boys are so fortunate (for once in their lives!) to be able to make relationships with and to be supported by a great variety of grown-ups with such personalities and talents – and I don’t just mean the obvious “stars”; I mean those who have quiet strength and commitment as well.

The team’s current way of relating is a bit “hyper” – much excitement, hilarity and affectionate teasing. On reflection, I see the influence of the boys as much as the influence of very demonstrative and lively staff. The boys are all interesting and quirky people and the “camp” and florid culture pervades the house. And the grown-ups, far from being fazed by this behaviour, can match it and share it so that it isn’t the delinquent and challenging behaviour that it could be (and may have been part of its original attraction) but is a shared social and relationship based culture. It is difficult to distinguish what has happened with this from collusion. The difference is that the adults are not reluctantly and uncomfortably tolerating behaviour that they disapprove of or makes them feel uncomfortable, but respecting the boys and sharing a delight in extravagant behaviour without colluding in the anti-social and damaging aspects. Thus the boys can learn to be themselves, respect themselves and make use of the role models that staff provide.

It was good to see that Janet (housekeeper) had started and her work was already being appreciated in the house. But, as we discussed in the practice forum, her role – of all the roles in the house – is most prone to exploitation. It could so easily and quickly turn into the typical mother’s role in the home – especially in a home where there are boys and men! – where the mother becomes a domestic servant and the rest of the household do nothing, learn nothing, take responsibility for nothing . . . never grow up, but remain babies to be cleaned, fed and clothed. This would be so bad for the boys and so contrary to the therapeutic task – thoroughly unprofessional. Don’t let it happen. In order to prevent it happening you will have to work against it, notice what’s happening, and give Janet and her role respect.

There was a great moment in the team meeting when a holiday was being discussed. The problems and expense of booking flights, accommodation etc. etc. But what about camping? (Stephen.) I mention this because I think it’s symbolic of building self-reliance for the boys . . . and, indeed, the grown-ups. We know these boys struggle to survive emotionally and materially. They think the answers lie in “things” and money but you are helping them to see the answers lie in people, relationships, self-reliance and building their inner strength. (Social, emotional, and practical survival skills.) There are so many things around the house and garden that need doing or that offer the potential for the boys to learn that they can make their mark (a positive one) on the world around them; that if something gets worn or broken it can often be restored or mended (like them). And there’s still no shade on the light in the office! Or do you really want someone to come along and buy one for you?

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There are many good signs to be seen and heard at the House – signs of good work.
Although there are plenty of things to be done, I get the feeling that they may well get done . . . sometime. So, the dining table is clearly in the process of repair/restitution. The holes and gouges have been filled and sanded, and, when the time is ripe or when the opportunity presents itself, it will probably be varnished. Damage to the front door will be repaired, and the cost of doing that has to be set against the “savings” that have been made and could have been spent on speakers. The boys know this and are involved. It’s becoming part of the House culture. These things make sense.

When J (on the day of his grandfather’s funeral) sits down to his breakfast, a grown-up comes and sits with him, has a bit of breakfast and a cup of coffee, and a chance to talk a bit. Later, she’s ironing his trousers in preparation for the funeral. Then we talk about – and I’m introduced to – geocaching. When Arthur comes in, J and Arthur immediately start talking about geocaching, sharing enthusiasm and achievement. Things are really happening for the boys. The House is helping them to become people in their own right, not totally controlled by their circumstances and background, just being bounced around by their histories and the hostile world around them.

So good to see/hear the two people working together in the morning just checking progress with each other – like a 30-second update and handover – brilliant.

When another grown-up comes in, she’s welcomed by the boys with concern and empathy – her father’s very sick in hospital. And this is someone who has never sought popularity with the boys – but now has respect and affection for being the person she really is.
More good signs: devolvement of responsibilities. Grown-ups and boys taking on more responsibility and becoming more accountable e.g. car, petty cash, front door, activities, shift planning.

Arthur and I went out for our now customery walk/talk and – to my shame – were late back for the lunch which Janet had prepared. This did not go unremarked, especially as I had drawn attention to exactly the same behaviour of others on my April visit.

I interpret the continuing absence of a lampshade in the office as an unconscious act of defiance – which I respect!

In the practice forum we explored themes of loss, change, birth, families, home. And Grace gave us good news of two young men who left the House some time ago.

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As I got out of my car in the school car park, I saw Sheila and J, arm in arm under an umbrella going to the bus stop for J to take the bus to college. Staff are now up at 6 a.m. to support J in the mornings. But when I got into the House, Anthony told me about M’s antics last night which resulted in Anthony being up all night, and driving around East London looking for him. He was returned by police at 4.30 a.m. The team go to great lengths to support and look after the boys – whether they may be going too far in this was a subject of discussion during the day.

The handover notes for the last month give a vivid and full picture of the sort of work that is being done. It’s so unusual and so encouraging to read this combination of the personal and professional, individual and group, factual and reflective – superb.

I particularly liked the account of the boys getting ready for Dean’s visit – full of deep significance and meaning, and charming.

There was an OFSTED inspection earlier this week and the House appears to have done well in spite of being marked down on “management”. How you can have a children’s home that apparently performs so well in its primary task and yet is managed at only an adequate level beats me. While there may be insufficient formal one-to-one supervision sessions, there is an everyday culture of supervision and learning at the House.

It was nice to see one or two little attractive additions such as the tablecloth and the artificial plant, and the camel soap-dish in the kitchen. But that kitchen tap that used to drip now runs! And the light in the living room is still missing a shade, and we were still drinking out of plastic picnic beakers at lunchtime. This is a corner yet to be turned. Of course the furnishings and fabric of the building are not as important as the care or the boys . . . if you had to choose between them; but you don’t have to choose because they are an intrinsic part of the care and respect for the boys. Like any other aspect of care, half-hearted, sporadic attempts do not work and their failure only confirms the doubts amongst the boys (and you) that you don’t deserve to live (and work) in a well cared for and attractive home. It’s no good simply getting new stuff, just as a refurbished kitchen without preparing with a fundamental change of attitude won’t work either. Someone has to lead – and then gather allies – in being intolerant of mess, destructiveness and neglect, and in making the House really attractive inside and out.
In various ways I picked up that the boys are now quite frequently coming into the office. To what extent has this been a considered and planned decision? You know what the negative potential is. Perhaps you are now at a stage to manage it and it’s a good development, but . . .
When speaking with J (junior) while he had his breakfast, he told me how the House was special because “they really care”. The inspector was perhaps surprised to get the message from the boys that the staff “love” the children. This is rare and very special, and a great tribute to the quality of your work.

This love and care, so unstintingly given, has its problems . . . of course! M is behaving as if he’s a baby being fed on demand. Your job is to help him to develop his own controls and the ability to contain and tolerate his apparently insatiable greed (not just for food). He can’t continue to demand love and attention – all your love and attention – whenever the urge takes him to the exclusion of all others. And, of course, you can’t continue to give in the way you do. Similarly, the boys are overstepping the boundaries in the way they demand physical comfort and contact from the women on the staff. They are children (sometimes infants) in men’s bodies and the work you do with the infant in them is symbolic and cannot be real. You can’t comfort them in the way one would a baby. While they need comfort and your love (in a symbolic way), they are also very sexual adolescents who must be given boundaries. It’s not OK for P to come up behind a seated woman and put his hands and arms around her. While some people feel OK about it, others certainly don’t. We had a good discussion of these issues in the practice forum, but I suggest that it needs a lot more discussion and some tough thinking through. (This is one of those issues that there is no clear solution to and is always with you in this work. So, it just has to be worked at, again and again and again!)

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When I arrived M was being woken – persistently – to get up and get ready to go off to school by taxi. J (senior) was up and dressed soon after I arrived but this was not one of his college days. J (junior) was surfacing and getting a bath/shower and ready for school. And P was holed up in his bedroom determined (from the night before) not to go to school today – or at least this morning. The staff team (A and J, and then S who had been away on holiday for some time) were operating well together. Seeing M going off to school reminded me what major advances these apparently small, everyday achievements are.

Later, in the team meeting, the 24-hour management plans were being discussed. The minute details of how to enable and prepare each boy for the challenge of each day were discussed. School clothes, precise preparation of breakfast, how to wake etc. etc. – wonderful, exacting, advanced therapeutic care.

It was great to see the new furniture, repaired light, plants, pictures etc. in the sitting room. This is no superficial make-over; it’s yet another stage in the maturation of the House.

When Arthur comes in, J (senior) immediately engages with him on some technical/IT discussion or other, but that didn’t divert attention later from a pretty hard, direct discussion about money, food, college, and being honest with oneself. The boys can usually rely on grown-ups at the House to be straight with them – affectionate, respectful, encouraging, supportive but in a direct and sternly loving way. No pretence, no collusion.
Up in the office, James is briefly reading to/with J (junior) who is now ready for school. The quality of the relationship is palpable. This boy can hardly believe his good fortune to have all these interesting, different, unusual, committed grown-ups around him and working in harmony for him. The confidence and openness with which he greeted me this morning were symptomatic of his state of mind.

Good to see the team meeting being chaired by Kay instead of Arthur. This is a good move – part of the continuing development of the “self-authorisation” of the team and the maturation of the home.
The team meeting was self-critical, honest and open, identifying things that are not working well, or things that are slipping (e.g. boys in the office) and then working on them. No big fuss. The team knows how to handle such situations and alter course to correct a fault. They aren’t lost; they’re just getting back on track.

In the practice forum we did discuss my ending the consultancy work with the House. I explained that this seemed a good time to finish and a lot of this is to do with the progress of the home. I likened it to growing up and the time coming when parents are no longer needed by their very grown-up children. I’ve been working with the House for nearly four years: the place has grown up and is working well. This isn’t a temporary situation; it is the way the House works now. I’ve played my part and while outside consultancy will be useful in the future, I suggest it should be less of a “parental” relationship and more of a “peer” relationship. While I can and do provide such consultancy, my relationship with the House has been to some extent “parental”. The next therapeutic consultant must recognise, acknowledge and respect the record, experience and expertise of Arthur and the team and provide that essential “outside” perspective which helps them to work the way they do. This is a place that knows what it’s doing!

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