Winnicott and Residential Work

By Cynthia Cross

Posted December 18th, 2013

Following a distinguished career in residential child care, Cynthia Cross became a freelance child consultant. She is a generous contributor to the goodenoughcaring Journal and a member of our editorial group. She is also the devoted owner of her dog, Lucy.

Like many people I am sad about the comparative paucity of books about residential work. I think that this can be attributed to the notion, that good residential child care workers have absorbed theories into their being and react to situations instinctively. Their work has become a way of life, in which you always try to respond helpfully to situations, and if you make a mistake, you go back and try to put it right. It is therefore very difficult to disentangle yourself from these day –to-day situations and lay them out in a way others can understand and benefit from them.

In October 1970, Winnicott gave the David Wills Lecture to the Association of Workers for Maladjusted Children (AWMC) now Social, Emotional and Behavioural Difficulties Association (SEBDA); the title was Residential Care as Therapy. I have read this again to try to stimulate my thinking about how Winnicott’s ideas influenced me as a residential child care worker.

Below I set out some extracts from this lecture:

“At one time I could have been heard saying that there is no therapy except on the basis of fifty minutes five times a week, going on for as many years as necessary, done by a trained psychoanalyst.”

“For me I think I started to grow smaller at the time of my first contact with David Wills. It was exciting to be involved with the life of this wartime hostel for evacuation failures outcome. What part did I play? Well, this is where I try to describe growing down. At first in my weekly visits I would see a boy or two, give each a personal interview in which the most astonishing and revealing things would happen. I would sometimes get David and some of his staff to listen while I told the story of the inter¬view, in which I made smashing interpretations based on deep insight, relative to material breathlessly presented by boys who were longing to get personal help. But I could feel my little bits of sowing fall on stony ground.”

“Rather quickly I learned that the therapy was being done in the institution, the therapy was being done by the cook, by the regularity of the arrival of food on the table, by the warm enough and perhaps warmly coloured bedspreads, by the efforts of David to maintain order in spite of shortage of staff and a constant sense of the futility of it all.”

When I came to look further into what was going on I found that David was doing important things based on certain principles which we are still trying to state and to relate to a theoretical structure. It may be that what we are talking about is a kind of loving……..”

“One of the things that David was doing was of the nature of a weekly session in which all the boys met and were free to talk. One could say that every individual boy, and it would be the same of girls, was screaming out for personal help, but personal help is not available for every individual and the work of this hostel was being done on the basis of group management.

It is also true that this was an exceptionally difficult group of boys because they were neither hopeless nor hopeful. On the whole they had not given up hope but they could not see the direction in which they should look in order to get help. The easiest way to get help is provocatively and through violence, but there was this other alternative, different in the extreme, in which they could save up things to say at the group meeting.

“Now it is necessary to look in detail at therapy that is provided by residential care. First I would like to say, however, that resi¬dential care is not just something that becomes necessary because there are not enough people properly trained to treat individuals. The therapy of residential care comes into being because there are children who lack one or both of two features essential for indi¬vidual therapy. One is that the only setting that can deal with them adequately as individuals is the residential establishment; and the other is that they bring with them a low quantity of what Willi Hoffer’ called an internal environment, that is to say an experience of good-enough environmental provision which has become incorporated and fitted into a system of a belief in things. In each case it is a matter of both personal and social diagnosis. In residential work we may leave out the verbalization and the material that is just ready for interpretation because the accent is on the total provision which is the setting. It can readily be seen that certain features are essential. I will enumerate a few.

(1) Reliability. There is a general attitude in the residential home, if it is a good one, which contains built-in reliability. You will want me to say quickly that this reliability is human and not mechanical. It might be mechanical in the sense that it helps if meals are on time by the clock; but whatever rules are laid down, reliability is relative because human beings are unreliable. In residential care reliability of a human kind can in the course of time undo quite a severe sense of unpredictability and a great deal of the therapy of residential care can be stated in these terms.
(2) An extension of this idea can be expressed in terms of holding. If the residential care needs to provide holding of a very early kind then the task indeed is difficult or impossible, but very frequently the residential therapy lies in the fact that the child rediscovers in the institu¬tional environment a good-enough holding situation which got lost or broken up at a certain stage. It always has to be remembered that where the child is hopeless then the symptomatology is not very troublesome. It is when the child is hopeful that the symptoms begin to include stealing and violence and ultimate claims which it would be unreasonable to meet except in terms of the recovery of that which is lost which is the claim of the very small child on the parents.
(3) You will want me to mention the fact that the therapy done in a residential setting has nothing to do with a moralistic attitude. The worker may have his or her own ideas of right and wrong. A child will certainly have a personal moral sense either latent and waiting for a chance to become a feature of the child’s personality, or else present and fiercely punitive. The residential worker, however, does no therapy by linking symptomatology with sin. There is nothing to be gained from using a moralistic category instead of a diagnostic code, the latter being based truly on aetiology, i.e. in the person and character of the individual child. Vindictiveness has no place whatever in child care and in residential work. Nevertheless we are all human and in the course of a year it might be found that almost anyone has had a vindictive moment. This would just be a human failure and outside the therapeutic approach.
(4) There are many more broad principles but one of them has to do with gratitude. I suggest that in so far as therapy is the byword you are not expecting gratitude.

(5) It is very much a part of the therapy of our work that when children do well they discover themselves and they become a nuisance. They go through phases in which violence and stealing are the manifestations of hope that they can manage to show. Your job is to survive. In this setting the word survive means not only that you live through it and that you manage not to get damaged, but also that you are not provoked into vindictiveness.”

“It can be seen, I hope, from what I have said, that from my point of view residential care can be a very deliberate act of therapy done by professionals in a professional setting. It may be a kind of loving but often it has to look like a kind of hating, and the key word is not treatment or cure but rather it is survival. If you survive then the child has a chance to grow and become some¬thing like the person he or she would have been if the untoward environmental breakdown had not brought disaster.”

I have quoted extensively from the Winnicott Lecture because I find it so much expresses my beliefs.

Theory is important, if only to reassure us that unpleasantness and disturbed behaviour from the child is not directed at us but is an expression of trauma and distress because of previous experiences.

But theory alone will not suffice, you have to have a belief system, which is strong enough to make you survive, and resilient enough to prevent you resorting to vindictiveness when under threat. One feature of residential settings, which Winnicott did not mention in his lecture is the importance of other workers who hold similar beliefs and will pick you up and nurture you when you are under pressure. Unfortunately in many institutions negative feelings are reinforced and children scapegoated.

Another important factor is the need to educate management boards etc. to the phenomenon that Winnicott described, i.e. “children get worse (in their behaviour) when they start to get better.”

How can we help the residential workers who are around now and will be in the future to take an “act of faith” and work in the manner described above, I am afraid that I think that as they say, such an approach is “caught not taught” and there seems a dwindling amount of establishments working or being allowed to work with the above principles – I hope that I am wrong.

Cynthia Cross, November, 2013

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