All of the fanciest qualifications in the world won’t help a client if you cannot develop a working relationship with them so that you can deliver what it is they really need from you.
You can walk into just about any community welfare of counselling space and see images of the Stage of Change model hung proudly on the walls – sometimes in multiple languages or in indigenous art in an attempt to make it more responsive to those who might be stuck. You probably know it off by heart – precontemplation, contemplation, preparation, action, maintenance. But sometimes the Stages of Change model just doesn’t seem to be working for you. It’s not enough. Indeed, sometimes, it’s just a reminder of how stuck you feel with a client.
The research on burnout among those who work with complex young people indicates strongly that it’s important to finish what we start in appropriate ways. We know that it’s not healthy for health service practitioners to leave things unsorted in our experience.
Here I explain why it’s so important for you (or your staff) to tie up loose ends after finishing work with a complex young person, and how this can be done so that you best serve their future as well as manage the impact on your own work life as a support worker.
Too often, treatment of complex young people (especially if it is contracted out) becomes isolated from the day-to-day management and ‘real life’ of the client. When treatment drifts away from its target and becomes fragmented across the agencies and individuals involved, client outcomes are affected, case managers lose touch and stakeholders may even do things for the client that are at odds with the treatment plan.
I send my ‘Dear Team Client’ emails to:
One of the many difficulties for support staff or carers assisting a complex young client is to establish, and then maintain, a healthy working relationship with them. Keeping a complex young person engaged is often very dependent on their relationship with support staff.In my experience, the efforts support staff put into building strong relationships with complex young people can sometimes fall flat. And in desperate attempts to help, some support staff may blur the relationship boundaries in dangerous ways.
How trauma affects relationshipsSupport staff usually enter the care field because they value warmth, like to help and want to make a difference. However if they expect warm and fuzzy feelings in their relationships with complex young people, they may experience a very long time between fuzzies and this can become problematic. Despite their best intentions and genuine care, when they come across a young person who doesn’t speak the same language of relationships, their care can be met with indifference. This is not because the young person is nasty, but because they have a history of relationships that tells them not to get close and to be cautious of shallow warmth and broken promises.
Formulation and treatment planning in complex cases involving a young person are particularly challenging because of the sheer volume of information available to us. The key question is how to make effective use of it all. My suggestion is that we extend the well-known 4P approach to take into account 4 more critically important areas. In my view, ‘4P + 4’ would enable us to reach much greater clarity on what to target, why and how in order to improve a young person’s situation.
For a long time now, good psychologists have been considering client issues with reference to the 4 Ps: predisposing factors, precipitating factors, perpetuating issues and protective factors. I believe that in complex cases involving young people, the 4Ps need to be developed further to take individual development, established evidence, bio-psycho-social approach and system politics into account.
Complex cases involving young people come in a whirlwind of politics, spent and burnt-out workers and a trail of services that, for whatever reason, have been unable to help. In fact, Taz the Tasmanian Devil, the animated cartoon character, comes to mind. He usually moves around in a whirlwind of chaos, but sometimes steps outside to watch from arm’s length. And that’s exactly what we need to do: step back in order to separate the actual presenting problem from the chaos in a complex case.
Complex cases involving young people can seem chaotic. There’s the trauma of their own experience; the multitude of variables introduced by the families, carers and agencies supporting them; and the confusion that can arise from interagency politics, policies and rules. It can be difficult to know where to start in formulation and treatment planning.I suggest taking a step back, like Taz. In my experience, what follows is the clarity that leads to formulation and treatment that are useful. Here’s what you should consider:
FAT FILE Syndrome… a sad and potentiality dangerous symptom of working with complex clients. A file full of assessments and reports that lead nowhere; expensive and wordy documents that are worth nothing to the client or the client’s team when it comes to creating the much-needed outcomes.
I’m determined to make assessments meaningful which is a direct result of years of working with young people in complex situations and the reams of paper generated about them. Here are 5 characteristics of useful psychological and behavioural assessments and reports that I believe Health, Forensic and Human service personnel should consider, indeed demand…
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