Tales from the therapy room

We’re talking about work.  She’s a part-time care assistant, working for local social work services. She works with elderly people, some of whom have dementia, many of whom are frail and ill, most of whom are lonely and poor.  We discuss what it is like to be old, poor, and on your own, or with a partner who is mentally or physically ill, and also what it is like to work with the old – to be party to the perceived ‘downward trajectory’ of this time in their lives, about the inevitability of death, the increasing loss of friends, family and partners, and the approaching end of their own lives.

–     She dreams, she says, of walking over the hills. Alone.  The wind in her hair, fresh air to breathe, a day ahead with just her and the landscape.

She complains about her exhaustion.  She says she looks at her colleagues and they look exhausted too. The demands to cover more cases, to work faster, is relentless.  Do six cases, not three, a day.  Close down any outstanding cases by referring them to universal services.  I look at her questioningly.  Universal services, she explains, are those that are publicly available to anyone: tell your clients to go to the library and pick up information there; go on the internet…  Her laughter is infectious, as we think of her elderly patients who can’t get out of the house without help, or who have dementia, or who can’t leave a partner even to go shopping.  I keep saying to myself – stop laughing.  It’s not funny.  What are we doing, laughing?  Why do we deal with this by laughing. Ha ha haing away the outrageousness and futility of this paltry idea of ‘care’ .  That she should have to perpetrate this outrageousness in her reports. It’s a betrayal of the old people she works with, she says, of her reasons for doing the work.  She goes into their houses, gets to know them, they get to trust her and she gets fond of them, they reveal their worries and dependency to her, and then she is supposed to tell them there aren’t going to be any regular visits, they might see someone every six weeks and, because of another new organisational practice, it won’t be the same person each time, just someone who reads their case notes prior to the visit; or that some service can’t after all be provided – they are, instead, to go to the library and read about their rights. She hates her betrayal of them, hates being forced to be this way.

–    She wanted to be a writer.  She wrote and wrote until she was ready to come to therapy.  It was her  way of coping.  She could only come to therapy once she’d sorted things out in her mind, by writing.  She wrote letters to her old teacher, a man whose authority excited her, his recognition of her, her school girl’s intellect, the thrill of his expectations of her mind, his body blocking the doorway that she had to squeeze past.

She’s caused trouble again, she sighs.  What have you done?  She giggles  – (semi)apologetically.  We are supposed to love her supposed ‘naughtiness’.  I do, but wonder how useful it is for us to think of it this way.   A couple of overgrown adolescents, dissing the adults.  Could we think about her making complaints about work in a grown up way – would that offer her more imaginative ways out of her impasse, more effective ways to change things?  Seeing it as ‘naughtiness’ castrates the potency of her criticisms, perhaps.  Safer that way?

So what’s this trouble you’ve caused then?  She’s received replies from another social work office in another part of the county.  There has been a reorganisation and, in a new and more remote system of accountability, the staff in this office now have a supervisory role.  They must read and pass the recommendations coming in from the uploaded care assistants’ reports. This is a strategy to control demand on a limited local authority budget. My client’s recommendations have been sent back to her because the office says she hasn’t filled the form in correctly.  It’s obvious from the form what was intended so my client suspects this is just a delaying tactic or, possibly, that someone who is ‘directed’ to only accept correctly-filled-in forms is not allowed to use his or her intelligence about them.  She writes back about the waste of time this involves.  Also, the office questions her recommendations.  They ask, “Have you considered universal services?”  She writes back, “No. I wouldn’t be recommending x if I thought universal services would do the trick. This client has dementia.”  It all takes time. Time when they could be getting on with finding some proper help for the client.  She is oppressed by her sense of urgency and ‘their’ lack of urgency.  She is frustrated by their questioning her decisions all the time.  Stupid.  It’s stupid.  She thinks they probably think of her as a trouble maker.

Could she not think of  ‘being a trouble maker’ as being someone trying to speak back to authority/power from the grassroots?  Oh dear, here I go, off the therapy-piste again. It’s that word, grassroots. Perhaps, I wonder to her, there’s a way to dignify ‘naughtiness’ by saying what it is – the resistance of the labour force to impossible demands placed on them? To speak with and from the authority of those who actually do the work?

But there’s the shame of having to tell supervisors and managers that the work is piling up, she’s not managing her case load, she’s weak because she has to confess that she’s feeling so stressed.  Being told to rework your recommendations perhaps feels like being told off at school again, your best isn’t good enough, do it again.  Shame isolates us, I say – we hide our sense of not coping out of shame.  When we begin to talk to co-workers, it is often an enormous sense of relief to discover that it isn’t you, your pathetic personality or difficult home life, it’s the work  that is the problem of not coping. Was there a way she could ask her manager if the team could have an hour a week to meet to identify shared  concerns and find solutions –  might allowing them this time appeal to managers as a way of them working more effectively?  But it’s a new manager, replacing the nice one that she liked (and who solved the workload problem by overworking herself, taking on her employees’ cases herself), this one is a ‘career’ manager, my client thinks. And some of her colleagues would think it’s risky – they just want to keep their heads down, she says. She wonders why.  Perhaps they’re afraid of losing their mortgages.

I look at her questioningly.  It’s a climate of fear.  Re-organisations, directives, more work coming down the chute all the time – perhaps they’ll be re-organised out of their jobs if they say they don’t like the way things are being done.  Each worker isolated in her job insecurity from the next. She wonders if she’d quite like to be ‘re-organised’ out of her job, do things she really cares about.  You really care about this job, I point out.

Recently,  her team were re-organised, something that seems to happen regularly.  Re-organisation meant removal from the office where the team often met each other and could share and discuss their experiences of the work they did.  It’s more efficient (rental and heating/maintenance costs reduced) if care assistants  ‘work from home’.  They are given shiny free laptops in order to do this. My client discovers, without much surprise but without resistance, that she works even more unpaid hours than before, following up the visits she makes to her case-load with lengthy assessment reports and recommendations for various ‘care packages’ to be put in place.She has a long backlog of unclosed cases that she’s always not finding the time to deal with because of all the crisis cases she is dealing with in the present.

The care assistants are ‘encouraged’ to visit the new office once a week where they ‘hotseat’ at desks vacated by other social workers – it’s so you feel part of the team of social workers, it’s to ‘stay in touch’, the managers say – but my client misses the ongoing conversations about work, the shared problem-solving and the supportive comments and emotional warmth from colleagues that was all part of being a ‘team’ with desks of their own, and a place for them – symbolically as actually – in the mind of the workplace.

Her supervisor offers to help with my client’s complaint that she has too much to do in the time available, even with all the extra unpaid time she gives to the work. Simples. She is just not working efficiently. Close down all these old cases – you just need to refer them to other services. Pass them on – most of them could be thought of as the responsibility of  mental health services. She knows she won’t.

Advertisements