[May] Fluency vs Complacence

Quote for Self-reflexivity Exercise

As part of my learning, I had asked to be given the opportunities to be attached to different clinicians so that I can get to experience different styles and learn from a broader pool of experiences. My supervisor had kindly arranged for that. In fact, I was fortunate enough to be put into a family therapy clinic and co-managed cases with 2 different therapists.

While the initial phase was filled with anxieties and excitement, I started to find myself getting somewhat uncomfortable with some of the practices from other practitioners. I do not know whether it was because I became more familiar and increasingly fluent with the different models and practices to be able to offer some critiques or have I simply become too complacent and in fact transfixed on how things should be done that I am less tolerance to differences. Either way, I did not share these thoughts openly with the practitioners involved. I did however trusted my supervisor to share briefly although it was not without apprehension as she was their supervisor as well.

I still believe that I had learnt a lot from them within the sessions. However, as I find myself getting more comfortable in the collaborative approach of working with clients and more familiar with conversations on power, I started to shift uneasily at times during some of the sessions with my co-therapists. In fact, there was once that I had to stop myself from interjecting into a conversation between the co-therapist and the client when I found them engaging in a power struggle. The client had expressed her thoughts about the therapy and the co-therapist, I thought, had taken offence and tried to defend herself and correct the client's perspectives. At a point in time, I thought there was some passive aggressive manner where the co-therapist indicated that she was there upon the referral of the social worker working with the family and if the client is not interested in the sessions, she would not be able to do what she was told to do and had to convey the information to the social worker accordingly.

Extending into my understanding and appreciation of key ideas about engagement such as joining, exploring client's perspectives of her concerns and invitation to dialogues, I thought the situation could be better handled. After the session, we had our debriefing. When I tried to explore the intent of the therapist (just in case it was a strategy which I was unaware of), I faced some resistance. In fact, as I reflected back, I remembered her crossing her arms and I backing off in my seat. While there was no hard feeling thereafter, I knew that I had been mindful of the power differentiation between us (qualified therapist vs trainee; employee vs trainee; local vs student; both of us under the same supervisor) and had chose not to articulate my thoughts in a bid to maintain peace.

Reflecting back, I wonder as I develop myself in this area of work, have I also end up like some of the therapists who often defend their theoretical inclination against others simply because of their loyalty to certain ideas and they reject those they do not agree with. I do not want to be a therapist who is not opened to differences but neither do I want to be a therapist who is so reluctant to voice my concerns when I think the situation may not be helpful to the work with the clients. The idea of social constructionism just came to mind. What is helpful and what is not? What is appropriate and what is not? Who defines them?

[April] The larger system

Another day at the placement. It was a tiring and long day. Had three sessions today. I think the most challenging bit of it was the digesting of how my hands are tied as a family therapist trainee.

I had been informed over the past two weeks that a couple of my cases will be transferring out from me to the family support team as they do not present any further safeguarding concerns. This will take effect in the next two to three weeks.

While I can understand the decision from the perspectives of the department and social work unit's perspectives, I still struggled with the situations. 

I do not fully understand the connection between the family support unit and the child protection unit. I came to realise that I was not the only one. It appeared that several practitioners in the department are not totally aware of the work done by the family support unit as well. This was somewhat appalling to me given the systemic nature of work that Hackney was to be known for. From my perspective, it will be important for the key functions of the teams to be known across the practitioners especially when we are the ones making the recommendations to the other unit. I was surprised that the responses I had from several individuals were they were not too sure what would the unit be doing exactly. I cannot help but think if this is indeed client centric.

Lots of what happened today made me questioned on how client centric the work that I had been doing has been. 

I had a few cases which required me to conduct an assessment on the family relationships and dynamics, their need and potential for further work under the purview of the social care. 

I understand that if the case does not pose any safekeeping concerns, it is unfair to keep the family under social care instead of providing them community support. However, I found it hard that after we had established rapport with them and had started to explore certain deep rooted issues, we had to inform the family that the case has to be transferred out to another unit. I am definitely coping with my own loss with regards to the aburpt disruption to the therapeutic work. I cannot help but think what does it mean for the clients who took time to connect with the therapist and open up only to be told that they have to redo this with another caseworker. 

It definitely did not helped when the practitioners working with me on the cases told me that this was how things worked here. They were caught off handed as well but did not think there was anything else they can do about it. Perhaps given my social worker's background and personality, I found that quite an unacceptable reason. While I understand that there are rules and a larger system that we all operate within, I hate to think that we are subjected to rules which are not necessary helpful and can in fact bring harm to the very people we are out to serve.

I thought that better communication can at least take place between the two subsystems to ensure that both parties know how the work will look like in order to best prepare for the transition; be it a case transfer or closure. A conversation on the timeline and the expected work needed sure does not sound too difficult a task to me.

[Post-script: I had brought up my thoughts with my supervisor and she had raised the concerns with the head of department. I was really glad that the viewpoints were concurred by the head and she had indicated that the welfare of the clients should be the priority over protocols. When deemed necessary, the clinical team should be allowed to request for an extension to conduct some ending work with families. That was definitely a relief to me. While it might be too late for some of the cases I had on hand, I did manage to secure an extension for one case which I thought will benefit from at least one to two more sessions to place a good punctuation to our work thus far. On the other hand, I cannot help but wonder what if someone had raised this concern in protocols up earlier?]

[March] Growth

I felt that this month was a month of rollercoaster. The month started really poorly where I constantly felt that I did not know what I was doing during my sessions with clients and highly doubted myself. It did not helped that I found myself constantly returning to the conversation I had with the seasoned practitioner at placement last month. I am so close to the deadline of the application of the MSc programme that I really did not know if I should go for it.

Thankfully, while all these are happening, I managed to speak to several people who put me in the right place.

Made an appointment to meet Petra. She had been really encouraging and helpful in helping me process my emotions and lack of confidence. Among all, she sent me an article about my sense of feeling deskilled. It was a good read and I will include this in the portfolio. I felt so much more at ease; knowing that I am not alone in this experience. First hand experience in normalizing!

On top of that, the seasoned practitioner whom I spoke to also sat me down one of the days and said that he went back and thought about my questions to him. He drafted up a piece of reflections and wanted to share with me. I was extremely grateful to that. With this permission, I am reproducing it in my portfolio.

For some reasons, after these conversations, and some positive experiences both in the classroom and sessions, I felt way better about myself. I realized that this is possibly what others called growth. And isn't that what I am here for exactly!

To end of this month, I had finally put in my application for the MSc programme.

[February] Struggles

Am I?

Rough month.

Had a debriefing session with one of the senior pracitioners at the placement after sitting in one of his sessions. He stumbled me several times with a series of questions relating to my learning as a systemic practitioner. Having been halfway through the programme, I suddenly had this moment of incompetence arising in me. I realised that I was unable to respond to his questions and he had to prompt me in several manners to help me understand what he was asking. Yet, I came up blank.

I felt bad at that moment. I questioned the progression I had made thus far. I realised that despite being a social worker for several years and having been given the role of a supervisor back in Singapore, I have little to boost about in terms of my clinical skills and knowledge.

It did not helped that I had received the results of my assignment. I managed to get a merit for it. While I understand from the feedback that I had done reasonably well and we were told at the start of the programme that a distinction is not as common, I did have expectations of myself to perform. I suppose this is largely owing to the association of the grades to what was perceived as reasonably well at home. Distinction is awarded here to papers receiving a score of 70 and above. In Singapore, we are more or less expecting ourselves to score at least that in order to think that we do ok in the subject. Throughout the years, I had also used that to ensure that I continue to perform within the acceptable range I set for myself. This situation is further complicated that I am here on a scholarship and the funder will have access to my results. I felt an additional pressure to ensure that I do well in the programme; not just ok. I reckon that much of these have to do with my cultural influences (and my personal script) that a key indicator to measure performance is to do it quantitatively through a scoring system.

For the reasons above, I struggled with the decision to put in an application for the master programme. I knew if I do get into the programme, I will probably do well enough to clear the programme. But I questioned if I will be good enough to go back to Singapore and say that these two years are not wasted on me and I am ready to come back to share the learning and influence the rest of the peers in this area of work.

Wondering.

[January] Racism

Who am I?

For some reasons, there had been several situations this month which made me ponder who I am exactly. Have I been hiding behind the facade of a non-judgemental and insightful person because I knew the right ways to how to conduct myself in public eyes when I am actually not congruent to these beliefs?

Several conversations within my personal and professional life had made me questioned if I am indeed racist. If I am indeed having elitism. While I enjoy my work tremendously and genuinely care for my clients who come from all walks of life, particularly those who are somewhat marginalised, I was challenged totally when I had to consider where I want to live at as I am considering purchasing my own property in Singapore. I was shocked with my own words when I eliminated certain neighbourhood because of the perceived complexity regarding crimes.

During one of the clinical skills lesson this month, we also touched on minorities. I was having the discussion with someone from a different ethinicity. What I came to realise was I was extremely careful over what I said in front of this classmate. I wonder why so? Does it matter that her ethnicity is one of the national racial groups in Singapore?

I realised that growing up in Singapore, I had been very well immersed with the importance and need to be racially sensitive; that we do not speak negatively about any particular race to avoid hurting each other. Over time, it seemed to be more of a learnt behaviour that we restrained from discussing about races such that it became difficult for me to be in touch with my own bias for the fear of being labelled racist. Thus, when repeated situations arose recently regarding my own views about races, I actually was caught off guarded when I found myself having bias against certain groups. Not that I will actively discriminate against them, but I had associated certain behaviours such as crime rates with certain racial groups. I did feel my stomach turned the first time I had to this realisation. In fact, I had actively dismissed it when my partner raised it up to me.

Having the time to sit and think, I think the experiences have been helpful. While I will not say that I had totally dismissed my association of certain behaviours with certain racial groups back home, I am definitely very mindful of this thought and conscientiously making sure that I continue to work on it. In fact, I am challenging myself to conduct my second assignment with an acquaintance who comes from a highly discussed religious (and prejudiced) group internationally to explore my relationship with the social graces.

[December] Review of learning

I am currently back home in Singapore. It is good to be home after being away this long for the first time in my life. I have pretty much allowed myself to take a break on this trip. I have very much expected people to be asking me about my experiences in London. Specifically, having to meet up with my employer, part of the conversations revolved around the learning I have been acquiring in London. After all, they took a big risk with me and it was quite natural that they wanted to know if the investment has been worthwhile.

I had initially thought about what I wanted to share with them. Despite it being an informal meet up, I felt the need to convince them that it was not play for me in London. It was difficult to put together my learning. After all, I did not suppose they will be very interested to know that I had learnt how Bateson had influenced the discipline with his contribution via cybernetics or that the original Milan team split to pursue their respective beliefs in family therapy. 

However, as the meeting went on, I realised that the best contribution I had brought back was the subconscious systemic thinking I was beginning to develop. As I listened in to the development in the clinical work that had taken place back in the office, I realised that I had been able to think about the challenges in a more systemic manner. While many things sounded as though they had linear causalities, I started to question the possible circularity that could be involved. I caught myself preaching about reflecting team, a concept taught in class and experienced during my placement. I explored the possibilities of having more distinctive roles between social workers and therapists and having them work in teams. In reality, social workers are expected to double up as therapists. When a family is assessed to require in-depth therapeutic work, they are referred to the counsellors within the organisation who are not trained in systemic work. In rare situations where a family sees both a social worker and a counsellor, the professionals' work with families are independent of each other; as though families could work on their family related issues totally exclusive of what happened in another part of the family system.  

I remembered walking away from the meeting feeling that I had showed my employers a brief glimpse of my development over the past three months. While it may not be significant at this moment, I liked what I had brought along with me to the meeting and I looked forward to sharing more during my next visit back home. 

[November] Placement

A sense of anticipation as I stand on the 4th floor where the family therapists are based at. 

The administrative work at the placement has finally been settled and I have started my time with Hackney Social Care (HSC).

My bad for not understanding what social service is all about when I first responded to Grace's email on my preference. Having understood social services from the Singapore's context, I had assumed that the same, if not, similar, structure applies. Social services are provided by charities in Singapore and I have came to realize that this is not the case in the UK! In fact, they are regulated by the government here. Having been a social worker working in charities for a good part of my professional life and having to return to the same sector after graduation, I thought it will be a good opportunity to experience the way services working with families here operate and bring the learning back to Singapore. Nonetheless, other than the governing of the services, I am glad that there has not been too significant a difference in the way services organised itself around families in need. 

I recalled the first thought when I stepped into HSC, "Wow!". Having spent years working in a small organisation with not more than 20 pax in the office, I was impressed with the mere size of this agency and more importantly, a sense that a lot of learning is going to take place at this place.

I had done some homework prior to my first visit and noted that HSC has been influential in establishing a systemic foundation for social work in the country. Being a social worker, that really excites me. Clinging very tightly to my familiarity with my identity as a social worker, it was comforting to know that I get to be in a place where I can interact extensively with both family therapists and social workers and see how these two professions come together to support a family. But yes, I have to constantly remind myself that I need to step out of my comfort zone in order to appreciate the best the programme, particularly the placement, can bring.

I started the placement with a number of nerve provoking concerns. Many of my fears revolving around my ability to fit into the context. I am a Chinese descent from an Asian country. A trainee having to deal with families who are possibly having conflicts with the system already. A female who has not donned a piece of lady's clothing since high school. Despite having English as a first language, brings with me an accent my fellow countrymen can identify me just by hearing me speak. Being unmarried and childless yet having to support families be more child oriented and child-safe. And what if I cannot remember or pronounce the names of the family members especially those from non English origin? Worst of all, what if I actually cannot catch what the family is saying? (Blame that on the long term exposure to American entertainment and the stereotype of the English accent!)

Many of these anxieties had proven itself inconsequential as I had conversations with my supervisor and participated in reflecting teams with her. I realized that many of these are self-imposed pressures. While GRRAACCEESS is a genuine consideration in our work with clients, it is important that I do not let them stand in the way of establishing a therapeutic relationship. The support and supervision from my supervisor allowed me to set aside a lot of my initial concerns.

I realized that ever I started appreciating GRRAACCESS and understand the role of power in systemic work, I began to view power differently. Previously, I saw it as an inevitable evil which I will have to tame. However, the appreciation of its facilitating and hindering forces led me to learn to work with it rather than against it. Particularly, Betrando's paper on having dialogues with clients led me to think how I can hold conversations around power issues such as what does it mean for the family when I am from a different ethnicity.

Ever since I started the programme, I have been hearing the word, "systemic". It baffles me a lot. Why is it that the tutors are emphasizing the uniqueness of the programme here as being systemic. I thought I had heard this word multiple times when I was having my social work training more than 10 years ago. The classic phrase, "person-in-environment" is akin to the living motto each social worker lives by. This idea never stops making its presence felt in my work. I wonder, am I going to learn something new here or it is a re-packaging of what I already knew.

I brought this curiosity to my supervisor at my placement when she asked me about my expectations. I asked her, being a social worker, I am unsure how do I draw the line between the scope of a social worker and a family therapy trainee. I am used to the expectation of a social worker having to take care of everything relating to a family's psycho-social and practical needs. Other than making sure that everyone in the family is not deprived of their basic needs, we are also expected to provide counselling to them in a bid to improve the family's lives. I had families coming to seek help for issues relating to parenting, domestic violence, marital and mental health. I am feeling confused. I do not know how is family therapy different from what I had learnt and practice as a social worker. I am hoping that through the programme and my experiences at the placement where there are actually separate job scopes for social workers and family therapist, I will get to learn more about the different professionals and how I can marry the tools I have in both areas to best support my work with families.