Trust in Care – Can I?

I was speaking yesterday at an Early Graduate Psychology conference and recalled an important part of my career when I worked as a psychologist with young people in the care of the state in a residential unit. These were some of the most vulnerable and at the same time remarkably resilient young people I’ve ever had the privilege of working with.

For a variety of complex reasons these young people could no longer be cared for by their parents and successive foster placements and mainstream residential placements were also unsuccessful in meeting their needs.

Before getting into a discussion about the issues of how difficult it is for young people in care to trust professionals (or anyone) I’d like you to take a few minutes to listen to “Their Story“. A hypothetical story strongly influenced by the narratives of pain, confusion, mistrust, fear, strength and resilience that characterizes these young people.

The themes in that story were sadly not unusual in the lives and experiences of the young people I worked with.

Trust Me – I’m a Psychologist

Why the hell should they?

If you’d lived the life of that young person in the audio clip would you trust yet another person propelled into your life, not by choice, not because you’ve asked for it but because it’s assumed you needed it, even if you didn’t want it?

If I couldn’t trust my parent why should I trust you, a stranger, a professional, a suit, a person of authority

I should trust you because you want / tell me to?

Fair points I think. With most of these young I tackled the issue of trust head on ” You should’t trust me automatically, I have to try to earn it“. Earning trust with children in care is not a quick process and nor is it one that you can manualise or have a script for. Each young person’s narrative is unique and so must our approach for building trust.

One of the things I learned early on was the importance of how we dress and what that conveys to a young person in care. Suits or even semi-formal work attire posed significant difficulties in building trust. For these young people there is symbolism of authority conveyed in formal work attire and even if those in authority placed the young person in care in the first place because it was for their safety and best interests, it is hard for a 12, 13, 14 to appreciate that. So out with the shirts and pants and in with jeans, t-shirts and even tracksuits and hoodies at times.

What I quickly had to learn was these young people were not going to conform to a traditional CAMHS model of delivering therapy, coming to a pre-arranged appointment, sit opposite you and discuss their emotions and mental health and take skills learned in the session and implement them for their greater well-being. From their perspective it didn’t work before (well I’m still in care in a residential unit why would you think it worked?) so why would I do it again? Relationships for these young people were temporary, transient and sometimes painful. 50 minutes in a room with me once a week was not and was never going to be life changingly therapeutic in terms of restoring their faith in professionals, people and relationships.

I also posed an inadvertent threat in terms of potential additonal stigma. For the young people there was an unavoidable stigma of being a child that their parents, families, foster parents and residential unit’s were unable to “manage“. So now I’m expected to talk to a Clinical Psychologist, is it not bad enough to be seen as a kid in care, now you want to stick labels on me and so people will also think “I’m mental“?

To reduce that perception of threat we need to take a more realistic and young person centred approach to building trust. Having lunch on the unit, FIFA on the playstation, pool tournaments, playing indoor soccer in the gym, taking part in sports days and water balloon fights, all designed to challenge pre-conceptions that as a psychologist all I wanted to do was get them to talk about memories, feelings, pain for my needs and not theirs. Not exactly what the psychology textbooks in college advised to do, but it was a lot more successful than sitting in a therapy room on my own waiting for a young person to come to a traditional appointment with me that they had no interest in coming to. When we reduce the expectation on others that they have to talk to us, when we engage in their interests on their terms, when they’re ready we have the potential to build trust.

I reference in almost every blog post the idea of #onegoodadult and in working with children in care this in more important than anything else. They have experienced relationships largely as something not to be trusted because they have hurt. They have learned to withdraw from relationships, keep people at a distance because it’s safer to do so, it’s their instinctual survival mechanism. We try to use positive regard with them, telling them about their strengths, how good they are at something, how they should have hope and work positively towards their futures. Why should they believe that? If my parent who brought me into the world can’t see enough good in me to have me live with them and care for me and keep me safe, why would I believe you, a professional, that I’m a good person?

Sometimes the most we can initially hope for is to re-adjust beliefs that people can’t be trusted, that people want to or will hurt you, that maybe the world and relationships aren’t as unpredictable, inconsistent and dangerous as they have been so far.

So my take home message for working with children in care, and maybe any vulnerable child:

I understand why you might not trust me straight away, all I ask, if you can, is to give me a chance to earn your trust and we’ll see where we go from there.

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