The ultimate shock absorber

Introduction

Since the publication of its strategy in 2012, the Offender Personality Disorder (OPD) Pathway continues to develop across the National Probation Service and prison estate (Joseph and Benefield, 2012). Central to its structure, from commissioning through to the frontline, is the integration of health with justice via partnership and collaboration. This is embedded in the Pathway’s outcomes, which link reducing repeat serious offending with improving psychological health and relationships. In turn, these are linked to developing staff competence, confidence and attitudes and service quality (NOMS and Department of Health, 2014). As such, positive outcomes for service users, services and the public are framed as inextricable from the relationships the Pathway involves, in keeping with the intra- and inter-personal nature of personality disorder (Millon et al., 2004). The relational crux of the Pathway exists between the probation officer and service user, with the former holding the lead professional role. This article is an overview and discussion of a small, grounded theory study that aimed to increase understanding of probation practitioners’ experience of this relationship. Practice-near qualitative research presented as a means by which this critical relationship could be explored, ensuring that efforts to foster psychologically informed practice are informed and supported by the experiences and perceptions of staff (Cooper, 2009).

The rationale and design underpinning this interview-led study will be provided, followed by an outline and discussion of the key findings. At the core of the data that emerged was the emotional complexity built into this area of practice. Practitioners described negotiating anxious organizational cultures to try and hold relationships with men who find such proximity extremely difficult. I hope that the discussion started here does some justice to the demands and meaning which practitioners described experiencing in this work.

Background to the research

The research was undertaken as a Service Development Project, the final tier of the MSc within the Personality Disorder Knowledge and Understanding Framework. This is an education programme that has contributed to the workforce development activity occurring under the auspices of the OPD Pathway. As such, this study was undertaken within an academic context that was predicated on contributing to personality disorder services. The inquiry question for this qualitative study was: how do probation officers perceive and describe their relationships with male service users eligible for inclusion in the OPD Pathway? The aim was to generate a context-specific grounded theory of the professional relationship, from the practitioners’ perspective. The hope being that through inviting participants to articulate and reflect on their relationships with service users, and the factors which impact on them, enhanced insight into this underwritten aspect of practice might emerge. Grounded theory was chosen as a methodology because it is congruent with the project’s aim of generating understanding of probation practice that is rooted in participants’ perceptions of their working contexts (Smith and Biley, 1997; Charmaz, 2014). The premise of this study was that in-depth understanding of practitioners’ experience could have useful implications for effective, responsive and sustainable training and supervisory structures. Her Majesty’s Prison and Probation Service (HMPPS) (the National Offender Management Service at the time of the project) tasks itself with the provision of environments which are positive, safe, secure and decent; this research was intended to contribute to enabling professional relationships which might also be described in such terms.

Literature review

Within the grounded theory tradition, a formal literature review is explicitly not undertaken because of the risk of imposing a preconceived theory. However, working from the understanding that any emergent theory ‘does not and cannot stand outside of’ the researcher’s view (Charmaz, 2014: 239), an overview of the literature that inevitably influenced this study will be provided, before further discussion of the methods and findings.

Most significant is the application of psychodynamic theory and practice to forensic mental health. As a theoretical and clinical approach, this body of work prioritizes understanding the relational and emotional complexity of forensic systems (Adshead, 2012; Yakeley, 2010; Reiss and Kirtchuk, 2009; Morgan and Ruszczynski, 2007). At the risk of over-generalizing, this paradigm depicts staff and service users as existing in complex relational webs, heavily influenced by formative and ongoing experiences of trauma, abuse, neglect, discrimination and exclusion. These dynamics are depicted as being played out within and by systems (Aiyegbusi and Clarke-Moore, 2009). Attending to this experience is presented as a core task of teams and services; failures to do so are linked to egregious boundary breaches (Fallon et al., 1999) and iatrogenic, fraught occupational cultures (Lowdell and Adshead, 2009). At its core, this is a position that holds that the emotional dimension of social experience contains meaning, and accessing this can assist in understanding how and why groups and organizations are structured and behave as they do (Menzies-Lyth, 1988 [1959]; Cooper and Lousada, 2005).

Along these lines, Kurtz (2005), Kurtz and Turner (2007), Boyle et al. (2009) and Gordon (2011) are all examples of research studies that aim to understand something of the practice worlds of staff in forensic and/or personality disorder settings. With different emphases, these studies illuminate the emotional complexity of forensic practice. Relationally, staff are asked to straddle a range of contradictions: being caring whilst detaining; knowing about early life trauma whilst managing a ‘perpetrator’; meeting high levels of need and deprivation whilst managing high levels of risk. In addition, the (often malevolent) influence of wider organizational and socio-political contexts is also repeatedly discovered. For example, the complexity of the work is disavowed in the policies and procedures that govern organizational life, being more oriented towards defending against systemic anxiety. The discussions that emerge from these findings argue that forensic work is predicated on engagement with trauma and distress, and as such reflective structures are critical in giving teams opportunity to metabolize this experience, in the service of good practice.

On a smaller scale, this research project is an attempt to explore similar territory, but within the context of probation and the OPD Pathway. It is not unchartered: most recently, Phillips et al. (2016) explore how the work the National Probation Service undertakes is experienced by its workforce. The emphasis on stress, supervision and workload are themes that resonate with this project. Further detail is provided by analysis of the provision of psychoanalytically-informed clinical supervision to probation staff (Wood and Brown, 2014). Resonant with the forensic mental health literature, emphasis is placed on the impact of wider organizational dysfunction, in addition to the emotional labour of working with service users who are ‘often severely traumatised’ (Wood and Brown, 2014: 330).

In the criminological field, desistance scholarship is the area that has given most attention to the supervisory relationship at the centre of probation practice. Indeed, one of the consequences of the findings of desistance research has been to re-establish the working alliance as central to the discourse of probation (NOMS, 2011), albeit with reservations about how fully this practice agenda reflects the prominence the research gives to social and political contexts (Farrall, 2004, McNeill, 2017). On a micro and macro level, relationships are integral to the way the process of desistance has been conceptualized. McNeill (2012), Barry (2007), Burnett and McNeill (2005), and Weaver (2012) have all, in different ways, put forward compelling cases for probation practice to be reconfigured to reflect the implications of desistance research. In relation to the cohort of men being included on the Pathway, whilst desistance scholarship engages with service users assessed to pose a high risk of serious harm (Weaver, 2014; Weaver and Barry, 2014), it has so far attended less to the interpersonal difficulties associated with the diagnosis of personality disorder and serious sexual and violent offending. So, a motivation for this research project was a view that the complexities of probation officers’ work with this heterogeneous group are underwritten, in part, in comparison to practitioners in the parallel health system.

Research methods

Individual interviews were conducted with seven probation officers who work as personality disorder leads on the Offender Personality Disorder (OPD) Pathway. The sampling procedure for participants was purposive: requests for participation were sent to all personality disorder leads in one large urban area, and interviews were then conducted with the seven staff who volunteered. The population invited to participate were selected because of their substantial experience of working with male service users who met the eligibility criteria for the OPD Pathway. Transparent and responsive processes around anonymity, data keeping and space for debriefing were used to ensure that participation in this project was safe. All ethical safeguards and processes were approved at the design stage. Consent was understood to be an ongoing process; participants were advised that they could choose not to answer questions, withdraw at any point with no consequence, and that their participation and answers would remain confidential, except if a significant and specific concern about a risk of serious harm to themselves or others was raised. Any identifying features have been removed, and the names provided for participant quotes are pseudonyms.

Between interviews the data gathered was analysed through a process of open-coding. The codes and categories generated by this analysis then informed the interviews as they developed. Because of the small nature of this study, it was not possible to meet the point of saturation (in which new data only results in the confirmation of already established key concepts). Similarly, a larger study would have enabled a fuller implementation of the constant comparative method, whereby further layers of analysis and comparison would have developed the process of theoretical sampling, in which the interviews would have become more focused according to the emerging analysis of the existent data. The study also relies exclusively on interview data, as opposed to a more diverse range of sources. Because of the small-scale nature of the study, the data gathered did not explore the diversity of the male service users that participants worked with, for example, in terms of age, race, and sexual orientation. This is a significant limitation, and it is understood that further work is necessary to understand how these dimensions of identity impact the professional-service user relationship, as well as considering the demographics of the male service users who are being included on the Pathway. Similarly, the seven interviewees were not asked to identify their own gender, age or race; as such, the data was not analysed in the light of this information.

Service user involvement is absent in the design and implementation of this research project. In both aspects it is notably one-sided and so is necessarily incomplete – in order for the probation officer-service user relationship to be comprehensively understood, the experience of both parties demands attention. Rather than try to integrate an element of involvement, which would inevitably be tokenistic, it seems more appropriate to highlight how important the absence of a meaningfully integrated service user perspective is. Mindful that there are many, the consequence that presents as most problematic is the risk that the service user is constructed as a pathological ‘other’. Whilst part of the task of the research is to understand how the participants perceive the individuals they work with, a wider frame needs to be held which understands this to be a situated construction, as opposed to an accurate description of male service users with personality difficulties. Had the research been co-produced with a service user lens it is likely that this would have generated more complex data and analyses, offering a more thorough insight into the area of inquiry (Gillard et al., 2009).

I was an employee of the same organization as the participants, and had previously occupied the same role as them. This insider-status may have caused them to censor or inhibit themselves. However, it also may have enabled them to speak more fluently and at greater depth about their experience, as they could take as given my familiarity with their practice contexts. My experience of this work enhances the risk of hypothesis testing, in which I construe the data so as to confirm preconceptions (Suddaby, 2006: 635). For example, there is a risk that the difficult aspects of probation work have been given disproportionate weight. However, I would import Cooper’s defence of research that focuses on the most painful aspects of social work: ‘that the easier bits…are perhaps not the ones that really need our urgent attention’ (Cooper, 2009: 441). It might also be argued that my insider-status enhances my sensitivity to the data and capacity to analyse it. It is understood that I am not a neutral interpreter of an objective reality, but a co-creator, together with the research participants, of a particular perspective of the subject under study (Charmaz, 2014: 13).

Findings

The core category that best encapsulates the data builds on a metaphor that one participant used to describe their experience: the probation officer as ‘the ultimate shock absorber’. Subsidiary to this, two strands of subcategories were developed. One strand relates to the interviewees’ subjective experience of the work they engaged in with service users. These were:

– Negotiating and working on the relationship within role;

These themes coalesced under a subcategory entitled: Demands of relational work with traumatized and traumatizing service users. The other strand – Organizational expectations and limitations – relates to the wider system inside which this work occurs, and which exerts a fundamental influence on how it is experienced. This subcategory incorporated the following themes:

– Organizational oversimplification of the primary task and the impact on the relationship and the probation officer;

Crucially, these two strands are inextricable: the relational and organizational factors are tightly linked in determining the nature and degree of shock absorption that the individual practitioner is engaged in. This is represented by Figure 1.

OPEN IN VIEWER

Figure 1.

Shock absorber: core categories.

Demands of relational work with traumatized and traumatizing service users

Personality disorder was framed as an interpersonal phenomenon in which a capacity for relational, emotional and social stability is compromised, primarily because of severely adverse childhoods. The diagnosis of personality disorder was accepted uncritically by some practitioners, and held in a more sceptical light by others, but common to the whole data set is a relational model of personality difficulties, with their roots in neglect, abuse and trauma. Service users were presented as having had consistently problematic relationships, both personal and professional, against which trend these probation officers were trying to push.

The relationship the practitioner has with an individual service user was unfailingly accorded central significance:

…working on that relationship is really, really important. (Simon)

Supervision sessions were imbued with high levels of emotional affect, resulting from the difficulties with relationships that defined personality disorder:

Because they’re confused about relationships, aren’t they, that’s the whole reason why they’ve got personality disorder…(Mouna)

The data contained descriptions of being on the receiving end of aggression, with the most challenging interactions experienced as psychological assaults:

…all the sort of explosive behaviours, or, you know, personal attacks. (Martin)

It’s just a war, straight away, are you on my side? Are you not on my side?

Are you my enemy or my friend? Are you with me or against me? (Julie)

[he] would see me as his target practice (Hannah)

In these instances the more benevolent connotations of practitioners persevering to build a working attachment are replaced with something more onerous, in which they must not retaliate. The visceral nature of the challenge is reflected in the physicality of the descriptions: pulling hair out, biting your tongue, getting dragged in. Practitioners described themselves invoking psychological theory in order to resist the expression of more combative or defensive responses. For example, a practitioner described being denigrated in her steadfast attempts to work alongside a service user, prompting a retaliatory urge that needs to be managed:

‘Oh right then, fuck you then’, but not really, not, because that’s just one reaction, isn’t it…you have to [tolerate these interactions] because this person’s, I think of him as being unwell…(Mouna)

This is an example of how practitioners sought to depersonalize encounters by using the lens of a disorder or schema. Consistently described was an internal process in which the practitioner has to catch their reaction and turn it into a thoughtful response, although emotional injuries were not disavowed:

…it’s his way of trying to undermine me, to empower himself, I got that, but it didn’t stop it from still hurting. (Hannah)

‘The job’ is defined as getting behind harmful behaviour, to obtain a vantage point from where the trouble that underpins it can be understood. Some used psychodynamic concepts such as transference and projection to explain the relational processes that occurred in the work – but whether named in such terms or not, there was an understanding that these behaviours served a protective or evacuative function for the service user. In being on the receiving end of aggression the probation officers are acting as containers for an internal state that could otherwise become an offence:

…he had to get it out, and it was safer for him to do that here…yes it’s horrible, and it’s draining…and you do have that worry that he might become violent [laughs] but then if that can be done and contained in here…then…you are…helping to protect the public a little bit. (Simon)

Here the probation officer is placed in harm’s way in order to achieve the task of public protection. Individual intuition is used to distinguish between situations in which tolerating challenging behaviour serves a purpose, and encounters that are more frankly abusive – experienced less as a replacement for an offence, and more a repetition of one.

In addition to the immediacy of interactions, the data contains a range of responses to the details of abuse, neglect and sexual and violent offending which is endemic to the work. Acknowledged is that what practitioners must know about can be ‘horrible, horrible, horrible’ (Mouna), and that strategies are necessary to manage it for the work to be possible. One stance that emerged was imbued with values and morals. For example, practitioners described themselves as being non-judgemental no matter what the offence. At its most extreme this stance saw serious offending being described in surprisingly diminished terms. For example, an interviewee explained how she did not share an appalled response to an offence involving the death of a child, rather seeing it as a stupid mistake. It is possible that such positioning enables practitioners to nullify the emotional responses they might have to acts of serious harm. A more common position was one in which the offending behaviour and the individual had to be differentiated. Practitioners described a process of struggling to keep the offence at a distance, but also hold it in mind enough so as to remain alert to risk. They were alert to the pitfalls of this:

I think we get a bit numb to it and a bit detached…there’s problems in that – but I think it’s also essential, that if we’re too emotionally close to it all, I don’t think we would be able to do our…how do you get that balance of properly taking it in and understanding it…but almost not feeling it? (Nadia)

To assist in this attempt to find a tolerable degree of emotional proximity, humour was identified as an anaesthetic, and a necessary one:

I’m joking, I’m joking, that’s dark humour isn’t it, but I, you know, I get flashes in my mind of imagining him of seeing him, what he’s doing…(Mouna)

The need to negotiate the knowledge of disturbing realities also applied to service users’ experiences of severe childhood abuse and neglect. It was taken as given that service users had experienced ‘horrific’ childhoods, the knowledge of which also had the capacity to disturb and shock practitioners at a very personal level:

…it would be easier not to trust anybody with your child…(Simon)

The dissolution of a neat boundary between ‘victim’ and ‘perpetrator’ generated tension, as it is the probation officer’s task to know about their co-existence. Without wanting to err on the side of sentimentality, the data suggests that working with men adjudged to have personality difficulties who have committed serious offences necessarily involves managing proximity to acute emotional pain.

Organizational expectations and limitations

The emotional weight and depth of casework was frequently set against a backdrop of a criminal justice system depicted as lacking in understanding of what the work involves:

I just went to the NPS website to see what our strapline is and it’s about ‘supervising high risk offenders in the community’ – and I thought that really only captures about a quarter of the work we do – and so for the organization not really to know what we’re doing. (Nadia)

The formal definition of the probation officer role was experienced as reductive, with much occurring in the relationship that ‘you can’t quantify’. In the face of this over-simplification, a division emerges between being someone’s probation officer, and being a person with whom meaningful contact can occur:

To be the probation officer, but also to be the person that, um, at some level, probably only at a very very tiny, tiny, tiny level – that they may be able to share something with you, and feel safe sharing that…(Keith)

This division recurred elsewhere, with a description of non-statutory work as more ‘human’ and ‘kind’. The person/probation officer split, becomes a response to an organizational construction of the role that is deemed to be inadequate and obstructive.

This split also emerges as a strategy to negotiate the care-control dichotomy that is at the core of the probation task: the probation officers’ territory being demarcated as neither judge nor therapist. The practitioner has to negotiate being an instrument of an unthinking system, whilst also striving towards a relationship whose therapeutic effect is located in its authenticity. Working on a trusting relationship, whilst also managing risk, was acknowledged to be a tension, although perhaps a useful one. Whilst an objective rationale for the dual nature of the role could be articulated, what was also manifest was the emotional challenge it posed:

I feel like I’m saying look, we’ll support you, we’ll try and do this and…then it’s like, you, you, have to then punish somebody…you’re holding out a hand and then you pull it away and slap them with it immediately afterwards…come on, come on, come on – right, slap. (Mouna)

Recalling service users to prison was the activity that sparked the most vehement criticism of the wider system. Recall was equated with failure, and as causing practitioners to feel gutted, sad, and guilty.

…I knew that prison wasn’t the right place for him, he doesn’t cope well in prison…I did have guilt there, and I did feel bad about it, but he wasn’t engaging, he wasn’t complying, I couldn’t work with him – so there wasn’t another option…so that’s how I kind of made it OK. (Simon)

Caught between the non-compliance of service users and the system’s reliance on custodial sanctions, practitioners have to excuse themselves. Not widely present in the data, but arising in two interviews, was a suggestion that attached to the guilt of recall was a feeling of relief. The vocalization of relief speaks to something that moved between being implicit and explicit in the data: the size of the responsibility the probation officer carries, and correspondingly the anxiety that surrounds serious further offending.

The wider criminal justice system – prisons, probation, police, multi-agency public protection arrangements – was presented as highly anxious and, as a result, oriented towards short-term, restrictive and poorly thought through decisions: ‘bang ‘em up, lock ‘em up, restrictions, restrictions, restrictions’ (Julie). The unthinking reactivity of the police is juxtaposed with a more responsive and psychologically minded approach that these interviewees perceived themselves to be advocating. The wider system is repeatedly described as pressurizing, and as lacking insight and sophistication in its understanding of service users. And so, the practitioner is caught in the middle:

…I think I’m the ultimate shock absorber…I feel like we’re the sandwich of the pressure from above, and anxiety and everything and all the problems that come up that we’re given to deal with, we’re in the middle being squeezed…(Mouna)

Whilst welcoming the changes the Pathway had ushered in, caveats were frequent. Whether the changes caused by Transforming Rehabilitation or the possible disappearance of clinical supervision, the positive aspects of the work were presented as precarious, providing a ‘fragile calm’ (Mouna). Whilst the data presents the work probation staff undertake as important and valuable, its limitations were also emphasized. Limitations were created by the interaction of two elements – the absence of adequate resources in the external environment, combined with the depth and breadth of the difficulties service users experience. Here, a practitioner reflects on the experience of recalling a life-sentenced prisoner to custody:

We have this false optimism about what…what can be done once you’ve become so – you’ve got these problems that in the end send you to prison or that’s part of the process, and then you become so institutionalized and damaged by the system then we hope, we’ve got this false hope, that they’re going to be able to make it. (Keith)

The consequence of these limitations was a sense of frustration. This could be voiced against a system or society that is not doing what it could and should in relation to service users with personality difficulties, or towards recalcitrant service users who do not respond to practitioners’ efforts or negate the gravity of their offences. The source of these curbs might be systemic, or psychological – either way, the practitioners were managing discordance between their intentions and reality. The government and partnership agencies were criticized for continuing to misunderstand service users, and not providing the resources to meet the psychosocial needs of the men. In this sense, the resources of the Pathway were celebrated, but also acted as a foil to the extent to which mainstream criminal justice and mental health services perpetuate cycles of failure and harm:

I’m not ashamed to say that I went back to see him inside and a tear came in to my eye because I just thought, what am I trying to do? What are we trying to do? (Keith)

Discussion

The themes that emerge from these findings coalesce around the metaphor that was chosen as the core category: the probation officer as the ultimate shock absorber. Intensive interpersonal work intersects with an instrumental organization, and it falls to the practitioner to manage the consequences:

…you’re trying to manage your own emotions and boundaries, but also try not to spoil the relationship, and you’re trying to hold that and contain that anxiety, at the same time as containing I guess your own anxiety about risk. (Nadia)

On this basis, perhaps the more important implications are systemic; not about what can be done to individual practitioners to make them work better with the men on the Pathway, but about what the conditions are in which good-practice can emerge. This invites attention to be paid to team functioning, clinical supervision and reflective practice at every layer of the organization. It chimes with Boyle’s call for the forensic mental health system to reconceptualize practice as existing within a ‘professional context of professional/service user relationships that are transactional, dynamic and intersubjective rather than proceduralised, static and objectivistic’ (Boyle et al., 2009: 309).

The temptation is to simply replace nurses or social workers with probation officers, and advocate the adoption of reflective structures, similar to those in the forensic health system. The contexts share key features – working in difficult organizations, with people who have often experienced serious trauma and social exclusion, and who pose risks to themselves and others. The similarities mean that practice development suggestions, such as those made by Kurtz (2005) and Reiss and Kirtchuk (2009), can be of real use. However, the difference between health and criminal justice frameworks also mean that service development initiatives that have their roots in health settings risk being lost in translation. There are differences of task, practice and training – more systemically, of structure, culture and mode of functioning (Menzies-Lyth, 1988 [1959]: 50). It is worth heeding the warning that reflective practice that is untethered from the particularities of the task at hand can feel useless, even threatening (Barrett, 2011).

Reflective structures are emerging in the Pathway in the community, and no doubt they have expanded since these interviews were conducted in 2015. Bettles et al. (2016) describe the use of team formulation sessions in an approved premises, echoing the influence of psychology on probation practice described by Ramsden et al. (2016). As they embed, a body of knowledge becomes available about the lived experience of this aspect of probation practice; this could inform how to adapt, design and implement the structures to support it. The indications from this small study are that the psychological containment practitioners seek to offer service users has its success determined by the extent to which the wider organization is structured to echo this offer of containment to its staff. And that there is value in focusing on what happens between people, as opposed to a more static and individualized approach.

A final note of caution is also valid. In stating that supervisory and reflective spaces are necessary, the complexity that the data points to risks being sanitized – because implicit is the suggestion that it might be resolved. Reflective practice is not a panacea: this work will continue to be vexed, practically, emotionally, and ethically. Enabling teams to come together and learn from their experience of the work must not be treated as a substitute for interrogating more macro questions. The practical, emotional and ethical complications of integrating psychological models within a criminal justice framework ought not to be underestimated. For example, the distinction between psychologically informed probation practice and psychological intervention ought to be foregrounded, given the ethical implications of applying medical models of treatment to justice (Genders and Player, 2014). In bringing health and justice together, questions around social exclusion, individualistic models of correctional rehabilitation and public protection become prescient – and are embodied in the emotional negotiations which probation staff are engaged in, both internally and with the men they work with.

Conclusion

This research tried to get near to the experience of probation practice with male service users eligible for inclusion on the OPD Pathway. It is hoped that it sheds light on how probation officers make sense of what is asked of them, and what they, in turn, must ask of themselves. Whether experienced as a battle, or as reparative – often both – the work contains deep significance; perhaps in part generated by the scale of the challenges it poses. Describing one-to-one supervision, an interviewee spoke of how the probation officer is ‘left with the remnants of what happened’ (Nadia). From a psychodynamic stance, these remnants of the supervisory-encounter between service user and practitioner will include remnants of what has happened before: experiences that might include childhood trauma, committing traumatizing offences, and years inside the criminal justice system. That these experiences remain alive in the relationships men on the Pathway have with their probation officers speaks to the need for training, supervisory and team structures that allow for relational security, in all its dimensions.