Don’t shoot the messenger: an exploration of how professional networks struggle to receive, contain and process painful communications from and about adolescents in the care system

I aim to explore the conditions that either facilitate or disable effective networking within the complex, transitory professional networks that support ‘looked after’ adolescents. Drawing on my experience of undertaking specialist mental health assessments, I identify dynamics within multiagency, inter-disciplinary systems that influence the extent to which these assessments contribute positively to the care planning process. I discuss how the intra-psychic and psychosocial difficulties of many ‘looked after’ adolescents are mirrored in their professional support networks. I use a grounded theory approach, underpinned by psychoanalytic theory, to analyse two reflective case studies of ‘looked after’ adolescents and two focus group interviews with residential care workers and CAMHS clinicians. Through my analysis I identify six interlinked themes with associated sub-themes. Two relate to the challenging ‘external worlds’ of many children who enter care and also of those professionals who support them. Two relate to the intense emotional pain and turmoil of the ‘internal worlds’ of these young people and their workers. The final two relate to various ways in which adolescents who have been neglected and abused attempt to numb or distract themselves from their emotional pain; and to defensive barriers erected by professionals to ward off their young clients’ unbearable projections. I argue that defences erected by individual workers against the significant emotional disturbance generated through close contact with these troubled and troubling young people may become rigidly entrenched at an organisational level. The intense anxiety generated by the work can trigger requests for specialist assessments in which the needs of adolescents take second place to those of workers. Conversely, when professionals are in less anxious states of mind they may, in order to enhance the quality of the care planning process, seek an expert opinion in recognition of the value of skills differentiation, alternative viewpoints and collaborative working practices.