The GROWTH Factor in the Human Services: supporting relationship-based practice
Did you see the 2016 film, ‘I, Daniel Blake‘, directed by Ken Loach? It gives a poignant and highly naturalistic insight into the absence of compassion in a social services office in the north of England. Complex “Catch-22” regulations, IT systems that keep crashing, and hours spent on hold on the telephone – you begin to get the picture and understand the escalating frustration and alienation of both those who work in such systems and those on the receiving end.
Relationships and the human services
Human services as diverse as health, mental health, education, social security, relationship counselling, corrections, disability, alcohol and drug treatment, family violence and child welfare, depend on the 3 R’s – relationships, relationships, relationships. Service delivery in the human services is not like Australia Post delivering a parcel. Even when it looks as if the service is of a material nature such as “meals on wheels” or “home help”, the human dimension is often valued as much, if not more, by socially isolated people.
Work in the human services is inherently expressive, not just instrumental, and is a form of what Hochschild (1983) first described as “emotional labour”. I have done a fair bit of “emotional labour” in my time as a social worker in the fields of mental health, sexual assault and child welfare, and more recently, as a volunteer with very disadvantaged children in school settings. I have also conducted research into the relationships between mental health nurses and their patients, maternal and child health nurses and mothers, and child protection workers and parents. All of this was relationship-based practice.
Friends and colleagues of mine have worked at the “social control” end of the human services spectrum, in probation and parole. This too is relationship-based practice. While based on a primary duty of care to the community, they are also based on a duty of care to the person involved in the criminal justice system. Such duties are complementary, not mutually exclusive, and the nature of the person’s relationship with their probation or parole officer is central to the goal of rehabilitation.
What does “relationship-based practice” really mean?
“Relationship-based practice” is often spoken of, but less often honoured in the way we provide human services. There are two common examples of this. One, clients are often transferred from a service provider with whom they have established a rapport to someone else for minor administrative reasons. Two, staff are typically selected for their qualifications and experience but with insufficient attention being given to their capacity to form good working relationships with vulnerable people.
There is strong evidence to support the importance of therapeutic relationships. For example, in a major meta-analysis of the variables associated with positive outcomes in psychotherapy (Lambert, 1992), four sets of factors were identified and weighted. They were: the client’s personality and environment (40%); the quality of the therapeutic relationship (30%); the use of evidence-based techniques (15%); and hope and expectancy of change (15%). The relationship matter is important in itself and as a vehicle for service engagement and for addressing some of the other factors related to positive outcome.
I have an acronym for the essential qualities that make a relationship therapeutic. It is G-R-O-W-T-H or Genuineness, Respect, Optimism, Warmth, Trust and Humility. These qualities constitute the crucible of relationship-based practice. When we are feeling fragile and perceive the presence of these qualities in a medical practitioner or a counsellor, for example, we are likely to feel greater trust and confidence.
The GROWTH qualities are not only values. They are also emotions, and it is wrong to reduce them to “interpersonal skills” or “emotional intelligence”. At the heart of those qualities is compassion. The Latin word “compassion” literally means “to suffer with”. The Hebrew word for compassion is “rachamim”, from the word “rechem”, meaning womb. We are talking about something profound in the human psyche and in the human encounter.
Those offering therapeutic relationships, a group much larger than psychotherapists, are the instruments of their own practice. We need to look after them as we would look after a fine musical instrument. In his work with deeply committed practitioners who have become “burnt out”, Parker Palmer explores “the gap between who I am and what I do” (www.couragerenewal.org/parker/). When this gap grows, so does the risk of demoralisation, high staff turnover, inadequate services and poor outcomes.
Perhaps the most powerful indicator of “burnout” is a decline in compassion on the part of the individual service provider and in the culture of the organisation. Well-functioning teams and high quality “clinical supervision” in which people are given a safe sounding board to reflect on their practice, and to deal with the emotions and stresses in their work, are vital.
Understanding the intrinsic motivation of people who bring compassion to their roles is essential. The challenge is not just to select staff who have compassion. An even greater challenge is creating organisations that strengthen compassion rather than weaken it. This is the ultimate test of leadership in the human services, whether it is at the level of team leader, manager or executive officer. Leaders need vision, a sense of vocation and enough of the GROWTH factor in themselves if they are to pass this test.
Blog by Emeritus Professor Dorothy Scott AM PhD
Honorary Professorial Fellow, University of Melbourne
Adjunct Professor, University of South Australia
Emeritus Professor Dorothy Scott is an honorary professorial fellow at the University of Melbourne and the University of South Australia. As well as having held several academic positions, Dorothy has held leadership roles in the philanthropic sector, and served as a social worker developing and providing innovative services in the fields of maternal mental health and child and family welfare. She was made a Member of the Order of Australia in 2017 for her contribution to the community.
Hochschild, A.R. (1983) The Managed Heart: commercialisation of human feeling. University of California Press. Berkeley.
Lambert, M.J. (1992) Implications of outcome research for psychotherapy integration. In J.C. Norcoss & M.R. Goldfried (eds) Handbook of Psychotherapy Integration, pp94-129. Basic Books. NY.