Making Visible: Preventing and responding to violence, abuse and neglect
Making Visible: Preventing and responding to violence, abuse and neglect
Episode 4. Holistic integrated care in justice health, critical reflection, and self-care
In the fourth and final episode of Making Visible, Mim and Lis reflect on the holistic integrated care perspective as they listen to two practitioner stories about substance use and pregnancy in the justice health space. These stories show the intersectionality in the justice health context and the importance of creating safety in a relational way within the justice health framework. Mim and Lis wrap up with the importance of engaging in critical reflection, objectivity in the practice and the ability to analyse the work while encouraging formal and informal supervision and self-care strategies.
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Welcome to Making Visible- preventing and responding to violence, abuse and neglect. The podcast supporting you to deliver best practise in your work with people who have experienced domestic and family violence, sexual assault, child abuse and neglect. The Agency for Clinical Innovation acknowledges the Traditional Owners of the Lands that we live and work on. We pay our respects to Elders past, present and emerging and extend that respect to other Aboriginal people here and listening today. We would also like to acknowledge those with lived experience. We recognise and appreciate consumers, patients, carers, supporters and loved ones. The voices of people with lived experience are powerful, their contribution is vital to enabling decision-making for health system change. Information about accessing personal support is available in the show notes and at the end of each episode.(UPLIFTING MUSIC PLAYS) This series is about preventing and responding to violence. We are making visible. This is a series that is about preventing and responding to abuse. We are making visible. This is a series about preventing and responding to neglect. We are making visible. From the Agency for Clinical Innovation- Violence Abuse and Neglect Network, in collaboration with the University of Wollongong and the Social Work Stories podcast, this is 'Making Visible- preventing and responding to violence, abuse and neglect.' We are making visible. This is making visible.
LIZ MURPHY:Hello, and welcome to the Making Visible Podcast. My name is Liz Murphy and I'm joined here with Dr Mim Fox. Hello, Mim.
DR MIM FOX:Hi. Liz. Hi, everyone. Great to be back.
LIZ MURPHY:Great to be back. Final Episode Episode four.
DR MIM FOX:I know.
LIZ MURPHY:...of this magnificent series of which I have learned so much about the breadth of the work that's being done in this space.
DR MIM FOX:I know it's bittersweet, I think, to get to this point, because there's been some amazing stories that have been shared, like some that have been really hard to listen to, Liz.
LIZ MURPHY:Grueling, in fact.
DR MIM FOX:I know and just but I've always come out of these stories just feeling so deeply inspired by the depth of skills, the amount of expertise that is out there working with these really hidden vulnerabilities in this population. Like, I'm kind of astounded at the skills that are being demonstrated every single day.
LIZ MURPHY:Yes. The unsung heroes and again, you and I love actually shedding the light on the depth of the work, as you describe it, that people are using with very, very complex, vulnerable issues, vulnerable communities and really, really tricky scenarios that we've heard. I mean, I you know, I needed a lie down every so often. Just yeah, this is hard work. This is really hard work.
DR MIM FOX:It strikes me, Liz how ethically complicated this space can be.
LIZ MURPHY:You're right. And I like the fact that that will be highlighted. I want to talk a little bit about some of the complexities in relation to ethics, in relation to boundaries in this episode.
DR MIM FOX:Yeah, it's a good place to come to actually, I think, in this series, because although we've referred to it every now and then and the wonderful clinicians have spoken about it, we haven't really sat too much in that space. So, I think today's the day.
LIZ MURPHY:I think so too that the sitting with the tension of the work that I do and some and thinking about some of the impact that it has in terms of, as you say, ethics questioning practise, questioning how they view this particular client. And I kind of hope that you and I can have a conversation about some of the things that might have been said if we were having supervision with these people.
DR MIM FOX:Yes. Yes.
LIZ MURPHY:I'm I think the need for self-care and supervision is really evident in this work as well. So, let's get into that today as well. Yes. So, we come to episode four, and this is a justice space that we're working in now.
DR MIM FOX:Yeah, justice health.
LIZ MURPHY:And they're two quite different stories, but working within the space of justice health and...
DR MIM FOX:Yeah, that's right. And which is, you know, violence, abuse and neglect work, Liz, just crosses sectors, right? Like, this is the really unique thing I think about this space is that it doesn't matter whether you're working in a justice health context. If you're working in the community, you're working in the hospital system, you're working in a child protection jurisdiction, the work is still present, right? The issues that are coming up across them. And one of the nice things about these stories is that they actually dive into mental health and drug and alcohol as well, which has been touched on in all the other stories. But you can see in these stories today about how in the justice health context, there's this intersectionality that happens where actually mental health, drug and alcohol, domestic violence, sexual assault, it all can intersect together.
LIZ MURPHY:Yeah.
DR MIM FOX:So, this is the first story that we're gonna do, we're gonna showcase here is an interesting substance abuse in pregnancy story, which really gives us a bit of insight into that everyday work that can happen in the justice health setting.
SPEAKER:Hello, my role is to work with pregnant women in a custodial setting. I support them from a mental health and psychosocial perspective. Unfortunately, many of the women I work with come from a history of violence and neglect. The case I'd like to speak about today is a composite of several women I've worked with over the past few years, but their stories and history are real events. Melissa, and this is obviously not her real name, entered into custody in her third trimester. She was around seven months pregnant. She was a young woman. She had a substance use disorder and had been engaged with appropriate services in the community when she was arrested. Before being arrested, police and ambulance had been called to the home and had witnessed her being severely assaulted by her partner. In fact, it was life-threatening. She had to attend hospital for her injuries and to her partner was arrested. She was transferred from hospital to custody for some outstanding matters. Melissa had several older children who were all in the care of Department and Communities and Justice, hereby known as DCJ. When I met her, she presented as a young, overwhelmed woman. She was very concerned about being in custody as this was her first time and worried about her baby. What also was really troubling her and continue to trouble her was how her partner was as he was also in custody for assaulting her. The fact that he had severely assaulted her did not seem to register with her. But I love him. He didn't mean. It was an oft-repeated phrase heard. Building a therapeutic relationship is a key part of the work that I do. So, I met regularly with Melissa, to support her and help plan for the birth of her baby. It became clear early on that she would be birthing in custody. Therefore, we assisted her to plan for this, and this involves supporting her with meeting with DCJ and to hospital services. As we continue to work together, it became apparent that the episode of domestic violence witnessed by the police was not the first that she had experienced and that there was a history both with her current and previous partners. She had also experienced sexual assault in the past, and all of this had impacted on her mental health and led to her substance use. She had also experienced the trauma of having all of her older children removed by DCJ and was very upset that with this child, history would be repeating itself. My colleagues and I became a stable, reliable touchpoint for Melissa during her pregnancy and post-birth when she returned to custody. She had not experienced this often in her life or with her family, and we were able to demonstrate what a healthy, supportive, professional relationships look like. We were not able to address her DV situation directly and it was very apparent that she did not see it as a problem. In fact, she was very concerned that he had a relationship with the baby and was very worried that he would leave her. It was pointed out how he treated her was not how a healthy, respectful partnership looked, but she found that very difficult to process. It was because of the drugs. He won't do it again. Working with Melissa was an interesting experience for me. I had to be very aware of my professional boundaries as it became evident that I risk becoming an attachment almost parent-like figure for her that I wouldn't be able to continue when she was released, and I didn't want to become another person who let her down. Another frustration was her absolute refusal to acknowledge how badly her partner had treated her. To me, it was crystal clear, but to Melissa, she loved him and he could change. I at times found myself wanting to tell her off, so to speak. And tell her how silly she was being. Of course, I didn't. But it was something to be mindful of. What was positive was that we were able to support her through a very stressful period in her life and help her plan for the birth of her baby and be involved in who would care for a baby. Having a baby is a very intimate period in a woman's life and walking with them while difficult decisions are being made is both a privilege and on a personal level, very difficult at times. Watching a woman give her baby away before returning to custody is one of the most difficult things I have done in my career. On her release, with my colleagues ensured that she was linked in to all the appropriate services, while carefully explaining that my work ended with her at that point. My experience is that women don't end to custody because they have had great lives. Working with women in custody is an opportunity to support them to make different choices. And hopefully, as I often say,"I never want to see you again."
DR MIM FOX:There's a real tension here for this worker, isn't there? It's like that issue of I wanna be present with my client modelling and a healthy attachment within a therapeutic relationship. I wanna be able to be consistent for the client. But at what point do I pull back? Right. Like, I love that bit where the worker says,"I hope I don't see you again." Right, because, yes, in a justice context, you don't want them to find themselves in this situation again. But in terms of the therapeutic relationship, having that attachment has actually yielded fabulous results for this person. So, at what point do you pull back healthily?
LIZ MURPHY:That is look, I've really, you've raised a really good point, Mim because I think there's that tension that's going on. What is of value to the relationship? But how do we actually let go? But then there's also that concept of leaving the door open for in the future as well. So there is that tension between letting go, I don't want to see you again, but my door is going to be open and that's going to be picked up in our next story. So, I'll leave that little bit alone now. But one of the issues I wanted to talk about is the issue of minimising violence. And I wanted to look at it from the perspective of the worker as well. So, there is she describes beautifully how challenging that can be to work with someone who's minimising the violence that they're experiencing, explaining it away.
DR MIM FOX:Oh, yeah.
LIZ MURPHY:She does it beautifully clear. But I wanted to just spend a moment thinking about how we as workers stop doing that ourselves as well. So, there's that tension between wanting to sit beside our clients and work with them in a partnership, but having to not buy in too much into the minimising of the violence.
DR MIM FOX:It's a really interesting point, Liz, because in some ways when you're working closely with someone, you start to mimic some of the ways that they're speaking, right? And some of the discourse that they're using. And so it would be really easy to actually sit alongside the person and minimise as well, especially when someone is presenting with all these other issues that may at that minute take precedence, like the fact that they're pregnant, like the fact that they're, you know, withdrawing from substance abuse, a whole range of things. Maybe they're having acute mental health issues, like there's a whole range of things that could actually or some of our previous episodes we've talked about the need for food, for shelter, right? These things can take precedence. How do you decide when is the time to challenge that discourse or that narrative that the person is holding? And what does that do to the therapeutic bond as well?
LIZ MURPHY:And that this is slow work. This is repetitive work.
DR MIM FOX:Yeah.
LIZ MURPHY:So, it isn't like this is one conversation that we have in our ongoing relationship with each other. Me challenging some of the ways in which this person is perpetrating violence against you. This is ongoing and I think at times you really can pick up from some of the clinicians that we work with that can also be like a real challenge in the therapeutic process, an exhausting part of the of that process too.
DR MIM FOX:I think the impact on the worker must be huge actually, and having to navigate that all the time that 'cause that is really quite a difficult space to sit in, I think.
LIZ MURPHY:And I, to be honest, I really like this clinician being honest about, you know, on the one hand, I have my professional persona with my clients. But behind the screens, you can actually say, "Oh, what does she say?" She says,"I felt like telling her off."
DR MIM FOX:Yeah, that's right. That's what she said.
LIZ MURPHY:And I loved that because, you know, like that is that is the reality of the duality, if you like, of the work that they're doing, There will be those ongoing frustrations of, oh, we're back here again.
DR MIM FOX:Yeah. I think I but I think that is the a large essence of frustration in the violence space, alright. Is because of the cycles of violence. As a worker, you can feel that you're in Groundhog Day with some of these conversations.
LIZ MURPHY:Yes.
DR MIM FOX:Yeah. Really, really tough. In the next story, Liz, we're gonna build on some of those ideas. Right. So, we're gonna go a bit deeper now into the justice health context, continuing with substance abuse in pregnancy. But we're actually gonna look at what happens when it doesn't end up how you think it might go. When you actually do sit in some of that frustration and some of that exhaustion that can come from working in this space, how does that feel as a clinician? It's tough, right?
LIZ MURPHY:It's really tough. And you're right. I think this next story really conveyed that to me that many threads and the hard work that's done by this particular subs worker with this client. That sounds like there's lots of again, lots of interagency work, lots of therapeutic work. But what I wanted to say to people is he's really good at bringing it back down to the basics as well. Even though this is a complex story, I want us to be able to come back and do what he's done a few times in it. Let's peel it back what is the essence of the work that he's doing with this particular person?
DR MIM FOX:I love that, Liz. Let's have that conversation when we come back.
SPEAKER:I'm the substance use in pregnancy, care coordinator for the Justice Health Program, my role in justice health and as a substance use in pregnancy is that I got to develop rapport really quickly with people, and that can be caused as a really short timeframe of turnaround. Someone can come in on a Friday into custody and they can get released on a Monday or Tuesday the following week. So, yeah, I've got to build it really quickly. Being a male in the role is really interesting because it has its challenges. I'm working with pregnant, vulnerable women who have got a history of, you know, family violence, domestic violence, of history of sexual assault, beginning when they were young people. There's all the emotional abuse and neglect. And we well know that this is all being perpetrated by males. So, it makes it really challenging for me to work effectively with pregnant women in custody. But the challenge is more on them, on the women themselves than on me, because the challenge for them is to have some confidence in my ability to be able to work effectively with them. And you try and do that and there's many ways you can do that. I work from a strengths-based model of care. I try to always be respectful, be genuine, non-judgemental, empathic with patients. I find that these are core skills that without using them with men, would render my role in the field almost impossible to do. I jointly work with patients. I try to work with patients in a way that we come together and we formulate a treatment plan for when they get released from custody. One of the important things with me walking in this field is to try to create a safe space to people to walk from. And that can be really difficult in a correctional centre. Correctional centres are noisy places. They aren't, they aren't safely secured in a way. And what I mean by that is older people are always listening to what goes on and information is power. So, people are reluctant to talk in settings in that way. So, it's about closing doors, having a quiet place. Usually, I'll have tissues available too. And I like you working from a narrative perspective, a narrative therapy. So, I like being curious, asking curious questions. And I find that if you're asking curious questions, you're being genuine, you're being respectful and, you know, non-judgmental comes out in life, people's life stories are interesting and I enjoy people's journeys and their life story. So, OK, look, that's not that's enough about me. Let's talk about I'll give you a little, I'll give you a snapshot of who we're gonna talk about today. Her name is gonna be Navita. Now, Navita is a 21-year-old lady from a South American background. Yeah, look, it happens with Navita from an early age. And what she told me was, was that that the problem started when she was at a very young age. And we're looking at, she told me, about five, maybe six years of age. She said that her father and his brother were best buddies and that her father and brother did everything together, but the father's brother, her uncle started sexually assaulting her from when she was of five or six years of age. And these assaults continued right up to puberty. They happen occasionally after puberty, but, you know, not very often. I think she said, it was about 11 or 12 years of age when she was when the assaults stopped, she was really fearful of our uncle. He was like, yeah, you can just imagine, he this was our father's best friend, not only his brother. He had told her over the years that if she ever said anything, he denied, you know, he'd say, you know, she initiated it and all this type of garbage he told about her. But she believed it. Navita, at this time around 11 or 12, she was really fearful the assault had finished. She had no friends. She felt really isolated, lonely, and she cut up for the first time. And people wanted to know why she cut up. And eventually, she should disclose to her parents why she cut up. With this disclosure, nobody believed her. And the isolation was for the young. She was for the marginalised. Uncle, of course, denied it. You know, time went on and she just decided to end it all. And she tried to take her own life. And with that, you know, her mother talked to her about it somewhat. And she disclosed to the mother that the reason she did that she had told them about the sexual assaults was that she was fearful. Now, that he, know, that the uncle had stopped assaulting her he would start assaulting her younger sister. So, that impacted on the mother because the mother became very protective of her daughter and over time believed. Then one day the mom came home and said,"Right, we are packing our bags. We're leaving. I've got a divorce from your father. We're leaving and we're going to Australia." Very challenging for a migrant family, come to a different country. They'd been in a village basically in South America. And then to come to a major city was another challenge in itself. Her mom got a job pretty quickly through family networks. And it took, you know, Navita had to look after our sisters and all that type of stuff. She was very protective of our brother, but she was especially protective of her younger sister. Navita felt really lonely and she suffered from loneliness and homesickness for a very, very long time. She'd overwhelming feelings of guilt and shame, and she blamed herself and all the family's problems. She also blamed herself on the family breakup and for coming to Australia and leaving family in South America. And look, for a long, long time, as far back as she could remember, she'd always felt anxious, depressed, sad, lonely. She didn't have a happy childhood. She was withdrawn from most people. She didn't have friends. She lacked focus on concentrating on any topics. She reported to me that she didn't have enjoyment in her life. And she, it took her a long time to even remember to remember happiness. A history of incarceration she has gone over the last possibly eight years. Her offences are directly linked to her substance use. When she came into custody, she entered custody. What we do when people enter custody is that we'll do a pregnancy test of all women entering custody. And we repeat that test 28 weeks later because we found in the past that women came in, tested negative when they came in and they were pregnant. Now, they didn't get pregnant in custody. So, there was a negative pregnancy test when they came in. And that's exactly what happened with Navita. She came in, pregnancy test was performed. It came back negative. Four weeks later, we did the pregnancy test again and this time it came back positive. And that's when I become involved. I immediately became involved when I know someone is pregnant and I make to go to that jail wherever they're in at my earliest opportunity. In this case, it was... It wasn't that it was an unwanted pregnancy, but it was certainly, Navita hadn't planned this pregnancy at all. She had met a new partner. The new partner was a married man, and she was having a basically an affair with him. So, I go and I meet Navita. And when you meet people who are only recently, especially if it's first time and even if it's not the first time, it can be a challenging time emotionally for them. Their freedom is denied. They're locked up. They will be if they're in a reception or a holding cell in that correctional centre. It's usually cold, has bright lights and it can be very, very intimidating. It can be very lonely for people, too. So it's yeah, emotions are very raw. The tears flow very, very freely. I'm emotionally exhausted, absolutely. And meeting Navita was no exception to that rule. At that stage, when I met with her, she would have been, Navita would have been only six weeks pregnant. So we would have then organised for her to go forward, you know, the dating ultrasounds and all that type of stuff. We also give women the option in custody of whether they want a termination or whether they want to, you know, continue with the pregnancy where she can speak to perinatal infant mental health about that. And she can also speak about, you know, she can speak to the midwives and whomever. Those discussions were held and Navita was she wanted to continue with the pregnancy. Look all day and look to because she had only just found out she was pregnant. It's a matter of referring are two different people. So yeah, make the midwife aware, prenatal, infant mental health aware. She hadn't spoken to her mother since she came in. She wanted to speak to her mum about the pregnancy too, and she hadn't spoken to the partner. So, in instances like that, I'll take details of all those people. I'll talk to the welfare in the jail, make them aware that she's pregnant, and that, you know, can they organise phone calls for her. We had upcoming court as well. And so one of the things that I can do is I can provide and indeed provide Navita with a court letter outlining that she's pregnancy. So, I contact her solicitor and all that type of stuff. So, that was my official first initial meeting with her and that was just to get to know each other, get some basic information and try and build rapport. So I then met with Navita, at the start it would have been twice a week and then it tapered off to once a week while she was in custody. And in that time I built, we quickly built rapport together. So Navita's story, the one thing that struck me about Navita from day one to the last time I saw her was the overwhelming sadness that was in our life. It just enveloped her appeal. It pour, it just was pouring out of everything. Everything, everything about her was just sadness. Young, she cried and cried so often. It was yeah, it was heartbreaking. It really was. And it that sadness, Navita's sadness has always remained. I can sense it. I can feel it still. Yeah. Look, so it was really difficult. New partner for Navita, in jail again, pregnant, all linked her into a variety of people in jail. I try to encourage her to go. We can get her in with a sexual assault counsellor, wasn't particularly happy to do that. Said she would do things when she left jail. But yeah, she wouldn't do it in jail. Linked her in with perinatal, infant natal health Talked a bit to those guys. But look, not a great deal. My concern in custody was the flashbacks and the nightmares, you know, all that type of thing. Hanging over her all the time was cut. And so we had to address the court matters, court was ongoing. Every time court came up, her anxiety or depression, her anxiety, hope and depression, depend on type of thing. Yeah, look, she was we have a system in jail where depending on your category, you may get into jack around the cottages, which would mean that she could remain in custody with the baby. But she was on sentence on these matters. And also she was a Cap three, so she wasn't eligible. So then we had the difficulties of where this baby's going to go. We had to get DCJj involved in parallel plan around if Navita remained in jail or if she got released, where would the baby go. That increases anxiety, of course, And in that heightening anxiety, Navita wasn't sleeping much and was getting much more unsettled in the jail. She was hopeful of the relationship with the new partner. However, I wasn't particularly helpful, but she seemed to think that this would go really well. So, we worked with DCJ. We work with the midwives who work with Navita. It was really challenging. And again, I'll go back because the sadness was just... It was overwhelming. Navita described with her relationship with partners. In the past, it was dominated by physical violence, sexual violence too. It was definitely there. There was the threats, the controlling behaviour, all that type of thing. I don't know, but she certainly alluded to one of the partners getting into sex work for yeah, for two, for money for one, but also to maintain him and her in, you know, in drugs, etc. She said that the new partner wasn't a user. I had me doubts about that. She certainly presented as someone with this pregnancy want the change, wanting to address issues. And she gave me guarantees that she, not so much guarantees, but she said, yes, she was interested in drug and alcohol counselling. She would go to psychologists and she was, you know, at that stage she said, "Yes, look, I will look to have, you know, to address all the sexual assault and try and move on with my life." There was all told that she felt guilty and neglect about her children and that she hadn't cared for them. But yeah, look, she was happy to go forward with this pregnancy. Now, I'll give her all the information about drugs in pregnancy, et cetera, et cetera. One of the good things about her being in jail was that she wasn't using, so this baby had got a chance, which was really, really important. I spoke to her about, you know, crystal met in pregnancy and fetal development and, you know, all that type of thing, and the risk of miscarriage and the risk of still bears if she's using on top if she's using while pregnant. And I reiterated that information the whole way through, as we went along. We also looked at, you know, all the relapse prevention strategies, and we looked at mindfulness and assertiveness skills, and she started to practise assertiveness in jail and doing all the mindfulness of, so we started to make a lot of progress. So, we developed a community treatment plan that looked at her engaging with substance use in pregnancy in the community. If she was released going to antenatal care at local hospital, they'll get her into the safe staff meetings, back in with her GP, mental health care plan, referral to a psychologist. I spoke to her mom. Her mom initially didn't want a living in the home. Eventually agreed that she could live in the home. DCJ didn't have objections to that, so that was really positive. We went, got to court, and court gave her bail on her charges. Now, this was, was a huge breakthrough because this meant then that we had a chance. We then had to go back to the State Parole Authority, looked at the State Parole Authority, and they reinstated her ICO. So, with the reinstating of the ICO, that meant that we had a release date. So, all the plans were put in place. She was really happy about that. Then it dropped off for a while and that was fine. And out of the blue, one day I got a phone call and I got a phone call from Navita, and basically, Navita was hysterical. And, Navita was hysterical because she basically was having a baby at that time. She had returned to substance use and she had the baby. And she had the baby basically in a toilet at home. And it was still wet. Ambulance came, took her to hospital. Yeah, it was, it was tragic. It was tragic. I spoke to her for weeks after that and we, it was, again, with the guilt, the shame. It was horrible. And it was horrible for her. It was horrible for me listening. And it was, it's been a challenge reopening Navita's box as such, because Navita's, it's a Pandora box. Yeah, look, it's how, how do... How do you cope with the sadness, the grief, the pain, the loss, the shame, the blame of Navita? Again, I try to get her into psychologists, I know she's back being back in custody once for a few days. I haven't heard from her in a very, very long time. And I hope she's OK. How do I look after myself? I walk every day. I come home. I shed all my clothes, all my work clothes. I share, I walk. I've got hobbies and I look for something every day that I'm grateful for. What keeps me going is the resilience of these women I work with, because I'm amazed. I'm astonished by their resilience. It's just unbelievable. If I can assist them with reconnecting with hope or I can assist them with finding something in their lives or rekindling a dream or reconnecting them with happiness, well, happiness is too much. But reconnecting them with hope and their relationship with hope is one of the things that sustain me. If I can make any slight bit of difference in someone's life, that's enough for me.
LIZ MURPHY:I've just got to have a moment. Wow. I'm exhausted. So, Mim, I'd like, I don't know, like, my initial reaction is this is just so much work that has been done by this particular person with the client.
DR MIM FOX:Yeah, I know exactly what you're saying.
LIZ MURPHY:And when I heard about the baby dying, the end, I don't know about you, Mim, but I had to actually just pause and just walk away for a bit.
DR MIM FOX:I know the sadness for the woman. And then the sadness for the worker. Right, like the commitment that he'd shown in that relationship and the breadth of activity and advocacy and casework and connection and networking was just it was huge. To get to that point, they're sitting in sadness parallel with each other, aren't they?
LIZ MURPHY:Yes.
DR MIM FOX:Now, this is what I meant earlier about leaving the door open.
LIZ MURPHY:Yeah.
DR MIM FOX:Because, and also leaving the door open. But coming back to those core skills that he identifies as being so essential in his work, having to build up a rapport and really, really working with core skills in this relationship together because, gosh, they went on a few interesting rides. But there was a sense of the doors open. Now they'd had a break in connection in working together, but she came back after the death of her baby. Now, that says an enormous amount about how he had worked really, really well with her. She comes back to him.
LIZ MURPHY:I know. I know. That's the phone call she makes. And I thought, like, look, we don't often get that in this world, right? Often the therapeutic relationship ends and we have no idea what the end of the story was for the person eventually. Right. So, in some ways, there's a gift in that in being able to have that bow tied. But... There is actually and I think maybe that's something that we heard in him making sense of it. Yes. Because you could hear the sadness. But if I could and you have to find the pills in this work.
DR MIM FOX:That you absolutely have to write.
LIZ MURPHY:And what I'd like to say to him is she came back to you at one of the worst moments of her life, guaranteed.
DR MIM FOX:If he was sitting in supervision with you, Liz, is that the conversation you'd have?
LIZ MURPHY:I'd be asking him about what it felt like to get that phone call.
DR MIM FOX:Yeah.
LIZ MURPHY:And that she chose to tell you about this?
DR MIM FOX:Yeah.
LIZ MURPHY:What does that say about all the work that you did together?
DR MIM FOX:Yeah. I think there's something really important there. I want to go back to how he mentioned that he used curious questions with her. And I wanna say how important that is in a justice health environment where so many assumptions are gonna be made about this woman and how she's ended up at this point in her life, right? Like, that's gonna be surrounding her every moment of every day. So for him to come on, come into the therapeutic space, not basing himself on assumptions and basing himself on curious questions, I think sets up that therapeutic relationship for the long term.
LIZ MURPHY:Yes.
DR MIM FOX:That means that then when she's calling him and making that call down the track, she knows she's not gonna make met with assumptions.
LIZ MURPHY:No, because these questions opens up the story.
DR MIM FOX:It does.
LIZ MURPHY:Opens up the person in a fuller way to becoming, say, problem-focused.
DR MIM FOX:Yeah. Yeah. I think that and I just think that's vital to that therapeutic arc, right?
LIZ MURPHY:Mim, what did you think about his commentary on the importance of trying to create safety within the justice framework, the difficulty of the environment and how he goes about creating safety in a relational way? The importance of that.
DR MIM FOX:Do you know what, Liz, struck me listening to that is that actually I think that's gone through each of our episodes in this series in the Making Visible series is that people are living in these unsafe environments, right? Whether that unsafe environment is in the prison, whether it's in their home, whether it's in the school environment, the peer environment, wherever it is, creating safety in these conversations has been a repeated theme, alright. And I think the skills that the clinicians have shown in being able to do that, in being able to say, "Within this relationship there is safety. Regardless of the environment that you are living in, in your world in this moment, there is safety here." That seems to me to be an essential skill of the VANN worker.
LIZ MURPHY:That's really well said, Mim. And I think another thread that I've seen woven through the four episodes is this the importance of integration in working with individuals and in families and really emphasising that this work cannot be done alone. That, yes, we create a safe space between myself, the clinician and you, the client and family, but will also create safety broader and get other services involved. And that's a big part of my role in working with you is bringing people in, but bringing services in at also pivotal time is not throwing services at families, being discerning in how that's done. Setting it up. So again, there is like a safety doughnut around these.
DR MIM FOX:That's right. That's right. Look, I tend to think that if we compartmentalise our role too much and we don't actually do that integrated care, I tend to think it's too easy for us to then become the disciplinarian, the gatekeeper, the assumer in someone's world, right? Where it's not a holistic perspective on the person in their environment to go that down that path. So, in order to stay true to actually the needs of the person in front of us, it's vital that we work in this holistic, integrated care perspective.
LIZ MURPHY:Good for our clients, but also good for us because you aren't solely looking after or working with this person. So, it's not just you staring up at the ceiling at 3am. No, you're actually creating a team that's going to be working with you.
DR MIM FOX:And that's gonna be able to debrief together. I mean, let's go back to the episode where the worker was talking about doing co-therapy, right? Like, I actually think these are self-sustaining practises that we need to make sure are embedded in our work.
LIZ MURPHY:Yeah, I absolutely agree with you. And as we talk about it in terms of the sustainability of this work as well.
DR MIM FOX:Yeah.
LIZ MURPHY:Sharing the load.
DR MIM FOX:Yeah, absolutely. Absolutely. It's hard for some of the workers out there, Liz. We really need to acknowledge that there are some VANN workers who are working in remote settings, rural settings. They might be the only VANN worker for however many kilometres. And I do think that that's something that COVID has shown us, that we can relate and engage with each other in different virtual ways and that we can create communities in different ways. That's one of the beautiful things about the Violence Abuse and Neglect Network is that you can have like conversations with different people who are doing the same work as you every day and it sustains you in your practise. Isn't it inspiring?
LIZ MURPHY:It does. It validates perhaps, what you're doing with your clients, and that's always reassuring, but it also shares other recipes. Haven't we just we've just seen such a broad smorgasbord of ways in which these particular individual clinicians have worked with people with very complex trauma backgrounds? And there's been, you know, from the narrative therapy to the art to the walking in nature.
DR MIM FOX:That's it, we've seen so many different interventions described. And like really it's about remembering as well that in order to continue and get better in your practise, you have to be able to reflect. Right, we have to be able to engage in critical reflection with each other, to sit back, have some objectivity to our practise, and be able to analyse our work and always come back to how do I do better, right? And that can't be done in isolation. It has to be together. So there's the more formal setting of supervision, which we know a large number of our workers have access to. And then there's that informal supervision that is so vital in the everyday world of this work.
LIZ MURPHY:I feel like this is the self-care stuff that our students, our clinicians need to be thinking about and doing more.
DR MIM FOX:Yeah.
LIZ MURPHY:You know, after a session, I couldn't help but think about some of the really, really hard work that's being done and how you actually have a break afterwards. Do you debrief with your team? Do you breathe afterwards? Do you have a walk around? How are these people building sustainability into their work practise beyond the supervision? Beyond, and I think you're right, Mim. I think it's about the communities of practise leaning into the support from our teams and other workers and also looking after ourselves in this space.
DR MIM FOX:And also remembering, Liz, that just because you spend every day working with people who are experiencing violence, abuse and neglect, doesn't mean that that's what the world consists of all the time, every day, right? Coming back to the positivity and hope that an inspiration that actually is around us every day allows you as a practitioner to continue in this work because you have balance right in perspective.
LIZ MURPHY:I think that's right. And I think we heard on that issue. I think we also heard how many of the clinicians drew on the strengths of their clients as reminders of this is why we do the work that we do. We notice the acts of resistance. We notice the exceptions. We notice the, you know, the strength, despite the challenges that these clients of ours live through.
DR MIM FOX:Yeah. Despite the adversity, the resilience that people have is just extraordinary, isn't it? Just extraordinary.
LIZ MURPHY:What an honour, Mim....
DR MIM FOX:I know.
LIZ MURPHY:This has been.
DR MIM FOX:I wanna say a huge, huge thank you to all of the practitioners who contributed their stories to the Making Visible podcast. I think this is important that we get the stories of our practise out there, that we showcase the incredible work that's being done and that we, you know, give voice to our consumers as well as our clients who we spend every day working so hard with, important that we know what's going on out there.
LIZ MURPHY:This has been an absolute pleasure working on this project. I have to say.
DR MIM FOX:It really has been. And just witnessing the stories that our practitioners are going through and working on every single day has been a real privilege, Liz.
LIZ MURPHY:I am in awe.
DR MIM FOX:Yeah, total awe. So, look, I think it's important that everyone, one last time I'm going to do a plug, get connected with the network.
LIZ MURPHY:Do it.
DR MIM FOX:Like, it's the way to keep developing skills, you know, engaging with professional development, debriefing every day, situations that everyone's going through. It's really important. So everyone, if you're out there, social workers, psychologists, other health care professionals, if you, I wanna stay up to date with innovations in the area, come on, join the Agency for Clinical Innovations- Violence Abuse and Neglect Network. It is such a good community and the website is on in the show notes, so get on that.
LIZ MURPHY:Indeed, we have...
DR MIM FOX:We have. And before we finish up, there are few thank yous to do, Liz. Look, the first thing is, thank you to all our storytellers and the consumers out there. Thank you for providing these stories and for the hard work that you do every single day allowing us to witness that as well. We wanted to also thank the VANN Reference Group that has been working on this project for the whole time. It's been an absolute privilege to work with everyone. We wanted to thank Ben Joseph and Dom Hopkins, our production team, for all the hard work behind the scenes. Thank you to you, Liz. Thank you to you, Mim, and thank you to our listeners. Yes, thank you to everyone out there. We know that this is a hard space to be in and you've got there with us, and good luck for all the work going forward as well. And take care of yourselves. All the best. Bye.
LIZ MURPHY:Bye.(UPLIFTING INSTRUMENTAL MUSIC PLAYS)
SPEAKER:Thank you for listening to this episode of the Making Visible Podcast. All clients' experience is discussed in making Visible have been de-identified. The content discussed in this podcast may be distressing. If you live in Australia and need support, please contact 1800RESPECT 1800 737 732 or Lifeline on 131114. Making Visible is produced by the Agency for Clinical Innovations Violence Abuse and Neglect Network in partnership with the University of Wollongong and the Social Work Stories Podcast Team.
