It seems that early on in the role, PSWs were vulnerable to over-identifying with the service users they were working with. It seems that they were enthusiastic about recovery, but at the beginning this was frequently based on the view that “what worked for me will work for you”.
Richard’s account illustrates this. He explained how it was difficult for him to not take a personal view when working with service users.
“I think initially it was very hard not to look at things other than through my own perspective of mental health and depression and what made me better and what helped me get better.” (Richard, 310-312)
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It could be implied that at the start of the role as a PSW, his stance was that he wanted to “fix” (which perhaps reflected his personal view of recovery at that time), and it would seem reasonable that there was a period of adjustment where he had to learn to not force his perspective onto others.
In the following quote Richard explains how this was particularly difficult early on in his role as a PSW.
“Certainly, early on, because it was still a big part of my life, it was still something I was doing. And it was almost like ‘Well come on, why aren’t you bloody doing it, I can do it, you can do it’ – and of course it doesn’t work like that at all. To realise people will learn at their own paces, do things at their own paces, and also need many different things to what I needed and things like that. So … yeah.” (Richard, 332-337)
The use of the word “bloody” may suggest that he felt frustrated with people if they did not seem to be moving forward in their recovery, and the “I can do it, you can do it” comment could be interpreted as a projection of his own
experience of recovery onto others.
Sandra also spoke about sometimes taking a stance which implied “knowing best” and she explained that sometimes she still has to hold back from telling service users what to do, and she can feel frustrated when they cannot do what she thinks may be best for them. In the following extract, she explained how she uses reflection as a way of helping herself get back to a more neutral stance:
“You know sometimes I find myself going down the track now that I’m well maybe thinking ‘Oh for God’s sake, just do it!’ I’m thinking with a patient you know ‘Why can’t you just do it? It will help you’. But I have to stop and think ‘No, Sandra, you’ve been there, it is not just a matter of just doing it’ - getting up and going to mindfulness or something like that – it’s not as easy as that when you’re in that place … but I have to keep reminding myself that.” (Sandra, 139-144)
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It seems that part of her adjustment to the role had been similar to Richard’s in that she had to recognise the individuality of recovery and learn to not project her own experiences onto service users. The words “oh for God’s sake” implies the frustration she felt, just as the word “bloody” did in Richard’s account. Sandra’s account raises the importance of reflection as a way of reducing unhelpful re-enactments. The way that she described talking to herself (“No, Sandra”) may suggest that she had
developed the ability to observe her own responses and be more reflective in her response to service users.
For Fran, a difficulty she found in her relationships with service users manifested as a struggle to instil hope in others when it was still early days for her own recovery:
“I mean it was difficult for me in the beginning because obviously I’d only just been unwell, and I was still putting things back together … it was difficult for me to be instilling that kind of hope in people. But now that it’s been longer, you know I do feel like I can sort of … like I always say like oh it takes time, or you’ll get there … and now I believe it.” (Fran, 551-556)
The words “still putting things back together” could be interpreted as meaning that she was in the early stages of her recovery and still figuring out how to manage after having been unwell. The phrase “now I believe it” suggests that at the start of the role, and at the early stage of her own recovery, she did not fully believe that recovery was possible.
The potential for becoming over involved is also reflected in Celia’s account:
“Like sometimes you get really attached to them without even meaning to … so if someone like self-harmed … I remember one girl, we used to get on so well, and then she self-harmed … then I had to sit with her … it was just so … you become involved. I was so annoyed with her, and obviously I had to keep my professionalism, but I think perhaps my
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answers to her were short, and she was like … she didn’t say why am I being grumpy, but I think she said something along those lines.” (Celia, 227-233)
Celia’s quote could be considered as an example of the difficulties of the PSW role and being able to balance an authentic response with a professional one. Celia was aware that she was required to demonstrate some “professionalism”; however, her comment of being “really attached” could be viewed as her being over-involved and then being more likely to respond emotionally, which could get in the way of being neutral.
Celia did not go into details in her interview as to how she managed these
experiences. However, the above direct quote is indicative of the difficulties with boundaries in the work as a PSW, and how this perhaps requires adjustment.
Tom also made reference to issues relating to boundaries in his interview when considering what he might say to someone who is thinking of becoming a PSW.
“And make sure that you’re in a good enough place that you’re not going to latch onto somebody else’s problems and live it with them, rather than experiencing just sharing. It’s about sharing – shared experiencing but not kind of getting stuck in each other’s lives. If people aren’t far enough in their recovery, that will happen.” (Tom, 413-417)
Tom used the term “latch onto somebody else’s problems” which could be related to a person over-identifying with another person’s difficulties. He explained how it is possible to “get stuck into each other’s lives” (which could be interpreted as being over-involved) if a PSW is not far enough ahead in their own recovery. This may imply that a person needs to be “ready” to start the role and that there perhaps needs to be a process within the PSW supervision that supports PSWs’ adjustment into this role.
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Sarah did not mention difficulties with becoming over-involved or attached, but highlighted another boundary issue when she explained the problem with knowing people who attend some of the groups she has co-facilitated. She explained:
“… one of the groups I supported there was a lady in it who I knew. So … I had a word with [her manager] and she said ‘well it’s up to you if you want to stay here’ kind of thing. And obviously she [manager] spoke to me about confidentiality if I shared anything, like confidential … and I stayed in the group, but it was difficult because I knew her [the service user].” (Sarah, 267-272)
Sarah’s experience not only raises the issue of boundaries, but also highlights the different roles that a PSW has to negotiate and manage. It seems that for Sarah it was a difficult experience, but having a member of staff she could discuss these problems with was important and helped her to remain co-facilitating the group even though it perhaps felt uncomfortable for her.