A lesser harm? Restraining self and others or holding and being held? An in-depth exploration of restraint and holding in residential child care

This thesis uses action research through work discussion groups to understand the intra-psychic, inter-personal and systemic factors influencing practitioners’ experiences of physical restraint in residential child care. It explores the ethical dilemmas, practice challenges and personal distress evoked in participants by this practice. It also examines their perspectives on how others, including the children involved, witnesses and professionals, experienced or thought about physical restraint. Their reflections on the impact of wider systemic factors on their experience are also considered. The findings show that physical restraint presents serious physical and emotional hazards for both children and adults involved. Participants all supported attempts to reduce restraint but believed that ‘no restraint policies’ presented greater risks than restraint itself. Other children who witnessed restraints were recognised as invisible victims as this experience was terrifying and potentially evoked traumatic memories. The level of ethical distress experienced by all participants was very high but previously unacknowledged. The perverse social defence that had enabled restraint to be an uncontested practice despite its clear dangers has been dismantled but the brunt of anxiety is felt by individual workers. This is exacerbated by the climate of suspicion and negativity experienced from external professionals and regulators as well as the public. The importance of a culture of reflection and curiosity to support staff’s capacity to remain connected to children and be able to survive hostile projections from both children and the external world was emphasised and external consultancy identified as helpful in this process. Strong leadership, a model of care and a supportive but challenging team were identified as key components of such a culture. Without such reflective practice, restraint risks being a gateway to institutional abuse. Finally, this thesis places the findings in the context of current research and practice and considers the implications for the wider sector.