Pointers for Practice: Working with resistance from the adult at risk and their carers

For adults at risk and their carers enquiries about possible abuse and neglect is stressful, frightening and raises anxiety levels. When this occurs, they may respond by taking one of the following approaches:

• Fight mode: by resisting what is happening. They may be verbally or physically aggressive and hostile to enquires, for example physically preventing the practitioner from entering the home
• Flight mode: by denying what is happening through distancing oneself by for example, lying -‘This was an accident’, avoiding practitioners by physically running away, not keeping appointments and non-engagement
• Freeze mode: by blocking out what is happening because there is an awareness that they do not feel powerful enough to fight this and they are too scared to run away. This can result in blanking out ‘I don’t know/I can’t remember’ or clamming up and saying nothing.
• Superficial compliance mode: individuals disguise or manipulate their presentation to appear that they are co-operating or that the situation is better than it actually is. In the Welsh review by Robinson et al., this was referred to as ‘hoodwinking’.

Alternatively, the adult at risk may be:

• Relieved that their needs are being recognised
• Resigned or accepting of the process because, for example, they have experienced it so many times before.

The practitioner can reduce anxiety levels by:

• paying attention as to how the adult at risk and carers are kept informed, where and by whom
• being honest and sensitive about the situation
• recognising them as people not ‘problems’
• acknowledging the power dynamic
• listening to what the adult at risk and carers have to say
• recognising their emotions and anxieties
• trying to differentiate between realistic and unrealistic fears

The way in which the initial engagement is managed has a direct impact on the quality of the subsequent worker-family relationship. This relationship:

‘will need sensitive handling by skilled practitioners. All attempts to resolve the situation should begin with negotiation, persuasion and the building of trust. Denial of access may not necessarily be a sign of wrong-doing by the third party; it may be an indication of lack of trust of authority, guilt about their inability to care or fear that the adult will be removed from the home. It is vital that until the facts are established the practitioner adopts an openminded, not judgemental approach’ SCIE p5

Rees et al (2018) in the Welsh review analysis found that disengaged or chaotic individuals were discharged from services and cases closed without needs being met when they failed to engage rather than being provided with a rigorous new assessment.

For further information see:

Robinson, A, Rees, A and Dehaghani R (2018) Findings from a thematic analysis into adult deaths in Wales: Domestic Homicide Reviews, Adult Practice Reviews and Mental Health Homicide Reviews Cardiff University (Accessed 21/ 7/ 2019)

Ruch, G., Turney, D. and Ward, A. (eds) (2018) 2nd ed Relationship-based Social Work: Getting to the Heart of Practice London: Jessica Kingsley

SCIE (2018) Gaining access to an adult suspected to be at risk of neglect or abuse: a guide for social workers and their managers in England. London: SCIE (Accessed 21/7/2019)