When the children cry: Social workers experiences when exposed to traumatic narratives shared by unaccompanied refugee children

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FACULTY OF HEALTH AND OCCUPATIONAL STUDIES

Department of Social Work and Criminology

When the children cry

Social workers experiences when exposed to traumatic narratives shared by unaccompanied refugee children

Annie Flodström

2020

Student thesis, Bachelor degree, 15 HE Social Work

Bachelor of Science in Social Work - Specialization International Social Work Supervisor: Sanaya Singh

Examiner: Tomas Boman

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Abstract

My aim was to explore the experiences of social workers working with unaccompanied refugee children when hearing traumatic narratives shared by the children. This is a qualitative research based on semi-structured interviews with three social workers with experience of working with these children in the social services in Sweden. The transcribed interviews have been interpreted with themes and the theoretical framework used is countertransference and vicarious trauma theory. The result shows that all the informants have been influenced by the traumatic narratives they have heard and their interaction with the client was affected by their personal experiences. The result also shows that a trustful relationship between the client and the social worker is fundamental for good communication, but also that more education and knowledge combined with support from the workplace and opportunities to exchange knowledge contribute to developing good and respectful interactions with clients.

Keywords: Social services, social workers, unaccompanied refugee children, interactions, countertransference, vicarious trauma, trauma, Sweden

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Acknowledgement

This journey has felt like it would never end.

Sometimes life just happens, and things get set on hold.

But finally, this will come to an end and I will be a graduated social worker.

I would not have been able to finish this without my incredible family and friends, who actually believed in me and told me this time I would make it.

A special thanks to:

Mom and dad My sister and brother

My best short friend

My furry companion who warmed my feet

And of course, a huge thanks to the ones who participated in the study with their stories and their experiences. Your wisdom made me wiser.

And at last, a thank you to my supervisor who guided me through this process of writing my thesis.

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1. Introduction

“Little child, dry your crying eyes. How can I explain the fear you feel inside. Cause you were born into this evil world, where man is killing man, and no one knows just why.”

– White Lion

Unaccompanied refugee children arriving in Sweden is not a new phenomenon. In 2004 there were 388 children arriving in Sweden and since then the numbers have increased constantly, 10 years later there were 7 049 who applied for asylum (SCB statistikdatabasen, n.d.), and at its peak in 2015, Sweden received 35 369 unaccompanied refugee children due to critical situations in Syria and Afghanistan (Swedish migration agency, 2016). These were children generally fleeing war from their home countries, arriving in a completely new country without a parent or a guardian to take care of them (Prop. 2005/06:46, 2005).

Upon their arrival in Sweden, unaccompanied refugee children got distributed all over the country, and the respective municipalities were put in charge of them. The overarching law for the wellbeing of these children is the Social Services Act of Sweden, leading to that social workers were the professions working closely with the children. The social worker's task was to assess the needs and provide support to the children (SFS 2001:453).

In 2015 when the number of unaccompanied refugee children arriving in Sweden rose sharply, the social services faced a situation they had never experienced before. Based on the new situation, social workers needed to find new ways to address the new arising issues that accompanied the traumatized children coming from such tough backgrounds.

Many unaccompanied refugee children have experienced some kind of trauma before arriving in Sweden (Gustafsson & Ödqvist Drackner, 2016) and they often have a minimal network surrounding them which make the relationships with their existing network utterly important. Social workers role was of significance in relation to the child’s wellbeing as legally, the social worker was a part of the child’s professional network, and a part of the social worker's role was to build a trustful relationship to be able to see to the child’s needs and best interests. “Research has shown that the support that unaccompanied refugee children receive during the first years after resettlement is vital to their adjustment and long-term outcomes” (Eide & Hjern, 2013, p. 668). In doing so, the social worker's role was to take part in counselling and interviewing the children,

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2 which more often than not meant listening to traumatic stories from different contexts form the children’s past. This was a new challenge for social workers, as is discussed by Cajvert (Cajvert, 2018, p. 103). It is believed that exposure to clients’ traumatic narratives makes social workers more susceptible to experiencing posttraumatic stress disorder symptoms. These may include feelings of terror, grief and anger. The term vicarious trauma is most frequently used to define this experience in social work practitioners (Newell & MacNeil, 2010). Exposure to such trauma can have damaging effects on the social workers therapeutic relationship, their personal life, and their profession (Michalopoulos & Aparicio, 2012). Vicarious trauma “relates to the natural and consequential behaviours and emotions resulting from knowing about a traumatizing event experienced by a significant other [or client] and the stress resulting from helping or wanting to help a traumatized or suffering person [or client]” (Newell & MacNeil, 2010). The term is often used in discussions about the impact of trauma on the experience of the social worker.

Save the children in Sweden is an organisation who encounter many stories from unaccompanied refugee children who call their support line for help and guidance. In the report “LISTEN TO ME!!” (Save the Children Sweden, 2017, p. 8) they present some topics that are brought up often in conversations with the children. They describe that when their support line first opened in 2015 the calls were about topics like “When can I start school” and as the years went by more and more calls were about mental health problems and not getting their rights fulfilled by different authorities. The conversations about mental health included suicidal thoughts, physical problems due to stress and anxiety, loneliness, trauma related to physical or sexual abuse. Some children told stories about seeing family members dying or getting murdered. The fear of being sent back to what they once fled from affects many parts of their lives. This is some examples of stories that professionals can hear when they meet refugee children. In the report, an 18- year-old boy is quoted:

‘Swedes are so happy and celebrate when they turn 18. We Afghans here in Sweden are afraid to turn 18 and never want the day to come’

(Save the Children Sweden, 2017, p. 7)

The topic of refugee children's experiences and stories of fleeing their home is an area that is researched by many. One example is Eide and Hjelm (2013, p. 667) who presents

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3 results from three different studies done in Belgium, Netherlands and Norway where all of the studies showed higher levels of depressive symptoms among unaccompanied refugee children compared to children who come accompanied. Eide and Hjelm describe that these depressive symptoms often originated in traumatic stress because of what they experienced. Jahanmahan and Bunar (2018, pp. 53-54) found in their interviews with unaccompanied refugee children stories about abuse and imprisonment while fleeing through Europe. When they arrived in Sweden the wait for permanent residence caused mental instability, loneliness and uncertainty which is caused by a fear of being deported.

In this research, I have focused on social workers who work with unaccompanied refugee children and are exposed to vicarious trauma as they need to hear traumatic narratives from the unaccompanied refugee children’s past, with whom they have a close relationship. I have chosen to refer to the theory of countertransference and vicarious trauma, which describe the interaction between client and social worker and how it can affect the work performance (Isdal, 2017, p. 112).

My experience, as a social worker for unaccompanied refugee children, is that the cultural differences and meeting children who often have experiences of trauma have created challenges for social workers. Which mean that the social workers must figure out solutions to new and difficult situations. The National Board of Health and Welfare is responsible for providing guidelines and handbooks to the social services so that the social workers are able to perform a legally secure work on equal terms. In addition to their handbooks for the management of the social services children’s cases, there are guidelines for social services regarding unaccompanied refugee children, a complement to the other handbooks. The social services on occasion also provide further education. For example, in conversation methodology with courses in Motivational Interviewing (MI) or different methods such as Signs of Safety. Most social services are working through the method of BBIC, a method which helps the social worker to put the child’s best interest first. Despite these available methods and guidelines, I experienced a lack of knowledge in the subject due to a majority of the education lacking a view towards unaccompanied refugee children cases. When I faced these difficult situations and heard traumatic stories it left traces but also inspired me to find out more about how social workers interact with these children and how it has influenced them in their work. Knowing more about the social worker's interactions towards their clients will lead to them being able to meet the child more respectfully, assist in build trustful relations and in that way be able to help, this

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4 correlates with what both Isdal (2017, p. 94) and Gušić, Gunge, and Andersson (2019, p.

28) expresses.

Based on my experiences, the question about social workers interactions towards unaccompanied refugee children arose. Earlier research shows that social workers are influenced by the children they meet in their work (Cajvert, 2018, p. 109) and that the relationship they build is very important for being able to guide and assist in their needs (Jahanmahan & Bunar, 2018, p. 51). When working in this field I have discovered a gap in the existing knowledge; what are the experiences of the social worker, what challenges and difficulties does the social worker face when hearing the traumatic stories of unaccompanied refugee children? Hence this research.

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1.1 Aim and research question

The aim of this study is to explore the experiences of social workers who listen to narratives of trauma experienced by unaccompanied refugee children, in the context of Sweden.

1.1.1 Research questions

- What do the social workers experience when they are exposed to difficult stories of unaccompanied refugee children while interviewing them?

- What kind of support and tools do social workers recognize are needed to reduce the impact of vicarious trauma they experience when working with unaccompanied refugee children?

1.2 Essay disposition

This essay is divided into six chapters. The first chapter contains an introduction to the thesis; it shows the aim of the research and gives an explanation of concepts connected to it. In the second chapter, I present previous research I have found that is connected to my aim and were used to give a foundation to my research. The third chapter contains an explanation of the theoretical framework that was used to analyse my result. In the following chapter, I describe the mode of procedure, which include sampling, data collection, tools of analysis, credibility, and ethical standpoints. In the fifth chapter I presents and analyses the result of the research and in the last chapter, I discuss my findings and give suggestions to further research.

1.3 Explanation of concepts

Following concepts will be mentioned in the thesis and are explained here for a better understanding:

Unaccompanied refugee children – Refugee children who arrive in a country without a parent or a guardian (Swedish migration agency, n.d.).

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6 Social workers – a social worker employed by the social services who work with managing client cases, in this case, unaccompanied refugee children who are under the care of social services.

The social services act – The law that is connected to the social services and state their responsibilities and their mission.

National Board of Health and Welfare – The National Board of Health and Welfare is responsible for providing guidelines and handbooks to the social services so that the social workers are able to perform a legally secure work on equal terms (National Board of Health and Welfare, 2019).

Guideline for social services regarding unaccompanied refugee children - A handbook published by The National Board of Health and Welfare to give guidance to social workers working with unaccompanied refugee children (National Board of Health and Welfare, 2020).

Municipalities – An area connected to a city in which for instance the social services are responsible for the inhabitants living in that area.

MI – Motivational Interviewing – An evidence-based communication style focusing on the client's motivation for change and the social worker's interaction with the client (Schumacher & Madson, 2015).

Signs of safety – The definition according to the official website is “A relationship- grounded, safety-organised approach to child protection practice” (Elia International Ltd.Signs of Safety, 2020). This approach is used by some social services to build better cooperation with the child’s network and to enhance the positive and protective parts in the child’s life.

BBIC – A method for the social services child- and youth care that is used by municipalities in Sweden, with a few exceptions. The definition of BBIC is a structure for handling, implementing and follow-up of the exercise of authority, and it is adapted to the social services' regulations (National Board of Health and Welfare, 2019).

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2. Previous research

In the upcoming section, earlier research is presented. I have studied four themes connected to my research question; these themes were chosen to give a foundation to my research. They give a picture of unaccompanied refugee children’s background stories, what social workers may face in meetings, how their personal experiences influence their work, what research there is in the field of professionalism in difficult meetings and if building relationships with clients affect conversations.

2.1 Personal experience and its impact on conversations

Every person has their own story, the things we experience have an impact on the rest of our life in one way or another. Cajvert (2018, p. 103) explains that we are influenced by our experiences and difficult conversations can reveal these and make us question ourselves and our professional position. Isdal (2017, pp. 64-65) describes that everyone has weak spots due to our own experiences. These weak spots may affect the professional even though the conversation might speak of other experiences that are not connected to one’s own. Isdal also states that professionals who have experiences that are similar to their client's experiences are more vulnerable to secondary traumatisation. He describes that research shows both positive and negative influences when the client and the professional have similar experiences, it can strengthen the relationship between the client and the professional but there is also a high risk of re-traumatisation when facing these experiences (Isdal, 2017, pp. 64-65).

2.2 Professionals reactions to traumatic stories

A stressful and serious incident of some kind will most of the time leave traces of stress in the person who experiences it. In the National Board of Health and Welfares (2018, p.

15) report “Krisstöd vid allvarlig händelse” (Crisis support during a serious incident) it is described that it depends on a combination of factors if the person will develop long term symptoms of stress after experiencing a traumatic event. These factors can, for example, be the reaction from the external stresses and the person’s ability to understand and interpret the situation. It is also mentioned in the report that children often have a harder

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8 time to relate to traumatic events and are dependent on guidance in these kinds of situations. The social services responsibility to give guidance and support to children who have experienced trauma or violence are stated in The social services act (Socialtjänstlagen) 5 Ch. 1 § and 11 § (SFS 2001:453).

Isdal (2017, p. 91) states that we get emotionally influenced by hearing about the suffering of others and we get physically put in a fight- or flight mode. This means, according to Isdal (2017, p. 94), that professionals often develop strategies to cope with these reactions and proceed with the conversation with the client respectfully regardless of their own feelings. This is also mentioned by Gušić, Gunge, & Andersson (2019, p. 28) who talks about the importance of getting to know the feelings you might experience in meetings.

Cajvert (2018, p. 103) describes that difficult conversations can touch subjects like anger, fear and disappointment which can affect the participants in a lot of ways. The choice to hide the reaction and feelings will probably impact the conversation anyway due to subconscious expressions. Cajvert emphasises that these feelings could make us question ourselves as both professionals and on a personal level, and that staff counselling meetings could be a forum where these feelings could be explored and given an explanation. Those who work with unaccompanied refugee children will be influenced by their life stories in one way or another (Cajvert, 2018, p. 109). The impact of life stories is also mentioned by Gustafsson and Ödqvist Drackner (2016, p. 28) in their handbook published through UNICEF to advise people who meet refugee children. It is described that it can either give a stronger determination to help the children in need or give a feeling of hopelessness when hearing stories of injustice and trauma.

2.3 A professional approach when facing difficult stories

I have explored how different authors discuss professionality when meeting clients. Holm (2009, p. 75) writes in her book “Det räcker inte att vara snäll” (It’s not enough to be nice) that in the study she has done among doctors and treatment assistants she found that communication and treatment of clients could be compromised when experiencing difficult and emotionally charged conversations. Holm tells a story about a treatment assistant who reacted reflexively with a habitual response to a story from a client, the reason to the reaction was that the treatment assistant was startled by the statement (Holm, 2009, p. 75). Holm finds in her study of treatment assistants and doctors that the ones

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9 with higher education had a more professional way of treating clients and had more tools to be able to cope with difficult conversations (Holm, 2009, p. 70).

Isdal (2017, p. 93) is of the opinion that professionals hearing traumatic stories need to express a calm presence in meeting to be able to support the client respectfully, even if their feelings impinge. How professionals react in these situations depends according to Isdal (2017, p. 94) on factors like competence, experience and also habituation.

Competence and experience can give calm and stability to the conversation, while habituation can have both positive and negative impact in terms of prior knowledge of what is to come but can also with time give numbness to suffering. Hedlund (2018, p. 20) brings up that research among e.g. social workers have found it to be challenging to work with children seeking asylum because of the trauma that many of them have experienced along their way. Hedlund describes that professionals working with asylum-seeking children can experience emotional labour when facing emotionally heavy stories and it can be a struggle to stay professional when hearing stories that affect you deeply. De Graeve, et al, (2017, in Hedlund, 2018, p. 20) states that involving yourself emotionally does not mean you are not professional. It can be a balance to not become privately involved but building a relationship to the client can strengthen and give positive energy to the case.

2.4 Building trust through client relationships

The importance of building a relationship to the unaccompanied refugee child is a recurrent theme that many researchers emphasise. The relationship between the social worker and the client is a relationship that is influenced by power dynamics. The client expects that the social worker will use their knowledge and their resources in a way that will help them (Cajvert, 2018, p. 84). Eide and Hjern (2013, pp. 667-668) state that when working with unaccompanied refugee children one must build relationships that are trustful and caring. This creates a greater understanding of what they go through and the victimisation they may face. Eide and Hjern also describe that since unaccompanied refugee children lack the close relationships that they had, the relationships to caregivers are essential for them to be able to build a stable future (Eide & Hjern, 2013, pp. 667- 668). Jahanmahan and Bunar (2018, p. 51) emphasise the importance of positive relationships between e.g. the social services and the children for them to be able to build a safe context and the possibility to build a trustful and stable relationship to its network,

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10 this is brought up by Kholi (2007, in Hedlund, 2018, p. 90) as well. All the sources above states that stability and trust are important in the relationship with the child. The importance of this is that when caregivers in the child's professional network are replaced and new relationships have to be built from scratch it can be a setback in the child's development and mental health (Eide & Hjern, 2013, p. 668).

3. Theoretical framework

I have chosen to use countertransference and vicarious trauma as my theoretical framework. Countertransference and vicarious trauma were chosen because they describe what can happen in the interactions between the social worker and the client and it also gives an explanation to the social worker's reactions in meetings (Pearlman and Saakvitne 1995, p.23, in Isdal 2017, p. 113).

3.1 Countertransference and vicarious trauma

Countertransference is a theory that has been questioned and redefined throughout the years. It originates from Freud's psychoanalytic theory as a way of explaining the therapist reactions in client meetings. Countertransference is about the effect a conversation with a client have on the therapist and the possible connection to the therapist’s own experiences. Freud believed that countertransference is something standing in the way of professionalism and that the therapist must overcome his or her reactions (Isdal, 2017, pp. 112-113). This way of seeing countertransference has later been questioned. Stolorow and Atwood (1992, in Isdal, 2017, p. 113) present countertransference as a tool for understanding the client and something worth noticing in therapeutic conversations.

Pearlman and Saakvitne (1995, in Isdal, 2017, p. 113) develop the theory of countertransference even further by combining a modern psychodynamic view with trauma understanding. They named their branch of the theory vicarious trauma. Pearlman and Saakvitne describe countertransference as the therapists natural and human reactions when facing pain and suffering.

”Countertransference comprises two components: 1) the therapists emotional, intellectual and physical reactions towards their client, the clients

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11 clinical material, transference and recreations, 2) the therapists conscious and unconscious defence towards the feelings, intrapsychic conflicts and associations awoken by the client.”

(Pearlman and Saakvitne 1995, p.23, in Isdal 2017, p. 113)

What Pearlman and Saakvitne conclude is that in every client meeting there are two people with sometimes similar life experiences reliving parts of it that might have caused one or both pain in some way (Isdal, 2017, p. 113). Therefor therapists have to be conscious of their countertransference reactions and how it reflects on their work with the client to be able to give professional guidance and therapy (Isdal, 2017, p. 114). The British Medical Association (2020) define that someone who works with survivors of traumatic incidents should be aware of signs of vicarious trauma. These signs are characterised by being overly involved emotionally with the patient, feeling a loss of hope and pessimism. The professional could experience a feeling of numbness when meeting clients, as well as feelings of self-doubt which also is one of the characteristics for vicarious trauma, this is also mentioned by Michalopoulos and Aparicio (2012, p. 646).

Newell and MacNeil (2010, p. 60) describe these reactions as natural behaviours and emotions when listening to a traumatic narrative. The British Medical Association (2020) states that there are strategies for reducing the risk of vicarious trauma. The professional must be observant of their experiences both when meeting the client and afterwards.

Another important strategy is for the professional to practice self-care emotionally, to be realistic about what you can accomplish and to avoid wishful thinking. Mentioned as well are to seek social support from colleagues and through staff counselling meetings, which create opportunities to debrief. Finally, the professional needs to be able to supply the clients with tools for them to look after themselves, help to self-help.

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4. Methodology

In this chapter, I will present the methods I have used to accomplish this research. The sections consist of methodological consideration, preliminary understanding, sampling, data collection, transcribing, tools of analysis, essay credibility and ethical considerations.

4.1 Methodological consideration

The research has a qualitative approach, this was done to create further discussion regarding questions about my informant’s experiences when meeting clients (Bryman, 2011, pp. 40-41). Choosing to do qualitative interviews instead of quantitative questionnaires allowed me to construct follow-up questions to explore the answers further (Patton, 2002, p. 14). In my research, I mainly used an inductive approach (Patton, 2002, pp. 55-56). The research question is based on my knowledge of the subject. Data was collected using open-ended interviews and the patterns found through those gave an answer to my question. The answers formed a theory that was compared to the theory of countertransference and vicarious trauma. A deductive element to my research was to try existing theory to the one developed from the answers to find if they were corresponding (Patton, 2002, pp. 56-57). My interpretation is that the research correlates with the theory of countertransference and vicarious trauma.

4.2 Preliminary understanding

My preliminary understanding is that I have similar work experience as my informants, a social worker for unaccompanied refugee children. My work experience can have both positive and negative impact on my research, especially when conducting the interviews.

It can be helpful because it can create more relevant and understandable questions and follow-up questions. There is a risk of me interpreting the information based on my professional role instead of the role as a researcher.

4.3 Sampling

The literature chosen were found through searching in databases with keywords connected to the subject, these were: unaccompanied refugee children, countertransference, vicarious trauma, social services, trauma. I used databases such as Google scholar and Wiley online library to search for relevant books and articles. The

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13 search for articles was narrowed down to the year 2015 until 2020. This sampling was done because of the change in the number of unaccompanied refugee children arriving in Sweden during those years compared to earlier years, which lead to new circumstances for social workers (Swedish migration agency, 2016). The articles and books chosen were those who gave their view of the subject or were discussing subjects related to it. I have chosen literature with a connection to Sweden because the research is done in the context of Sweden and the informants are Swedish social workers. Literature comparing studies done within a similar field but in other countries would have contributed to an even deeper understanding. For example, Eide and Hjern (2013, p. 667) do compare research about the mental health of unaccompanied refugee children done in different European countries.

The study is limited to three interviews with social workers who have worked in social services with unaccompanied refugee children within the last 3 years. The three informants were chosen through personal connections and previous network meetings among social workers working with unaccompanied refugee children in the social services in the county of Dalarna. The choice was made to extend the time span and interviews were only made with social workers who worked in this area within the last three years. This limitation was necessary because of the declining number of active clients and therefore likewise social workers specialised in working with unaccompanied refugee children. Further narrowing down the sampling, the informants were situated in the county of Dalarna. This also allowed me to conduct face to face interviews. This benefits the research because face to face interviews allow me as a researcher to receive a greater understanding of the informants whole appearance, all the spectrum of emotions and the tone of the conversation, not just the facts of the answer (Kvale & Brinkmann, 2009, p. 129). One of the interviews had to be made through video-link due to restrictions linked to Covid-19, in comparison with a face to face interview this was a disadvantage due to technical issues such as sound recording. Another disadvantage was the difficulty to read body language when not meeting each other in person.

My aim was to find informants who had experience in the research field and were interested in discussing their experiences in an interview. The informants were chosen through snowball sampling, which is a process where one informant is asked to give suggestions of other suitable candidates that they have in their network and in that way the study grows organically (Patton, 2002, p. 237). The positive aspects of this outcome

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14 were that the informants recommended to me other possible informants with the right criteria that I was searching for. A downside to this is that the informants often knew each other or had been employed at the same workplace at some time which could give similar answers and a lack of diversity. As a counterweight to that, the three participants were of different ages, genders and have worked with unaccompanied refugee children between 1,5 and 8 years in different municipalities in the county of Dalarna, which grant the study somewhat of a broader perspective. The participants were chosen not through their current employment but because of their lived and professional experience in the field of social services.

4.4 Data collection

I chose to conduct my data collection based on interviews with social workers about their lived experiences and opinions on their interactions with unaccompanied refugee children. The interviews were semi-structured with a majority of open-ended questions, the interview guide (see appendix 1) was designed this way to create space for reflection and storytelling (Patton, 2002, p. 21). The interview guide consists of four of the main questions and to each question, there are several sub-questions. My main questions were constructed based on the themes, which were: Experience of getting influenced, impact on work, support at work and further education. The themes I explored the most were their experiences of being influenced and its impact on their work, these questions were the ones that were close to my research question and in that way could be an important part in conducting my research. I choose to construct the interview guide in this way to have distinct themes of what I wanted to know and still be able to let the informants tell their own story in relation to the questions. Open-ended questions give the informant the possibility to interpret the question in a way that depicts what they find is the importance of the subject. Therefore, using this interview design it can reduce the risk of asking irrelevant follow-up questions. A disadvantage in using open-ended questions is that the interviews can spiral in different directions depending on the informant. In my interviews, I choose to create space for follow-up questions, both planned and spontaneous. I also choose to let the interview go in line with the answers I got and not to steer the interview too much but still returning to my main questions to keep a structure to the interview (Kvale & Brinkmann, 2009, p. 167). Due to the informants being social workers I am acquainted with while conducting the interviews I were regarded both a researcher and a

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15 social worker. This can be a disadvantage when distinguishing my role as a researcher, but also an advantage for creating a flow in the conversation.

4.5 Transcribing

I choose to record my interviews to be able to give a more precise transcription of the collected data. The recordings were listened to several times and transcribed into text.

The interviews were done in Swedish and transcribes in the same language. Due to the interviews being done conversationally in Swedish there was a difficulty in translating them and still preserve the correct meaning of the quote. The translation was done by me with guidance from a person more knowledgeable in the English spoken language. In my transcription, I have chosen to only use the informant's spoken word. Because two of the interviews were done face to face, my experience of what happened in the conversation, both consciously and unconsciously, have possibly influenced my way of transcribing and later interpreting the interviews.

4.6 Tools of analysis

I choose to do a thematic analysis to interpret my data by searching for patterns in my findings and analysing those thematically (Patton, 2002, p. 453). This was done to find recurring patterns throughout my interviews that I found important to highlight in my result. When the transcription was completed and read thoroughly, the answers from each informant were compared to the others to be able to find similarities but also differences between the three of them. I found that there were recurring patterns throughout the interviews and the topics that were the most relevant to my research question were selected. Choosing which ones that were of importance were done by comparing my preliminary understanding, earlier research and theoretical framework. Then, quotes from my interviews were chosen since they highlighted the informant’s experiences, these quotes are what my result consists of. One of the themes that occurred was that the informants experienced importance in the social workers building a relationship to the client. This pattern was something that was not explored in earlier research before conducting the interviews and it was added when the pattern occurred. Finally, the result was compared to earlier research and interpreted through the theory of countertransference and vicarious trauma.

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4.7 Essay credibility

In this chapter, I will describe and discuss the reliability, validity and generalisation connected to my research.

4.7.1 Reliability

Reliability is described by (Kvale & Brinkmann, 2009, p. 327) as to whether the research could be replicated at another time and by another researcher with the same measurements and be able to receive the same result.

Regarding my interviews, some things could have been done to heighten the reliability of the research. I managed to find four social workers who said yes to participate in the research, before the interviews were carried through one of the social workers informed me that she could not participate, so in the end, there were three informants. In contrast with the number of informants, the interviews were in-depth which gave an opportunity to collect a lot of data from each interview. Despite the small number of informants, their answers compared to each other were consistent which show a tendency to this being applicable to similar situations. Having a larger number of informants would have contributed to the reliability, and the credibility of the result had increased. The interviews were between 30 to 40 minutes long and the length of the interviews was due to scarcity of time and the informant’s work situation. The interviews kept a high pace in the conversation which also contributed to their length. It is possible that longer interviews would have given more data. The interview guide was the basis for the research questions and the tool which were used to shed light on the questions posed in my aim.

The questions were made part of the conversation and sometimes presented in a different way to the informant, adapted to person and context but not in the exact words written in the interview guide. This adaptive style of interviewing makes the research more difficult to replicate with the same outcome, but similar results may be possible by using the same measurements. Using open-ended questions contributed to the informant’s interpretation of the questions which caused a variation to some of them. This could have been prevented by having clearer questions, and this would also lead to the research being easier to replicate by another researcher. The transcription of the interviews was carried through by focusing on their spoken word. It could have been done differently to find

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17 other aspects of information, by for example collecting information about non-verbal expressions. I choose to interpret my result by finding themes in relation to my research question. The selection was made due to the recurring topics that were identified in the interviews. By using other methods to analyse the material, for example, summarise the interviews one by one and then comparing them to each other, could have given different results.

4.7.2 Validity

To question a research’s validity is to evaluate if what is measured is what was supposed to be measured (Grinnell, 2001, p. 134). The main question I have asked myself in this chapter is if my questions brought me closer to an answer to my research aim? I found that the main questions in my interview guide gave me an answer, but the follow-up questions gave me more precise answers connected to my aim. Therefore, my main questions could have been better constructed to be easier to understand for the informants.

Because I am acquaintance to the informants there was an exchange of experiences in the conversation that may have contributed to their answers, on the other hand, those experience exchanges created a flow in the conversation and lead up to interesting answers connected to my aim. Likewise, to have open-ended questions were an advantage in the way of the informants being able to freely give their interpretation of the question and express their experiences. The disadvantage was that because the informants all have different experiences their interpretations of the answers vary a bit. As a researcher, I do not want to correct their way of interpreting the questions but still guide them in the direction of my aim, which is a challenge that could compromise the validity of this research. My interpretation of the answers given by the informants is that they are truthful and trustworthy.

The interviews were done in Swedish and later translated which can compromise their validity because of the translation and therefore the researcher’s interpretations of their answers.

The majority of the literature that was reviewed, were books and articled found by searching the university library and databases. The remaining literature was strongly connected to the subject and from reliable sources, for example, Save the Children Sweden and The Swedish migration agency. This contributes to its validity as well as the

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18 fact that the literature search was done with keywords connected to my aim and the literature chosen were read thoroughly to make sure it would contribute to the research.

Having more informants, longer interviews and clearer questions could have improved the validity of my research.

4.7.3 Generalisation

Every researcher must ask themselves if the result of their study can be generalized and applied to other fields of study. This is a rather small study with few informants, this means that I have not collected data in such a way that the sheer volume of the material can argue for the possibility of generalization. It is my conclusion that aspects of my study can be generalized and be applied to somewhat understand and give indications about other structurally similar situations. This is a study made on a specific occupational group, social workers employed in municipalities in the county of Dalarna, and I argue that the result of my study can be generalized and relevant to understand the experiences of social workers working with unaccompanied refugee children. Furthermore, this study explores a certain aspect of the social worker's tasks: to have difficult conversations. The framework in which these difficult conversations about traumatic narratives happens, where the social worker sits in a room with the client and needs to retain their professionalism while experiencing countertransference, is a work task that is shared by many social workers. Conversations about traumatic narratives are a part of the work for many social workers, not only those working with unaccompanied refugee children.

Therefore, this study might be applicable to situations where conversations about traumatic narratives take place - but further studies are needed to confirm this. Such situations might be vulnerable children or people who suffered from domestic abuse.

4.8 Ethical standpoints

Ethical considerations have been used in this thesis from the beginning. When preparing and conducting the interviews a couple of ethical principles has been considered to protect the informants' privacy and rights. These principles are as follows: informed consent, confidentiality, consequences and the role of the researcher (Kvale & Brinkmann, 2009, p. 68). Bryman (2011, p. 132) point out the importance of how the material is handled, who has access to it and that it will only be used for the study.

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19 The focus of the study lies in the social workers own experiences of meeting clients who are unaccompanied refugee children. The informants were asked in person and orally gave their consent to their participation in the study. They were at the same time given a summary of the subject and questions. In two cases the informants asked to be given the questions before the interview to be able to prepare themselves. At the time for the interview, the informant was informed that participation is voluntary and can be cancelled at any time. They were are also informed about the research confidentiality and how the material is to be handled, including that the material from the interview will be deleted when the study is finished. During the interview, summaries were used to avoid any misunderstandings and to clarify the answers.

Because of the researchers' own experience of the subject, it is important to stay objective and not to influence the answers with their own experiences.

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5. Results and analysis

Under this heading, I will present and analyse the result. I have compared my result with relevant research and analysed it through the countertransference theory. The interviews have been done in Swedish and are translated into English by the researcher. The informants have been working as social workers for unaccompanied refugee children within social services. None of the informants is currently working within that context but they have been within the last three years.

The main question for the interviews was “What are the experiences of social workers who listen to narratives of trauma by unaccompanied refugee children” The questions discussed in the interviews were about their experiences and reactions in meetings with unaccompanied refugee children. There were also questions about their experience of support at their workplace and if further knowledge would have made any difference in their interactions with the clients. The complete interview guide is found in appendix 1.

The research question is if the informants were influenced in their interactions towards the client and all informants feel that they have been influenced. All the informants have a couple of years of work experience in the social services and they meet clients with different struggles every day. The informants answered a distinct yes to the question if they have been influenced by difficult narratives. Robin said: ” Yes I have. Absolutely.”

and Riley agreed: ”Yes, I feel I did”. The informants experienced it being hard to meet difficult stories, Kim portray it like this: ” …it was not so easy to listen, it was quite stressful.”. To sum up, the interviews show that the informants have been influenced to a high degree. This result corresponds with earlier research where it is described that Save the Children Sweden’s support line experienced a lot of difficult conversations with unaccompanied refugee children (Save the Children Sweden, 2017, p. 8).

5.1 Connection to personal experience

This theme describes how the informant’s experiences have influenced themself and their clients in meetings. One's experiences and life situation are something that influences everything we do, as well as in meetings with clients.

One of the things brought up by the informants was that personal circumstances can affect your reactions in conversation with a client. Robin gives an example:

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21

“…some things have affected me more because I might have had kids of the same age, and then you think, how would it have been for me if my child went through this.”

Riley states the personal circumstance of being a woman and meeting other women:

“And then I felt like, the majority were guys, but it was ... I think I had the hardest time with the girls I met, or the hardest ... yes ... that they had ... I do not know ... maybe it is because I am a woman myself and you can imagine what they have been exposed to because you can understand them in a different way (…)While, with the boys, it becomes more difficult to identify with them. Even if they have also been exposed to very horrible things, it was probably a little harder to feel with them… you feel for them but not with them.”

Kim finds that conversations with the clients where the stories are about their past experiences are easier to meet constructively:

” Then there can be other conversations that become difficult for me, it is information that comes from the children about something that may have happened earlier, if they speak about fleeing for example. But in some way, it has been much easier for me to handle those because I am not part of the story in the same way, I enter it where they start telling it to me and then it feels so much more that you can use your interaction with them in a much more constructive way.”

Kim continues to describe that clients present experiences have caused much more frustration in the interactions:

” However, when you yourself become part of the story in that way it becomes incredibly frustrating.”

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22 In summary, the informant’s own experiences and circumstances affect their relation to the client and therefore also their interactions towards them. Kim clearly defines that it is easier to cope with stories that you have no experience in, but that it still can influence you and engage you in the conversation.

5.1.1 Analysis

Cajvert (2018, p. 103) emphasises that every person has their story and your experiences affect the work you do, and difficult conversations can bring that to the surface. Isdal (2017, p. 65) discusses weak spots which that can be related to social workers having children in the same age or being of the same gender as the client, it creates a vulnerability in the conversation. The experiences of unaccompanied refugee children are so specific that none of the informants has experienced anything like it and cannot relate to the experiences on a personal level. Isdal describes that if they would have had experienced similar things it would have influenced the meeting (Isdal, 2017, p. 64). Arriving in a country as an unaccompanied refugee child is an exceptional situation that is hard to relate to based on own experiences, one is fortunate to not have those experiences but because of that, it is harder to understand what they been through. Even if the theory not specifically talks about unaccompanied refugee children’s situation it is possible to apply it to my research. The theory gives an explanation of the interactions that occur between the social worker and the client. According to the countertransference and vicarious trauma theory, the social worker can be both aware and unaware of how their interactions are influenced (Pearlman & Saakvitne 1995, p.23, in Isdal 2017, p. 113). In this case, the informant who has children of the same age are probably aware that this factor has an impact, but it might not be as clear in the case of being the same gender as the client and how it impacts the conversation.

5.2 Difficult topics

Another theme is about meeting difficult narratives and if some topics are harder to face than others. Unaccompanied refugee children often have experiences that social services are not so particularly familiar with.

It varies immensely how different people react to different challenging situations. One person could find a situation highly stressful while another finds it difficult but still

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23 handling the situation with ease. Robin feels that cases, where a client has been a victim of sexual assault, are the hardest ones to encounter:

” It is difficult to understand, I think, what they have experienced. What I think has been the most difficult thing to talk about is sexual abuse, and how do you talk about it in a good way. How do you bring it up? I think that is very difficult.”

Likewise, Riley describes the difficulty of obtaining stories of sexual assault. Especially when the circumstances are new and there are no clear guidelines to work with:

” …we had a lecture with a policeman, Mustafa, he lectured about "dancing boys" and boys who have been sexually abused. I thought that was difficult to talk about. Because it was so new to me and I had no… how should I handle it if they tell me that they have experienced this? What should I do then? Do you bring it up? How should I handle it? You should also be able to take in what they say.”

In this quote, we see clearly how the client will get affected because the social worker lacks the knowledge and therefore are unable to give the right support.

Another type of difficult questions can be rejection notices from the Swedish migration agency. Kim experience that as one of the hardest subjects to talk about with clients:

” Rejection notices, for example, how they handle it. Yes, it is mostly that. Yes, I think that in almost every meeting there has always been something that has been challenging in that way, that you have been influenced by.”

A difficult conversation can be challenging by itself. Meeting clients who are unwilling to cooperate can strain the conversation even more. Riley describes situations where there has been a power struggle between the client, who is a minor, and the social worker:

“The most difficult of those kinds of meetings were probably when the adolescents got angry when they did not get what they wanted. (…) But it was kind of difficult to deal with because you are not really used to it. They

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24 were usually, many were much older in their behaviour, or how should I describe it, than what a 14-year-old usually is, that you have met. So, there is a lot of power struggle and things like that. That is my experience.”

Riley mention cultural differences as a complicating factor:

“Yes, I thought that the cultural topics, or like, when you lack knowledge of another culture or what can happen. I thought it was difficult to talk about things I didn’t know anything about. … And culture is one part of it…”

Furthermore, Riley finds that sometimes when hearing the same kind of stories repeatedly you became numb to them, which can affect the way the social worker responds and act towards the client:

“Yes, some stories affected me. Not that I became unprofessional or how should I say it, more that I was affected by their fates and stories. So, some of those were terrible stories. Then there were many young people who had the same kind of story, so of course, you got a bit used to hearing about them fleeing and that they had been exposed to things and such. So, some things became easier to hear but were still very emotional.”

The informants mention severe situations, like sexual abuse and rejection notices, where they have had a hard time knowing how to respond and interact with the client. Other difficult topics mentioned by the informants are clients who are unwilling to cooperate and cultural differences which makes it more difficult for the social worker to know how to interact with the client. It appears that there is a risk for the social worker to be numb to difficult subjects which affect the conversation and interaction towards the client.

5.2.1 Analysis

The social services act (SFS 2001:453) states that social services have an obligation to protect, guide and help children in need. This can be very demanding and that is what my research shows. This is also described by Cajvert (2018, pp. 103, 109), who describes that some subjects can bring up feeling which can affect the participants in a lot of ways, especially social workers meeting unaccompanied refugee children will experience this.

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25 This is something that is brought up by the informants and correlates with the earlier research. Isdal (2017, p. 94) emphasises that social workers might develop a numbness for difficult subjects when hearing similar stories over again. When correlating this with the informants reasoning about numbness, my interpretation is that it is an important factor to have in mind when working with clients telling traumatic stories to be able to interact with them respectfully. In my opinion, the result is in accordance with earlier research. When interpreting the result with the theory in mind, it is found that countertransference defines these reactions as a natural and human way to respond to traumatic experiences (Pearlman and Saakvitne 1995, p.23, in Isdal 2017, p. 113). These reactions are clearly visible in my informant’s answers. The social worker and the client is influenced by each other. Newell & MacNeal (2010, p. 60), as well, states that vicarious trauma can emerge when social workers meet clients who share traumatic narratives and The British Medical Association (2020) emphasises the importance of the social worker being observant of their experiences both in the meeting and afterwards, due to the risk of vicarious trauma.

5.3 Meeting clients who have experienced trauma

The third theme identified is about how social workers interact with clients who have experienced trauma. To a social worker, it is important to still be able to support the client despite being emotionally touched by their narratives.

All the informants have experienced meetings where the client’s story have emotionally influenced them in ways that which in turn affected their behaviour towards the client.

Robin discusses ways of reacting to traumatic stories and how a visible reaction can be a good thing if it is shown in the right way:

” I can get sad, I can get… well, affected in many ways of course. … I think that even if I get emotionally moved, if I get teary-eyed or whatever it is, I don’t cry directly in the meeting, not in that way. But it affects me, and I think it’s visible and I also think it’s good that it’s visible. It would be worse if I sat completely unaffected and received this.”

Riley also discusses different ways of reacting and how some stories never will be forgotten:

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26

“But she has had experiences that, I mean… not even an adult has those. And it was tough, in some conversations you felt that… well… that it was difficult to keep the feelings away… you cannot be completely stone-faced. And I can still think about it sometimes, how she feels and wonder how it is. So many young people have left traces, like left… they do… it is difficult to just forget.”

Kim describes occasions when a speechlessness occurred due to the client’s story and therefore difficulty to proceed with the meeting in a good way:

” Yes, I can remember a few times where it felt like you became kind of, paralyzed is a bit too strongly worded, but almost so that you don’t really know what to say. Speechless. You just feel that you understand exactly the hopelessness that they feel or that they have felt. And it has of course not made it any easier that you have been… so it becomes more of a confirmation of that feeling. It has usually not led to a good meeting, most of the times.”

Kim concludes that complicated client cases often make the interaction towards the client more difficult:

“Then we also had staff counselling meetings which were kind of… where we could bring up certain cases that we thought were difficult to handle. And because they were difficult to handle, of course, they were also difficult in the interaction.”

In situations where the social worker had more background knowledge about the client and felt more prepared for what was to come, they were able to meet the client in a better way despite difficult conversations. This is brought up by Kim:

” Then there are times when you have been prepared for it and you have known that this is how they feel and know the circumstances. Then I’ve been able to go in and not be speechless, but I’ve actually been able to say something that has changed or calmed a bit, at least that’s my view of it.”

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27 Riley also describes situations where the interaction with the client have been successful despite difficult conversations:

“I didn’t get sad when I heard things or sort of showed that I was affected but more that… more like acknowledged it: "what you have been through is terrible".”

The result shows that the informants were emotionally influenced in a way that is visible for the clients. The social worker experiences these situations difficult to handle and that is has influenced the quality of the meeting. To have support in managing client cases can make it easier and so can also prior knowledge of topics that may occur in the conversation, this makes the social worker more prepared and able to interact more constructively. The result also shows that social workers can develop coping mechanisms to be able to meet their clients in a good way.

5.3.1 Analysis

My result is consistent with what Holm (2009, p. 75) found in her research among doctors and treatment assistants, she found that communication and treatment of clients could be compromised when experiencing difficult and emotionally charged conversations.

Hedlund (2018, p. 20) explains that because of the trauma many unaccompanied refugee children have experienced it can be challenging for social workers meeting them and it can be hard to stay professional when the stories affect you deeply. This is something that is clearly visible through the result and the informants describe that they have explored what strategies that work best for them when interacting with clients, they are influenced by the stories but have found ways to show empathy despite that. The informant’s reactions in meeting clients who have been through traumatic experiences can be explained through the theory of countertransference and vicarious trauma, which state that the social worker and the client affect each other (Isdal, 2017, p. 112) and these reactions are a natural behaviour related to hearing traumatic narratives (Newell &

MacNeil, 2010). This is described by the informants as a common encounter. To find ways to show empathy to clients despite difficult conversations correspond well with what Isdal (2017, p. 114) says about being conscious of your countertransference reactions and how it can affect the meeting, this is also something that is mentioned by Gušić, Gunge, & Andersson (2019, p. 28). According to De Graeve, et al, (2017, in

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28 Hedlund, 2018, p. 20) there is a need for balance in how the social worker show this empathy and that involving yourself emotionally does not mean you are not professional.

5.4 The social worker's relationship with the client

This theme consists of how the relationship between the social worker and the client influence the conversation. Because unaccompanied refugee children often have a minimal network the relationship could be vital for a good collaboration between social worker and client. Another aspect worth mentioning is how the relationship could influence the social worker's experience of being able to carry out their work in a good way.

The social worker's relationship with their client can be of great importance in meeting the client in a good way. The informants describe that the relation to their client has influenced their interactions and the depth in the conversations. Robin describes:

” However, I have become close to many of my clients. Not everyone, because some have a very strong resistance and doesn’t want to, but most clients. And I think that it can be some proof that it has been a good conversation, I think.”

Kim describes that following a client from the beginning of the case and creating a relationship from the start makes it easier in the interactions, in comparison to when you step into an already ongoing case and need to build a new relationship:

” ... I think the overall most important thing, for me at least, was that it was dependent on what relationship you had from the beginning. And then it was mainly the adolescents that I had received and handled [their cases] from when they arrived in Sweden, it was most often them that I could talk to and felt that I dared talk to the most and ask the most questions to. Those who had been here and perhaps met other social workers before me were the ones I had the hardest time to determine… and daring to step in to.”

Informants were asked how they reacted to difficult conversations, and how it influenced their relationship to their client. Riley describes their reactions like this:

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“An acknowledgement of their feelings perhaps. Which meant that they… as I experienced it anyway, that I gained more confidence and they could open up more about things. There was a boy who talked about missing his mother a lot…of course you feel like…that this boy misses… he became sad and started crying and it became so emotional that… and maybe a fear of how I should react to it. But I can’t do anything except to affirm that I understand that you miss your mother. I think I still got positive reactions in my interactions with them.”

In conclusion, the informant’s answers show that a trustful relationship and being able to meet the client constructively are easier done if you are able to follow the client from the beginning of the case. On the contrary, it is more difficult to continue someone else’s work in an already ongoing case and building trust and relationships with a client who must open up to someone new. One way of building trust and relationship with the client can be through the social worker acknowledging the client’s feelings. The acknowledgement creates positive reactions, eases the conversation and creates opportunities for mutually good interactions.

5.4.1 Analysis

Earlier research shows that it is important to build trustful and positive relationships with an unaccompanied refugee child to be able to guide them in building a safe context and a stable future, this is something that is emphasised by Jahanmahan and Bunar (2018, p.

51). Kholi (2007, in Hedlund, 2018, p. 90) also talks about the importance in building relationships to the client and giving the child the possibility to have a trustful and stable relationship to its network. This is something that the informants saw in their work as well and my research shows their experiences of the importance in building relationships, therefore the research correlates with the earlier research. The theory of countertransference and vicarious trauma is a theoretical description of this phenomenon.

Pearlman and Saakvitne (Isdal, 2017, p. 113) conclude that in every client meeting there is an exchange of experiences and because every person is influenced by different things the relationship and trust between client and social worker can be a vital part in how successful the meeting is. This is also mentioned by (Michalopoulos & Aparicio, 2012).

De Graeve, et al, (2017, in Hedlund, 2018, p. 20) states that building a relationship to the

When the children cry: Social workers experiences when exposed to traumatic narratives shared by unaccompanied refugee children

FACULTY OF HEALTH AND OCCUPATIONAL STUDIES