I have an enormous dog. I didn’t see it coming – or maybe I chose not to. As soon as I locked eyes with him as a puppy he was coming home with us. Others in the know, or with a more objective perspective, knew exactly what lay ahead, of course. “Wow he’s got paws like saucers” they would say when I took him for a walk. “I know! So cute!” I would smile back, brightly. As he grew bigger and bigger we had no choice but to accommodate him. He outgrew his crate, his bed, the kids being able to take him for a walk……Indeed, there were some pretty major unintended consequences – like when he outgrew our car. (Ouch). But the hardest thing to get used to was his tail.
He is the softest, gentlest most loving dog you could ever care to meet – but his tail is a lethal weapon. The irony, of course, is that the happier and more pleased to see you he is, the more dangerous his tail becomes. Like the bough of a tree broken off in a hurricane it thrashes around doing untold damage. We have to move everything and everyone out of it’s way – especially small children who he is particularly pleased to welcome. The tail needs a whole management strategy to keep danger at bay. It is, quite literally, wagging the dog and everyone else too.
Working in the public sector the concept of the tail wagging the dog is one I am very familiar with. Just like my dog, the intentions are often positive – but the unintended consequences of blanket policies and procedures can be enormous. Day in day out there are many examples – particularly for psychologists and therapists working in health which is inevitably dominated by a more medicalised model. A typical example was the infection control directives about getting rid of soft toys – often the biggest source of comfort and familiarity for our most traumatised children. These children are not physically vulnerable when they come to see us, and so the risk of infection is low – but they are emotionally vulnerable and reconnecting with a favourite toy can be a vital aspect of the therapeutic work. Another example are the community based multi-purpose clinic spaces with examination beds and sometimes even stirrups. It might be the only space available close to a young person’s home where we can offer appointments for therapeutic work – but it is wholly inappropriate, particularly when the issues might be about sexual abuse.
Indeed, often these general policies make absolute sense for physical health settings. A room that a podiatrist, a gynecologist, an ophalmologist can all use is a great use of limited space – but it is useless for a psychologist. There are many many examples like this where we just don’t fit. From the way data is collected to the response to not attending appointments (engagement and building trust is often a major part of our work and can take a significant amount of time for our more vulnerable families). Often we can challenge the ‘standard practices’ when they really don’t work for us, and we are listened to. But it takes energy, an awful lot of it, when the work itself is already demanding enough and we have so little time. Often we have to let things go. Or we become so accommodated to our settings we may not even notice the subtleties of the messages they give out. For example having a ‘referred child’ named in correspondence. It is easier for filing, record keeping and governance purposes of course – but if ever there was a clear message that the problem is located within the child it is this. They might have experienced domestic violence at home, severe bullying at school or a whole host of other contributing factors in their context – but they are the one identified as having ‘the problem’ and all correspondence is organised around them, and filed into history and the narrative of their life. Tackling more subtle messages like this is overwhelming – and so we don’t.
Of course health is not the only setting where the tail wags the dog. Education is another classic. At a recent parents evening I was told by one of the teachers that my son ‘knows more than me about the topic and makes connections I had never even thought of’. He then added ‘but he needs to learn to narrow his answers down and stick to the mark scheme or he wont get the grade he deserves’. I could have cried. I do not blame the teacher – he is exceptional – and I do not blame the school – they are judged entirely by their grades, and parents are as guilty of this as anyone. But I do blame a system in which examination results trump all – even curiosity and connection making. My son is able to adapt and ‘play the game’ – and he very much sees it this way. However, for our more vulnerable children in society this endless focus on exam results is particularly damaging. It is a sure fire way of disenfranchising our most disenfranchised.
Indeed, the tail wagging the dog applies to so much of what happens to our children. A focus on exam results, pressure to conform, family discord, poverty, insecurity, neglect, abuse, poor diet, lack of play opportunities – all have such a powerful impact on our children’s mental health and yet rarely are these the target of our attention. If we started with this, and by asking what our children need in order to flourish, we would have very different systems and expectations and support models in place. Instead we continue to ask what is wrong with our children, why their mental health is such a growing problem, and how we can get more mental health specialists to ‘fix’ them in (hopefully) comfortable therapy rooms. If we started with the needs of children at the centre of our communities and institutions instead of trying to make them fit how different would things be? At least, for my dog, his tail is in charge BECAUSE he is happy and not the other way around.