Therapeutic containment and physical restraint in residential child care

Sometimes it can feel like walking on a knife edge-this work in residential child care. Decisions often have to be made quickly under intense pressure, and the consequences of those decisions may have long term and significant impacts. Sometimes it can appear no good decision is possible, just a choice between wrong ones. Physical restraint is firmly located on possibly the sharpest edge of practice. There have long been concerns about physically restraining children. The potential for things to go wrong is great. Restraint has been and probably continues to be misused, violating children's basic rights, damaging the relationships that are meant to heal, and sometimes traumatising or re-traumatising children. Even when properly implemented, there remain significant risks of physical and psychological harm-both to children and to staff. Yet, some children in residential child care have had such damaging life experiences that they act out their pain and confusion in harmful ways. And sometimes, staff are unable to find a way to keep everyone safe without resorting to restraining a child. This piece will discuss a large research study in Scotland that explored the views and experiences of staff and children in residential child care related to physical restraint. While much of what has been written about physical restraint has been negative, the findings of this study reveal a subtler and more complex picture-one that can be better understood by applying theories of therapeutic containment and holding environments. These theories will be explained first and then used as one way of making sense of what study participants had to say