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Managing the two sides of the same coin: harnessing the psychoanalytical notion of paradoxes within the care system

By Richard Cross

The notion of paradoxes in psychoanalytical thinking is often associated with the work of the Austrian psychoanalyst and psychiatrist Otto Rank (1884- 1939). He was a close collaborator of Sigmund Freud and significantly contributed to psychoanalysis.

One of his key contributions was the exploration of paradoxes in the human psyche and their relevance to psychological development and therapeutic practice. Paradoxes were closely tied to understanding the human experience and the individual’s struggle for autonomy and self-realisation. As individuals, we often face inherent paradoxes such as the simultaneous desires for independence and dependence or the conflicting urges for freedom and a sense of security.

Paradoxes and Social Care Organisation and Society

Although this article seeks to bring into consciousness elements of working in therapeutic social care, these ideas may be helpful for any individual within any social care, health or educational organisation seeking to understand tensions which often arise within organisations.

Usually, though, the role of the unconscious is not given a place, and only the conscious aspects are held. These often drive thinking without understanding an organisation’s emotional life. This can often lead to anxieties and tensions remaining unspoken and being kept under the carpet, consciously (silence: aspects not being spoken out loud due to lack of psychological safety) and unconsciously.

Recognising these tensions is the first important step, which ‘opens the door’ to addressing them. This requires holding both sides of the coin’ to explore the contradictions and conflicts within the living, breathing organisational system. Organisations can ensure reduced risk of decline and ongoing growth by not allowing these tensions to become wider or an unspoken dynamic.


Within care organisations, individuals may perceive the notion of financial performance and care delivery differently depending on where you connect within the hierarchical structure. The care staff may see the upper levels as being all about the ‘bottom line’, whilst the upper structure might perceive the care structure as purely interested in the care aspect. This is a fallacy, as it’s two sides of the same coin: one needs to deliver good care, but there is no point without sustainable financials to keep any organisation alive. Can each aspect be held metaphorically in ‘each hand’?

This is often played out in discussions, such as the current review of the care sector; discussions are often polarised around the care vs financial arguments. We need to support the sustainability of organisations (within reasonable parameters) and ensure the proper care (services) to meet children’s needs.

To ensure this, we must be able to monitor any shifts towards focusing on one side of a coin to the detriment of the other; both ‘sides of the coin’ need to be kept in mind. One way of doing this is to explore reporting and meeting structures and how much is dedicated to understanding the quality of care vs. business performance. Keeping both helps sustain the ‘soul’ and often the organisation’s vision alive and avoids collapsing into being felt as soulless.

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Navigating Paradoxical Challenges: The Balancing Act in Foster Care

Supervising social workers are deeply invested in the foster care system and provide vital support to foster carers who care for children. They must navigate a complex and paradoxical web of challenges daily, presenting conflicts between care and financial constraints, individual needs, group dynamics, and more. The risk is not identifying or considering addressing these challenges with empathy, creativity, and resilience.

The Paradox of Care versus Cost

In an ideal world, the care provided to children in foster care would be our sole consideration in every decision. However, we operate within a framework of limited resources and financial constraints. There isn’t a bottomless purse of gold.

This paradox is at the heart of many difficult decisions, from determining the level of support that can be provided to a foster family to deciding whether a child can attend a specific therapeutic program that is deemed beneficial but costly. To navigate this paradox, we must be both advocates and innovators.

Advocacy involves pushing for adequate funding and resources to ensure that children in foster care have access to the services they need. Innovation calls for creative solutions that maximise the impact of available resources and innovative uses of resources so that more children can be supported. This could mean employing cost-effective, evidence-based practices that deliver positive outcomes for children.

The Paradox of Permanency versus Stability

The goal of foster care is to achieve permanency for children, whether through reunification with their biological families, adoption, or other long-term permanency in foster care. However, the journey to permanency can be fraught with instability, as children may move from one foster placement to another. This paradox between pursuing a permanent solution and needing immediate stability can be deeply unsettling for children.

Social workers must strive to minimise disruptions and promote stability, even as they work toward permanency. This can involve thorough assessments of foster carers (the quality of relationships is a significant factor in placement stability) to ensure a good match, providing robust support to foster families to prevent placement breakdowns, and advocating for policies prioritising the child’s need for stability.

The Paradox of Attachment versus Loss

In foster care, children are encouraged to form attachments with their foster families, which are crucial for their emotional development and well-being.

Yet, these attachments can lead to profound experiences of loss when placements change or when children transition out of the foster care system (Importance of identifying the correct placement the first time, which might not be foster care, e.g., residential care). Social workers must delicately balance the need for healthy attachments with the certainty of loss. Training foster parents in attachment theory and providing them with tools to support children through transitions can help mitigate the impact of loss.

The Paradox of Autonomy versus Safety

As children in foster care grow, they naturally seek greater autonomy and independence. However, due to their vulnerable status and the state’s role as guardian, they are often subject to stricter safety checks and controls than their peers. Striking a balance between empowering children within foster care with the autonomy they need to develop and ensuring their safety and well-being can be challenging.

Creating a supportive environment where children can make choices within safe boundaries is essential to address this paradox. Life skills programs can teach practical independence skills. In contrast, mentorship programs can provide the guidance and support that foster youth need to navigate the complexities of growing up in the foster care system.


The paradoxes we face in foster care (or any care system) are a testament to the complexity of our work. They challenge us to think critically, act compassionately, and advocate fiercely for the children and families we serve.

As professionals, we must navigate these paradoxical challenges with grace and determination, always keeping the child’s best interests at the forefront of our efforts.

By embracing these paradoxes as part of our professional landscape, we can develop innovative approaches and strategies that honour both the individual and the collective, the present and the future, care and cost. Let us continue to support one another as we strive to create and maintain a care system that manages these tensions and upholds the dignity and worth of every child in it.

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