‘Anxiety, frustration and understanding’. Swedish personal social service workers’ cognitive appraisals of encounters with violent clients

ABSTRACT

Workplace violence and threats from social service users towards social workers (client violence) is a problem in Sweden and internationally. This article explores the circumstances that make client violence stressful to social workers who exercise public authority in Swedish individual and family social services. The empirical data are based on qualitative interviews with social workers (n = 19) who, according to their own perception, have been threatened or assaulted by a client in relation to work. Theory on cognitive appraisal of threat and harm is used. The results, analysed by Inductive Thematic Analysis, show that client violence is stressful because it poses a threat to social workers’ professional identity and private life, and occurs in uncertain and repetitive ways. The results suggest that a negligent safety culture in social service agencies, characterized by normalization of client violence and limited organizational support, may contribute to stress related to client violence. The results are discussed in light of how social workers and social service agencies transact and affect each other.

KEYWORDS:

• Cognitive appraisal
• client violence
• social services
• social work
• stress
• workplace violence

Introduction

Violence and threats from social service users towards social workers (client violence) in work-related contexts is a problem in Sweden and internationally (Enosh and Tzafrir 2015; Koritsas, Coles, and Boyle 2010; Macdonald and Sirotich 2005; Padyab and Ghazinour 2015; Radey and Wilke 2018; Shin 2011; Swedish Work Environment Authority 2018; Zelnick et al. 2013). Client violence may involve physical assault, verbal harassment, property damage, or threats in conjunction with, or as a result of social workers’ execution of their job (Waddington, Badger, and Bull 2012). In some cases, client violence involves assault and threats from clients towards social workers’ family members (Littlechild 2003). Bowie (2012) expounds the definition of client violence to include vicarious trauma and staff violence towards clients. However, this article focuses on client to worker violence. Client violence negatively affects social workers’ physical and psychological wellbeing (Robson, Cossar, and Quayle 2014). However, most available empirical research is correlational, with a paucity of research on the processes through which client violence affects social workers’ wellbeing. In this article, we seek to explore the circumstances that make client violence stressful for Swedish social workers in individual and family care services.

International research has established associations between client violence and psychological problems like fear, anxiety, depression, sleeping disorders, and burnout among social workers (Enosh, Tzafrir, and Gur 2013; Littlechild et al. 2016; Newhill and Wexler 1997; Winstanley and Hales 2015). Similarly, Swedish findings suggest associations between client violence and poor general mental health (Padyab and Ghazinour 2015; Vaez et al. 2014), and an intention to quit (Tham 2007). Close to 4 in 10 of work-related illness/injuries leading to sick leave among Swedish social workers are due to client violence (AFA Insurance 2018). These findings show the significance of client violence to social workers’ wellbeing, but do not explain relevant factors through which the violence operates to affect wellbeing. We trichotomize our literature review of possible explanations into individual, situational, and sociocultural/structural factors.

At the individual level, the stressfulness of client violence seems to lie in the role conflict that social workers experience when faced with violent clients. Social workers are normally committed to promoting clients’ wellbeing (Wild, Horner, and Barnard 2008). When faced with violent clients, social workers’ role as helpers is challenged because organizational procedures may call for punitive action against the clients. Yet despite clients’ problematic behaviour, social workers’ responsibility to care must continue (Littlechild 2005b; Regehr and Glancy 2011). Additionally, the risk of a broken service contract with the clients causes mental dissonance among the social workers. In his study of child protection workers, for example, Littlechild (2005b) elucidates that client violence creates the need of balancing personal safety, fulfilling commitments to protecting children at risk of abuse/neglect, and minimizing conflict with the children’s parents. Waddington, Badger, and Bull (2012, 150) highlight that despite client violence, the binding ‘moral contract of professional service’ accounts for the levels of distress that the violence arouses in social workers.

Furthermore, public authority that gives social workers control over the private lives of service users is another relevant factor. Social workers deliver social services in ways that reflect the desire for governments to control its citizens (Carson et al., 2015; Ratliff, 2019). Clients use violence to resist the control, leaving social workers in an unfamiliar powerless position. This role reversal may negatively affect social workers’ wellbeing, because it poses a challenge to their professional identity (Keesman and Weenink 2020). Social workers sometimes appraise violent encounters as nonthreatening, or use attributions e.g., ‘it was not intentional’ to avoid the shame associated with the victim-role imposed on them (Lamothe et al. 2018).

At a situational level, anticipation and uncertainty related to client violence seem to be stressful. Often, social workers have a long-term relationship with their clients and they know which clients are potentially violent. Whereas this knowledge is relevant in planning for such clients, the anticipated risk of violence raises social workers’ anxiety (Barck-Holst et al. 2019; Waddington, Badger, and Bull 2012). Furthermore, violent encounters are rarely one-off incidents. Littlechild (2005b) introduces the concept of ‘developing violent scenarios’ (DVSs), meaning that violent encounters are normally continuous and uncertain processes that develop and change over time. Anticipation and uncertainty increase perceived vulnerability because of the limited control of the situation (Lazarus and Folkman 1984). Another stressor is the encroachment of violence on social workers’ private life. Littlechild (2005a, 2005b) mentions that client violence that is personal towards the social workers and their families and friends is the most distressful and hard to manage.

Beyond the personal and situational stressors, sociocultural/structural influences could play a role in the extent to which client violence is stressful for social workers. Violence and its use are socially constructed, and therefore understood and reacted to in different ways depending on the context (Stanko 2003). In social service organizations in Sweden and internationally, there exists a notion that client violence is part of the job (Radey and Wilke 2018; Spencer and Munch 2003; Swedish Work Environment Authority 2018; Zelnick et al. 2013). Social workers struggle to accept this notion, well aware of the looming and undesirable effects of violence. The culture of normalization and silence makes social workers vulnerable for repeated assaults and threats, while experiencing inadequate support from their supervisors/managers (Littlechild et al. 2016; Shier et al. 2019; Vogus et al. 2016). In this way, structures and practices in social service agencies may unintentionally contribute to a toxic environment that heightens social workers’ stress.

In summary, the individual, situational and sociocultural/structural influences seem to work together to affects social workers wellbeing in relation to client violence. Whereas previous research shows that client violence often has negative effects on social workers’ psychological wellbeing, most research is correlational, with limited investigation of the processes and conditions that make the violence psychologically taxing. The few studies mentioning why client violence negatively affects social workers’ psychological wellbeing do so peripherally. Moreover, very few studies investigate the Swedish context. Following Stanko (2003), we suppose that client violence is not normatively stressful to social workers since they perceived it as nonthreatening in some situations. We suppose that different social workers experience different emotions in varying intensity when faced with violent encounters. It is therefore essential to understand the conditions in which client violence is harmful to wellbeing to inform prevention and management interventions. In this article, we explore the circumstances that make client violence stressful to social workers who exercise public authority in Swedish individual and family care services. We utilize the stress and coping model proposed by Lazarus and Folkman (1984).

The Swedish context

Swedish personal social services are principally statutory covering three broad areas: individual and family care, elderly care, and care of people with disabilities (Government Offices of Sweden 2021). The Swedish Social Services Act of 2001 is the framework law for social service provision. Domestically, three levels of government apply in Sweden: national, regional and local. Personal social service delivery occurs at the local level through Sweden’s 290 municipalities. The Swedish Local Government Act of 1991 enables the municipalities to organize service delivery autonomously. The National Board of Health and Welfare provides overall guidance and quality control (Government Offices of Sweden 2005).

Individual and family care services, the focus of this article, are generally specialized with separate units in the social service agencies handling three traditional problem areas: (1) child and youth care, (2) financial assistance and (3) substance abuse and dependence care. Additionally, function-based specialization is common in child/youth- and abuse/dependence care units, characterized by separation of exercise of public authority from treatment, rehabilitation and support (Lundgren et al. 2009). Other family services and emergent problem areas e.g. violence in close relationships, violent extremism and homelessness are organized differently depending on municipalities’ local needs and political ambitions (National Board of Health and Welfare 2020). Specialization in Swedish individual and family care can be problematic because clients with complex needs or problems that do not fit in the traditional areas of specialization find themselves in grey zones. For some, navigating the social services causes insecurity and frustration (Grell, Ahmadi, and Blom 2016).

The municipal Welfare Board is responsible for making decisions in cases related to individual and family care. The Local Government Act of 1991 provides for delegation of authority to board committees, board members or employees in social service agencies. However many decisions, especially those involving gross invasion of clients’ privacy, cannot be delegated. Nonetheless, social workers who exercise public authority play a central role in service delivery. They are in charge of investigations, assessments and direct contact with service users. This exercise of public authority involves many micro-decisions that can cause affect, frustration and mistrust, which in some cases escalates to threats and/or violence towards the social workers (Swedish Work Environment Authority 2018).

The Swedish Work Environment Act of 1977 prescribes that employers must assess risks, document injury, and implement initiatives that keep employees safe from ill health and accidents. Employers are punishable by law if they do not follow the act. In addition, violence towards persons exercising public authority is punishable according to the Swedish Penal Code. However, the decision to file a lawsuit against a violent client lies with the assaulted or threatened social worker. This is difficult as suggested by international research (e.g. Littlechild 2005b). In addition, the culture in social service agencies fosters normalizing of violence as part of the job, hindering efforts to effectively deal with the problem (Swedish Work Environment Authority 2018).

Theoretical perspective

Our point of departure in the analysis of our data is cognitive appraisal as theorized in Lazarus and Folkman's (1984) model of stress and coping, summarized in Figure 1 below. Cognitive appraisal is the mental process whereby a person evaluates whether and how an encounter affects their wellbeing.

Figure 1. Model of stress and coping (adapted from Lazarus and Folkman 1987, 144).

In the model, two kinds of cognitive appraisal, primary and secondary, occur. In primary appraisal, a person evaluates what threats the environment poses. While no emotional arousal may occur if as encounter does not threaten the person’s wellbeing, psychological stress arises if the encounter involves harm, loss or threat to wellbeing. Personal goals and beliefs affect the quality and intensity of emotions in potentially stressful encounters (R. Lazarus and Folkman 1984, 1987). Secondary appraisal involves judgements about what can be done to alleviate the threats (R. Lazarus and Folkman 1984, 1987). In secondary appraisal, a person evaluates his or her personal resources e.g. mastery, and environmental resources e.g. support networks, demands, constraints and resources, to determine whether the threat and its’ potential effects on wellbeing can be alleviated. In summary, cognitive appraisal involves asking oneself the questions ‘am I in trouble or being benefited, now or in the future, and in what way?’ and ‘What, if anything, can be done about it?’ (R. Lazarus and Folkman 1984, 31). Psychological stress arises when a person considers that his/her wellbeing is at stake, yet his/her resources are strained or inadequate to deal with the demands of the situation (R. Lazarus and Folkman 1984).

The conjuncture of personal and environmental factors, mediated by cognitive appraisal explains why stress may arise for some people, but not others, while facing a similar threat. This perspective is relevant for social workers because it suggests that client violence is only stressful when it harms or threatens the things social workers hold dear, beyond physical safety. Stressfulness therefore is seemingly rooted in ‘the ability of the event to reach out and shake the things that people care about’ (Pargament 1997). Therefore, Lazarus and Folkman’s perspective seems appropriate to explore the underlying stresses associated with client violence. Lazarus and Folkman (1984, 1987) claim further that primary appraisals involve assessment of benefit and challenge, e.g. the potential of growth or exhibition of mastery in difficult situations. These appraisals are characterized by pleasurable emotions like excitement (Lazarus and Folkman 1984), and are not part of this article.

Methods

We utilized data collected for a wider qualitative study of experiences of client violence among Swedish social workers’ exercising public authority. Based on a phenomenological approach, we conducted semi-structured interviews between November 2018 and March 2019. We purposively recruited informants who, according to their own perception, were threaten or assaulted by a client at any one time in their career as frontline social workers. We initially channelled a call for participation through social service agency heads in Stockholm County. We chose Stockholm given its mix of urban, peri-urban and rural municipalities, and the large number of social workers in the County. Due to a low response rate, we published a call for participation via a Facebook group for Swedish social workers (Socionom), opening up for informants from municipalities outside Stockholm. We recruited 19 informants from 7 Counties: they were aged between 24 and 63 years (mean 38 years), 13 were female, 11 worked with children or youth, 7 worked with financial assistance, and 1 worked with sheltered employment. The median years of experience as a social worker was 6 years, with the informant with the shortest career having worked for 1.5 years and the most experienced having 21 years of experience. Informants' details are presented in Table 1 below.

Table 1. Informants’ characteristics.

Nr	Fictitious name	Age	Gender	Living situation	Specialization	Work experience in years
1	Adam	36	Male	Alone	Financial assistance	2
2	Birgitta	26	Female	Partner	Financial assistance	3
3	Christian	24	Male	Partner	Financial assistance	2
4	Diana	42	Female	Partner & children	Financial assistance	11
5	Eva	32	Female	Alone	Financial assistance	1.5
6	Frida	34	Female	Partner & children	Youth	7
7	Gina	28	Female	Alone & child	Youth	5
8	Helena	51	Female	Partner	Youth	10
9	Irene	32	Female	Alone	Youth	8
10	Jane	30	Female	Partner & children	Financial assistance	4
11	Kristina	50	Female	Partner & children	Children	10
12	Lina	29	Female	Partner	Children	5
13	Mike	35	Male	Partner & Child	Sheltered employment	8
14	Noah	52	Male	Partner & Children	Children	21
15	Olivia	43	Female	Partner & children	Youth	12
16	Pia	47	Female	Partner	Youth	15
17	Rita	31	Female	Partner & child	Children	3
18	Simon	63	Male	Partner	Youth	6
19	Tim	34	Male	Partner & children	Financial assistance	6

The first author conducted all the interviews at a time and place preferred by the informants. A majority (n = 15) opted to be interviewed at their workplace. Two (2) were interviewed in their homes, 1 at the interviewer’s workplace, and 1 at a public conference centre. The interviews lasted between 45 and 90 minutes (on average 68 minutes). The interviewer requested the informants to recall and describe a memorable encounter when they felt assaulted or threatened by a client. Themes relevant for the wider study were probed: (1) description of the encounter, (2) personal psychological and behavioural responses including coping efforts, (3) organizational response, and (4) consequences for the informant. All through the interviews, we avoided assigning fault or labelling the informants as victims. Instead, we followed the informants’ narratives without our own subjective connotations.

We used Swedish language during the interviews and translated excerpts only into English. Inductive thematic analysis was done following a six-step model by Braun and Clarke (Braun & Clarke, 2006). This involved: (1) data familiarization through transcribing verbatim, reading, re-reading, and noting initial ideas; (2) open coding of meaning-bearing units; (2) collating codes into potential themes; (4) reviewing themes for code-fit, mutual exclusivity and relevance to the research question; (5) refining, naming and defining each theme; and (6) interpretation of the themes with the help of selected data extracts, in relation to the research question, theory and previous research. We analysed data at a latent level by uncovering underlying assumptions and conceptualizations related to informants’ experiences. The first author initially coded and analysed the data and later discussed with the co-authors to reach consensus. We used ATLAS.ti version 8 for data management.

Participation was voluntary and we took informants’ consent before the interviews. Informants got information about the possibility to withdraw at any time without explanation, and that unauthorized persons would not access their personal data. In this article, we excluded informants’ name, workplace, and residence, used fictitious names, and modified some narratives and quotes to protect the informants’ identity and integrity. In addition, Sweden has a stringent secrecy law and we respected the informants’ decision when they opted not to divulge client information. The Swedish Ethical Review Authority approved our study (Dnr. 2017/429).

Results

The results are structured around three major themes that elucidate sources of stress when social workers are threatened or assaulted by their clients: (1) threats to professional identity, (2) threats to private life, and (3) threats due to uncertainty and duration of client violence. Corresponding sub-themes expound each theme. The themes are based on the narratives of all 19 informants. Quotes have been extracted from 7 narratives based on their representativeness and ability to illustrate the themes. In Table 2 below, we provide a summary description of the violent encounters narrated by each informant.

Table 2. Description of the violent encounters.

Nr	Fictitious Name	Trigger of client violence	Nature of client violence	Elapsed time from violent encounter	Gender of perpetrator
1	Adam	Rejection of application for financial assistance.	Threats to get the informant dismissed for professional misconduct.	1 year	Male
2	Birgitta	Rejection of application for financial assistance.	Threats to get the informant dismissed for professional misconduct.	½ year	Male
3	Christian	Rejection of application for financial assistance.	Threats of physical assault outside the workplace.	½ year	Male
4	Diana	Rejection of application for financial assistance.	Physical assault in the workplace. Stalking.	7 years	Male
5	Eva	Delayed response to application for financial assistance.	Threats of physical assault outside the workplace.	½ year	Male
6	Frida	Client’s preference concerning institutional placement not met.	Repeated threats to commit suicide. Self-harm by the client.	1 year	Anonymous
7	Gina	Recommended mandatory institutional care for the client.	Threats of physical assault outside the workplace. Threats to kill the informant. Threats to assault the informant’s family members.	2 years	Female
8	Helena	Refusal to divulge information on where the client’s child was placed in protective custody	Threats of physical assault outside the workplace. Stalking. Vandalized the informant’s house.	½ year	Male
9	Irene	Rejection of discharge request from mandatory institutional care.	Verbal assault. Physical assault in the workplace. Threats of physical assault outside the workplace.	^1/10 year	Female
10	Jane	Rejection of application for financial assistance.	Vandalized office property. Verbal assault. Threats of physically assault.	3 years	Anonymous
11	Kristina	Refusal to divulge information on where the client’s child was placed in protective custody	Verbal assault. Threats of physical assault outside the workplace. Threats to assault the informant’s children. Incessant emails and phone calls with unreasonable demands and subtle threats.	3 years	Male
12	Lina	Undisclosed	Threats to sue the informant. Threats to get the informant dismissed for professional misconduct. Incessant emails and phone calls with unreasonable demands and subtle threats.	1 year	Anonymous
13	Mike	Rejection of application for unemployment financial assistance.	Verbal assault Threats of physical assault. Threats to get the informant dismissed for professional misconduct.	1 year	Male
14	Noah	Client’s child was placed in protective custody	Verbal assault. Threats to assault the informant’s children.	¼ year	Male
15	Olivia	Refusal to divulge information on where the client’s child was placed in protective custody	Threats of physical assault outside the workplace.	3 years	Male
16	Pia	Rejection of discharge request from mandatory institutional care.	Verbal assault. Threats to assault the informant’s family members.	3 years	Female
17	Rita	Client’s child taken into protective custody.	Verbal assault. Used threatening body language. Threats to get the informant dismissed for professional misconduct.	1 year	Male
18	Simon	Client’s child taken into protective custody.	Threats of physical assault. Threat to vandalize the informant’s house.	3 years	Male
19	Tim	Rejection of application for financial assistance.	Threats to assault the informant’s children.	5 years	Male

Threats to professional identity

Our informants perceived that client violence involved a risk of diminution of their professional role, proficiency or values. They consequently experienced a number of dilemmas, presented in two sub-themes: (a) exuding own incompetence in a non-supportive environment and (b) role conflict.

Exuding own incompetence in a non-supportive environment

Many informants expressed that the workplace culture implicitly created the expectation of resilient and infallible social workers. They felt that managers and supervisors expected them to keep clients content, and manage violent encounters with little support. When violence occurred, some informants felt blamed and seen as incompetent by managers and colleagues. This further bred the culture of mistrust and silence, whereby informants involved in violent encounters opted not to talk about it, as illustrated by one informant:

Being assaulted and reporting client violence was more like a sign of weakness. That is how the manager perceived. That is how we [social workers] felt anyway. Therefore, when I was assaulted, I did not talk about it because the managers did not encourage me. No one talked about violence and I did not want to come across as overly sensitive. (Kristina, aged 50, Child welfare worker, 10 years’ experience)

Like Kristina, many informants believed that managers/supervisors did not offer adequate support or protection. The informants found it easier and comforting to share their experiences with work colleagues. However, Kristina also expressed disinterest in sharing with colleagues because according to her, the workplace had a strong culture of silence. Some other informants echoed this experience. Furthermore, informants explained that it was particularly embarrassing and stressful when they had to continue having a professional relationship with clients who earlier assaulted or threatened them.

Role conflict

The informants experienced cognitive dissonance when pitched against their clients in ways that challenged their professional role and values. Firstly, several informants were unsure about reporting their clients to managers or the police. Whereas the informants did not condone client violence, with some even advocating for zero tolerance, they simultaneously attributed violent behaviour to irrationality caused by the clients’ precarious conditions. Common attributions included substance abuse, mental illness, unstable family situation, and affective reactivity. The informants felt that reporting would lead to punishment that risked worsening the clients’ lives. An informant described her thoughts when asked about her expectations from a police case filed against a client who assaulted her:

Many social workers do not want to report to the police/ … /. They have a heart for the clients. We are social workers and we like people. We do not want to punish and we do not believe in punishment/ … /. I believe that some clients need berating so that they understand that violence is not right. But punishment! Where does it lead? (Helena, aged 51, Youth worker, 10 years’ experience)

The assault on Helena occurred in the presence of the police, which compelled her to file a police case. Other informants instead actively chose not to report. They understood the importance of reporting as part of their workplace procedures, but ignored or trivialized the violent encounters. One informant who declined to file a police case articulated that the employer, rather than the assaulted employee, ought to file the police case. She explained:

I wouldn’t have loved to sit face to face with my client in court, while at the same time thinking that I made that choice /…/ and that it would probably be documented somewhere that I am the one who wanted to report to the police. On the other hand, if it were policy that the agency filed the police case and I was requested to help in the process, then it would have been something different. (Frida, aged 34, Youth Worker, 7 years’ experience)

Another source of role conflict arose when informants unwillingly fulfilled the violent clients’ requests to avoid escalating the conflict, despite violating agency regulations and values. Other informants felt compelled by managers who seemed to care more about the reputation of the agency. These dilemmas posed a psychological conflict for the informants.

Threats to private life

Informants expressed the importance of keeping work and private life separate. To them, client violence was extremely stressful when it transcended the professional boundaries into their private life. Two sub-themes demonstrate this experience: (a) personal physical safety concerns outside the workplace and (b) threats/assault involving family members.

Personal physical safety concerns outside the workplace

The informants rarely mentioned issues related to personal physical safety in the workplace arena. However, the concern arose when they talked about the prospect of violent encounters outside the workplace. The informants expressed that safety measures predominantly focused on the workplace, leaving social workers unprotected outside these boundaries. An informant explained:

The fact is that when I am not in office then I am unprotected. Therefore, this so-called safety at work is highly imaginary. It is not real. If a client really wants to hurt me then I am completely unprotected when I step out of the office door. (Noah, aged 52, Youth worker, 21 years’ experience)

Some female informants drew parallels between life as social workers and as women. They felt susceptible to community violence as women, and were therefore similarly sensitive to the risk of client violence outside the workplace.

Threats/assault involving family members

The informants felt that client violence and threats were extremely stressful when their loved ones were the targets. For many, this marked the point beyond which client violence and threats became intolerable. Having a partner and/or children seemed to play a big role in how informants appraised violent encounters. For example, a married informant, extremely stressed because a client threatened to ‘come after her’ outside the workplace, explained:

I think that if I did not have children, I would not have cared much. But when you have a family, you think differently. (Olivia, Female, aged 43, Youth worker, 12 years’ experience)

A single informant who described herself as foolhardy cared less about the risk of client violence due to her current family situation:

Right now I have only myself to care about, but if the violence spilled over to someone I cared about in my private life, my partner, my child, my brother, my parents or someone like that, then I think it would be something else (Irene, aged 32, youth worker, 8 years’ experience).

Beyond physical safety concerns, some informants expressed the need to protect their loved ones psychologically by not disclosing to them information about violent encounters and the risk of workplace violence. They believed that disclosure of such information would be psychologically taxing to their loved ones. Mostly informants perceiving themselves as strong enough to deal with the violence and threats on their own held this view. However, some other informants talked about their experiences of client violence with their family members.

Threats due to uncertainty and duration of client violence

The informants had concerns about having to deal with client violence continuously. Moreover, there were uncertainties about the violence. We expound these issues in two sub-themes: (a) uncertainties related to assault and threats and (b) prolonged assault and threats.

Uncertainties related to assault and threats

Most informants experienced threats, some of which were ambiguous (e.g. ‘I know where you live’) but carried a message strong enough to arouse the informants’ emotions. This resulted in uncertainty regarding if, how or when the clients would effectuate the threats. The informants had continuous rumination about the threats, which sometimes resulted in fear. The informants further mentioned that they continuously made subjective judgements about the dangerousness of clients based on earlier knowledge or perceptions of the clients. Threats from perceivably dangerous clients seemed more stressful. For example, Kristina continuously received threats from a client who emphatically mentioned belonging to a criminal gang:

The client was very disagreeable and shouted every time I tried to say something. He told me to watch out. He was certainly crazy/ … /and in my world, I thought that there were many [gang members] after me/ … /. It felt as if they were everywhere, and my world became small/ … /I magnified the threat and felt that the situation became very strenuous. I ended up not wanting to go to work. (Kristina, aged 50, Child welfare worker, 10 years’ experience)

Kristina’s turning point came after she talked to the police, who assured her that the gang would probably not want to get involved in private matters that did not concern the gang’s operations. As opposed to Kristina’s experience, several informants appraised threats from certain clients e.g. juveniles as harmless. They perceived that juveniles used verbal assault and threats to communicate, but never intended to cause harm. Many informants therefore experienced distress when threats unexpectedly culminated into actual assaults. An informant described her unpreparedness after a female juvenile client assaulted her at a meeting:

When the client stood up, I thought she would only shout in my face like they (juveniles) usually do/ … /. But then she also repeatedly hit me over my face, and I was not at all prepared for that. I was very sure she would only shout at me (Irene, aged 32, Youth worker, 8 years’ experience)

Irene had many years’ experience working with juveniles, and to her, verbal assault and threats from juveniles normally posed no real threat. Therefore when unexpectedly assaulted, she, like other social workers in uncertain situations felt helpless because her ability to mobilize anticipatory coping strategies was limited.

Prolonged assault and threats

The informants expressed heightened stress due to threats and assault perpetrated repeatedly by the same clients. Such encounters often unfolded as series of related incidents. Whereas informants sometimes normalized and/or trivialized client violence, they appraised differently encounters of a repetitive and prolonged nature. A female informant who received incessant e- mails with subtle threats narrated:

It is okay for clients to vent, and normally they move on thereafter. However, this client never stopped and something new came up every time./ … /the persistence of the threats became a big issue that made my work situation unbearable. The tipping point came when I was affected in such a way that I lacked the energy to do things in my private life because I thought about the client all the time./ … /I did not want to go to work because I knew what was waiting in my mailbox every morning. (Lina, aged 29, Child welfare worker, 5 years’ experience)

Whereas some informants mentioned becoming resilient, the prolonged assault and threats seemed to cause a cumulative psychological burden. Ultimately, some informants ended up on sick leave, while some even chose to quit partly due to client violence.

Discussion

We explored the circumstances that make client violence stressful to Swedish social workers with statutory authority, with our point of departure in the model of stress and coping by Lazarus and Folkman (1984). The data showed that social workers’ threat appraisal involved concerns beyond personal safety. The social workers had concerns about negative evaluation by colleagues and superiors, the wellbeing of their violent clients, as well as the wellbeing of their own family members. Additionally, concerns existed about the uncertainty related to ‘if, when and how’ client violence would occur, and the strain due to persistent assault and threats. Seemingly, social workers’ values and beliefs together with an unconducive workplace safety culture affected the intensity of arousal in the event of client violence. There we no general differences in appraisal of threat based on the informants’ age, years of experience or gender. As a negative case, one male informant expressed that men had a higher threshold for perceiving client violence. This can be explained through masculinity norms, or the tendency to consider vulnerability to violence as central to femininity (Hollander 2001). However, our sample was too small to support the aforementioned assertion. Instead, exercise of public authority was the common denominator in all narratives; threats and assault occurred in relation to clients’ discontent over formal decisions about social services.

Our findings support the theoretical position of Lazarus and Folkman (1984, 1987) that an external stimulus e.g. a punch from a client is not adequate on its own to threaten a person’s psychological wellbeing. Personal values, commitments and beliefs as well as environmental factors (e.g. demands, resources and constraints) interplay to determine whether the stimulus poses a threat or not. For social workers, values and commitments related to their professional identity are important when appraising encounters involving violent clients. Statutory social workers have power and control over clients, and client violence is stressful because it portrays a perceived loss of power and control by the social workers. A similar finding from homeless shelters was established by Keesman and Weenink (2020) who demonstrated that ‘the professionalism of being a social worker thus determines what they should and should not feel’ and ‘displaying fear would mean a loss of control’ (2020, p. 185). Moreover, social workers seem to maintain commitment to professional values like empathy, care and compassion towards clients irrespective of the clients’ shortcomings (Håkansson 2016; Wild, Horner, and Barnard 2008). When violent encounters threaten such commitments, role conflict occurs. However, social workers’ commitment to professional service seems to surpass personal safety and punitive procedures related to managing violent clients. These professional dilemmas, identified by previous researchers (e.g. Keesman and Weenink 2020; Littlechild 2005b; Macdonald and Sirotich 2001; Waddington, Badger, and Bull 2012) highlight a stress moment for social workers.

Lazarus and Folkam further suggest that situational factors e.g. uncertainty regarding whether a harmful even will occur, and if it does, the duration over which it persists, affects the intensity of stress associated with the event. Statutory social work, often involving emotionally charged interactions with clients puts social workers at a constant risk of violence from clients (Pollack 2010; Waddington, Badger, and Bull 2012). Therefore, social workers seem to experience unending thoughts about the risk of client violence, contributing to social workers’ psychological stress. Lazarus and Folkman (1984, 92) assert that uncertainty ‘can lead to a long, drawn-out process of appraisal and reappraisal generating conflicting thoughts, feelings, and behaviours which in turn create feelings of helplessness and eventual confusion’. In line with Lazarus and Folkman’s model, our findings suggest that social workers who endure actual or anticipated client violence over extended periods eventually experience burnout. However, not all our informants who experienced recurrent violence developed burnout symptoms. It is possible that personal resources (e.g. self-efficacy) and coping resources within their workplaces account for differences in the extent to which client violence is taxing. Nevertheless, our study extends on previous research linking client violence to psychological ill health (e.g. Padyab and Ghazinour 2015; Vaez et al. 2014) by highlighting the possible mediating role of uncertainty and repetitiveness of threats and assault.

Lastly, our findings add to previous research suggesting that the safety culture in social work agencies risks contributing to social workers’ stress. Organizational safety culture is the extent to which an organization and its’ employees’ attitudes, values and practices are synchronized to recognize risks and promote safety in the daily activities of the organization (Vogus, Sutcliffe, and Weick 2010). Sweden has made multi-dimensional advances in law and procedures for workplace safety. These include criminalization of breaches by employers, demands on employees’ active involvement in risk assessment and prevention, and stronger penalties for threats and assault towards persons exercising public authority (Wikman 2012). There are special provisions (AFS 2015:4) for averting ill health related to organizational and social conditions in the work environment. However, many of these efforts do not necessarily translate into practice partly due to lack of a safety culture in social service agencies (Swedish Work Environment Authority 2018). Similar to previous international research (e.g. Littlechild 2003; Shier et al. 2019; Vogus et al. 2016), our findings suggest that social workers experience inadequate support from employers, a culture of silence, and normalization when dealing with client violence. This tendency is explained partly by workloads that supersede attention to the risk of violence (Turpin et al. 2020) and legislation that makes employers and employees jointly responsible for safety promotion, with assaulted/threatened employees experiencing self-blame as a result (Wikman 2012).

It is noteworthy that social workers may normalize client violence occurring within the professional arena, but draw the line when the violence encroaches their private lives. In our study, informants living with a partner and/or children seemed more sensitive to client violence. Even those living alone perceived that their appraisal and reaction to threats/assault would be different if they had a partner and/or children. Similar to international research (Littlechild 2005a, 2005b), threats involving social workers’ family members seem extremely stressful; the need to protect the wellbeing of loved ones seems to outweigh professional commitment. We draw parallels with findings from domestic violence research (Rasool 2015; Vatnar and Bjørkly 2010) showing that mothers chose to stay in abusive intimate relationships for the good of their children, and only leave or seek help when the abuse spills over to the children. Thus, the safety culture at work allows for continued client violence up to the point where social workers’ family members are the target.

In all, these findings seem to align with the model of stress and coping by Lazarus and Folkman (1984) by highlighting the interaction between the personal and environmental factors. For example, attachment to professional identity intertwines with systemic constraints, which, in the case of client violence affect social workers’ wellbeing. We must therefore understand social workers’ responses to client violence in the context of their workplace safety culture. Moreover, social workers’ experiences seem to reflect a conjuncture of client violence and organizational violence, which according to (Bowie 2012, 12) involves ‘organizations knowingly placing their workers or clients in dangerous or violent situations or allowing a climate of abuse, bullying or harassment to thrive in the workplace’.

Although this study provides important insights, we must also acknowledge its limitations. Researchers’ preunderstanding may influence the creation of knowledge. In our case, we introduced the study to potential informants from the viewpoint that client violence was a problem for social workers. This predisposition, together with self-selection and the exclusive focus on social workers who experienced assault or threats, creates the risk of magnifying problems related to client violence. Social workers who experienced client violence but judged their experiences as nonthreatening or exciting may have chosen not to participate. In addition, our small sample limits transferability of our results. Majority of the informants were females working with children, youth or financial assistance. This may limit the extent to which our findings are relevant in other social work functions within the personal social services. Furthermore, the informants chose the events of violence to narrate. The study made no limitations based on the manifestation of violence or elapsed time between the violent encounter and the interview. This could have introduced recall bias, or bias due to narrating extremely negative violent encounters only. However, we did not observe differences in the informants’ appraisal of threat based on how much time had elapsed between the violent encounters and the interviews. Finally, cognitive appraisal and coping are continuous and changing processes, and the source of stress in one specific event may vary at different times as the event unfolds (R. S. Lazarus 1993). For this study, we did not investigate threat appraisals at the different stages e.g. before, during and after the violent event.

Despite the limitations, the findings provide a foundation for understanding circumstance that make client violence stressful for social workers who exercise public authority. The study highlights the importance of a workplace safety culture that does not blame client violence on ‘deviant clients’ or ‘incompetent social workers’. To effectively deal with client violence, personal predispositions must be considered in relation to structures in the workplace. The findings warrant broader quantitative investigation of the sources of stress in relation to specific stages along the trajectory of a violent event.

Disclosure statement

No potential conflict of interest was reported by the authors.