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Published in The
Adlerian Society (UK) and the Institute for
Individual Psychology Year Book:
A Collection of Topical Essays 2007. Published by
Anthony Rowe Ltd Great Britian.
Jan Hawkins
How fortunate it is, that the work I am involved in
– therapy, supervision, training – are labours of
love. These three work strands interweave, and all
bring the same joy: being alongside people who are
developing and overcoming obstacles in their lives.
Coming alongside for part of the journey, and
attempting to meet at relational depth ensures that
I too, am developing. My passion for enabling people
who have severe learning disabilities comes from my
perception that many of those I have seen as clients
have been raised in environments where, like Morph
(the television plasticine man) they were
persistently squashed, undermined and every effort,
it seemed, was given to the endeavour to destroy who
they are or could be. Many of my clients with severe
learning disabilities (SLD) lived in long-stay
institutions, and most were subjected to various
types of abuse. “Dispersed” (King’s Fund, 1999;
Thompson & Mathias, 1999) into smaller group homes
within communities, teams of support workers
endeavour to care for them. I attempt to take my
learnings from working with these clients into the
training I give to support workers.
Major obstacles in unblocking the attitudes of
support workers, with a long-standing culture within
care for people with learning disabilities, come
from a focus on management rather than development.
Some support workers seem to want to punish “bad”
behaviour in their clients. This desire is born of
deeply-held attitudes and beliefs about other
people’s motivations, leading to a culture of
punishment and power-seeking and sometimes to giving
up on certain clients altogether. As social care
policies have changed, there is resentment in many
longer-serving support workers that they are
expected to “put up with” what they often describe
as “bad” or “naughty” behaviours, with the result
that there is a lack of consistency among teams in
responding to “challenging behaviours”. I feel angry
on behalf of my clients that they live in
environments that continue to discourage and
undermine them.
I have a deep conviction that we all have it within
ourselves to be more: to self-actualise, to be more
fully functioning (Maslow, 1943; Rogers, 1951). On
this theme, Rogers (1978) talks of “persons of
tomorrow”, emphasising certain trends including
“towards creativity of all sorts - in thinking and
exploring - in areas of social relationships …” (p.
282).
From the Adlerian perspective, Mosak (1995)
describes the “ideal” state in this way: “There is a
sense of belonging and contributing, the ‘courage to
be imperfect’, and the serene knowledge that one can
be acceptable to others, although imperfect” (p.
78).
My conviction extends to those people who came to
this life with not only external obstacles to
overcome, but also internal obstacles in the form of
cognitive deficits or organic damage which holds
them under the umbrella term “learning disabled”
(LD).
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“If I accept the
other person as something fixed, already
diagnosed and classified, already shaped by
his past, then I am doing my part to confirm
this limited hypothesis. If I accept him as
a process of becoming, then I am doing what
I can to confirm or make real his
potentialities” (Rogers, 1967, p. 147). |
The language used to
describe people who have learning disabilities has
changed considerably over the years (see for example
Sinason, 1992); mostly these changes have reflected
the “abled” community deciding what is more
respectful, descriptive or simply more politically
correct. Here I will be focussing on people who have
severe learning disabilities and, as a result, rely
on support workers and family to ensure that they
are able to live safely. Sadly it is often the case
that people with SLD do not have the opportunity to
do much more than live safely with constraints on
budgets as well as the limitations of people who
work as support workers on minimal hourly rates and
with little training. However, there are also
efforts to give more training to support workers,
especially in the field of “challenging behaviours”.
This term is used to describe people with LD who
present difficulties with their behaviours. Most
often the difficulties are in the form of violent or
destructive behaviours or inappropriate sexualised
behaviours that create difficulties for support
workers and other people with LD who they live with
or go to activities with. In this paper, I intend to
explore how training support workers can enable and
encourage them to enable and encourage the people
they support. My practice is rooted in the
person-centred approach and informed by my training
in Adlerian psychology.
In my practice, I work directly with clients who
have the whole range of LD as well as clients who
are fully abled. I also give training to staff
teams. This latter has come about because for many
years I would see clients with SLD in my practice,
and recognised that they were continually prevented
from developing new ways of being because of the
environments in which they found themselves. Unlike
clients who are fully abled, they cannot choose who
to spend time with, what activities to do or what to
eat, when to eat it, when to go to bed, when to get
up - the list is endless. I came to realise that any
developments within the therapeutic hour were likely
to be lost or squashed within the less therapeutic
hours that followed!
The only people with SLD who get funding for private
therapy are those who have been through the system
many times and things have not changed. They have
thwarted the efforts of multidegree’d persons who
have attempted to change their behaviours through
“behaviour management programmes” or modified
cognitive behaviour therapies. They have been seen
by psychiatrists who have attempted to manage them
with drugs. But the people who eventually have
funding and have agreed to come into therapy in my
private practice have “outwitted” all these
professionals, and their “challenging behaviours”
have become entrenched. The workers responsible for
the fight for funding are all people who really want
to help, but do not know how. They are discouraged
by the fruitless efforts of the professionals who
have been involved with their clients, and are daily
having to manage the behaviours that challenge them.
So the clients I see who have SLD have not
themselves chosen to come into therapy, but in the
main we are able to establish a “therapeutic
alliance” that allows us to work together. Well over
a hundred studies and meta-analyses find a
significant, consistent relationship between the
therapeutic alliance and a successful outcome. This
finding holds across all therapy approaches studied.
(Horvath & Bedi, 2002; Wampold, 2001; Martin, Garske
& Davis, 2000; Krupnick, Sotsky, Simmens, Moyer,
Elkin, Watkins & Pilkonis, 1996; Gaston, 1990). It
is therapy within relationship that allows growth to
occur for my clients with severe learning
disabilities as well as for the cognitively abled.
Connection
Giving my clients with severe learning disabilities
a relationship in which they are empowered to lead
the process and receive accompaniement in that
process is most unusual for them in their lives. It
is also unusual for those individuals to be allowed
to explore whatever is on their minds without a task
to achieve. A relationship of this order allows the
client to connect (Adler, 1938/1998) and that
increases the desire for connection. For some years
this has felt like a dilemma for me. Without working
with the staff team too, the client is faced with
their usual environment that is often
anti-connection. How unfair of me to give an
individual a taste of what can be, and then leave
them for the rest of their week with no way of
developing that connectedness. My policy now is to
let funders know at the start that I will only work
with the client for a defined number of sessions
after which I must work with the staff team
supporting the client. Without that, I say, they are
wasting their money. I have written elsewhere
(Hawkins, 2002) about “challenging behaviours” and
the changes that can happen when the behaviour is
understood and the need expressed is met. Behaviours
always communicate. If we can free ourselves from
judgements and interpretations of motivations based
on our own worldview, and instead aim to “see with
the eyes of another, to hear with the ears of
another, to feel with the heart of another’ (Adler,
as cited in Ansbacher and Ansbacher, 1964, p. 135),
we can begin to comprehend what “challenging
behaviours” are actually communicating. I believe
“that human beings flourish best when they can
experience acceptance and understanding rather than
adverse judgement and a lack of informed
responsiveness from others” (Mearns and Thorne,
2000, p. 15)
In order to meet their clients with learning
disabilities with this kind of responsiveness,
support workers need to experience that acceptance,
lack of judgement and informed responsiveness
themselves.
Support Workers
Historically people who came into the caring
professions as support workers, did so with few
qualifications and therefore were very poorly paid.
I recall my first teaching job in a further
education college as tutor to a group of 16-19 year
olds who had learning and emotional difficulties. I
found that colleagues with similar responsibilities
had backgrounds as full-time parents, teaching
assistants and a variety of non-related employment.
But, it seemed, it was not necessary to have
qualifications to teach students who had LD. In the
care field it is still the case that most care
support workers have no previous training or
experience when they come to work with people who
have LD. Many organisations now do provide training
for their staff, but this is still relatively ad
hoc, even with the advent of the requirements
provided for by a programme of National Vocational
Qualifications (NVQs). Many people come into care
work with open hearts and a desire to get the best
out of the people they care for. However, it has to
be faced that some come into care work for other,
less positive reasons. It is also true that we all
take our own “baggage” which we carry into our work
- and nowhere is this more apparent than in the care
of people with LD. My experience as a trainer is
that many care support workers attend training
because they have been instructed to, or because
they are required to fulfil a certain amount of
training as part of their contract. For these
people, encouraging and inspiring them to see the
training as beneficial firstly to themselves and
then to the people they care for, is a task in
itself. Others have a thirst for learning, and may
request training - these are the people who are
ready to engage. There are those too who are
required to attend training, but feel no need, and
are therefore resentful and unwilling to engage. In
a group, there may be these different attitudes as
well as others, so when meeting the group for the
first time, I am vigilant for who is coming from
where.
I notice too, that many support workers are
intensely discouraged. They bring discouragement
from their own lives, as well as discouragement from
the challenges they face with their clients, the
client’s family and their colleagues and managers.
For some this intense discouragement appears in the
form of apathy, and a “going through the motions” in
any activity. Support workers are increasingly
required to deal with mountains of paperwork as well
as the practical elements of the care work i.e.
washing, dressing, feeding, cooking, cleaning,
managing behaviours and so on. With ever-restrictive
budgets, there are rarely sufficient staff on duty
in any one team to ensure all the practical tasks
and paperwork are completed. Considering the
emotional lives and needs of the clients is
therefore often completely missed. In terms of
Maslow’s hierarchy of needs (Simons et. al, 1987),
people with SLD who rely on the care of others
rarely achieve more than the two basics of having
their physiological and safety needs met. In the
increasingly abuse aware culture we have swung into
the “abuse of under involvement” (Thorne 2006 in
press) such that the needs for love, affection and
belongingness are rarely met. For many people with
SLD the support workers and other residents in care
are their only family, but many support workers tell
me they are afraid to show any affection for fear of
having to go through a very stressful “vulnerable
adults” investigation. In one home where I recently
provided training, the workers told me they felt
they were “banned” from giving any form of hug or
physical contact (other than for personal care
needs). This placed additional stress on them when
they perceived one of their clients in distress, but
felt they were not allowed to comfort them. When I
checked this with the management of the
organisation, there was no such edict, but still the
workers were anxious. They did not know how they
could both protect the client and themselves without
adhering to what they felt was a rule against
physical contact.
Training
The training I give within teams of support
workers (or other care professionals) is often the
result of working with a specific client. As
explained above, I will work with the client, and
then bring general understandings (though not
confidential material) to the team for training.
Usually the benefits to the team go beyond the
client in question as they generalise the learning
and understanding. Other times, I will work with
teams where I do not have specific clients from
their care, but the issues are similar. Mostly the
call for training and therapy for the individuals
with SLD come under the headings of “challenging
behaviours”, inappropriate sexual behaviours, and
loss and bereavement issues. The latter receives far
less attention and only gains funding when the loss
leads to challenging behaviours. For me, the focus
of the work is in encouraging and developing empathy
for themselves as workers, and especially for the
clients they are supporting. It never ceases to
amaze me that so much training for the caring
professions is so lacking in care. This is often
shown in the way the training is set up. One team I
worked with had managed to get a training room away
from the unit they worked in, in order to create a
training environment. Unfortunately the room in
question was tiny, with large damp patches and
peeling wallpaper - the damp smell pervaded the
space. They had been required to bring their own
packed lunch; as it was raining outside, this was
consumed in the ghastly workroom, which was cramped
by the circle of chairs and flip chart. The one
toilet was in a worse state of repair than the
workroom. I was aware of how these workers felt
undervalued and not especially enthusiastic at the
start of our two days together. Another example is
of a team who had to have their training in the
group home where they worked. This meant that the
residents who lived there had to be out at their
activities (whether they wanted to go or not), and
wandered back from time to time. This was hardly
conducive to the kind of experiential training I
offer.
I encourage managers and funders these days to see
the training environment as integral to the training
itself. If possible, I suggest they should also
provide lunch for their workers. Mostly, when I make
these suggestions, they are taken up with
acknowledgement of their importance. I usually send
a piece of work for the participants to engage with
before the training and some of them do. I always
explain to the manager or funder who is arranging
the training, that I work experientially, and they
decide the degree of prior disclosure to their team,
knowing that some would be frightened off before we
began. However, it is interesting that the feedback
from participants is always positive.
It seems that much training is of the “talk and
chalk”’ variety, and doesn’t’ allow the participants
to participate.
“Attention Seeking” and the Mistaken Goals
Dreikurs’ (1972) helpful outline of the mistaken
goals of children’s behaviour has been crucial to
the training I give to support workers. Describing
the needs of undue attention, power, revenge and
assumed disability helps broaden the thinking of
those who previously described client’s behaviours
as “just attention-seeking”. This is with the
implicit belief that there is something inherently
wrong in desiring attention. When I identify that we
all need and seek attention, there is often a sense
of lights going on for some people. One of the
phrases I find most disrespectful and unhelpful
about clients in therapy, people with SLD and
children is that they are just “attention seeking”.
That phrase allows the speaker to “avoid really
listening” (Hawkins, 2002). Often I detect among a
team a feeling of anger towards their clients who
are presenting challenging behaviours. They will
refer to these as “attention-seeking” and feel
justified in ignoring the person. I try to flush out
the extent of these feelings.
It is not uncommon to find a split in a team at this
point, with some members having what appears to be a
desire for punishment for “bad” behaviour, e.g.
“s/he always gets away with it”. Others in the team
can find this distressing and are perceived as
“soft”. So this split in a team is important to
explore and the facilitation of the dynamics of the
team is essential prior to any input. In the
negotiations that precede training, I explain the
importance of space to explore team dynamics and
attitudes. Often, of course, the need for power and
also for revenge, exist within support workers.
Because of this, clients with learning disabilities
are often caught in psychological battles with
support workers who have their own reasons for being
stuck with a need for power, or for revenge. In the
training, I see participant’s growing awareness of
their own needs and behaviours. For example, one
participant in a team I was training recognised that
the reason she had more difficulty “helping” a
particular client get dressed than other team
members was because she wanted power over the
client, and wanted her to do it in the “right way”.
Exploration of this need allowed for some of the
tension to subside and for new possibilities to
exist.
Using Humour to Break Down Barriers
I challenge the “attention-seeking” attitude by
exploring mistaken goals of behaviour (Dreikurs,
1972). Having playfully illustrated these, I invite
participants to consider which, if any, is their own
dominant mode of behaving. This often leads to light
banter among team members, as well as the dawning of
new insight. Having allowed time to explore the
meanings of the mistaken goals, we are able to turn
our attention to those clients the team are
supporting, and whether they are able to identify
anything different to describe the client’s
behaviour. Adler’s ideas about children’s
goal-directed behaviours and Dreikurs’ explanation
of the mistaken goals are practical and immediately
accessible. I find that this part of the training
opens up people’s minds, and there is often a
discernable change in energy as people begin to
think in a different way.
Looking at Yourself...
After exploring the mistaken goals of behaviour, I
will often invite the group to consider their own
“challenging behaviours”.
When a sufficient level of relaxation and trust
develops, participants will consider themselves
rather than immediately thinking of merely managing
their client’s behaviours. I invite the group to
consider how they would feel if a
behaviour-management plan were designed to dissuade
them from their own particular behaviour. Through
this process - which looks very simple on the page,
however, is anything but in reality there is another
shift in energy occurring. People in the group begin
to comment on how resistant they would be to being
encouraged/coerced/forced into doing something they
did not want to do, and recognise the parallels for
their clients. At this point we can explore how the
worker’s own mode of behaving may clash badly with
the client’s. For example, having identified that a
worker likes to be in control, and identifies
her/himself as someone who wants power, we can
explore how difficult it would be for this
particular worker with this particular need, to be
trying to get a task completed with a client who is
also needing power. The power struggle which ensues
is likely to end with frustration, or the client
presenting her/his “challenging behaviour”. I am
always surprised at what a revelation it is to teams
of support workers when I ask them to think about
what they were doing, thinking and feeling prior to
a client’s destructive outburst for example.
The forms that have to be filled in to record the
incident rarely require information about who was on
duty or what they were doing. The incident is
recorded as just that, an incident. In my experience
there are many times when people with LD have an
outburst, or harm themselves or someone else and are
able to explain what happened from their own
perspective; these are revealing moments. At such
times I am aware that a worker has been consciously
or unconsciously goading the client. This goading
behaviour does not get recognised as such. Rather,
the behaviour is seen in isolation, and often
reduced to pejorative statements: “she/he was just
attention seeking”, or “she/he just wanted her/his
own way”. By taking some examples, I am able to
encourage support workers to focus on the wider
picture. This involves reframing “challenging
behaviour” as an attempt for discouraged individuals
to make a connection, to be in contact; yet also
acknowledging that the client needs help to develop
her/his repertoire of behaviours to make that
contact positive.
Developing Empathy
In order to develop insight into, and empathy
towards, the clients the support workers are
responsible for, I then invite them to think about
who is on their mind during the training. Usually it
is possible to create small groups of those thinking
about particular clients and their behaviours. In
these smaller groups, I invite participants to write
on a large sheet of paper everything they know about
the client. This is always interesting and fruitful
for participants as they learn more about the
individual as a person, once again broadening from
the reductive “challenging behaviour” to the whole
person. Inevitably some team members know details
about the individual that others do not. This
approach allows us to detect if there are
possibilities for empowering the individual in
positive ways. Having gone through this process, I
then engage the groups in a guided visualisation,
where they become the client they are focussing on.
For many this is an emotional experience and
requires sensitive facilitation. Having become the
person, there are often insights to share about what
the true meaning of particularly difficult
behaviours might be.
Encouraging the participants to reflect too upon
their own feelings in response to the difficult
behaviours allows them to deepen their own empathy
with self as well as with the other. This process
develops the potential for anticipatory action. So
much distress and challenging behaviour could be
avoided if empathy is developed so that situations
that may be distressing for the client can be
anticipated. Then positive interventions may be
employed in order to reduce the anxiety that
inevitably leads to challenging behaviours.
Making Contact
My experience with people who have SLD, especially
those who have no speech, is that much of their
behavioural repertoire is aimed at making contact.
It is evidence of a desire for connection, for
belonging, for community. Sadly, it is often the
case that the method employed attracts entirely the
opposite response, invoking paradox. If my only way
of communicating is biting, then I am likely to
repel someone rather than attract the contact I
want. Many of the “challenging behaviours” have
become entrenched, and their underlying intentions
lost in the habits they have adopted. By utilising
an approach that focuses on individual meaning,
rather than judgements and interpretations (which
can only ever be assumptions based on the history,
attitudes and beliefs of the judge), a fresh
possibility exists.
For many support workers, the process outlined above
has enabled them to want to do things differently,
or to think in a different way. Ironically, it is at
this point that I find myself feeling most
frustrated. Translating the ideas and understandings
into meaningful interactions between support workers
and clients involves more than a set of skills.
Skills are far easier to teach than the art of
allowing openness of spirit in oneself. Too often, I
am stretched at this point in my work to maintain my
empathy with those I am training who are resistant
to engagement with clients at this level. It is at
this point, therefore, that I am exercised by my own
“challenging behaviour”. The core attitudinal
qualities of the person-centred approach to
interacting with others are key in my way of being
as well as in the training at hand. The government
has developed a requirement of “person-centred
planning” for all care professions. This means
ensuring that the individual client is placed at the
centre of service provision. However, there has been
no training in how to ensure this can happen in
meaningful ways. This is where the overlap with my
training comes in. Workers are familiar with the
term person-centred planning, but often recognise
that the person in the form of the client is neither
able to explain what their difficult behaviour is
about, nor what they really want. It is in the how
to have a meaningful person-centred planning
provision that the core attitudinal qualities of the
person-centred approach are so vital.
For this undertaking, I rely on Prouty’s (1994) work
on making contact with clients who are difficult to
connect with. Prouty works mostly with people who
have severe mental health needs and who are
difficult to make contact with because of their
psychoses. Others have extended his work to include
people who have SLD (Portner, 2000). Prouty (1994)
suggests that his approach is “pre-therapy” for
those who are not able to engage with psychotherapy.
However, I argue that the work I do with clients who
have SLD is therapy, not pre-therapy. For the
person-centred therapist the first stage of the
therapeutic relationship is “making psychological
contact” (Rogers, 1951). Essentially Prouty has
clarified how that may be facilitated, by describing
five different levels of responding.
Levels of Responding
When someone is behaving in a challenging way, they
may be behaving destructively towards themselves,
others or objects; they may be withdrawn, vacant and
unresponsive; or they may be inwardly focussed and
caught in obsessive, repetitive behaviours. All
these behaviours challenge support workers. The
importance for the individual of having support that
encourages and enables them to re-establish
communicative contact needs stressing for some
support workers, especially those who are caught in
“contain and manage” rather than “developmental”
attitudes to their clients.
The following levels of responding can enable
psychological contact to be regained.
- Situational
reflections - these responses would focus on the
environment, making clear statements about what
is close by, i.e. “this room is warm”, “the sofa
is soft”.
- Body reflections
- these responses would focus on the
individual’s body language, i.e. “your shoulders
are high”, “your fist is clenched”.
- Facial
reflections - would focus on the expressions the
individual is showing i.e. “you are frowning”.
- Word for word
reflections - interestingly, the dilution of the
person-centred approach is often demonstrated by
simple reflections of this nature. Word for word
reflections must be used with great caution as
they can seem patronising and superficial.
However, for someone with very few words, or who
rarely speaks at all, this type of reflection
can allow contact to be made simply through
hearing the words back in their original form.
- The reiterative
principle - these reflections rely on something
that has worked before. If a way of responding,
or doing a particular thing has established
contact in the past, it is useful to try it
again.
The purpose of the
above points is to enable contact to be
re-established. Most often when challenging
behaviours ensue, it is because there is no
contact or contact has been lost. To change the
behaviour, merely using a behavioural approach
actually increases the loss of connection. For
training support workers, to use these five
levels of responding when problems arise with
clients involves considerable practice and
encouragement. The following transcript provides
an example of what such an interaction looks
like.
Making Contact - An Example Transcript
Ann is stomping about, refusing to listen and
swearing loudly. You want her to come into the
house and have lunch. You’ve been trying to get
her to listen and come in for ten minutes to no
avail; she continues to ignore you all and
continues to rant. Three members of staff are
surrounding her to ensure she does not run off
towards the road, as is her pattern.
Ann (under her breath): Fucking stupid
man, stupid bloody woman, fucking stupid….
One support worker(SW) takes the lead and
tries to make contact. The other two may keep in
the background in case she tries to run. The two
back up support workers say nothing, unless Ann
particularly looks in their direction - if this
happens the lead worker says “you are looking at
…..”, then that SW takes over as lead with the
following:
Support worker: Ann, you seem angry. It is
cold/hot out here. (give names of the other
two carers) and I came to be with you.
Ann (avoiding eye contact, eyes fixed on the
ground and slightly louder): Fucking stupid
man, stupid bloody woman, fucking stupid….
Support worker: Ann, you are looking at the
floor. You are saying fucking stupid man,
fucking stupid woman.
Ann (ignores you, stamps foot and swears
louder).
Support worker: You seem angry, you’re so angry
you stamp your foot (stamping own foot).
Ann (glances briefly in your direction and
kicks out at the wall).
Support worker: Thank you for looking at me. I
see you kick the wall. Sore foot.
Ann (glances again slightly less agitated).
Support worker: Ann, you are quiet maybe you are
thinking.
Ann (screws up her eyes and looks at carer
and mumbles): Stupid man
Support worker (quietly, and screwing up eyes
in the same way as Anne): Stupid man - I
wonder who’s the stupid man…
Ann: Stupid man John.
Support worker: John is stupid - I wonder what
John did so stupid….
Ann (very quietly, but looking at carer):
Stupid man John.
Support worker: Ann, you seem calm now. I would
like to know what John did that made you feel
angry and swear. Can you tell me? (or show me
if that is more appropriate).
Fully Functioning
For people with severe learning disabilities,
the extent to which they are enabled to become
fully who they can be is reliant on their
support workers and families finding ways of
being that increase the possibilities for growth
rather than impede them. Here I have focussed on
training support workers, encouraging them to
become more fully themselves and encouraging
practical ways of understanding the clients they
support. Recently I heard about Mary (not her
real name) who had SLD and no speech. She was
living in a home with care workers who had been
supported and empowered to be with her in a way
that allowed her to grow beyond her extremely
violent and destructive behaviours. They had
provided her with a home where she was able to
feel secure, as evidenced by the decrease in her
destructive outbursts. She needed a high level
of personal care for all of her life, but the
quality of that care had improved, and so she
had been able to change. Her fully functioning
stage of development was demonstrated by what
she taught her workers. Especially in the months
leading up to her death, she taught them that
serenity and acceptance can lighten every day.
She had been reached with loving contact by
workers who were supported to develop ways of
contacting her. To ensure that she always had
that care, those who managed her workers made
certain that every new worker was supported and
trained. Mary died in her own home supported by
workers who had been alongside her and
maintained contact with her till her last
breath.
The phrase “fully functioning” conjures up an
image of a super person, capable on many fronts,
living life to the full and achieving. Mary was
a fully functioning person. She knew how to love
and be loved. Throughout her life, however, she
had the experience of being cared for by workers
who did not know how to make contact with her.
They did not know how to understand her
behaviours, and as a result her destructive
behaviours had increased. Fortunately for Mary,
she had an advocate, who fought for her to have
her needs met and understood. Unfortunately this
is not the case for most people with SLD.
Community
The trend towards “care in the community” which
has “dispersed” (Thompson & Mathias, 1999)
people with SLD and severe long-term mental
health problems from long-stay institutions into
the community has behind it the assumption that
there is a “community” to go to. In practice, it
is often not the case. If we think about what
community means, for many of us it means
connection with family first, and with those in
close proximity who become friends. For many of
the people I have seen in my therapy practice
who have SLD, they have been placed in homes in
local communities with the best of intentions.
Most of us would rather live in an ordinary
house, than in a hospital or other large
institution. However, many of my clients had no
choice in the matter, as no one knew how to make
contact at depth with them. Some who can speak
have told me of the day they were put on a mini
bus and taken to their new home. The sense of
loss does not go away. For these people the
community and connection was with the hospital,
institution, nurses and other patients. For
these people to find a sense of belonging, they
need support workers who are able to make real
connections, real relationships. For this the
workers need to feel empowered, supported and
given skills in understanding what behaviours
might mean for the individual. Support workers
need time and encouragement to develop their
empathy and their skills in establishing and
maintaining contact with clients who have severe
learning disabilities. There needs to be a
structure for this training and development that
goes beyond the one or two day training event.
Every behaviour is a communication - if we can
keep an open, accepting attitude, communicate
empathic understanding and be willing to share a
real, genuine relationship with support workers,
they will in turn develop the ability to embody
those qualities in their relationship with
clients. All clients challenge in their own
ways, and it is within relationship that
co-operation can be modelled and encouraged.
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Jan Hawkins
Contact Details:
The Foundation for the
Developing Person
376 Hale End Rd,
London, E4 9PB
Tel/fax: 020 8 531 9760
www.janhawkins.co.uk
Copyright © Jan
Hawkins 2007
This material may not be
reproduced without the written permission of the
author.
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