By Anne Laney, Practice Manager

Many of the people we support have a favoured object, which seems to have particular importance or significance to them. They may hold it, flap it, mouth it, or seek it out with determination. As we become increasingly aware of the impact sensory processing has on people’s ability to engage with the world, and how they may use these things to alleviate anxiety and establish their sense of self, we become increasingly aware of how important it is to work with them to explore how these items of safety can become gateways to shared engagement. Often, when we begin to build our relationship with people, and sometimes for a considerable time, people are reluctant to share or be parted from their favourite thing. And, we must ask ourselves, why should we expect them to? They may serve a vital role in how they make their lives work. The impact of not having access to them can lead to them feeling adrift, anchor-less, unsettled, and in some cases provokes huge anxiety. Of course there is sometimes a simpler explanation for why someone is so focused on something they are manipulating. It may be that the object is, to them, just more interesting, exciting or predictable, than people have proved to be.

When used creatively, with Intensive Interaction at the core of the process, favoured equipment can form the foundation of strong and trusting relationships. Sometimes the object eventually becomes superfluous as the relationship grows and the person discovers, and explores, how human connection can be as fulfilling and pleasurable as time spent with their favourite possession.

Us in a Bus began working with Rebecca when she was in her final year of school. We have been fortunate to follow her through her attendance at two further education colleges, with home visits during school/college holidays. This case study sets out our journey with her, and illustrates how Intensive Interaction can play a role in supporting people to gain confidence to communicate and to express their wants and needs, establishing resilient and adaptable qualities that will hopefully extend to other areas of their lives.

Our initial sessions with Rebecca were spent exploring her range of vocalisations, in conjunction with her preferred objects. At the time, these were tactile books which she explored with her thumbs predominantly, saying “feel it, feel it” frequently and with great enthusiasm. We quickly established several things.

  • These books formed a safety net for Rebecca. Feeling the books (or often the carpet, or sofa) seemed to provide a sort of “reset” for Rebecca’s sensory world. Perhaps when she was experiencing interaction that was becoming too intense? Often an increase in unexpected or unfamiliar sensory or social contact creates an overload of sensation that becomes uncomfortable and necessitates regulating in some way. People are incredibly skilful at knowing when and how to do this but the methods may look strange to others
  • We were not allowed to be in charge of the books for anything other than a short period of time, although she was willing to hold them out to us for us to feel.
  • Rebecca seemed to enjoy our echoed and mirrored responses to her suggestion we “feel it”
  • When we responded by embellishing her words slightly she became more interested, especially if we used alliterative words. 
  • This interest often developed into laughter, especially when we left large spaces and waited for her to say her next word before we responded.

We also noticed how frequently Rebecca looked closely at our mouths as we were echoing her sounds and words. Over time, we came to think that she was becoming increasingly aware of the connection between how our mouths looked and what the sound was. She occasionally seemed to ‘test out’ a shape and then utter a variation of a word. 

We spent many weeks exploring her books, feeling them when directed by her; always handing them to her when asked; creating daft stories about the characters; exploring the tactile concepts as widely as we could. We established a trusting relationship with her with Intensive Interaction at its heart, within which we responded reliably, always following her lead and encouraging her to control our interactions. 

After some discussion, we agreed that offering some alternatives to her ‘feely’ books would be a way of testing Rebeccas level of attachment to, and interest in equipment. We also thought that our objects would offer her opportunities to expand her experiences and potentially spark her curiosity. We chose a variety of items that were all visually appealing, interesting for tactile exploration and some of which made musical sounds. Placing them all in a large, red, plastic bucket, we proceeded to encourage Rebecca to explore the items however she wanted to, following her lead as she twirled ribbons around her fingers or poked her fingers into the back of bricks. We used all her vocalisations, repeating and often embellishing with alliteration and playfulness. 

A good example of this is our joint focus on “The ball with the bell that goes bing”. 

Rebecca often used the word “bing” and even more frequently “boing”. 

We supplied a ball that happened to contain a bell. The articulation of the sentence above was ours, but its content was Rebecca’s. The rhyming was us, responding to Rebecca’s expressions of pleasure when we suggested words that would fit. The fact that the sentence (together with close focus, eye contact, laughter and physical exploration of the ball) provided the basis for an interaction that lasted for 20 minutes illustrates so many things about fundamental communication skill acquisition. Repetition is good. Actually it’s more than good, it’s vital. Operating within a relaxed and unpressured environment maximises opportunity for concentration. Creating fun and laughter is motivating. Having the confidence to be led entirely by the person you’re with, without making demands, is an incredibly successful way of actively exploring how they can have a positive influence on others. These interactions provide the ideal environment for encouraging expressive language, and treating these expressions as communicatively significant maximises the possibility of them becoming intentional and meaningful.

Gradually, the “feely” books became almost superfluous. They were still present, but Rebecca rarely chose to access them except occasionally when a new member of the Us in a Bus team visited. This added to our thoughts that they acted as a “safety” net for her.

We consciously began to take less equipment with us in the hope that Rebecca’s need for the safety net of “things” would be replaced by her recognition that we were, in fact, more interesting than equipment and could provide the same level or consistency of response but in a slightly different way. In the same way a fluffy book felt the same each time she rubbed her thumb over it, we could be similarly reliable and consistent each time she vocalised. The responses from Rebecca were reassuringly reflective of our hopes. She did indeed seem to consider us – the Us in a Bus practitioners – as a stable, consistent alternative to things. She did not demonstrate any desire (and therefore presumably need) to calm her internal processing systems by “feeling” and “fiddling”. Our time together became entirely based on an exploration of how we could maximise the social and wonderfully warm connection we had established. 

For the last year, we have been visiting Rebecca at the college she attends. 

We take no equipment with us and spend time continuing to investigate how Rebecca can build upon the confidence she has gained to both initiate communication with us, and persevere to make herself understood. Her vocabulary is increasing and she is linking words together to form sentences. She is exploring concepts such as “taller and shorter” and most exciting of all is spontaneously inviting turn taking and sharing, both of which are significant developments in understanding of the social world and communication. The clearest example of this developing awareness of other people, was illustrated when she carefully took a bracelet off the wrist of my colleague. She explored it carefully, handed it back to her, looked at her, smiled, gently took it back again and then passed it to me. We sensed she had a real understanding of fairness. She seemed to want to ensure we had equal access to this thing. This is a significantly more advanced communication tool than the very definite holding on to her favourite things from when we first knew her. On a very recent occasion, she welcomed a brand new practitioner with the most welcoming manner, almost affectionately drawing her into our space. She seemed to be saying “come on in, the connection’s fine”.

To finish, a quote from Rebecca’s mum which we think illustrates that all we hope for Rebecca is happening.

“She is doing really well at college and really benefiting from the sessions she has with “Us in a Bus”. She is much more aware and lets us know if she wants to do a particular activity or go to another room etc. She will gently nudge you on the arm, which is really great as she has always had such a placid nature. It is so good that she is not content to just let people ignore her, as this can happen as she is such a happy young lady”.

Possibly one of the most pleasing aspects of our journey with Rebecca is how her family reflect upon the changes in her. They describe everything that we hope will happen. An increase in self esteem that translates into having the confidence to express wants and desires, the motivation to connect with others (because people are interesting after all) and, most importantly, the recognition of the role of Intensive Interaction in this process. It offers a genuinely effective tool for supporting people at times of transition, and ensures that the person, the essence of who they are, remains the focus as they run the gamut of education and life skill acquisition. 

In the words of Oscar Hammerstein “I simply remember my favourite things, and then I don’t feel, so bad”. We must always remember the importance and significance of people’s favourite items. Intensive Interaction gives us the perfect way to become someone’s favourite thing, opening to them the possibilities and excitement of venturing out of their safe inner world, into our stimulating and social one.  

December 2019


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Published by

Marilyn Anderson

10 Dec 2019

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