By Janet Gurney, Director of Training
I’ve been delivering workshops about Intensive Interaction for nigh on 20 years now, and have stood up in front of groups of expectant participants more than 1000 times. You might think by now that I wouldn’t get nervous before a workshop, but to be honest, I would be worried if I didn’t feel a shiver of anxiety before I launch into the introductions. And that is because it is hugely important to me that I do justice to the subject matter – and to the people who have supported me to know about it; among them, Phoebe Caldwell, Dave Hewett, Melanie Nind and the hundreds of people with profound and multiple learning disabilities and complex needs I have met over the last 30 years.
Now, when I feel anxious, my knees get a bit wobbly, which makes me shuffle my feet. I might grip my marker-pen a bit tighter, lean back on the sharp edge of the table behind me, or clasp my hands together. Do you recognise that sensation? It is a pretty universal physical reaction to anxiety. What’s happening is this: When I am anxious, my sense of proprioception (the sense that tells me exactly where my body is and what it is doing), is momentarily inaccurate and I cease to feel ‘anchored’; so I automatically and unconsciously increase the amount of proprioceptive feedback I am sending my brain – by clenching my fists, crossing my fingers, etc..
There is a brilliant BBC documentary ‘Dissected – the Incredible Human Foot’ [available here on iplayer – https://www.bbc.co.uk/iplayer/episode/p01mv2rj/dissected-2-the-incredible-human-foot] which looks at the science behind this sense (you might want to skip the first 45 minutes if dissection isn’t your thing!).
So, what is the link between this and the way we can support people with pmld/complex needs? Understanding the sensory processing issues that will be a daily reality for many of the people we support, allows us to present ourselves in a way that is less challenging for them. It means we might be able to understand the things they do, from their perspective rather than ours. A workshop participant recently said to me “This really helps me to stop making assumptions and judgements”. It also means we can interact in a way that doesn’t just notice, but addresses the sensory issue. I hope the following case study illustrates this:
Sarah is a lady in her 40’s. She has autism and, we think, quite a mild learning disability, although because she does not use language, she can give the impression of having a more complex learning disability. We meet Sarah at the day centre she attends 3 days a week. The staff team who support her are clearly fond and protective of her, but worry that she is not happy. Sarah spends much of her time there wandering around, looking at the ground rather than at people and often approaches the door and reaches for the door handle. Staff think this means she wants to leave and encourage her away from the door. Sarah complies with this request, but without glancing at whoever makes it – and with no obvious sign of pleasure in their company or any activity they offer.
We are invited to meet Sarah to suggest ways to engage and connect with her. We start by watching closely what she actually does, to see if this can give us ideas about how she is feeling and what the significance of her actions are. We start to wonder if what she is showing us, are the actions she uses to help mitigate the impact of the sensory processing issues, which her autism presents her with. We notice that she walks with an emphatic, regular rhythm – almost a stomp; she swings and shakes her hands, constantly twiddling her fingers. We see that when she reaches for the door handle, which is long, flat and made from smooth metal, she doesn’t hold it, but presses her fingers firmly against it, rubbing the side of her thumb on its edge. We think all of these actions are showing her need to give herself extra proprioceptive input. Proprioception is our sense of where we are in space; if we are not accurately processing the proprioceptive input our brain is receiving, we will naturally find a way to increase the input until we ‘know where we are’.
So… using this observation and the principles of Intensive Interaction (a way of mirroring someone’s own actions to acknowledge them) we start to walk in a similar way to Sarah, not following her (no-one likes that!) but walking where we think she can watch us indirectly, as she seems more comfortable using her peripheral vision. We swing our arms in a similar way. When we think she is beginning to notice us – and more importantly, show a little bit of interest in what we are doing – we exaggerate our movements a little. She looks at us a little more directly. When Sarah approaches the door, one of us quietly follows a second or two later and stands against the wall, where we can reach the handle, but careful for our body language and facial expression to convey interest, instead of any “Come away” signs. When I see Sarah pressing and rubbing the handle, I reach out and do the same (resisting any urge to embellish or comment on the action). After about 30 seconds of this, Sarah turns her head and makes direct eye contact. She doesn’t smile – so neither do I; I don’t want to lead her or change her mood. The most important message we want to convey is that we notice and value her. Whilst in this position, I notice that the skin of her index finger is hard and calloused – and think this might be evidence of years of finger chewing – more evidence of her need for proprioceptive stimulus. I gesture towards her hand and then reach out and hold her index finger firmly, figuring that applying pressure may be another way of acknowledging and valuing her. Sarah doesn’t resist my hold; in fact she leans in towards me and I see her shoulders drop, as if in relief or comfort. Again she looks right at me, and I see a little flicker of amusement (or recognition?) in her eyes.
One of the many exciting aspects to this exchange is that it is something any of Sarah’s support team can do. They are keen to learn, once they see how engaged and connected Sarah is when we enter her world, rather than expecting her to enter ours. A solitary, self involved ‘behaviour’ soon becomes a shared social activity. Sarah relaxes and her team stop worrying that she wants to leave the room – the door handle becomes a starting point for many conversations-without-words.
If you are interested in learning more about sensory processing and how you can use it to enhance your use of Intensive Interaction, I would love to meet you at one of our workshops. Our ‘open to all’ workshops in Redhill are [8thMay (a few places left), 6thSept, 3rdDec 2019] http://usinabus.org.uk/what-we-do/training-consultancy/.
Go to www.caldwellautismfoundation.org.uk to watch the Responsive Communication films of Phoebe Caldwell and myself discussing this, and/or read Phoebe’s book “The Anger Box” (Pavilion Publishing 2013)
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