By Carol Thomas
At Us in a Bus we work with adults with learning disabilities and complex needs. We use an approach known as Intensive Interaction to foster communication and make connections with people, but this is not all we do. One of our unique selling points is that we work with people in groups, something which may seem a little unusual, especially if you consider Intensive Interaction at its purest.
There is nothing more connected, more fundamental than having relationships with others and In a normal day I spend time with my partner, my work colleagues, staff at care homes (among many others), and all enable me to form relationships in their many different guises. Humans form a wide variety of these relationships which serve different emotional, social and practical functions. Familial relationships are rooted in biology and early socialisation but may also vary culturally. Romantic relationships involve emotional and physical intimacy, love and commitment. Our working relationships are typically structured in a hierarchical way but with shared goals. There are acquaintances, people that you may have a more superficial relationship with. Then there are mentors, teaching relationships as well as transactional relationships where you engage for a specific reason such as to acquire services.
Some of the people we see may have difficulty forming and developing these relationships for a number of reasons which include the following –
· Communication skills – Difficulty with expressive language/verbal skills, understanding social cues, processing language.
· Emotional Regulation – Struggles with managing frustration, anxiety or emotional responses.
· Executive functioning – Trouble organising thoughts or remembering details.
· Social Understanding – People with conditions such as Autism.
· Physical or sensory disabilities
Every home and set-up are different, every person having their own unique challenges that may impact on their ability to connect and communicate in a way that is meaningful. Sometimes we aim to simply enable people to experience empathy, to experience ‘other’ in their world and all the positive experiences that could open up to them. By using Intensive Interaction to create a bridge between someone’s own internal world and that of the outer world, we also offer the opportunity for that person to influence the outside world. For everyone to be a part of what they are offering. To share behaviours that may be perceived as isolating with others so that they can sense the good feelings that come from having that sense of direction and control over others.
The groups we facilitate vary in number, with a maximum number of 6 people. Once larger than this, it can be difficult to maintain focus and connections can be overly diluted.
It also seems a pertinent point to visit the fundamentals of communication here as well, as these points help assimilate the benefits of this group experience.
The Fundamentals of Communication as adapted by those originally made by Melanie Nind and Dave Hewitt –
· Learning to give brief attention to another person.
· To share attention with another person.
· Learning to extend those attentions, learning to concentrate on another person.
· Developing shared attention to ‘activities’
· Taking turns in exchanges of behaviour
· To play and have fun.
· Using and understanding exchanges in eye contact.
· Using and understanding facial expression.
· Using and understanding non-verbal expression such as body language and gesture.
· Learning use and understanding of physical contacts
· Learning use and understanding vocalisations, having your vocalisations more varied and extensive, then gradually more precise and meaningful.
Intensive Interaction can be used very successfully to facilitate and support relationships within groups of peers or housemates.
We make group sessions from around 40% of the sessions run. Sharing the facilitation, two practitioners are then able to ensure that those who may require some extra inputs are able to receive this, as well as having two sets of eyes to ensure that we are not missing any of the subtler communications throughout.
These group sessions offer several valuable benefits. This may include social learning and peer modelling. Seeing or hearing others engage may encourage imitation of sounds & gestures. The group setting lends itself to a sense of community, with relationships extending outside of the hour-long session. Groups offer a natural environment for practicing social engagement and as the focus is not simply on one person, anxiety may be reduced. Participants can choose how and when to engage. We often sing variations of a tune we call the ‘resolution song’. We leave pauses for people to fill with their sounds, movements or simply their expressions. Group sessions are perfect for enabling unstructured or unexpected moments of authentic connection. Groups also enable turn taking and shared attention. Skills such as watching, waiting and joint attention may develop more naturally in a group setting.
Let’s not forget there may also be a practical reason too. Group sessions allow for more individuals to access support with fewer resources especially useful where funding may be difficult. In these challenging financial times, this may mean the difference between someone receiving input or not.
We do have to balance the benefits and possible downsides to the individual when considering a group setting. Groups aim to be inclusive and supportive but there may be occasions where it is simply not in the best interests of the person to work this way. Groups can sometimes take time to bond and to become cohesive times where we are able to share whatever people may bring.
During a group session that another practitioner and I facilitate, the people in the group have changed a great deal over the years due to the deaths of some of those. This changes the dynamic and adds a layer of emotional complexity. The group was initially made up of 6 (the maximum amount that we feel is practical & ideal for those involved). There are now 5, all with very different levels of disability and need. There is a lynch pin person, as there often is. I’ll call him Edric. He is a man with such enthusiasm, joy and level of engagement that he easily becomes the catalyst for connection to everyone else. He chooses who we should sing to first.
Doing so by looking in the direction of that particular person when we ask, “who should we sing to next?”. He seems to appreciate banter and playfulness and when we suggest he is in charge of the group he laughs at a feverish pitch. We have in fact appointed him an honorary practitioner and made him a badge to reflect this, which he almost screams in celebration as we notice when he is wearing it.
Then there is a gentler lady, Lola. She seems to understand a lot, is non-verbal and indicates her preferences for objects by reaching out her hand, very slowly and deliberately, like the queen holding out a hand for a royal introduction.
Ellie, who is more vocal can form a few words, but directs us by pushing our hands in a particular direction.
Pauline is usually curled up tightly and seemingly oblivious to the world. And finally Barney, who is full of laughs smiles and demonstrates his level of audio overwhelm by putting his fingers in his ears so he can presumably hear the internal deep humming that he makes at the same time he has his fingers in his ear.
On first observation, they all seem to have their own way of being in the group and it seems difficult to think about how they currently might ‘notice’ one another. Suddenly, Ellie calls out and we start to sing hello to her. She takes a hand, drawing us in momentarily before directing us to something that she wants.
We go around the group singing hello to each person in turn and, while with Pauline, echo her subtle, high-pitched sounds. We stretch a rapper snapper (an extendable tube through which we can amplify sound) between her and the person next to her. We then echo their sounds through the tube, making it clear who this has come from. We then get a response from Edric. He has been watching what we’ve been doing, and he finds it amusing. We offer him 2 instruments with which to join in with the Pauline’s vocalisations that echo in a melodic way. He chooses the keyboard which, with great effort he plays, concentrating as he taps on the keys. Ellie then joins in with a tambourine that was already in her lap on our arrival. As we celebrate her joining in, she smiles and laughs, playing it even harder by shaking it vigorously. This may well not have been a deliberate act, but by responding we hope to foster her awareness of others and increase her understanding and appreciation of those that live with her. We notice Pauline physically uncurls and sits up a bit more and we see a hint of a smile across her face when we notice and share things that others do.
At this point, Barney starts lifting his arms and laughing too, so we offer him 2 instruments. He seems to make a very positive, deliberate selection and starts scratching his fingers to play it in his own way. We are aware of his apparent love of rhythm and tapping and we simply aim to celebrate this, hopefully creating a shared experience rather than an internal isolating action. As we move over towards Lola and begin to share what everyone is doing, she vocalises. We join in, echoing these vocalisations back to her, letting her know that we have heard her. She then vocalises louder, and we match this pitch and volume. The whole room builds a crescendo of music until suddenly and seemingly intuitively everyone stops all at once. We end with a big cheer.
We have managed to connect this group of seemingly unconnected individuals in a variety of ways, and when we do there is something almost magical in the shared experience. This is what we aim for. Engaged moments, where people are aware of others around them, sharing some laughter, fun and connection.
Ultimately the groups work as a result of the underlying approach that we use known as Intensive Interaction. This is the key to unlocking each individual and then being able to facilitate a sharing of this experience with others. If the main points of Intensive Interaction are to build trust and relationships through shared activities and enjoyment, to encourage shared attention, to promote turn taking and joint attention while strengthening non verbal connection then groups are definitely one of the ways that we can achieve this.
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