We visited Claire over a period of months. She was very anxious in all aspects of her life and would defend against her fears by drawing her knees up in her wheelchair, tucking her head in by her knees and shrieking a loud upset sounding vocalisation. As someone who rarely made any other sounds, when she responded like this it was distressing.
Claire seemed to enjoy watching our interactions with others, suggesting at least an interest in us, which her fears appeared to inhibit her from experiencing directly. She responded calmly and compliantly when home staff used, kindly, functional touch and close proximity. We used these observations to guide our practice, initially bringing our interactions with others nearer to Claire and using a running commentary at times, so she could build associations with our voices, actions and the positive responses from the other people present. As she accepted this closer proximity we began offering incidental touch to her wheelchair frame only, Claire would balk at this and begin to lift her knees and every time she gave us these signals we withdrew, giving her the strong message that we were listening to her fully and that she was in ultimate control.
But! Withdrawing does not mean stopping!
We continued this repetition, ever so slightly increasing our input until the touch was comfortably received on the wheelchair and tentatively received on Claire herself. We began to respond to Claire’s anxiety signals by pausing rather than pulling away and Claire developed the confidence to push our hands away if she wanted to, or keep them in situ, while relaxing again, if she wanted. This further developed, into Claire pushing our hands away but keeping hold of them and then pulling them back.
Fast forward, and now on a weekly basis Claire reaches for our hands, manipulates our fingers between hers, while smiling. She hasn’t expressed distress vocally for weeks and seems to trust us. We are able to continue extending her comfort zones and Claire is discovering things she enjoys and can control, enhancing her life through new experiences. Claire actively joins in with group activities, after a period of observation and although she still shows signs of her anxieties, she now seeks us for support and reassurance.
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