Intensive Interaction: is it ‘different paths, but with same goal’ or ‘the same path, but with different goals’ 

I was recently reading an online piece about my beloved football team 'Uddersfield Town. The obviously very clever (and/or very pretentious) sports journalist quite surprisingly quoted the renowned German philosopher Friedrich Nietzsche. He did this in respect of the different ways of playing football that the very successful 'Uddersfield Town manager had used with his team (be patient, this blog will eventually get around to Intensive Interaction at some point). 

Remember - after a few years in the footballing wilderness 'Uddersfield Town are now on a journey to the upper-reaches of the the English Premier League (and have recently beaten Manchester United - a team followed mainly by fans who journey from outside Manchester!)

Anyway,  the quote he used was this:

‘Many are stubborn in pursuit of the path they have chosen, few in pursuit of the goal’

All well and good, I hear you ask, but what has this to do with Intensive Interaction?

Well, I recently got a copy of a book on using Intensive Interaction strategies with people with late stage dementia. This book, called 'Adaptive Interaction and Dementia' by Dr Maggie Ellis and Prof. Arlene Astell, sets out their case on 'how to communicate without speech' with people with late stage dementia by referencing strategies set out by both Hewett & Nind, and Phoebe Caldwell in their respective books on the approach. 

In chapter 3 of this book, 'I Hear You Now - Collaborative Communication', Ellis & Astell set out what they see as contrasting conceptualisations of Intensive Interaction, and the person with whom the approach is used. In referencing the works of Hewett & Nind they say that 'some practitioners consider the focus of II to be on teaching the 'pre-speech fundamentals of communication'' and identify 'the communication-impaired partner [as] the learner'. They contrast this view of of II with that of Caldwell, which posits 'the caregiver or professional as the learner, attempting to 'learn the language' of their partner'. Interesting views I'm sure you'll agree.

Where do I stand on this: well I see the merits of both positions. With any collaborative  social endeavour learning goes on on both sides - but, I think, possible so at different points in the II intervention. Initially I see a 'social inclusion aspect' of an intervention where the practitioner learns how to adapt to the communication impaired partner's preferred and available means of social expression. But then I hypothesise a developmental process subsequent to successful social inclusion* - and I don't discount this even potentially for people with late stage dementia. 

However I don't see any developmental aspect for people with late stage dementia as necessarily being reliant on any retention, via short term episodic memory, of recent engagements with II (which may effectively be absent for some people with late stage dementia). However I do see there being the potential that repeated practising, and therefore neural accessing, of previously retained understandings of 'pre-speech fundamentals of communication' through II, could have a cumulative effect of improved access to those social understandings and associated social functioning.

I think this because of a paper Intensive Interaction: to build fulfilling relationships, by Charly Harris  & Emma Wolverson (Journal of Dementia Care, 2014), which pointed to some small but noticeable cumulative  improvements in the duration and ease of initiation of social engagement, over time, for some people with late stage dementia when using Intensive Interaction (although admittedly from a  small scale study).

This brought to mind another philosophical quote that I have liberally used myself over recent years, this time by Plato (who's being pretentious now, eh!) who apparently said that 'The greater part of instruction is being reminded of things we already know'! - Teaching being mainly about building upon the current knowledge base i.e. in II building on the current but potentially latent social skills and understandings that a person already has, and which are not being used to the maximum potential.

So, perhaps the two potential paths of II are not actually separate then, perhaps they are just temporal stages on the same path, and after successful social inclusion it is a journey that we go on, and learn on, together. Surely it is the pursuit of the universal goal of improved social engagement and connectedness (over both the short and longer term) that is the thing that we should be most stubborn in pursuing!

(p.s. I think that philosophy must be the new 'rock & roll' - even non-pretentious, cheeky-chappy, cockney comedian Micky Flanagan quoted existentialist philosopher Kierkegaard on Desert Island Discs last week - so its not just me!)

(*see: Firth, G. (2008) ‘A Dual Aspect Process Model of Intensive Interaction’, British Journal of Learning Disabilities, 37(1), p.45-49.)