'Being with' and 'making psychological contact'- fostering the development of the person’s sense of self?

Writing last week about the term 'Being with', which was used by Ben Smith in the new book Integrating Intensive Interaction (2017, Routledge),  well it made me think about the conclusions that were drawn (mainly by Dr Ruth Berry) in our 2014 paper: ‘Clinical Psychologists’ Views of Intensive Interaction as an Intervention in Learning Disability Services’, Berry, R., Firth, G., Leeming, C. & Sharma, V. (2014) Clinical Psychology & Psychotherapy, 21 (5), 403-410.

In our research we interviewed some Intensive Interaction minded clinical psychologists to gain insight into their views on and use of the approach. One of our findings was that:

'... the participants were using Intensive Interaction to establish psychological contact with people who are difficult to reach ... as one participant emphasised: ‘you can’t overstate the importance of communication: without it you can’t interact and without interactions you can’t have a relationship’.'

Also: '[The] participants talked about using Intensive Interaction with people who are difficult to reach and their comments about its benefits can be understood in Person Centred Therapy terms; they described it as a means for establishing psychological contact.'

Now apparently (and please remember, I am not a psychologist) Person Centred Therapy (also known as Rogerian therapy as it originated from the work of the American psychologist Carl Rogers) is an established form of therapy that is designed to  promote improved psychological well-being by helping a person develop their self-knowledge and self-awareness. The therapeutic process aims to both nurture psychological growth, and also through the therapeutic process reduce a person's emotional distress.

So just 'being with' someone, and doing so with 'unconditional positive regard' (as Rogers would say), could justifiably be seen as a humanistic psychological intervention to help those people who, for a number of reasons, are difficult to socially engage. Extrapolating that thought, surely Intensive Interaction could therefore also be seen as a therapeutic tool that, by developing unconditional inter-subjective communication, directly fosters psychological contact and thus has the clear potential to promote emotional well-being.

So perhaps there needs to be more work (in 2018?) directly linking Intensive Interaction conceptualisations to established psychological theory? As we (well Dr Ruth really) say in our paper, we need to do this:

'....[to] create the prospect of an evidence-based therapy for people who are unable to access traditional psychotherapies but may be in great need of experiencing psychological contact and connectedness'.

Rogers C. (1957) ‘The Necessary and Sufficient Conditions of Therapeutic Personality Change’ Journal of Consulting and Clinical Psychology, 21, 95–103.

'Being with' - some more Intensive Interaction thoughts …

As I said in my last blog, I am currently reading the new Intensive Interaction book 'Integrating Intensive Interaction' - I'm a really slow reader! 

The bit that is making me think this week (it's like I can only have one thought a week - and to be honest, that is probably just about enough for me) comes from the chapter: ‘Intensive Interaction: from Einstein to Lady Gaga’ by Ben Smith (what a title Ben, that's brilliant!). 

In this chapter Ben, a team leader in the West Wales Specialist Behaviour Team, recounts how Intensive Interaction changed his focus from just behavioural modification to also look at relationship development and emotional well-being. Ben’s re-evaluation came about through his work with a socially isolated man called Mick, but he also talks more generally about using behavioural approaches with service users.

'...utilising often powerful reinforces and incentives to get ‘control’ over or suppress other human beings behaviour in order to attain participation and activity engagement goals or ‘better quality of life’ feels somewhat adrift of the care values statements of many service or care providers (p 104).

He goes on to say: '... simply ‘being with’ each other has equal if not more significance than ‘doing things’ with each other and if the ‘being with’ is done well, it can be immensely mutually satisfying and pleasurable. (p107).

'Being with' is a term I seem to hear more often now, and I have previously tried to usefully define this state of ‘being with’ someone in an Intensive Interaction way (initially in 'Firth, G., Berry, R. & Irvine, C. (2010) Understanding Intensive Interaction: context and concepts for professionals and families, JKP: London), where I refer to it being synonymous with more prosaic phrases such as: ‘tuning in with’, ‘attuning to…’, ‘going with the flow’, ‘just hanging out with…’, ‘chilling out with’, ‘sharing quality time with…’. I go on to say that: 

Just ‘being with’ someone can only happen if we put to one side any agenda of physical care, behaviour modification or educative development, enabling us to share moments with people in a way that is truly non-directive. (p.58)

However looking at this now, I think that it defines 'being with' as some things or qualities that it isn't, and perhaps it would be better to also define it by the characteristics it actually possesses. So, my most recent attempt to pin it down (rationalised with the help of my most estimable colleague Dr Jon Wain) is that the state of ‘being with’ someone is a social state that is: 

Purely equitable, two way, task-less,  contingent, emotionally attuned, negotiated in structure, open ended, and purely social in nature. 

(Please see the colour-coded diagram below which sets 'being with' apart from other social (or non-social) contexts that people in support roles may also need to enact) 

Does that help?
 

A new Intensive Interaction book & a new Intensive Interaction thought …

I am currently reading the new Intensive Interaction book recently published by Routledge:

Integrating Intensive Interaction

(edited by Intensive Interaction coordinators Amandine Mourière & Jules McKim).

Generally, as I read books that I feel I should fully understand, I take brief notes of any noteworthy points, statements or passages that I think illustrate something of particular significance or that are particularly insightful or thought provoking (and also that I think I might quote at some point later to make myself appear intelligent and well-read).

So here I will share just one statement from this book that stopped me a bit in my tracks, and set me musing for a while. This was from the chapter ‘Building an emotional connection through Intensive Interaction’ by Lucy Hankin. Working with Vincent, a 7 year-old boy who was ‘difficult to reach’ and ‘socially isolated’, Lucy relates how her Intensive Interaction practice developed hand in hand with the progress of Vincent’s abilities to connect with her.

At one point Lucy writes about watching some video of her Intensive Interaction with Vincent and noticing that ‘as Vincent was walking past he would gently touch his hand on my arm in an affectionate way: it was his way of keeping in contact with me as he moved around the room’.

And that observation led her on to make her next statement: and the bit I have underlined is what struck me as an extremely simple but also a profoundly insightful concept:

‘As this emotional connection [between herself and Vincent] continued to grow, the way he used touch also developed a further fluency as Vincent developed it alongside other fundamentals of communication…’

That bit about Vincent gaining ‘fluency’ (i.e. the ability to express himself more easily and more articulately) with touch … or more specifically gaining ‘fluency’ in the communicative and social significance of sharing touch with someone else … well I thought, what does that really mean for Vincent, and more broadly, for us?

I am still musing on this, because if we can help develop someone’s fluency in a pre-verbal means of fundamental communication, does that then directly equate touch as a means of sharing some form of inter-subjective meaning, and therefore it being an identifiable ‘language’? And does that idea of fluency also pertain to exchanges of eye contact and facial expression?

Well yes, I think it does, if we conceptualise the intentional sharing of touch, or eye contact or facial signalling, in a ‘language’ kind of way… and I’m still musing on the further issues of what does conceptualising touch (or eye contact or facial signalling) as a meaningful ‘language’ in which we can become more fluent mean for us, for children like Vincent, and for many other people who are ‘difficult to reach’ and ‘socially isolated’?

We teach foreign languages as specific ‘compulsory’ subjects in schools, but not fundamental communication for those who aren’t yet fluent [unless the school ‘voluntarily’ uses Intensive Interaction]: why is that? 

Being 'mainstream' but not yet 'established' ... continued

At the start of last week I received a copy of a report about supporting people with profound and multiple learning disabilities. 

SUPPORTING PEOPLE WITH PROFOUND AND MULTIPLE LEARNING DISABILITIES:'CORE & ESSENTIAL SERVICE STANDARDS'
(by Dr Thomas Doukas, Annie Fergusson, Michael Fullerton & Joanna Grace)

Developed with the help of a diverse group of family members, professionals and academics 'these Service Standards are the result of a positive and passionate desire to ensure people with profound and multiple learning disabilities, regardless of age and circumstance receive excellent support and services consistently and are always respected as a person' (from the forward by Rt Hon Norman Lamb MP).

These standards outline a number of key objectives and principles that should be adopted by commissioners and service providers so that families and other representatives can be clear about what level and type of support and services they should expect for the person they represent. The report is available via the PMLD Link website, and so please go and download it for free at: www.pmldlink.org.uk/resources/#commissioning

The authors of the report hope that these standards will be adopted nationally - and this point reminded me of my previous blog (04/08/17) in which I made the point that Intensive Interaction is now a mainstream approach (and it is therefore included in this report), but not yet an established one - it doesn't happen as it should, as a matter of course! We still need to continue our work in the areas of dissemination and sustainable practice and service level development more broadly.

Anyway, back to Intensive Interaction, which is represented in four sections of this report:

Individual Standard 1: Communication
2b. Continuity of communication is demonstrated ... paying particular attention to gaining insight from those who know the individual best (e.g. family and familiar support staff) and then as many perspectives as possible, utilising as many avenues for understanding (e.g. Intensive Interaction, sensory engagement such as hydro, massage, music, responsive environment etc.)

3b. Supporting staff are skilled in delivering a total communication approach, e.g. sensory engagement, Intensive Interaction, routines and sensory cues, objects of reference.

Individual Standard 3: Meaningful/Quality Relationships. 
9. Staff understand the implementation and benefits of safe touch (functional use of touch vs. natural and emotional touch) and Intensive Interactions techniques.

Organisations Standard 3 : Staff development (skills and confidence)
2. All support staff receive regular in-house training, refreshed at appropriate intervals. Such training includes Total Communication, Manual Handling of People, Postural Care, Intensive Interaction or Sensory Engagement, Active Support, Safe Eating and Drinking skills, Supported Choice and Decision Making, involvement in services etc.

Finally I will leave you with a great quote from this report: 

“A person’s ability to communicate is not dependent on their being able to master certain skills, it is dependent on our ability to listen and communicate responsively” 

Jo Grace, The Sensory Projects