More 'indirect' evidence in support of Intensive Interaction practices?

Continuing the theme from my recent blog (Using 'Perseverative Interests' ... 02/04/18) about 'indirect' evidence supporting aspects of Intensive Interaction practice, I was recently pointed to an interesting case study (by II Institute Associate Jules McKim) that described the use of 'silent mirroring' in the treatment of Ms M., a 75 year old woman with a diagnosis of chronic paranoid schizophrenia, dementia with agitation, and several medical problems. Below I set out some extracts about the case from the paper:

The Mirror of Silence: A Method of Treating a Preverbal Schizophrenic Patient

Susan R. Blumenson (1993) Modern Psychoanalysis, 18(3), 179-189.

‘During her 3 years in the nursing home Ms M. spent her time in bed or in a wheelchair ... she was minimally verbal and unresponsive ... When spoken to or questioned, Ms. M. would turn away without responding ... She was agitated much of the day – constantly shifting from side to side in the wheelchair crossing and uncrossing her legs, turning her head, placing her hand with outstretched fingers over her face covering her mouth, nose and eyes.’

The 3 months of treatment for Ms M. was described  by the clinician as 'basically silent mirroring of her bodily movements', by the end of which ... ‘Ms. M. had stopped being verbally disruptive and her physical agitation had diminished to a fraction of its original form. She had accepted the presence of the analyst as she sat with her, she had stopped screaming except for rare instances, and she had responded verbally several times to the analyst’.

At the end of the paper the author concluded that: ‘Whatever had happened in Ms. M.’s life had caused her to retreat behind a defense of not talking. Her screams were understood to be a form of communication, presumably of discomfort or displeasure, perhaps a plea for attention. Being minimally verbal seemed to be her attempt at withdrawing from a hostile environment while maintaining a slim thread of verbal contact, at her discretion. She rejected the world as it undoubtedly had rejected her’.

Now, as I said in my last but one post, 'silent mirroring' is not in itself Intensive Interaction, but it is (or was) a therapeutic approach that clearly utilises one of the main practices of Intensive Interaction (behavioural mirroring); it clearly resulted in reduced disruption and agitation, 'to a fraction of its original form', as well as an increase in Ms. M's verbal responsiveness. 

So again I ask,  does this case-study add to the evidence base for Intensive Interaction [which, as noted above incorporates forms of 'mirroring' as one of its central features] ... well, again I would say "yes"; again only indirectly, and again only for this one particular 'mirroring' strategy ... but I think it is still a 'yes'.

Interestingly, in her exploration of 'the literature' that informed her therapeutic intervention the author points us to other evidence that I think indirectly supports aspects of Intensive interaction practice: 

'Spotnitz (1985) … discusses “joining techniques” … especially those reflecting preverbal functioning. The therapist makes interventions which support and even reinforce continuation of the resistance until such time as the patient develops awareness and ego strength to replace it with more adaptive and controlled behaviour'.

'Tiegerman and Primavera (1981) conducted a study of object (toy) manipulation with autistic children. The behaviour characteristics of the children included: mutism or echolalia, looking at or through people, an indifference to physical contact, rocking and head-banging, among others. The experimenters discovered that imitation of the child’s performance by the experimenter was most effective in increasing the frequency and duration of object manipulation in the autistic subjects.  Their data support the premises that the imitation of the child by the adult may be a critical factor in the autistic child’s learning to establish and maintain interaction. Imitation of the child placed her/him in complete control of the environment, the adult and the adult’s performance’.

So, irrespective of age, diagnosis or presentation, there is something going on here that goes to the very heart of how we treat (clinically or generally) other people with communication and/or social impairments. It would appear from a wide range of evidential sources that, if we focus on our common humanity, and treat other people (clinically or generally) in a socially responsive and empathetic manner, we should expect to get better social and therapeutic outcomes! (no s**t Sherlock!)