Intensive Interaction as a psychological therapy

Again this week for my Blog I am relying on the good work of others to illuminate us on the use of Intensive Interaction in a particular field - and as last week, that is the field of psychological therapy. So, below I have abridged an article from 'The Psychologist' by Cathy Harding and Ruth Berry (both being, quite predictably, psychologists themselves); this article also includes a report on the 'therapeutic' use of Intensive Interaction by one of the authors. 

So, here it is:

Intensive Interaction as a psychological therapy 

by Dr Cathy Harding & Dr Ruth Berry 

from The Psychologist (2009) Vol 22.

At the broadest level, Intensive Interaction is consistent with three major schools of psychological thought – humanistic psychology, attachment theory and positive psychology. All these approaches share a core tenet that positive human relationships are crucial to our sense of self-worth, ability to realise our potential, and our psychological well-being.

Intensive Interaction ... has the potential to function as a powerful therapeutic intervention for people who struggle to use words to express their emotional state and for whom social interactions are difficult. 

More direct evidence ... comes from the case studies of Nind (1996) and Kellett (2000, 2003, 2005) ... Nind’s study involved six residents of a long-stay hospital, and Kellett’s ... involved children from three community special schools. Both researchers ... provide support for what can be seen as psychotherapeutic changes.

Typical of the cases is Jacob (Kellett, 2003), who is reported to have shown significantly decreased levels of self-injury and stereotypical behaviours pre- to post-intervention. In addition, the staff who knew him well saw him as a much happier child and described a change in his personality: they ‘had discovered a delightfully humorous, mischievous side to his character that they had not known before’. In psychotherapeutic terms, it can be suggested that the Intensive Interaction Intervention enabled the one-to-one worker to develop a meaningful relationship with Jacob and that this promoted his psychological well-being (made him happier) and enabled him to show his potential (humour and mischief).

There are a handful of case studies with clinical psychologists as authors ... [which] have yielded promising evidence for the psychotherapeutic potential of Intensive Interaction with adults with severe or profound levels of learning disability and chronic problems of withdrawal and/or self injury. The Elgie & Maguire (2001) study involved a client, Anna, a 39-year-old woman with a profound learning disability who was blind. She was extremely isolated and had self-injured since childhood. Thrice weekly Intensive Interaction sessions were seen to result in her spontaneously reaching out to her therapists, a behaviour that had not been observed during the six-month baseline period, and that was ‘interpreted as indicating the development of an emotional bond and a satisfying relationship with [her therapists]’.

Lovell et al. (1998) offered sessions of Intensive Interaction to a 53-year-old man, W, who had lived in institutions since the age of nine and who was seen by nursing staff as one of the most withdrawn people in his hospital. A variety of measures indicated that during the Intensive Interaction sessions W initiated more contact with the therapist, showed more interest in people and enjoyed the interaction. Anecdotal evidence supported these findings: ‘[n]ursing staff commented that during the intervention period W appeared happier and more willing to interact than he had before’.

Our own case study ... ‘Susan’ ... shows many of the features typical of children who have experienced ‘global neglect’ such as hyperarousal, difficulties forming meaningful relationships with others, and lack of impulse control. She has displayed severe self-injury and aggression towards others since early childhood, and we can hypothesise that her early attachments and subsequent ‘care’ in institutions led to these behaviours becoming the only ways that she could draw a consistent and predictable response from her social environment.

Past records stated that Susan liked drawing, so we took paper and crayons to our sessions. Susan immediately engaged with us, requesting that we draw particular objects such as flowers, faces and cars ... The activity expanded into sharing songs when Susan started to sing ‘Round and round the garden’ as we drew flowers, and her expressed vocabulary expanded as the sessions progressed. For example, she requested ‘more petals’ on a ‘sunflower’. 

The sessions of Intensive Interaction seemed to provide Susan with human contact that she enjoyed and within which she could exercise control in a safe way (for example, telling us what to draw). This relational context may have provided the basis for her using an increased vocabulary – perhaps ... we had earned her trust that we would not respond negatively to her speaking (this had previously been discouraged). It was possible to find a way of being with Susan that encouraged her potential rather than controlled her. The sessions also highlighted that Susan wanted to engage others and could do so very skilfully ... Both therapists felt that there were moments of connectedness, especially when Susan held up her drawings to us and we all shared in her pleasure in them.

So, overall the authors are making a strong case that Intensive Interaction has a positive i.e. a psychologically 'therapeutic' effect across all the cases discussed - which will come as no surprise to those of us who have experienced the positive effects of the approach, both for the person and for ourselves.