FLOW: The psychology of optimal experience* (sounds nice!)

Prompted by two things coincidentally coming together at the same time last week (some II practice related research that I and my placement student Gemma Denby are currently writing up, and a posting on the 'II Coordinators' Facebook page), I will set out my understanding on the particular psychological state that is called 'Flow' (helped by some of Gemma's kind work). 

So, 'Flow' is viewed as the psychological state where an individual is operating at their optimal potential level within any given task i.e. when they are fully immersed and engaged in a task (sometimes referred to as being ‘in the zone’) - and this is something that I think I experience when I am fully engaged in a really good episode of Intensive Interaction. This psychological state was first conceptualised by psychologist Mihaly Csikszentmihalyi, who described experiencing the state of ‘flow’ as being ‘so involved in an activity that nothing else seems to matter’ (1991). Yes, that is the state that I have often experienced!

Now, in order to experience a state of flow, the content of the experience must be realistic to that individual i.e. an individual must be able to fully engage with, understand and attend to the task in order to become fully immersed in it. Once in a state of flow, an individual gains the ability to perform this task at the highest level, with effortlessness and ease, and quite often experiences a transformation of time, i.e. where time seems to speed up as we reach a peak of attention, engagement and enjoyment.

Below are some quotes taken from Csikszentmihalyi's book that I think might be of interest to us Intensive Interactors: 

 ‘the best moments in our lives are not the passive, receptive, relaxing times ... the best moments usually occur when a person’s body or mind is stretched to its limits in a voluntary effort to accomplish something difficult and worthwhile - optimal experience is thus something that we make happen.’ (p.3)  

  'optimal experiences add up to a sense of mastery- or perhaps better, a sense of participation in determining the content of life.’ (p.4)

‘the flow experience is typically described as involving a sense of control - or, more precisely as lacking the sense of worry about losing control that is typical in many situations of normal life.’ (p.59)

During an optimal experience ‘self-consciousness disappears, and the sense of time becomes distorted. An activity that produces such experiences is so gratifying that people are willing to do it for its own sake, with little concern for what they will get out of it…’ (p.71)

‘We need not change ourselves to be with friends; they reinforce our sense of self instead of trying to transform it ... friendship usually involves common goals and common activities, it is “naturally” enjoyable.’ (p.185 &186)

To develop this idea of 'flow' a bit further, beyond the individualistic state described by Csikszentmihalyi, it seems to me that to construct an optimal social state of ‘flow' (i.e. one shared by two socially 'attuned' people), we need to look at intrinsically motivating sociable interactivity that sits somewhere between one of externally imposed challenge (and potential loss of control), and a state that creates too little of interest to claim the attention of the person, potentially creating a state of boredom, disengagement and/or sustained isolation. 

Therefore to create such a socially shared state of 'Flow' (via Intensive Interaction) there needs to be sufficient mutual familiarity generated through the repetition of the basic patterns of any prior social interactivity, but with sufficient carefully calibrated offers of variation (either natural, intuitive or contrived) to create the potential for a steady upward spiral of interactive communication (in content and levels of sophistication). But we need to get that balance right so that we don't ever go too far in advance of the skills and capabilities of the learner i.e. acting very much within or at the boundary of a person's current social understanding (for students of such things - their Vygotskian 'Zone of Proximal Development'). Hmm, interesting!

* Csíkszentmihályi, M. (1991) 'Flow: the psychology of optimal experience', Harper, NY.

Intensive Interaction: a growing world-wide phenomenon

Over the Christmas holidays I did some work helping update sections of The Intensive Interaction Handbook for the upcoming second edition (due out in June 2018 from Sage Publications). Looking at one section, it started to make me think about how the profile and knowledge of Intensive Interaction is now building across many countries.

In the handbook we point the readers to the sterling Intensive Interaction work being done in Australia, Finland, Denmark, Greece and Germany. There is also a list of countries in which Dave Hewett and his associates have delivered training and presentations, these including: Hong Kong, Russia, Hungary, Tajikistan, New Zealand, Cyprus, South Africa, Portugal,  Sri Lanka, Romania, Slovakia, Trinidad &Tobago and Czech Republic.

Also in our Intensive Interaction Newsletter (Issue 58 - I'm sure you will all remember), I listed some international social networking sites for II, including:

Intensive Interaction Australia (at: https://www.facebook.com/Intensive-Interaction-Australia-149574338571931/)

Intensive Interaction Finland (at: https://www.facebook.com/groups/1497688260510338/)

Intensive Interaction Denmark (at: https://www.facebook.com/IntensiveInteractionDanmark/)

Intensive Interaction France (at: https://www.facebook.com/groups/1041373799263424/)

There's even one for South Yorkshire (at: https://www.facebook.com/groups/1798797420399688/ ) which is not an independent state yet, but who knows what t' future may bring!

But things seem to be moving on rapidly for Intensive Interaction. I have mentioned before that I am a member of the 'Researchgate' social networking site (at: https://www.researchgate.net/profile/Graham_Firth/), and as of last week my Intensive Interaction research papers have now been read and/or downloaded 1,122 times from academics/researchers in 36 countries (in approx. order of frequency): UK, Australia, USA, Ireland, Hong Kong, Taiwan, New Zealand, South Korea, China, Iran, Spain, Thailand, Italy, Denmark, Finland, Canada, Belgium, Greece, Germany, Japan, Austria, Brazil, Czech Republic, Norway, India, Netherlands, Egypt, East Timor, Russia, Nigeria, Israel, Kenya, Croatia, Saudi Arabia, Singapore, Sweden …

... and there's more! 

This very Blog has now been accessed over 6,000 times by readers in ... wait for it ... 59 countries (in approx. order of frequency): UK, USA, Ireland, Australia, Canada, Greece, Finland, Ukraine, Germany, France, Denmark, New Zealand, United Arab Emirates, Belgium, Cyprus, Norway, Russia, Malta, Iceland, Sweden, Italy, South Africa, Slovakia, Brazil, Trinidad & Tobago, Indonesia, Spain, Hong Kong, Portugal, Gibraltar, Pakistan, Switzerland, Thailand, Colombia, South Korea, Estonia, Poland, Singapore, Barbados, Peru, Fiji, Bukino Faso, Japan, Dominican Republic, Grenada, Czech Republic, Montenegro,  Netherlands, Philippines, Macedonia, India, Lithuania, Belarus, Laos, Mexico, Tajikistan, Cape Verde (I had to look Cape Verde up on Google maps; its a small island state in the mid-Atlantic - I'd love to go!).

So should we now be looking to have more country/regional social media sites being set up to help all our II people hook up together? Should there be an Irish or North America Facebook group? or one for Greece & Cyprus, or one for Africa or east Asia? 

Surely the way to build an identifiable and supportive local Intensive Interaction community, is to start to build an identifiable and supportive local Intensive Interaction community!

In praise of ... not praising?

Recently I received a question via email from someone who is studying Intensive Interaction as part of the overall classroom communication strategies used with children with autism. She had done a classroom observation of a teaching assistant, and was seeking clarification on her view that using overt 'praising' within Intensive Interaction exchanges isn't recommended practice (in this case the teaching assistant giving verbal praise to a child for some 'good' eye contact being made).

Of course, she is right; overtly praising our partner within an Intensive Interaction exchange isn't recommended Intensive Interaction practice - as she correctly pointed out herself in the email: using praise is not recommended II practice 'because it is not natural to praise people for taking their turn in an interaction'. Below is my answer to her query:

'Yes, externally applied/delivered praise is not recommended as Intensive Interaction practice as this can become a reward (one in the gift of the practitioner), rather than any mutual enjoyment created being the implicit reward generated by the act of engagement itself. 

I also think giving praise can reinforce the power imbalance that many learners exist and communicate within i.e. praise indicates a prescribed correctness of response from someone else, and is either given or withheld by an external agent. We want to develop the feeling of an equitable power relationship with interactions i.e. being partners during Intensive Interaction engagements rather than having a hierarchical teacher-pupil relationship (even though in reality that is what it is). 

Indeed, for some students with demand avoidant behaviours, externally applied praise can be very disaffecting and negatively affect the behavioural response of the learner.'

I think that this is an interesting area, and the more I think about it the more I think that any praise clearly acts as an indicator of hierarchical positioning (which is obviously a position we will sometimes need to take); when we praise other people we are taking a judgemental stance over them - albeit a positive one. Indeed, I personally don't like being praised by someone if I deem it to be a deliberate indication of their perceived authority over me (managers take note!) - and I do think that praise is sometimes deliberately used in this way.

But, in a school classroom praise will be given, and it will also be an effective way of positively managing the behaviours of most of the children in many normally occurring school circumstances - so we don't stop praising, but we just use it when it is an appropriate and effective strategy. 

However, we should always remember that the driving motivational force of Intensive Interaction is not just to please others, but it is to please ourselves and our communication partners, both at the same time, by the positively affirming 'mutual pleasure' generated in and by an equitable social engagement.

Oh, and very well done to everyone for reading this Blog!

“far too many people ... have no one to talk to or share their thoughts and experiences with”

Theresa May (UK Prime Minister)

On Wednesday last week there was an announcement of a new UK Government Minister of Loneliness (hopefully not 'for' loneliness). Tracey Crouch (whilst also being Minister for Sport & Civil Society) will 'lead on loneliness', and will therefore head up the government’s work to tackle this problem – with this appointment apparently being the result of the identification of a continued breakdown of social support networks generally across society, and this then having a profound effect on many people's psychological (and physical) well-being, with loneliness now affecting around 9 million people across the UK.

All of this is apparently in response to a report from the Jo Cox Loneliness Commission identifying the need for the government to act and develop a national strategy to combat loneliness. 

Prime Minster Theresa May said: “For far too many people, loneliness is the sad reality of modern life. I want to confront this challenge for our society and for all of us to take action to address the loneliness endured by the elderly, by carers, by those who have lost loved ones – people who have no one to talk to or share their thoughts and experiences with'.

To me this paints a sad picture of the current social trends in our society, ever towards a more nominally independent and individualistic view of the person (these being potentially socially isolating), and away from an interdependent and collaborative societal view. I also think it sad that it is only now that this kind of endemic social isolation has become a serious political issue ... and anyway, loneliness isn't just a social issue: social isolation (resulting in chronic loneliness) can have the same negative health effects as 20 fags a day (Ref: some people on the BBC News website) and look how seriously that physical 'health' issue is now taken by the NHS!

Now I really welcome this move, but I am not sure how aware Mrs May is of the significance of the final part of her statement - because I think that there is in fact a broader issue here about 'people who have no one to talk to or share their thoughts and experiences with' - not for some people because there is no one actually around them (i.e. it being nothing to do with any geographical isolation), but because for some people, their communicative means of sharing 'their thoughts and experiences' isn't acknowledged, isn't shared and isn't responded to by those around them e.g. if the support staff or carers of a person with severe or profound intellectual disabilities and/or autism (or late stage  dementia) aren't proficient in Intensive Interaction.

This point was further reinforced for me later on that same day when I met a young man (for the first time) who has been identified as having some 'behavioural difficulties', but who responded to Intensive Interaction fantastically well (with me as a strange man ('strange' as in not familiar!), and especially so with his CLDT nurse who used Intensive Interaction wonderfully to 'connect' with him). I did then think that this lovely, sociable young man is someone who has the potential to become: 

a) very well socially engaged by those around him (if his support staff or carers are proficient in Intensive Interaction), or ...

b) increasingly socially isolated (and thus chronically lonely, even in the presence of others) if his support staff or carers do not sociably respond to his pre-verbal communications using Intensive Interaction ... and potentially then being driven to gain social attention in more desperate/less socially acceptable ways.

Theresa and Tracey, well done - that's a good start ... but are you ready to listen and think more broadly around this 'loneliness' and 'social isolation' issue?

'An increased emphasis ... upon process-based learning'

As a member of 'Researchgate' (this apparently being the largest/most 'active' academic social networking site in the world - where researchers and academics share their papers and network with each other), last week I was notified of a paper from the Scottish Educational Review. 

This paper (Rees et al, 2017*) looks at the implementation and evaluation of the South Lanarkshire Framework for Supporting Children with Severe and Profound Learning Needs. This Framework was set up to assist Scottish schools implement the 'Curriculum for Excellence' for this group of learners. In this paper (p.69) the authors state that:

'The most recent curricula developed by individual schools in England attempt to achieve a balance by adopting a developmental perspective to learning and life skills ... Emphasis is placed on providing a relevant and personalised curriculum, with a narrower range of key areas which enable pupils to develop skills in independence and communication. These areas include: Communication and Social Development, Cognition, Self-Care and Independence, and Physical and Motor Development. Whilst behaviourist approaches are still used widely to develop a pupil’s abilities to carry out new skills and to break down skills into smaller, achievable tasks (for example, self-care and independence skills such as putting on/taking off a jacket), an increased emphasis is placed upon process-based learning (where the interactive process between staff and pupils takes precedence over the outcome of the task).

Yet, in both England and Scotland, evaluations of current curricular approaches for this group of learners have been scarce (Lacey, 2011). In addition, although there is an increasing body of evidence highlighting the positive impact of ‘intensive interaction’ as a means of encouraging pupils’ interaction and communication (Firth, 2006), there are still very few evaluative studies of other specific teaching approaches.'

Now the 'bolding' of some of the text is mine - and the bits that I bolded (if there is such a word) are because:

a) the identification of 'process-based learning (where the interactive process between staff and pupils takes precedence over the outcome of the task)' is exactly what we in our Intensive Interaction community (and in particularly Dr Dave Hewett) have been banging on about (i.e. quite reasonably arguing for) for years!, and 

b) Intensive Interaction is correctly identified as the most evidenced of these 'curricula approaches for this group of learners' ... and in these days of 'evidence based practice' Intensive Interaction should surely be elevated to the very core of the curriculum above other, less well (or some almost entirely not) evidenced approaches to the teaching/learning of this important group of learners. 

*Rees, K., Tully, S. & Ferguson, K. (2017) “This is theirs” The implementation of the South Lanarkshire Framework for supporting pupils with severe and profound needs, Scottish Educational Review, 49(1), 67-88.

Intensive Interaction: an approach that sits across disciplines - its greatest strength ... and its greatest weakness?

With my most recent Blogs focusing on linking Intensive Interaction to established psychological theories and therapeutic models, it has increasingly dawned on me that I think that this highlights one of the approaches greatest strengths, but also one of its greatest weaknesses.

In other Blogs I have written about Intensive interaction being developed through the same practices, but successfully fulfilling different educational, social or therapeutic functions depending on the context or aims of its use e.g.: 

• a 'Social Inclusion' process* - evidenced in shorter term improvements in sociability as both recipient (e.g. a person with an LD, autism, or as is increasingly reported, people with late stage dementia) and practitioner develop and improve their social engagement and rapport.

• a 'developmental process'* - seen in the longer term acquisition/extension of social skills and understandings, as new social experiences are accommodated and new learning takes place.

• and, as I have written recently, a psychological or therapeutic process (Berry et al, 2013) which can help to develop psychological contact and emotional connectedness for people who are difficult to reach and/or in emotional distress. (Here in Leeds, when and where relevant, we include personalised Intensive Interaction guidelines into the ‘proactive strategies’ section of Positive Behaviour Support (PBS) plans i.e. to train staff/carers to work 'at the level of the antecedent', thus negating a person's need to resort to any challenging communication behaviours).

So, one approach, many uses - and as I allude to above, I think this is a great strength of the approach - with all these uses, aims, contextualised functions being obviously positive, and the outcomes highly plausible and increasingly well evidenced. 

But this is where I think it sometimes gets difficult. This breadth of use and function could I think be identified as a weakness for Intensive Interaction, in that the approach is therefore not 'owned' i.e. defined, developed and disseminated, by one key discipline. Instead it sits across many disciplines - special education, speech & language therapy, social or specialised care, psychology, occupational therapy, LD nursing, disability studies, etc.; with no discipline being the focused intellectual hub for, and thus the key driving force behind, the approach.

However, all of the discipline or domains mentioned above are actually human intellectual constructs that help us individually give order to what in reality is a complex, interrelated and conceptually overlapping human and social world. Sometimes that constructed conceptual ordering (which takes place inside our heads and is projected out onto the world) gives us a cognitive framework within which we can create meaning; but sometimes it tricks us into thinking that there are clear intellectual boundaries between all these domains of understanding - and of course, in the 'real' real world, as opposed to our individual cognitively constructed world, there aren't.  

Intensive Interaction sits between all these disciplines because our work, and the needs of all our different people, sit between them - it is our job as Intensive Interaction advocates and practitioners to think outside our constraining disciplinary boxes, and look at the bigger picture. We therefore need to continuously and actively work together to counteract the lack of a single disciplinary focus (which remember, is also a great strength), and collectively make the approach more accepted and understood whenever and wherever it is need.

*Firth, G. (2009) ‘A Dual Aspect Process Model of Intensive Interaction’, British Journal of Learning Disabilities, 37(1), p.45-49.

Berry, R., Firth, G., Leeming, C. & Sharma, V. (2014) ‘Clinical psychologists’ views of Intensive Interaction as an intervention in learning disability services’, Journal of Clinical Psychology and Psychotherapy, 21 (5), p.403-410.

Intensive Interaction and psychological therapies

In my most recent Blogs I have been focusing on how Intensive Interaction could, and I believe should be usefully conceptualised as a psychological intervention for those people who have intellectual disabilities (and/or autism) who are unable to access traditional (i.e. talking) psychotherapies, but as Dr Ruth Berry stated: 'who may be in great need of experiencing psychological contact and connectedness' (Berry et al, 2014). 

These people (our Intensive Interaction people) are currently often (and in reality, almost entirely) excluded from being able to access traditional psychological therapies simply because such therapies rely on two-way exchanges of some form of 'symbolic' meaning as the means for addressing psychological difficulties and emotional distress.

Well as it turns out, in the 2015 UK report on psychological therapies for people who have intellectual disabilities (carried out for the Faculties for Intellectual Disabilities of the Royal College of Psychiatrists and the Division of Clinical Psychology of the British Psychological Society and edited by Professor Nigel Beail), there is clear evidence that this issue is starting to be more clearly and thoughtfully considered. In their imaginatively titled report 'Psychological therapies and people who have intellectual disabilities' there were indeed several references to the use of Intensive Interaction as part of variously framed psychological interventions. 

These references included: 

Chapter 7: Solution-Focused Brief Therapy - SFBT (Helen F. Lloyd, Alasdair Macdonald & Lauren Wilson p.88).

‘Case studies of direct SFBT work with those people with ID with little or no language are emerging. Bliss (2012) describes using SFBT principles with ‘Beth’, a resident in a home for people with Autism Spectrum Disorder. She self-injured, engaged in flicking, rocking, screaming and playing with saliva. As ‘Beth’ did not speak, staff voiced the preferred future for ‘Beth’ and gave examples of times when she responded positively. Exception-seeking was combined with behavioural observations of ‘exceptions’ and Intensive Interaction techniques as described by Firth (2006)’.

(Ref: Firth, G. (2006) ‘Intensive Interaction: a research review’. Mental Health and Learning Disabilities Research and Practice, 3(1), 53-58).

Chapter 9: Group Interventions (Rowena Rossiter, Celia Heneage, Nicky Gregory & Layla Williams (with thanks to Paul Willner & John Rose) p.118).

‘There are published case examples of group work, such as Leaning & Watson (2006) … who describe group therapy with people who have ID.’

(Ref: Leaning, B. & Watson, T. (2006) ‘From the inside looking out: an Intensive Interaction group for people with profound and multiple disabilities’. British Journal Learning Disabilities, 34, 103-109).

Chapter 10:  Art, Drama & Music Therapies (Simon Hackett , Kate Rothwell, & Chris Lyle, p. 132).

'Art psychotherapists working with people who have ID often use a flexible, adapted and individualised approach in their work. When working with people who have limited verbal communication, adaptation can include using picture symbols and other communication aids within the therapy. Additional communicative techniques such as Intensive Interaction may also be used'. 

So there is an obvious pattern developing of a growing number of therapists/psychologists using Intensive interaction across the UK as part of their psychological intervention toolkit - and from the report above, often in imaginative and (perhaps for some of us) unexpected ways e.g. as part of group or arts based therapies. 

But what now, and what next - how can this increasing recognition of the psychological use of Intensive Interaction be brought together? And how can those who work in this way be further supported to continue this important (no lets be frank - 'absolutely vital') psychological work for those people who until this happens will remain 'in great need of experiencing psychological contact and connectedness'.