sheridanforster

Receive and then respond

Some of you may have heard me talk about “receive and then respond”, which has come from the work of Video Interaction Guidance.

Typically in interactions one person takes a turn, then (often with a lot of very subtle crossover) the other person takes the foreground turn. There is a lot of assumed shared meaning (the other person understood me before taking their turn), and if the interaction is not breaking down, you can assume that you’re both on the same page in the interaction.

When there are difficulties in communication, there may be difficulties with gaining a shared meaning. One person may express something and the other person may too, but the first person may not know that they’ve actually been heard or understood in the first place.

Receiving a person’s message is a way of trying to let someone know that they’ve been heard or understood. It can take different forms: repeating back part of the message in words, saying out loud what you think the person might have been trying to say (either through words or body language), or even showing a similar emotion state.

Receiving a person could serve different purposes. It might give the person the sense that they’ve been heard. It could serve to clarify whether you’re interpretation was right or not, and give space to the person to either confirm or clarify ( I’ve found this to be particularly useful with many people with autism). It might also give words or gestures to a person who might struggle with words.

The other day I had a profound sense of NOT being received. I was running a webinar. I talked to a camera for an hour and a half. There was not clear reception for me – no nodds of recognition, no smiles of affirmattion, no signals of confusion. Occasionally I would see a flicker of a typing icon next to someone’s name – I felt maybe someone would say they’re there, but nothing would come through (maybe their cat was walking on the keyboard?) It was very difficult to continue communicate in the absence of clear reception.

I wondered how this might relate to some people with communication difficulties. How often is someone saying I see you’re they’re, I sense what you’re feeling, I hear what you’re saying. It’s all very well to look at someone from across a room (or over the internet) but unless the person gets a message in a way that is meaningful to them they will not feel heard, acknowledged or received.

Receive a person first – let them know they have been heard, apprehended, understood, and then, respond.

(ps. two days later I got excellent ratings from the audience 🙂 – that was a relief, and a motivator to not shy away from webinars)

Sharing re restraints and women with Rett’s

I just wanted to share this posting by Rett syndrome Australia regarding restraints and people with Rett syndrome.
I think it a really important statement in light of hand restraints being indiscriminately removed from women with Rett’s in the absence of a strong evaluation examining the individual pros and cons of their use.
I think there is a time, place, and person for restraints – cases need to be examined individually rather than an ideal being applied to all.
http://www.rettaustralia.com/2014/11/restraint-is-a-positive-intervention-in-the-management-of-rett-syndrome/

We are an X school or centre…

Recently I’ve been thinking about the pros and cons of therapy exclusivism (my own term). What I mean by this is schools, services or individuals who decide on a single therapeutic pathway. This might be a school that says “we only use this approach for communication”, or a therapist who only uses one particular intervention. In these situations therapeutic orientation may be decided prior to client/person contact.
I can see pros in having a very strong orientation to a particular therapeutic approach:
– it allows for expertise to be developed in practitioners – expertise is invaluable
– it may give potential clients/students/people a very clear picture of expectations of therapeutic contact
– it may give consistency over time of therapeutic approach.
I do have worries about it too. I recently watched a Youtube video where a practitioner advised parents to not send their child to a school unless it used a particular approach.
I worry when I feel that a particular approach is decided before knowing the person to whom it will be applied and the skills and experience of practitioners.
However, some may argue that some interventions could be applied to everyone irregardless of diagnosis, current presentation, or presenting problem…
What are your thoughts? Are my concerns unfounded? Do we have more to gain from therapy exclusivism than we have to lose?

Presume competence?

I’ve been thinking a bit ability the “presume competence” movement.
Presume competence is often something stated in relation to supports for people with disabilities. It involves approaching people with the presumption that the person does understand your speech and has the capacity to develop more complex levels of communication. In many ways I applaud this approach, in particular with children.
But is their risks inherent with this approach?
Sometimes I feel like I sit in between two camps – there are people that I’ve met that I’ve suggested that the person does understand more than appears apparent (in particular some people with autism). On the other hand, I’ve met people for whom I am quite confident they did not understand speech and their body language and facial expression would be their ongoing communication methods.
Some people may criticise me for essentially judging incompetence. They may suggest that I am the greatest impairment in the person’s life, that I am doing a disservice to the person.
But are there times when it is best to presume or judge incompetence or inability to understand and express in a more complex form. Do we risk an injustice to a person by only seeing what we want people to become rather than how they might present currently? Does just talking to a person who may not understand speech compromise the interaction? Do we increase our compensatory interaction strategies when we don’t presume competence? Do we accept different types of engagement than what we might if we presume that a person can understand everything?
Are there populations for whom not presuming competence is okay such as people who have daily uncontrolled seizures as adults, people with advanced dementia, people who appear barely alert? How does this affect the interaction that we engage in?
How long do we presume competence before we make a judgement that a person doesn’t in fact understand? How long do we take the “we just need to find the right key to open the person” or “we just need to ask the right questions or set up the right accessible response mechanisms”? Where is the intersection between presuming competence and “they understand everything I say” in the absence of evidence that a person does understand?
As professionals how do we deal with an objective assessment of comprehension if we maintain a constant “presume competence” stance? How should be able to have a final word?
Additionally, do we we automatically assume that incompetence is a worse state, that people deemed to have a profound ID are lesser people who haven’t reached their potential?
Don’t get me wrong – it is important to try to find out what someone understands and support them to develop. I don’t want to see people who are showing understanding have these signs ignored and get treated as though they don’t understand. I’ve seen enough people who do understand look at people with exasperation when they’ve high pitched them in speech. But I’ve also seen people who do not appear to understand speech have their body language ignored while interaction partners talk at them.
I don’t think there are clear answers, but I do feel that there is a point at which presuming competence might not be always be the best thing (though I’m sure there might be people who disagree).