MAKING CONNECTIONS: EXPERIENCES OF TRAINING SUPPORT WORKERS

Published in The Adlerian Society (UK) and the Institute for Individual Psychology Year Book:
A Collection of Topical Essays 2007. Published by Anthony Rowe Ltd Great Britian.


Jan Hawkins


How fortunate it is, that the work I am involved in – therapy, supervision, training – are labours of love. These three work strands interweave, and all bring the same joy: being alongside people who are developing and overcoming obstacles in their lives. Coming alongside for part of the journey, and attempting to meet at relational depth ensures that I too, am developing. My passion for enabling people who have severe learning disabilities comes from my perception that many of those I have seen as clients have been raised in environments where, like Morph (the television plasticine man) they were persistently squashed, undermined and every effort, it seemed, was given to the endeavour to destroy who they are or could be. Many of my clients with severe learning disabilities (SLD) lived in long-stay institutions, and most were subjected to various types of abuse. “Dispersed” (King’s Fund, 1999; Thompson & Mathias, 1999) into smaller group homes within communities, teams of support workers endeavour to care for them. I attempt to take my learnings from working with these clients into the training I give to support workers.

Major obstacles in unblocking the attitudes of support workers, with a long-standing culture within care for people with learning disabilities, come from a focus on management rather than development. Some support workers seem to want to punish “bad” behaviour in their clients. This desire is born of deeply-held attitudes and beliefs about other people’s motivations, leading to a culture of punishment and power-seeking and sometimes to giving up on certain clients altogether. As social care policies have changed, there is resentment in many longer-serving support workers that they are expected to “put up with” what they often describe as “bad” or “naughty” behaviours, with the result that there is a lack of consistency among teams in responding to “challenging behaviours”. I feel angry on behalf of my clients that they live in environments that continue to discourage and undermine them.

I have a deep conviction that we all have it within ourselves to be more: to self-actualise, to be more fully functioning (Maslow, 1943; Rogers, 1951). On this theme, Rogers (1978) talks of “persons of tomorrow”, emphasising certain trends including “towards creativity of all sorts - in thinking and exploring - in areas of social relationships …” (p. 282).

From the Adlerian perspective, Mosak (1995) describes the “ideal” state in this way: “There is a sense of belonging and contributing, the ‘courage to be imperfect’, and the serene knowledge that one can be acceptable to others, although imperfect” (p. 78).

My conviction extends to those people who came to this life with not only external obstacles to overcome, but also internal obstacles in the form of cognitive deficits or organic damage which holds them under the umbrella term “learning disabled” (LD).
 
 

“If I accept the other person as something fixed, already diagnosed and classified, already shaped by his past, then I am doing my part to confirm this limited hypothesis. If I accept him as a process of becoming, then I am doing what I can to confirm or make real his potentialities” (Rogers, 1967, p. 147).

The language used to describe people who have learning disabilities has changed considerably over the years (see for example Sinason, 1992); mostly these changes have reflected the “abled” community deciding what is more respectful, descriptive or simply more politically correct. Here I will be focussing on people who have severe learning disabilities and, as a result, rely on support workers and family to ensure that they are able to live safely. Sadly it is often the case that people with SLD do not have the opportunity to do much more than live safely with constraints on budgets as well as the limitations of people who work as support workers on minimal hourly rates and with little training. However, there are also efforts to give more training to support workers, especially in the field of “challenging behaviours”. This term is used to describe people with LD who present difficulties with their behaviours. Most often the difficulties are in the form of violent or destructive behaviours or inappropriate sexualised behaviours that create difficulties for support workers and other people with LD who they live with or go to activities with. In this paper, I intend to explore how training support workers can enable and encourage them to enable and encourage the people they support. My practice is rooted in the person-centred approach and informed by my training in Adlerian psychology.

In my practice, I work directly with clients who have the whole range of LD as well as clients who are fully abled. I also give training to staff teams. This latter has come about because for many years I would see clients with SLD in my practice, and recognised that they were continually prevented from developing new ways of being because of the environments in which they found themselves. Unlike clients who are fully abled, they cannot choose who to spend time with, what activities to do or what to eat, when to eat it, when to go to bed, when to get up - the list is endless. I came to realise that any developments within the therapeutic hour were likely to be lost or squashed within the less therapeutic hours that followed!

The only people with SLD who get funding for private therapy are those who have been through the system many times and things have not changed. They have thwarted the efforts of multidegree’d persons who have attempted to change their behaviours through “behaviour management programmes” or modified cognitive behaviour therapies. They have been seen by psychiatrists who have attempted to manage them with drugs. But the people who eventually have funding and have agreed to come into therapy in my private practice have “outwitted” all these professionals, and their “challenging behaviours” have become entrenched. The workers responsible for the fight for funding are all people who really want to help, but do not know how. They are discouraged by the fruitless efforts of the professionals who have been involved with their clients, and are daily having to manage the behaviours that challenge them. So the clients I see who have SLD have not themselves chosen to come into therapy, but in the main we are able to establish a “therapeutic alliance” that allows us to work together. Well over a hundred studies and meta-analyses find a significant, consistent relationship between the therapeutic alliance and a successful outcome. This finding holds across all therapy approaches studied. (Horvath & Bedi, 2002; Wampold, 2001; Martin, Garske & Davis, 2000; Krupnick, Sotsky, Simmens, Moyer, Elkin, Watkins & Pilkonis, 1996; Gaston, 1990). It is therapy within relationship that allows growth to occur for my clients with severe learning disabilities as well as for the cognitively abled.

Connection

Giving my clients with severe learning disabilities a relationship in which they are empowered to lead the process and receive accompaniement in that process is most unusual for them in their lives. It is also unusual for those individuals to be allowed to explore whatever is on their minds without a task to achieve. A relationship of this order allows the client to connect (Adler, 1938/1998) and that increases the desire for connection. For some years this has felt like a dilemma for me. Without working with the staff team too, the client is faced with their usual environment that is often anti-connection. How unfair of me to give an individual a taste of what can be, and then leave them for the rest of their week with no way of developing that connectedness. My policy now is to let funders know at the start that I will only work with the client for a defined number of sessions after which I must work with the staff team supporting the client. Without that, I say, they are wasting their money. I have written elsewhere (Hawkins, 2002) about “challenging behaviours” and the changes that can happen when the behaviour is understood and the need expressed is met. Behaviours always communicate. If we can free ourselves from judgements and interpretations of motivations based on our own worldview, and instead aim to “see with the eyes of another, to hear with the ears of another, to feel with the heart of another’ (Adler, as cited in Ansbacher and Ansbacher, 1964, p. 135), we can begin to comprehend what “challenging behaviours” are actually communicating. I believe “that human beings flourish best when they can experience acceptance and understanding rather than adverse judgement and a lack of informed responsiveness from others” (Mearns and Thorne, 2000, p. 15)

In order to meet their clients with learning disabilities with this kind of responsiveness, support workers need to experience that acceptance, lack of judgement and informed responsiveness themselves.

Support Workers

Historically people who came into the caring professions as support workers, did so with few qualifications and therefore were very poorly paid. I recall my first teaching job in a further education college as tutor to a group of 16-19 year olds who had learning and emotional difficulties. I found that colleagues with similar responsibilities had backgrounds as full-time parents, teaching assistants and a variety of non-related employment. But, it seemed, it was not necessary to have qualifications to teach students who had LD. In the care field it is still the case that most care support workers have no previous training or experience when they come to work with people who have LD. Many organisations now do provide training for their staff, but this is still relatively ad hoc, even with the advent of the requirements provided for by a programme of National Vocational Qualifications (NVQs). Many people come into care work with open hearts and a desire to get the best out of the people they care for. However, it has to be faced that some come into care work for other, less positive reasons. It is also true that we all take our own “baggage” which we carry into our work - and nowhere is this more apparent than in the care of people with LD. My experience as a trainer is that many care support workers attend training because they have been instructed to, or because they are required to fulfil a certain amount of training as part of their contract. For these people, encouraging and inspiring them to see the training as beneficial firstly to themselves and then to the people they care for, is a task in itself. Others have a thirst for learning, and may request training - these are the people who are ready to engage. There are those too who are required to attend training, but feel no need, and are therefore resentful and unwilling to engage. In a group, there may be these different attitudes as well as others, so when meeting the group for the first time, I am vigilant for who is coming from where.

I notice too, that many support workers are intensely discouraged. They bring discouragement from their own lives, as well as discouragement from the challenges they face with their clients, the client’s family and their colleagues and managers. For some this intense discouragement appears in the form of apathy, and a “going through the motions” in any activity. Support workers are increasingly required to deal with mountains of paperwork as well as the practical elements of the care work i.e. washing, dressing, feeding, cooking, cleaning, managing behaviours and so on. With ever-restrictive budgets, there are rarely sufficient staff on duty in any one team to ensure all the practical tasks and paperwork are completed. Considering the emotional lives and needs of the clients is therefore often completely missed. In terms of Maslow’s hierarchy of needs (Simons et. al, 1987), people with SLD who rely on the care of others rarely achieve more than the two basics of having their physiological and safety needs met. In the increasingly abuse aware culture we have swung into the “abuse of under involvement” (Thorne 2006 in press) such that the needs for love, affection and belongingness are rarely met. For many people with SLD the support workers and other residents in care are their only family, but many support workers tell me they are afraid to show any affection for fear of having to go through a very stressful “vulnerable adults” investigation. In one home where I recently provided training, the workers told me they felt they were “banned” from giving any form of hug or physical contact (other than for personal care needs). This placed additional stress on them when they perceived one of their clients in distress, but felt they were not allowed to comfort them. When I checked this with the management of the organisation, there was no such edict, but still the workers were anxious. They did not know how they could both protect the client and themselves without adhering to what they felt was a rule against physical contact.

Training

The training I give within teams of support workers (or other care professionals) is often the result of working with a specific client. As explained above, I will work with the client, and then bring general understandings (though not confidential material) to the team for training. Usually the benefits to the team go beyond the client in question as they generalise the learning and understanding. Other times, I will work with teams where I do not have specific clients from their care, but the issues are similar. Mostly the call for training and therapy for the individuals with SLD come under the headings of “challenging behaviours”, inappropriate sexual behaviours, and loss and bereavement issues. The latter receives far less attention and only gains funding when the loss leads to challenging behaviours. For me, the focus of the work is in encouraging and developing empathy for themselves as workers, and especially for the clients they are supporting. It never ceases to amaze me that so much training for the caring professions is so lacking in care. This is often shown in the way the training is set up. One team I worked with had managed to get a training room away from the unit they worked in, in order to create a training environment. Unfortunately the room in question was tiny, with large damp patches and peeling wallpaper - the damp smell pervaded the space. They had been required to bring their own packed lunch; as it was raining outside, this was consumed in the ghastly workroom, which was cramped by the circle of chairs and flip chart. The one toilet was in a worse state of repair than the workroom. I was aware of how these workers felt undervalued and not especially enthusiastic at the start of our two days together. Another example is of a team who had to have their training in the group home where they worked. This meant that the residents who lived there had to be out at their activities (whether they wanted to go or not), and wandered back from time to time. This was hardly conducive to the kind of experiential training I offer.

I encourage managers and funders these days to see the training environment as integral to the training itself. If possible, I suggest they should also provide lunch for their workers. Mostly, when I make these suggestions, they are taken up with acknowledgement of their importance. I usually send a piece of work for the participants to engage with before the training and some of them do. I always explain to the manager or funder who is arranging the training, that I work experientially, and they decide the degree of prior disclosure to their team, knowing that some would be frightened off before we began. However, it is interesting that the feedback from participants is always positive.

It seems that much training is of the “talk and chalk”’ variety, and doesn’t’ allow the participants to participate.

“Attention Seeking” and the Mistaken Goals

Dreikurs’ (1972) helpful outline of the mistaken goals of children’s behaviour has been crucial to the training I give to support workers. Describing the needs of undue attention, power, revenge and assumed disability helps broaden the thinking of those who previously described client’s behaviours as “just attention-seeking”. This is with the implicit belief that there is something inherently wrong in desiring attention. When I identify that we all need and seek attention, there is often a sense of lights going on for some people. One of the phrases I find most disrespectful and unhelpful about clients in therapy, people with SLD and children is that they are just “attention seeking”. That phrase allows the speaker to “avoid really listening” (Hawkins, 2002). Often I detect among a team a feeling of anger towards their clients who are presenting challenging behaviours. They will refer to these as “attention-seeking” and feel justified in ignoring the person. I try to flush out the extent of these feelings.

It is not uncommon to find a split in a team at this point, with some members having what appears to be a desire for punishment for “bad” behaviour, e.g. “s/he always gets away with it”. Others in the team can find this distressing and are perceived as “soft”. So this split in a team is important to explore and the facilitation of the dynamics of the team is essential prior to any input. In the negotiations that precede training, I explain the importance of space to explore team dynamics and attitudes. Often, of course, the need for power and also for revenge, exist within support workers. Because of this, clients with learning disabilities are often caught in psychological battles with support workers who have their own reasons for being stuck with a need for power, or for revenge. In the training, I see participant’s growing awareness of their own needs and behaviours. For example, one participant in a team I was training recognised that the reason she had more difficulty “helping” a particular client get dressed than other team members was because she wanted power over the client, and wanted her to do it in the “right way”. Exploration of this need allowed for some of the tension to subside and for new possibilities to exist.

Using Humour to Break Down Barriers

I challenge the “attention-seeking” attitude by exploring mistaken goals of behaviour (Dreikurs, 1972). Having playfully illustrated these, I invite participants to consider which, if any, is their own dominant mode of behaving. This often leads to light banter among team members, as well as the dawning of new insight. Having allowed time to explore the meanings of the mistaken goals, we are able to turn our attention to those clients the team are supporting, and whether they are able to identify anything different to describe the client’s behaviour. Adler’s ideas about children’s goal-directed behaviours and Dreikurs’ explanation of the mistaken goals are practical and immediately accessible. I find that this part of the training opens up people’s minds, and there is often a discernable change in energy as people begin to think in a different way.

Looking at Yourself...

After exploring the mistaken goals of behaviour, I will often invite the group to consider their own “challenging behaviours”.

When a sufficient level of relaxation and trust develops, participants will consider themselves rather than immediately thinking of merely managing their client’s behaviours. I invite the group to consider how they would feel if a behaviour-management plan were designed to dissuade them from their own particular behaviour. Through this process - which looks very simple on the page, however, is anything but in reality there is another shift in energy occurring. People in the group begin to comment on how resistant they would be to being encouraged/coerced/forced into doing something they did not want to do, and recognise the parallels for their clients. At this point we can explore how the worker’s own mode of behaving may clash badly with the client’s. For example, having identified that a worker likes to be in control, and identifies her/himself as someone who wants power, we can explore how difficult it would be for this particular worker with this particular need, to be trying to get a task completed with a client who is also needing power. The power struggle which ensues is likely to end with frustration, or the client presenting her/his “challenging behaviour”. I am always surprised at what a revelation it is to teams of support workers when I ask them to think about what they were doing, thinking and feeling prior to a client’s destructive outburst for example.

The forms that have to be filled in to record the incident rarely require information about who was on duty or what they were doing. The incident is recorded as just that, an incident. In my experience there are many times when people with LD have an outburst, or harm themselves or someone else and are able to explain what happened from their own perspective; these are revealing moments. At such times I am aware that a worker has been consciously or unconsciously goading the client. This goading behaviour does not get recognised as such. Rather, the behaviour is seen in isolation, and often reduced to pejorative statements: “she/he was just attention seeking”, or “she/he just wanted her/his own way”. By taking some examples, I am able to encourage support workers to focus on the wider picture. This involves reframing “challenging behaviour” as an attempt for discouraged individuals to make a connection, to be in contact; yet also acknowledging that the client needs help to develop her/his repertoire of behaviours to make that contact positive.

Developing Empathy

In order to develop insight into, and empathy towards, the clients the support workers are responsible for, I then invite them to think about who is on their mind during the training. Usually it is possible to create small groups of those thinking about particular clients and their behaviours. In these smaller groups, I invite participants to write on a large sheet of paper everything they know about the client. This is always interesting and fruitful for participants as they learn more about the individual as a person, once again broadening from the reductive “challenging behaviour” to the whole person. Inevitably some team members know details about the individual that others do not. This approach allows us to detect if there are possibilities for empowering the individual in positive ways. Having gone through this process, I then engage the groups in a guided visualisation, where they become the client they are focussing on. For many this is an emotional experience and requires sensitive facilitation. Having become the person, there are often insights to share about what the true meaning of particularly difficult behaviours might be.

Encouraging the participants to reflect too upon their own feelings in response to the difficult behaviours allows them to deepen their own empathy with self as well as with the other. This process develops the potential for anticipatory action. So much distress and challenging behaviour could be avoided if empathy is developed so that situations that may be distressing for the client can be anticipated. Then positive interventions may be employed in order to reduce the anxiety that inevitably leads to challenging behaviours.

Making Contact

My experience with people who have SLD, especially those who have no speech, is that much of their behavioural repertoire is aimed at making contact. It is evidence of a desire for connection, for belonging, for community. Sadly, it is often the case that the method employed attracts entirely the opposite response, invoking paradox. If my only way of communicating is biting, then I am likely to repel someone rather than attract the contact I want. Many of the “challenging behaviours” have become entrenched, and their underlying intentions lost in the habits they have adopted. By utilising an approach that focuses on individual meaning, rather than judgements and interpretations (which can only ever be assumptions based on the history, attitudes and beliefs of the judge), a fresh possibility exists.

For many support workers, the process outlined above has enabled them to want to do things differently, or to think in a different way. Ironically, it is at this point that I find myself feeling most frustrated. Translating the ideas and understandings into meaningful interactions between support workers and clients involves more than a set of skills. Skills are far easier to teach than the art of allowing openness of spirit in oneself. Too often, I am stretched at this point in my work to maintain my empathy with those I am training who are resistant to engagement with clients at this level. It is at this point, therefore, that I am exercised by my own “challenging behaviour”. The core attitudinal qualities of the person-centred approach to interacting with others are key in my way of being as well as in the training at hand. The government has developed a requirement of “person-centred planning” for all care professions. This means ensuring that the individual client is placed at the centre of service provision. However, there has been no training in how to ensure this can happen in meaningful ways. This is where the overlap with my training comes in. Workers are familiar with the term person-centred planning, but often recognise that the person in the form of the client is neither able to explain what their difficult behaviour is about, nor what they really want. It is in the how to have a meaningful person-centred planning provision that the core attitudinal qualities of the person-centred approach are so vital.

For this undertaking, I rely on Prouty’s (1994) work on making contact with clients who are difficult to connect with. Prouty works mostly with people who have severe mental health needs and who are difficult to make contact with because of their psychoses. Others have extended his work to include people who have SLD (Portner, 2000). Prouty (1994) suggests that his approach is “pre-therapy” for those who are not able to engage with psychotherapy. However, I argue that the work I do with clients who have SLD is therapy, not pre-therapy. For the person-centred therapist the first stage of the therapeutic relationship is “making psychological contact” (Rogers, 1951). Essentially Prouty has clarified how that may be facilitated, by describing five different levels of responding.

Levels of Responding

When someone is behaving in a challenging way, they may be behaving destructively towards themselves, others or objects; they may be withdrawn, vacant and unresponsive; or they may be inwardly focussed and caught in obsessive, repetitive behaviours. All these behaviours challenge support workers. The importance for the individual of having support that encourages and enables them to re-establish communicative contact needs stressing for some support workers, especially those who are caught in “contain and manage” rather than “developmental” attitudes to their clients.

The following levels of responding can enable psychological contact to be regained.

  • Situational reflections - these responses would focus on the environment, making clear statements about what is close by, i.e. “this room is warm”, “the sofa is soft”.
  • Body reflections - these responses would focus on the individual’s body language, i.e. “your shoulders are high”, “your fist is clenched”.
  • Facial reflections - would focus on the expressions the individual is showing i.e. “you are frowning”.
  • Word for word reflections - interestingly, the dilution of the person-centred approach is often demonstrated by simple reflections of this nature. Word for word reflections must be used with great caution as they can seem patronising and superficial. However, for someone with very few words, or who rarely speaks at all, this type of reflection can allow contact to be made simply through hearing the words back in their original form.
  • The reiterative principle - these reflections rely on something that has worked before. If a way of responding, or doing a particular thing has established contact in the past, it is useful to try it again. 

The purpose of the above points is to enable contact to be re-established. Most often when challenging behaviours ensue, it is because there is no contact or contact has been lost. To change the behaviour, merely using a behavioural approach actually increases the loss of connection. For training support workers, to use these five levels of responding when problems arise with clients involves considerable practice and encouragement. The following transcript provides an example of what such an interaction looks like.

Making Contact - An Example Transcript

Ann is stomping about, refusing to listen and swearing loudly. You want her to come into the house and have lunch. You’ve been trying to get her to listen and come in for ten minutes to no avail; she continues to ignore you all and continues to rant. Three members of staff are surrounding her to ensure she does not run off towards the road, as is her pattern.

Ann (under her breath): Fucking stupid man, stupid bloody woman, fucking stupid….

One support worker(SW) takes the lead and tries to make contact. The other two may keep in the background in case she tries to run. The two back up support workers say nothing, unless Ann particularly looks in their direction - if this happens the lead worker says “you are looking at …..”, then that SW takes over as lead with the following:

Support worker: Ann, you seem angry. It is cold/hot out here. (give names of the other two carers) and I came to be with you.

Ann (avoiding eye contact, eyes fixed on the ground and slightly louder): Fucking stupid man, stupid bloody woman, fucking stupid….

Support worker: Ann, you are looking at the floor. You are saying fucking stupid man, fucking stupid woman.

Ann (ignores you, stamps foot and swears louder).

Support worker: You seem angry, you’re so angry you stamp your foot (stamping own foot).

Ann (glances briefly in your direction and kicks out at the wall).

Support worker: Thank you for looking at me. I see you kick the wall. Sore foot.

Ann (glances again slightly less agitated).

Support worker: Ann, you are quiet maybe you are thinking.

Ann (screws up her eyes and looks at carer and mumbles): Stupid man

Support worker (quietly, and screwing up eyes in the same way as Anne): Stupid man - I wonder who’s the stupid man…

Ann: Stupid man John.

Support worker: John is stupid - I wonder what John did so stupid….

Ann (very quietly, but looking at carer): Stupid man John.

Support worker: Ann, you seem calm now. I would like to know what John did that made you feel angry and swear. Can you tell me? (or show me if that is more appropriate).

Fully Functioning

For people with severe learning disabilities, the extent to which they are enabled to become fully who they can be is reliant on their support workers and families finding ways of being that increase the possibilities for growth rather than impede them. Here I have focussed on training support workers, encouraging them to become more fully themselves and encouraging practical ways of understanding the clients they support. Recently I heard about Mary (not her real name) who had SLD and no speech. She was living in a home with care workers who had been supported and empowered to be with her in a way that allowed her to grow beyond her extremely violent and destructive behaviours. They had provided her with a home where she was able to feel secure, as evidenced by the decrease in her destructive outbursts. She needed a high level of personal care for all of her life, but the quality of that care had improved, and so she had been able to change. Her fully functioning stage of development was demonstrated by what she taught her workers. Especially in the months leading up to her death, she taught them that serenity and acceptance can lighten every day. She had been reached with loving contact by workers who were supported to develop ways of contacting her. To ensure that she always had that care, those who managed her workers made certain that every new worker was supported and trained. Mary died in her own home supported by workers who had been alongside her and maintained contact with her till her last breath.

The phrase “fully functioning” conjures up an image of a super person, capable on many fronts, living life to the full and achieving. Mary was a fully functioning person. She knew how to love and be loved. Throughout her life, however, she had the experience of being cared for by workers who did not know how to make contact with her. They did not know how to understand her behaviours, and as a result her destructive behaviours had increased. Fortunately for Mary, she had an advocate, who fought for her to have her needs met and understood. Unfortunately this is not the case for most people with SLD.

Community

The trend towards “care in the community” which has “dispersed” (Thompson & Mathias, 1999) people with SLD and severe long-term mental health problems from long-stay institutions into the community has behind it the assumption that there is a “community” to go to. In practice, it is often not the case. If we think about what community means, for many of us it means connection with family first, and with those in close proximity who become friends. For many of the people I have seen in my therapy practice who have SLD, they have been placed in homes in local communities with the best of intentions.

Most of us would rather live in an ordinary house, than in a hospital or other large institution. However, many of my clients had no choice in the matter, as no one knew how to make contact at depth with them. Some who can speak have told me of the day they were put on a mini bus and taken to their new home. The sense of loss does not go away. For these people the community and connection was with the hospital, institution, nurses and other patients. For these people to find a sense of belonging, they need support workers who are able to make real connections, real relationships. For this the workers need to feel empowered, supported and given skills in understanding what behaviours might mean for the individual. Support workers need time and encouragement to develop their empathy and their skills in establishing and maintaining contact with clients who have severe learning disabilities. There needs to be a structure for this training and development that goes beyond the one or two day training event.

Every behaviour is a communication - if we can keep an open, accepting attitude, communicate empathic understanding and be willing to share a real, genuine relationship with support workers, they will in turn develop the ability to embody those qualities in their relationship with clients. All clients challenge in their own ways, and it is within relationship that co-operation can be modelled and encouraged.



References


Adler, A. (1938/1998). Social Interest. Oxford: Oneworld Publications.

Ansbacher, H.L. & Ansbacher, R.R. (Eds.) (1956/1964). The Individual Psychology of Alfred Adler: A Systematic Presentation in Selections from his Writings. New York: Harper and Row Publishers, Inc.

Dreikurs, R. (1972). Coping with Children’s Misbehavior. New York: Hawthorne Books.

Gaston, L. (1990). The Concept of the Alliance and its Role in Psychotherapy: Theoretical and Empirical Considerations. Psychotherapy, 27, 143-153.

Hawkins, J. (2002). Voices of the Voiceless: Person-Centred Approaches and People with Learning Difficulties. Ross-on-Wye, UK: PCCS Books.

Hawkins, J. (2003). I Can Do It Softly. In: S. Keys (Ed.). Idiosyncratic Person-Centred Therapy: From the Personal to the Universal.. Ross-on-Wye, UK: PCCS Books, pp. 37-51.

Hovarth, A.O. & Bedi, R.P. (2002). The Alliance. In: J.C. Norcross (Ed.) Psychotherapy Relationships That Work New York: Oxford University Press, pp. 37-69.

Martin, D.J., Garske, J.P. & Davis, M.K. (2000). Relation of the Therapeutic Alliance with Outcome and Other Variables: A Meta Analytic Review. Journal of Consulting and Clinical Psychology, 68, 438-450.

King’s Fund. (1999). Learning Disabilities: From Care to Citizenship. Published by the King’s Fund. Available online at: www.kingsfund.org.uk

Krupnick, J.L., Sotsky, S.M., Simmens, A., Moyer, J., Elkin, L., Watkins, (J) & Pilkonis, P.A. (1996). The Role of the Alliance in Psychotherapy and Pharmacotherapy Outcome: Findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology, 57, 76-80.

Maslow, A.H. (1943). A Theory of Human Motivation. Psychological Review, 50, 370-396.

Mearns, D. & Thorne, B. (2000). Person-Centred Therapy Today. London: Sage.

Mosak, H. (1995). Adlerian Psychotherapy. In: R.J. Corsini & D. Wedding (5th Ed.). Current Psychotherapies. Istaca, IL: Peacock Publishers Inc., pp. 51-88.

Portner, M. (2000). Trust and Understanding: The Person-Centred Approach to Everyday Care for People with Special Needs. Ross-on-Wye, UK: PCCS Books.

Prouty, G. (1994). Theoretical Evolutions in Person-Centred/Experiential Therapy: Applications in Schizophrenic and Retarded Psychoses. Westport, CT: Praeger.

Rogers, C.R. (1951). Client-Centered Therapy. Boston, MA: Houghton Mifflin.

Rogers, C.R. (1961/1967). On Becoming a Person. London: Constable & Co Ltd.

Rogers, C.R. (1978). On Personal Power: Inner Strength and its Revolutionary Impact. London: Constable & Co Ltd.

Simons, J.A. Irwin, D.B. & Drinnien, B.A. (1987). Psychology – The Search for Understanding. New York: West Publishing Company.

Sinason, V. (1992). Mental Handicap and the Human Condition: New Approaches from the Tavistock. London: Free Association Books.

Thompson, T. & Mathias, P. (Eds.) (1999). Lyttle’s Mental Health and Disorder. (2nd Ed.) London: Harcourt.

Thorne, B. The abuse of under-involvement – a College of teachers seminar. To be published in ‘Education Today’ December 2006

Wampold, B.E. (2001). The Great Psychotherapy Debate. Manwah, NJ: Lawrence Erlbaum Associates.





Jan Hawkins
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