Learning To Listen: Positive Approaches and People with Difficult Behaviour - Softcover

Lovett, Herbert

Softcover

ISBN 10: 1853023744 ISBN 13: 9781853023743

Publisher: Jessica Kingsley Publishers, 1995

Synopsis

[the author] reflects on the history of the management of difficult behaviour and provides many fascinating examples of the extraordinary ways in which previous generations have tackled similar issues... historical analysis is interwoven with vivid accounts of people who have been referred to him for advice. But this book is more than a set of case studies. Lovett hopes that we will be stimulated to reassess how we relate to our clients and to reflect on our own experience and practice... this book is to be strongly recommended.'

- Community Care

'The analysis of how labelling, politics and control have dominated the provision of care is full of insight. The book is relevant to day-to-day interventions, while providing points for consideration when local services are being planned.'

- Nursing Times

`...offers alternatives to professionals dealing with people with intellectual disabilities. He [the author] shows that, by building an atmosphere of mutual trust and respect, many of the more unpleasant answers to behavioural problems can be avoided.'

- In Touch Newsletter

'An encouraging book with an impact! It provokes thought on the way in which services and individuals are involved in the lives of people with a learning disability'

- The National Association of Occupational Therapists working for people with Learning Disabilities.

Learning to Listen offers alternatives to professionals dealing with people with intellectual disabilities. The aim of the book is to promote a more interactive approach to caring, taking the views of both the client and the carer into consideration, on a personal rather than a clinical level. Through the use of illustrative use of case studies Lovett suggests that many of the behaviour modification techniques in present use are overly controlling and ignore the client concerned. He shows that by building an atmosphere of mutual trust and respect many of the more unpleasant answers to behavioural problems can be avoided, with benefits to providers and users alike.

He urges carers to be more open and sympathetic to the past and present needs of the client, pointing out that a wider knowledge of the client can be of use in determining the cause of their behaviour, so as to come to a more informed conclusion about the best action to take. This straight-forward yet sensitive book leaves the carers providing a better service and the clients with their dignity in tact and with greater autonomy.

CONTENTS: Chapter 1, Learning to Listen. Chapter 2, The Politics of Behavior and Behaviorism: The politics of labeling behavior. Chapter 3, The Hierarchy of Control. (a) 'Positive' reinforcement. (b) Overcorrection. (c) `Ignore and redirect'. (d) `Time out'. (e) Physical restraint. (f) Chemical restraint vs Medication; Medical models vs Personal support. (g) Mechanical restraint. (h) Aversives: The use of pain to control behavior. (i) Behavioral surgery and mutilation. Chapter 4, People Who Hurt Themselves. (a) Agnes. (b) Abuse, trauma and self-injury. (c) Medical aspects of self-injury: Norma. Chapter 5, Choices and Challenges: The Practical Struggles of Positive Supports. Appendices.

About this title

About the Author

Herbert Lovett, Ph.D., was a clinical psychologist, who worked for inclusive, person-centered educational, residential and vocational services for children and adults with disabilities throughout North America and Europe. He was a founder and past president of the Autism National Committee, a social justice organisation.

Excerpt. © Reprinted by permission. All rights reserved.

Excerpted from chapter 1 of Learning to Listen: Positive Approaches and People with Difficult Behavior, by Herbert Lovett, Ph.D.

Copyright © 1996 by Paul H. Brookes Publishing Co.

I was once asked to demonstrate positive approaches at a large professional training conference by listening and responding to stories about people who were difficult to serve. The first person described was Robert. The staff of a group "home" talked about how he had come to them from an institution, and on his first night he had become extremely destructive. Because of this violence, Robert has been immediately sent back. What exactly had happened? He had a reasonable evening, but when it was time to go to bed, he destroyed his bedroom. I always assume that serious behavior has serious meaning. It may not always be obvious to every bystander, but most of us have good reasons for our behavior. So, I wondered, why did going to bed have so much meaning for Robert? My guess was that his anger was about something bad that had happened in the past or that something was upsetting to him in the present. With whom did he sleep in the institution, I asked.

People in institutions often sleep in the same room with many others, most of whom they have nothing more in common with than their address. There may be partitions and low dividing walls between the beds, but even then there are often four beds in such an area. Although people are expected — contrary to all probability — to live asexually, they often form important relationships that are only rarely acknowledged in any sustaining way, if at all. Still, I was not surprised when the people telling Robert's story knew exactly who his significant other had been. My suggestion was that they begin to think of Robert's next living arrangement not as a program but as his home. The best first step in this planning would be to ask him if he wanted to live with his friend. I made a small joke about how this would be an example of how, once again, doing the right thing would be cost effective because only one bed would have to be purchased.

The audience reaction to this mild observation was surprisingly vivid. Ostensibly, they were indignant to think that public money would be used to subsidize a sexual relationship. In retrospect, money was not the problem because Robert was already having this relationship in a publicly funded institution. The issue is partly the rights of any citizen to privacy, but the wider concern is Robert's right to choose his life as much as any of us choose ours. It hardly seems fair that the price for a decent and life-sustaining service should be his sexuality and most important emotional connection in the world. For these professionals, this man belonged in their community as long as he knew his place — the place where all oppressed people are supposed to stay, where they are invisible and can neither challenge a system that regards them as less than fully human.

The nature of oppression divides the oppressed from one another. Many of the people in this audience worked in poorly paid high demanding direct service jobs. Many of us working in human services ourselves do not command much respect and are the targets of various bigotries, and yet we fail to see how much our own difficulties to silence or hide Robert, these workers were colluding in their own oppression.

Institutions have disembodied people at every level. Institutions have separated citizens with disabilities from their communities, and institutional practices have further divorced people from their own bodies. Although people might have had preferences about when and how long they like to sleep; when, what, and how much they liked to eat; what they liked to wear; and how they liked to look, none of these preferences was seen as worth attending to. Although not necessarily intentional, by ignoring individual differences and nuances, all the residents were seen to be the same idealized resident.

Given this group identity, it is not surprising that the literature of the institutional era referred to "the retarded," or "the retardate," as if such diverse people were one person. When we do not regard people as individuals, we are able to talk about them by freely replacing the individual with the collective, the same way people might talk about animals. When people study animals, they might begin by referring to the elephant, but after living with and observing a particular herd, individual animals emerge with particular identities and nicknames. the tragedy is that people labeled retarded, just like every other living being, have always had unique personalities but these were just not seen through the opacity of the label.

People's bodies, in general, and their sexuality, in particular, often form the crucible in which the wide variety of individuals are reduced to a group (mis)identity or to stereotypes. Women, for example, still have to confront the curious division of themselves into "madonnas" (uncomplaining, passive, asexual nurturers) and "whore" (women possessed of a wild sexuality that exhausts and victimizes men). Neither role offers much room for reality.

These same unrealistic sexual stereotypes are commonly imposed on people with intellectual disabilities. Instead of being thought of as madonnas, they are seen as asexual "holy innocents"; instead of being thought of as whores, they are sometimes labeled as "children in adult bodies," capable of a dangerous and ungovernable sexuality.

One of the first tasks of a liberation movement is to reclaim individual identities form an oppressive stereotype. Whenever women have organized for their liberation, they have collectively used their individual experiences to define themselves independently of the stereotypes imposed by the male-dominant culture. Similarly, people with intellectual disabilities have begun to assert their rights to sexuality, to marriage, and to family as a matter of individual choice rather than accepting what others assume about them.

Stereotyping and sexuality can also inform us about the nature of institutions and community. The institution began as a place but became a set of values, while community began as a set of values that, for many people, has become a single place. The unreality and the "un-human-ess" of institutions were justified by the presumption that the people in them were less real. As people with disabilities have become more vocal, they have claimed their right to full lives, which included sexuality. Institutions began with the assumption that the people in the institutions were asexual; and some institutions, recognizing that error, have wrestled with ways to reconcile that misperception with their operations. Many institutions have promulgated policies about opportunities for relationships and sexuality, often in the hope that this will make them more reasonable places in which to live. This is just another example of how institutions try to invent a world both parallel and superior to the real and ordinary one.

At the moment, the read and ordinary world of industrialized English-speaking countries is fairly confused on the topic of sexuality and who should be "allowed" to do what. Generally, though, citizens are subject to laws rather than policies and, even more generally, to the erratic enforcement of laws. A policy that would protect service users' rights to behave as they chose within the law would make sense, but here, as elsewhere, people with disabilities find their lives more strictly controlled than those of other citizens. One so-called community service has a policy that allowed people using their services to have sexual relationships, provided that the staff had determined that these relationships were "meaningful." This bit of naiveté revealed that these people might have moved into the community, but ideology that governed them remained in the institution. As is too often the case in our work, the understandable need for a coherent set of values to govern services becomes an imposition on those who use them.

This issue can also be applied to just about every other aspect of service users' lives. Just as we expect people with disabilities to exist invisibly, even at the physical level, we also expect them to be invisible financially, except as the passive recipients of public welfare. Similarly, we do not expect people to take the initiative to speak for their rights as citizens or of their hopes as ordinary people. This failure to take seriously the most ordinary wishes and needs of people is sometimes makes by service agencies who want to "help." The help that is offered, though, is for an idealized or de-realized client rather than for a real person.

I doubt that Robert intended for his behavior to make him a test case. I suspect he was just asking for a home with the person with whom he most wanted to share his life. If that was indeed what his behavior was telling us, then having heard it, the most positive approach I can think of would be to provide that for him. Somehow, this idea that we should respond to people's request still strike some people as unnecessary or pointless. If people labeled retarded were as stupid as they were stereotyped, then there might be little point in asking much less waiting for the answer. But experience has taught us that people labeled retarded are often well aware of who they are and what they need. It is surprising how smart people become when we find ways of understanding what they really mean!

Edition details

• Publisher: Jessica Kingsley Publishers
• Publication date: 1995
• ISBN 10: 1853023744
• ISBN 13: 9781853023743
• Binding: Paperback
• Language: English
• Edition number: 1
• Number of pages: 224