ESTABLISHING, MAINTAINING AND ENDING THERAPEUTIC RELATIONSHIPS
المؤلف:
IAN PEATE & DEBRA FEARNS
المصدر:
Caring for People with Learning Disabilities
الجزء والصفحة:
P13-C1
2025-10-04
297
ESTABLISHING, MAINTAINING AND ENDING THERAPEUTIC RELATIONSHIPS
The process of, and considerations for, effective communication with adults with learning disabilities will be discussed in “Communication and Adults with Learning Disabilities” (‘Communication and Adults with Learning Disabilities’). This section will explore key considerations and reflect on establishing, maintaining and ending therapeutic relationships.
When thinking about our contact with another person, first impressions can be significant in setting the tone for building a rapport and relationship with that person in whatever context we encounter one another.
Reflecting my experience as a student nurse, contact with adults with learning disabilities prior to commencing the course related to working in a school for children with special educational needs and family contacts with individuals with mild learning disabilities and/or Down’s syndrome. As a student, arriving in a long-stay hospital for adults, with a variety of needs relating to their learning disabilities, while walking along a corridor, a fellow student and I encountered a young man with what could be described as significant facial and physical characteristics associated with his disability. I later discovered that this was acrofacial dysostosis (ACD) Catania type – a rare autosomal syndrome (Jablonski 2005).
Greeting this man, my initial response was to feel empathy, and to honestly assume that he would have limited ability to respond. My fellow student reflected feeling quite disturbed by this man’s appearance. At this point, he ‘blew a raspberry’, poked his tongue out and proceeded on his way, leaving us quite dumbfounded!
Later opportunities to interact with this man enabled us to see the ‘man behind the mask’, and discover who he was as a person. The lesson here in thinking about our work with adults with learning disabilities is to remember that, first and foremost, they are people. We need to be aware of our own experiences of interacting with people with learning disabilities. We need to adopt a questioning approach, increasing our knowledge, thus reducing the opportunity for us to make assumptions and judgements about people based purely on their appearance or diagnosis. We need to utilize support mechanisms to address our learning needs, such as through supervision and appraisal processes. This will enable us to ensure that our practice is based on an anti-discriminatory approach (ADP) and help us to develop a heightened sense of awareness of ADP issues within the work environment and wider society. In “Legislation and Learning Disabilities”, McIver discusses legislation addressing issues relating to ADP and legal concerns.
In treating people as individuals, we need to acknowledge their disabilities and adapt our communication and interaction to ensure that the adults have every opportunity to engage with us, and demonstrate who they are as individuals. Often, adults with learning disabilities rely on others to interpret and convey their messages, leaving them vulnerable to misinterpretation and misrepresentation. As a student or paid/voluntary carer, you will often be in the position of trying to establish meaningful communication and interaction with adults whom you support. You will need to ensure that you have the appropriate skills to take on this responsibility.
Alongside this awareness of beginning interpersonal relationships with adults with learning disabilities, consideration needs to be given to how to maintain these relationships, using everyday opportunities to engage in valued conversation. Often, as carers, our interaction with people is associated with personal care (Ambalu, in O’Hara & Sperlinger 1997). The demands of time and perhaps staffing levels can limit opportunities; care must be taken to guard against this and to be conscious of developing opportunities for ‘real’ conversations. We need to accept and value times at which people may choose not to interact with us, hence supporting people to be assertive and enabled to indicate to carers when they wish to disengage or be left alone, which is equally important (Ferris-Taylor, in Gates 2003).
Often, carers can find themselves in a position of power. As outlined above, you may be asked to initiate contact and conversations, as adults with learning disabilities may be reluctant to do so, for a variety of reasons, such as difficulty experienced in the communication process, type of disability or their life experiences. The last point can relate to some of the negative experiences that adults with learning disabilities may have had in past interactions. Hence, gaining trust and building a relationship over a period of time are important considerations, not only in establishing and maintaining relationships, but also in thinking about endings. This is particularly pertinent for carers who may encounter people for a fixed period of time, within a practice placement, for example.
It is important to consider ending relationships. Very practical strategies can include openness with people with whom you are working about the length of time you will be there. Using innovative ways to represent this may also be helpful, perhaps through use of a pictorial chart or adapted calendar to ‘mark off the days’. You also need to ensure that the learning opportunities with which you engage are realistic within the given timeframe. Link any activities undertaken with a permanent staff member, working alongside him/ her to ensure that continuity for the person is maintained when you leave.
Such endings are vital, as people with learning disabilities are often in environments in which they are reliant upon paid carers; inevitably, staff change and move on, leaving the person to build new relationships with new carers. This pattern of continual change and loss can affect both the person’s ability and his/her desire to interact. This is a very important factor to consider within an educational context in which we are continually moving in and out of people’s lives.
Appreciating the diversity of needs of adults with learning disabilities and developing an appropriate range of skills to support these needs necessitate opportunities for students to work with people in varied settings, who may have a wide range of needs. We have a responsibility to guard against negative outcomes for learning-disabled adults engaging with students and other staff during these opportunities.
Further issues of diversity are considered within the subsequent topics. The next section will explore considerations specifically relating to culture and issues for older people.
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