ENDINGS AND BREAKS IN COMMUNICATION/ THERAPEUTIC RELATIONSHIPS
المؤلف:
ALAN RANDLE
المصدر:
Caring for People with Learning Disabilities
الجزء والصفحة:
P32-C2
2025-10-06
231
ENDINGS AND BREAKS IN COMMUNICATION/ THERAPEUTIC RELATIONSHIPS
Unintentionally, communication with service users is perhaps not always ended or finished appropriately, such as walking away from service users without informing them of the reason behind this act, which might be as simple as forgetting to collect or bring something that is required for an activity, but was not communicated to the service users. You may know the exact reason for leaving, even if only briefly, but may have unintentionally not communicated this to the service users. They then may experience this as a break in the communication or activity, which may affect their interactions with you when you return. (This issue of communication could be considered from an attachment theory perspective.) Although these breaks in communication are important, they can be easily rectified; Fraser (1997) mentions this in terms of repair. The emphasis within this section will be on ending or finishing therapeutic work/communication with a service user. This is particularly important for students who may be introduced to service users, engage with them during a piece of work and leave at the end of the placement period. It is extremely important to finish, end and ‘say goodbye’ in a meaningful manner (Mattison & Pistrang 2000).
All of our interventions with adults with learning disabilities, or any other service user group, have a beginning, a middle and an end (Trevithick 2000). Adults with learning disabilities may not always pick up on cues that indicate that a period of being engaged with someone has ended and Trevithick (2000) highlights that this may be experienced in an abrupt fashion. This may be partly due to the issues relating to pace and understanding. In a world in which the pace of life is based on what is considered as ‘normal’, adults with learning disabilities may experience being left behind (Pörtner 2001). Some of these issues have been briefly discussed above. The immensely valuable contribution made to the learning disability fi eld by Mattison and Pistrang (2000, 2004) cannot go without mention in this section. Their study not only considered the views of staff members and their thoughts and feelings about disengaging with service users, but also provided us with a moving insight into how adults with learning disabilities feel about how the endings of relationships with staff are handled and dealt with. They discuss the limited literature within this area in a succinct manner and provide us with a clear and balanced view of the importance of ending therapeutic encounters in a sensitive and meaningful manner.
Mattison and Pistrang (2000) highlight how adults with learning disabilities have limited social networks and may rely on staff members for friendship, including emotional support, and, due to the nature of some disabilities (i.e. additional physical disabilities) and service support (e.g. shift patterns and staffing ratios), there may be difficulties in enabling service users to build other socially supportive networks. They go on to discuss in detail how service users may then feel the trauma of the loss of these significant relationships which were not ended in the most appropriate manner and that due to limited means of expression, this could lead to exaggerated behavioral issues, including withdrawal rather than more overt behavioral expressions of their upset, i.e. exhibiting challenging behavior. Therefore, it is important to consider how any therapeutic intervention is commenced, worked through and processed, and ended. Two main skills are identified as important to take into account when ending a therapeutic relationship/encounter: to have some awareness of how service users with learning disabilities may respond to the ending of a therapeutic relationship or a communicative encounter, and to be able to help service users name and express their feelings (Mattison & Pistrang 2000). Whilst these authors do discuss more profound and significant losses overall, it is nonetheless important for us to consider these issues in relation to ending communication appropriately with service users. Fortunately, Mattison and Pistrang (2000) draw attention to the communication issues in relation to the above. Outlining that type and severity of the learning dis ability will call upon practitioners’ skills in recognizing how the service user’s feelings are expressed and the skills required to assist with this process. This is explored further in their work, clearly suggesting that as staff members, we should not underestimate the impact that we have on service users. Knowing when to mention the ending to service users was also examined and the importance of preparation is indicated – some service users may have experienced the ending as more abrupt due to their disabilities; they may need the message repeated and reinforced (Emerson 1977, cited in Mattison & Pistrang 2000, 2004). The skill required here is at least to be aware when you are leaving, finishing or ending a communicative encounter with people with learning disabilities and to inform them as best you possibly can. Jackson and Jackson (1999) offer one possible alternative way of communicating with adults with limited abilities. They have produced a small piece of work demonstrating how they utilized photographs to help adults with learning disabilities communicate issues related to endings and losses.
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