Bristol & The South West

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Client Group: Young People (10-18yrs) with Profound and Multiple LD & Challenging Behaviour

Client: "J", Female, 17 years old.

In the last years, my work has developed into something which heavily involves the client's carers. I've seen and believe that in order for there to be true trust, competence and care when working with LD, staff must find a way and understanding of the complex nature of working with vulnerable people, helping them to support the soul as well as the body. The issue of lack of care in society and it's consequences is heavily visible in media and social politics and is a very current and modern problem. Through this inclusivity in the creative therapeutic work, I have seen the immense confidence and authentic connection the process has given the staff and the young people. Carers have developed an increasing ability to expand their skills and learning, connecting with the young people openly but appropriately, on a human (rather than business) level, without boundaries or parameters of what they "should be doing" or "need to be doing". Owning, articulating and working on their youngster's needs as well as their own and sharing it appropriately, allows us all to be participants in the group rather than rigid roles of 'staff and carers'. Having an honest and human relationship without impossible expectations from either 'side' gives the youngsters and their carers a much more fruitful, productive, happy and ultimately, caring relationship.

J initially couldn't even enter the space, watching the action from outside the doorway, very anxious and tense but curious.  Through encouragement, within weeks she gradually began entering the room and sitting by the door, sitting inside the room with the door open and eventually being in the room with the door closed. She now remains for the entire hour inside the room and is the last to leave as she vigorously tidies up. Last week saw her abandon her usual solitary corner to join the circle on the floor. It has been astounding and moving to watch her growing confidence, ease and increasing ability to manage her anxieties, involve herself and open up to playfulness and creativity.

Our beginning and ending rituals were a 'check-in' in which we all creatively shared our feeling and a routine of choosing something from the box of resources. After choosing, each person had to use their imagination to tell the other's what it was (e.g. a piece of wool could be a cloud or a sheep, a tube could be a pirate's telescope or an umbrella). This had various purposes; to create a ritual at the start which marked the beginning of the session, to introduce an element of imagination and help the more creatively shy carers, to provide a starting point for the story's narrative and introduce the concept that we all got to chose something and therefore all had a 'stake' in the story.

Both J and her carers initially struggled with this. She found it hard to suddenly have to listen to and consider other people's imaginative input and not start the story immediately with her own ideas. The staff meanwhile floundered a little at the idea of having to call up their own creativity (which they often were adamant didn't exist) or they became a little too enamoured with the freedom of suddenly not having to follow J's (often bossy and obsessive) direction and would sometimes became a little too complex or convoluted in their ideas.

J particularly disliked the immediate lack of control she felt and gravitated to things that made her feel safe, obsessing about particular areas of the space or fixating on objects such as the lights or curtains. I worked hard to help the carers not get pulled into her anxieties by responding fearfully or immediately to her behaviour, assuming she wouldn't manage. When it would occur, I encouraged them to stay in the space and continue with the story, using their characters or the narrative to carry on inviting J to join in. She eventually realised that in order to be a part of the action, she had to listen and partake in other people's directions as well as her own. Despite this difficulty, J never,in the entire 11 months displayed any aggressive, difficult or challenging behaviour (the reason for her 2 one-to-one carers). At some stages early on, she would occasionally run out of the room if things became too much. I would encourage her carers not to run after her, to give her space and she would return very quickly, seeming grateful for the freedom to escape and the possibility to return without consequence or a 'telling off'. She very quickly showed a trust and safety in the space as it was not one that was pressured.

The more carers began to get the hang of the sessions, the more confident they were on inputting their own initiative into the story. To her credit, J quickly realised that mine or his carers directivity in the story did not mean she was excluded or 'out of control'. While she did initially reject other input, ignoring us or hiding herself, our consistent invitations to join, coupled with a firm conviction that the story continued regardless, she began to grasp the ideas that we all had an equal role. This built into curiosity at her carer's intentions eventually developing into genuine pleasure and seeking out other people's ideas, thoughts and characters.

As the months continued and with regular 3 monthly 'reviews' (with myself and the carers) we began to look at particular events in J's life and how we could use our stories to help her look at or adjust to them. When the decision was taken that J's main carers step away for a large 'bank' of staff to support her (attachment issues brought difficult and aggressive behaviour), they were able to use the stories to express their goodbye and their sadness and J was able to convey this too (being being an injured animal which needed and asked for their help). The new, large group of carers presented a challenge to begin a new process of working creatively with self-conscious and reticent individuals, but J proved her learning and new skills often, by inviting themto participate in the stories and not letting them sit on the side lines.


Rosie Strain Dramatherapist

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