Recognising and embracing my (as yet not formally diagnosed) neurodiversity has been a game changer for me, not least in the way that I deliver my training. I now understand that I live with (sharp intake of breath….) Borderline Personality Disorder. There. I said it. Add in a few markers for ADHD, a dose of Rejection Sensitive Dysphoria, stir well with depression and social anxiety, and you may start to see why I procrastinate, have a very inappropriate sense of humour, can never meet deadlines, doggedly avoid social situations or become hyper-focussed, and ‘go off on one’ at the drop of an unintentionally discarded hat.
But it did make me think. We are ALL the sum total of our experiences, yes?
You see, I unequivocally believe that human beings are driven by two things and two things only; what they see, and what they feel. These in turn, drive our behaviours.
Once, when I was working in residential child social work, my mentor said to me that the reason ANY of us come into care work of any description, be it carer, doctor, nurse, whatever, is because at some point in our history, we have experienced something that hurt, damaged, or otherwise affected us so deeply that we didn’t want anyone else to feel the same way, and so we unconsciously go into professions that allow us to protect people from those feelings. Secondly, because we felt we had no control over the relationship or situation in which we experienced it, we again unconsciously choose professions that allow us full control over those relationships.
The nett effect of this is that, as carers, with all our unconsciously driven behaviours, we generally over-intervene and de-skill the very people we care for as our default setting; not because it’s of benefit to them, but because it makes US feel good. We do it for us.
Now, to begin with I wasn’t buying this idea at all, until one day many moons ago, we were receiveing child safeguarding training, and I was asked to roleplay the part of an abused child. My life changed forever during those few moments, because all of my suppressed memories came flooding back, all the pain of psychological, sexual and physical abuse I endured as a child. Who, when, and where is not important, but what IS important that I realised that my mentor was right. Those experiences DO influence our decisions and attitudes. Our experiences actually DO drive our behaviours. Its where all the empathy, compassion, and fury at the unfair world we rail against comes from, and its why we ‘serve to protect’, because no one was there to protect us. Read that last bit again. In fact, I will engineer any opportunity to ask carers that I train; “Why did you become a carer? What drives you?” And there are nearly always the same common denominators, even though their responses are usually somewhat vague.
Once we understand what drives us unconsciously, we can consciously take steps to prevent over-intervention. Factor in Maslow’s Hierarchy of Needs, and we are able to identify exactly where we de-skill our residents.
All of us, man, woman, and child, has a basic human need to contribute to the society, family, club, clan, or group with whom they most interact. It validates us. It makes us feel ‘we belong’. Withdrawal of that need only grants us a sense of alienation and isolation from that group.
For example, suppose I have a resident living with vascular dementia, and because she has difficulty with mobility, I ask her “would you like a cup of tea?” she nods and I shuffle off to make her one, in the belief I have done something good for her. I probably make one for several other residents too. I haven’t. I’ve done something good for me. I feel good because of it. It would have been better to say “Cup of tea? Come on then, show me where the kettle is”
Now, she may not be safe around a kettle of boiling water, but she can select her own cup, drop a teabag into it and so on, thus contributing to the process, up-skilling her, and giving her a sense of validation and recognisisng her as an individual, rather than just acknowledging that she is merely one half of the ‘me carer, you resident’ relationship.
Here’s another resident: She worked in the hospitality industry. She ran a busy restaurant. Now, day after day, she sits in her chair in the day room, barely interacting with anyone. I ask her to help me lay the table. Her eyes light up, even though she has Alzheimers. If she puts only one plate on the table, I acknowledge it. “Thank you!” I say. “Now you’ve done that, everyone else can eat!” How do you think she is going to feel? Six weeks from now, six months, makes no difference, she will add more as her cognitive ability and memory will allow. She’s validated. Recognised. Contributing. And levels 3, 4, and 5 of Maslow are realised. BASIC. HUMAN. NEEDS.
Lastly: A male resident. Ex-army. Dementia, immobile, gets terrified whenever he’s in the hoist. His limbic system goes into ‘fright’ mode, his pupils dilate, the anxiety makes his temperature drop, and he shivers, knuckles white as he grips the straps on the sling. Why? because he has no control over the process. So why does it never occur to carers to offer him the hoist controls? “Oh…” they say….“he doesn’t have capacity”. How do you know? Have you tested it? One cannot simply state that someone lacks capacity. Every case is time and issue specific. Kneeling down before him, I offer him the hoist controls. I may have to show him how to do it, press his thumb onto the control buttons until he’s got the hang of it and so on, but I don’t care if he wants to play upsy-downsy in the hoist for the next ten minutes. He has some control back. Some input into the process. He’s being SEEN. How do you think he now feels? Less anxious? More in control? Validated? More human?
And yet, as carers, we do this over-intervention every damned day. They say that it doesn’t matter what you say or do to someone with dementia, because they won’t remember it. Maybe not, but they WILL remember exactly how you make them feel. They may not know WHY they feel this way about you, but feel it they will.
The beauty of all this is two-fold. Firstly, you’ve lessened your own workload, secondly, when you see these diamonds you’ve created from the clay, you too will feel great, validated, and a part of something special. Stop worrying about what your patients or residents CAN’T do, and focus on the things they CAN. Examine those experiences that drive your behaviours, look at Maslow, and make that change. Let go of the reins. Relinquish control. Step over that edge. You’ll feel great, sure, but more to the point….so will those you care for.
SEED Training 