EMOTIONAL DEVELOPMENT: FROM ASSESSMENT TO SUPPORT

Transcription

1 EMOTIONAL DEVELOPMENT: FROM ASSESSMENT TO SUPPORT Filip Morisse PC Dr. Guislain, Ghent, Belgium Leen De Neve PC Caritas, Melle, Belgium Solicited Symposium: Meaning of the level of emotional development for diagnostics and treatment of persons with ID and MH-problems EAMHID-congress 10/09/ Firenze

2 Assumptions Caregivers often reluctant to act restrictive discours and highly prevalent use of control and freedom-impeding measures (mis)use of psychotropic drugs exclusion Assessment or diagnosis that doesn t serve a treatment/support, serves nothing No categorizing diagnostics, but dynamic, functional and action oriented diagnostics, based on narratives of people, dynamics, discussions, hypothesis rather than facts, symptoms, deficits.

3 Assumptions Not changing clients, but ecological changes: fine-tuning the support on their basic emotional needs by coaching the environment: Coaching to emotional availability Coaching to mentalisation

4 From assessment to support Tool / method (publication) for this proces: Facilitating the focus on the environment and the awareness of own transfer Turning from ready-made answers right questions Proces = Out-of-the-box-thinking Transform knock-down arguments into creative answers Themes in support strategies Distance and nearness Structure and boundaries Activities Communication Challenging behavior

5 Distance and closeness WE-dentity Unconditional valuing companionship Distance and closeness Emotional availability Interdependence Affective synchrony, sensitive responsiveness Individual treatment: alert for velocity, signals Regulation towards homeostasis Structure and boundaries Basic trust/by regularity in time, space and persons, predictability Delimitation: taking over, fysical nearness STAGE 1: Adaption (0-6 m) Homeostasis Disregulation Sensory integration Fysiologic adaptation (dis)regulation Arousal Integration of space and time Activities Communication Challenging behaviour Stimuli reducing Non-verbal = total Close observation signals deregulation Adaption of the Proximity senses Unconditional environment Here and now acceptance Flexible balance Need for To limit between between closeness Safety rest and action Medication?? Being together> Doing alone

6 Questions to reflect upon A recipe???? In stead of give instructions, ask questions invite people to read behavior, to reflect, (coaching on the job)

7 Case Ahmed Ahmed is a 17-year old boy, with severe intellectual disability and ASD. He lives in a home. Network: parents, brother and sister; he goes home for short periods Problem behavior: restlessness, psychomotoric irritability, wetting trousers, dysthymia, eating and drinking without control, yelling, crying, pulling one s hair, constantly taking out his clothes, Diagnosis: severe ID, ASD Assessment: SED-R 2 : stage 1

8 HOMEOSTASIS DISREGULATION Stage1: Adaptation (0-6m)

9 Ahmed: support should start by Type of support needs: homeostasis disregulation Easily corrupted, also physically Very sensory; high-strung Floating on internal tension barometer Most important job of the caregiver To regulate

10 Ahmed: proximity and distance To BE together Together (safe) is better than alone (unsafe) Just to be is important How can we do this with Ahmed? Use WE-dentity in every way (WE = save) In which way is the client looking for proximity? How do you react to this, which format is effective? What works and what doesn t? Be emotional available: Quick response to signals, disregulation Being sensitive for emotions and needs, and give a fine-tuned response Coaching the staff

11 Ahmed: activities Take a close look on the time-period f.e. from 8 10 u with this client. Whith which stimuli is this cliënt confronted? Which are pleasant, which are stressfull? How do you see this? Dosage of stimulation Person-specific How is this for Ahmed? Protection Dosage = regulation = often impovermishment (but not always!) emptiness Stimulation-poor being alone

12 Case Anne Anne is a 32-year old lady. She has a traumatic history (emotional neglect, sexual abuse, suïcide of brother in jail). Lots of psychiatric admissions. Challenging behavior and psychiatric symptoms: agression, automutilation (burn herself), withdrawal, splitting and projective identification, dissociation, affectlability, existential anxiety, suicidal episodes, paranoïa, low treatment-compliance. Lives alone in a flat with support of assisted living but most of the time in flat of mother. Network: caregivers 1/week, also 1/week for mother, GP, guardian, outreach Diagnosis: borderline ID, borderline PD, PTSD Assessment: SED-R 2 : stage 2-3

13 TRUST SUSPECT Stage 2: first socialization (6-18m)

14 Stage 2: support should start by Type of support needs: Trust Suspect: Constantly wanting and having to follow the attendant: sticking, attention-seeking Afraid to be alone, to be rejected: unsafety Emotional refill Can this world be trusted? Attract push off Most important job of the caregiver: To circle

15 AUTONOMY DEPENDENCE Stage 3: first individuation (18-36m).

16 Stage 3: support should start by Type of support needs: autonomy dependence: Fighting in order to expand, but in strong need of the other and even afraid to lose; looking for the ideal distance Me me me No no no Self self - self Negative attention > no attention Most important job of the caregiver: To play (the game)

17 Anne: communication Indirect communication by mobile phone and social media: holding a line Never a typical one-to-one caregiving talk No strict expectations Emotional neutral: No rejection Not judging No you but I or we Distract her Chit-chat; peace-talks Which reactions and interactions, starting from your side have a positive effect on this client? How do you see this? Issues: money, administration, medical problems...

18 Anne: structure and borders Borders = to offer safety Based on connection and trustworthiness Transparant and consequent, with repetitions Clearly indicate the borders of yourself and the environment Actively deal with: take over, get out of the situation Start over again Why does this client need borders? How do you set borders with this client?