When Emma first joined my service we discovered she had a complex history of trauma and institutional abuse, with an Intellectual disability, borderline personality disorder and anxiety diagnosis. After being bounced around the NHS and being put in the ‘too hard’ basket, she joined the small group home I managed which had a high client to staff ratio, but most importantly, a team of committed and insightful practitioners with excellent values. Emma presented with high frequency severe self-injurious behaviours, typically hitting her head into sharp objects (e.g., table edges) resulting in significant injury requiring hospitalization. Emma appeared to find the hospital experience reinforcing and it was ascertained that attending hospital and being attended to by hospital staff was a validating experience for her, intertwined with her previous trauma history.
I’ll give you a few specific examples to help illustrate the sorts of interventions we used with Emma. One of our first interventions was actually to make the hospital experience less exciting – we developed a protocol with the local hospital that the attending staff not wear their white lap coats and hold back on the offers on soft drinks. Next, we worked on getting Emma connected with people socially through participating in group art activities and excursions in the community. We also worked on teaching her self-soothing techniques and supported her with de-escalation behaviours when she started to get elevated.
At a time when Emma’s behaviour might have been written off as attention seeking, my team and I viewed her behaviours as her struggling to get her needs met and we painstakingly worked to develop a range of interventions to help Emma develop her skills and meet those needs without resorting to using self-injurious behaviour. Honestly, it was two steps forward, one and a half steps back at times, but Emma’s challenging behaviours stabilized over time, and we helped her to manage her distress differently, and also to really achieve her needs through meaningful connection.
Emma was no doubt a challenging client for our service. Months of staff hard work could come undone in a moment. Emma required a lot of staff time and her self-injurious behaviours were dramatic and unsettling as they were highly distressing to witness. Emma had been put in the ‘too hard’ basket for much of her adult life, and it took resilient and supported practitioners to help her turn a corner. We saw that Emma was in pain, she was mentally suffering, and our hearts went out to her. We wanted her to get her needs met in safer and more sustainable ways, and we wanted her to heal, not just from the self-inflicted wounds, but from the wounds of her traumatic past. Through compassion, we overtime helped to support her creative soul to connect with others in healthier ways, and manage her anxiety with more peaceful practices. Emma remains strong in my memory – as someone who was ‘given up’ upon and came with a warning label, I’m proud to have been part of a team who wanted to get to know her at a genuine level and believed in her capacity for growth and change with the right supports in place.
**Notes, client name and details have been modified to maintain anonymity.
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