Back in April, Alan started to go for aromatherapy sessions. This was not a random decision or a token gesture to fill his days, it was borne from research I had been doing around the reduction in self injurious behaviours due to positive touch.
The research and case studies I had read gave overwhelming evidence that therapeutic massage combined with aromatherapy can significantly reduce the frequency and intensity of self-injurious behaviours, and can also help to promote positive body image and greater self-worth.
I was apprehensive for Alan to have sessions outside the home as he finds visits to the doctors and dentist very stressful and such appointments have often been extremely upsetting for him in the past. However, our Head of Service was keen for Alan to extend his circle of support outside the home so I had to think of a way for him to see his aromatherapy sessions in a different light to that of an appointment with a health professional.
I met up with Emily Baker (Aromatherapist and Reflexologist BA hons, MIFPA, MAR, CNCH registered). We discussed Alan’s needs and what we needed to achieve in order to give Alan the best chance of engaging in, enjoying and benefiting from his sessions with her. We discussed in detail the environment of her treatment room and her appearance then together made some changes so Alan would not perceive it or her to be threatening. Emily swapped her therapist uniform for casual clothes in muted colours and moved the furniture so the room was more like a sitting room. We also discussed positioning, both to keep her safe and to help Alan feel at ease, music, lighting and most importantly expectations.
In my research a common downfall in facilitating the engagement and trust of the person receiving therapy seemed to be that the therapist and the supporting staff’s expectations and desire to start therapy asap did not allow the person receiving support enough time to learn to trust or to understand what was going to happen. When a person’s mental capacity is unable to retain information or to connect an action with an outcome, being pushed and rushed into an unfamiliar environment, being expected to submit to strange sensations, smells and touch with no real comprehension of why, can be terrifying and leave the person feeling they have no control.
The case studies that had the best outcomes where those in which the foundations of treatment sessions had been laid brick by brick – slowly and carefully building trust and friendship and always respecting and upholding the choices of the individual person.
Emily and I are on the same page with our values and our passion for equality in life no matter what your abilities are, we worked easily together and prepared the first brick to begin building the foundations for the best possible outcome for Alan.
So, the first appointment was made. I now needed to work with Alan to prepare him to meet Emily. I had a photo of her and some lavender aromatherapy oil that she had given us. I chose times when Alan was very calm and I would show him her picture and let him smell the oil. I would talk to Alan about going to meet Emily next week, I did this on all my shifts leading up to his appointment and in that time he learned her name and to recognise her photo, he would also smell the oil on his hands. We had begun the positive association and he could link Emily – smell – touch of hands.
When Alan met Emily they greeted each other and she showed him into her treatment room. He had a little dance to the soft music playing and sang for her. We had decided to leave the door open, signalling to Alan that he could leave if he wanted to. And sure enough, leave he did. Alan got back in his car and put on his seat belt, I wound down his window and Emily came out to thank Alan for coming. She gave Alan a gift; it was a cotton wool pad with diluted lavender and chamomile oils on. Emily wiped the oils on his hand and said ‘goodbye’ and ‘see you soon’. All the way home, Alan was smiling and smelling his hands.
We continued like this for some months, gradually laying and setting the bricks of trust and choice; when Alan wanted to leave he did, sometimes he would change his mind and come back in again for some more. The length of his sessions varied from five minutes to twenty minutes depending on his mood. Emily would note his reactions to different oils and began to find the ones which Alan favoured and those he really didn’t! We have vowed never to use Patchouli oil again, but that is another story.
We came upon a sticking point though, and it was quite a big one. In order for Alan to get the best treatment and for Emily to begin to use touch effectively Alan really needed to be sitting down. Now, Alan is not a sitting down kind of guy, he likes to stand, dance, walk and move to look around and explore. We tried many things to encourage Alan to sit down: sitting on the floor, taking it in turns, we even had one session in the car as I wanted Alan to find out what would happen if he did sit for long enough for Emily to massage his hands. Alan was quite receptive to this but I knew it was not the answer and I needed to step back and think about things differently as we were at the stage where Alan trusted Emily and enjoyed seeing her, but he was becoming frustrated by our constant requests for him to sit down.
I thought about it for a long time and realised that I was doing exactly what we had set out to avoid. My expectation for Alan to sit down was starting to have a negative impact on his sessions.
I thought back over times when in the past Alan had been expected sit – ‘sit down till you calm down’, ‘sit down and eat your dinner’, sit for the dentist, sit for the doctor, sit while I do this or that, sit down for anything Alan does not want to do. Ok, so when does Alan actually make the choice to sit down? Occasionally to watch tv, but not for long; in the car but that is to go out or to come home; getting dressed and undressed – let’s not go there! And finally after one of his favourite things, a long walk- Let’s try it…
So it was a warm sunny Tuesday afternoon, we set off and Alan was happy as he likes to see Emily. I asked Alan if he would like to go for a walk first and he said yes. We parked down the way from Emily’s house and started to walk up the hill, no rush just looking at the people and houses. I talked to Alan about Emily on the way and at the end of her road he recognised her house. He pointed and said ‘look, Millie’ and he then lead the way.
Emily came out to greet us and Alan flashed her one of his winning smiles that set the tone for the session! Alan went in and sat down then offered his hand to Emily. She started with lemongrass oil which Alan loves, then went on to massage both of his hands. Alan sat still, comfy and relaxed for half an hour. He was engaging with Emily in a way that I hadn’t seen him do before, he showed her parts of his hands that were sore, looking her in the eyes and asking for her to make it better (Emily and I must have had something in our eyes as they were watering a bit by now).
When Alan had had enough, he stood up and said ‘goodbye’ then pottered off down the road waving behind him as he went.
For the rest of my day with Alan he was calm and in good humour. At any sign of anxiety I would encourage him to smell the oils on his hands and he would smile.
Alan and Emily are at the start of their journey together, but I believe that the time taken to lay strong foundations have paved the way for Alan to be able to benefit from the positive touch, aromatherapy and massage in a way that improves his body image, self-worth and confidence. This, with the other positive changes in Alan’s life, will, over time help him to reduce his self-injurious behaviours and help him to express himself in positive ways.
Senior Support Worker
Best Practice Mentor (Great Interactions)
Positive Behaviour Coach