LISTENING TO THE SILENCE: HOW ASSISTIVE TECHNOLOGY CAN HELP OR HINDER THE THERAPEUTIC PROCESS

Alan Corbett weighs up the pros and cons for assistive technology.

Assistive technology is a growing industry, with a wide range of tools being developed to help people with disabilities process and communicate spoken language. As this issue of Frontline demonstrates, there is much to be excited about in this wave of technological innovation. The lives of people with disabilities, and those who live and work with them, could be improved immeasurably over the coming decade as aids and devices become more affordable. As a psychotherapist who specialises in working with people with intellectual disabilities, I can see many ways in which technology could help bridge the gap between my more severely disabled clients and the outside world.

Many of the clients I assess and work with are referred to me because trauma has entered their life. Sometimes the trauma is a historical one, involving childhood abuse, neglect or deprivation; in other cases it is more recent—a raw, open wound. Trauma tends to silence its victims, making them feel powerless and unable to loosen its grip on them.

Trauma also tends to exacerbate disability. The clients I work with may have a primary, organic disability, but this can then be hidden under a secondary disability that stems from the abuse they have experienced. The aim of therapy or counselling someone with an intellectual disability is to help them work through and process the traumata they have experienced. People with disabilities tend not to refer themselves—this is usually done by a carer or family member. It is rare that someone is referred to me because it has been decided that they could benefit from a space in which to think about who they are, what they want to do with their life or how to manage feelings of sadness. More usually people are referred because they have developed a destructive behaviour or a habit that is causing people around them to be worried. One of the first conversations I have to have is with the referrer to let them know that my primary job will not be to manage or get rid of the troublesome behaviour. My real role is to help the client work out why the behaviour is there.

Disability Therapy has had to engage with the world of assistive technology for some time now, particularly when working with clients with profound verbal communication difficulties, or physical disabilities. And yet, despite the inevitable adjustments one has to make when technology is introduced into the consulting room, the key to therapy remains within the relationship. There is a risk that we as therapists may become overly preoccupied with the technology itself, at the risk of losing the core components of the relationship. The addition of anything more than two people into the consulting room increases the risk of the client experiencing feelings of being sidelined or overlooked, feelings that are painfully familiar to many of the clients with whom we work.

While supervising a counsellor who was working with a client who used a computer package to help her be understood, I noticed how the majority of our supervision sessions seemed taken up by discussions about the technology rather than the person. In looking at this is more depth, it became clear that what was happening in the supervision session was a fairly good reflection of what was happening in the counselling sessions. The counsellor had forgotten that her primary job was to attend to her client, rather than to her client’s computer.

This highlighted an important reminder of the risk of technology masking the primary needs of our clients. When someone has been traumatised, what they tend to need more than anything else is to know that someone else can bear the weight of their experiences. With people with severe and profound disabilities, we should not restrict ourselves to the spoken word. The more severe the disability, the more we need to use and be open to non-verbal communication. Play therapy, sand tray work and art therapy are just some of the ways in which people with severe verbal communication difficulties can be helped to tell their story. Much of therapy is about facilitating a process of mourning. Trauma is a form of loss which, unless treated, can lead to permanent and debilitating emotional and behavioural difficulties. Mourning needs to take place in the presence of another human being, and when someone lacks words, the communication between one person and another may need to be translated through all sorts of exchanges. Foremost amongst these is silence. Many of the clients with whom I have worked have struggled to put their experiences into words, and have needed much reassurance from me that perhaps they will not be able to do so, but they can still, through their silence, communicate the weight of what they have been through. In doing this we are listening to the whole person and not just the words they use.

As technology evolves to enable more people with disabilities to voice their stories, it is vital that we are mindful of the risk of becoming attuned more to the technology than the person it is seeking to help. Technology can undoubtedly increase the possibility of stories being told and heard. It should not, however, be at the risk of other less technological but more human techniques.

Author Bio

Dr Alan Corbett is Chair of the Training Committee of the Institute of Psychotherapy and Disability. He has been Director of Respond, National Clinical Director of the CARI Foundation and Clinical Director of ICAP. He teaches on a number of psychoanalytic trainings in Britain and Ireland, lectures internationally and publishes widely on disability, psychotherapy and trauma.

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