During my 12 years as a Complementary Therapist, I have often found myself working with adults with learning difficulties at day centres, residential homes and privately. Although there are a few extra challenges involved, the work can be immensely rewarding if somewhat unpredictable.
A learning disability can be described as a reduced intellectual ability and difficulty with everyday activities; something that affects the way a person learns new things in any area of life, the way they understand information and how they communicate. Difficulties include understanding new or complex information, learning new skills and coping independently. Learning difficulties can be mild, moderate or severe; those with a learning disability tend to take longer to learn and may need support to develop new skills, understand complicated information and interact with other people.
Holistic therapies are not always the first choice of activity for this client group as there can be initial worries about such as whether they are suitable, how long individuals can sit still for or whether they will enjoy them. However, there are many benefits to be gained such as:
• Calming of the nervous system
• Stress relief
• Improvement of overall health
Often, people with learning difficulties have quite complex health problems including:
• Bowel blockages
• Joint pain
• Backache (often due to poor posture, wheelchair use etc.)
• Tiredness/severe fatigue
• Side effects of medication
Therapies may help to manage pain relief and tension from these conditions and treatments can be adapted to accommodate those who are less mobile, such as people who are in wheelchairs or need assistance moving their limbs. In addition to physical challenges, there are a number of accompanying mental health challenges such as:
• Stress or tension due to difficulties understanding or relating to other people’s emotions or knowing why they are not allowed to do certain things
• Depression/feeling upset
• Changes in mood and energy
Adults with learning difficulties often respond well to sensory stimulus including light, sound, touch and textures so the therapeutic touch experienced during massage and healing, with the addition of essential oils and gentle music, can really help them to relax and feel more balanced. I tend to offer shorter treatments of 15/20 minutes to these clients with a mixture of:
• Head, neck, shoulder and arm massage
• Hand massage/reflexology
• Foot massage/reflexology
Some clients can cope with a longer treatment and prefer a back massage with oil or full length reflexology session. There are a few challenges that can prevent this client group from receiving treatments or having regular sessions, namely:
• A lack of cash flow or reluctance of decision makers (support workers or family members) to agree to agree to them having treatments, especially if they do not recognise the benefits
• Lack of willingness of the individual to ‘give it a go’. This can be due to nervousness or suspicion of new situations and people and preferring to stick with repetitive ‘known’ tasks
• Difficulty maintaining interest in a new experience for long enough to commit to regular treatments or being a bit ‘faddy’ about things
• Difficulties in sitting still/mental and physical restlessness
• Having ticklish feet or a dislike of being touched!
But for those who are able to commit, regular therapy sessions can have enormous benefits, both physically and emotionally. The healing power of touch alone can be a very welcome addition to what can be quite a confusing or disjointed existence.
“Susie is 55. She has severe learning difficulties and is only able to communicate with basic childlike gestures and noises and simple words like “no”, "mama" and "dada". She responds to basic commands or questions but won’t always take the initiative herself and will initially refuse to come for her treatment at all. Susie will often point to her hands, head or shoulders, indicating areas in which should would like to receive treatment. She will also point to the massage oil indicating that she would like me to use some. Treatment involves hand massage/reflexology using oil and shoulder and head massage over clothing. I sometimes work on her feet but she is a little ticklish and her feet are quite tense and curled up. She enjoys the percussive movements of the Indian head massage on her head and shoulders. During the sessions she will often look me in the eye and make noises of what appear to be excitement. At other times her eyes will gaze into the distance and she appears thoughtful or sleepy. She seems to enjoy the sessions although she is unable to express this contentment in the usual way.”
Another client, Simon, is a young man in his 30s:
“Simon does not use verbal language of any kind and seems to move around in quite a random and unpredictable manner. He suffers from low energy levels and can spend a lot of the day asleep and the night awake. I work on his hands, arms, shoulders, neck and head and he seems to enjoy the session and become more relaxed afterwards. He prefers having his left hand massaged to his right which he will often pull away. He sometimes has an ‘off day’ when he doesn’t want to sit still but support workers will guide him back to the seat and he will usually settle. He has become more used to the massaging activity and will usually let me work on his head, shoulders, arms and hands.”
I have discovered that there are really 5 key tools which make working with Adults with Learning Difficulties a more enjoyable and rewarding experience as a therapist, namely:
• UNDERSTANDING: Finding out as much as possible about the clients beforehand: their likes and dislikes, behaviour patterns, background, personality; talking to carers/ relatives to manage both your expectations and theirs.
• ADAPTATION: Being flexible when it comes to treatment length and cost; observing how long they can sit still without getting restless and what type of treatment they seem to prefer; adapting as you go along.
• COMMUNICATION: Learning from how other people react with them; remembering that they may comprehend more than they are able to express. Eye contact and non-verbal communication are also valuable tools.
• LOOKING AT THE BIGGER PICTURE: Working to your best ability given the challenges and resting assured that the individual benefited from the experience even if they weren’t able to thank you afterwards; remembering that the healing process is an individual experience
• PERSISTENCE: Recognising that it may take several weeks or months to build up a relationship with someone with learning difficulties and that the smallest of changes in how they relate to you or the treatment might signify huge overall progress.
Although there may be additional challenges, there are also some very positive aspects to this work as it is:
• REWARDING: Developing and nurturing a relationship with these very unique individuals who are often very accepting, albeit vulnerable, and childlike in expressing their emotions and contentment can add another dimension to your practice and offer valuable insight into this area of disability
• A HEALTHY CHALLENGE: Working out how individuals can get the most from the treatments can really encourage you to ‘think out of the box’ and become creative about your treatment plans (which might go out of the window at any time!)
• EXPANSIVE: Working with adults with learning difficulties forces you to look at your work from a different angle, loosen your expectations and re-consider the value of sensory aspects such as touch, sound, smells and non-verbal communication.
“Anne is a 50 year old lady with Down’s Syndrome who also displays traits of Autism. She is quite verbally communicative and friendly but very repetitive and over-talkative. She can get quite upset about particular incidents but calms down considerably during the treatment; her silence during a session is often a good indication that she is feeling relaxed. She is able to make a choice about which treatment she wants and chooses a seated head and shoulders massage to relax tension in her neck and shoulders or Reflexology when her feet are feeling achey. She is very keen to have regular treatments and seems to enjoy the whole process of being pampered”.
These are just a few ideas and thoughts about working with adults with learning difficulties in a therapeutic context. Treatments are always tailored to individual needs; no two treatments or clients are the same and each has their own unique way of communicating along with behavioural idiosyncrasies and likes and dislikes. Where possible, I try to adapt my work to accommodate these unique characteristics.
More details of the therapies I offer can be found on www.magentatherapy.co.uk
Marie Long © 2017