Introduction to the Heijkoop method to challenging behaviour in ID
The Heijkoop method is used widely in ID challenging behaviour services across Northern Europe; the lack of an English-language account has inhibited its uptake in the UK. The method is fundamentally experiential and aimed at understanding the ‘Who’ of the client to complement the objectified ‘What’ knowledge of standard diagnostics. It is conceptually grounded in developmental psychology, focusing on interpersonal relationships and intersubjectivity, in particular Daniel Stern’s combination of clinical and empirical perspectives on attachment and the emerging sense of self. This working paper is informed by 5 years’ clinical use in Nottingham of Discovery Awareness, a process of video-analysis that is the core instrument in Heijkoop’s approach. Heijkoop introduced and developed this during three separate week-long periods of service consultancy into two NHS Assessment and Treatment Units within Nottinghamshire Healthcare NHS Trust’s specialist service for adults with ID.
When challenging behaviour exists, we assume that the self of the patient is in some way precarious and vulnerable, and seek to identify aspects of it for consideration. The best way we can come to understand the nature of their self is by becoming aware of the impact they have on us while striving to understand the world from their point of view. Yet the staff’s view of the patient's personhood can get clouded by serious concerns regarding deterioration of the general development; by negative experiences resulting from the threat emanating from problem behaviour; and/or by difficulty making contact or communicating. In professional services, the view of a person can also be clouded by lack of time to think about them at all. Yet only really seeing this person brings back the possibility of connecting. It is the very first step to self-strengthening.
We study the here and now with people who are important within the person’s daily life. This is a particular type of investigation that depends upon an active and open communication between those present as they talk with each other. The subject of study is on the one hand the feelings, expectations, thoughts, doubts, insecurities, worries, contacts and cooperation which the person with ID (hereafter referred to as ‘the patient’ because the second author’s context of practice is a specialist ATU) brings to meetings with important people. On the other hand it is about the feelings, expectations, thoughts, doubts, insecurities, worries, contacts and cooperation these important people themselves bring to their meetings with the patient. Most of all, the method enhances awareness of how these two sides fit and sometimes misfit. Conversation about these issues is conducted from an open and interested attitude, in particular without blaming or shaming anyone.
The process addresses multiple aims. It seeks to increase general sensitivity to the patient and the motivation of staff to engage with them, since interaction is the fertiliser that strengthens the person’s self. To identify deficits which require compensation from important others so that the patient’s capabilities can flourish. And to start and support a process of individual and collective movement which leads to a more (inter)personal and safe space in which both important others and the patient can move.
Different instruments increase consciousness as well as insight about who this patient is as a person for important others, and how those important others are as persons for the patient. Although an understanding of these internal affects is created by studying patterns of relating in the here and now, the method also brings the needs and demands of the client into the picture. Such needs and demands were already there before admission, and they will be there after the patient leaves and enters a new living situation.
There are five instruments in this method. Each instrument makes its own contribution; each contribution has a mutual effect. They affect the thoughts, beliefs and expectations each individual caretaker holds about the patient and themselves. Becoming aware of these has an almost immediate impact on the attitude that frames the way each patient is met, contacted, cared for and co-operated with. In turn that has an almost immediate effect on the experiences the patient has with the caretaker. In the short run it has a calming and relaxing influence on both parties. In the long run it builds self-confidence and mutual trust.
- Discovery Awareness: video review to raise awareness of what is going on for and between people
- Functional Developmental Profiles that help staff to become aware of expectations and open the way to insight about over- and or under estimations
- Relationship Dynamics that compensate for the vulnerable self
- Problem-solving Co-operation
- Video Training: Enabling important others to develop, by supporting them to validate their own personal ways of interaction based on insights from the process.