Intensive Interaction: to build fulfilling relationships

Harris, C. & Wolverson, E. (2014) Journal of Dementia Care, 22 (6), 27-30.

In this paper the authors share their experiences of using Intensive Interaction to support people living in the later stages of dementia. For EW [a clinical psychologist] Intensive Interaction is especially useful when working with people who present with challenging behaviours – a sign that needs are unmet, often due to a communication breakdown. CH [a SLT] first used Intensive Interaction when working with adults with learning disabilities, but when she began working with people with dementia, she realised that their communication needs tended to be neglected, and so started to use Intensive Interaction if she thought it appropriate.

CH researched the use Intensive Interaction with people with dementia: for the three participants in CH’s research, she found a sense of relationship development over the week of the study, and also in the following weeks. Two of the participants in particular also showed signs of engagement and social interaction, such as ‘looking at carer’, ‘vocalising’, ‘initiating’, ‘smiling / laughing’, which were more prominent in the Intensive Interaction session than in the standard interaction.

For one participant Mr D (who was bed-bound) Intensive Interaction gave him an opportunity to initiate interactions to control another person’s social behaviour e.g. moving his hand to his ear as CH sang. Mr D also started to change his vocalisations: outside of the Intensive Interaction sessions he vocalised loudly and constantly (it almost sounding painful), but shortly into the first Intensive Interaction session he began to adapt his vocalisations so that they were gentler (mirroring CH’s sound).

Mrs K flinched at touch and was isolated through her constant walking. She allowed CH to join her on her stroll.  During sessions they shared moments of laughter and game playing as Mrs K showed CH her favoured routes and routines. As the sessions progressed Mrs K allowed CH to gently touch her arm, and this eventually developed into twirling each other’s hair. Perhaps most important of all was Mrs K’s husband’s comment that for the first time in months she had made eye contact with him.

The study was small and exploratory, but the results suggest great potential for the use of Intensive Interaction with people with dementia.

Reflections on teaching Intensive Interaction to staff: Intensive Interaction training for staff has been about permission giving and encouragement and as such appears to have positive effects on self-esteem. As Intensive Interaction can be emotionally and physically demanding so ongoing supervision and support is essential. Ultimately a culture change in services is required where services can move away from reactive communication towards proactively seeking out ongoing dialogues and building trust.

Concerns and queries: Given the concerns of some staff, it is right to consider the suitability of Intensive Interaction for people who once had full verbal communication. Staff should be careful when responding to the changing levels of both receptive and expressive communication in people with dementia. Therefore ‘personalisation’ is vital i.e. communicating in a way that has meaning for the person. Concerns about the use of touch are also a common barrier, therefore for Intensive Interaction to be embraced, dementia care services need to develop person-specific touch guidelines.

Reflections on using Intensive Interaction with families: The authors note that family caregivers are very interested in Intensive Interaction, and many family caregivers automatically move into communicating in an Intensive Interaction manner having spent a lifetime already tuned into one another, delighting in all interactions.Conclusion: The authors state that Intensive Interaction can be an approach to improving well-being in dementia, that respects personhood, adds quality to the working lives of staff, and reintroduces a bond based on fun and understanding.

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