(As with all discussions of clients, materiel changes to any identifying information are made for reasons of confidentiality.)
Tina is about 30 and has lots going for her. She holds down a job, is pretty independent and can be very caring and considerate (when I was sitting awkwardly in my office dealing with some chronic back issues she'd reliably inquire - over the course of months - how my back was feeling.) Tina has mild autism, mild cerebral palsy and mild cognitive delays. She has great support, the result of her parents aggressive management of a system in Georgia that is often very difficult to negotiate. And she has great staff helping her in her independent living program.
Tina had been living in a supportive living home through a local agency that does a good job at caring for adults with developmental disabilities. Her core staff there was great, and over time as I worked with her, I found myself growing as close to her staff members who would accompany her into our meetings as I grew to her. (I often have caretakers/parents of adults with DD's come in the meetings, using a family therapy approach. Happy to discuss the whys and wherefores of that if there's interest.)
So it was curious and concerning when she began some behaviors that jeopardized her placement with them. The specific behaviors are besides the point, but she did things that were unacceptable and even dangerous. There were meetings with the program administration. Meetings with me, with her psychiatrist. E-mails and phone calls were furiously exchanged between the program's administration, parents, myself, the psychiatrist etc. We came up with theories, strategies, plans and contracts - all of which came to naught.
My own perspective was to review with Tina what she might be angry about. So often when we misbehave (all of us, as far as I'm concerned) we're angry about something. Tina was open to the possibility of being angry, but was unable to identify any cause or source of anger. She was closely supervised by staff and an administration with a fine track record. There's always the concerns about adults with DD's being sexually abused, but Tina was convincing that nothing like that had happened and there were no other reasons to suspect that as a cause. We were mostly flummoxed about why - but we sure knew what - was happening. She was in trouble.
After not too long, Tina was asked to leave the placement she'd been in for years. It was understandable. The agency was no longer able to guarantee her safety given her behaviors. It was a crises that her family rose to quite well, mobilizing to obtain another placement for Tina that has worked out well. Tina's parents, in particular, get the highest praise in my book for managing systems that are seen by many professionals and family members as unmanageable.
Tina and her staff continue to meet with me, generally for supportive therapy, sometimes with challenging issues, and we've gone merrily down our way dealing with what might be considered the mundane topics that adults with DD's struggle: personal hygiene, cleaning of her apartment, cooking, being willing to involve herself with social activities. Standard stuff.
Somehow we recently stumbled on what happened a few years ago during that very tough time. We discussed it - didn't come up with any specific conclusions, but just reviewed it. Then something most significant happened. One of Tina's primary staff members, Molly, continued the conversation with her after our session ended. Molly, who knows Tina well, and was familiar with specifics of her last placement, offered a suggestion as to what Tina might have been dealing with during the time she was behaving so poorly. Unlike in the past, Tina, in her matter of fact way, endorsed Molly's suggestion as to what had sparked her anger. She was articulate, succinct and direct about what she didn't like in her old placement and how it had made her angry. She was also able to point out the difference between what had been happening (nothing immoral, nothing illegal, nothing horrifying, just things that rubbed her the wrong way - things that she didn't know how to respond to appropriately) and what happens in her current placement that don't replicate what was happening before.
I took what seemed the obvious next step, which was to discuss with Tina the subject of "self advocacy." She had heard the phrase and we spent some time defining it and discussing how, with Molly's help and the help of her other staff members, she'd been learning how to advocate for herself so she didn't get into the same jam she was in a few years back. A lot of credit goes to her staff for their willingness, insight, dedication and persistence. (Staff who work with people with DD's so often do so motivated by great love - it's certainly not for the money. Many of them see it as their personal ministry. My experience of them is heartening - I see them as models of love and dedication that most of us could learn from.)
It's taken time, but Tina's learning an important lesson about how to care for herself. I'm really proud of her - and have told her so. It's taken a while, but that seems to be Tina's pace. With the proper supports, her pace is just fine.
