Colleagues, let’s call out some arrogant attitudes

In clinical services autism is a diagnosed ‘problem’ where people are too often discussed in terms of their problems and what needs to be done. Our Clinical Director, Jeremy, writes about how practitioners need to change.

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Psychology is all about experimentation, so let’s try one

Grab 3 bowls. Put hot(ish) water in one, cold water in another, and temperate water in the third.

Now, put one hand in the hot water and 1 in the cold water. Leave them there for 10 seconds. Now put both hands in the temperate water.

Funny isn’t it? Your two hands can’t seem to agree on the temperature of the temperate water. One thinks it is hot, the other that it is cold.

This simple experiment illustrates that your viewpoint depends on your experience, and that it is vital to understand that others’ points of view are just as valid as our own.

Now, keep both hands in that bowl for a while and they begin to agree on the temperature.

They’ve achieved a shared understanding of the situation, and are better for it.

I’m rethinking how I previously worked

I actually am a psychologist. Specifically, a Clinical and Forensic Psychologist.

I have been providing services for people with autism who have learning disabilities and complex mental health difficulties since the early 1990s. In 2020, I changed job and moved from the position of head of therapies at a rehabilitation hospital to Dimensions, where I am currently the Clinical Director charged with ensuring we support individuals with complex backgrounds and needs to thrive in their own homes.

If you like, I’ve experienced hot water and cold water, and I’m gradually getting to a temperate position. I plan to use this blog to highlight something important that I’ve learned as I’ve put the two hands together. An experience that is leading me to rethink how I previously worked, in fact.

In clinical services autism is a diagnosed ‘problem’ with a frequent narrative of pathology that sets an unwritten theme where people are too often discussed in terms of their problems and what needs to be done.

A cornerstone of therapy that is often misinterpreted is that the individual is the expert in their own experience. What this means is that dialogue is essential for therapy. It means that practitioners need to change and develop, and really understand each unique individual they work with. It is clear that one hand alone in the experiment above only gives half the picture, but you may not be surprised to hear that some of my past colleagues have viewed this as virtual heresy.

Over the years I’ve adapted my practice to meet individual needs – that is, to encourage change, create less distress and more growth – by understanding and responding to how individuals I work with communicate……or so I believed.

Since moving into Dimensions, I have seen things from a new perspective. My colleagues are undoubted experts in the individuals they support. After all, they support them day and night and share much of their lives. Indeed for many they are the most important and knowledgeable people in the individual’s life.

Yet I have witnessed ‘professional’ attitudes – that is, from community and in-patient teams – that have been dismissive, strongly resistant or indifferent to the voices of my colleagues. I’ve seen support workers tolerated, not respected with some professionals seeming surprised that colleagues might ask questions, make observations, offer opinion or simply not agree with them.

Why is that, when as in my experiment above, the left hand and the right hand have to work together to get the full picture? (and yes, families and individuals and many others have utterly vital voices too, but my analogy falls apart beyond 2 hands…)

The experience has led me to reflect on how others may have experienced me in the past (and perhaps still today). I’ve experienced people feeling frustrated, irritated, having a sense of being ‘left out’ or ‘present at the table but not in the decision making’ and I wonder if this has been a reaction to how I previously worked.

Without a doubt, ‘experts’ need to lose their arrogant attitudes.

What else would I change?

Well, whilst some positive changes have taken place in language, legislation, NHS and local authority services, the scandals continue to have a familiar theme.

I would question whether, despite the introduction of different ways of discussing autism and learning disabilities, the experience has changed for people and their families in a meaningful way:

• Environments continue to be unsettling, often terrifying.
• Staff training and approaches vary and fundamental lack of comprehension or understanding remains evident, despite some areas of outstanding work.
• The approach of professionals remains one of ‘doing to’ in the guise of ‘doing for’; where people are required to engage in therapy to move on.
•  Often interventions are agreed upon without even discussing this with the person first.

Building on my recent experience, I hope to be able to do with people we support, colleagues, friends, and encourage shared understanding and adaptation. After all, each of us is wonderfully unique, yet startlingly similar depending upon where you choose to focus your attention.

You can dry your hands now.

About Jeremy

Dr Jeremy Tudway is a Chartered Clinical and Forensic Psychologist and the Clinical Director for Dimensions.

Jeremy is as a professional psychologist by background, working with people with autism, with learning disabilities and complex mental health difficulties since the early 1990’s. During his career, he has been actively involved in training and research, and has delivered numerous international conference and keynote presentations and written professional psychology papers for journals, book chapters and co-authored a book on integrating psychotherapies.

Jeremy came to work as Clinical Director for Dimensions leading an integrated clinical team to develop the positive ways we provide to people we support. In addition, he is active in improving the ways in which society can become more inclusive for people with learning disabilities and neurodiversity.

Email: jeremy.tudway@dimensions-uk.org

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