‘Challenging behaviour’ is a common term in the field of intellectual disability, and is used to describe any behaviour that negatively affects a person in their daily life, or negatively affects the people around them (CDDHV, 2005). People with intellectual disability are often referred to counselling because of a behaviour change that is causing problems for themselves or others in the home, workplace, school or wider community. Behavioural issues may also have negative impacts on the client and counsellor within the therapeutic context.
The kinds of challenging behaviour that people with intellectual disability might display include (CDDHV, 2005):
- Self-injurious behaviour (self harm)
- Property destruction
- Oppositional behaviour
- Socially inappropriate behaviour (including sexualised behaviour)
It is extremely important that people with intellectual disability who display challenging behaviour are not labelled as ‘challenging’ themselves. It is the behaviour that is challenging. Challenging behaviour should be viewed as a form of communication. People supporting or counselling a person who exhibits challenging behaviour need to work hard, often over long periods of time, to understand the messages behind the behaviour.
It is important that a person’s challenging behaviour is not simply dismissed as an inevitable feature of their disability. A person’s disability can influence their behaviour, but is not necessarily the cause of the behaviour. This is particularly important given the over-representation of people with intellectual disability in the criminal justice system. Clients with intellectual disability who experience difficulty with their behaviour should be taken seriously and given support to explore the causes of the behaviour, as well as strategies to deal with it.
There are numerous medical, psychiatric, social and environmental reasons why a person with intellectual disability might display challenging behaviour in their life and/or in the counselling context. CDDHV (2005) suggests that these can include:
- Physical pain or discomfort (recognised or unrecognised)
- Background medical conditions
- Substance abuse
- Syndrome-specific conditions
- Mental illness
- Abuse and exploitation
- Communication difficulties
- Lack of self-determination and control over life
- Social isolation
- Grief, loss and bereavement
- Life stages and transitions
- Living and working environments.
People with intellectual disability sometimes change their behaviour as a way of creating change when their needs and desires are otherwise difficult to communicate and meet. Any change in a person’s usual behaviour could, therefore, indicate that they are seeking to change some part of their internal or external environment, including within the counselling session.
Difficult behaviour in counselling may be related to a change the person is seeking in the counsellor, in themselves, or in any other context that is affecting them at the time. It is important not to assume that, just because a client has arrived for their session, they want to be there or are ready to be there in a calm and collected manner.
Useful strategies for supporting a person who is displaying challenging behaviour in counselling include:
- Maintain self-awareness and critical reflection to ensure that a client’s negative reactions are not taken personally (for example, a client’s anger may be directed at you as the counsellor, but you shouldn’t take it personally and may need to seek supervision)
- Remember that the client is trying to create a change and they can’t see another way of achieving it
- Foster an environment of learning and understanding about the client rather than punishment for what is essentially a problem of communication
- Change the counselling environment – consider home visits, going outside the office, sitting on the grass, going to a park, or meeting at a coffee shop
- Create safety in the therapeutic relationship – focus on trust and take the time needed to build genuine rapport. Demonstrate commitment to helping the client by showing that you will not judge them or refuse service due to their behaviour (show this by not taking their behaviour personally)
- Use symbols or artwork – these may help the client to find other ways of expressing their needs, wants and desires
- Try a less formal approach if the client withdraws – use humour, play cards, go for a walk or a drive, wash up, or create a new and less threatening conversation. Talk through doing.
Many people with intellectual disability experience difficulty empathising with others, which can lead to very difficult situations when negative behaviour is directed towards or harmful to others. This is particularly difficult for many workers to accept, particularly if they are the target of the behaviour.
It is important not to punish a client for their behaviour, but to openly explore the concepts of ‘others’ feelings’ and ‘apology’ through concrete examples that are meaningful for the client. For example, ask questions like:
- ‘How would you feel if that happened to your mother/friend?’ (refer to someone specific whom the client respects)
- ‘What would your mum/friend think about you doing this?’ (refer to a key, nonjudgemental person in the client’s life).