‘Mixing the values of gentleness, inclusion and person-centred care with the science of behavioural technology is like mixing oil and water’
As part of the ‘AGAINST PBS & ABA’ campaign, Guest contributor, Brendan Maguire, shares his journey of discovering Gentle Teaching and advocates for a move away from behaviourist methods that are at odds with supporting people in an inclusive, person-centred way.
By 2002, I had already given up on the behavioural model of support because it, in my experience, effectively sanctioned authoritarian cultures within care settings and contributed to what American Psychologist Herb Lovett had called ‘The Hierarchy of Control’. As luck would have it that year, I came across some videos and training materials advertised in a copy of Community Living Magazine UK. The videos were of Dan Hobbs, one of the co-founders of Gentle Teaching, and they showed real life examples of alternative, gentle responses to challenging behaviours. Something clicked and I became obsessed with Gentle Teaching for the next several years. I travelled to conferences and training events wherever they were held in North America and Europe. With its inclusive language, universal Quality of Life values and a focus on changing our own behaviour, not the supported person’s, Gentle Teaching seemed like the way to go. I’d had an idea for a project called ‘Learning Together’ for a long while. Learning Together was going to use a Gentle Teaching approach combined with video analysis to help evidence practice and support self-reflection. I figured the evidence of how outcomes were achieved was more important than the outcomes themselves.
By the end of 2011, Learning Together was commissioned to support two individuals, ‘Jim’ and ‘Mary’. Just as we were getting started in 2012, the national outrage following the Winterbourne View scandal was continuing to fuel a demand for change and greater training for frontline staff. The government sought advice from experts and soon, Positive Behaviour Support (PBS) with its focus on ‘nonaversive treatments for challenging behaviour’, was anointed as the evidence-based model of choice. At the time, PBS was still a relatively obscure and not-widely known enterprise. It was being implemented by only a very small group of people in the UK but almost overnight, it became embedded in government strategy. Care organisations and staff up and down the country now needed to be trained in PBS. Who was going to provide all this expertise and deliver all the training that was needed? Well, it would have to be the very small group of professors, consultants and experts already fully versed in PBS. If it didn’t say ‘PBS’ on the tin, commissioners were advised not to commission it.
“Learning Together was going to use a Gentle Teaching approach combined with video analysis to help evidence practice and support self-reflection.”
Against this backdrop, we started supporting Jim and Mary. Due to a series of hospitalisations and placement breakdowns in-county, Jim had been sent to live in what was effectively a bunker, one hundred and fifty miles from his family home. On the day he was moved there in 2010, he was told very little, and staff had to literally drag him out of the back of the van and into his new ‘home’ with him shouting, “I don’t want to be here. I want to go home”. This placement was simply about containing Jim. He’d caused psychiatrists and local services so much trouble and confusion, they’d run out of ideas and needed him out of sight and out of mind. During his eighteen months there, he ate and played alone. Staff were not allowed to even sit with him. Five-person restraints were a regular occurrence. He had no outside space or garden to walk in and was heavily medicated to control his behaviour. One of his managers described him as a, “world champion of breaking his environment” and “his own worst enemy.” Mary posed similar challenges and was being held in a local specialist setting, isolated on a ward due to the danger she posed staff and other patients. During the assessments I undertook for each, I took very few notes and completed almost no paperwork. Almost all the assessment was made up of video recordings which have since been invaluable training and advocacy resources.
By 2014, I had made some connections with local commissioners. I had put together a draft proposal for something I’d tongue-in-cheek described as a ‘Positive Relationship Support’ model. PRS would be essentially ‘Gentle Teaching’ values and strategies coupled with video reflective practice. It would be used to support and advocate for those Autistic children most at risk of being sent to expensive, out-of-county specialist schools. After a couple of meetings, I was asked in an email to make more reference to the county’s Challenging Behaviour Strategy. I responded by saying our county, “…like many organisations, has adopted Positive Behaviour Support as the model they wish to pursue. Learning Together’s ethos does not fit within the PBS model. Although I do believe PBS is a step in the right direction, Learning Together was originally founded to provide an alternative to the traditional behaviour-focused model of support.”
I received a lovely reply, “Perhaps what we are finding is that the offer from Learning Together does not fit the training component so well and the attempt to unify a model and look at training to families is where we are hitting a stumbling-block. But it would be a shame to lose the learning from what you could offer and potentially miss an opportunity, and although your model is not PBS, it’s not inconsistent with PBS (just perhaps several steps further).” I never responded and due in large part to my own pig-headedness, PRS was never developed further.
“I was being asked to just pretend to work under the PBS umbrella and go on practising something else quietly.”
In the years to follow, I was asked twice: “Brendan, just call what you are doing ‘PBS’. All the commissioners need to do is tick their PBS box”. I was angry and explained I would rather pack it all in and live in a camper van than call what we were doing ‘PBS’. I probably seemed quite mad but to my mind, PBS was clearly defined as “an amalgamation of … Applied Behaviour Analysis, the Normalisation/ Inclusion movement, and Person-centred values” (Gore et al., 2013). PBS “owes more to applied behaviour analysis (ABA) than any other conceptual foundation” (Morris & Horner, 2016). Gentle Teaching was the antithesis of ABA but no one locally seemed to care about that. I was being asked to just pretend to work under the PBS umbrella and go on practising something else quietly. I couldn’t bring myself to do it.
Over the years, I’ve had to accept that Gentle Teachers are on the endangered species list here in the UK. Despite searching repeatedly, I only ever found one other organisation that said they used ‘Gentle Teaching’, but they said they also used PBS. Again, to my mind this was not possible because, at their hearts, the two concepts were diametrically opposed to one another.
Last word, I am not against PBS as such, only the behavioural science aspect of it. The other elements of PBS have been around since the 1980s, and they combine very well with the values Gentle Teaching. However, mixing the values of gentleness, inclusion and person-centred care with the science of behavioural technology is like mixing oil and water. You can stir and stir and stir until they seem to mix but eventually, left alone, they will always separate.
