What are restraints?

A lot of staff people talk about restraints like they are not the greatest thing, but it seems like they don't understand what is wrong with them. I am not an expert but this is just how I feel.

I think a lot of people feel like restraints are bad because they are scary-looking. To be honest a lot of people don't even seem to feel that much(1), but anyway. Some people and places are "restraint-free." They believe in being gentle. The question is: is gentleness restraint-free?

I have always been told stuff like, ask someone what shirt they want to wear not whether they want to get dressed(2). Make statements about what's happening, don't ask questions. The idea is that if you do this the idea of disagreeing with what you're doing won't even enter the person's head. Which is supposed to be the ideal thing--no conflict. But these "tricks"--presented as innocently as advice on how to transfer someone--are intended to keep a person from making decisions about their own life that might be inconvenient to you. Is this extremely different from physically making it so the person can't move?

Picture a staff person who reacts with complete sweetness and friendliness to a resident who's trying to do something like get up when he is supposed to be asleep. The staff person distracts the resident with conversation while gently guiding him back to his bed, and it seems that she has successfully caused him to forget what he had planned to do.

I can't think of any supervisor I know who would watch this interaction and not come away thinking, "wow, what a good staff person." The person is avoiding conflict and keeping the resident (apparently) calm and happy, while still efficiently controlling him. The supervisor might even think that this is a staff person who really cares about her residents because she is so "gentle" and didn't do anything that came off as angry or aggressive.

But what is actually caring about not allowing someone to make a choice, and not even having enough respect to tell them what you're doing? Is it caring to try to trick someone to the point that they won't even know what is going on? (If someone has a disability like dementia, is it really going to help them keep skills as long as possible if you are trying to control them by making them confused?)

There are other things that aren't always recognized as restraints, like failing to offer someone the support they need to do something you don't agree with. But I feel like these this are sometimes recognized as restraints. Like in Ohio, leaving someone in a locked wheelchair is a restraint, which seems to be along the right lines. (Chairs are not though, which is weird since at least some people could unlock a wheelchair.)

I feel like the idea is that it's bad to do something that would look immediately abusive at a glance or look like someone's stereotype of a restraint. Merely being controlling isn't recognized as wrong and the implications and affects of trying to manipulative someone into doing what you want are not considered.

(1)In my nurse aide class, we were told that while we would be shown how to put someone in restraints, we didn't need to learn how to do it because it was no longer on the state test. As part of the class we were taught and tested on lots of things that could be considered attitudes or ethics, like "don't try to convert residents to your religion" or "be willing to listen to a resident talk about their problems." Our various teachers, who were nurses, would give us advice from their experiences about how to treat residents properly.

But absolutely no subjective comments were ever made about restraints and why they were no longer on the state test. No one even said, "it's better not to use restraints" or the most basic thing in support of more facilities being restraint-free.

When one of our teachers put a student in a restraint to show us, everyone just watched like it was normal. Except one girl was really creeped out. She said, "I have a friend who can't stand being held still and if you did that to her she would go crazy. Anyone would go crazy if you did that to them. It's wrong." She said this almost to herself, not like she expected a response, and no one gave her one.

(2)When I described this "trick," Pancho Ruiz suggested that it could work not because the person has actually been kept from considering other options, but because assuming consent like this would be sufficiently scary to stop the person from disagreeing with staff.

Let me be played

I think that expectations for staff should be based in service not control. Which is to say you should try to give someone what they want not what you think they need. The obvious response to this is "but some people run out in traffic" and that's definitely true; obviously control is called for in some cases. But I feel like staff should start from a place of trying to serve people and then if the person is actually in danger, you can try to stop that specific situation. I think controlling someone should be something you decide to do in an emergency, not something you're expected to do as a regular part of your job. I think staff should be judged on whether the people they work with are satisfied and happy.

I was reading some of Roia's posts at The Mindful Music Therapist about how she felt really judged by the staff of someone she was a therapist for because her client kept taking her clothes off during therapy sessions. She felt like they thought she wasn't competent because she wasn't able to keep the person from doing that.

This is really depressing to me because I think there are a lot of motives for someone taking their clothes off that would actually reflect well on the staff person/therapist/teacher they did that with. I'm not saying it's good that someone strips, but it could mean that they feel safe, or in my experience it could mean that they want to play a trick on their staff person and see how they respond. I feel like if someone is trying to fuck with you, that's a pretty good sign of the person wanting to relate with you and learn more about you, and also to my mind can indicate that the person is confident about expressing themselves and initiating connection with other people.

So why would anyone be seen as incompetent because a person she was working with did that?

There were some times at camp when I'd be really pissed at someone and then I would realize, "I'm upset because I'm trying to stop a man twice my age from carrying his tape player with him to breakfast. What the fuck is wrong with me?"

The answer is, a lot.

Presumably in Real Life I don't get pissed at people for carrying tape players around. Actually, a person who carries a tape player around sounds like someone I would really like. And also, if I was the parent of an adult (that is, if I was an authority figure but without the policies/rules that someone like a staff person has) I can't imagine getting pissed at my son for wanting to carry around a tape player.

One reason a person might get angry would be if they think another person is angry at them or is trying to upset them. I knew that David generally liked me and we were having a conflict because he wanted to have his tape player, not because he wanted to disagree with me for the sake of disagreeing. So that doesn't explain why I was angry.

I should mention that when I say I was angry, I don't mean that I actually yelled at anyone, but just that I realized I wanted to, and then generally backed down and felt incredibly creepy and messed up. This happened probably three times, fully, but I think there were several campers who I resented on a low level even if I tried to be positive and get along with them on the surface.

I know that staff people can't always have positive feelings toward the people they work with, because some people just don't click with each other. But in retrospect, I think that I resented a lot of people not because of anything they were or did, but because I felt I would be judged for the things they couldn't or didn't do. This was a big problem with people who were slow or spacey or had a very specific way of doing things--I would be thinking, "fuck, we're going to be late for [breakfast/activity/etc.] and people [i.e. staff] are going to think I'm not competent" or "people are going to patronize me because I can't get three people showered in forty minutes"--or, with David, "people are going to think I'm a bad counselor if David is sitting there listening to his tape player instead of participating in activities."

Which is a sign that I'd gotten the impression my environment valued control above service.* When I felt like I would get in trouble or be judged if I couldn't compel my campers to do things a certain way, that caused me to take completely innocent behavior personally. Like lots of people, David often preferred listening to music to interacting with a group--but when I felt like my job entailed getting everyone to interact in a group, wanting to listen to music became something David was doing to me. When he wouldn't participate the way I was expected to be able to get him to, then I felt I looked bad, and ended up thinking things like, "Why does he have to be so selfish? Can't he think about how his behavior affects me?"

Which is really bad because it meant that totally normal and inoffensive things about David became a source of conflict, and made our relationship less positive. Although I think we had a good relationship overall, it would certainly have been better if I hadn't been stressed about how his personality traits were going to affect me. I could certainly have served him better than I did.

*I don't want to sound so critical of the place where I worked. For example, during orientation we were told, "Some campers with autism or OCD may obsess over checking things or may want to do things a certain number of times. We have all the time in the world--if it makes someone feel better, then do stuff a certain number of times." But despite this, I still ended up feeling pressured to control my campers, and I know I wasn't the only one.

I can't let that happen though. I think my goal as a staff person should be to be patronized by other staff. I want people to tell me I'm gullible and a pushover and I'm not being professional. He's not really sick. He's not really in pain. You can't just let him do what he wants all the time! You have to hurry him up. Oh, he tries to get people's attention all the time, just ignore it. Why is he all the way over there? What is he doing? She shouldn't be talking to you like that. He's playing you.

One time at the ABA school I saw a kid tracing squares on the carpet and I reached out to do the same. His teacher said, "Don't do that! You're encouraging him."

Fuck, I hope so.