Why am I falling apart mentally physically

Andreas Prescher

Client-centered interaction with mentally handicapped people

by Andreas Prescher
Intellectual Disability - What is it?

Intellectual disabilities are part of what I bring into the world - like hair color, body size, temperament. It is a peculiarity that is my own until death. (Dörner and Plog)

People who, as a result of congenital ailments, birth defects, illnesses, accidents or for other reasons, suffer permanently or long-term from physical, mental infirmities or mental disorders and therefore cannot fully participate in the life of the community without special help. (Bertelsmann Lexicon)

Intellectual disability is not a disease, and because it is not a disease, mentally retarded people deal with their surroundings like everyone else. They show what they want and what they don't like. You set yourself apart and dare to push yourself to the limit. They are happy when they achieve what they want and they get angry when they fail. In difficult situations they try to find the best possible solution for them and they resort to the strategies that will bring them to their goal the fastest and most effectively - just like everyone else! (Elbing)

The people who are described as mentally handicapped by the so-called normal have abilities and skills that are for the most part either not known to us or are foreign to us. You are extremely creative (e.g. in the way of constantly thinking up new behaviors that lead parents and professionals to the limits of their options for action). Many mentally handicapped people do not lie, all of them have an infallible sense of insecurity.
They often have excellent long-term memories or reproduce an incredible amount of stored data.
We do not know how mentally handicapped people think, feel, perceive and process. So the obvious conclusion is that they are different.
Therapeutic concepts that view the mentally handicapped person ... "as an acting subject with individual resources and personal responsibility, who are less interested in the causes of the handicap, but rather seek to use current, individual and family resources therapeutically "(Hennicke & Rotthaus1993), correspond to our image of man and thus also to our basic therapeutic attitude.
For these reasons we reformulate the ascription "mentally handicapped" into the term "differently capable". (Rohmann)


Problem - sources in coexistence

Mentally handicapped (otherwise capable) people, like all people, fall back on the best possible strategy that is available to them when dealing with their environment. However, the choice of the best possible strategy for the same concern can be very different. For example, non-disabled people can express in many ways that they do not like a meal, for example, and that they find it unreasonable to eat a whole plate of it. But how can this be expressed by people who have no language and who also face a non-handicapped person who has the key to the kitchen and the following view: "What is on the table is eaten and the plate is empty "? Throwing the plate against the wall or eating it out and then vomiting can be very appropriate measures under these circumstances. At a price, however: after such actions (and especially when they have been successful a few times) an invisible sign hangs around the neck: "Caution! Disordered!"

There is another source that often makes living together difficult. It arises from the fact that mentally handicapped (otherwise capable) people develop certain coping strategies in very difficult life situations and continue to use these strategies later when their living conditions have long since changed. For example, you may have learned as children: The best way to overcome another person's spontaneous reluctance to come into contact with a disabled person is to hug them with a disarming, sunny smile. As adolescents and adults, they stick to this once successful strategy. What used to be a good idea is now becoming a nuisance, and your once successful strategy is beginning to hinder you further. They act like children who have grown too big and the people around them like to treat them that way. The once successful solution has thus become a boomerang for your own development.
Developing good solutions that later come back as a boomerang is by no means reserved for mentally handicapped (otherwise capable) people. The people who live and work with them have also developed solutions in their own lives that now (not only) become a handicap in contact with mentally handicapped (differently capable) people. In this way it can happen that mentally handicapped (otherwise capable) people as well as non-handicapped people hinder each other in their development and paralyze their personal development. This mutual paralysis is usually put on record as a behavioral problem or disorder that is ultimately attested to the mentally handicapped (differently capable) - especially when the non-handicapped people who live and work with them are professionals who have learned to use medical or psychological terms for certain phenomena.

What is a client-centered approach?


I had a few problems with boundaries before I wanted to include them in my mind map. Are limits in the interests of my clients?

After a few deliberations, however, I realized that my work is not a therapeutic or similar process, but everyday professional life. I don't work with a single client, I am exposed to group processes. Within these group processes, the needs of all group members come first. Without defined group rules, there can be no continuous work process in such situations.

Each group member should also learn, regardless of their disability, the consequences of moving outside these limits. For example, it cannot be acceptable for a group member to permanently drink the drinks of his work colleagues. In such or similar situations, I am challenged as an authority figure.

The awareness of mutual acceptance is particularly important to me.

I want to offer my clients self-determination in all possible situations that everyday working life has to offer. If the work assignments allow it and there should be no disputes in the group, clients can choose work or work steps that they enjoy most at the moment.

The aim of this approach is to motivate the client. I myself go to a self-chosen task more motivated than to a dictated activity. I also use it to train my clients' self-perception and self-assessment. It is always astonishing how clients choose exactly the job that they neither over- nor under-demand.

In our workshop, we even offer our clients the opportunity to make their own decisions in the field of work training. This means that everyone has to complete an internship in each of the four production departments within the first year. At the beginning of the second year, they can choose between two departments, in which they then receive further training. At the end of the work training area, you will switch to one of the departments that you have chosen yourself.

I believe authenticity in dealing with mentally handicapped (otherwise capable) people is particularly important. In the beginning there is a lot of fear. Fear of getting involved with the other, mentally handicapped (differently capable) person. Afraid not to understand him. And finally the crucial question: Is the failure of the relationship due to his or my own inability?

Authenticity is important to the extent that I can imagine that the mentally handicapped (otherwise capable) person asks himself the question of inability and often doubts us “normal” people when they misunderstand.
I also feel it is important to remain genuine and clear in my own statements. Not everyone will be able to understand linguistic distinctions such as irony etc. The result would probably be helplessness, which would rather damage the relationship.

There is an innumerable variety of behavior patterns among mentally handicapped (otherwise capable) people, which can drive even the most tolerant people to the limits of incandescence. In my group there is the employee S.
S. asks one question after the other all day long. Since I have the feeling that these questions are important to him in some way, I try to answer these questions honestly and openly. In order to remain real to myself, however, I try to present the situation to him in an appreciative manner in situations in which I can no longer bear the questioning, but perhaps also offer him the opportunity to answer the question himself.

At this point in my work, I primarily see the acceptance of letting others be the way they are. I want to give him the feeling that I accept him as he is as a person, with his otherness and his disabilities.

If he doesn't want to speak, or just the bare minimum, that's okay with me. I will of course try to shape the relationship with him in such a way that he talks a little more than before. In this specific case, it even looks like the person in question in my department is on the phone and is allowed to accept all calls. This success did not develop from the fact that I persuaded him to speak, but came about voluntarily in an almost incomprehensible way.

For me, acceptance also means that I don't want to work deficit-oriented. The skills that the employees in my department bring with them are worth a lot and are recognized as valuable. All I can do is develop these skills further. “You're very good at assembling these parts. Maybe we can still manage that you can take over the final quality control for this work. "

Dörner and Plog write: “It is particularly clear with the mentally handicapped The "I understand you" attitude is impossible. The other is too strange ...
... so only posture is possible > I don't understand you, but maybe - within our relationship - I understand you. "
It is important to me to make it clear to disabled people that I want to understand them. Even if his behavior becomes too unclear.

- Client C. shows a total change of mood from one second to the other. Just now she is sitting in her chair, tears streaming down, her head buried in her arms. There was no observable situation as a trigger.
- Client T. loves to stack things until they fall over and laugh quietly to himself.
- Client G. changes her boyfriend from one second to the other. She realizes that she would rather be with S. now than with V. Client V. first reacts jealously but later congratulates S. on his new girlfriend.
- Client M. uses every opportunity presented to him to injure himself. If he sits near a table, his head immediately drops on the edge of the table.
- Client F. pushes his thumb and forefinger deep into his eye sockets (almost all the time) so that the eyes themselves almost fall out.

There are a multitude of behaviors that I cannot understand, but which arouse my interest in understanding them. This interest can be expressed well in the sentence: "Take me with you, what you are doing, thinking and feeling." However, I also had to learn to accept that I by no means have to understand everything.


When looking for examples for the individual points, I noticed again and again how closely these factors belong together. That empathy is closely linked to acceptance and authenticity and can hardly be found individually, but rather must merge into an overall attitude.

I came across a text from a friend who, I think, aptly formulated her thoughts on dealing with severely mentally handicapped people. I would like to add these lines without explanations as a conclusion to this elaboration and I would like to recommend everyone to embark on this adventure themselves.

I'm going for a walk with you. We walk side by side in silence. Suddenly you tear yourself away and plunge into the next bushes, I stop and wait until you return to me on the way from this adventure in your newly discovered jungle, happy with you and your discoveries. From now on you happily bounce next to me and I let myself be carried away by you, without really knowing the exact reason for your joy. We get faster and suddenly slower again. We jump past strollers coming towards us and sometimes, when you feel like it, you walk up to a strange dog completely suddenly, so that it becomes very scary to me and I wait, spellbound and fearful, for the dog to grasp and your cry of pain . But nothing of the same happens. You and the dog, you have made an inaudible agreement for us bystanders, you do not need any words to communicate, it is always difficult to understand and accept this, because the awareness that I am actually responsible for you wins over and over again and should run off safely back home. We keep walking and slowly the shock settles in me and I give myself back to your ideas, which arise in your very own world, without ever getting a word of explanation from you. But since we have known each other, I have understood more and more every day that you don't need words to find each other. On the contrary: when a person senses that someone else wants to accept him and accepts him for who he is, all external limits are suddenly overcome. Language, the articulation of wishes and ideas are all means to bring people who do not really know you about their world. In order to get along with a person without words, you basically only need the courage to get involved with him and suddenly he is no longer a resident for whose well-being you are responsible, but a good friend who lets you peck into his world, you reaches out and lets you forget who of us two is actually the disabled and in need of protection.

Miriam Baghai, 1996

Andreas Prescher