An excerpt from the upcoming book on Restraint and Seclusion Elimination: The Studio 3 Approach by Professor Andrew McDonnell, coming soon!
This book is the product of many years of practice and research. As a young, enthusiastic assistant psychologist in 1985, I was asked by some nursing staff to assist them in restraining an individual who was incredibly distressed. The image above is a rough facsimile of the procedure we undertook. In this scenario, I was the person lying over the legs of the individual. To this very day, I still remember how it felt to overpower that vulnerable and highly distressed individual. At the time, I justified what we did to myself and others by saying that we had no choice.
As a trainee Clinical Psychologist studying at the University of Birmingham in 1987, I attended a training course called ‘Managing Violence and Aggression,’ which had a profound impact on my work and future practice. I was shown a wide range of methods to help me break free from individuals. At the time, I was also a relatively junior martial arts instructor studying and teaching the martial art of Jiu Jitsu. I was struck by the resemblance of the course to martial arts-style training. I began to reflect not only on what I was being taught, but also what the rationale was for teaching people such skills in the first place. Where was the training focusing on de-escalation of violence?
Over the next few years, I attended a range of different workshops, taking on the role of a mystery shopper. I was so interested in how these training courses were delivered, and what their purpose was. It became increasingly difficult for me to attend these events without becoming vocal. I have no doubt that the majority of the trainers I met sincerely believed that they were keeping people safe. Nevertheless, the methods they were teaching often involved the deliberate infliction of pain on potentially vulnerable individuals.
In 1987, I was invited to design crisis management training from scratch at Monyhull Hospital, a residential hospital in Birmingham for people with intellectual disabilities. I had been complaining fairly vociferously that there was no evidence base for the training I had received, and that if we started from scratch we could do better. The management at the time allowed me to create, deliver and evaluate a training course for my Master’s thesis in Clinical Psychology. This training was two days in duration, and was a very crude first attempt. Two thirds of the training focused on physical methods, culminating in the roleplay of a chair restraint hold developed specifically for the programme. The foundations of the Low Arousal Approach were there even at that time, though unformulated. What I can say on reflection is that, even in the early days, we had a strong human rights-based approach.
From the very foundation of Studio 3, I anticipated that we would be viewed as ‘left-wing extremists’ in the crisis management field. In some ways, my colleagues and I embraced this position, as the alternative meant being part of the negative side of the industry. Some individuals are drawn to violence, and my colleagues and I have met some quite intimidating people in the field over the years. Leading training organisations in the UK in the 1990s were led, for the most part, by men with some kind of martial arts background. I want to stress that there is nothing wrong with practicing a martial art in this field, and indeed some of the best practitioners I have worked with have a background in martial arts. There are huge physical and psychological benefits to practicing a martial art. However, the ‘self-defence mindset’ has very little place in any caring environment, and we must be careful to draw a distinction between the martial arts world and caring for vulnerable individuals. In my own practice, I have managed to keep these worlds very separate over the years. It is only relatively recently that I am becoming more comfortable with talking about the small but significant contribution my own and others’ martial arts skills made to the Studio 3 Approach.
The organisation Studio 3 was officially formed in the early 1990s. It consisted of like-minded individuals from a variety of backgrounds – education, psychology, and the martial arts. I am very grateful to so many people who have contributed to making Studio 3 what it is today. In particular, I would like to mention Stephen Allison, David Walker and the late Peter Farrar, who encouraged me to develop these ideas further. The name Studio 3 was suggested by Peter, who was himself a martial arts instructor with no care experience, but who loved what we were trying to do. Over the years, I have been told that the name Studio 3 sounds like a hairdressing salon or (my personal favourite) a plumbing company. Getting away from names that focus on violence, aggression and abuse was, with hindsight, a very good decision. Peter suggested Studio 3 because a studio is associated with artistic work and creativity, and creativity has been central to our ethos since the organisation’s inception. The number 3 represented the union of a scientific evidence base in human psychology with the philosophical elements of martial arts, which combined to make a humanistic approach to supporting distressed individuals. Therefore, conceptually, Studio 1 represented the martial arts world of Jiu Jitsu, Studio 2 represented the academic world and psychological science. Studio 3 as an entity represented both.
My colleagues and I have challenged people in the training industry, and I would not hesitate to say that we will always do this. In the UK, we now have some guidance and regulation from the Restraint Reduction Network (RRN), which my own organisation whole-heartedly supports. However, the last 30 years have been a challenging period for our organisation as we continue to battle against rigid thinking surrounding the teaching of physical methods, restraint and seclusion. My colleagues have often had to defend their approach to other training organisations and staff teams who are reluctant to accept that our methods are as effective as restrictive practices. This book is my honest attempt to answer the multitude of questions my organisation receives around how to not only reduce the use of restraint and seclusion, but eliminate it entirely from the care sector. My personal journey with the issue of restrictive practices began over thirty-five years ago as a young assistant psychologist. It has been a long and trying journey, and I am not innocent of having used restrictive practices. However, my journey has proven that we can operate care and educational environments without resorting to practices such as physical restraint and seclusion. Whilst this book sets a very high standard, I passionately believe that, by a process of practice-based evidence and evidence-based practice, we can eradicate restraint and seclusion in caring environments.
In 2019, I published a book called The Reflective Journey: A Practitioner’s Guide to the Low Arousal Approach. In this book, I outlined the evolution of the Low Arousal Approach for managing crisis situations. I deliberately avoided talking about and describing all forms of physical interventions. The whole area of restraint and seclusion, and what people teach in reality, is a difficult and even taboo topic. Discussing what people do in a crisis can be a highly emotional and uncomfortable subject for individuals, family members and staff teams alike. However, openness and honest dialogue is urgently required if we are to reform the crisis management training industry, and eradicate the use of restrictive practices for good. It is the aim of this book to describe the Studio 3 Approach in context, and help to lift the veil on restrictive practices in reality, and what we can do to eradicate them.
It is my hope that by describing the full spectrum of what my colleagues teach, from de-escalation right through to the difficult topic of physical interventions, that it will encourage other organisations to do the same. I consider myself to be a human rights campaigner, and I fully believe that for change to truly occur people must be willing to reflect on their own experiences. The dominant narrative in the industry is that restraint and seclusion are a necessary evil which must be taught in order to keep people safe. This is a false narrative that exacerbates fears around violence and aggression in care environments. I do understand these fears, but I do not support the use of excessive force on vulnerable individuals. My journey is not over yet, but I do hope that, by sharing my experiences and those of my colleagues, people will see there is an alternative to restraint and seclusion, and that we can get by without these tools in our toolkit. One of the wonderful things about human beings is that we evolve, we learn and we question – but it is not easy to do this.
Professor Andrew McDonnell,
Clinical Psychologist
Coming soon to the Studio 3 website!
Meanwhile, get your hands on The Reflective Journey: A Practitioner's Guide to the Low Arousal Approach, on sale now as paperback and in eBook formats!
Read a recent review of The Reflective Journey by Dr Rebecca Fish here: www.studio3.org/post/book-review-the-reflective-journey
Buy now: www.studio3.org/shop