A Healing Environment for People with Special Needs and How to Make Life Flow

A Healing Environment

for People with Special Needs

Healing Climate, part 1

 Working on a mission demands ‘devotion to the smallest details’

Rudolf Steiner: Education for Special Needs

Preface

This booklet is the first in a series of four on shaping the life-sphere for those with intellectual disabilities. In this second edition some changes and additions in the text have been introduced and some exercises have been added. This is a real bonus.

In the dynamics of organizational changes in anthroposophical care the NVAZ (Nederlandse Vereniging van Anthroposophische Zorgaanbieders) [Dutch Association of Providers of Anthroposophical Care] is pleased to have taken on the  task to support  the publication of further issues in this important series. The contents have arisen from the life and work with people with intellectual disabilities, but can equally be applied to others in need of special care in any other category, be it in their own homes or not.

A Healing Environment is all about establishing the actual physical surroundings. Anthroposophy has been the most important source of inspiration for this. In the course of the past decade the concept of ‘a healing environment’ has become an increasingly general one, although it is interpreted in different ways. This booklet enables the specific expertise developed within the anthroposophical setting to become accessible to a wide area of care.

Ted van Schie

Chair of NVAZ

Table of Contents

Preface

Table of Contents

Introduction

1.      A Healing Environment: Basic Principles

1.1   A view of care and treatment

1.2   Cultural aspects

1.3   Basic needs of the target group

1.4    A healing environment

Exercise 1

Becoming aware of the effect of the environment

2.      Organic Architecture

2.1   Familiar, natural and in harmony with the surroundings

2.2   Choice of materials and sustainability

2.3   Design and health

3.      Culture

3.1   Attention and care

3.2   Interest in the environment

3.3   Beauty

3.4   Empathy with the experience of the client

3.5   Independence and autonomy

4.      Interior Design

4.1   Recognizable and understandable

4.2   Functional and sturdy

4.3   Natural materials

4.4   Fabrics

4.5   Quality of sound and air

4.6   Lighting

Exercise 2

Observation and Assessment of Living Areas

5.      One’s Own Room

5.1   Children’s bedrooms

5.2   Private rooms of young people and adult clients

6.      Colours

6.1   Organic use of colour

6.2   Colour spectrum

7.      Healing Images

7.1   The healing effect of pictures

7.2   Choosing pictures

7.3   Pictures from nature

7.4   Identity, pictures and symbols

8.      Nature

8.1   Contact with nature

8.2   Plants and seasonal table

8.3   Gardens

9.      Motivation and Inspiration

9.1   The ritual of laying the foundation stone

Notes

Bibliography

Introduction

I am entering a home for 6 to 12 year old children with delayed development and learning disabilities. I come into a light-filled, spacious hallway. On the left there are coat hooks; above every set of two hooks there is a little shelf with the name of a child, as well as a recognizable picture for those who are unable to read. Below it there are separate shoe compartments and above it shelves for gloves and hats. All of the coats, apart from one, are hanging neatly on the hooks. I bend down and hang the one coat that was on the floor on a hook.

This place calls up a pleasant feeling in me: it radiates attention and care and gives the impression that there is space for each child. This experience calls up trust in what is being done here for the children. The well-ordered way in which things have been organized is inviting: it is not difficult to simply put the coat that had fallen down back in its place.

This booklet is about the art of creating a healing environment.  I used the example so as to give an impression of what I mean by this.  A healing environment is the result of several factors, material as well as non-material, such as how clients deal with the surroundings. The aim of this booklet is to bring this more into awareness. Also concrete advice is given on how to go about doing this. In this new edition more attention has been given to learning to observe the environment and its effect. Although the text is mainly about the environment of clients, it also gives ideas for the interior design of spaces for support staff.

It should be obvious that the point here is not to follow exactly what has been described. Creating a healing environment could be seen as an ideal that can inspire and can help to decide what actions to take.

Working out of an ideal often gives energy, but can also be testing.  Daily reality is often stubborn. Then the challenge lies in setting oneself manageable goals and in knowing when concessions need to be made.

I have really enjoyed working on this booklet. I sincerely hope that it will contribute to the creation of types of environment which have a healing effect on clients and parents, as well as on support staff.

Annemieke Korte

October 2016

1.   A Healing Environment: Basic Principles

In this chapter we will shed light on the anthroposophical view of the human being, describe the concept ‘healing environment’ and identify criteria that a healing environment for this target group needs to meet.

1.1. A View of Care and Treatment

The anthroposophical view is a holistic one, in which the human being is seen as having a physical body, a soul (psyche) and a spirit, as well as an individual task in life.

From our point of view not only the client, but also the support worker can continually develop in the care- and treatment situation. Client and support worker can help each other in this development.  ‘Connection’ is a key concept here.  Only those who connect with themselves, with others and with their surroundings will be able to develop with the help of these aspects and learn from them. Those with special needs have difficulties in connecting with themselves and the world around them. They need extra support, as well as an environment that is specifically geared to them.

We can call an environment ‘healing’ if it addresses all aspects of a person. A healing environment will provide a better balance for the clients and provide a basis for further development.  Nature, art, culture and spirituality are considered to be wellsprings of health and development.[i] In this booklet we will show how to dip into these wellsprings when bringing about a healing environment. 

1.2  Cultural Aspects

When creating a healing environment you are dealing with material conditions as well as with the involvement of the co-workers in the environment. Here we want to go more deeply into this involvement: ‘the culture of the healing environment’ is a culture in which support- workers will pay attention to and care for the environment and where clients also contribute, according to their abilities.

As was said earlier, it is often difficult for people from this target group to connect with their environment. For this reason it is important that they have the example of an attitude of interest and of respect for the environment. This can encourage clients to be more open to their environment and form a connection with it. The environment should not be seen as separate from the greater whole of which we are a part. The realisation that we are responsible for the earth also belongs to the kind of culture we are talking about here.

1.3  Basic Needs of the Target Group

Someone who is well integrated and healthy will somehow be able to compensate for an environment that feels unpleasant to them. They will be able to distance themselves from their environment, close themselves off from it or adapt to it. For people from this target group this is much more difficult. They are quite heavily dependent on their surroundings, which they often find hard to understand due to their problems.  They are greatly helped by an environment that they can recognize and understand as much as possible.  Being unable to make sense of and integrate information will lead to restlessness and anxiety. Especially highly sensitive people- those with a too open, outflowing constitution[ii]- and those with disorders on the autistic spectrum, can be totally overwhelmed by impressions.   The fact that these people are often also unable to communicate these things  can lead to challenging behaviour and aggression. 

 Window Blinds

A 28 year old man with severe learning difficulties and Autism Spectrum Disorder (ASD) would regularly pull down the curtains in the corridor. After quite some time it became clear, that he was unable to tolerate the blinding light that shone into the corridor.  When good window blinds had been installed he ceased to pull down the curtains.

 People who are highly sensitive and restless benefit from an environment in which stimuli are just ‘kept’ to a minimum, subject to the people’s problems and possibilities. Service users, especially those who have difficulties in getting going and who have a constitution that is too slow or too heavy[iii] sometimes need strong stimuli.

People with attachment disorders often suffer from a disturbed relationship to their environment. They tend to find security in a safe and steady environment, where things, if at all possible, retain a fixed place for a long period of time and where there are clear norms in place how to deal with them.  

Moving

A 12 year old girl with mild learning disabilities, attachment disorder and severe challenging behaviour changed her room around every three days. Her bed, wardrobe and coffee table would be moved to a different place all the time. Her room always looked messy and not very cosy. This girl’s behaviour stems from an inner restlessness and feeling uncomfortable, also physically. After a consultation with her doctor this type of behaviour was restricted.  Together with her a suitable way was found to furnish her room.

The multidisciplinary team prescribed external therapies in order to help her feel more at home in her body.[iv] Half a year later she received art therapy[v]. During this therapy she made a lovely painting of a bear with her cub in a warm hollow in the ground. The painting was hung up in her room. She was very proud of it. It remained there for a couple of years. In the course of three years the girl has become much more peaceful within herself.  The need to change her room around can still be observed in more difficult periods.    

Some people have a limited ability to control their impulses. A safe environment is required to make this possible, for instance by using non-threatening objects and by offering clear, physical boundaries.

People with complex needs are strongly linked to their environment, which makes them extra dependent on it. As many of them have poor communication skills they are often not able or hardly able to indicate that something is bothering them. They demand from us that their needs in this area are observed closely.

The environment for all those who are at risk should not elicit any fear, restlessness or depression.  This is especially the case for those with psychiatric problems, such as undigested trauma, psychosis and severe anxiety. 

Criteria for Organizing the Environment

The following criteria are valid to a variable degree, dependent on the level of the problems and the possibilities of the service user. The environment should:

-        be understandable and familiar  

-        be safe

-        have a well-balanced variety of stimuli

-        not elicit fear, restlessness or depression  

-        have fixed places for things

-        follow clear standards in how it is being dealt with                                                                                                                                                                                                                                     

These criteria form the foundation for creating a safe and suitable environment that can lead to a reduction of many so-called behavioural problems.  Yet if all you do is organizing the environment according to these criteria you do not automatically have a safe environment. In a healing environment all aspects of the human being need to be addressed.  More on this in the next chapter 

(picture) 

1.4 A Healing Environment

What is it that characterizes a healing environment and how does it address the whole human being? In the box below we will first give a list of the characteristic aspects, which will be explained afterwards.

A Healing Environment

-radiates care and attention

-comprises natural elements and possibilities for contact with nature

-offers experiences of beauty and has artistic elements within it

-is authentic and expresses the unique personality of the users

If an environment radiates care and attention, you will give to those who live and work there the message that they are worthy of such an environment. This will contribute to their self-awareness and enhance their physical and mental wellbeing.  Contact with nature and with natural elements in the environment will engage with you as a living being and enhance physical and mental health. Do not only think of objects from nature here, but also of natural materials, working with organic forms, the use of colour and the introduction of a seasonal nature table.

Experiences of beauty and artistic elements are nourishment for the soul. They can offer a counterbalance to feelings of anxiety or inner emptiness and address the deeper individual core of the service user.

In organizing the environment, the individuality and autonomy of the service user is respected and encouraged as much as possible. If the environment expresses something that is part of you it will offer recognition and promote self-awareness.

If one is allowed to have an autonomous influence on the environment, both health and wellbeing can be highly enhanced.[vi]

There are, of course, various ways of expressing this. Different aspects can be stressed, depending on the target group and location. And finally: places that radiate ‘wholeness’ are always unique, because they express the motivation and inspiration of the people who live and work there. Some places already have an inherent positive energy that can contribute to this.[vii]

In the next chapter we will address the theme of ‘design’ and its effect, but here is first an exercise that can help you become more aware of your environment and the effect it has on you.

(picture)

Exercise 1

Becoming Aware of the Effect of the Environment

We are constantly affected by our environment, although we may generally not be very aware of it. The environment influences our health, our mood and our consciousness. This exercise is meant to help develop more awareness of the influence of the environment. The exercise can be done anywhere. You can learn even more from it if you do it together with others and exchange experiences with them.

Observation

Empty yourself inwardly and tune in to your surroundings. Asking yourself the following questions will help you to discern what is coming towards you.

-What strikes you most when seeing this space?

-What kind of physical sensations are called up in you by this space?

-What feels pleasant to you?

-What bothers you?

-How do you experience this place from the point of view of your sense of balance?

-What kind of effect does the place have on your mood?

-What effect does it have on your consciousness and concentration?

-What colour arises within you when you allow this space to work on you?

-To what does the space invite you?

- What in this space has a special significance for you?

Reflection

How did you experience doing this exercise? What are your conclusions?  Finally, picture someone you support and try and find out for yourself how they would experience this environment. (See also 3.4.)

2.    Organic Architecture

Organic architecture is a multiform architectural movement that arose at the beginning of the twentieth century. We will now discuss the principles of organic architecture as developed within anthroposophy[viii], characterized particularly by ideas about the influence of design on health. 

2.1 Familiar, Natural and in Harmony with the Environment 

In designing organic buildings certain formative principles are used that have been derived from nature, in particular from the mineral or plant world or from the human body. Among other things, these forms can improve physical wellbeing.[ix] (See also 2.2). Interior design and the use of colour will enhance this as much as possible. The experience of physical wellbeing is an important foundation for healthy child development, but can also influence health and mood in adults.

 Going with the Flow

The corridor in a medical-therapeutic centre has been shaped in a gentle wave-like movement and painted in soft colours that flow into each other. The overall impression is pleasant and relaxing. It is striking that children and young people with ADHD begin to run less fast in this corridor. It invites one to go with the flow.

A building should, of course, also be functional. It should respond to the aim for which it has been built. Something of this functionality should be visible on the outside.  If this is not the case it could lead to disorientation and feelings of estrangement.

Familiar

The accommodation for groups 1 and 2 of a school for special educational needs has been built on to the main building as a separate unit. This low-rise building appears much more friendly and playful than the section for pupils from age 7. It can therefore already be experienced from outside what this section is meant to be.

In the design of buildings an attempt is made to tune in with nature, with the forms in the landscape, with the surrounding buildings and the natural environment. In this way feelings of coherence and connectedness are stimulated and enhanced.

Coherence and Connectedness

The life and work community Bronlaak for adult service users is situated in a wooded area. The houses were designed organically. The trees on the estate have been taken into account when the houses were built.  The partitions between the gardens were designed in flowing lines. In several places one can find works of art, some made out of wood or willow branches.

Another example is the care garden Oosterheem in Broek op Langedijk, a care home project for young adults. The dwellings at Oosterheem are linked with the workshop via a little bridge.  

The participants leave the work place in a little boat to go the garden. In a contemporary way the design of the buildings fits to the historic environment of Broek op Langedijk with its vegetable auction.[x]

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 2.2 Choice of Materials and Sustainability

 In the organic way of building it is preferable that the materials are natural and sometimes also locally sourced. Natural materials are more alive than artificial ones and enable the users to experience a relationship to the living environment.  They also offer differentiated impressions to the senses. (See also 5.4).

It goes without saying that building in a sustainable and energy efficient, or energy neutral, way is part of organic design. By this we mean, for instance, the use of solar panels and materials that can be reused or recycled as much as possible, making use of certified indigenous wood, heat conservation, as well as measures for improvement of the internal climate, like walls that breathe, and the use of water, plants and measures f preventing electro-stress. [xi]

 We shape our buildings, and afterwards they shape us.

Winston Churchill

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2.3 Design and Health 

We constantly explore the shapes that surround us with our eyes. We enter into them involuntarily and subconsciously imitate them inwardly. We also tune into that which surrounds us with our movement and our sense of balance. Eventually the impressions we gain in doing this will have a formative effect on our organism. [xii]

In connection with this, the anthroposophical psychiatrist Bernard Lievegoed (1905-1992) speaks about organic design as a source of health. He pleads for what he calls ‘living architecture’, pointing to the rigidifying effect of being surrounded by straight lines and angles and a lot of mathematical repetition.  He is of the opinion that such an environment weakens vitality.[xiii] Our thinking also tends to be influenced by the surroundings. If we are mainly surrounded by cubistic forms we will begin to think in a linear and less creative way. This is why living architecture aims to find a plastic, malleable design, making use of rhythms and natural formative principles. This stimulates development, vitality and mobility in thinking.

A Communal Building

On the estate of a care home there is a building for children and young people with learning difficulties and complex needs. It is placed in a ‘protective gesture’ around a small courtyard where children, young people and support staff can meet. The doors to the hall are made of thick, solid wood and resemble a portal. When walking through it you have a kind of solemn feeling. On the other side, in a rhythmical order, there are high, narrow windows up to the ceiling. The fact that you can see the tops of the trees and the sky outside has a restful effect. As the windows are rather narrow you will not get lost in the outside space. There are various planes and angles in the walls and ceiling and a lot of wood has been used. This gives mobility to the space without it becoming restless.

 (picture)

 People who are in care often live in buildings that have not been designed organically. If this is the case, an organic character could nevertheless be given to these spaces by means of internal refurbishment or the use of natural colours and materials.

Organic design is not only effective for those needing special care. Support workers also may experience something of this healing influence.

If we wish to evaluate the value of organic design it would help to suspend our initial reaction of ‘beautiful’ or ‘not beautiful’. Let the building work on you, and experience what it does to you.

3.    Culture

 In this chapter we will discuss aspects of attitude and approach. The role of art and the furnishing of spaces will also be addressed. The empathy exercise in relation to the experience by a person in care is an important element here.

3.1  Attention and Care

Sometimes when you enter a space you may immediately have a pleasant feeling. This could be connected with the dimensions, the proportion of height, width and length, or with the interior design. It could, however, also be connected with the care and attention given to the space.  It is not only important whether a space is hygienic and clean, but also the actual attention that has been given to it.  Attention affects the energy and atmosphere in a space. Such a space invites one to be in it and calls up positive feelings. Sometimes a space may not be quite ideal as to dimensions or interior design, yet it can have a positive effect because it has been cared for and lived in with a sense of commitment.

The opposite can also be the case. Just imagine a neglected space, stairwell or parking place. There might be rubbish lying around or it might smell bad.  Such a place can make one feel afraid or unsafe or it can elicit behaviour that goes beyond limits. Many people who are at risk are extra sensitive to these kind of influences.

Fixed

Every Wednesday afternoon the maintenance team comes to do maintenance and repairs in the home of a group of 6 to 8 year old children with attachment disorders, ADHD, a lot of challenging behaviour and mild or moderate learning difficulties. The support workers are finding to their surprise that on the Wednesday evenings there is less aggression than on the previous ones.

Working with attentiveness- in this case in relation to the environment- also has a positive effect on vitality. Experiencing little or no connection with what you are doing will have a weakening effect on the etheric or life-body, thus aggravating stress. [xiv] Nowadays an attentive attitude is sometimes also called ‘mindfulness’.

3.2  Interest in the Environment

Being an example as someone who has interest in the environment could be considered a fundamental attitude in this work. Such an attitude encourages people to become aware of their surroundings and to establish a connection with it.

Zen and the Art of Bicycle Maintenance

In a care group for 8-13 year old children with mild learning difficulties and psychiatric problems a support worker looks after the bicycles.

One Saturday morning he is teaching one of the children to repair a tyre, while two others are watching. It is interesting to try and find the hole in the tyre together with others. The inner tube is being dunked into a bucket of water. Where do the bubbles come from? How big is the actual hole? How long does it take for the glue to dry?

Things only reveal their secrets to those who observe closely. One of the other children is getting very good at pumping up tyres. This becomes his ‘speciality’ in the group. No one should be surprised that the children in this group take better care of their bikes than is usual.

 Interest in things, however, only leaves an impression if the support worker is also genuinely interested. It goes without saying that the interests of support workers vary. In this way the uniqueness of members of a team can come to the fore.

 3.3  Beauty

 We can consider beauty and art to be healing aspects in the life-sphere.  By this we mean attention to details, such as how to arrange flowers in a vase, what kind of pictures to put on the wall, what crafts to do or the use of special crockery on a Sunday. As for pictures on the wall, the ones that are true to reality and recognizable can offer the best way to give service users something to hold on to.  

Some form of unity in the wall decorations has a calming effect. Pictures should not call up fear, restlessness or depression. Caricatures, such as of certain characters from comics, can have an alienating and frightening effect, and also offer little room for one’s own imagination (7.3). Young people and adults in need of special care should be included in the choice of wall decorations as much as possible.

 Art

A home group for people with learning disabilities between the ages of 20 and 40 comprises mixed types of people. This group has a subscription to an art library. Every couple of months a delegation from the group visits the library. The choice of the new painting is made by the residents in consultation with the support workers. Making the choice is a social exercise, as those who come along must be able to feel and empathize with what the other members of the group will think of the painting. Usually, colourful pictures are chosen, often figurative, sometimes partly figurative and partly abstract.

 If you have a surface that ‘jumps out’, you could choose reproductions in strong frames or consider having a wall hanging. Wall hangings can be decorative, have a warm effect and will muffle noise.

Hanging up works of art made by the residents themselves can contribute to their feeling of self-worth and joy, but could also increase restlessness and confront people with their lack of abilities. Dealing with this issue demands careful deliberation.

 3.4  Empathy with the Experience of the Service User

 What kind of criteria should be used when furnishing a space? How can one prevent basing the decisions too much on one’s own taste and preferences?

The following exercise could help with this. It can teach one how to experience a space from the perspective of the service user through empathy.[xv]

 Empathy Exercise

1.      Choose a person you have been working with, preferably already for a longer time.

2.      Try and picture them very exactly and concretely in your mind, focussing on the person’s outer appearance.

3.      Try and imagine how this person moves. How do they walk? How do they sit down?

4.      Now walk and move like this person. Take your time for this.

5.      Then sit down or stand in a particular place in the room, for instance at the place at the table where the person usually sits. Then walk around a bit. Remain in the role of the service user when doing this.

6.      Ascertain what the space does to you as the service user and then ask yourself:

-Is this what you would wish for this person?

-What works well and what could be done differently?

 When doing this exercise you will often notice that you observe and know much more about a person than you had realised. Steps 2 and 3 of this exercise have the aim to be able to tune in carefully with the person.  The more carefully these steps are done, the more reliable the information will be. They can bring clarity to questions of interior decoration as well as of approach.  It goes without saying that the adaptations you are applying as a result of the exercise should be evaluated according to their effectiveness.

 3.5  Independence and Autonomy

Addressing the responsibility of those in need of special care at an appropriate level can stimulate their independence.  This will also enhance their self-awareness and their sense of ‘belonging’. With this in mind it could be helpful to occasionally discuss the theme of ‘interior decoration’ in group discussions.

A healing environment is one that has an optimal harmonizing effect on the residents and stimulates their individuality and autonomy.  This may lead to fields of tension at times. It is good to be aware that this is part of the process. If it is clear that what the client wants goes against the aims of their support plan, the deliberations will not be that difficult. The problems, however, are often more subtle. It also depends on whether you are dealing with children, young people or adults. For instance, you would want to give young people the opportunity to find themselves. (See also 5.2). The only way to shape a healing environment is by assessing what is appropriate in each individual situation.

 The place 2 be

Some of the living areas for young people with psychiatric problems and mild learning difficulties have been designed to be relatively free from stimuli.  There are mainly gentle colours on the walls and wherever possible natural materials have been used. The social space, however, was decorated entirely with and by the young people.  A large cartoon with strong colours shows that this is ‘the place 2 be’. There is a bar with plastic covered stools. There are sitting corners with red velvet cinema chairs and garlands with coloured lights. On a dark grey wall there are dartboards, on another wall there are photo-collages of social activities. Wall-sized murals have been planned for the other walls.

 (picture)

 4.    Interior Decoration

      How do we design and decorate common areas? How can we look at existing spaces with new eyes?

  4.1 Familiar and Understandable

 The familiarity of a space increases if it is divided up in clear areas with are easily distinguishable functions. This distinction can be supported by colours, pictograms or pictures. Challenging behaviour tends to decrease whenever familiarity and clarity have been guaranteed as much as possible.

 Points of Reference

-Is it easy to have an overview of the space?

-Is it easy to distinguish the various functions of the space?

-Is it clear where the different doors lead to?

-Are the picture boards clear?

-Is there enough storage space and is it clear where things belong?

-What is conspicuous? Is this a good thing?

As clarity and familiarity are so necessary, it is not advisable to change rooms around regularly. If this needs to happen for some reason or other it would be good if the support worker could involve the clients in this process or prepare them for it.

 Taken by Surprise

 A nine year old boy with a mild learning difficulty and ASD is standing at the entrance of a common area. He does not dare to enter. When the support worker asks what the problem is he replies that he is scared. He does not dare to go in because the upholstery of the couch has been changed without his knowledge. It was changed from dark blue to dark red.

 The sense of security is increased if the residents have been sufficiently able to influence what happens in a space, or, if necessary, can withdraw from the situation, for instance by going to their own room or a different suitable space, such as a ‘time-out’ room. Some clients need a safe corner from where they can have an overview of a space.

 4.2 Functional and Sturdy

 Common rooms and other spaces are usually in intensive use. This is why both the furniture and utensils need to be functional and sturdy. Things that break easily can contribute to a feeling of insecurity.

As many clients have difficulties processing information it will help them if there is a correlation between the form and the function of utensils. This is not the case, for instance, when coffee mugs have feet and a face, or if a thermos flask has a lid in the shape of a cat’s head. Such items could be funny, but tend to give the service users too much non-functional information and sometimes even call up fear.

As for furniture, you could choose organic design in solid wood.  Its sturdiness can have a safe and grounding effect on people who are ‘too open’ or anxious. 

 4.3 Natural Materials

 In interior decoration the preference is for natural materials. These materials enhance feelings of physical wellbeing, security and warmth[xvi] and allow for differentiated perceptions, promoting the development of the senses. Also in the design of play corners it is advisable to use natural materials, both for toys and for furnishings.[xvii]

The best way to get a sense of the qualities of certain materials is to experiment for oneself. How does a table top made of man-made material feel to the touch? How do you experience the difference between a wooden toy truck and a plastic one? Truthfulness is also a criterion in the choice of materials. By this we mean the correlation between the shape of something and what it is in reality. For someone with problems orientating in the world honest materials can provide security.[xviii] It goes without saying that the choice of natural materials has to be in balance with the demands for cleanliness and maintenance.  Cleaning should preferably be done with eco-friendly materials, not only because they are better for the environment, but they are often also more pleasant to use and better for our health.

 4.4 Furnishings

 Fabrics such as cotton, wool or leather are preferable if there is a question of regulations for fire-safety as well as for prevention of possible allergies. The flooring should preferably be darker than the walls, and could be slightly mottled. We would advise against busy patterns for curtains and carpets. 

Net curtains in front of the windows can serve as a kind of separation from the outside world, ensuring that the attention of clients who are easily distracted is not too much directed towards the outside.

Distraction

In a care group of 8 to 14 year old children on the child psychiatry ward, the dining room has two tables facing a peaceful garden. It is a lively group with many hypersensitive children. Four of the children eat at a table where the window has been covered up to eye level. At the table of the other four children you can look out of the window normally.  At a certain moment it became clear that the meals at the second table were often more restless. Even the appearance of a little bird would cause two of the children to turn round on their chairs and take the others along in this behaviour. As soon as net curtains had been hung up the mealtimes became quieter.

Curtains and net curtains give an impression of warmth. Window blinds or stick-on plastic make a less warm impression and can have a bare effect in sparsely furnished rooms. Where there is a lot of challenging behaviour one could opt for indestructible curtains.[xix]

 4.5 Quality of Sound and Air

 Too much noise should be avoided as much as possible. Poor acoustics, a sloppy finish of floors and walls, or audio-visual equipment that has been turned up too high or is only on as background noise, can trigger restlessness and aggression. Those with problems related to ASD, ADHD and people who are ‘too open’ tend to be extra sensitive to these things.

 Noise

‘…did you know that squeaking cars hurt my ears, and did you know how painful it is when the microphone goes haywire? Also other sounds hurt me, such as (……..) conversations of educators and other special people: they speak so fast and all at the same time, both the volume and the talking at the same time are unbearable….’

(From ‘I don’t want to be inside me anymore. Messages from an autistic dungeon’. Birger Sellin, 20 years old).[xx]

 Good acoustics are also important where there are people with impaired vision, because they have to orientate with the help of sound.  Impaired vision is quite common among people with learning difficulties.[xxi]  Also the quality of the air influences mood and behaviour. Areas that are too hot, damp or stuffy have a negative effect on concentration and can cause irritability. Bad smells are immediately noticeable.  Although you get used to them after a couple of minutes, they nevertheless continue to have a subconscious effect. Giving the place a good and regular airing is important. The use of chemical air-fresheners should be discouraged. It is possible to obtain natural air-fresheners.

 (picture)

 4.6 Lighting

 In this paragraph we will list a number of reference points in relation to lighting and will also pay attention to specific needs of the target group and to different kinds of lighting.

 Points of Reference

-Is the lighting appropriate for the purpose of the space?

-How is the balance between functional and atmospheric lighting?

-Has the lighting been adapted to the specific needs of the clients?

-Are the fittings safe and strong?

-Is it dark enough at night and are there appropriate night lights for orientation?

 Particular problems in relation to lighting occur, among others, for people with complex needs, people with epilepsy, people with a visual impairment and elderly people. For people with complex needs who tend to sit or lie in a particular position, care should be taken that the light does not shine directly into their eyes.  Hard, shiny surfaces could reflect light very strongly and thus cause a problem. Light sensitivity can play a part in certain types of epilepsy. Flashing (sun)light and flashing images on a screen may trigger epileptic seizures.  Those who have impaired vision and people who are elderly have more need for light than the average person.[xxii] A good level of light during the day can improve sleep and slow down cognitive decline in elderly people and those with dementia. As much light as possible is preferable. If necessary, ‘daylight’ lamps could be considered. [xxiii]

 Visual Impairment

A 6 year old boy with a visual impairment and complex needs has assistance with eating. He is usually able to cope well with this. After a change in the seating arrangements he regularly refused to open his mouth. After some research it turned out that his new seat was a bit in the shade, so he was unable to see the spoon approaching.

There is enough awareness in our time of the importance of daylight. Daylight is a living form of light. It is different every day, due to the changing position of the sun and the different weather conditions. Lack of sunlight can cause sleep disturbances, feelings of depression, stress and concentration problems.

Here are some points relating to the different qualities of artificial lighting. Lightbulbs and halogen lamps work according to the principle of heating. [xxiv] They produce light by heating a wire, causing their radiation to be rather hot. Especially with incandescent lightbulbs this causes high energy consumption, which is why they have been taken off the market.  Strip lighting and energy saving lightbulbs produce light by means of electronic discharge. These lamps are more energy efficient but have a cooler effect. Compared to halogen and incandescent lightbulbs their light is somewhat diffuse, which can cause restlessness. Led-lighting is a calming kind of light, yet it does not radiate, so it can feel cool and unnatural. It is advisable to do appropriate research in particular situations to see what is most suitable.

 It will gradually have become clear how many different aspects there are in the interior decoration of the environment. If you want to assess an area carefully you can often be beset by so many things that it can be quite hard to know where to begin.

The exercise below was designed to help observe a space methodically, how to identify its characteristics and to reach carefully considered assessments and recommendations. 

Exercise 2

Observation and Assessment of Living Areas

 The questions below can be helpful when observing a space. If you look carefully you will notice that these questions address different ‘layers’ of an area. A material layer, one that is connected with the climate and atmosphere inside the space, and one that is related to what the space wishes to express. This classification has been taken from the book Zorg voor mens en omgeving [‘The care of the human being and the environment’( not available in English, tr.)]  It can enable you to make sense of your impressions.[xxv]

If you look at an area together, keep in mind that what you see often has a history and that a hasty judgement could hurt people. In such a case it could be helpful to begin by asking some questions.

Observation

Stop for a moment at the entrance. What is the entrance like? What is your first impression? Is the entrance welcoming? Are you able to get orientated easily?

Then walk around the room and also sit down. Let the space work upon you. What do you observe? Also include the view onto the space outside.

What materials have been used? Has the room been finished off properly? Look at the walls, the floor and the ceilings, for instance.

How is the inside climate? Consider things such as acoustics, temperature, humidity, smell, the way the light comes in and what kind provisions have been made to enable this to happen.

What is the atmosphere like? Observe things like care and attention, the use of colour, furnishings.

What does this space wish to convey? Think of the language of forms, identity, cohesion, significance and familiarity.

Characterization and assessment

A characteristization is a comprehensive description based on your observations. For instance: in this case there is cohesion: the colours and materials are in harmony with each other and the wall decoration shows a certain unity. One way to find the characterization is by means of opposites, such as to materials: are they hard or soft? Or: is the lighting warm or cool?  Formulate three striking characteristics of the space.  Which are the strong points and what needs to be improved? Include in this the function of the space and the criteria necessary for the target group.

 Recommendations

Based on the above, formulate two or three recommendations for improvement.

 5.    One’s Own Room

For those in need of special care their own room is usually the only place that is totally their own. Their own background and interests, wishes and preferences can be expressed here. Parents and befrienders often like to have a role in this as well.

5.1 Children’s Bedrooms

Children who are young, anxious or ‘too open’ need extra shelter. This can be provided by painting the ceiling the same colour as the walls. A white ceiling gives the impression of more space. Another possibility would be to put a kind of ‘heavenly canopy’ over the bed head (only use fireproof fabrics). For hygiene reasons there is often vinyl on the floor. A bedside mat is then not a luxury, so the child will not have to put their bare feet directly on the cold floor in the morning.

Certain children, especially those with attachment disorders, may be unable to cope with direct attention.  One could give these children extra attention by caring for their room and their belongings.  Children tend to have an increasing number of toys, things and ‘cuddlies’.  More space could be created in the room if, in dialogue with the child or their parents, some of these things are stored away. Order and a limited number of toys will encourage play and enable the children and their support workers to tidy up more easily. This will demand some extra care, but will give security and peace of mind. If necessary, enhanced reduction of stimuli could be brought about by having a plain bedspread of the same colour as the curtains.

 Attention for the Bedroom

A very anxious 9-year old boy with a mild learning difficulty and a severe attachment disorder tends to run away on a regular basis. He often seeks the attention of the group leaders, but is then unable to cope with it. He also has problems with falling asleep. In the care review the decision was made to give him extra, indirect attention by caring for his room and possessions.

The boy’s key worker does the empathy exercise we described in paragraph 3.2. This helps her to get a better idea how to improve certain things in his room. Twice a week she spends about ten minutes in his room at fixed times. Then she may tidy up a little or repair something, or at other times she may frame a new picture and hang it up, all in the presence of the boy. He is allowed to help, but does not have to. The regular indirect attention gives the boy something to hold on to and provides peace of mind; he is beginning to look forward to these moments and to join in more often.  After some time he is able to fall asleep more easily. Gradually he also runs away less often.

 5.2 Private Rooms for Young People and Adult Clients

 Young people who are in puberty feel the need to experiment in all areas of life in order to find themselves. They also want to do their own thing in the interior decoration of their own room. Respecting their freedom does not mean just to let them do what they like. Young people want to find what their educators and those in their surroundings believe in, also in the area of interior decoration and the care of their things. They will be able to get to know themselves by dealing with these things.

Young adults also often still need guidance in decorating and furnishing their own room. Below is an example of a female resident who, after some years, has discovered what works for her.

 Closed Off Cupboard Doors

In the room of a 38 year old woman with a moderate learning disability, attachment disorder and a severe compulsion for collecting things, the furniture needs to be replaced. She has indicated that from now on she would like to have less open cupboard space. In her own words: ‘Closed cupboard doors make me feel less agitated’.

 (picture)

 When allocating rooms it is advisable to take into account the client’s constitution. A room to the east, for instance, can have a positive influence on people with a tendency to depression. Also the use of colour, if chosen with a specific person’s needs in mind, can have a positive effect. We will speak more about this in the next chapter.

6.    Colour

What are the possibilities for working with colour in interior decoration? We will first explain what we mean by the use of organic colours, and then we will describe the effect of different colours.[xxvi]

 6.1  The Use of Organic Colours

Colours have a powerful influence on people’s mood and physiology.

When using organic colours , those with a natural effect are preferable. It is also important where colours are applied: darker colours should be used lower down and lighter colours higher up. Earth-like shades, such as ochre, burnt sienna and brown are suitable for floors. This enhances the feeling of being able to ‘ground’ oneself in a room. In the same way that you do not really find planes of all the same colour in nature, it is also possible in interior decoration to opt for various shades of colour. This could be done with so called ‘layer’ or ‘veil’ technique. Here, transparent layers of colour are applied on top of each other, giving the impression of liveliness and transparency.  This technique is in keeping with the way the human eye works. In a subtle way the human eye always tries to find movement and contrast.

Harsh, strong colours are best avoided. They tend to become too intrusive and to prevent a sensitive ‘breathing’ within a space.  Gentle colours tend to be inviting and help one to become more sensitive to colour as such. Gentle pastel colours are suitable for spaces with few distractions. If necessary one could use strong colours to bring in accents and to help activate people with motivation problems.  Colours that flow into each other make us dreamy. Colour contrast wakes us up.

One can play around with these effects, according to the needs of the target group.

6.2  Colour Spectrum

How do colours work? What are the possibilities when working with them? In the description below I have given an impression of a number of colours and their effect. In practice it is good to consult a therapeutic art practitioner who is able to observe the target group and the colour combinations, while taking into account the way the light falls and the space in general.

 (this part of the book, as well as the description of the individual colours, was done with

                                              background colours, not font colours, Tr.)

Magenta  Carmine           

Cadmium  Orange

Yellow  Light green

Green  Cobalt blue

Ultramarine   Indigo

Blue-violet    Red-violet

Magenta

Magenta is a synthesis of pink and violet. In a gentle shade it is the colour that belongs to babies. Magenta can evoke the sensation of being surrounded by a living, moving ocean. This colour has a slightly excarnating effect, i.e. it can make you feel a bit ‘out of yourself’. This colour is often used in nurseries.

Carmine

Carmine is a deep red shade, such as of dark red roses. It is a warm colour that enhances alertness in the body and limbs. Carmine is the colour of love and social life.

Warm

In the common room for a group of children from 6 to 12 years old who have suffered trauma, have attachment disorders and ADHD, a deep shade of carmine red has been chosen for the curtains and the upholstery of the chairs, matching the colour of the wood in this room.  In a similar group of children the fabrics in the bedrooms are of the same carmine red shade. The colour has a warm effect and is not too restless.

Cadmium

Cadmium, also called ‘traffic light red’ or ‘fire engine red’, has an active quality. The colour seems to say: ‘Watch out, here I am’. Cadmium red calls up will power and enthusiasm. If you are sensitive to this it could also cause anxiety. For our target group this colour is mainly useful because it accentuates things, for instance when trying to bring clients with motivation difficulties into action.

Orange

Orange is a colour with a lot of movement. It gives the sensation of continuous ‘expansion’. Orange is somewhat transparent and can provide warmth, energy and inner certainty. In interior decoration one could choose less vibrant shades of orange, if need be with the addition of earth shades, such as browns or burnt sienna.

Yellow

The colour yellow- and here we mean lemon yellow- is related to light: yellow wants to radiate. It is the colour of wakeful consciousness and has an awakening, stimulating effect. For this reason too much of this colour in a bedroom is not recommended. Orange yellow or gold have more warmth than lemon yellow. Gold is connected with feelings of joy and gratitude and can have a nourishing effect on people who feel tired or burdened.

Sunny

A 13 year old girl with a moderate learning disability and hemiplegia suffers from bad moods in the mornings. She has a sunny character but, most likely due to the paralysis, she faces a barrier when coming into the day. In consultation with her, her room is painted in cheerful shades of orange on a white background.  For the curtains a contrasting plain blue is chosen. The girl is happy with the choices. Although her morning mood has not simply vanished, a certain improvement has taken place over time.

Light green

Think of the new leaves of the birch tree. Many young plants have a similar colour. Light green is connected with a youthful feeling, inner mobility, light and ease. Because of its spring-like character this colour brings about confidence in life. In an urban environment or in places with little green this colour can bring a counter balance.

Green

Green is connected with the forces of harmony and balance. In relation to human physiology the effect of green is linked with the experience of the whole body.  Green is the colour of the middle. Traditionally it is the colour of healing and resurrection.

Cobalt blue

This shade of blue is connected with the ability to reflect and with the awareness of being independent, with one’s own inner world and the ability to take a distance from the world around one. Cobalt blue is not intrusive, but rather has a quality of withdrawal and of providing space. Other qualities of cobalt blue are reverence and devotion.

Viridian

Staff of the medical therapeutic centre Helianthus (adult care) is trying to find a colour for the walls of the corridor and the waiting room.  The carpet is orange. A light shade of viridian green is chosen, layered onto white walls. Viridian is a clear blue green colour sometimes visible in the sky at sunrise.  The idea is that the colour will have a harmonising effect on residents who are here waiting for medical treatment or therapy. Users have generally been very positive about this space. On entering, one notices the colour immediately. It has a calming and awakening effect. Because of this colour it is not so obvious that there is not much daylight in the corridor.

(picture)

Ultramarine

There is more warmth (red) in ultramarine than in cobalt blue. Ultramarine has more carrying and sheltering qualities than cobalt blue. The different shades of blue can have too much of a cool effect. In a living room one would like to have a warmer atmosphere. Blue is good in spaces where strong emotions or aggression occur. Applying a blue colour in hospital casualty wards can decrease aggression in patients.[xxvii]

Calming

The common room of a group of 14 to 17 year old youngsters with mild learning disabilities, ASD and attachment disorders is in need of refurbishment. In this group there is much restlessness, aggression and destructive behaviour. A dark shade of blue, going towards ultramarine, is chosen for the upholstery of the sitting area and the curtains. The walls are painted off white. Lilac accents are applied to the woodwork. This room has a calming influence. The addition of wood and plants insures that the room does not make a cool impression.

Indigo

Indigo is the most appropriate colour for puberty. At the same time it is also the colour of our time, because it expresses depth and has an inherent quality of loneliness and doubt.  Human beings attain their individuality, individual insights and personal choices whenever they experience loneliness and doubt. This colour is not very suitable for use in a living room. Indigo may also be used in classrooms for young people because of its profoundness.

Violet

When adolescents have completed their path through loneliness and doubt, they begin to stand in the world with a certain amount of independence and wisdom of their own. Blue violet expresses something of this. It is the colour of inner calm, reflection and wisdom. The more reddish shade of violet is linked with action based on this wisdom. In interior design violet is most suitable for older clients. Certain children, the so-called ‘millennials’, often prefer this colour.[xxviii]

Quiet Rooms and Time-out Rooms

In adult services, positive experiences have been gained by walls painted in light, transparent shades of green paint. This may be combined with the use of wood (calming and warm) and carpeting in earth-like shades. A combination of bright lighting and a lot of white in a quiet room can increase the sensation of losing oneself. Light shades of violet would be an option for so-called ‘time-out’ rooms.

Here is an exercise in what to look for when observing a space. In exercise 2 we looked at the various levels in a space. Here we will try and find characteristics with the help of the four elements: earth, water, air and fire.

(picture)

Exercise 3

Observation in the Light of the Four Elements

In this exercise you will be researching the qualities of a space in the light of the elements earth, water, air and fire. The idea of the elements occurs in many cultures in various forms. Rudolf Steiner founded his ideas on the western theory of the elements going back to the Greek philosopher Empedocles (@490-@430 BC). The overview below gives a direction for orientation.  Do keep in mind here that objects, forms and colours could be related to several elements.

Observation

Choose a space you wish to observe and try and characterize it in the light of the following elements.

      Earth

             Earth provides support. It gives peace of mind, enabling one to let go.

Characteristics: sturdy, functional, practical and whole; the use of earth-like colours; things have a fixed place;   there is clarity about how we deal with the environment; the presence of stones or minerals; the use of solid wood.

Water

Water provides flow, relaxes and dissolves.

Characteristics: smooth, round shapes, sometimes also fan-like or drop-like. There is space around the things; it is easy to move around. Here one can live. There could also be water in the form of a fish tank or flow form and green plants.

Air

Air brings movement and provides space and clarity.

Characteristics: playful, lively and cheerful. Everything is fresh and clean; there are small variations. It is easy to breathe here: there is sufficient room and there are not too many things.

The use of gentle, transparent pastel colours, flowers, mobiles, windows.

Fire

Fires warms, transforms and provides safety.

Characteristics: cosiness, warmth, shelter; stove, hearth, atmospheric lighting, candles and warm colours; the use of wood.

Taking stock

Which elements are present in this space? Which elements are less present? Underpin this with observations. A description of the effects of each element has been provided. Looking at it from this point of view, would you wish this for this target group? Formulate recommendations for improving the balance in this space, taking into account the needs of the target group.

7.    Healing Images

What do we understand by healing images? How can one choose such an image for a particular person? And how can images and symbols promote feelings of cohesion and connectedness?

7.1 The Healing Power of Images 

A healing image can help one make a connection with one’ inner self. Such an image represents qualities that can help a person on their way. Think of concepts like courage, joy in life, strength, adventure or wisdom. One can choose healing images for individuals and also for a group of people. They could offer inspiration and support to a team on a ward, in the form of a painting on the wall, as a mural (see photograph a couple of pages back [in case the same pictures are used in the English edition]) or in a different art form.  Images appeal to a deeper level of consciousness than words, making them quite powerful.  You do not always have to choose pictures that belong to the level of development of the person in question. Addressing the actual age of the client via these pictures can have a formative influence.

Not everyone is sensitive to images. Music can have a similar effect for people who are more acoustically inclined. We will discuss this further in one of the next booklets.  

7.2 Choosing Images 

In their own room clients are usually alone. Here there will be fewer outer stimuli, allowing them to relax. Yet this could also cause restlessness, anxiety and insecurity, especially during the transition between waking and sleeping.

A picture one can regularly look at, such as a religious image, an image from nature or from stories and fairy tales from different cultures, can be very helpful.  Allow young people or adults as much as possible to help find a suitable picture, for instance from a number of pictures you have selected beforehand.  One could also involve parents and befrienders. Sensitivity and being aware of the person’s cultural and religious background are the conditions of success in this matter.

 (picture)

Healing Images

-A 14 year old girl with a moderate learning disability and severe attachment problems sees a picture of the Sistine Madonna by Raphael in her nursery class.[xxix]  She reacts very positively to this. Her teacher buys a small reproduction of this picture and hangs it up near the girl’s desk. During that year she experienced much support from this picture. She is overjoyed when, at the end of the year, she is allowed to take the picture along to hang up in her room.

-A 50 year old man with Down Syndrome and moderate learning difficulties has for many years gained confidence from the picture of an angel by his bed side.

-A 22 year old Hindustani woman with a mild learning disability and an attachment disorder is shy and withdrawn. Only when dancing is she able to show something of herself. She receives a picture of a graceful Indian dancer for her birthday. This proves to be a good choice. The picture increases her confidence and enhances her sense of identity.

7.3 Pictures from Nature

Research has shown that pictures from nature have a positive effect on many people.[xxx] A majority of patients in hospitals, independent of age, gender and cultural-ethnical background will choose non-abstract images from nature, which are true to reality. There is a preference for pictures of gardens and landscapes, water and non-threatening animals. These tend to evoke positive feelings or to distract from dark thoughts. They also have an influence at the physiological level. While looking at such pictures, heart rate, muscle tension and blood pressure will decrease very soon. Comparable research with sick and healthy school children shows similar results. One can conclude from this research that abstract, cartoon-like images are less suitable for children in a care situation than is often presumed. [xxxi]

A branch with blossoms

A therapist chooses for her room a picture from nature. It is a reproduction of a sunny, impressionistic painting  of a branch with blossoms.

People often choose reproductions in the form of nature photographs. In relation to this we should mention that nature photographs are ‘frozen moments’ of something that in itself is alive and in movement. For this reason nature photographs are less suitable for looking at over a longer period of time, for instance regularly over a number of years. Paintings, or their reproductions, in which the artist has expressed something of this aliveness deserve preference. It is also possible to express the aliveness of nature with the help of a seasonal nature table (see 8.2).

7.4 Identity, Images and Symbols

The identity and sense of connectedness of a group can be reinforced if the group has its own name, symbolism and stories related to this.

 (picture)

 Virgil

A group has been established for children who are being assessed on whether they can be housed in an alternative form of housing, the so-called ‘family-type unit’. The group is being called ‘Virgil’.  Virgil is a gnome from a book by Paul Biegel. It is about an enterprising gnome that goes into the world to find out all kinds of things. A support worker paints a picture of this gnome on the wall of the common room. At the festive launch of the group, Virgil’s story is told as an illustration of the aims of the group.

 Treatment rooms and therapy rooms should emanate a certain sense of professionalism. Nevertheless it is, also here, so that if something unique is brought into the room it will have a positive effect. If a therapist places a beautiful stone or an inspiring object in their room, it will become a pleasant eye-catcher.  With such a personal choice the therapist shows something of themself. It will also be an invitation to visitors that they are allowed to be themself.

8.    Nature

 In this chapter we will describe the relationship between the human being and nature, the effect of plants, the seasonal table and garden design.

 8.1  Contact with Nature

 Many people consider nature to be a place of healing.  Mountains, forests, sea and beaches are places that call to mind physical wellbeing and feelings of joy, relaxation and wholeness. In reality contact with nature means contact with certain aspects of oneself.  We carry within us certain laws from the world of minerals, plants and animals. [xxxii]

People who have lost their balance can gain more equilibrium through contact with nature. The earth element, for instance, helps one to come to peace and to find a better anchor within one’s body. Each of the elements- earth, water, air or fire- has its own effect. (See page ??).

Contact with nature enhances the awareness that we are part of a greater whole and that experiencing natural rhythms promotes health and vitality. Contact with animals can also have a positive influence. Animals can offer distraction and consolation at difficult moments and contact with them can improve confidence and communication. Care farms offer a variety of such elements and represent the ultimate healing environment to many people.

8.2  Plants and the Seasonal Table

 Plants and flowers in a room add something to the atmosphere and its quality. Plants have a positive effect on mood and concentration.  Good care of the plants is an important condition here. If they are not being cared for properly they will have the opposite effect. Artificial flowers and plants are not recommended from the point of view of truthfulness. (See also 4.3)

The seasonal table is an aid for those in need of special care to connect with nature. It is a fixed point in the living area, where images and colours from nature can be introduced. The seasonal table helps one to experience the rhythm of the year and of the annual festivals. Whatever can be found during a particular part of the year can have a place on this table: objects from nature, such as beautiful stones, branches and flowers which have been found together with the clients. Also reproductions, a page in a picture book and figurines like gnomes, animals or Mother Earth can be put here.[xxxiii]

A special place

In a group of 4 to 12 year old children with mild or moderate learning disabilities who are in for observation there is a lot of challenging behaviour. In the common room there are few stimuli.  On entering you immediately notice the seasonal table. It is in the corner of the room on a small low table enabling every child to be able to easily see what is on it. When there is snow, King Winter with his long beard takes centre stage on the table; in spring it is a Mother Earth figure.  New support workers are interested to see that the children’s aggression is never directed to the nature table. The team leader says: ‘From the start, the team has made it very obvious that the nature table is a sacred place. We ourselves are very careful with it. The seasonal table is special and you simply do not touch it. New children will pick this up as a matter of course.

A seasonal table is not only suitable for children. An age-appropriate seasonal table can also contribute to an experience of connectedness and cohesion for young people and adult clients.

 8.3  Gardens

 A view of the green outside and the presence of gardens will promote the wellbeing of clients as well as that of their support workers.  

 A support worker:

“In the morning, when I walk onto the village square with its two old beech trees I often think: These old trees have seen it all! They give me a feeling of peace and trust and tell me that all things are relative, which helps me in my work.”

The garden should invite children and young people to move and to play. For young people and adults the element of meeting each other plays a role as well. Apart from this, the various sensory experiences can also have a harmonizing effect: the sensation of the sun on one’s skin, the softness of the grass, the different scents and the sound of the birds. It is good to keep these things in mind when designing the garden, for instance, by choosing trees that attract a lot of birds or by planting flowers and bushes which remain interesting in form, colour and scent over various seasons.

 Work-coordinator ‘Green’ (adult care services)

‘Over the last couple of years the problems of the participants in our workshop have increased. There is more challenging behaviour. In spite of this we decided to continue the garden work. To make this possible we made the upkeep of parts of the garden easier.  We now have fewer flower beds and more shrubs.  When doing this we made sure that the various shrubs would provide different experiences throughout the year.  We are also keeping an eye on the ecological balance on the estate and will more often choose indigenous trees that do well here.  We work with beds of box trees in a number of places. These offer structure to people with attention deficit problems.  The mandate is clear: stay within such a bed and only stop weeding when everything is done. Such a thing gives something to hold on to.’

Some target groups demand a good overview of the garden and clear physical boundaries. It is better to avoid potentially dangerous plants, like plants with prickles or poisonous berries. There have been positive experiences with garden plots for individual clients of all ages. For people in wheelchairs it is helpful to use beds in raised frames so as to enable them to experience and care for the plants close up.

In many places young people and adults work in the garden as part of learning and work-projects. This gives an element of commitment both to the clients as well as to the support workers.  Seeing how a resident makes an effort to hoe the garden, rake up the leaves or pull weeds will naturally bring about more attention for the garden.

9.    Motivation and Inspiration

In this booklet you can find points of view which may be help you make choices when designing your environment. As was pointed out in the introduction, the creation of a healing environment may be seen as an ideal. In this chapter we will describe a ritual that can be supportive to a group of people who together wish to connect with an ideal.

9.1  The Foundation Stone Laying Ritual

Rituals make it possible for people to feel connected with each other. They offer something to hold on to so the deeper intentions and ideals connected with the daily work can be more easily kept in one’s awareness.

The so-called ritual of ‘laying the foundation stone’ is a specific ritual belonging to the inauguration of a new building.  It takes place when the foundations for a building have almost been completed.

A foundation stone is linked with the intention of future residents for a building. Connecting with others with an intention can have a positive effect.  In this way a spiritual foundation is added to the physical foundation of a building.

(picture)

Laying the foundation stone of a community hall

When the foundations have almost been completed everyone involved gathers at the building site.  Those in need of care, support staff, architect and builders, everyone is there. During a short ceremony the common intentions are read out in the form of a verse or another kind of text. Then a beautiful document with the text is rolled up and put into a copper container. This container is then sealed and cemented into the foundations.

Sometimes the foundation stone is not laid inside a building but in the grounds of an institution. This was the case in OlmenEs (see photograph).  From an anthroposophical point of view a foundation stone ritual does not only forge a link among the people who are present. By means of the ritual you can also make the intentions of the group known to other helping forces and spiritual beings such as angels, but also nature beings that are connected with the place. [xxxiv]

In the example, a copper stand was chosen. Copper is an excellent conductor of warmth. Warmth, - both warmth of heart as well as energy for deeds-,  is needed if we want our intentions to become reality.

 Notes

The quotation used in the vision statement was paraphrased from words by Rudolf Steiner in ‘Education for Special Needs, the Curative Course’ (1997), pp.179.

[i] Baars, E. et al (2005) p 138-141

[ii] A constitution that is ‘outflowing’ or is ‘too open’. This designation refers to the anthroposophical constitution types which are complementary to mainstream diagnostics. See: Niemeijer, M.H et al (2004), pp 73-90. Also: Post Uiterweer, G. 2012. In this book indications have been given for creating a healing environment for each of the constitution types.

[iii] ‘A constitution that is too slow or too heavy’. See note ii.

[iv] In external therapies the client’s own forces for recovery are supported and enhanced with the help of swaddling, compresses or baths.

[v] In artistic therapy one works in a healing way via applied art, in this case painting, drawing and modelling.

[vi] Recent research into types of care environment has affirmed this. See: Prevosth, J & Voordt, T. van der (2011). This book also gives an overview of scientific research into wellbeing in relation to the area of healing environment.

[vii] Already in pre-Christian times it was known that every place has its own energy.  Some places were considered to be holy.  At these holy places one would build temples, for instance, and in later periods, churches.  Certain places could also be out of balance energy-wise. A description of how it is possible to do something about this may be found at www.ecointention.com.

[viii] For this chapter we made of use of Ree, P, van der. (2003) and Lievegoed, B.J. (1994)

[ix] See also the interview with the architect M.van Huut about the Isala clinics in Zwolle, Holland: www.isala/ove-isala/architectuur

[x] This project received a nomination in the framework of the Hedy d’Ancona- award for excellent architecture in the care sector. See www.hedyanconaprijs.nl.

[xi] Gils, J. van. (2015)

[xii] In relation to this, see: Ree, P.van der. (2003), pp220-224 and Lievegoed, B.C.J. (1994). pp19-24

[xiii] Lievegoed, B.C.J. 1994), pp 23-24

[xiv] Steiner, R. (2003). The ether body is that which keeps a human being, an animal or plant alive. It cannot be perceived via the usual senses. It is, however, possible to observe its effects, in this case by the decrease in vitality.

[xv] About imitation and empathic observation see: Baars, E. et al (2005) pp128-130

[xvi] Baars, E. et al., p93.

[xvii] Goebel, W. & Gloeckler, M. (2003)

[xviii] Baars, E. e.a. (2005) p92.

[xix] Zorg en bouw voor sterk gedragsgestoorde ernstig verstandelijk gehandicapten (2006), p 22

[xx] Birger Sellin is a young man with severe autism, unable to speak. With the aid of facilitated communication, however, he is able to type on a computer. Sellin, B. (1995)

[xxi] Sjoukes, L. (2008), p 69

[xxii] Licht (see notes re healing environment). (2004)

[xxiii] We are here talking about full-spectrum lamps. These are most like daylight because they have such a broad radiating spectrum.

[xxiv] Nauta, W. (2006), pp15-16

[xxv] I. Bakker and J. de Boon have developed a tool for assessing spaces. It is based on the anthroposophical ideas about the senses.  This tool comprises the entire range of observations you can make in relation to an area. See: Bakker, I. & Boon, J. de. (2012). Pp 95-113.

[xxvi] For this chapter we consulted a number of art therapists. We also made use of the book by Colot d’Herbois. L. (2005)

[xxvii] Healing Environment.  Annual Report. The Five Senses.

[xxviii] For a description of this group of children who are sensitive to spirituality see: Baars, E. et al (2005), p26.

[xxix] According to Rudolf Steiner the work by the painter Raphael (et al) has a therapeutic effect. See also: Dullaart, l. (2005)

[xxx] The data in this paragraph, except for the sentence in the box below it, has been taken from the chapter by Roger S. Ulrich ‘The importance of the right art form’, in Frampton, S.B. &Charmel, P.A. (ed) (2008) Putting Patients First: Best Practices in Patient-Centered Care

[xxxi] Frampton, S.B. & Charmel, P.A. (ed) (2008) Putting Patients First: Best Practices in Patient-Centered Care

[xxxii] For an explanation of this aspect of the anthroposophical image of the human being see: Baars, E. et al (2005), pp 198-203

[xxxiii] Leeuwen-Zier, M.van & Moeskop-Groenewoud, J. (1990), p 7. See also http://seizoentafel.startpagina.nl.

[xxxiv] Stolp, H. (2015)

Bibliography

Baars, E., Blomaard, P., Bijloo, M., Heldt, B.,Koning, W. de, & Niemeijer, M.(2005). Goede zorg. Ethische en methodische aspecten. Zeist: Christofoor 

Bakker, I., & Boon, J. de. (2012). Zorg voor mens en omgeving. Het zintuig als maatstaf. [Utrecht]: Aedes-Actiz Kenniscentrum Wonen-Zorg.

Collot d’Herbois, L. (2005). Light, Darkness and colour in painting therapy. Edinburgh: Floris Books

Dullaart, L. (2005). De Madonnas van Raffael. Assen

Frampton, S.B., & Charmel, P.A.(ed) (2008) Putting Patients First: Best Practices in Patient-Centered Care 

Gils, J.van (2016). Elektrosmog. Amsterdam: Pentagon. 

Goebel, W & Gloeckler, M. (2014) : A Guide to Childhealth

Healing environment. Annual report. The five senses. (seen on Sept 2nd 2016) at http://webarchive.nationalarchives.gov.uk/20071104145445/http://www.dh.gov.uk/en/Policyand guidance/Organisationpolicy/Healthcareenvironment/Browsable/DH_4116478.

 Leeuwen-Zier, M.van & Moeskop-Groenewoud, J. (1990). De seizoentafel. Zeist: Christofoor

 Nauta, W. (2006). Het wezen van kunstlicht. Dronten: Centrum Social Gezondheidszorg.

 Niemeijer, M.H., Gastkemper, M. & Kamps, F.H.M.(2004). Ontwikkelingsstoornissen bij kinderen. Medisch –pedagogische begeleiding en behandeling. Assen: van Gorcum.

Post Uiterweer, G. Je kunt er ook anders naar kijken. Gedragsproblemen bij kinderen en volwassenen. Inzicht, begrip, treatment. Zeist: Christofoor (You could look at it differently- in process of being translated into English, tr.)

Prevoscht, J., Voordt, T.van der. (2011). Sturen op een gastvrij Albert Schweitzerziekenhuis. Invloed van de gebouwde omgeving. Delft: Technische Universiteit, Faculteit Bouwkunde.

 Ree, P. van der. (2003). Organische architectuur. Zeist: Vrij Geestesleven.

 Sellin, B. 1995 ‘I don’t want to be inside me anymore. Messages from an autistic mind’.

 Sjoukes, L. (2008). The impact of visual impairment on adults with an intellectual disability.  Rotterdam: Erasmus University

 Steiner, R. 1998 Education for Special Needs. The Curative Education Course. London: Rudolf Steiner Press

 Steiner, R. (2003) Gezondheid, ziekte, genezing. Zeist: Vrij Geestesleven

 Stolp, H. (2015) Natuurwezens. Assen: Nearchus

 Zorg en bouw voor sterk gedragsgestoorde ernstige verstandelijke gehandicapten. (2006). Report 604. Utrecht: College bouw-zorginstellingen.

Websites 

www.antrovista.com

http://seizoentafel.startpagina.nl

www.zorgtuiderij-oosterheem.nl

www.isala.nl/over-isala/architectuur

www.hedydanconaprijs.nl

www.ecointention.com

With gratitude to those who helped fund this edition of ‘Healing Environment), without whom this publication would not have been possible.

With thanks to the Raphaelstichting, Stichting  DeSeizoenen, OlmenEs en studio De Vier Jaargetijden for making available the photographs.

Text: Annemieke Kort

Editorial: Nard Besseling

Translation: Edeline LeFevre

Nothing from this booklet may be copied without permission from NVAZ (publishers of the original Dutch edition)

This booklet (in Dutch), as well as the second one in the series, can be ordered from NVAZ Postbox  839 3700 AV Zeist

Tel 0031 85 77331833 or info@nvaz.nl

 [1] Baars, E. et al (2005) p 138-141

[1] A constitution that is ‘outflowing’ or is ‘too open’. This designation refers to the anthroposophical constitution types which are complementary to mainstream diagnostics. See: Niemeijer, M.H et al (2004), pp 73-90. Also: Post Uiterweer, G. 2012. In this book indications have been given for creating a healing environment for each of the constitution types.

[1] ‘A constitution that is too slow or too heavy’. See note ii.

[1] In external therapies the client’s own forces for recovery are supported and enhanced with the help of swaddling, compresses or baths.

[1] In artistic therapy one works in a healing way via applied art, in this case painting, drawing and modelling.

[1] Recent research into types of care environment has affirmed this. See: Prevosth, J & Voordt, T. van der (2011). This book also gives an overview of scientific research into wellbeing in relation to the area of healing environment.

[1] Already in pre-Christian times it was known that every place has its own energy.  Some places were considered to be holy.  At these holy places one would build temples, for instance, and in later periods, churches.  Certain places could also be out of balance energy-wise. A description of how it is possible to do something about this may be found at www.ecointention.com.

[1] For this chapter we made of use of Ree, P, van der. (2003) and Lievegoed, B.J. (1994)

[1] See also the interview with the architect M.van Huut about the Isala clinics in Zwolle, Holland: www.isala/ove-isala/architectuur

[1] This project received a nomination in the framework of the Hedy d’Ancona- award for excellent architecture in the care sector. See www.hedyanconaprijs.nl.

[1] Gils, J. van. (2015)

[1] In relation to this, see: Ree, P.van der. (2003), pp220-224 and Lievegoed, B.C.J. (1994). pp19-24

[1] Lievegoed, B.C.J. 1994), pp 23-24

[1] Steiner, R. (2003). The ether body is that which keeps a human being, an animal or plant alive. It cannot be perceived via the usual senses. It is, however, possible to observe its effects, in this case by the decrease in vitality.

[1] About imitation and empathic observation see: Baars, E. et al (2005) pp128-130

[1] Baars, E. et al., p93.

[1] Goebel, W. & Gloeckler, M. (2003)

[1] Baars, E. e.a. (2005) p92.

[1] Zorg en bouw voor sterk gedragsgestoorde ernstig verstandelijk gehandicapten (2006), p 22

[1] Birger Sellin is a young man with severe autism, unable to speak. With the aid of facilitated communication, however, he is able to type on a computer. Sellin, B. (1995)

[1] Sjoukes, L. (2008), p 69

[1] Licht (see notes re healing environment). (2004)

[1] We are here talking about full-spectrum lamps. These are most like daylight because they have such a broad radiating spectrum.

[1] Nauta, W. (2006), pp15-16

[1] I. Bakker and J. de Boon have developed a tool for assessing spaces. It is based on the anthroposophical ideas about the senses.  This tool comprises the entire range of observations you can make in relation to an area. See: Bakker, I. & Boon, J. de. (2012). Pp 95-113.

[1] For this chapter we consulted a number of art therapists. We also made use of the book by Colot d’Herbois. L. (2005)

[1] Healing Environment.  Annual Report. The Five Senses.

[1] For a description of this group of children who are sensitive to spirituality see: Baars, E. et al (2005), p26.

[1] According to Rudolf Steiner the work by the painter Raphael (et al) has a therapeutic effect. See also: Dullaart, l. (2005)

[1] The data in this paragraph, except for the sentence in the box below it, has been taken from the chapter by Roger S. Ulrich ‘The importance of the right art form’, in Frampton, S.B. &Charmel, P.A. (ed) (2008) Putting Patients First: Best Practices in Patient-Centered Care

[1] Frampton, S.B. & Charmel, P.A. (ed) (2008) Putting Patients First: Best Practices in Patient-Centered Care

[1] For an explanation of this aspect of the anthroposophical image of the human being see: Baars, E. et al (2005), pp 198-203

[1] Leeuwen-Zier, M.van & Moeskop-Groenewoud, J. (1990), p 7. See also http://seizoentafel.startpagina.nl.

[1] Stolp, H. (2015)

Bibliography

Baars, E., Blomaard, P., Bijloo, M., Heldt, B.,Koning, W. de, & Niemeijer, M.(2005). Goede zorg. Ethische en methodische aspecten. Zeist: Christofoor

Bakker, I., & Boon, J. de. (2012). Zorg voor mens en omgeving. Het zintuig als maatstaf. [Utrecht]: Aedes-Actiz Kenniscentrum Wonen-Zorg 

Collot d’Herbois, L. (2005). Light, Darkness and colour in painting therapy. Edinburgh: Floris Books

Dullaart, L. (2005). De Madonnas van Raffael. Assen

Frampton, S.B., & Charmel, P.A.(ed) (2008) Putting Patients First: Best Practices in Patient-Centered Care

Gils, J.van (2016). Elektrosmog. Amsterdam: Pentagon.

Goebel, W & Gloeckler, M. (2014) : A Guide to Childhealth

Healing environment. Annual report. The five senses. (seen on Sept 2nd 2016) at http://webarchive.nationalarchives.gov.uk/20071104145445/http://www.dh.gov.uk/en/Policyand guidance/Organisationpolicy/Healthcareenvironment/Browsable/DH_4116478.

Leeuwen-Zier, M.van & Moeskop-Groenewoud, J. (1990). De seizoentafel. Zeist: Christofoor

Nauta, W. (2006). Het wezen van kunstlicht. Dronten: Centrum Social Gezondheidszorg.

Niemeijer, M.H., Gastkemper, M. & Kamps, F.H.M.(2004). Ontwikkelingsstoornissen bij kinderen. Medisch –pedagogische begeleiding en behandeling. Assen: van Gorcum.

Post Uiterweer, G. Je kunt er ook anders naar kijken. Gedragsproblemen bij kinderen en volwassenen. Inzicht, begrip, treatment. Zeist: Christofoor (You could look at it differently- in process of being translated into English, tr.)

Prevoscht, J., Voordt, T.van der. (2011). Sturen op een gastvrij Albert Schweitzerziekenhuis. Invloed van de gebouwde omgeving. Delft: Technische Universiteit, Faculteit Bouwkunde.

Ree, P. van der. (2003). Organische architectuur. Zeist: Vrij Geestesleven.

Sellin, B. 1995 ‘I don’t want to be inside me anymore. Messages from an autistic mind’.

Sjoukes, L. (2008). The impact of visual impairment on adults with an intellectual disability.  Rotterdam: Erasmus University

Steiner, R. 1998 Education for Special Needs. The Curative Education Course. London: Rudolf Steiner Press

Steiner, R. (2003) Gezondheid, ziekte, genezing. Zeist: Vrij Geestesleven

Stolp, H. (2015) Natuurwezens. Assen: Nearchus

Zorg en bouw voor sterk gedragsgestoorde ernstige verstandelijke gehandicapten. (2006). Report 604. Utrecht: College bouw-zorginstellingen.

Websites

www.antrovista.com

http://seizoentafel.startpagina.nl

www.zorgtuiderij-oosterheem.nl

www.isala.nl/over-isala/architectuur

www.hedydanconaprijs.nl

www.ecointention.com

With gratitude to those who helped fund this edition of ‘Healing Environment), without whom this publication would not have been possible.

With thanks to the Raphaelstichting, Stichting  DeSeizoenen, OlmenEs en studio De Vier Jaargetijden for making available the photographs.

Text: Annemieke Kort

Editorial: Nard Besseling

Translation: Edeline LeFevre

Nothing from this booklet may be copied without permission from NVAZ (publishers of the original Dutch edition)

This booklet (in Dutch), as well as the second one in the series, can be ordered from NVAZ Postbox  839 3700 AV Zeist

Tel 0031 85 77331833 or info@nvaz.nl

HOW TO MAKE LIFE FLOW

Health and Wellbeing in People with Developmental Difficulties - Healing Climate part 2

By Annemieke Korte

RHYTHM CARRIES LIFE

(Rudolf Steiner, from a conversation with Rudolf Hauschka)

Foreword

This little book is the second in a series about giving shape to daily life. The first part, ‘Healing Environment’, is about designing the surroundings and choosing relevant colours, forms, and materials. This second part is about the care of physical health and shaping the home atmosphere, in the way it is experienced within the environment of the home but also in school, in daycare or at work. An important aspect of this is how to deal with time as an essential part of life.

The health and wellbeing of the people living in the home can be promoted through paying proper attention to its atmosphere. The positive effect of the environment on people’s health and wellbeing has meanwhile become generally known within society by the term ‘healing environment’. Interest in the relationship between lifestyle and health is also on the increase. Growing attention is being paid to the factors that promote vitality or also to those that have a negative impact on it. This booklet connects with these things. In relation to this, we can still find certain wisdom in the old threefold concept of ‘peace, cleanliness and regularity’. Yet, as is being explained in this little book, organizing peace, cleanliness and regularity is not straightforward. One has to live with these concepts within each situation. It is important to learn to perceive how things really are and how they work.

The practical examples given in this publication clarify this. It is, however, not possible to simply apply these examples in just any situation, because people and situations vary so much. Yet they can help to intensify one’s observation. This is supported by the observation exercises that are given. The exercises as well as the recommendations in this little book point to a way to make conscious and foster certain values which can then be translated into one’s own circumstances.

The ‘Healing Climate’ series has a unique way of bringing order into a plethora of knowledge that has been developed within anthroposophical care over the years. Many caregivers and support workers have some idea of the themes that are important without being able to explain what they are all about and how to deal with them. For this reason it is helpful to present these important issues in a clear and accessible way. This was done in this booklet.

In this way also the second part in this series contributes to a clear overview of ideas for the vision of care and offers practical indications. It sharpens one’s attention and offers suggestions about how to approach things. With this an accessible introduction has come about which, at the same time, offers practical advice.

Dr Pim Blomaard, Council Member of the Raphael Stichting

HOW TO MAKE LIFE FLOW

Health and Wellbeing in People with Developmental Difficulties

 Healing Climate part 2, By Annemieke Ko

RHYTHM CARRIES LIFE

 (Rudolf Steiner, from a conversation with Rudolf Hauschka)

Foreword

This little book is the second in a series about giving shape to daily life. The first part,

‘Healing Environment’, is about designing the surroundings and choosing relevant colours, forms, and materials. This second part is about the care of physical health and shaping the home atmosphere, in the way it is experienced within the environment of the home but also in school, in daycare or at work. An important aspect of this is how to deal with time as an essential part of life.

The health and wellbeing of the people living in the home can be promoted through paying proper attention to its atmosphere. The positive effect of the environment on people’s health and wellbeing has meanwhile become generally known within society by the term ‘healing environment’. Interest in the relationship between lifestyle and health is also on the increase.  Growing attention is being paid to the factors that promote vitality or also to those that have a negative impact on it. This booklet connects with these things.

In relation to this, we can still find certain wisdom in the old threefold concept of ‘peace, cleanliness and regularity’. Yet, as is being explained in this little book, organizing peace, cleanliness and regularity is not straightforward. One has to live with these concepts within each situation. It is important to learn to perceive how things really are and how they work. The practical examples given in this publication clarify this. It is, however, not possible to simply apply these examples in just any situation, because people and situations vary so much. Yet they can help to intensify one’s observation. This is supported by the observation exercises that are given. The exercises as well as the recommendations in this little book point to a way to make conscious and foster certain values which can then be translated into one’s own circumstances.

The ‘Healing Climate’ series has a unique way of bringing order into a plethora of knowledge that has been developed within anthroposophical care over the years. Many caregivers and support workers have some idea of the themes that are important without being able to explain what they are all about and how to deal with them. For this reason it is helpful to present these important issues in a clear and accessible way. This was done in this booklet. In this way also the second part in this series contributes to a clear overview of ideas for the vision of care and offers practical indications. It sharpens one’s attention and offers suggestions about how to approach things. With this an accessible introduction has come about which, at the same time, offers practical advice.

Dr Pim Blomaard, Council Member of the Raphael Stichting

Table of Contents

Foreword

Table of Contents Introduction

1.     Creating Flow: basic principles

1.1.         A view of health

1.2.         Promoting physical wellbeing

1.3.         Promoting balance

 2.     Rhythm

2.1.         What is rhythm

2.2.         The power of rhythm

2.3.         Offering structure

2.4.         Allowing life to sing

 3.     Rhythm in the day

3.1.         Getting out of bed on the right side

3.2.         Rhythmical variation

3.3.         Evening

3.4.         A good night’s sleep

 4.     Weekly, monthly and annual rhythms

4.1.         The weekly rhythm

4.2.         Sunday and Saturday

4.3.         The days of the week

4.4.         The monthly rhythm

4.5.         The seasons and the annual rhythm

 Breathing space

 5.     Mealtimes

5.1.         Mealtimes and refreshment breaks

5.2.         How to conduct mealtimes

5.3.         Nutritional qualities

5.4.         Eating disorder

6.     Daily Care

6.1.         Care practice

6.2.         Observation and empathy

6.3.         External support

 7.     Warmth, clothing and caring for the sick

7.1.         Caring for the warmth organism

7.2.         Clothing

7.3.         Caring for the sick

 8.     Domestic Work

8.1.         A different approach to domestic work

8.2.         Social aspects

8.3.         Improving balance

 9.     Inner conditions

9.1.         Aspects of attitude

9.2.         Inner schooling

 A word of thanks

Notes

Literature

Introduction

Every river finds its own pathway. As soon as the stream hits an obstacle it will attempt to flow around it. If the river bed is shallow or too narrow, the river will burst its banks. If there is too little flow the river will eventually run dry. Yet if the riverbed is right the water is able to flow freely.

With this image I would like to express the theme of this booklet. A good riverbed allows water to flow freely. By its nature water tends to meander. The flow and mobility of water forms an image for life and how it evolves.

People who have developmental difficulties are central in this little book. They form a broad target group with very diverse problems, ages and levels of development, yet with clear similarities as to their experience of physical wellbeing. Many people in this target group have difficulties to feel at one with and at home in their physical body. Many will experience pain or discomfort due to a physical restriction. Hunger, pain or fatigue will not always be perceived in the right way. Sometimes they will notice these physical signals but will not be able to communicate or do something about them. Many of these people also have difficulties orientating in time and adjusting to everyday life. This can cause restlessness and a basic lack of wellbeing. Not feeling well and being unable to express this properly may show in disturbing behaviour, such as aggression or self-harm. Rhythm and the promotion of physical wellbeing can help diminish or prevent this type of behaviour.

By making sure that people who have developmental difficulties feel well within their body you are creating something like a ‘riverbed’ for them. A sense of physical wellbeing usually has an immediate effect on one’s mood and possibility to function. In anthroposophy this is called ‘caring for the life-processes’. This can result from proper physical care and bringing rhythm into one’s life. Rhythm allows us to flow along with everyday life. This creates stability and room for development. What has been described in this booklet also has a formative influence on the entire organism of a young child.

As I was writing this booklet, I realized all the more strongly that care in many of the places is under great pressure. Very often it is not possible to do anything extra. Nevertheless, I am convinced that the core of what I have attempted to describe will always remain valid. The essence lies in very basic things which are easily forgotten in hectic daily life. What has been described here, however, always needs to be shaped in new ways, depending on the specific situation and time.

I hope that this little book will invite people to look at the daily care practice with new eyes, and that it may be helpful in making choices. I also hope that the contents will contribute to bringing clarity into the vision statement of the various teams. In my experience a clear vision statement in a team or department has a positive effect. Such a statement makes something visible which will make it easier to attract the people and the helpful sources that are needed to put one’s aims into practice.

Annemieke Korte November 2015

1.       Creating Flow: Basic Principles

 In this chapter we will shine a light on our view of health and have a closer look at the conditions for creating ‘flow’.

1.1.     A View of Health

From an anthroposophical perspective the human being is not only physical, psychological and social, but also spiritual: an individuality -a self- with an individual life’s task i . During life the individuality and the soul (psyche) are connected with the body in an individual way. We call the way they are linked and work together ‘constitution’.

Health is here not considered to be the absence of illness, but the ability to adjust and, as much as possible, take control of the challenges with which we are presented in life. This could be physical challenges, such as illness, but also psychological or social ones. Health is therefore related to buoyancy and the capacity to always find a new balance ii. We call whatever contributes to finding this balance ‘healing’.

People with intellectual difficulties often need extra support in finding or retaining their equilibrium, while being allowed, as much as possible, to remain in charge. The emphasis of this booklet is on physical support, although it is not possible to separate this from support in the other areas.

1.2.     Promoting physical wellbeing

As a condition for the promotion of physical wellbeing, support workers should pay attention to the physical state of the people they support. They should notice signs linked with this and be able to understand through empathy what these signs might mean for a person. In this booklet I have described the kind of help support workers could give in relation to this to people in their care. I also focus on things that those in care could do for themselves, not only as to physical care, but also nutrition and clothing. Small details can often make a great difference. In addition, the anthroposophical physician can prescribe medication or a particular therapeutic treatment.

Here is an example of an external therapy comprising ‘Einreibungen’[(literally ‘rubbings’

(tr.)] with an etheric oil iii.

External therapy

Peter, (8 years old, with a moderate learning disability) is a frail, hyperactive boy with Foetal Alcohol Syndrome and an attachment disorder. He has recently been admitted after having lived in a foster family. Peter looks pale, has problems falling asleep and tends to wake up early in the morning. He gobbles down his food without tasting it. Peter makes a good-natured impression but can also be aggressive. In his multidisciplinary review it is decided to let the anthroposophical nurse have three diagnostic sessions with him.

In the sessions Peter reacts well to rhythmical ‘Einreibungen’ with malvae oil, leading to the decision that he should have full-body ‘Einreibungen’ twice a week for six weeks. ‘Swaddling’ is also included, as well as a period of rest afterwards. The malvae oil has a vitalizing effect. In the course of the sessions Peter undergoes the ‘Einreibungen’ with ever more ease and loves the story read to him by the therapist while he is having a rest.

In the group Peter now falls asleep more quickly in the evening. As he is more rested during the day, he now has fewer conflicts. The therapy is repeated in the spring. A year later, during a difficult period, Peter himself asked for the therapy.

This example sheds some light on the connection between physical state and behaviour. We also see that Peter himself is finding out what is good for him. He himself asks for the therapy to be repeated when things are not going well for him. In anthroposophic terms this is linked to ‘the strengthening of the sense of life’. This means that by experiencing what brings health, the body itself is increasingly more able to recognize this iv. In external therapies one also works with swaddling, compresses and baths in addition to the

‘Einreibungen’. The anthroposophic physiotherapist does movement therapy as well as rhythmical massage. In Eurythmy therapy one works via movement on improving physical health, among other thingsv.

The anthroposophical physician can also refer people to mainstream therapists. In order to be able to make an informed choice, both the physician and the therapists depend on the questions and observations of the support workers.

How can physical health and wellbeing be promoted?

·       Try and observe closely the signs in relation to the physical constitution of those being cared for, while tuning into this as well as possible in your care activities.

·       It is also possible to use specific measures such as those relating to external support, nutrition and clothing.

·       Also consider the use of (anthroposophical) medication and /or therapy

1.3.     Promoting balance

People who are not feeling well are often extra sensitive to the atmosphere around them. A harmonious atmosphere will promote physical and psychological wellbeing. The first part of this series (‘Healing Environment’) described how to create a harmonious atmosphere by means of interior design. Now we are talking about the role of the support worker and about the way groups are constituted. If the different diagnoses, age groups and mental levels of those in need of care complement each other, the atmosphere in the group may be significantly improved. (See Amir’s case study below).

Amir

In a paper processing workshop for people with mild to moderate learning difficulties it is extraordinarily busy. Participants are working on various projects and it is not an easy job to support these appropriately. Two participants are demanding extra attention because of their restlessness and compulsive behavior. The restless atmosphere improves considerably as soon as a young person with severe complex needs joins the workshop for a couple of hours a day. A support worker and two workshop participants collect him from his home group every working day after coffee. He will sit in the workshop and his eyes follow what is going on there. He enjoys the fact that there is always one or the other

person who makes contact with him. Amir is the focus of everyone’s attention in the group. His presence is bringing about more peace for the participants. Their confidence is growing because there is a person here whom they can care for.

Apart from a harmonious atmosphere, support can also be offered in the form of rhythm. Rhythm promotes physical and psychological balance and offers people who have problems with orientating a clear view and some stability. We are here talking about rhythm in the course of the day, the week and the year, but also about a rhythmical way in varying activities with a good balance between rest and movement and between effort and relaxation. A healthy rhythm will give those with special needs a better basis to develop a sense for what is good and manageable for them. This will support the development of their sense of life. A person with a well-developed sense of life is better able to keep control of their own life and health. One could also work with rhythmical variations in one’s approach, thus supporting the psychological equilibrium of those in care.

What is needed for a healing home atmosphere?

·      A harmonious atmosphere

·      A rhythmical course of the day, the week and the year.

·      A rhythmical variety in activities and approach

In the next chapters we will go more deeply into the phenomenon of rhythm. We will describe the effect of rhythm and the difference between rhythm and structure. Aspects of rhythm will also be found in the chapters that have a more thematic character. The role of ritual will only be discussed marginally in this booklet. How to work with and give shape to rituals will be the subject of part three. The theme of sport will also be discussed in part three as it will address leisure time.

2.       Rhythm 

2.1.     What is rhythm

Rhythm can be described as the repetition of a given event that never happens exactly in the same way. Think of breathing: every breath is similar to the previous one yet is also always a little bit different. There is an average composed out of subtle variations. Our breathing adapts to the degree in which we feel tense or relaxed and thus it fulfils a mediating role.

Our physiology is completely permeated by such rhythmical laws forming a reflection of greater, cosmic rhythms. The rhythms according to which the planets in our solar system move are not only found within our physical body, but in all life on earthvi.

In the past centuries the human being has become ever less dependent on natural rhythms. The invention of artificial light, for instance, has made us less dependent on daylight. Artificial light allows us to do things at any time of the day. We have also become more mobile and can be reached anywhere. Although these achievements have led to great freedom, they have also caused more irritability and the undermining of our healthvii

A living atmosphere which has been rhythmically designed can offer a lot of support to people who are physically or psychologically vulnerable. This requires from support workers a sense for processes in time, as well as a certain amount of inner harmony. Is your own pace as support worker too fast or too slow, for instance? Are you able to anticipate transitions and are you managing to attune processes to each other?

2.2.     The power of rhythm

One could say, therefore, that rhythm is a dynamic principle inextricably bound up with life. We meet rhythm everywhere in nature: in the waxing and waning moon, in ebb-and flow tides and in the annual rings of treesviii. There is a relationship between rhythm, physiology and behaviour. We usually only become aware of the effect of rhythm once it has been disturbed. Think of the transition from summertime to wintertime due to daylight saving or jetlag. If our rhythm has been disturbed, we become more vulnerable. Feelings of disorientation or tiredness occur.  Science has increasingly acknowledged the importance of rhythm.ix Recent research has shown that there is an increase in the number of heart attacks in the first days of ‘summer time’x.

Apart from having a carrying quality, rhythm can also replace strength. Whatever is being done rhythmically will eventually need less energy. On the basis of rhythm our organism is better able to be prepared for what is being asked of us. Activities that are done regularly and rhythmically will also lead to the forming of habits. This is important for people with

learning difficulties. You can ‘inhabit’ your habits. Habits can offer a form of stability if you suffer from a surplus of stimuli, are chaotic or unable to have an overview of things.

Daily, weekly and annual rhythm

Children who have severe behavioural problems are admitted into a crisis group (Learning Disabilities/Mental Health). This group is in a house with two other groups for long-term residential care. There is a clear rhythm in day, week and year and there are fixed rituals around meals and transitions during the day. Parents are sometimes amazed that their child’s behaviour in the group is so different from when they are at home. Problems with eating, sleeping and transitions during the day sometimes diminish within a short time. The child calms down and begins to look well.

Bringing about a rhythmical order is strenuous, but once it has come about it will begin to have a carrying effect. Then you will have created the right conditions for daily life to become more flowing.

2.3.        Offering structure

When working with this target group you often hear about the importance of providing structure. Structure in the shape of clear agreements and a fixed daily programme gives stability to those in need of support. The ability to offer structure to those they support demands from support workers a certain strength of character. As a support worker you should be able to be strong and convinced about the way something needs to happen and stick to this consistently. This is necessary for people who are severely unstable or display a lot of challenging behaviour. Structure is also needed in situations where people are out of control or chaotic. Too rigid a structure, however, will eventually have a negative effect on the mood and vitality of those being supported. This in itself may then escalate into a new form of problematic behaviour. The element of rhythm can prevent rigidity. A way to counteract rigidity could be, for instance, by interrupting a fixed habit in a rhythmical way. An example of a fixed habit may be that we eat with knife and fork, ‘apart from on Saturdays, when we have bread-rolls’. The rhythmical element is especially important for people who have a great need for predictability. If the structure is too fixed, their one- sidedness may be reinforced.

Reading stories

Every day, except on Sundays, from a quarter past seven until about half past seven stories are read to a residential group of children with mild learning difficulties. This was going well, until Ivor (8 years old with ASD) joined the group. Ivor tended to become restless just before half past seven, was no longer able to sit still and would keep looking at the clock.

This changed when it was decided to always only read one chapter. These chapters are shorter one day and longer another day. He is able to go along with this. 

2.4 Allowing life to sing

As was mentioned earlier, rhythm belongs to the life sphere. It is flexible and has a flowing quality. The small inherent changes in a rhythm allow for development. Rhythm is related to the element of water because of its ability to adjust and its flowing quality. Structure is determined by the clock and may be characterized as fixed and not flexible. From this point of view structure is related to the element of earth.

The relationship between rhythm and structure may also be found in music. A piece of music is divided into equal parts by the beat, which can be compared to structure. Rhythm brings cadence and mobile repetition into this. Together they form the basis for the melody.

What significance does this have for the life sphere? Fixed agreements, such as the working day starting at nine o’clock, are needed so as to be able to shape daily life. The ‘ritual’ of the morning gathering, however, has a rhythmical element: in every season there is a different morning song and on birthdays we sing to the person whose birthday it is. If both of the elements, structure and rhythm, work together well life can begin to sing and there will be enough room to adapt the support-plan to what is being asked for at that moment in time.

3.         Rhythm in the Course of the Day

A rhythmical course of the day can come about if we take into account the atmosphere in the morning, the afternoon and evening and if there is also a healthy alternation in activities and approach.

 3.1.        Getting out of bed on the right side

 Many people with special needs have problems waking up, as, for instance, is the case with those with a constitution that is ‘too heavy’xi. They continue to dream in their own world. Their body does not cooperate, leaving them to react crossly and with annoyance to things like getting up, getting washed and getting dressed. They need time to get up and need an incentive, for instance by opening the curtains for them or telling them about something nice that is going to happen.

People who are ‘too light’ and hyperactive, on the other hand, usually wake up early and tend to throw themselves into the day with seemingly renewed energy. Nevertheless they often look pale, which shows that they are not really rested. Speaking to them gently and leaving the curtains closed a little longer can be helpful for them. People with an attachment disorder have a more or lesser disturbed connection to their own body. They will often start the day feeling physically uncomfortable. If you, as support worker, are aware of this, it will be easier to show that you understand them.

For many people a fixed sequence of washing, getting dressed and caring for the room is helpful. You can support this by using photographs, pointers or picture cards.

A good start…..

In a home group for 8–12-year-old children with mild learning difficulties there is a lot of restlessness. In a team meeting the team leader asked each coworker to explain exactly how they start the day up to the time of breakfast. By hearing from each other exactly how they accompany the start of the day, the support workers are consciously or also subconsciously adjusting their style of support somewhat. Some agreements about how to start the day are also reaffirmed. In the following days the effect of the discussion is clearly noticeable. The restlessness decreases, the mood in the group improves and the transitions during the whole day are more peaceful.

‘Waking up’ music can be helpful for getting up. Suitable music will stimulate those who

have problems waking up.

A short piece of recorder or flute music or a little song is the sign that it is time to get up. Waking-up music can also set the tone for a special day such as a Sunday or a festive day. After breakfast there is the transition to school or to work. Around this transition there is often some restlessness and tension. Shaping this transition with a ritual allows it to proceed more smoothly.

3.2.        Rhythmical variation

Rhythmical variation of different activities brings ‘flow’ into the day. Such variation in approach will also have a supportive effect on psychological equilibrium. Below is an overview of the areas to which this principle can be appliedxii.

 Rhythmical variation in activities and approach

·      Physical rhythms:

Rhythm of eating, rhythm of sleeping and waking, alternation between exertion and relaxation, movement and rest. These will influence vitality and physical equilibrium.

·      Psychological rhythms:

Alternation between paying attention and not paying attention, between humour and seriousness, concentration and delving into the surroundings, being inside or outside and between peaceful and busy activities. This will support psychological equilibrium.

·      Rhythms of Self:

Alternation od activites aimed at the individual and at the group, of making one;s own choices or ‘going with the flow’ and of repetition of activities or experiencing new things. This will support personal development.

We will here go more deeply into some examples of a healthy alternation in the course of the day.

Moodiness and restlessness in residents towards the evening indicates that they have not been able to cope well with the day. They receive too many impressions with too little space to digest them. There is too little balance between exertion and relaxation. This may be prevented by introducing a rest-hour after the midday meal. Such a rest-period can differ from person to person; some might like to read a book while lying on the bed, some might like to draw pictures, listen to music or have a nap. For children and young people it is usually necessary to shape the afternoon break with the help of firm agreements. Below is an example of the afternoon break of an adult resident who has a physical disability.

Manuel

Manuel, (35 years old, with complex needs) wears tight orthopedic shoes. After lunch he sits in an easy chair with his legs up. His shoes are taken off for this half an hour. This improves the circulation in his legs and warms his feet. Without this break he is often very tired in the evening and his mood will clearly be less positive.

 If those in need of special care stay in school or at work during lunch time it is not always possible to insert such a rest period. For this reason the residents may be given time to stay in their room when they come back into the house. This break usually has a more active character than an afternoon break because it is not in the time of the ‘dip’ after lunch.

Many people with special needs have difficulties finding the right balance between rest and movement. Some will very soon exceed their limits. They appear to be enjoying an activity, but later on there will be a negative reaction in the form of aggressive behaviour or not being able to come to peace. This demands from the support workers that they observe carefully when the time has come for something different.

And to finish: a joke at the right moment can lighten the day. Laughing is healthy! On the other hand, however, you only really take the people you support seriously if they are also allowed serious moments.

 3.3.        Evening

The evening is the transition phase from day to night. It is important that the evening can be organized in such a way that it can be a good preparation for the night. If a rhythmical variety (of activities) was provided during the day this process will happen more smoothly. Sleeping problems often point to a lack of rhythmical variety.

As for the evening itself it may be helpful to begin to create an evening-like mood already for a while before bedtime. This may be done by closing the curtains early on, listening to suitable music or reading a story. Using screens (television and computer, but also smartphones) up to the moment of going to bed is not advisablexiii.

Listening to music

Sebastian (22 years old, mild learning disability, ASD) says that he has difficulty falling asleep and is still tired in the morning. He also has problems getting up and going to work. His visiting support worker asks how it is when he goes to bed and what he is doing before going to sleep.

It turns out that he is playing computer games until late into the evening, which makes him quite tense. Sebastian is given an explanation how the body has to make melatonin in order to be able to sleep and that this does not really work because he is watching the screen which is making him tense. Sebastian understands and wants, from now on, to listen to music during the last hour before going to sleep. For a while this has the desired effect, but making sure there is relaxation before going to sleep remains an ongoing theme in the discussions with his support worker.

 Letting go of the day can also be made easier by tidying up both outer and inner affairs. You can let go of anything superfluous by giving a place to what has happened during the day and, if possible, rounding it off further. Looking ahead to the next day, for instance laying out the clothes you are going to wear is a way of giving security and helping orientation in time.

These aspects may be part of a regular evening ritual. Speaking a verse or a prayer can help in letting go of the day in confidence. According to anthroposophical ideas the human being comes into contact with the spiritual world, as well as with their own spiritual being, also called one’s ‘higher self’, during sleep. A spiritual moment before going to sleep can promote openness to thisxiv. We are normally not really conscious of the effect of the night. You can sometimes sense something of this through dreams or unexpected ideas.

Team leader (children and young people with mild learning disabilities, aged from 10 to 16)

“All the children and young people here have their own evening rituals. Eleven-year-old René has ADHD and an attachment disorder and is someone who will react to everything and everyone all day long. He needs a lot of time to calm down, which is why we let his evening ritual begin earlier. He benefits from a bath with lavender bath milk and he will have a half an hour-long bath on Mondays and Thursdays. Afterwards we have a chat with him about the day and read him a simple story. Unlike the other children he still needs simple, complete stories. Afterwards we speak a short verse together. René belongs to the children who gladly accept these things, as it gives him peace and confidence.

Nicole is ten years old and will usually read a bit in her children’s Bible at the side of her bed after a little chat. We usually write down with her into a notebook a positive moment out of the day.

We have one sixteen year old person in the group. We have a drink together with him and speak about the day. He does not want us to come upstairs afterwards to say goodnight to him. A time has been agreed for him to switch off his light. The fact that he does not always manage to do this is often the subject in the conversations with his key-worker .”

3.4.        A good night’s sleep

By getting a good sleep at night we build up the vitality again that has been used up during the day. While we are asleep our body works on recovery and growth. A good sleep will improve our ability to function and make sure that we have less anxiety, irritability and aggression.

Before someone is going to sleep pay attention to how they lie in bed, whether they are not too warm or too cold, and have sufficient fresh air. If a mattress with artificial covering is used it is advisable to use a flannelette mattress cover. Having only a cotton sheet on top of such a mattress is not very comfortable. For people who are restless one could consider using blankets instead of a duvet. Blankets give more security because with them one can tuck the person in more snugly, helping them to come to themselves and sleep more

peacefully. A good night’s sleep is not a given for all people in need of special care. You need to feel well within yourself in order to be able to sleep well. This may be achieved by means of a relaxing bath, an ‘Einreibung’ or an application with oil or ointment.

A chamomile compress

Deborah (21 years old, mild learning disability, attachment disorder) sometimes suffers from a stomach ache, especially when she is worried about a forthcoming event. She will then usually have trouble falling asleep. At the onset of puberty, she received external therapy for this. She has asked her General Practitioner for a prescription for it. The anthroposophical nurse is now teaching her to apply a hot chamomile compress to herself. She goes to bed with such a compress on her stomach. This relieves the tension and cramp. She becomes rosy and then falls asleep more easily.

People with special needs who are hyperactive, anxious and ‘too open’ are usually too much awake. Their sleep is often light and restless, because they go into the night with too many undigested impressions. It is for them even more important to care for the transition to the night.

Fixed times for getting up and going to bed will diminish sleeping problems. If they wish to sleep in or go to bed later, an hour will usually not cause any problems, but if the difference is greater the sleeping rhythm will be disturbed. 

4.         Weekly, Monthly and Annual Rhythms

4.1.        The weekly rhythm

The seven day rhythm is sometimes called a ‘reactive rhythm’. You can notice this in events that have made a great impression. If you look back over such an event a week later you usually see it differently. A rhythmical course of the week makes it possible to react to physical and mental burdens in a more flexible wayxv.

Support worker in an independent living situation:

“Lisa (25 years old, mild learning difficulties) is a woman who is ‘too open’ and who has been living independently for two years now. She works in a shop on Tuesdays, Thursdays and Fridays and it is going well. She manages to go shopping, cook and to keep her apartment clean, although she struggles with these things. In the meantime, she has found a lot of support from going swimming with a friend on Wednesday afternoons. She did not have an easy time starting this and she was almost immediately going to stop doing it. It was all becoming too much for her. Now that we have moved on four months, I have noticed that she is finding her equilibrium more easily. She is now really able to relax on those afternoons, which makes the rest of the week also go more smoothly.”

This example shows how this regular activity in the middle of the week is making Lisa stronger. It has helped her to create more ‘flow’ for herself. It also shows that introducing rhythm needs effort, but that things will begin to flow better afterwards.

A rhythmical course of the week arises when the days of the week gain their own colour as much as possible and begin to be filled with suitable activities. 

4.2.        Sunday and Saturday

Sunday has a special place in our culture. It is considered to be the first day of the week, the day of a new beginning. Sometimes, Sunday can bring about an undefined feeling because you do not have to do anything, which in itself may also create restlessness. This can be prevented by assigning to Sunday a colour that corresponds to the nature of the day. A new beginning may be marked with a special Sunday celebration. You could add something festive to the mood of the day, for instance with a special breakfast and a beautiful tablecloth. The Sunday afternoon could be marked by a daytrip. You could go for a walk in nature together or do something different.

The character of Sunday will stand out more prominently if you also give a particular colour to the days before and after.  Then you will notice that Saturday now has more the character and mood of rounding off the week. Activities such as cleaning and tidying up fit well to this. It is also a good day to prepare for the new element of Sunday by going shopping or by baking something nice. Saturday morning may therefore still have a bit of the mood of work or exercising. A completely free weekend is rather long, which for some people might make the transition to the working week more difficultxvi. On Monday morning attention may be given to the start of a new working week in the form of the ritual of a school- or workshop opening or assembly.

4.3.        The Days of the week

In our language (in Dutch as well as in English) we link the names of the days of the week, such as ‘Sun’-day and ‘Mon’-day, to a relationship that exists between the days and the planetsxvii. This relationship has been known for a long time and there is much wisdom within it. Via the planets, for instance, you will be able to find out the intrinsic quality and character of the days of the week. The brief survey below is not meant to be a fixed guideline, but it might inspire you in assigning colour to the days of the week.

Sunday (Sun). The sun determines and irradiates everything; it is a life-giving source of warmth. Qualities: strong, balanced, joyful, a new beginning.

Monday (Moon). The moon reflects the light of the sun and constantly changes its appearance: from waxing to full moon and from waning to new moon. The moon’s rhythm influences ebb and flow. Qualities: receptive, reflecting, changeable, nourishing, enjoyment.

Tuesday (Mars). The planet Mars has a red colour and flickers a little. Qualities: fieriness, courage, being active, enterprising attitude, motivation, sportsmanship, shrewdness, confidence, purposefulness.

Wednesday (Mercury). Mercury is fleeting and is only visible for a few days at dawn and at dusk. Qualities: mobility, playfulness, humour, dexterity, having an overview, versatility.

Thursday (Jupiter): Jupiter is a very clear and bright planet. Qualities: expansion, optimism, growth, breaking down limitations, wealth, spirituality, wisdom, order, lawfulness, logic.

Friday (Venus). Venus radiates with a warm glow in the morning or evening sky. Qualities: culture, tastefulness, peace, love and harmony, beauty, comfort and recreation.

Saturday (Saturn). The planet Saturn is relatively distant and not very striking. Saturn’s rhythm is the longest one. Qualities: boundaries, discipline, integrity, faithfulness, searching, consolation, dealing with suffering, rounding off and a new beginning.

The relationship between the days of the week and the planets

English          French           Planet            Colour

Sunday            Dimanche        Sun                   gold/ white

Monday          Lundi               Moon              silver/ lilac

Tuesday          Mardi              Mars                red

Wednesday     Mercredi         Mercury          yellow

Thursday         Jeudi                Jupiter             orange

Friday              Vendredi         Venus              green

Saturday         Samedi            Saturn             blue

A support worker in adult services:

“The qualities of the days of the week were totally new to me. I first tried to find out for myself what I recognized. I find that Tuesday is good to get going with things. For me Wednesday is more of a day of mobility: organizing things, doing chores or going shopping.

Once every two weeks we have a group discussion in the group on a Monday. The Monday is good for reflection, looking back and making new resolutions.

In our institution we make use of the colours of the week to indicate what day it is. All kinds of aspects play a role in making a good weekly schedule. Using the planetary qualities is one of these aspects.”

4.4.        The monthly rhythm

The monthly rhythm is the rhythm of habit forming and stabilizingxviii. Generally, at least four weeks are needed before a new skill can really become a habit. The best way to form habits is by adhering to a six-week rhythm: a week to get into it, four weeks to practice it and a week to round it off. Letting go and forgetting it for a little bit also play a specific part here. Experience has shown that learning housekeeping skills, for instance, will proceed more smoothly if they are picked up anew after a period of rest. These periods can become more visible if you can give them a place between two seasonal festivals or between a festival and a holiday break. In a school setting this principle of practicing and letting go may be applied by offering lesson content in periods. Digesting material continues subconsciously during the time of letting go and can be picked up again more easily in a later period.

As a team you are able periodically to choose a common topic and also let it go again after six weeks or so. By focusing together on the attention for the topic it is often possible to achieve more and then such a topic will ‘stick’ better. In anthroposophical therapies one usually also works with a six-week rhythm. The therapy is often given over a period of six weeks and is sometimes repeated after a period of restxix.

4.5.        The Seasons and the annual rhythm

Nature changes every season and we also change with nature. We feel different in spring than in autumn. We want to eat different things in summer than in winter. Our thinking tends to a bit more relaxed in the summer and a bit less concentrated than it is in winterxx. By taking the seasons into account you will be going along with them instead of fighting them and this will give you energy. Going along with the seasons will also make it possible for you to adjust your calendar of activities accordingly. Activities belonging to winter would be those that demand more inwardness, such as listening to music or to a story, but also activities that create a homely feeling such as board games. Summer is the time for outdoor activities such as contests and outdoor games or a day open to the public. A season table (see part 1. Healing Environment) can support this.

Support worker for adults with complex needs

 “On the estate of our institution there is a farm with a vegetable garden and a shop which also sells seasonal products. This makes living with the seasons more straight forward. We eat seasonal products too. Our residents recognize where these foods come from. In the common room there is a special table which draws attention to the seasons. All these things contribute to the sense of being embedded within the greater whole.”

Some of those in need of special care tend to react strongly to the change of the seasons and of the weather. Thunderstorms, storms and falling leaves can cause restlessness. It is good to take this into account. Winter depressions and fatigue also occur in spring. These complaints will usually diminish if one remains sufficiently active and goes outside daily throughout the winter so as to absorb the necessary amount of daylight. Each season offers different possibilities for a healthy contact with the elements. This will increase our vitality, especially if the boundaries of the exertions are always being moved slightly.

Support worker for children and young people with moderate learning disabilities

“Living with the seasons means living with the elements! In autumn this can be done by going for a good long walk wearing rain gear and rubber boots or by helping to sweep up the leaves in the garden and afterwards having a nice drink together; in winter by having a snowball fight or going sledging and in summer by playing outside or going swimming in a nearby lake.”

The seasons move in cycles: after one cycle one year has passed and a new series of seasons begins. The cycle of the year is linked with adapting oneself in the long term. Whenever you experience a season for the second time in the same place you will become familiar with itxxi. A fixed cycle of annual festivals can support you. Such a cycle gives stability and always again brings the joy of recognition. Vitality is also enhanced if you are able to look forward to certain moments and to look back on them with pleasure.

The rhythm of the year is also related to the physical level. You can gauge this by the fact that recovering from an operation often takes a full yearxxii.

Therefore, if you wish to make sure that residents have a lasting and better relationship to their own body, the annual rhythm will play a part in this. Shaping the rhythm of the year organically can support this process.

Breathing Space

Here is an exercise for the support workers themselves, as a different approach to the theme of rhythm. This may help you to get in touch with your inner peace during a break. This exercise is useful if you are finding it hard to relax in your break timesxxiii.

 If possible, sit up straight with both feet on the ground. If this is impossible this exercise can also be done standing, while leaning your back against a wall.

Direct your attention to your breathing. Follow your breathing movement while focusing on the breaks within it. You are not meant to influence your breathing. By directing your attention inwards, you might find that you become conscious of your thoughts or feelings. The art is merely to observe this. At this moment you choose to direct yourself to the breathing spaces.

How do you experience these breathing spaces? What is their quality? Is it possible for you to allow this quality to permeate you? 

5.       Mealtimes

Rhythmical variation also plays a part in nutrition. This chapter is about the quality of food as well as the way mealtimes are conducted.

 5.1.      Mealtimes and refreshment breaks

Every infant developing normally learns to get used to foods in small steps. Our digestive system has to learn to respond to each new nutritional element. Children will generally get used to a new food after having eaten it about ten times. If they do not want to eat something it might be because they need more time to get used to it by being given small portions.

Having meals and food or drink breaks at regular times provides stability and has a strengthening effect on the entire organism. Many eating disorders can be made worse by an irregular eating pattern. The risk of overeating is smaller if you eat at regular times. This is related to the fact that the digestive system is then better able to prepare itself for the food.

Healthy food that is age-appropriate and given with a daily regularity will help to develop within us a sense for what is good and healthy: it strengthens our sense of life. Organic or biodynamic ingredients are preferable here. Apart from the fact that these products do not contain any residue of chemical substances, they have usually also had more time to grow and will therefore have more life forces at their disposal. A biodynamic head of lettuce, for instance, will keep better than lettuce that was grown in a regular way and will often be tastier. In the meantime, organic vegetable juices and baby foods have also become available.

5.2.        How to conduct mealtimes

Apart from healthy, nicely prepared food the atmosphere in which the meal is eaten also becomes important. Is there sufficient peace and quiet in which to digest the food? It is also important how the food is presented. You will then become interested in the food and, if it looks well prepared and attractive, you can look forward to it. This is also the case with the way the table is set.

Support worker in adult care (a group with complex needs):

“In the group where I started to work not much attention was given to the meals. The residents set the table in a haphazard way. At lunch the bread used to be put on the table in a bag. In the meantime, we have bought bread baskets and nice placemats. On Sundays we put some flowers on the table. In this way it is easier to encourage the residents to lay the table in a nice way. This has improved the atmosphere at the table; we often have pleasant conversations and we spend a longer time sitting at the table.”

It has a positive effect if support workers join the meal. Seeing someone eat makes you want to eat as well! Sharing a meal is also an archetypal image for community, thus offering a counter balance to institutionalization. It is, moreover, a good thing if you know what is being cooked. Looking at a menu or having a peep inside the saucepan helps the digestion. A peaceful moment of transition can be created with a little ritual at the beginning of the meal.

Many places have central kitchens. If this is the case it is helpful if the residents can have some contact with the kitchen so they know where the food comes from. Cooking together in the group on a regular basis and going shopping together is also recommended. This can be a way to help residents get more involved in choosing the menu. It is also possible to involve people with more complex needs and disabilities in the meal-preparation. Even if they are not able to help actively you could let them sit nearby or let them touch, smell or taste things.

A care manager in an institution for children and young people with complex needs and learning disabilities:

“Until a few years ago we as support workers used to do the cooking ourselves in our institution, often helped by the children and young people. At a certain moment we decided to have our meals delivered by a catering firm.  A year ago, however, we changed our minds. In the meantime, the support workers have done a cooking course for groups and now prepare the meals themselves again. I fully support this. It brings a sense of homeliness and it is very clear that the meals are being enjoyed much more again.”

If you wish to focus the attention on the food it can be helpful to not start a conversation straight away. In this way the main attention remains focused on the food. It is good if the support worker prepares some questions or light topics for the table conversation. Speaking about the food itself or how it was prepared can make people taste the food more consciously.

If for some reason a table conversation is not possible or desirable it would be important that support workers do not hold a conversation over the heads of those they care for, but remain focused on them and on the food. It is a good thing to again round off the meal

together with a short ‘ritual’ [e.g. saying a verse or a grace or blowing out a candle (tr.)]and,

if need be, to have a period of rest afterwards.

5.3.        Nutritional qualities

We know from the anthroposophical ideas about nutrition that the way the plant grows brings additional qualities besides the content of the nutritional ingredientsxxvi. The winter carrot, for instance, which has been allowed to grow quietly beneath the cool soil, represents something of an earthly quality. Compared to the carrot, fruit that has been able to ripen in the sun has more warmth qualities. Particular grains also contain warmth qualities, as do seeds and nuts. Green vegetables represent the qualities of air and water.

You could keep these things in mind when compiling a menuxxvii . It is also possible to influence a constitutional one-sidedness via nutrition, for instance by taking into account substance and taste. It is possible to consult an anthroposophical dietician for thisxxviii . A simple example follows in relation to working with flavoursxxix.

The effect of certain flavours

Sweet: soothing, calming, think of a ‘sweetener’. Salty: aids body awareness

Sour: mobilizes, wakes up, brings clarity and refreshes

Bitter: activates, aids digestion, helps you to develop something within yourself.

Food for children should generally not contain too many stimuli (spicy, salty). Sugar burdens the system and can contribute to tiredness and hyperactivity. Drinking cold drinks straight from the fridge burdens the organism, because adapting to our body temperature takes a lot of energy. Sometimes herbal teas are preferable to black tea, because they contain less caffeine, which has an awakening affect. One can adapt the type of herbal tea to the time of day or to the season. A warming tea could be given in winter and a relaxing tea in the evening. Regular use of a microwave is not advisable, because the heating method of the microwave is completely different from other forms of heating.

5.4.        Eating disorders 

Eating and drinking disorders occur relatively frequently in people with developmental difficulties. They usually have problems chewing or swallowing, or motor problems in the region of the mouth. This is especially the case in people with complex needs.

It is also important to keep an eye on posture during eating. If a person has slipped down or leans over sideways, they will have trouble swallowing. A proper eating position will be hindered if a person in need of care is unable to rest their feet on the floor or on a specially adapted foot rest. For those who lean backwards or are lying down you have to ensure that they swallow with their neck bent (this is called ‘swallowing with a short neck’). Choking can easily lead to pneumonia. Apart from motor problems one can also be presented with behaviour that is hard to understand, such as gobbling down food, refusing food, messing around with food or pica (eating inedible things). These problems require a specific multi- disciplinary approach. In any situation one needs to observe the person’s posture and sudden changes in their eating behaviour or excretion patterns.

6.         Daily Care

How can you make sure that residents feel more at home in their bodies with the help of day to day care? What kind of support can you offer for this?

 6.1 Care practice

Many people in need of special care depend on help for washing, getting dressed and undressed, eating, toileting and mobility. If this is done respectfully and attentively this caring attitude becomes a gesture which helps a person to feel that they are being seen on a basic level. In relation to people with more complex needs it is helpful for the team to agree on a fixed sequence of the care activities. By allowing room for the person’s own movement impulses, you can make sure that they are less passive during the care activities. In this way the person you are caring for can be much more involved. In the area of the day-to-day care habit forming has an important place. It can be helpful to keep to certain times for things like cutting nails, having showers or baths and washing the hair. When working with those who are physically not so strong it is good to know that showering can be quite strenuous.

In such a case it is preferable to wash the person with a flannel or let them have a bath that is not too hot (36.5- 37.0 degrees).

You can make use of the moments when you are caring for a person to observe how they are. Are they pale? Are there any hidden wounds or is their skin dry? Do they feel warmed through? How is their breathing? Such moments are usually unavailable when people are more independent. In such a case it is a good idea to pay attention to these things at certain fixed moments. In the next paragraph we describe an exercise which is aimed at improving your observational skills for such matters. There are medicaments for the treatment of minor ailments and for first aid, which can support health in a natural way and address a person’s ability to self-heal. Paul Meuwese’s guide book about prevention of illness and self- medication offers helpful indications about this. 

Ailments

Anja (30 years old, mild learning difficulties, PDD-NOS) often looks pale and tends to have problems getting up in the morning. She can wash and dress herself independently. She often wants help with minor ailments, like a torn nail or a small finger wound. At a certain moment she felt listless and was very irritable. After some time, it became clear that she had a large abscess on her back for which she had not asked any help. 

6.2.        Observation and empathy

It is generally known that observation needs to be learned, also by you as support worker. Learning to observe is an integral part of your training. The exercise below is meant to help you form, as clearly as possible, an inner living picture of the person in need of special care. This exercise, as well as the empathy exercise that follows, can also be done as a preparation for a client review which is meant to give a picture of the personxxxii. The exercise is not aimed at the observation of behaviour, but you are asked to form a picture of the person’s outer appearance and movement patterns. By doing this exercise on a regular basis you will become more alert to certain signs from those in your care, allowing you to respond to these more quickly. People who work with this actively have said that they have become more creative in problem solving.

Observing a person in your care (outer appearance and movement patterns)

Preparation

Take a few minutes to call up an image of a person by trying to see them in front of you very clearly.

Ask yourself the following questions. You yourself could, of course, add questions and different points to the list.

·      How is the overall form?

·      How is the posture?

·      What is the proportion between head, rump and limbs?

·      What does the face look like? Pay special attention to eyes, nose and mouth.

·       How is the complexion?

·       How is the skin? Thin or thick?

·       What colour are the eyes?

·       How is the hair? Pay attention to shape, colour and thickness.

·       What was the person wearing today?

·       How does the person move?

With this exercise you will probably notice that you cannot see everything in your

mind’s eye. In such a case, try to guess what you do not know. If, for instance, you are unable to imagine the shape of a person’s eyes or chin, try to fill this in based on your own estimate. Such activity will help you to have a more alert power of observation. If you then see the person in real life you will notice that your image of them will become more precise. Do not spend too much time on this exercise and round it off consciously. This you can do by actively wiping away the image you have inwardly built up just like you wipe a drawing off a blackboard.

This exercise is not meant to achieve a fixed final image. It is much more important that you practice active observation. You could also use this exercise as a preparation for an

empathy exercise, which was also described in the first part of ‘Healing Environment’. In this exercise you tune in to the person with whom you wish to develop empathy, by imagining them as precisely as possible, in the way it was described above. Then you should also take on their posture, and walk and move in the same way as this person does. While doing this you try to find out how it feels to be this person. Put yourself in their place. What do you notice? How do you experience your body? What about your consciousness? What feels pleasant and what does not? How do you experience your surroundings and the people around you? Can you indicate what you might need as the other person?

When doing this exercise, it is important not to do it for too long in one go and then also to finish it consciously. You could do this by having a stretch and shaking off the experience or trying to feel that you are really in your own skin again.

This empathy exercise can give you a better insight into a person. It can also inform you about how to improve your care for them and how you can refine your way of supporting people. This exercise can also be very fruitful if done as a form of role play together with a colleague, in which the one is a person in need of special care and the other the support worker.

 6.3.        External support

In this paragraph we will describe a form of physical support which you, as the support worker, could offer. This is usually done under the supervision of an anthroposophical nursexxxiii. Below, we will describe an oil application (‘Einreibung’) by way of example. An ointment or essential oil is rubbed into (part of) the body with light strokes. Such an oil application helps the patient to become more conscious of their body and can give the experience of things beginning to ‘flow’ again. Good results with ‘Einreibungen’ have also been shown in people with dementia.

Oil application

For some months it had not been easy to approach Ronald (67 years old, PDD-NOS, moderate learning disability, uses a walker on wheels). He had increasingly been withdrawing to his room and appeared to be anxious and confused. On some days he was no longer able to find his way to the day care facility where he had been going for years. He also paid less attention to his hobbies.

In a review it was proposed that one of his regular support workers could give him

‘Einreibungen’ with rose oil (harmonizing), applied to his feet. When she suggested this to Ronald he reacted negatively. He was unable to form a mental image of it. His support worker then tried again after a couple of days. When she reassured him that he would surely like it he agreed to try it. The support worker then explained clearly and slowly what she would be doing. Ronald was very alert during the first two sessions. Although he remained on the bed he would constantly lift his head to see what she was doing. This, however, improved quite soon and in the course of time he began to look forward to the sessions. He would tell others about it, became more communicative and seemed less anxious.

Improvement in body experience can reduce confusion, anxiety and disorientation.

Apart from using rhythmical oil applications, it is also possible to work with compresses or with applications of ointments or oils. These are specifically used to support certain organs. For instance, a liver compress could be used for someone who has difficulties processing their food properly. These applications can also help people who are over-sensitive to touch or should preferably not be touched. This also applies to the use of (partial) baths with essential oils or bath milk. The principle behind external support is that the skin is one large sense organ that does not only perceive touch but also the qualities of the ointment or oil that is being used.xxxiv The body perceives these qualities and reacts to them. The different etheric oils all have a specific effect, such as relaxation of the muscles (chamomile), revitalizing (malvae and prunus), bringing warmth and light (‘light root’-‘lichtwortel’). In some cases when bathing someone, gloves made of sisal or linen or a brush could be used to stimulate the body . This has an awakening effect on the body.

Anthroposophical nurse:

‘If you are considering using external therapies, it is important to realize that this will only be effective if offered rhythmically. A lavender bath once a week at a fixed time and for a fixed length of time is more effective than five times a week at irregular times’.

A period of rest afterwards is often also part of external therapies. In some cases, someone might rather need to be active afterwards, for instance by going for a short walk. After other forms of therapy it may also be the case that a person needs some time to themselves. This is something that needs to be taken into account in the group and needs to be discussed either with the person themselves or with their therapist. 

7.         Warmth, Clothing, and Caring for the Sick

7.2.     Caring for the warmth organism

We human beings have a differentiated warmth organism at our disposal.  Each organ has its own temperature that fluctuates according to different rhythms. Our bodily functions depend on our temperature. When there is a slight cooling down, some functions will slow down and our thinking, for instance, becomes slower. According to the anthroposophical image of the human being our individuality nected with the body via warmthxxxv.  This can  be experienced through the phenomenon of enthusiasm. Being enthusiastic for something means forming a connection with it.  You literally ‘warm’ towards it. If those we care for walk around with cold arms or legs, or have a cold abdomen or back, they will be less able to connect with other people and with the world around them. The process of digesting impressions or food will then also function less well than before.

Cold feet and cold lower legs

Winnie (6 years old, with complex needs, dependent on a wheelchair) comes down to the day care facility in the morning by a special bus. On arrival her feet and lower legs are cold and she seems withdrawn. Her support worker applies an ‘Einreibung’ (oil application) with rosemary oil to her feet and lower legs. The oil has a warming effect. Afterwards Winnie takes part in the morning assembly with a hot water bottle at her feet. This has the result that she is much more present during the day and more able to make contact. Already after a number of weeks it is no longer always necessary to put a hot water bottle at her feet.

After the ‘Einreibung’ they stay warm more often without it.

In order to promote a healthy development, it is important to keep an eye on the person’s warmth organism and to check whether this needs to be supported. It is advisable when doing this not to take one’s own experience of warmth as standard. The person in your care may well have a different digestive system or move to a greater or lesser degree than you do.

Supporting warmth

Psychological warmth

·      By performing care activities attentively, with an eye for what the other person needs

Physical warmth

·       By stimulating meaningful physical movement

·       Via nutrition, such as warm porridge instead of bread, a warming tea or herbs

·       By means of external support

·       Via clothing, for instance by making use of layers

·       By means of a hot water bottle or by wearing bed socks

All these forms of support work are basic preconditions. Apart from this you could also try to find out what is really important to a person and to encourage them to do something with it.

7.2.        Clothing

Clothing plays an important part in regulating warmth and cold. Clothing made from natural fabrics such as (organic) cotton, wool or silk is preferable to synthetic materials. Natural fabrics absorb or transfer perspiration much more easily. Warmth is kept in or held off much better by these materials, which each also have their own specific qualitiesxxxvi. Sometimes residents are not dressed warmly enough. Although the body can harden itself against this it is not advisable from the point of view of the way warmth works. Hardening processes can, moreover, diminish physical buoyancy in the later stages of life.xxxvii

Working with layers can be helpful in promoting healthy warmth. Make sure that you also keep an eye on the type of fabric the person is wearing. In cold weather remember to let the person wear tights or long-johns underneath trousers or a wool or cotton vest and, when going outside, a scarf, hat and gloves. In the summer a cap is helpful to keep out the sun if it is too bright.

Support worker of young people with mild learning disabilities (12-16y)

“We would like to respect the young people’s own dress sense as much as possible. Clothes express something of who you are. Sometimes we have a discussion with them about this, for instance if they are not dressed warmly enough. We also find the right type of shoes important. High heeled shoes are, to our mind, more suitable to wear for going out or on special days. We discourage pictures of violent scenes or words printed on clothing, as they call up a particular atmosphere and may frighten other people.”

The above example shows something of the field of tension between educator and young person. Young people feel the need to experiment, not only with their clothing but also with their self-care and eating and sleeping habits. It is helpful if you and your team have a clear vision in this field, on the basis of which you can begin a dialogue and find out how much leeway is suitable for a particular person. 

7.3.        Caring for the sick

People who are sick are often extra sensitive to their surroundings. Even people who normally would not be bothered by them are more open to impressions. A fresh, clean room with few stimuli, a well-made bed and a tidy bedside locker gives a pleasant feeling. If someone has a fever, they will be more sensitive to draughts and more susceptible to cold. In such a case it is better not to let people walk around with bare feet or only wearing piyamas. As soon as the fever has abated the patient would still need at least one more day to recover.

The use of allopathic medication in order to subdue fever is advisable in only a small number of cases. A fever is often not a bad thing.  On the contrary, a raised temperature will stimulate the metabolism, calling a halt to viruses or bacteria and preventing them from spreading throughout the body. When sick people, and especially children, have a temperature, they undergo a process that helps them to take ownership of their bodyxxxviii. It is a matter of course that it is important to accompany the patient properly in this process. Make sure that they have plenty to drink and that there is no build-up of warmth. An important aspect of being ill is the idea that each patient also carries within themselves opportunities for development.xxxix Being ill is, for this reason, not merely a nuisance and something that has to pass as quickly as possible. You can feel ‘better’ after an illness: illness can bring back into balance what was out of balance. From this standpoint it is good to find out whether a period of illness has also brought something positive to the person, such as a change in their behaviour or attitude. After a children’s disease one can often see a sudden step in the child’s development. It may have helped to form their personality, they may eat better or become continent at night.

Below is an example which shows that introducing a day in night clothes can be desirable.

Nurse

“Living in a group of six or seven while you are not feeling well is quite demanding. Introducing a piyama day at the right time may prevent problematic behaviour and make sure that a person’s equilibrium is maintained. Yet for some residents it might be of greater benefit if their rhythm is not interrupted. In such a case it is important that they can slow down a little at school or in the workplace.”

8.   Domestic work

This chapter addresses how domestic work can be approached creatively. Domestic work and the care for the environment bring along unexpected opportunities over and above their importance for independence.

8.1.  A different approach to domestic work

We often look upon domestic work as a necessary evil. It consists of more or less unchangeable activities which you feel are never done. Yet if you can see the care for the environment as being part of a stream into which you can bring rhythmical order, a different picture will arise. By giving each of the different activities their own momentum they will leave you free at other times.

Being taken up into such a stream, either by joining in or by simply being present can be revitalizing. Experience has also shown that those in our care often derive great satisfaction from having performed a domestic task successfully and it gives them an increased sense of self-worth too.

Domestic tasks have a formative character as well. Washing a floor, cleaning a window or wringing out a floor cloth will help to develop one’s motor skills. These activities have an intrinsic logic and connectedness which stimulate the development of thinking. Being able to use domestic appliances correctly demands attention and precision and increases a sense of competence. It is self-understood that domestic tasks can also call up resistance, because they demand a certain amount of perseverance and discipline. By not avoiding this resistance one can develop something healthy within oneself. The will becomes stronger, which gives energy. In the guidance of children yet another aspect plays a role. Children will connect with their surroundings via the interest shown by the adult. Whenever an adult does domestic work attentively it becomes something interesting for children. This will often have a stimulating effect right into their play.

8.2.        Social aspects

Through sharing life and caring for it, residents experience that they depend on each other. If you do not set the table in time your house mates will be late getting to work or school. Young people often learn best to take on responsibility through this social component of household chores. You will usually be able to get into conversation while you are doing something together with them.

The act of cleaning or tidying up together can bring about a positive turnaround after a crisis or a difficult phase. Getting a big job done together brings an experience of connectedness and strength. Anyone can join in and even those with a more severe disability can make a small or symbolic contribution. In this way you can make a new start together. After such a job the atmosphere in the house is usually remarkably much better and things will run more smoothly again. In connection with this we still want to make a remark in relation to holidays. Holiday times can be quite hard for many people with special needs. There is less activity, causing much of their stability to fall away. This can bring about insecurity and problematic behaviour.

Coordinator of a care farm (children and young people with mild learning disabilities): ‘In the weekends all children and young people have a task, for instance clearing the table or emptying the dishwasher. In the holidays this is different. Then there is usually an hour in the morning after breakfast where everyone has a larger task. The support workers are also included in this. One person will vacuum all the bedrooms, the other will bring the bottles to the bottle bank and someone else will sweep the yard. Whoever has finished

their job is allowed to do something for themselves. Afterwards we will sit at the table for a drink and to discuss the day. In the course of time this custom has become self-understood and it forms a good foundation for the rest of the day.’

8.3.     Improving balance

In this paragraph we will go more deeply into the effect of the various domestic activities, as they also can have a positive influence on certain problems. Bringing order into things, for instance, can have a calming effect on someone who is confused. Anxiety and stress will diminish if you have to concentrate on something concrete. By cleaning something, you yourself can also often feel clear and refreshed again which creates space within yourself. As an aid to observe the effect of the different activities, you could look at them from the point of view of the four elements.

Domestic work and the four elements

-Water:

brings flow, relaxes, dissolves

Activities: mopping up, washing floors, cleaning windows, doing the dishes, doing a hand wash, cleaning vegetables, watering plants

-Air

brings movement, gives space and clarity

Activities: airing, beating a carpet, removing cobwebs, sweeping, hanging out laundry

-Fire

Warms, transforms, takes away sorrow

Activities: ironing, cooking, baking, waxing something

-Earth:

Offers resistance, helping you to experience yourself, which brings alertness and inner peace

Activities: carrying a bucket, carrying shopping, cleaning and scrubbing, grating carrots, kneading dough, scrubbing pots and pans

From the aspect of the four elements, it may be understandable that also constitutional

problems can be influenced through certain activities. We will clarify this with the following examples:

Too congested, too dense

Robert (fifteen years old, with a moderate learning disability and severe epilepsy) is often sleepy and hard to approach. This is caused by his medication but is also related to his constitution which is too dense.

His Saturday task is to shine shoes after they have been polished. He does this with devotion and it does him good. The experience of the resistance when shining the shoes wakes him up. He becomes more communicative and his mood improves. On better days he also benefits from pushing the large dustbin on to the roadside together.

Sometimes people actually prefer activities which are beneficial to them, in which case it is up to the support worker to recognize this. In other cases one needs to experiment and gradually begin to find out what is helpful for someone. Apart from observing this from the aspect of the four elements one could also observe which gesture is characteristic for an activity, such as for instance beautifying something, giving things their own place, mending something that was broken (making ‘whole’ again) or folding laundry, during which activity you gradually make a small parcel out of something large.

Too open

Myrtle (twenty-four years old, with moderate learning difficulties) has a constitution that is too open. She often clings to her support workers with anxious questions and long stories. She works in a laundry three days a week. The activities of ironing and folding laundry make it possible for her to come to herself better and help her calm down. In the residential group she likes to care for the sick. Mopping with a heavy, wet floor cloth is usually too much for her. By doing jobs that suit her Myrtle finds herself and makes a more peaceful impression.

In conclusion here are some general remarks in connection with constitutional problems. It is preferable that residents with a constitution that is too light are given activities that do not need fine motor skills. They often receive negative feedback because they tend to do things quickly and messily. An important element for them in their work is to be guaranteed success. For people with a constitution that is too slow and heavy clear instructions as well as repetition are important. They also like doing things for someone else. It benefits them if in their work they have opportunities to get into movement and make contact with other people, for instance by delivering something or doing some shopping. People who have compulsions benefit from activities which are always organized in the same way. It is, however, a good idea to build in some small changes to enable them to stay flexible. People who are forgetful can gain stability from the concrete nature of domestic work. Repetition is important for them. Children who are forgetful may be supported by appropriate songs, and older people by looking at symbols, photographs or pictograms so they can see what needs to be done.

9.       Inner Conditions

1.     Aspects of attitude

As a support worker you could read this booklet with the question how it can help you to be well balanced. Care work is often demanding and it is not unlikely that you will not have enough time for yourself. You may be able to counteract this by taking good care of yourself and trying to find out where you could bring more rhythm into your life if necessary.

In chapter 1 we stressed the importance of a harmonious atmosphere. This also demands something from you as a support worker. The question is how you can contribute to this. Reality shows that sometimes you are not in the best of moods and that certain situations do not always go the way you would like them to. How can you deal with such things? It will definitely be helpful if you are able to distinguish between your own feelings and what you experience those you are supporting; it also helps if you accept your own experiences for what they are without judging yourself or others. You can practice this skill in your daily work and may be able to deepen it through meditative exercisesxl.

In relation to this the manner in which you start work is also a determining factor. What do you as a support worker need to do so you can begin your work in the right way? And are you making sure that this happens?

Team leader for young people with moderate learning difficulties: thinking ahead “Whenever I am not feeling quite myself or am dreading a shift, I usually do a ‘preparatory thinking exercise’. I try and imagine as concretely as possible how I will be coming to work. What does the room look like? Which colleague is there? Who will be the first to speak to me? Then I imagine a scenario that is as negative as possible. For instance: A. has just had a temper tantrum, there is hardly any time for the handover and J. has not yet been taken to school. I try and imagine this in a way that is a realistic as possible for a short time and then let go of it. When I arrive I will then be quite ‘present’ and well able to go along with what is happening, even if the reality is always and again different from how I imagined it.”

In this example the care giver works with ‘thinking ahead’, imagining in advance a work situation which is possible and difficult, so as to be able to get to work in a more alert and conscious way.

It is also possible to imagine how you will round off your shift. This is a different kind of exercise and is all about working with intentions.

In this exercise you literally imagine yourself ready to leave at the door at the end of your shift with your hand already on the door handle. Then you ask yourself what would give you a feeling of satisfaction at that particular moment.  What do you hope to have achieved and how would you have wanted to do this? This you bring along with you into work as an intention. This exercise has a focusing effect. It helps you to distinguish between important and secondary issues, enabling you to be present in a more balanced way.

It goes without saying that your motivation plays an important part here as well.

Are you still enjoying your work? What motivates you? Is there enough room for what motivated you? If this is the case it will be easier to be present in a balanced way.

9.2. Inner schooling

In her little book ‘ De oerbronnen van gezondheid’ [The Sources of Health: Salutogenesis (not available in English, tr.)], Michaela Gloeckler describes various research projects on factors that could promote health and vitalityxli. According to this research the most powerful source lies within the notion that you are part of the divine and that the divine is also within you. You could also choose different words for ‘divine’ such as ‘the All’ or ‘the Light’.

In ‘Education for Special Needs- the Curative Education Course’ Rudolf Steiner describes a meditation which is especially suitable for social care workers and which supports this awareness of the divine in and around us.xlii Anyone can find their own form of meditation in which they can deepen this awareness. If you manage this it can help you to stand within your work with a sense of wholeness and this will give you strength and confidence. This subject will be dealt with more extensively in the fourth part of this series.

A Word of Thanks

I would like to dedicate this little book to Wim van der Lans († 2011), former teacher at Zonnehuis School ‘Veldheim’ (now Zonnehuizen Intermetzo). He helped me on my way with this volume.

I would also like to thank Edith Maryon College, as well as those who gave me subsidies. They made it possible for me to work on this booklet.

The inspiring discussions with the colleagues at Edith Maryon College helped me to get going again and again.

A thank you is also due to all the people who let me interview them, to Mirjam Zonneveld who read along with it diligently and encouraged me, and to Truida de Raaf for her support.

Annemieke Korte

 Notes

(Where available I have substituted the English publications, tr)

For the quotation in the motto, see. www.dr.hauschka.com/nl_over-ons/ritme (https://www.dr.hauschka.com/en_US/about-us/pioneers-and-rebels/our-founders/) tr.

i Baars, E. (Ed). (2005). P.52.

 ii Huber. M (2014). In this thesis M. Huber describes this concept of health, which has been received positively by various stakeholders in Health Care in the Netherlands.

 iii In external therapy the patient’s own forces for recovery are supported by means of wrappings, compresses,

‘Einreibungen’ (lit. ‘rubbings’. Tr.) or baths. See: Emous, I., e.a. (2009).

iv In the anthroposophical view of the human being a distinction is made between the ‘sense organs’ and the ‘senses’. Sense organs are the actual organs in the physical organism. The twelve senses are not necessarily linked to any one particular sense organ. See also: Goebel. W, Gloeckler. M. (2013)

 v Eurythmy Therapy is a specific form of movement therapy aimed at influencing blockages in physical or organic processes, with the aim to promoting balance in the patient. Good results have been achieved, for instance, in cases of anxiety, restlessness, hyper-activity and sleeping disorders. For experiences with eurythmy therapy see: www.euritmietherapie.nl/ervaringen [also: https://hermeshealth.uk/eurythmy- therapy/about-eurythmy-therapy ( tr.)]

vi Goebel, W. & Gloeckler, M. (2013) vii Goebel, W. & Gloeckler, M. (2013) viii Baars, E. (ed.) (2005), pp 93-95

ix In the 20th century a separate branch of biology was established, chrono-biology, which researches these things.

x Research done in Sweden shows that the number of heart attacks tends to increase in the first three days after the introduction of summer-time: Janszky, I. & Ljung, R. (2008).

xi People whose constitution is ‘too heavy’ or ‘too light’: these terms point to the anthroposophical view of constitutional types which complement mainstream diagnostics. See: Niemeyer, M.H.et al (ed). (2009). Pp. 23- 34 and: Post Uiterweer (2012).

xii This overview is a further development of the diagram by: Raaf, T. de. (2001) p.27

xiii In part 3 of this series of booklets we will expand on the subject of the use of screens. In relation to the physical effects of this and its influence on the life processes see: Schoorel, E., (2016)

xiv Connecting to the higher self during sleep: Dam, J.van. (2007) pp 11 & 14

xv Goebel, W. & Gloeckler, M. (2013)

xvi According to Goebel and Gloeckler this point of view is also supported by chronobiology: Goebel, W. & Gloeckler, M. (2013).

xvii Goebel, W. & Gloeckler, M. (2013) xviii Goebel, W. & Gloeckler, M. (2013) xix Emous, I., e.a. (2009), pp. 42-45.

xx Wessels, P. (2006), p.6.

xxi Goebel, W. & Gloeckler, M. (2013) xxii Emous, I., e.a. (2009), pp. 42-45 xxiii Gloeckler, M. (1994), pp. 141-142 xxiv See also: Saal, J. (2014), pp.23-26

xxv See also: www.maltison.com

xxvi This approach is related to ayurvedic nutrition, but adapted to the western situation. See also: Huber. M. (2012), PP. 26-29.

xxvii Ypma, R., with Huber, M. (2012), pp. 26-29.

xxviii See:www.antroposofischedietisten.nl

xxix Ypma, R. (2011)

xxx Vierzen, R. van. (2001), pp.17-21. This article describes a phenomenological approach to the effect of the microwave oven. It comprises an overview of various scientific research projects into its effects. There are several indications that eating microwaved food has inherent health risks.

xxxi Meuwese, P. (2007)

xxxii About the client review which forms a picture of the person and of the methodology of phenomenological observation and empathy see also: Niemeyer, M.H.et al (ed). (2009). Pp.57-58. And: Baars, E. (Ed). (2005). Pp. 128-133.

xxxiii Emous, I. e.a. (2009). See also: Zon, A. van (2014). This booklet describes good examples of external support with children with complex needs.

xxxiv See: Schoorel, E. (2017). Although this book is geared to the developing child it is also applicable to adults with physical disabilities.

xxxv See: Schoorel, E. (2017). xxxvi See: Schoorel, E. (2017). xxxvii See: Schoorel, E. (2017).

xxxviii Goebel, W. & Gloeckler, M. (2013)

xxxix Thomas, L. (2014)

xl Zajonc, A, (2008)

xli Gloeckler. M. (2003), p.17

xlii Steiner, R. (2014)

Bibliography

Baars, E. (ed). (2005). Goede zorg. Zeist: Christofoor

Dam, J.van, (2007) Slapen en waken. Dronten: Centrum Sociale Gezondheidszorg

Emous,I., Hees. S.vn., Willink-Maendel, K& Zonneveld, M. (2009). Uitwendige therapieen: wikkels, kompressen, baden. Zeist: Christofoor.

Goebel, W. & Gloeckler,M.,(2013) A Guide to Child Health: A Holistic Approach to Raising Healthy Children

Gloeckler, M. (1994). Ouders en hun kinderen. Opvoeding en ontwikkeling, een ontdekkingsreis. Zeist: Christofoor.

Huber, M. (1995). Mens en Voeding: Een dynamische visie. Dronten: Centrum Sociale Gezondheidszorg

Huber, M. (2014). Towards a new, dynamic concept of Health: Its operationalisation and use in public health and healthcare, and in evaluating health effects of food. Thesis, University of Maastricht.

Janszky, I. & Ljung, R., (2008). Shifts to and from daylight saving time and incidence of myocardial infarction. New England Journal of Medicine, 359, 1966-1968.

Meuwese, P. (1997). Gids voor ziektepreventie en zelfmedicatie. Dronten: Centrum Sociale Gezondheidszorg

Niemeijer, M.H., Gastkemper, M.& Kamps, F.H.M., (Ed).(2009). Ontwikkelingsstoornissen bij kinderen en volwassenen: Medische begeleiding en behandeling. Assen: Van Gorcum.

Post Uiterweer, G. Je kunt er ook anders naar kijken (English translation in process). Zeist: Christofoor

Raaf, T. de. (2001). Heilpedagogische methodiek in dagcentra voor jonge kinderen met een ontwikkelingsachterstand. Driebergen: Ita Wegmanstichting.

Saal, J.C. (2014). Biodynamische Landbouw: Gezonde voeding als bron van levenskracht.

Dronten: Centrum Sociale Gezondheidszorg.

Schoorel, E.(2016). Managing Screen Time: Raising Balanced Children in the Digital Age.

Edinburgh: Floris Books

Schoorel, E.(2017). Warmth: Nurturing Children's Health and Wellbeing . Edinburgh: Floris Books

Steiner, R.(2014) Education for Special Needs, The Curative Education Course London: Rudolf Steiner Press.

Thomas, L. (2014) Why Cleaning Has Meaning: Bringing Wellbeing Into Your Home.

Edinburgh: Floris Books

Vierzen, R.van. (2001). De Magnetron: Warmte zonder vuur. Motief: Monthly Magazine for Anthroposophy, no 38. Zeist.

Wessels, p. (2006). Leven met de seizoenen (part 1-4). Zoetermeer: Weleda Nederland. Ypma, R. (2011). Reader bij de lessen voedingsleer: Zeist: Edith Maryon College.

Ypma, R. & Huber, M. (2012). Eten met aandacht: Doe ik het goed of doet het mij goed?

Driebergen: Louis Bolk instituut.

Zon, A. Van.(2014). Warmte vraagt vele jaren groei: De effecten van warmteondersteuning by kinderen met ernstige meervoudige beperkingen. Schoorl: Raphaelstichting.

 Websites:

www.antroposana

www.antroposofischedietisten.nl

www.dr.hauschkka.com/nl_NL/over-ons/ritme

www.euritmietherapie.nl.ervaringen

www.gezichtspunten.nl

www.maltison.com

www.plegan.nl/instructiefilmpjes

www.weleda.nl

www.weleda.co.uk