People with learning disabilities and the interpersonal construction of self-determination

People with learning disabilities experience limited self-determination and
have very little opportunity to take control and make choices affecting their
own lives (Stancliffe and Wehmeyer, 1998). In recognition of this,
government policy emphasises the importance of empowering people with
learning disabilities to take more control and make choices that influence
their own lives (DoH 2001, 2009). In order to meet the values set out in
policy, the interactions between people with learning disabilities and the staff
who support them is of particular importance. This study focuses on the
interpersonal construction of self-determination between service users with
learning disabilities and front line staff.
Discourse analysis, informed by principles of discursive psychology, was
used to examine naturalistic data from video recorded interactions.
Secondary data was generated through the use of a recall session where staff
and service users met separately with the researcher to watch the recording
and comment on parts of the video they felt were important.
The analysis revealed a number of actions present within the talk that served
to facilitate or limit self-determination. Staff frequently occupied a position of
power in influencing the available opportunities for self-determination.
Actions used within the talk included but were not limited to: recruitment of
parental view, colluding to enable choice, coaching, using constructions of
competence and incompetence. Repertories of incompetence and
competence, protection and independence were identified. Ideological
dilemmas around protecting service users vs encouraging self-determination
and autonomy were also found.
The research is discussed in relation to the wider literature concerning
empowerment and self-determination. The findings suggest that the policy
goals of facilitating choice, control and enhancing service user’s self-determination are complex in practice and difficult for frontline staff to
achieve. A number of clinical implications are identified including the use of
video material as an effective training tool for interventions aimed at
developing staff confidence and competence in empowering practices.