Acting as if FC Works

In a previous blog post, I wrote about Facilitated Communication (FC) and Ouija. From some of the feedback we got, I am guessing this may be a sore spot for believers unwilling or unable to accept the fact that facilitator behavior plays an integral role in making FC “work” and that these behaviors (as a form of automatic writing) are well documented. I am, btw, not the first person to notice the similarities, nor will I be the last.  (See Andersen, et. al., 2018; Heinzen, et. al., 2015).

The Boston Planchette first made in Boston in 1860. For sale by G.W. Cottrell, 36 Cornell, Boston. (Source: American Broadsides and Ephemera, Series 1; circa 1860)

In 1990, Douglas Biklen, founder of the Facilitated Communication Institute at Syracuse University (now “Inclusion and Communication Initiatives”) was aware of FC and its association with Ouija. He wrote in his article Communication Unbound: Autism and Praxis:

The behaviors of people labeled autistic are often unusual and appear to reflect lack of attention and/or awareness of social and communication cues and/or severe intellectual disabilities. Perhaps it is such behaviors, including the on-again, off-again ability or willingness of students to communicate, that cause some people to worry that facilitated communication is no more real than a Ouija board.

Not only did Biklen fail to do his due diligence by taking a step back and ruling out facilitator influence he moved forward in his promotion of FC under the “presumption” that it worked.

It should be noted here that problems of facilitator cuing were raised not just by critics of FC but by parents and educators who wanted to believe in the technique. Biklen essentially ignored, downplayed, or rationalized away their examples of facilitator cuing. (See blog post).

Critics were less concerned about the “on-again, off-again ability or willingness of students to communicate” using FC than they were about facilitator behavior during the typing activity.

Students who fail to participate during FC may do so for reasons not directly associated with their autism: they do not like or understand the activity, they do not wish to have their arm controlled by a facilitator, or they prefer independent forms of communication to FC (e.g., PECS, sign language, gestures, verbalizations). Their protestations can be viewed even in pro-FC documentaries (including Biklen’s 1991 training video, I AMN NOT AUTISTIV WHEN I TYP) where students scream, push their facilitators away, close their eyes, flee, hit, bite, and otherwise vocalize their discontent while the facilitators ignore their verbal and non-verbal communication. Facilitators, on the other hand, are often seen focused on the letter board, and providing physical, auditory, and visual cues while their clients physically and/or emotionally disengage.

By 1993, when his book Communication Unbound: How Facilitated Communication is Challenging Traditional Views of Autism and Ability/Disability was published, Biklen seemed convinced that facilitator control vanished after the initial (arguably more self-conscious) stages of learning to facilitate. His response to these concerns was to admonish his facilitators to be positive. He wrote:

This exhortation to be positive does not always meet with complete acceptance. Some people ask: How can you be sure? Why must one believe the student can communicate in order for facilitated communication to work? Well, of course, we cannot be sure it will work. But it is important to act as if we are sure. (p. 48, emphasis mine)

I cringed when I read this passage. For me, there is a double meaning here. Biklen, I think, was making a statement about presuming competence in students. But, consciously or not, I believe he was also signaling to current and potential facilitators to act as if FC itself worked, even when they were concerned that it did not.

Despite Biklen’s assertions that facilitator cuing effectively disappears with time, reliably controlled tests do not support this position. Even with a significant amount of training and experience with FC (e.g., weeks, months, years), facilitators still failed to demonstrate independent communication when tested under reliably controlled conditions. In other words, when facilitators are blinded to test protocols the facilitated messages are 1) unintelligible, 2) based on content that the facilitator knows, and/or 3) correctly spelled but unrelated to the content being tested. Research indicates that most facilitators, though well-meaning, are unaware of the extent to which they control the messages.

Diagram of how the ideomotor response influences letter selection. When the facilitator-client pair moves away from the desired letter “a,” the facilitator’s hand reflexively tenses to slow or inhibit movement. When the two move toward the desired letter “a,” the facilitator’s hand reflexively relaxes to enable movement in the “correct” direction.

I think it is possible that facilitators, when first learning FC, start off self-conscious and are, perhaps more aware of their individual contribution to the typing process (e.g., moving their client’s hand or the letter board in the air). In this stage, facilitators are more likely to notice times when they control letter selection and less likely to rationalize away incorrect answers. Over time, this self-consciousness decreases and their ability to facilitate becomes more fluid (like driving a car on “auto-pilot”). As a result, their awareness of their own actions diminishes and they are less likely to consciously “register” times when they actively cued their client.

Proponents report that FC works best when they trust the process and “let go.” In this, more fluid state, facilitators remember the “hits” (e.g., times when the messages seemed to confirm their beliefs) and forget the “misses” (e.g., times when the messages were incorrect or contained incongruous information). Not that any facilitator has succeeded to date, but my guess is that the more a person practices facilitation, the less likely they would be able to pass a reliably controlled test.

Many accounts from facilitators include a moment when FC seemed to “miraculously” start working. And it is this moment, I believe, that facilitators let go of doubt and psychologically buy into the idea that independent communication can be accomplished by building dependence on a facilitator. As Daniel Wegner suggests, believing that FC could work increases that chances that it will work. We have seen this happen time and time again. It is difficult to convince someone of FC’s deficiencies once they have passed this point.

Biklen provided extensive attitudinal and behavioral “guidelines” in his book, presumably to make his technique sound legitimate to potential facilitators. I think it is just as plausible that these guidelines help prime facilitators into thinking FC could work. The guidelines are heavy on “presuming competence”—which lays a bit of a guilt trip on facilitators if they do not succeed—and light on objective criteria to ensure independent communication. The guidelines, for example, do not address the fact that “independent” typing cannot be determined in uncontrolled settings when two people are involved with the activity. Visual, physical, and auditory cues all play a role in generating the words on the page. (Saloviita and Sariola, 2014)

Hopeful facilitators, for example, are likely to fail to recognize that FC success, even in the early stages of the practice, depends on them knowing the answers to set work (e.g., fill-in-the-blank) or other structured activities with predictable answers.

Facilitators are instructed to go back to set work if it appears FC is not working. Whether it be “cloze” activities or multiple choice, the facilitator is always aware of the correct answers (e.g., letters, words, pictures, symbols), is not blinded to concepts being taught, and is encouraged to take FC-generated responses at face value. At no time is the student required to demonstrate independent mastery of skills. Testing for competency (i.e., determining that the communication is free from facilitator control) is vehemently discouraged.

In addition, facilitators, while tasked with not influencing the communications, are encouraged to help their client “not make mistakes” by pulling the person back from incorrect or echoed selections. I wonder how facilitators can pull on their clients’ hands or shirt sleeves and think they are not influencing the communications?

The guidelines caution facilitators to “watch for poor muscle tone, shakiness/tremor, movement of the index finger to one side or another when pointing, tendency to hit keys next to the one desired, and other problems that may require support.”

Facilitators may not be aware of the extent to which they are “helping their clients not make mistakes” (i.e., providing cues). In one instance, facilitators may push or pull their clients’ hand toward a desired letter. Especially in the beginning stages of facilitation, they may notice this error and tell themselves that, while they moved the client’s hand this time, they will not next time.

“Overshooting of letters, ” on the other hand, may be less about poor muscle tone, as suggested in the guidelines, than the non-conscious muscle movements of the facilitator (e.g., the ideomotor effect). Without conscious intent, the facilitator reflexively tenses his or her hand when moving away from the desired letter and relaxes when moving toward it. As the desired letter is reached, the facilitator again tenses (to stop the momentum), which acts as a subtle cue to press that particular letter. Once the correct letter is selected, the facilitator relaxes, signaling that it is okay to hunt for the next letter. These impulses happen in a split second and tend to go undetected unless specifically controlling for it. (See Kezuka, 1997; Banachek, 2011).

Image by Kal Visuals

Biklen recommended videotaping FC sessions as an assessment tool for correcting facilitator technique and to learn about the (purported) unique styles of typing their students exhibited. In theory, this video analysis would be useful for facilitators interested in identifying visual, auditory, or physical cues that occur during FC sessions. Certainly, videotaping FC sessions with the intended purpose of openly addressing facilitator behaviors would be a great start. However, some cues may be difficult to detect with the naked eye, so videotaping FC sessions should not replace reliably controlled testing.

Videotaping the sessions may look good on paper, but In practice, it seems that facilitators’ desire to believe in FC interferes with their ability to admit on a conscious level even the most egregious cuing when it occurs on video.

I am guessing that seeing the cuing for facilitators (i.e., admitting that facilitator interference is integral to the typing activity) may lead them to not believe in the technique. For individuals invested in making FC work, that might be too emotionally risky. FC is, after all, the “technique of last resort.” Perhaps it is psychologically easier just to maintain a positive attitude and act as if it works, even when the weight of scientifically rigorous evidence says it does not.