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Service user views of long-term individual psychodynamic psychotherapy
- Authors:
- MERRIMAN Charlotte, BEAIL Nigel
- Journal article citation:
- Advances in Mental Health and Learning Disabilities, 3(2), June 2009, pp.42-47.
- Publisher:
- Emerald
Long-term psychodynamic psychotherapy is a costly service to provide, but many clinicians believe it is of benefit for people who have learning disabilities and psychological problems. There is also now some evidence for its effectiveness. However, the views of recipients is unknown. In this study, recipients of more than two years of psychodynamic psychotherapy were interviewed about their experiences and views. Themes emerged about the referral process, the experience and the outcome. Areas of strength were identified, as well as areas for improvement. The findings concur with previous findings on group therapy and help inform current and future provision of long-term psychodynamic psychotherapy.
Empathy and theory of mind in offenders with intellectual disability
- Authors:
- PROCTOR Tracey, BEAIL Nigel
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 32(2), June 2007, pp.82-93.
- Publisher:
- Taylor and Francis
Little research has been carried out on empathy and theory of mind in offenders with intellectual disability (ID) and these concepts are often poorly defined. Various models of empathy and theory of mind are discussed and scores on 2 empathy and 3 theory of mind tasks are compared for 25 offenders with ID and 25 non-offenders with ID (all male). Differences were found in empathy and theory of mind performance of offenders and non-offenders with ID. Offenders performed better than non-offenders on a second order theory of mind task and on emotion recognition. They required fewer prompts to mention emotions, and gave empathic/caring responses more often than non-offenders when observing happiness (but not sadness or anger). Results suggest that offenders with ID may have better, rather than poorer, empathy and theory of mind abilities than non-offenders, and that empathy training is therefore not indicated for this group.
Evaluation of a psychodynamic psychotherapy service for adults with intellectual disabilities: rationale, design and preliminary outcome data
- Authors:
- BEAIL Nigel, WARDEN Sharon
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 9(3), 1996, pp.223-228.
- Publisher:
- Wiley
The debate concerning the provision of psychotherapy services for people with intellectual disabilities has moved on from issues of 'relevance' through 'equity' to the current issue of 'effectiveness'. The latter is hard to prove from the available research and clinical literature. Reports on preliminary results from an evaluation of a psychodynamic psychotherapy service for adults with intellectual disabilities. Presents the rationale and design, including details of process and outcome measures, and preliminary results. Issues concerning operationalisation of such a study in normal clinical practice are discussed.
The use of mechanical restraint with people who engage in severe self-injurious behaviour: impact on support staff
- Authors:
- BETHEL Nichola, BEAIL Nigel
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 7(5), 2013, pp.312-318.
- Publisher:
- Emerald
Purpose: There continues to be a small group of people who have intellectual disabilities who need some form of restraint in their support plan due to their self-injurious behaviour. The mechanical restraint restricts their freedom of movement to help prevent injury. Despite the growing literature on the use of such devices, there is very limited literature looking at the impact the use of mechanical restraints has upon service users and support staff using them. The aim of this study was to ascertain the experiences of support staff who apply the restraints to the people they support. Design/methodology/approach – Qualitative methodology was utilised. A semi-structured interview was conducted with nine support workers who: directly worked with a client with intellectual disabilities who engage in self-injurious behaviours; followed positive behavioural support plans developed with a multi-disciplinary team; applied restraints as a response to severe self-injurious behaviours to prevent harm; and they had to have been directly involved in the application and removal of the mechanical restraints in the last week. Content analysis utilising emergent coding was used to analyse the data. Findings: All participants described using mechanical restraints as having a negative impact upon them. Participants said they manage the negative impact by reframing, inhibiting their emotions, following support plans closely and gaining support from other staff. Participants described concerns and unmet needs regarding whether they were applying the restraints correctly, the responsibility of teaching others to use restraints, not feeling prepared on starting their current job and that the impact/concerns of using restraints is not talked about. Recommendations for practice are made. Originality/value: This is the first study to explore the views of care staff who are required to use mechanical restraint. It provides insight on the impact of this on them. (Publisher abstract)
Assessing components of empathy in sex-offenders with intellectual disabilities
- Authors:
- RALFS Sonya, BEAIL Nigel
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 25(1), January 2012, pp.50-59.
- Publisher:
- Wiley
Aiming to examine empathy in sex offenders with intellectual disabilities because of a lack of previous research, this study focused on the components outlined in the 4 stage process model of empathy (emotion recognition, perspective taking, emotion replication, and response decision). 21 male sex offenders with intellectual and developmental disability and 21 male non-offenders with intellectual disabilities completed the Test of Emotional Perception, and the responses were compared. The study found that there were no significant differences between the 2 groups across the components of empathy, but that sex offenders who had received treatment performed better on tasks of emotion recognition, emotion replication and response decision than the non-offenders. The authors conclude that further research is needed to understand empathy in sex offenders with intellectual disabilities.
Self-harm among people with intellectual disabilities living in secure service provision: a qualitative exploration
- Authors:
- BROWN Jessica, BEAIL Nigel
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 22(6), November 2009, pp.503-513.
- Publisher:
- Wiley
This study explored the experiences and understanding of self-harm among people with intellectual disabilities living in secure accommodation. Interventions associated with this behaviour were also explored. Semi-structured interviews were carried out with nine people who self harm, had intellectual disabilities and had been placed in secure accommodation. Interpretative Phenomenological Analysis yielded three master themes. The first related to the interpersonal context of self-harm and included sub themes relating to past experiences of abuse and loss, and current issues of control and protection. The second master theme related to the emotional experience of self-harm, which varied throughout the process of self-harm and was characterized by anger, frustration, hopelessness, relief, guilt and regret. The third master theme related to the management of self-harm. Participants had experience of helpful individual and collaborative strategies, as well as interventions that were experienced as controlling, unhelpful or ridiculing. The emerging themes are considered in relation to the wider-self-harm literature and current psychotherapeutic models. A number of limitations to the study are noted and the use of this methodology with people with intellectual disabilities was discussed.
The experience of detention under the Mental Health Act (1983)
- Authors:
- McNALLY Carolyn, BEAIL Nigel, KELLETT Stephen
- Journal article citation:
- Advances in Mental Health and Learning Disabilities, 1(4), December 2007, pp.47-53.
- Publisher:
- Emerald
This study explored the experiences of detention under the Mental Health Act (1983) of people with learning disabilities. Seven semi-structured one-to-one interviews were analysed using interpretative phenomenological analysis. Participants had mild learning disabilities and had been detained under the Mental Health Act in England for compulsory assessment and treatment within a two-year period prior to the study. A number of valuable insights emerged, including: the impact of perceived lack of control over self, experiences of vulnerability/powerlessness/victimisation (both prior to and following detention), participant's sense of care versus punishment; the development of 'role' within the mental health system and attribution of blame.
The dose-effect relationship in psychodynamic psychotherapy with people with intellectual disabilities
- Authors:
- BEAIL Nigel, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 20(5), September 2007, pp.448-454.
- Publisher:
- Wiley
Although there is an established body of evidence attesting to the dose–effect relationship in psychotherapy with non-disabled adults, the issue as to whether such a relationship exists for persons with intellectual disabilities has not been previously examined. Dose–effect essentially concerns the amount of psychotherapy required to produce positive results. The current study used a naturalistic design to examine and compare the outcomes of three groups of participants with co-morbid psychological problems undergoing treatments of differing lengths (i.e. ‘doses’) with psychodynamic psychotherapy. Three measures of psychopathology were completed at assessment and at subsequent eight-session intervals until the conclusion of treatment. Each patient received a 3-month follow-up appointment, at which time the measures were again completed. Three treatment duration groups were subsequently constructed and compared via anova: eight sessions (n = 8), 16 sessions (n = 5) and 24 plus sessions (n = 7). Results were supportive of a dose–effect relationship, in that outcomes were generally equivalent regardless of treatment duration. It is concluded that most change appears to occur in the first eight sessions of treatment, with subsequent outcomes trailing off over time. The clinical implications of the study are discussed in the context of the methodological limitations identified.
Naturalistic evaluation of the effectiveness of psychodynamic psychotherapy with adults with intellectual disabilities
- Authors:
- BEAIL Nigel, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 18(3), September 2005, pp.245-251.
- Publisher:
- Wiley
This study used an open trial design with a 3-month follow-up period. Widely available and used psychotherapy outcome measures were adopted, but administered in an assisted completion format at intake, outcome and follow-up. Data were collected on teh completed treatment and follow-up for 20 people. Data were analyzed using repeated measures ANOVA. Effect sizes were also computed. The results show statistically significant reductions in recipients' levels of psychological distress and interpersonal problems and an increase in self-esteem. Effect sizes were modest to large. The study shows that adults with intellectual disabilities can benefit from individual psychotherapy provided in routine clinical practice. The method has obvious limitations because of its uncontrolled, open trial design. However, the study had a recipient group that represents the client population and thus has greater generalisability to clinical practice. This study also provides some suggestions for routine audit and evaluation exercises and more rigorous designs.
Learning disability: experience of diagnosis
- Authors:
- KENYON Elinor, BEAIL Nigel, JACKSON Tom
- Journal article citation:
- British Journal of Learning Disabilities, 42(4), 2014, pp.257-263.
- Publisher:
- Wiley
Studies have focused on the experience of diagnosis from the perspectives of parents of children with learning disabilities, but there has been limited methodologically rigorous investigation into the experience for the person themselves. Eight participants were recruited from a range of different backgrounds. Interviews were analysed using interpretive phenomenological analysis. Three main themes emerged. The first concerned awareness of difference. Participants described becoming aware of an unwanted difference at school. Adolescence appeared as a time when an increased understanding of disability developed. In the second theme of ‘the relationship with nondisabled others’, participants described their opinions on labelling and their perspectives on how others viewed them. The final theme explored coping responses to stigma. (Publisher abstract)