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The balance of power in therapeutic interactions with individuals who have intellectual disabilities
- Authors:
- JAHODA Andrew, et al
- Journal article citation:
- British Journal of Clinical Psychology, 48(1), March 2009, pp.63-77.
- Publisher:
- Wiley
Establishing a collaborative relationship is a cornerstone of cognitive behavioural therapy (CBT). Increasingly CBT is being offered to people with intellectual disabilities who may have problems with receptive and expressive communication, and a history of disadvantage or discrimination in their relationships with those in positions of power. Consequently, they may have difficulty establishing a collaborative interaction with their therapist. This paper uses a novel method of interactional analysis to examine if collaboration increases as therapy progresses. Fifteen participants with borderline to mild intellectual disabilities and significant problems of depression, anxiety and anger were recruited from specialist clinical services to participate in this study. Verbatim transcripts of therapy sessions 4 and 9 were coded using an initiative-response method of analysing power distribution in dialogue, to investigate collaboration at the level of therapeutic interaction. The initiative response scores indicated that power was relatively equally distributed between clients and therapists. On this measure there was no significant increase in collaboration as therapy progressed, as the dialogues were relatively equal from session 4. Analyses of the pattern of interaction showed that whilst the therapists asked most questions, the clients contributed to the flow of the analysis and played an active part in dialogues. The implications of these findings are discussed, along with the possible uses of such interactional analyses in identifying barriers to communication and ways of establishing effective therapeutic dialogue.
Planning and support for people with intellectual disabilities: issues for case managers and other professionals
- Editors:
- BIGBY Christine, FYFFE Chris, OZANNE Elizabeth, (eds.)
- Publisher:
- Jessica Kingsley
- Publication year:
- 2007
- Pagination:
- 308p.
- Place of publication:
- London
The authors outline the skills needed and common issues in case management practice across a range of people with different disabilities at different stages of their life. Emphasising the importance of taking a rights-based approach to supporting people with learning disabilities, the authors argue that effective case management needs to be individualised and carried out in partnership with the individual and their family in order to draw up a lifestyle plan that meets their many needs, including employment, education, vocational training, therapy and behaviour support. The book includes chapters on inter-agency and cross-sector negotiation and collaboration, balancing rights and protection, listening to individuals and families, communication, optimising health outcomes, approaches to behaviour support, ethical decision-making and reflective supervision, and the text is complemented by case studies throughout.