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The use of Intensive Interaction within a Positive Behavioural Support framework
- Authors:
- McKIM Jules, SAMUEL Judith
- Journal article citation:
- British Journal of Learning Disabilities, 49(2), 2021, pp.129-137.
- Publisher:
- Wiley
Background: Positive Behavioural Support (PBS) provides an overarching framework for supporting quality-of-life improvements for people who use challenging behaviour. Rapport, or the lack of it, is well understood as a setting factor for some challenging behaviours. Intensive Interaction is an approach that, among other possible outcomes, can develop rapport and feelings of safety, security and connection. Method: Within an NHS Trust, the Intensive Interaction Service works in partnership with the Intensive Support Team. We present case descriptions of people who used challenging behaviour and received Intensive Interaction support. Changes are described using staff and family interview data. The Intensive Interaction techniques that helped develop rapport at each PBS phase are described. Results: Intensive Interaction was used in all PBS phases. It played a role in preventing placement breakdown for one individual. Conclusion: Intensive Interaction should be considered at initial assessment within PBS so that immediate and important improvements can be made to the person's social and communication experience. It is hoped that Intensive Support Services and all PBS practitioners will use it. (Edited publisher abstract)
Talking about real-life events: an investigation into the ability of people with intellectual disabilities to make links between their beliefs and emotions within dialogue
- Authors:
- HEBBLETHWAITE Amy, JAHODA Andrew, DAGNAN Dave
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 24(6), November 2011, pp.543-553.
- Publisher:
- Wiley
This study explored how adults with mild-moderate intellectual disabilities talk about emotive real-life experiences and whether they identify and make links between events, beliefs and emotions within their narratives. A cognitive-emotive interview was used to assist 19 adults with intellectual disabilities from the west of Scotland and 19 adults without disabilities to generate an account of an emotive, interpersonal event. Participants (mean age 42-43 years, 23 women in total) also completed a cognitive mediation task and an assessment of intellectual and verbal ability. Between-group analyses indicated that participants with intellectual disabilities scored significantly lower than those without disabilities on the cognitive-emotive interview and the cognitive mediation task. Participants with intellectual disabilities generated fewer beliefs within their dialogues and were less likely to provide alternative perspectives on events. Within-group comparisons showed no significant association between the ability to talk about events, beliefs and emotions within a dialogue and performance on a cognitive mediation task, or with Full Scale or Verbal IQ scores. The authors conclude that because participants with intellectual disabilities had more difficulties in talking about events, beliefs and emotions they are likely to require assistance to reflect on events and consider alternative interpretations, which take into account individual and environmental factors.
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.
Do people with intellectual disabilities and psychosis have the cognitive skills required to undertake cognitive behavioural therapy?
- Authors:
- OATHAMSHAW Stephen C., HADDOCK Gillian
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 19(1), March 2006, pp.35-46.
- Publisher:
- Wiley
Cognitive skills thought to be necessary to undertake cognitive–behavioural therapy (CBT) include the ability to recognize emotions, link events and emotions, and recognize cognitive mediation. These skills have been assessed in people with intellectual disabilities, but not in those who also have psychosis. Tasks assessing receptive language ability and cognitive skills including the ability to differentiate between behaviours, thoughts and feelings were administered to 50 participants who had intellectual disabilities and psychosis. The majority of participants were able to link events and emotions and differentiate behaviours and feelings. Participants found any task involving cognitions significantly more difficult. Performance on recognizing emotions, linking events and emotions and on some of the cognitive mediation and differentiation tasks was associated with receptive language ability. The study concludes that people with intellectual disabilities and psychosis have some of the skills thought to be required to undertake cognitive behaviour therapy. Recognizing cognitions and cognitive mediation is particularly challenging. The differentiation task introduced in this study may usefully supplement existing assessments.