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Psychotherapy with persons with intellectual disabilities: a review of effectiveness research
- Authors:
- PROUT H. Thompson, BROWNING Brooke K.
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 5(5), 2011, pp.53-59.
- Publisher:
- Emerald
This review aims to provide an update on the effectiveness of psychotherapy with persons with intellectual disabilities. It summarises the conclusions of other reviews published in the last ten years, including a recent review by the authors. There is evidence that psychotherapy with persons with intellectual disabilities is at least moderately effective. There is also evidence of effectiveness of psychotherapy across child and adolescent and adult age groups. A range of therapeutic interventions are effective and a spectrum of problems can be addressed via psychotherapy. However the authors found relatively little relevant research literature and noted a lack of methodologically sound and rigorous studies. They suggest there is a need for well-designed studies, particularly randomised controlled trials, better specification of treatments (e.g. manualised), better outcome measures, and clearer specification of diagnostic categories within the intellectual disability population.
Commentary on “Narrative therapy groups for people with intellectual disability: a critical review of the literature
- Author:
- HAYDON-LAURELUT Mark Andrew
- Journal article citation:
- Tizard Learning Disability Review, 25(4), 2020, pp.223-227.
- Publisher:
- Emerald
Purpose: This paper is a commentary inspired by Laura McKenzie-Smith’s review paper. Design/methodology/approach: This commentary provides a personal perspective on the intersections of narrative practice and the support of people with a learning disability. Findings: This commentary highlights some further possibilities of narrative ideas beyond therapy. This paper explores examples of record keeping and research as sites for story construction about lives and identities. Research limitations/implications: This is a personal perspective of a systemic psychotherapist and academic working with people with a learning disability. Practical implications: This paper argues that the stories we tell ourselves and others about our work and the people we support are powerful in ways of which we may not always be aware. Social implications: In common with person-centred planning, narrative ideas highlight the power of the stories circulating about a person and their network and the implications they may have for their lives and identities. Originality/value: This commentary explores narrative practices beyond the context of therapy, highlighting organisational, administrative and research practices as story-constructing activities that co-create identities of persons with a learning disability, their networks of support and health and social care professionals. (Edited publisher abstract)
People with intellectual disabilities’ experiences of psychological therapy: a systematic review and meta-ethnography
- Authors:
- EVANS Lauren, RANDLE-PHILLPS Cathy
- Journal article citation:
- Journal of Intellectual Disabilities, 24(2), 2020, p.233–252.
- Publisher:
- Sage
- Place of publication:
- London
The effectiveness of a range of psychological models adapted for use with people with intellectual disabilities has been well documented. A number of studies have used qualitative methods to examine people with intellectual disabilities’ experiences of these adapted interventions. Such research is important for identifying service users’ views on the helpful and challenging aspects of psychological interventions to ensure that they meet the needs of people with intellectual disabilities. To consolidate this research, a systematic review using a meta-ethnographic approach was undertaken. A systematic search identified 16 relevant studies. These studies were reviewed, critically appraised and key themes were extracted. Five key concepts were identified: adapting to therapy, the therapeutic environment, group dynamics, the therapeutic relationship and the impact of therapy on life. The need for further consideration of power differentials within the therapeutic relationship and further adaptations to ensure accessibility of therapy for people with intellectual disabilities is discussed. (Publisher abstract)
Do levels of evidence affect breadth of service? A study on the use of clinical guidance in a learning disability service
- Authors:
- PATERAKI Eleni, MacMAHON Kenneth
- Journal article citation:
- British Journal of Learning Disabilities, 45(2), 2017, pp.121-128.
- Publisher:
- Wiley
Background: For services across the UK, increasing emphasis is placed on the use of evidence-based psychological treatments. In this context, the Scottish Government published the MATRIX, a best-practice clinical governance document, with a brief section on therapies for people with learning disabilities. As with most clinical guidelines, randomised controlled trials were considered the “gold standard.” However, within the learning disability field, the existing evidence base is relatively limited, resulting in a narrow guidance for services. Methods: This study evaluated the use of best-practice guidance (the MATRIX), in a psychology service for adults with learning disabilities, covering one of the largest NHS Boards in Scotland. A randomly selected 50% (N = 73) of case notes opened since October 2011 (publication date for the MATRIX) was reviewed. Eight case notes were second-rated by an independent clinician. Results: Findings showed that service users typically presented with multiple psychological difficulties, and clinicians offered a range of therapies additional to those suggested in the guidance. This was particularly evident in cases managed by clinical psychologists. Conclusions: Applying rigid therapeutic recommendations may limit opportunities for integrative practice. The potential impact of inflexibly adopting clinical guidelines on service planning and resources is discussed. (Publisher abstract)
Adapting compassion focused therapy for an adult with a learning disability: a case study
- Authors:
- COOPER Rosalind, FREARSON Julia
- Journal article citation:
- British Journal of Learning Disabilities, 45(2), 2017, pp.142-150.
- Publisher:
- Wiley
Background: Joe was referred to the Community Learning Disabilities Team (CLDT) for support around low mood and overeating. Initial formulation suggested compassion focused therapy (CFT) as an intervention. The evidence base for using CFT with people with learning disabilities is currently limited. Materials and Methods: Adaptations were made to the CFT framework, accounting for Joe's learning disability. A case study design was used to investigate the effectiveness of intervention. Joe attended 13 sessions of assessment, formulation and intervention. Client feedback was incorporated to assess suitability of the CFT approach and adaptations made. Results and Conclusions: Changes in scores on outcome measures were limited. However, findings from this exploratory study suggest that CFT can be meaningfully adapted for use within the field of learning disabilities. Implications for clinical practice and directions for future research are discussed. (Publisher abstract)
‘I don't feel trapped anymore…I feel like a bird’: people with learning disabilities' experience of psychological therapy
- Authors:
- LEWIS Nicola, LEWIS Karin, DAVIES Bronwen
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 29(5), 2016, pp.445-454.
- Publisher:
- Wiley
Background: This current research was developed in response to a clinical psychology service recognising the need to evaluate their psychological service for and, as part of this evaluation, the importance of consulting with service users about their experience of psychological therapies. Methods: Six service users with a learning disability were interviewed about their experience of individual psychological therapy. The interviews were analysed using interpretative phenomenological analysis. Results: Themes were generated from the interviews which highlighted both positive and negative feedback on the psychological therapy process. The feedback covered areas such as access to therapy, feelings about therapy, preparing for therapy, skill development and collaborative working, accessibility and making therapy fun, challenges to confidentiality, positive feelings towards the therapist, aspects of the therapeutic relationship, therapy being challenging but helpful, and positive outcomes. Conclusions: These results have contributed to the evidence base that people with a learning disability are able to meaningfully engage in research and provide essential feedback on the services that they receive. (Edited publisher abstract)
Therapeutic relationships with individuals with learning disabilities: a qualitative study of the counselling psychologists' experience
- Author:
- JONES Rachel Ann
- Journal article citation:
- British Journal of Learning Disabilities, 42(3), 2014, pp.193-203.
- Publisher:
- Wiley
The therapeutic relationship, between client and therapist, is seen as a fundamental aspect in the outcome of therapy in the nonlearning disabled population. Literature suggests that the issues that are important in psychological therapy with the nonlearning disabled population should not lose significance with individuals with learning disabilities. Despite this, there exists a poor empirical and theoretical understanding of the complexities of the therapeutic relationship, when the individual has a learning disability. As a discipline, Counselling Psychology has a particular interest and skill base in understanding the therapeutic relationship and is therefore in a position to offer a valuable contribution to understanding the therapeutic relationship when an individual has a learning disability. Through eight semi-structured interviews, counselling psychologists currently working with individuals with learning disabilities were asked to share their experiences and understanding of the nature and role of the therapeutic relationship. A qualitative methodology guided by interpretative phenomenological analysis (IPA) enabled detailed exploration of the counselling psychologists' perspective. Themes emerged identifying the therapeutic relationship as fundamental yet difficult due to variables such as the client's experience in relationships, the need for multiple relationships, the experience of needing to facilitate reassurance and the necessary skills for therapeutic approaches. Themes also emerged relating to therapist's motivations, values and needs when working with this client group and tensions concerning individualisation and the setting culture. The themes are discussed in relation to the existing literature and implications for theory and practice are explored. (Publisher abstract)
Do persons with intellectual disability and limited verbal capacities respond to trauma treatment?
- Authors:
- MEVISSEN Lisebeth, et al
- Journal article citation:
- Journal of Intellectual and Developmental Disability, 36(4), December 2011, pp.278-283.
- Publisher:
- Taylor and Francis
People with intellectual disability have been found to be more likely to experience traumatic events and negative life events. This study aimed to examine whether eye movement desensitisation and reprocessing (an eight-phase psychotherapeutic approach) would be an applicable and effective treatment method for clients with substantial limited verbal capacities. It focused on 2 clients with moderate intellectual disabilities, serious behavioural problems, and histories of negative life events. The article provides a description of the 2 clients and a summary of the results of their treatment. In both cases, post-traumatic stress disorder-like symptoms decreased and gains were maintained at follow-up. The authors conclude the study suggests that eye movement desensitisation and reprocessing is a potentially applicable psychotherapeutic treatment method for clients with intellectual disabilities, even if they have substantially limited verbal capacities. They note that the findings highlight the need for further research.
An exploratory study of the defence mechanisms used in psychotherapy by adults who have intellectual disabilities
- Authors:
- NEWMAN D. W, BEAIL N.
- Journal article citation:
- Journal of Intellectual Disability Research, 54(7), July 2010, pp.579-583.
- Publisher:
- Wiley
An important concept in psychodynamic theory and practice is that of defence mechanisms; mental operations that remove components of uncomfortable affects from conscious awareness. The identification of defences is a primary task for the therapist who then uses them in the formulation of their interventions. Work with adults who have intellectual disabilities (IDs) suggests that they use primitive defences. This hypothesis is tested in a case series analysis of the defences used in therapy by adults who have IDs. Transcripts of psychotherapy sessions with eight adults with mild IDs (two men, six women, age range 20-40, IQ 45-65) were evaluated using the defence mechanism rating scale (DMRS). Contrary to expectation the participants use a wide range of defences from primitive to mature. There was evidence suggesting the development of a defensive style, but little evidence to show change in defensive structure across the first eight sessions of treatment. This exploratory study suggests that adults who have IDs use a range of defences in psychotherapy and have particular defensive styles. Further work with more participants and a longer time frame is recommended. The findings also indicate that the DMRS may need development work to make it a more sensitive and valid measure of the full range of defences used by people with IDs.
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.