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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)
IAPT and learning disabilities
- Authors:
- CHINN Deborah, et al
- Publisher:
- King's College London
- Publication year:
- 2014
- Pagination:
- 66
- Place of publication:
- London
This study explores the relationships between the Improving Access to Psychological Therapies (IAPT) programme in England and people with learning disabilities and the people and services that support these service users. It looks at the barriers and facilitators facing people with learning disabilities in accessing IAPT and at the strategies and practices that staff employ to support people with learning disabilities to make good use of IAPT services. It also considers what advances are needed at the level of individual staff capabilities, service delivery models, management, commissioning and policy development to ensure equitable access to IAPT for people with learning disabilities. Study findings were drawn from interviews with staff, service users and carers and a wider national online staff survey. They show that the IAPT programme as a whole has not adequately addressed access issues for people with learning disabilities. Some IAPT services exclude people with learning disabilities from the outset, by specifying eligibility criteria that rule them out. The report argues that IAPT services work best for people for learning disabilities when IAPT staff and learning disability staff have developed good working relationships and can co-ordinate their input. It suggests that claims to eligibility may be promoted in the following ways: clearer statements of inclusion in IAPT services for people with learning disabilities; recording systems that allow for monitoring of people with learning disabilities’ access to IAPT; training for qualification of therapists to include material on working with people with learning disabilities, where possible delivered with the involvement of people with learning disabilities; pathways for joint working between IAPT services and local specialist learning disability services; clear goals and targets regarding use of IAPT by people with learning disabilities specified by commissioners and funded appropriately. (Edited publisher abstract)
Telling our story: a narrative therapy approach to helping lesbian, gay, bisexual and transgender people with a learning disability identify and strengthen positive self-identity stories
- Authors:
- ELDERTON Anna, et al
- Journal article citation:
- British Journal of Learning Disabilities, 42(4), 2014, pp.301-307.
- Publisher:
- Wiley
Historically, and to a somewhat lesser extent presently, people with learning disabilities have had little or no voice in the stories other people (particularly professionals) tell about them and their lives. Four psychology workshops, based on a narrative therapy approach, were run for a group of people with learning disabilities who identify as lesbian, gay, bisexual or transgender (LGBT) who regularly attend a support group called ‘Mingle’. The workshops invited members to tell their stories, especially the parts not usually told. The aim was to support people to identify and strengthen positive self-identities. Workshops were facilitated by two trainee clinical psychologists within a Community Learning Disability Team (CLDT). (Publisher abstract)
Intellectual disability and mental health: is psychology prepared?
- Authors:
- RAZZA Nancy J., et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 8(6), 2014, pp.381-389.
- Publisher:
- Emerald
Purpose: The purpose of this paper is threefold: to document the relationship between intellectual disability (ID) and psychopathology; to raise awareness of the ongoing lag in professional training for psychologists in the area of mental health treatment for people with intellectual disabilities; and, to provide recommendations for advancing professional education and, ultimately, adequate mental health treatment availability for people with intellectual disabilities. Design/methodology/approach: The paper reviews the literature on prevalence of mental health problems in people with intellectual disabilities. At the same time, the paper reviews the training of psychologists relative to the burgeoning growth in awareness of the mental health needs of people with intellectual disabilities. Findings: The paper concludes that ID is a significant risk factor for psychopathology. In addition, the paper concludes that the education of psychologists regarding the mental health needs of people with intellectual disabilities is insufficient. The authors document the need for incorporating research and treatment advances related to intellectual disabilities and mental health into to the professional training of psychologists. The paper also describe the potential this training holds for improving both the lives of people with intellectual disabilities and the overall competence of psychologists. Practical implications: This paper provides a literature-based rationale for the need to include education in the mental health needs of people with intellectual disabilities into the general training of mental health professionals. In addition, it provides specific recommendations for how such training can be incorporated into graduate psychology programmes. (Edited publisher abstract)
A survey of experiences of abuse
- Author:
- HEWITT Olivia
- Journal article citation:
- Tizard Learning Disability Review, 19(3), 2014, pp.122-129.
- Publisher:
- Emerald
Purpose: Understanding the prevalence of abuse of people with learning disabilities allows for appropriate planning and service development. Understanding more about the type and frequency of abuse (and the perpetrators) facilitates prevention of abuse. The paper aims to discuss these issues. Design/methodology/approach: All clients allocated to a psychologist between 2009 and 2011 were included in this survey. The psychologist reported whether the client had experienced any abuse over their lifetime. Information regarding the type of abuse experienced, the relationship to the abuser, and the number of different episodes of abuse was recorded. Findings: Of the 695 clients in the survey 25 per cent had experienced abuse. Of this 25 per cent, 46 per cent were men and 54 per cent were women. In all, 23 per cent of the group who had experienced abuse were referred to the service as a direct result of abuse, whilst 77 per cent were referred for another reason. The most prevalent types of abuse were emotional (27 per cent), sexual (24 per cent), physical (20 per cent), and neglect (12 per cent). Originality/value: Prevalence rates within this study are broadly in line with the existing literature. However, differences included high levels of emotional abuse, and high frequency of abuse perpetrated by women, and by family members. Psychology services should routinely screen for abuse experiences and be alert to the possibility of abuse from female caregivers. (Edited publisher abstract)
The effectiveness of psychodynamic interventions for people with learning disabilities: a systematic review
- Authors:
- JAMES Chris W., STACEY James M.
- Journal article citation:
- Tizard Learning Disability Review, 19(1), 2014, pp.17-24.
- Publisher:
- Emerald
Purpose: Recent governmental policy has emphasised the need for greater choice and inclusion for people with learning disabilities. Accordingly, learning disabilities services are increasingly offering a greater choice of psychological interventions to people with learning disabilities. A growing body of research has examined the use of psychodynamic interventions for people with learning disabilities. The purpose of the this paper is to identify, outline, and evaluate research on the efficacy of psychodynamic approaches with people with learning disabilities and to consider the implications for clinical practice. Design/methodology/approach: A systematic search identified 13 relevant studies. A qualitative review of these studies was carried out. Findings: Overall, the reviewed studies offer some preliminary support for the use of psychodynamic approaches with people with learning disabilities. Research limitations/implications – A number of methodological issues are identified (particularly concerning the influence of extraneous variables and the generalisability of findings) and further, larger scale and more robust, research is required. Practical implications: Learning disabilities services should consider providing psychodynamic psychotherapy for people with a mild learning disability experiencing mental health, behavioural, and/or offending problems. Originality/value: This paper provides an up-to-date, comprehensive review of the literature on the efficacy of psychodynamic psychotherapy for people with a learning disability that will be of use to services providing therapeutic support to people with a learning disability and to people commissioning those services. (Publisher abstract)
Commentary on “The effectiveness of psychodynamic interventions for people with learning disabilities: a systematic review”
- Author:
- BROWN Hilary
- Journal article citation:
- Tizard Learning Disability Review, 19(1), 2014, pp.25-28.
- Publisher:
- Emerald
Purpose: This paper is a commentary on “The effectiveness of psychodynamic interventions for people with learning disabilities: a systematic review” by Chris James and James Stacey. The purpose of this paper is to illustrate the thesis that standardised ways of evaluating health care interventions may have the inadvertent effect of undermining the case that people with intellectual disabilities should be offered the same opportunities to address their emotional and mental health difficulties as other citizens. Design/methodology/approach: The commentary argues that while the evidence base focuses on the outcomes of orthodox one-to-one interventions, sometimes broader “contextual reformulation” and systemic interventions are called for. However, family- or service-based interventions tend not to feature in studies. Findings: The commentary illustrates these issues by discussing two case studies, which demonstrate how relational issues tend to be unhelpfully focused on the person with intellectual disabilities to the detriment of family members or direct care staff, who may be struggling to make sense of the person's behaviour or distress. Originality/value: The commentary supports the argument put forward in the longer paper and also argues for mental health services to be offered on a non-discriminatory basis to people with intellectual disabilities and to their family members. But it also suggests that one of the additional impacts of service level psychotherapeutic interventions is to re-establish respect for the work of direct care staff whose work is often presented as if it is little more than domestic drudgery when in fact it involves negotiating and responding to people and their issues with great sensitivity and balance. (Publisher abstract)
PTSD in adults with intellectual disabilities: stabilisation during inpatient stay
- Authors:
- TVETER Louise, HOEIDAL Siv Helene, KILDAHL Arvid Nikolai
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 8(4), 2014, pp.237-247.
- Publisher:
- Emerald
Purpose: This paper describes and discusses interventions of stabilisation of emotions and behaviour in adults with post-traumatic stress disorder (PTSD). Design/methodology/approach: The study investigates interventions of stabilisation in persons with more severe intellectual disability; i.e. persons with moderate or severe intellectual disabilities. Five patients in a specialised psychiatric inpatient unit for patients with intellectual disabilities were included. Information about treatment of the patients was collected through case files, observations, and interviews. The authors of this paper followed a training programme for trauma therapists in addition to the inpatient treatment of the five patients. Findings: Six main areas of stabilisation of emotions and behaviour were identified: validation, anxiety relief, treatment of depressed mood, increased mastering of daily activities, protection against anxiety triggers, and facilitated staff communication. Protection from anxiety triggers seems to be a core element of milieu therapy interventions. Interventions for neurotypical PTSD patients, such as exposure therapy may be contraindicated for patients with more severe intellectual disabilities. Originality/value: Research on interventions of stabilisation towards adults with more severe intellectual disabilities is still in its infancy. The case reports may help milieu therapists to facilitate interventions towards patients with moderate or severe intellectual disabilities. (Edited publisher abstract)