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Significant therapy events with clients with intellectual disabilities
- Authors:
- WILLS Sarah, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 12(5-6), 2018, pp.173-183.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore significant events in psychotherapy with clients with intellectual disabilities (IDs). Design/methodology/approach: Four therapy dyads, each consisting of one client and one therapist, were recruited. Following the brief structured recall procedure (Elliott and Shapiro, 1988), semi-structured interviews focused on helpful events in psychotherapy, using video of particular sessions as a stimulus to help prompt recall of that session. Findings: Using interpretative phenomenological analysis, five super-ordinate themes were identified: “The Uniqueness of the Therapeutic Relationship”; “Using adaptations to Express Emotions”; “Client Behaviour/Therapist Behaviour”; “Hope and Paternalism”; and “Meaning-Making”. The results provide additional evidence that significant therapy events occur for clients with IDs. Furthermore, the research enabled insights to be gained about the process of therapy for this client group and for exploration of therapeutic factors that may be involved in facilitating a significant therapy event. Research limitations/implications: This study highlights the need for therapists to work in such a way as to facilitate significant events in therapy. Whilst this study was a necessary first step, owing to the non-existence of research in this area, the sample size and qualitative design may limit any wider generalisation of the findings. Originality/value: Significant events have not previously been explored in psychotherapy with clients with IDs. This research could therefore make an important contribution to our understanding of the process of psychotherapy for this client group. (Publisher abstract)
“Is it because I’m gormless?” A commentary on “Narrative therapy in a learning disability context: a review”
- Author:
- OLSEN Angela
- Journal article citation:
- Tizard Learning Disability Review, 20(3), 2015, pp.130-133.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to reflect on “Narrative therapy in a learning disability context: a review”. Design/methodology/approach: This commentary reflects on the use of Narrative therapy and considers it in the wider context of assisting people with learning disabilities to develop self-understanding. The commentary makes connections between the use of Narrative therapy and narrative approaches to research reporting. Findings: The use of Narrative therapy can assist in the development of positive personal stories for individuals with learning disabilities. Case study research provides a useful reference point from which to develop future work. Reporting of case studies sometimes omits data that might be useful for others attempting to replicate findings. Originality/value: This paper highlights the need for authors to ensure that the “small details” are included in research reporting. A narrative approach, rich in detail of research participants might enable authors to tell a “thicker” story, thus improving generalisability. (Publisher abstract)
We can still feel good: evaluation of the I can feel good programme second edition in a low secure unit
- Authors:
- ASHWORTH Sarah, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 15(2-3), 2021, pp.33-45.
- Publisher:
- Emerald
Purpose: This paper aims to present the process of reviewing, adapting and evaluating, the second edition of the I Can Feel Good programme (Ashworth et al., 2018) and adapted DBT programme facilitated at a low-security psychiatric hospital for men with intellectual disability. Through the presentation of programme development, evaluation and revision, a more thorough and transparent understanding of the process involved can be disseminated. Design/methodology/approach: The programme lasted approximately 14 months and covered all four modules. N = 5, all-male, ages ranged between 23 and 57 years old. All detained under the MHA (1983) with a primary diagnosis of Mild ID with comorbid psychiatric diagnoses including mental illness, autism spectrum disorders and personality disorder. To evaluate routine effectiveness a pre-post comparison within groups design was used. A standardised GAS approach provided a template to score the degree to which identified goals were achieved over the intervention for participants. Findings: Wilcoxon signed-rank tests were used due to data not meeting parametric assumptions regarding normal distribution. Except for the mindfulness module, all modules saw pre to post programme psychometric results in the desired direction, evidencing skills acquisition. Coping in crisis and managing feelings modules outcomes neared statistical significance, with the module of people skills demonstrating statistical significance (p < 0.05). Originality/value: Upon examination of the results, it appears as though the second edition pilot programme, displayed initially promising results. The clinical and statistical aspects of the programme are explored, in the hope that clinicians may consider the programme’s application and utility within various clinical contexts, in addition to gaining insight into the process of programme development and refinement. (Edited publisher abstract)
An open trial of psychodynamic psychotherapy for people with mild-moderate intellectual disabilities with waiting list and follow up control
- Authors:
- SKELLY Allan, McGEEHAN Caoimhe, USHER Robert
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 12(5-6), 2018, pp.153-162.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to examine the outcome of psychodynamic psychotherapy for people with intellectual disabilities (ID), which has a limited but supportive evidence base. Design/methodology/approach: The study is a systematic open trial of flexible-length psychodynamic therapy offered in an urban community to 30 people with mild and moderate ID, presenting with significant emotional distress on the Psychological Therapies Outcome Scale for people with intellectual disabilities (PTOS-ID). Allocation to therapy was made according to an established stepped care approach according to need, and the mean number of sessions was 22.03 (range 7–47). Treatment fidelity was checked via notes review and cases excluded from analysis where there were other significant psychological interventions. Findings: On both self-report (PTOS-ID) and independent ratings (Health of the Nation Outcome Scales-Learning Disability (HoNOS-LD)) recipients of therapy: did not improve while waiting for therapy; improved significantly during therapy, with large pre–post effect sizes; and retained improvements at six-month follow-up. Research limitations/implications: While it is important to conduct further controlled trials, the findings provide support for previous studies. High rates of abuse and neglect were found in the sample, suggesting that more trauma-informed and relational approaches should be explored for this client group. Originality/value: No other study of this size has been completed which used dedicated standardised outcome measures, with this therapy type, with both waiting list and follow-up control and with account of model fidelity. (Publisher abstract)
Intellectual disabilities and ACT: feasibility of a photography-based values intervention
- Authors:
- BOULTON Natalie Elizabeth, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 12(1), 2018, pp.11-21.
- Publisher:
- Emerald
Purpose: There is limited evidence regarding clinical effectiveness of therapeutic interventions for people with intellectual disabilities (ID). Previous research has highlighted challenges regarding adaptation of Acceptance and Commitment Therapy (ACT) for people with ID. Central to ACT is a focus on living in congruence with individual core values. The concept of values is abstract and difficult for people with a limited verbal understanding to comprehend, and yet this approach holds much promise for people with ID. The paper aims to discuss these issues. Design/methodology/approach: The current study outlines the adaptations undertaken to facilitate making the concept of values more accessible to people with ID. It also explores the feasibility of the adapted approach to the values component. Findings: This trial has shown that it is possible to isolate a single component of ACT and adapt it for use with people with ID. The findings highlight the potential feasibility of a value-based approach for people with ID augmented through the use of participant-produced photography to enhance conceptual understanding of the values component of ACT. Research limitations/implications: Findings were reliant on self-report data, which may result in inaccurate reporting and may be influenced by social demands. Given the diverse and unique presentations of people with ID, the inclusion and exclusion criteria limits the extent to which the current findings may be generalised to people with ID more widely.Practical implications: Participant-produced photography may be directly applied to clinical practice, with implied benefits of improving access to, and meaningful engagement with psychological therapies for people with ID. Development of (and ability to articulate) a readily available and easily accessible values system, during times of adversity, represents a key implication arising from the current trial. Originality/value: The current study shows that people with intellectual disability can be helped to appreciate abstract concepts such as personal core values. It also shows the potential to work through the medium of personal photography to explore the feasibility of the adapted approach to the values component – potentially a logical preliminary step towards an ACT-ID evidence base. To the authors’ knowledge, this novel approach is the first of its kind in the ID literature. (Edited publisher abstract)
Working with persons with an intellectual disability: the transferential process between therapist and client and the systems they inhabit
- Authors:
- COTTER Padraig, HOLLWEY Sara, CARR Alan
- Journal article citation:
- Tizard Learning Disability Review, 22(3), 2017, pp.136-143.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to appraise “transference” and “countertransference” when working with people with intellectual disabilities (PWID). Design/methodology/approach: A review of the literature was conducted, followed by a discussion. Findings: No research articles were found. Potential reasons for this are discussed. Historical influence, complexity of the topic and resistance among professionals may be contributing factors. Despite this, these phenomena are important for several reasons. These include the high levels of trauma these clients experience; the manner in which they have been marginalised by mainstream society; the strong likelihood of PWID evoking difficult countertransference from therapists; and the myriad of coping mechanisms and defences that these clients may employ. Research limitations/implications: Research is needed to further current understanding of these issues. Practical implications: An awareness of these issues amongst practitioners and other key members of a PWID’s system is important. Originality/value: This is the first review and commentary on these issues. (Publisher abstract)
A systematic review of behavioral health interventions for sex offenders with intellectual disabilities
- Author:
- MAROTTA Phillip L.
- Journal article citation:
- Sexual Abuse a Journal of Research and Treatment, 29(2), 2017, pp.148-185.
- Publisher:
- Sage
This article reviews evaluation studies of programs designed to treat sex offenders with intellectual and developmental disabilities (IDD) published in peer-reviewed journals between 1994 and 2014. Eighteen treatment evaluation studies were identified from the United States, the United Kingdom, Australia, and New Zealand. Cognitive-behavioural treatments were the most commonly delivered treatment modality to sex offenders with IDD. Other less common treatments were dialectical behavioural therapy, problem solving therapy, mindfulness, and relapse prevention. No randomised controlled trials were identified. The most common designs were multiple case studies and pre- and post-treatment assessments with no control and repeated measures follow-up. Small sample sizes, no control groups, and wide variation in treatment length and follow-up time complicate the qualitative synthesis of study findings. Short follow-up times introduce the potential for bias in conclusions surrounding treatment efficacy for many of the studies reviewed in this analysis. The review concludes that overall quality of studies examining treatments for sex offenders with IDD is poor and requires further development before rendering firm conclusions about the effectiveness of interventions for this population. (Edited publisher abstract)
Community dialectical behaviour therapy for emotionally dysregulated adults with intellectual disabilities
- Authors:
- BAILLIE Aubrey, SLATER Sean
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 8(3), 2014, pp.165-173.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to reflexively examine the challenges of implementing a community dialectical behaviour therapy (DBT) service for adults with intellectual disabilities (ID) and describes the practical lessons learned about how to maximise the effectiveness of DBT with this client group. Design/methodology/approach: A brief overview of DBT is provided and reference is made to literature which highlights the potential benefits of providing a DBT service to clients with an ID. This is followed by a discussion of the clinical presentation of the clients receiving DBT in the service that is the focus of this case study. Using a reflexive approach, a detailed discussion follows of the challenges faced in implementing a community DBT service for the clients served. Findings: Solutions to a variety of challenges faced in four years of service delivery are described, key lessons learned are highlighted, together with issues meriting further research. Research limitations/implications: This case study and its implications are limited to community DBT services. Another limitation is that, although outcome data have been collected over the past two years, the dataset is not yet large enough to draw statistical conclusions. Practical implications: The paper describes adaptations to treatment structure and strategy which the authors believe are necessary to improve treatment outcomes in community DBT services for adults with ID. In particular, the practical experience suggests that a didactic approach to teaching DBT skills is not effective and should be replaced by the “community of learners” approach that involves the trainer contingently responding to client input. Pre-set lesson plans inhibit the trainers’ ability to respond contingently. Originality/value: The existing literature on providing a DBT service for people with an ID has principally focused on providing a rationale for providing this type of intervention, and on assessing outcomes. Given that this is still a relatively new type of provision for this client group, a detailed examination of process issues is called for. (Publisher abstract)
From “what do you do?” to “a leap of faith”: developing more effective indirect intervention for adults with learning disabilities
- Authors:
- LEWER Alix, HARDING Celia
- Journal article citation:
- Tizard Learning Disability Review, 18(2), 2013, pp.74-83.
- Publisher:
- Emerald
Purpose – The purpose of this paper is to analyse some of the factors which affect the implementation and outcomes of indirect intervention for people with learning disabilities in residential homes and day centres. Design/methodology/approach – Data were gathered through a series of semi-structured interviews which were transcribed and analysed according to the principles of grounded theory. In total, four carers/support workers and three speech and language therapists (SLTs) were interviewed. Findings – Analysis of the data indicated distinct areas where intervention breakdown could occur, some of which were within the SLTs' control and some of which were not. Originality/value – This paper builds on previous research to identify barriers to successful therapy outcomes and develops a way of looking at these barriers which can inform intervention planning and delivery. (Publisher abstract)
Science and pseudoscience in developmental disabilities: guidelines for social workers
- Authors:
- THYER Bruce A., PIGNOTTI Monica
- Journal article citation:
- Journal of Social Work in Disability and Rehabilitation, 9(2-3), April 2010, pp.110-129.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Individuals with a developmental disability can now be provided a variety of empirically supported treatments that have been shown to be useful in promoting educational attainments, social and vocational skills, self-care, and in reducing behavioural problems. Unfortunately, a large number of pseudoscientific or bogus therapies continue to be offered to this population and their families. This article reviews the characteristics of pseudoscientific and bogus treatments, and provides several examples of unsupported or harmful interventions offered by contemporary social workers and other human service professionals, to the detriment of people with disabilities. It examines pseudoscientific treatments such as animal-assisted therapies. In conclusion, the authors encourage social workers to identify pseudoscientific interventions and avoid providing these, in favour of using empirically supported treatments.