Search results for ‘Subject term:"learning disabilities"’ Sort:
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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)
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)
Psychological interventions for anger and aggression in people with intellectual disabilities in forensic services
- Author:
- BROWNE Claire
- Journal article citation:
- Aggression and Violent Behavior, 39, 2018, pp.1-14.
- Publisher:
- Elsevier
This systemic review investigates the current evidence for the effectiveness of anger and/or aggression interventions for people with intellectual disabilities (ID) in receipt of forensic mental health services. Due to the prevalence within this population of difficulties with anger and aggression, and the associated substantial individual and societal consequences, the provision of psychological interventions has become increasingly common. However, no critical synthesis of the empirical evidence relating to their effectiveness has previously been conducted. Sixteen peer-reviewed controlled trials or case series designs published between 2001 and 2016 met the inclusion criteria. The results highlight an emerging evidence base for the use of CBT in improving anger regulation, and for a range of psychological therapies in reducing aggressive behaviour. However, consistent methodological shortcomings limit the generalisability of findings and currently preclude firm conclusions on effectiveness. Recommendations are made for future research to address these shortcomings, including clearly-defined adaptations, adequately powered sample sizes, carefully designed baselines and follow-up periods. Despite the current status of evidence, the review provides an accessible and objective foundation to inform decision-making by service commissioners and clinicians providing anger and aggression interventions to people with ID. (Publisher abstract)
Improving access to psychological therapies for people with intellectual disabilities – role of a reference group in achieving change
- Authors:
- DODD Karen, et al
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 11(5/6), 2017, pp.173-186.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to explore the importance of equal access to Improving Access to Psychological Therapies (IAPT) for people with intellectual disabilities. Design/methodology/approach: The paper identifies barriers to access and shows how a reference group can work to solve the barriers and increase access. Findings: The paper evaluates the authors’ progress to date and how the authors plan to continue to take the work forward. Practical implications: The paper highlights some of the factors responsible for the authors’ success and gives information that will be helpful to other areas who are interested in facilitating equal access. Originality/value: The paper demonstrates how the focus of a reference group can drive improvements across services to improve access for people with intellectual disabilities to IAPT services. (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)
The therapeutic process with children with learning disorders
- Author:
- PALOMBO Joseph
- Journal article citation:
- Psychoanalytic Social Work, 8(3/4), 2001, pp.143-168.
- Publisher:
- Taylor and Francis
Clinicians who work with children and adolescents with learning disorders must be aware of the relationships between the learning disorder and the psychopathology the children present. This article offers a conceptual framework, abused on psychoanalytic self psychology, to understand the modifications that are necessary in the treatment of this population. The author suggests that, in contrast to other approaches, it is not possible to conceptualise the treatment of these children as having a beginning, a middle, and an end. Rather, the therapeutic process is open-ended and conceived as occurring during a series of moments. The moments may be categorised as concordant, complementary, or disjunctive. During concordant moments a holding environment is created: during complementary moments the transference and countertransference is addressed; and during disjunctive moments the ruptures that inevitably occur during treatment are dealt with.
Exploring maintaining gains following therapy during the coronavirus pandemic with adults with an intellectual disability
- Authors:
- PURRINGTON Jack, NYE Arthur, BEAIL Nigel
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 15(6), 2021, pp.253-268.
- Publisher:
- Emerald
Purpose: The novel coronavirus and associated mitigation efforts have caused significant increases in stress for adults with intellectual disabilities. Such increases in life stress predict an increased risk of relapse following psychological therapy. This contributes to the high global disease burden of common mental health difficulties. Therefore, this paper aims to explore service user experiences of maintaining gains following therapy within the context of the Covid-19 pandemic. Design/methodology/approach: A mixed-methods evaluation was completed in a psychology service based in the North of England which specialises in supporting adults with intellectual disabilities. Descriptive statistics and effect size calculations were used to examine therapeutic outcomes pre-therapy, post-therapy, and at follow-up. These findings informed a framework analysis of eight semi-structured interviews. Findings: Overall, outcome results improved post-therapy and regressed at follow-up. The framework analysis revealed facilitators to maintenance include a recollection of specific aspects of therapy and the regular utilisation of strategies and resources. Conversely, barriers to maintenance include a recollection focussed on personal outcome, a reliance on social support and an inability to remember therapy. Originality/value: This is the only study to the authors’ knowledge examining service user experiences of maintaining gains following therapy within the context of Covid-19. It is hoped that these findings will inform further research and be useful for services in preparing service users for discharge as the Covid-19 pandemic continues and moves towards the post-pandemic phase. (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)