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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)
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)
Computer‐assisted cognitive behavioural therapy: the experiences of adults who have an intellectual disability and anxiety or depression
- Authors:
- COONEY Patricia, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 31(6), 2018, pp.1032-1045.
- Publisher:
- Wiley
Background: Despite its evidence base in the general population, computerized cognitive behavioural therapy (cCBT) has not yet been adapted for use with people with intellectual disability. This study aimed to explore the experiences of adults with an intellectual disability who played a cCBT programme. Method: Twenty‐four adults (with a mild or moderate intellectual disability and clinically significant anxiety or depression) who were in the treatment arm of a pilot randomized controlled trial evaluating the cCBT programme were individually interviewed. Thematic analysis was used to analyse and report themes within the data. Results: Participants found playing the programme to be an enjoyable and novel experience and that it was challenging and helpful. It allowed them to develop and reflect on relationships and increased their awareness of thoughts, feelings and behaviours. Conclusions: Combining technology with CBT is an effective way to reduce barriers to accessing mental health interventions and technology for this population. (Edited publisher abstract)
Adapted DBT programme for individuals with intellectual disabilities and problems managing emotions: staff awareness training
- Authors:
- ASHWORTH Sarah, MOONEY Paul, TULLY Ruth J.
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 10(3), 2016, pp.185-198.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to present the development and evaluation of an original training package for staff members on an awareness of an adapted Dialectical Behaviour Therapy programme, the “I Can Feel Good” programme (Ingamells and Morrissey, 2014) designed for individuals with intellectual disabilities (ID) and problems managing emotions. The quality and effectiveness of the training was assessed and is reported in this paper. Design/methodology/approach: The training was delivered for staff working with individuals with ID in a UK medium-secure psychiatric hospital and was attended by nursing staff. The workshop consisted of six modules: “Introduction to the programme”, “Mindfulness”, “Managing feelings”, “Coping in Crisis”, “People skills” and “Application and summary”. Level of self-reported knowledge, confidence and motivation regarding seven aspects of the training was measured by an evaluation questionnaire completed pre and post training. Findings: The results of this study showed that following the training there was a significant increase in self-reported knowledge, confidence and motivation regarding the seven aspects of the training. When perceptions of staff behaviours are observed, although in the right direction, this change was found not to be significant. Originality/value: This study highlights the potential for staff training to increase awareness of newly adapted therapeutic programmes for individuals with ID. The staff training may increase their ability and willingness to facilitate the running of such programmes and ability to support learning transfer in group members. (Publisher abstract)
IAPT practitioners’ experiences of providing therapy to people with intellectual disabilities
- Authors:
- SHANKLAND Jennifer, DAGNAN Dave
- Journal article citation:
- Advances in Mental Health and Intellectual Disabilities, 9(4), 2015, pp.206-214.
- Publisher:
- Emerald
Purpose:The purpose of this paper is to describe the views and experiences of Improving Access to Psychological Therapies (IAPT) practitioners in providing therapy to patients who have an intellectual disability in order to support IAPT services in increasing their capability in this area. Design/methodology/approach: An online survey was conducted of IAPT practitioners in four IAPT services in the north of England. The survey collected respondents demographic information and their experience, confidence and attitudes to working with people with intellectual disabilities. Qualitative responses regarding respondents attitudes, views of barriers, problems, successes and possible solutions to the delivery of therapy to people with intellectual disabilities within IAPT services were collected. The survey results were interpreted by thematic and statistical analysis. Findings: The majority of respondents report having worked with people with intellectual disabilities and identify the need to adapt therapy, but also believe that such therapy should be offered within mainstream services. Thematic analysis identifies the needs for support in training, therapy adaptation and adjustment to pathways. However, the majority of respondents could identify positive outcomes and experiences. Research limitations/implications: This data supports the further development of pathways and offers some broad frameworks for the focus of training and development work for people with intellectual disabilities within IAPT. Social implications: This project has identified a positive attitude and willingness to consider adaptation of therapy for people with intellectual disabilities in practitioners working within IAPT services. Originality/value: Until now the views and experiences of IAPT practitioners in working with this patient group were relatively unknown. (Publisher abstract)
Children and young people with intellectual disability in residential childcare: prevalence of mental health disorders and therapeutic interventions
- Authors:
- AGUILA-OTERO Alba, et al
- Journal article citation:
- International Journal of Social Welfare, 27(4), 2018, pp.337-347.
- Publisher:
- Wiley
Children with intellectual disability are more likely to suffer abuse and neglect. Therefore, they are over‐represented among children in childcare interventions, particularly in residential childcare. The main goal of this article was to explore the correlates of mental health diseases in a sample of 169 children (6–18 years old) in residential care with intellectual disability compared with a group of 625 children, also in residential care but without disability. Results show that the prevalence of intellectual disability in residential childcare in Spain is about 19%, which is significant due to their special needs. In addition to this disability, they have a higher frequency of clinical problems in the scales of withdrawal‐depression, thought problems, attention problems and, above all, social problems than do their peers in residential care. They are also referred more frequently to therapeutic services, in particular to psychiatric intervention and they receive more pharmacological treatments.337-347
The effects of social and therapeutic horticulture on aspects of social behaviour
- Authors:
- SEMPIK Joe, RICKHUSS Cathy, BEESTON Alex
- Journal article citation:
- British Journal of Occupational Therapy, 77(6), 2014, pp.313-319.
- Publisher:
- Sage
Introduction: Social and therapeutic horticulture has been shown to be a useful intervention for a wide range of vulnerable groups, including those with a mental health problem and/or learning or physical disabilities. However, there is still a need for additional research that examines evidence of its effectiveness. Method: This study analysed scores in four areas (social interaction, communication, motivation, and task engagement) collected as part of routine assessment during a programme of social and therapeutic horticulture. The sample comprised a heterogeneous group of participants and included a range of vulnerable people, predominantly those with a learning disability or a mental health problem. Findings: Scores for social interaction were significantly higher after 90 days of participation. This effect appeared to be most evident in participants with a learning disability. Conclusion: Social and therapeutic horticulture provides the opportunity for social interaction. Increased scores relating to social interaction suggest that the programme was effective in promoting such interaction and that it may, therefore, promote social inclusion among vulnerable and isolated groups. (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)
Equine-facilitated learning for youths with severe emotional disorders: a quantitative and qualitative study
- Author:
- EWING Carrie A.
- Journal article citation:
- Child and Youth Care Forum, 36(1), February 2007, pp.59-72.
- Publisher:
- Springer
The present study quantitatively and qualitatively evaluated the effects of an alternative therapeutic learning method on youths with severe emotional disorders (SED). The youths participated in a nine-week equine-facilitated learning program. Very little research exists investigating the effectiveness of utilizing horses in the therapeutic learning process. The present study encompasses three years of research on a unique program hypothesized to enhance traditional therapy and facilitate the learning process for youths with special needs.