Psychological therapies and interventions

Citation

(2013), "Psychological therapies and interventions", Advances in Mental Health and Intellectual Disabilities, Vol. 7 No. 5. https://doi.org/10.1108/AMHID-07-2013-0049

Psychological therapies and interventions

Article Type: Guest editorial From: Advances in Mental Health and Intellectual Disabilities, Volume 7, Issue 5

This special issue focuses on psychological therapies and interventions for people who have intellectual disabilities. One very satisfying development over the last 30 years has been an expansion in the range and type of therapies now available. However, provision is still patchy and what you get depends very much on where you live. It has taken a great deal of effort to challenge those who do not believe that a full range of psychological interventions should be available to people who have intellectual disabilities. There also continues to be a mind set around that has a very limited view on whom is suitable to engage in psychological therapy: especially the talking treatments. Whilst putting this issue together I saw that a paper had been published on a new “Suitability for psychotherapy scale” (Laaksonen et al., 2012). Intrigued I used the scale with a young person I was assessing for psychological therapy. A colleague who had already carried out a triage assessment felt the client's needs would be best met through psychodynamic psychotherapy. I carried out two assessment appointments and agreed with my colleague's recommendation. However, I then applied the suitability for psychotherapy scale which had seven dimensions and the young person was rated as unsuitable on all of them. Some of the constructs contained in the scale have been used in the past to affirm that people who have ID are not suitable for psychotherapy, for example, poor ego strength, poor capacity to reflect, lack of verbal fluency, etc. However, these difficulties have never proved a problem for those providing psychological therapies to children. We would not use such scales to assess a child's suitability for psychotherapy and I would similarly argue that such scales should have little relevance with adults who have intellectual disabilities.

In this issue Pat Frankish has agreed to her keynote speech given at the Joint Congress of the European Association for Mental Health in ID and IASSID SPIG in Challenging Behaviour and Mental Health to be published. Pat provides an account of the paradigm shift that has taken place over the last 30 years bringing about disability psychotherapy in the same way as child psychotherapy and adult psychotherapy. What is clear is that psychotherapy can, and is being made available and this is due to the acceptance that with adaptation most approaches can be effective in bringing about the same results as with the general population. Unfortunately, we are rather short of outcome data to support the clinical view. However, we have been short of approaches to evaluating change. In this issue Simon Hackett reports the use of the conflictual relationship theme method; a method initially developed for use with typically developing adults receiving psychotherapy. Here he shows how he has used the approach to evaluate art psychotherapy with offenders who have ID. Then Pat Frankish reports her work developing an approach to measuring the emotional development of adults with intellectual disabilities. Pat also suggests this approach be applied to evaluate change. Commissioners of services have also become concerned with service users’ views of the treatment they have received. In their paper Khan and Beail report a study using two scales to evaluate user views who have received psychological therapy. It is surprising there is so little reported on this but the result show high levels of satisfaction. They suggest the routine use of such approaches in services.

In the last special issue on psychotherapy I edited in 2009, Kellett et al (2009) described and illustrated the use of single case experiment designs to evaluate change. In this issue Kevin Wright reports a single case experimental design evaluation of a cognitive behavioural intervention with a man with ID and autism and social anxiety. The value of this approach is the clear presentation of information on change through graphs. Beail then reports a different approach, this time monitoring change in psychotherapy using the assimilation model. Previous research (Newman and Beail, 2005) has demonstrated that people who have ID often present with a poor understanding of their problem or in a state of denial. Thus they find it difficult to define what their problem is and it is difficult for the therapist to determine what the focus should be. Referring to my earlier point about the suitability scale, such a presentation contributes to unsuitability, however, Beail shows how psychodynamic psychotherapy can help a person with ID to explore what the problem might be and move toward an assimilation of their problems.

The final two papers concern staff training and staff experience. Dodd et al. describe the impact of a training programme for non-psychologists on using CBT skills in their work. This is an important area of work as we seek to improve access to psychological therapies and psychologically informed interventions for people who have ID. Finally, Bethel and Beail describe the impact on staff of applying mechanical restraints as a last resort in the management of severe self-injurious behaviour. This paper examines what it is like for staff working with service users who have care plans based on positive behavioural support principles, but due to their severe self-injurious behaviour require reactive strategies.

There are some new resources available. Robert Fletcher of the National Association for the Dually Diagnosed has published an edited selection of papers on “Psychotherapy for individuals with intellectual disability”. This book is reviewed in this edition. Taylor et al. (2013) have published “Psychological therapies for adults with intellectual disabilities”. Interestingly there is little overlap between the two volumes; they reflect developments either side of the Atlantic. What they do confirm along with the growing literature is that people who have intellectual disabilities are suitable recipients of a wide range of psychological therapies and interventions. Basically the needs of people who have ID are no different from anyone else's and, with adaptation; they can access the same range of interventions as anyone else.

Professor Nigel Beail
Consultant Clinical Psychologist based at South West Yorkshire Partnership NHS Foundation Trust, Barnsley, UK and University of Sheffield, Sheffield, UK

References

Fletcher, R.J. (Ed.) (2010), Psychotherapy for Individuals with Intellectual Disabilities, NADD Press, New York, NY

Laaksonen, M.A., Lindors, O., Knekt, P. and Aalberg, V. (2012), “Suitability for psychotherapy scale (SPS) and its reliability, validity, and prediction”, British Journal of Clinical Psychology, Vol. 51 No. 4, pp. 351-7

Kellett, S., Beail, N., Bush, A., Dyson, G. and Wilbram, M. (2009), “Single case experimental evaluations of psychodynamic and cognitive behavioural psychotherapy with people with learning disabilities”, Advances in Mental Health and Learning Disabilities, Vol. 3, pp. 36-44

Newman, D.W. and Beail, N. (2005), “An analysis of assimilation during psychotherapy with people who have mental retardation”, American Journal on Mental Retardation, Vol. 110 No. 5, pp. 359-65

Taylor, J.L., Lindsay, W.R., Hastings, R. and Hatton, C. (Eds) (2013), Psychological Therapies for People with Intellectual Disabilities, Wiley, Chichester