The purpose of this paper is to reflexively examine the challenges of implementing a community dialectical behaviour therapy (DBT) service for adults with intellectual…
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.
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.
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.
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.
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.
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.
THE first of the Islington Public Libraries, opened on September 21st, has proved a phenomenal success, and, at the same time, has thrown an interesting light on several modern theories in librarianship. It is, as our readers know, the fust of a system of five libraries, towards the erection of which Dr. Carnegie has given £40,000. The building itself is, as many librarians had an opportunity of judging at the “private view” described in our last number, of an exceedingly well‐lighted and attractive character. The arrangement and accommodation provided present several novel features. On the ground floor, opening from the Central Hall, is the Children's Lending Library and Reading Room. This is stocked with about 3,000 volumes for lending purposes, including French and German juvenile literature, and the reading room portion has seating accommodation for about a hundred children. A representative selection of children's magazines are displayed here, and there are special study‐tables for girls and boys equipped with suitable reference collections. A feature of this room is a striking dado of pictures illustrating scenes from English history, which goes far to make the room interesting and attractive.
THE scientist and philosopher will tell us that the mind of man cannot in a lifetime fully grasp and understand any one subject. Consequently it is unreasonable to expect that the librarian—who, in spite of popular belief, is but man—can have a complete understanding of every department of knowledge relative to his work. He must, in common with his fellows in other callings, content himself with a more or less general professional knowledge, and may specialize, if he be so disposed, in certain branches of that knowledge. The more restricted this particular knowledge is, the greater will be its value from a specialistic point of view.