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Psychotherapies

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Psychotherapies & Learning Disabilities Developmental journey Experience of the family Life-long dependency on others Located within a complex system – PowerPoint PPT presentation

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Title: Psychotherapies


1
Psychotherapies Learning Disabilities
  • Developmental journey
  • Experience of the family
  • Life-long dependency on others
  • Located within a complex system
  • Managing consent issues measuring outcomes
  • Possible psychotherapeutic approaches
    adaptations

2
The Developmental Journey of an Individual with
Learning Disabilities
  • Early Development
  • Family relationships
  • Lifelong dependency/vulnerability
  • Mental health

3
Early Development
  • The quality and reciprocity of communication
    and physical contact with primary care-giver can
    be impaired, resulting in
  • Fragile emotional attachments
  • Impairment of symbol formation
  • Delayed development of self and object
    constancy
  • (Banks, 2003 Psychiatry, Vol 29)

4
Family relationships
  • the birth of a disabled child can be experienced
    by parents as a loss of the anticipated 'healthy'
    child (see also Lindsey, PSYCHIATRY 2003 29
    48). This bereavement can be a lifelong issue
    that becomes reinforced at various life stages
    and by the individual's inability to fulfil the
    'normal' expectations of our culture and society.
    Siblings may also be affected, experiencing
    difficult and conflicting emotions such as loss,
    resentment or guilt. (Banks, 2003 Psychiatry,
    Vol 29)

5
Lifelong dependency/vulnerability
  • People with learning disabilities, either out of
    necessity or because of the limited expectations
    of others, tend to be highly dependent on other
    people for care and protection they are also
    less able to deal with choices, problems and
    challenges. This makes them vulnerable, and it is
    well known that people with learning disabilities
    are more likely to be sexually abused. (Banks,
    2003 Psychiatry, Vol 29)

6
Mental health
  • the prevalence of psychiatric disorder in people
    with learning disabilities is higher than in the
    general population (see also Prasher, PSYCHIATRY
    2003 28 11) estimates range between 10 and
    39. In addition to defined disorders, there may
    be traits and symptoms (such as identity
    disturbance, problems with symbolization and
    concepts of reality) that are similar to poorly
    integrated or borderline personality disorders.
    (Banks, 2003 Psychiatry, Vol 29)

7
The Development of Defences
  • The handicapped smile (Sinason 2010) comes from
    loss and abuse and is a defensive way of dealing
    with trauma.
  • Sometimes the smile is to keep depressed parents
    happy, sometimes it is to prove that no
    intelligence is alive. (p.124)

8
Managing consent
  • CONSENT
  • Capacity to consent is determined by individuals
    being able to
  • understand information about the decision
  • remember that information
  • use that information as part of their
    decision-making process
  • communicate their decision by talking, using
    sign language or by any other means
  • It is often difficult to establish whether or not
    the person is making an informed choice about
    therapy, and we may only have a persons
    demeanour, mood, and willingness to remain in the
    room or to return to it, to go on.

9
Measuring outcomes
  • Adapted CORE
  • Outcomes chart

10
Psychotherapeutic approaches in learning
disabilities
  • Adapting traditional psychoanalytic methods has
    enabled considerable progress to be made, and a
    variety of related approaches are being
    developed. Sinason (1992) has written extensively
    in this area, with vivid illustrations of case
    material. She emphasized the significance of
    secondary handicap as a defence against the
    trauma of disability. Together with Hollins, she
    described issues that commonly arise with this
    patient group, which are too painful to address
    in everyday life, and thus assume the nature of
    taboo subjects or 'secrets
  • The disability or handicap itself
  • Dependency on others
  • Sexuality
  • Death
  • Fears of annihilation
  • (Banks, 2003 Psychiatry, Vol 29)

11
Adapting psychotherapeutic approaches
  • The therapeutic relationship the fundamental
    importance and efficacy of the therapeutic
    relationship is common to all psychological
    therapies. It is characterized by attentiveness,
    empathy, consistency, warmth and non-intrusive
    concern. People with learning disabilities whose
    early relationship experiences have been of
    rejection or lack of intimacy, and who expect to
    be devalued or disliked, may find it difficult to
    form a trusting treatment alliance. If the
    therapist takes the concept of 'analytic
    neutrality' too literally, they may be perceived
    as cold, rejecting or lacking in concern.
  • A greater degree of warmth and friendliness,
    combined with a more flexible approach to the
    timing of sessions and the use of physical touch,
    can help to establish a more positive and
    trusting relationship, although this may be at
    the expense of the patient's ability to express
    and process negative emotions in therapy.
  • (Banks, 2003 Psychiatry, Vol 29)

12
Adapting psychotherapeutic approaches
  • Communication it can take time to establish an
    effective communication style in therapy.
    Non-verbal communication and the use of
    adjunctive methods such as drawings, doll figures
    and picture books are emphasized art, music,
    play and drama therapies are particularly
    prominent. If difficulties in communication are
    experienced, it is important that silence can be
    both tolerated and used therapeutically.
  • (Banks, 2003 Psychiatry, Vol 29)

13
Possible psychotherapeutic approaches
  • Potentially, any approach that is used with
    the general population could be adapted for use
    with a person with a learning disability
  • Arts Therapies
  • Counselling
  • CBT
  • CAT
  • Eye-Movement Desensitisation and Reprocessing
  • Systemic work
  • Psycho-educational approaches CBT DBT-based
    work.

14
The Arts Therapies
  • The arts therapies represent an area of
    psychotherapy that encourages emotional
    expression and psychological healing through
    involvement in a creative process. They offer
    approaches that can be used with individuals who
    have little verbal expression and/or more
    profound intellectual disabilities.
  • There are four separate professions within
    the arts therapies
  • Art Psychotherapy
  • Dance/Movement Therapy
  • Dramatherapy
  • Music Therapy
  • Each approach has a unique quality associated
    with the particular art form, but each share the
    same outcome goal to help the individual
    overcome their emotional difficulties.
  • The arts therapies can be experienced
    individually, or as a member of a group.

15
Who uses the Arts Therapies?
  • The arts therapies are suitable for people of all
    ages, genders, ethnicities, and disability. It is
    not necessary to have any previous experience or
    particular talent in any of the art forms.
  • One of the advantages of an arts therapies
    approach is the containing aspect of the arts
    medium when experienced in a safe and supportive
    therapeutic relationship. This provides the
    client with the possibility of working through
    painful or distressing material in a more
    bearable and symbolic way.
  • Within the safety of the session the client is
    encouraged to experience the therapeutic
    relationship and the creative process as a means
    of personal exploration, identifying and
    connecting with emotions, making sense of past
    events and the expression of things that are hard
    to name or say in other ways.

16
Specialist Counselling
  • A counselling session is most often an individual
    session. The counsellor will be attentive to the
    clients range of emotional expression and will
    tailor the session to meet each individuals
    needs. This might include the use of sandtray
    therapy techniques, drawings, diagrams, figures
    and found objects.
  • Sandtray therapy is a non-verbal way of
    encouraging the expression and construction of
    images which have special meaning for the
    individual. The process involves using trays of
    sand into which small figures and objects are
    placed, thereby creating a representation of a
    persons inner and outer worlds. The technique
    utilises experience of creative play,
    imagination, symbolic thinking and metaphor.

17
Psychological Therapies Learning Disabilities
  • As was said earlier, potentially, any
    approach that is used with the general population
    could be adapted for use with a person with a
    learning disability
  • Cognitive Behaviour Therapy
  • Cognitive Analytic Therapy
  • Eye-Movement Desensitisation and Reprocessing
  • Systemic work
  • Psycho-educational approaches CBT DBT-based
    work.

18
The Individual or the Support?
  • Even if the extent of an individuals learning
    disabilities is such that a verbally-based
    individual therapy cannot helpfully be offered, a
    psychological therapy can inform support and
    advice given to carers.

19
Cognitive Behaviour Therapy as an example
  • Some learning disabled individuals can be
    appropriately referred to Plymouth Options
    (i.e. the IAPT Service).
  • If someone can
  • catch the thoughts he is thinking and consider
    them,
  • Identify/label the feelings he is experiencing,
    and
  • Discuss the connection between thoughts and
    feelings,
  • Then that individual is likely to be able
    to engage in individual, slightly adapted CBT.
    (Dagnan and Chadwick, Chapter 7,
    Cognitive-Behaviour Therapy with People with
    Learning Disabilities (1997), Stenfert Kroese, B.
    (Ed)

20
Cognitive Behaviour Therapy
  • If the individual struggles with one of the
    three tasks, then a referral to the specialist LD
    service might allow the individual to be helped
    to develop some relevant skills and then to
    engage in a more heavily adapted form of CBT.

21
Cognitive Behaviour Therapy
  • If it becomes apparent that the individual
    cannot engage in CBT herself, then the carers can
    be engaged by the therapist to assist in the
    management of anxieties or low mood by offering
    guided relaxation, interruption of/distraction
    from troubling thoughts the labelling of
    feelings and the offering of insightful
    observations that help the individual make sense
    of her experiences.
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