Psychotherapy and learning disability

Abstract

In Ireland today it is considered that approximately 6.7% of the population have learning disabilities.' According to the National Intellectual Disability Database Report, 2 26,760 people are registered as being in receipt of, or in need of, a learning disability service (prevalence rate of 7.38/1000 total population). Many of these people have coexisting physical disabilities and psychiatric disorder, both of which increase in prevalence in proportion to the severity of the learning disability. Actual estimates of co-morbidity of learning disability and psychiatric illness have ranged across studies from 10% to 39%, 3 but all are significantly higher than the general population and the prevalence of behaviour disorders (which often reflect psychiatric disorder in this group) has been found to be even higher at 60.4%. 4 The World Health Organisation, 5 in its definition of learning disability, points to the importance of holistic approaches to understanding individual needs; however there is still a tendency to attribute much emotional distress experienced by an individual to the disability rather than to particular emotional needs or psychiatric disorder.Over the last 20 years many changes have taken place in the development of care and services for people with learning disabilities. The philosophies of normalisation 6 and inclusion have brought about a change in focus for these services, with more emphasis on individual characteristics and needs than disabilities, so that even people with severe problems are seen as having a right to be supported in community settings.Increasingly, people with mild and moderate learning disabilities now find themselves working and living within the community, where they benefit from the advantages of choice in many aspects of life but also have to endure the many stresses and disadvantages, including difficulties with access to mainstream services. It is within this changing context that the whole issue of psychotherapy provision for people with learning disabilities is beginning to be addressed. Psychological difficultiesThe development of a child with learning disabilities will be Therapeutic difficultiesTraditionally, people with learning disabilities were excluded from the 'talking therapies'.' 3 In the first instance, many emotional and mental health problems were not recognised as such, and when they were, low IQ was commonly used as an exclusion criterion for suitability for therapy. In practice, there are significant problems in adapting psychotherapeutic approaches to working with this patient group. These include a high frequency of sensory disabilities, communication problems, dependence on others to access therapy, and related to this, consent to engage. However, regarding the dynamic based treatments, an acknowledgement of the importance of the therapeutic relationship between therapist and patient has allowed a rethink of the capacity of people with learning disabilities to participate and benefit.' 4 ' 5 Similarly the cognitive based therapies require some adap...

Adapting Individual Psychotherapy for Adults with Intellectual Disabilities: A Comparative Review of the Cognitive–Behavioural and Psychodynamic Literature

“…Historically, however, adults with intellectual disabilities have had little access to individual therapeutic interventions for psychological problems (Stavrakaki & Klein 1986;Hurley 1989;Butz et al 2000;Dodd & McGinnity 2003;Johnson et al 2003;Lynch 2004). Bender (1993) describes the 'therapeutic disdain' of mental health professionals towards psychotherapy with this client group and, like Stenfert Kroese (1998) and Hurley et al (1998), highlights the over-reliance on behaviour modification and use of medications.…”

“…Increasing the volume and quality of literature on individual psychotherapy for adults with intellectual disabilities that clearly describes procedures, methods and outcome data will have implications for intellectual disabilities services, as they will have to develop expertise in order to meet the therapeutic needs of their clients (Dodd & McGinnity 2003), and mental health services, which will need training in intellectual disabilities issues (Prout & Nowak-Drabik 2003). The need for specialist skills and training is an issue that has recently been raised by Beasley (2004) and is also highlighted in the report on psychotherapy and learning disability by the Royal College of Psychiatry (2004).…”

“…The slightly higher prevalence of mental health problems combined with evidence suggesting that some adults with intellectual disabilities have the ability to self-report on their emotional states (Lindsay et al 1994;Stenfert Kroese et al 1998) suggests that individual therapeutic interventions should be widely available to the general population. Historically, however, adults with intellectual disabilities have had little access to individual therapeutic interventions for psychological problems (Stavrakaki & Klein 1986;Hurley 1989;Butz et al 2000;Dodd & McGinnity 2003;Johnson et al 2003;Lynch 2004). Bender (1993) describes the 'therapeutic disdain' of mental health professionals towards psychotherapy with this client group and, like Stenfert Kroese (1998) and Hurley et al (1998), highlights the over-reliance on behaviour modification and use of medications.…”