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Resistance to the new paradigm from the other? Personal reflections on becoming a disability psychotherapist
Abstract
Purpose
– The purpose of this paper is to reflect on putting a paradigm shift into practice to become a disability psychotherapist (Frankish, 2013a).
Design/methodology/approach
– A personal reflective account.
Findings
– The author suggests seven conditions necessary or advisable for growth of disability psychotherapy (DP) within the workplace.
Originality/value
– Strategies to help implementation of DP have not been published to date.
... It is also a task that demands high personal resources and dealing with institutional contexts, which is why supervision, personal therapy and working on other tasks are suggested to mitigate the stress of the therapist himself. (McInnis, 2016). ...
... Remember that, of the three functions, the one with the largest effect size was the first: Involvement. ID work is a task that demands high personal resources and deal with insti-tutional contexts (McInnis, 2016;Wodrich et al., 2010), as well as working with patients who usually present psychiatric comorbidities (Stünkel-Grees et al., 2018) and who cognitively do not have the same abstraction capacity as adults with normal cognitive development (Capri, 2014). Based on these aspects, it is recommended to be flexible in your approaches and set goals according to the possibilities of your patients with ID (Capri, 2014). ...
... Unlike what can happen in the general clinic, where patients with a wide heterogeneity of symptoms or in search of personal development are seen (Fernández-Álvarez and Opazo, 2004). The aforementioned factors may also be influencing, such as psychiatric comorbidity and institutional work, which direct professionals to work in a more structured manner (McInnis, 2016;Stünkel-Grees et al. 2018;Wodrich et al., 2010). ...
The objective of this article is to describe the Therapist´s Personal Style (TPS) in clinical
psychologists who work with patients with intellectual disabilities, and to analyse the
effect of the theoretical approach and the years of professional experience. This research
was conducted on a group of 104 psychotherapists from Argentina divided into two equal
groups: 52 who work with people with intellectual disabilities and 52 who work with
the general clinical population in private practice. As a result, significant differences
were found in three dimensions of the TPS: Operative, Involvement, Expressive, which
obtained higher scores in the first group of therapists. The theoretical approach did not
show a differential effect on the therapist groups except for the Expressive function,
and a significant difference was found in years of professional experience in intellectual disability therapists. These results are discussed with previous research and the
importance of studying the profile of therapists is reflected upon.
Positive behaviour support (PBS) is behaviour analysis applied in support of people with challenging behaviour. Questions have been raised as to PBS effectiveness, costs, and accessibility.
Outcome studies meeting specified criteria for PBS were selected for review. All told, 12 outcome studies encompassing 423 cases were included.
This review showed that PBS was effective with both severe and high-rate behaviour problems, was cost-effective, used a methodology that was easily trained and widely disseminated, and worked in institutional settings in which the most difficult problems are thought to be, as well as in the community.
The major implication of this review is that practitioners may be obligated to use PBS when faced with the need to develop a plan of support given the ethical principle of using the least restrictive method consistent with the right to effective treatment.
Information collected in the context of a survey of all people with learning disabilities and challenging behaviour in a single metropolitan borough indicated: (1) care staff report that a significant proportion of their colleagues usually display such emotional reactions as sadness, despair, anger, annoyance, fear and disgust to episodes of challenging behaviour; (2) respondents reported that the most significant sources of stress associated with caring for someone with challenging behaviour centred upon the 'daily grind' of caring, their difficulty in understanding the person's behaviour, the unpredictability of the behaviour and the apparent absence of an effective way forward; (3) care staff attribute the causes of the person's challenging behaviour to a diversity of internal psychological, broad environmental, behavioural and medical factors. These results are discussed in relation to their implications for staff-seeking and implementing external advice regarding the management of challenging behaviour.
Psychological therapies are rarely used in people with learning disabilities. Learning disability is often given as an exclusion criterion. There is insufficient published research to conduct a systematic review. Few outcome studies of psychoanalytic or cognitive psychotherapy have been reported.
To describe recent advances in understanding and practice within the learning disability field which have not received wider recognition within mainstream psychotherapy and psychiatry.
The availability of different psychotherapeutic approaches is discussed. We explore developmental issues including the contribution of attachment theory to our understanding, and the effects of trauma on the lives of people with learning disabilities.
Theoretical and clinical perspectives suggest that many therapeutic opportunities exist.
Practitioners are encouraged to extend their therapeutic repertoire, and to report measurable outcomes.
Disability Psychotherapy draws heavily upon the ideas of theorists who understood that early care relationships are pivotal in emotional development. This chapter describes a clinical approach which places central importance on thinking about emotional development and attachments. The ideas have been developed through training in Disability Psychotherapy and relate to working with adults with intellectual disability (ID) in staffed community living settings. It is common in mental health services to find client personal histories revealing the presence of issues that have adversely affected an individual's attachment experiences and emotional development. The chapter addresses the most fundamental human needs of having emotional attachments and being emotionally cared for and looked after. These are the elements of care that sometimes feel lost in the midst of services juggling the multiple demands of provision, budgets, commissioners and involved professionals, but which are crucial to remember and keep in mind.
Purpose
The purpose of this paper is to report the evidence base for the practice of individual psychodynamic psychotherapy with adults with intellectual disabilities (IDs).
Design/methodology/approach
Literature review.
Findings
In total, 14 papers were reviewed. From these, one existing review and seven individual papers provided enough evidence to support effectiveness of individual psychodynamic psychotherapy for people with IDs.
Research limitations/implications
This research indicates individual psychodynamic psychotherapy to be of benefit. Indeed, all studies reviewed supported individual psychodynamic psychotherapy, but methodological shortcomings weakened the confidence placed in findings for some studies. Limitations of this review include methodological shortcomings of studies reviewed, a small number of existing studies and reliance on case studies.
Practical implications
Therapists and commissioners of services should routinely make individual psychodynamic psychotherapy available as part of a spectrum of therapies available to people with IDs who experience emotional and behavioural problems. This is because it is needed for some clients and they benefit.
Social implications
Individual psychodynamic psychotherapy for people with IDs adds to the range of therapies available to alleviate emotional distress and enhance well-being. These are necessary to provide a foundation for meaningful contribution to society, particularly for those who have experienced psychological trauma (Frankish, 2016).
Originality/value
This review includes more relevant studies than previous reviews and adds to a limited number of reviews in this area.
On December 20, 1964, Fannie Lou Hamer and Malcolm X spoke at the Williams Institutional Christian Methodist Episcopal Church in Harlem, New York, for a political rally in support of the Mississippi Freedom Democratic Party’s (MFDP) upcoming congressional challenge. The Student Nonviolent Coordinating Committee Freedom Singers also performed during the rally. This chapter reproduces Hamer’s speech, in which she recounts her personal experiences with oppression and challenged her black Harlem audience to recognize their own oppression. Hamer sought not only to garner support for the MFDP’s impending congressional challenge but also to direct national attention to the endemic racism in America. She argued that African Americans with relatively more rights and with more influence were not using their power to help African Americans with less.
Purpose
– The purpose of this paper is to report effectiveness of disability psychotherapy with a male adult with a mild intellectual disability presenting with complex emotional and behavioural problems.
Design/methodology/approach
– An individual case study was used with repeated analytic, quantitative and qualitative measures. This reported progress from individual weekly disability psychotherapy of psychodynamic orientation within an emotional disability framework.
Findings
– Disability psychotherapy led to a reduction in emotional and behavioural problems, reduction in emotional disability and facilitated protective psychological growth. In total, 88 sessions resulted in cessation of problem behaviours when other approaches did not. Given this therapy is likely to be reserved for the most complex and severe of cases, this study suggests more sessions of psychotherapy are needed than inferred from previous studies of effectiveness (Beail et al., 2007). This is to promote a sense of self which facilitates psychological well-being.
Research limitations/implications
– Limitations of a single case study include generalisability, controlling other factors in real life settings and subjectivity from inclusion of analytical measures. Further studies and follow-up would determine longevity of benefits. Nevertheless disability psychotherapy can be effective and should be available in a culturally appropriate service to meet the diverse needs of people with intellectual disabilities.
Originality/value
– This case study adds to the limited body of evidence on effectiveness of psychotherapy for people with intellectual disabilities. It is novel to report formal outcomes from an emotional disability model (Frankish, 2013a) and the use of analytic and attachment outcome measures.
Objectives To compare the nature and prevalence of use of procedures employed to treat and manage challenging behaviours across two approaches to providing community-based supported accommodation for people with intellectual disabilities (ID) and severe challenging behaviour: noncongregate settings where the minority of residents have challenging behaviour, and congregate settings where the majority of residents have challenging behaviour. Setting Community-based supported accommodation for people with ID and challenging behaviour. Design Longitudinal matched groups design. Main outcome measures The nature and prevalence of use of procedures employed to treat and manage challenging behaviours. Observed and reported severity of challenging behaviours. Results Both types of settings were associated with low prevalence of use of behavioural technologies for the reduction of challenging behaviour (less than % of participants). In contrast, high proportions of participant received antipsychotic medication in both noncongregate (%) and congregate (%) settings. Congregate settings were associated with the increased use of physical restraint as a reactive management strategy, with over half of participants being in receipt of physical restraint by two or more members of staff. Discussion Changes in reported and observed challenging behaviour over a -month period were slight. The use of evidence-based behavioural technologies for the reduction of challenging behaviour may have led to better outcomes.
Purpose
– The purpose of this paper is to focus on the theory and practice of disability psychotherapy (DP) using the integrative Frankish model (2013a). This draws on the model’s use with a 28-year-old male with a mild intellectual disability (ID) who presented with a range of emotional and behavioural problems.
Design/methodology/approach
– A case study reporting on the practice of DP of psychodynamic orientation.
Findings
– Adaptations useful in providing DP with people with IDs and the type of issues which arise are reported.
Research limitations/implications
– DP is possible and beneficial in community settings. Limitations of a single case study include generalisability of findings.
Originality/value
– Existing papers focus on the model (Frankish, 2013a), development of the emotional development measuring tool (Frankish, 2013b) and contextual issues (Frankish, 2013c). This case study provides novel information on the practice of DP, and analysis of manifestations of white supremacy (Ani, 1994) in psychotherapy with people with IDs.
Purpose
– The purpose of this paper is to provide a viewpoint on what needs to be done to develop competent residential services for people with intellectual disabilities and challenging behaviour.
Design/methodology/approach
– This article draws on previous accounts of the actions required. Whilst these have been available for decades and are still valid, they have not been fully implemented, hence the theme of “Back to the future”.
Findings
– The need to continue developing small‐scale, community‐based services that have a clear value base and are committed to taking person‐centred action is highlighted. The paper focuses on the need to enhance service quality through the dissemination and implementation of Positive Behavioural Support and discusses some key issues regarding this with reference to recent work in Wales.
Originality/value
– This paper makes a timely contribution to the current debate and highlights some practical actions and tools developed in Wales that may be of wider interest.
Purpose
– This paper charts the development and practice of disability psychotherapy for the author and for services.
Design/methodology/approach
– A personal account relating events to the development of thinking and practice.
Findings
– The author suggests that a paradigm shift has occurred over the 30 years to a position of “doing with” as opposed to “doing to”.
Originality/value
– This has not previously been put forward as a way of understanding present day services.
This article summarises the historical development of positive behavioural support. The main features of this approach are described, and the evidence for its effectiveness outlined. Despite clear empirical support for its use, relatively few people with learning disabilities and challenging behaviour appear to have access to this form of therapeutic intervention. Reasons for this are discussed, along with recommendations for future development.
Intervention for behavioural and psychiatric disorders in people with intellectual disabilities often only takes place once these conditions are well established and more resistant to change. As an alternative, this paper promotes a public health prevention model and maps out opportunities for intervention at primary, secondary and tertiary levels. The resulting model is partly derived from generic research into these issues and partly on specific evidence on interventions for people with intellectual disabilities; it also contains more theoretical considerations. The additional research that is necessary to demonstrate the efficacy of the interventions identified is also considered. Central to this proposal is a greater integration of issues for people with intellectual disabilities within much broader policy and research agendas.
A substantial literature now exists that indicates that cognitive-behaviour therapies are effective for a wide range of psychological problems (See Hawton, Salkovskis, Kirk, & Clark, 1989). However, it is only very recently that cognitive-behaviour therapists have considered people with learning disabilities as suitable clients for this particular approach. The present paper describes some of the challenges that are encountered when applying cognitive-behaviour therapy to this client group.
To compare the nature and prevalence of use of procedures employed to treat and manage challenging behaviours across two approaches to providing community-based supported accommodation for people with intellectual disabilities (ID) and severe challenging behaviour: noncongregate settings where the minority of residents have challenging behaviour, and congregate settings where the majority of residents have challenging behaviour.
Community-based supported accommodation for people with ID and challenging behaviour.
Longitudinal matched groups design.
The nature and prevalence of use of procedures employed to treat and manage challenging behaviours. Observed and reported severity of challenging behaviours.
Both types of settings were associated with low prevalence of use of behavioural technologies for the reduction of challenging behaviour (less than 15% of participants). In contrast, high proportions of participant received antipsychotic medication in both noncongregate (56%) and congregate (80%) settings. Congregate settings were associated with the increased use of physical restraint as a reactive management strategy, with over half of participants being in receipt of physical restraint by two or more members of staff.
Changes in reported and observed challenging behaviour over a 10-month period were slight. The use of evidence-based behavioural technologies for the reduction of challenging behaviour may have led to better outcomes.
The Unconscious at Work. Individual and Organisational Stress in the Human Services
- A Obholzer
- V Z Roberts
Obholzer, A. (2009b), "Managing social anxieties in public sector organisations", in Obholzer, A. and
Roberts, V.Z. (Eds), The Unconscious at Work. Individual and Organisational Stress in the Human Services,
Routledge, East Sussex, pp. 169-78.
The Speeches of Fannie Lou Hamer. To Tell It Like It Is
- Williams Malcolm
- Cme Institutional
- Church
Malcolm X at the Williams Institutional CME Church, Harlem, New York, December 20, 1964", The Speeches
of Fannie Lou Hamer. To Tell It Like It Is, The University Press of Mississippi, Mississippi, pp. 57-64.
PAGE 204 j ADVANCES IN MENTAL HEALTH AND INTELLECTUAL DISABILITIES j VOL. 10 NO. 3 2016
Balancing care and control: the supervisory relationship as a focus for promoting organisational health
- C Clulow
Clulow, C. (2009), "Balancing care and control: the supervisory relationship as a focus for promoting
organisational health", in Obholzer, A. and Roberts, V.Z. (Eds), The Unconscious at Work. Individual and
Organisational Stress in the Human Services, Routledge, East Sussex, pp. 179-86.
The Unconscious at Work. Individual and Organisational Stress in the Human Services
- A Corbett
Corbett, A. (2009), "Words as a second language. The psychotherapeutic challenge of severe intellectual
disability", in Obholzer, A. and Roberts, V.Z. (Eds), The Unconscious at Work. Individual and Organisational
Stress in the Human Services, Routledge, East Sussex, pp. 45-62.
Outside in: the effects of trauma on organisations
- T Cottis
- D O'driscoll
Cottis, T. and O'Driscoll, D. (2009), "Outside in: the effects of trauma on organisations", in Cottis, T. (Ed.),
Intellectual Disability, Trauma and Psychotherapy, East Sussex, Routledge, pp. 177-88.
Positive and Proactive Care: Reducing the Need for Restrictive Interventions , Department of Health
- Department
- Health
Department of Health (2014), Positive and Proactive Care: Reducing the Need for Restrictive Interventions,
Department of Health, London.
Facing emotional pain a model for working with people with intellectual disabilities and trauma
- P Frankish
Frankish, P. (2013b), "Facing emotional pain a model for working with people with intellectual disabilities and
trauma", Attachment: New Directions in Psychotherapy and Relational Psychoanalysis, Vol. 7, pp. 276-82.
The Unconscious at work. Individual and Organisational Stress in the Human Services
- W Halton
Halton, W. (2009), "Some unconscious aspects of organisational life. Contributions from psychoanalysis",
in Obholzer, A. and Roberts, V.Z. (Eds), The Unconscious at work. Individual and Organisational Stress in the
Human Services, Routledge, East Sussex, pp. 12-18.
The Unconscious at Work. Individual and Organisational Stress in the Human Services
- D Moylan
Moylan, D. (2009), "The dangers of contagion. Projective identification processes in institutions", in Obholzer, A.
and Roberts, V.Z. (Eds), The Unconscious at Work. Individual and Organisational Stress in the Human Services,
Routledge, East Sussex, pp. 51-9.
A Comprehensive Guide to the Activities Catalogue
- J O'brien
O'Brien, J. (1987), "A guide to lifestyle planning", in Wilcox, B. and Bellamy, T. (Eds), A Comprehensive Guide
to the Activities Catalogue, Paul Brookes Publishing, Baltimore, MD, pp. 175-89.
Have a heart: helping services to provide emotionally aware support
- A Shackleton
Shackleton, A. (2016), "Have a heart: helping services to provide emotionally aware support", in Fletcher, H.K.,
Flood, A. and Hare, D.J. (Eds), Attachment in Intellectual and Developmental Disability, Wiley, West Sussex,
pp. 175-96.
The unconscious at work in groups and teams. Contributions from the work of Wilfred Bion
- J Stokes
Stokes, J. (2009), "The unconscious at work in groups and teams. Contributions from the work of Wilfred
Bion", in Obholzer, A. and Roberts, V.Z. (Eds), The Unconscious at Work. Individual and Organisational Stress
in the Human Services, Routledge, East Sussex, pp. 19-27.
We are the tools of our trade: the therapist’s attachment history as a source of impasse, inspiration and change
- D Wallin
Wallin, D. (2014), "We are the tools of our trade: the therapist's attachment history as a source of impasse,
inspiration and change", in Danquah, A.N. and Berry, K. (Eds), Attachment Theory in Adult Mental Health:
A Guide to Clinical Practice, Routledge, London, pp. 225-40.
“I’m sick and tired of being sick and tired. Speech delivered with Malcolm X at the Williams Institutional CME Church
- M P Brooks
- D W Houck
Brooks, M.P. and Houck, D.W. (2011), "I'm sick and tired of being sick and tired. Speech delivered with
Malcolm X at the Williams Institutional CME Church, Harlem, New York, December 20, 1964", The Speeches
of Fannie Lou Hamer. To Tell It Like It Is, The University Press of Mississippi, Mississippi, pp. 57-64.
Outside in: the effects of trauma on organisations
- T Cottis
- D Driscoll