LEARNING DISABILITY

LEARNING DISABILITY

The provision of psychotherapy for people with learning disabilities needs to address not only common mental health problems and emotional needs in this population, but also the very particular issues of impairment, disability and handicap. These issues may be the main focus of therapy, psychological disturbance or distress being seen as secondary to the trauma and developmental impact of disability for the client and their family or carers.

For psychotherapies to be effectively delivered to this group, established models of therapy can be modified to accommodate differences in intellectual ability and the particular issues of the disabled individual that affect not only the content but also the process of therapy. Rigid adherence to established models of psychotherapy and its delivery can effectively exclude people with learning disabilities from receiving appropriate treatment.

The particular issues for therapy for people with learning disabilities may require specific training and supervision. Generic psychotherapy training is unlikely, at present, to equip a therapist to be able to work with these issues without some additional training in learning disabilities. ‘Top-up’ training in learning disability for psychotherapists and the availability of supervision by disability psychotherapists is likely to be the most effective way to increase access to therapy for people with learning disabilities.

There should be appropriate training at all levels to deliver a psychologically informed service which will have the dual effect of fostering good mental health and supporting early detection of problems and appropriate and timely referrals. There is a requirement for trained professionals with competence in the provision of psychotherapy in various modalities with this client group.

The contents of this report should be widely disseminated and acted upon. A multi-disciplinary group should be established to develop evidence-based guidelines for treatment choice in psychological therapies for people with learning disabilities.

The Royal College of Psychiatrists (1991, 1997, 1999) has highlighted that psychological therapy services are a vital component of effective, coordinated mental health care. The 1995 Joint Report with the British Psychological Society recommended ‘the development of comprehensive, coordinated and integrated services in all the major psychological therapies’. It acknowledged in its introduction that psychological therapies are relevant to a number of client groups such as children, older people and those with learning disabilities. The document’s focus was on the mental health of adults between school leaving age and retirement, which should include adults with learning disabilities, but this was not addressed in the report.

It is important to recognise that in its development from early Freudian psychoanalytic theory, the term psychotherapy has come to encompass not only a model of therapeutic intervention, but also an underlying theoretical model of human personality and its development. Therefore, in the case of individuals with learning disabilities, there are both implications for the application of the therapy and for the psychological aetiology of the individual’s difficulties.

There are a number of ways to consider psychological development and developmental psychopathology, including perspectives from epidemiology, genetics, psychiatry, psychology, neurology and sociology. Approaches include the study of causal factors in understanding the processes of development with reference to adaptive and maladaptive responses, and the links between normality and pathology. The field of learning disability is an obvious and rich area for study, given the variations that may occur in some or all of these aspects. The importance of such complex psychological factors in presenting problems strengthens the case for including a psychotherapeutic approach to assessments and treatment.