beail nigel Speaker 

Nigel Beail  

Consultant Clinical Psychologist and Professional Lead for Psychological Services. South West Yorkshire Partnership NHS Foundation Trust, UK. Professor of Psychology, University of Sheffield, UK

BIOGRAPHY

Psychotherapy in Supporting People With ID: New Advances From Research and Clinical Practice


There was a time when many people asserted that models of psychotherapy provided to the general population are not appropriate or plausible for use with people with intellectual disabilities. Looking back, early accounts of psychotherapy with people with intellectual disabilities were few and ambiguous as to the nature or degree of impairment presented by clients, and further confused by a lack of consensus, consistency and clarity in the terminology used to describe people with intellectual disabilities and the nature of their impairments. Early attempts to use a psychoanalytic approach, notably by Pierce Clarke in the 1930s, were with people described as having amentia or being feebleminded. However, it may be like other early reports published which later referred to “mental retardation” that were found to be of clients diagnosed prior to the change in the diagnostic criteria in 1971 from one to two standard deviations below average IQ. Examination of participant details found these to be now classified in the borderline range of intellectual functioning.

There is a general consensus that the earliest published account of psychodynamic therapy with someone with an intellectual disability meeting current diagnostic criteria was Neville Symington’s paper published in 1981,“The Psychotherapy of a Subnormal Patient”, in which he reported his own therapeutic work with a man having an IQ of 59. It is notable that clinical interest in delivering this and other approaches increased around this time as exemplified by an increase in published accounts. Concurrently, applications of cognitive behaviour therapy were being made and published accounts started to appear.  Between the end of the 1980s and 2000 several books on the subject were published. Concurrently, our knowledge and understanding of the mental health needs of people with ID has developed. The recently published DMID clearly shows that people who have ID are affected by the same range of mental health concerns as the rest of the population. Further research on prevalence suggests that they have even greater needs. Therefore, it is logical to argue that if the mental health needs of people who have ID are the same, then the range of interventions available to them should be similar.

There is now a wider range of psychological therapies available to people who have ID, as exemplified through published work in Europe, the USA and Australia. A range of approaches has now a well-established case study literature and an evidence base is starting to emerge. Cognitive behavioural psychotherapy is more widely available and has a larger corpus of literature. This has been well described and several meta-analyses of its effectiveness are available (e.g. Nichol et al., 2013). The literature has also expanded to address specific issues, difficulties, and unique considerations of providing psychotherapy for people who have ID.

It has become noticeable at international research congresses, such as those organised by EAMHID, IASSID and NADD, that a wide range of psychological therapies was being made available to people who have ID. This has been confirmed in more recent publications. NADD in the USA have published a book (Fletcher, 2011), and the UK British Psychological Society and the Royal College of Psychiatry of Intellectual Disability have published a report (Beail, 2016) on the current range of psychological therapies available on either side of the Atlantic. In addition to CBT and psychodynamic psychotherapy, these include Dialectical Behavioural Therapy, Cognitive Analytic Therapy, Solution-Focused Therapy, Mindfulness and Acceptance and Commitment Therapy, group approaches, systemic approaches, and arts therapies. This has involved much pioneering work of individuals and teams who have been prepared to explore which reasonable adjustments need to be made to psychotherapeutic approaches in order to enable people with ID to access and make use of them.

In this presentation, the development of psychotherapy provision is considered against [JB1] the translational continuum. The five phases (basic science, early studies, early clinical trials, late clinical trials, and implementation) will be used to evaluate advances from research to clinical practice. Unfortunately, the research available is scarce as intellectual disability has and continues to be an exclusion criterion in psychological therapy research trails. Hence, this evaluation uses data from published accounts of psychotherapy with people who have ID, research studies, reviews, and meta-analyses. These reports and studies are used to populate the five phases of the continuum. What emerges is that some parts of the basic science phase are now clearly populated, but methodological research is still needed (e.g. Vlissides et al, 2017). There are several early studies (e.g. Lindsay et al., 2015), but early clinical trials are noticeably absent. Attempts at late clinical trials have been made and it would seem that implementation has gone ahead on the basis of what is available along with a pioneering spirit (Beail, 2016). This leads to reflections on the future role of research across the phases and the question who should be doing what in our enterprise to contribute to patient benefit.


References

Beail, N. (Ed.). (2016). Psychological therapies and people who have intellectual disabilities. Leicester: British Psychological Society.

Fletcher, R. J. (2011). Psychotherapy for individuals with intellectual disability. Kingston, New York: NADD.

Lindsay, W.R. Tinsley, S., Beail, N., Hastings, R. P. Jahoda, A., Taylor, J. L. & Hatton, C. (2015). A preliminary controlled trail of a transdiagnostic programme for cognitive therapy with adult with intellectual disabilities. Journal of Intellectual Disability Research, 59, 360-369.

Nicol, M., Beail, N., & Saxon, D. (2013). Cognitive behavioural treatment for anger in adults with intellectual disabilities: A systematic review and meta-analysis. Journal of Applied Research in Intellectual Disabilities, 26, 47-62.

Vlissides, N., Beail, N., Jackson, T., Williams, K., & Golding, L., (2017). Development and psychometric properties of the Psychological Therapies Outcome Scale – Intellectual Disabilities (PTOS-ID). Journal of Intellectual Disability Research. (In press)