Therapeutic relationships with individuals with learning disabilities ... an interesting paper!

Having last week taught a short introduction to Intensive Interaction on a Clinical Doctorate course for clinical psychologists in training, and edging into some discussions about the potential therapeutic outcomes of using Intensive Interaction with people with profound and multiple learning disabilities, I was reminded of an paper that I was pointed to (sorry but I can't remember by whom, but thanks anyway!) ... and about the central importance of relationship development between a therapist and their client in any psycho-therapeutic work - irrespective of the type of therapy being used.

So below I have set out some extracts from the aforementioned paper that look at the issue of developing and sustaining the vitally important 'therapeutic relationship' which sits at the centre of much counselling or psycho-therapeutic work (although the paper isn't about Intensive Interaction per se).

'Therapeutic relationships with individuals with learning disabilities: a qualitative study of the counselling psychologists’ experience' by Rachel A. Jones (2014), British Journal of Learning Disabilities, 42, 193-203.

‘Traditionally, psychological therapy has been concerned with working with individuals in isolation, on a one-to-one basis. The results of this study suggest that this practice is altered when working with individuals with learning disabilities ... Participants identified that developing a triadic relationship [i.e. with the staff or cares as well as the client] facilities comfort and reassurance ... [and] that the systemic relationships available to the individual should be involved in the therapeutic process to ensure that advances made during therapeutic work are reinforced and sustained after its completion’.

‘Individuals with learning disabilities are known to have limited experience of relationships, especially of those with an emotional focus ... the therapeutic relationship is often the first relationship of its kind for individuals with learning disabilities.  It is therefore suggested that as a result of their limited experiences, the therapeutic relationship has greater therapeutic impetus for individuals with learning disabilities’ (my underlining for emphasis).

‘There was a sense however that it was difficult for participants to introduce elements of their philosophical positions such as humanism, the therapeutic relationship and client-led rather than medical approaches ... resource limitations combined with the described setting culture were felt to significantly undermine the delivery of psychological therapy and the potential for positive therapeutic relationships’.

In summation the author states that:

‘The results [of this study] suggest that the therapeutic relationship with individuals with learning disabilities requires therapists to be flexible with some of the traditional assumptions of psychological therapy ... however, as suggested, one consistent factor remained fundamental, the significance of the therapeutic relationship’.

So in summation, I will also have a say, this being that for people with a severe communicative or social impairment, whilst acknowledging the difficulties presented by resource limitations and an encultured preference for 'medical approaches'), the development of a client-led 'therapeutic relationship' will undoubtedly have more 'impetus' when developed through the sensitive and responsive use of the 'humanistic' and 'client-led' approach called Intensive Interaction. 

But additionally it should be noted that this will not have the maximum therapeutic 'impetus' if it just done by developing a 'therapeutic relationship' with the person on a one-to-one basis; it needs to happen by working in systemically to make the social and emotional contact more universally encompassing i.e. by the full involvement of all the staff or cares, as well as the therapist.