Therapeutic relationships with individuals with learning disabilities: a qualitative study of counselling psychologists' experience
Individuals with learning disabilities are at a significantly greater risk of developing mental health problems than the general population. Historically, treatment has been dominated by psychopharmacology and applied behavioural models; however, an evidence base is growing, which advocates the use psychological therapy with these individuals. In the non-leaming disabled population, the therapeutic relationship, between client and therapist, is seen as a fundamental aspect in the outcome of therapy. It is suggested by Moss (1998) that the issues that are important in psychological therapy with the non-leaming disabled population should not lose significance with individuals with learning disabilities. Despite this, there exists a poor empirical and theoretical understanding of the complexities of the therapeutic relationship, when the individual has a learning disability. As a discipline, Counselling Psychology has a particular interest and skill base in understanding the therapeutic relationship and is therefore in a position to offer a valuable contribution to understanding the therapeutic relationship when an individual has a learning disability. Through eight semi-structured interviews, counselling psychologists currently working with individuals with learning disabilities were asked to share their experiences and understanding of the nature and role of the therapeutic relationship. A qualitative methodology guided by interpretative phenomenological analysis (IPA) enabled detailed exploration of the counselling psychologists’ perspective. Themes emerged identifying the therapeutic relationship as fundamental yet difficult due to variables such as the client’s experience in relationships, the need for multiple relationships, the experience of needing to facilitate reassurance and the necessary skills for therapeutic approaches. Themes also emerged relating to therapist’s motivations, values and needs when working with this client group and conflicts concerning individualisation and the setting culture. The themes identified are discussed in relation to the existing literature. Implications for theory and practice are explored, together with suggestions for future research.
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