Therapeutic Methods (LD specific)

[mrlahhh]

Hi guys,

I am currently a student nurse and formerly a Low Intensity CBT therapist.

Although it has its critics, LICBT can be very useful for a variety of reasons. Psycho-education, thought-challenging, Behavioural Activation and Exposure therapy are all useful tools to combat mental health. I don't believe this is specific to people without Learning Disabilities but I am not currently aware of any schemes/training offers, etc that are specifically adapted for people with Learning Disabilities.

A large number of the staff in my placement area have no awareness of any of these CBT techniques and I have had discussions about training/raising awareness so they are able to use them in their everyday roles.

Is anybody out there aware of therapies (CBT, DBT, etc) which have been specifically adapted for use with people with LD? Or have any contacts/places I can go investigating/rummaging?

Thanks

[STP1]

I'm a retired nurse in LD and when working I did a 6 week ENB (English national Board of Nursing) course in CBT in LD . I was community based so had clients living at home and in residential homes. I used CBT but found many barriers as many people with LD's issues that gave them 'unhelpful' thoughts were related to their life experiences as a person with a LD or their immediate environment. Many did not have the opportunities to form 'normal' social circles as the rest of us and often became depressed and were treated with meds.

Also many did not have insight and were unable to reflect and therefore I was unable to challenge unhelpful thoughts and support them to make helpful changes and positive actions. One man I counselled was alcoholic, overweight and was gay and hadn't 'come out'.

He had a mild LD and was engaging in unsafe sex in public toilets as he saw these encounters as having a relationship. he did use CBT well, as he was able to identify that he wanted to lose weight and he wanted a relationship that was meaningful to him. He used alcohol to make himself feel better at that time. I am still in touch with him and he looks good, has made friends who celebrate him being a gay man and has a relationship that meets his and his partners needs.

I have found CBT is more successful in people who can reflect.

[Galwaybay2]

Alongside any strategies for changing behaviour there will be underlying unprocessed emotions and these need to be an equal part of the work of change. Behaviour is the external manifestation, a symptom, of something deeper and wordless that needs to be explored innovatively when verbal ways may not be available and my experience has shown that play, art, music, walking and talking are amazingly effective. These allow access to an internal world which can then be understood with sensitivity. This reflecting back of feelings at least gives some relief and maybe a vocabulary and over time may help the brain reconnect to an emotional part of the self with less need to rely on unhelpful outward discharge. Attending and naming can be transformative - 'what fires together wires together', (Hebbs). Behaviour may well need intervention for everyone's sake but, even if emotional insight is impaired, feelings are there and need to be an equal part of the therapeutic equation so that they don't need to be acted out and can be discharged in better ways.

[mrlahhh]

Thanks for the replies guys, really interesting reading your thoughts and experiences