Service user views of long‐term individual psychodynamic psychotherapy

Facilitating transformative endings: Therapists' experience of ending therapy with people with intellectual disabilities-An interpretative phenomenological analysis

BACKGROUND

Endings in therapy are discussed widely in mainstream literature, however, there is only a small amount of research that considers endings in therapy for people with intellectual disabilities.

METHODS

Eight therapists were interviewed about their experience of ending therapy with people with intellectual disabilities. Interviews were analysed using Interpretative Phenomenological Analysis (IPA).

RESULTS

Four superordinate themes associated with endings that go well were identified: 'recognising', 'readying', 'reframing' and reflecting', with a fifth theme reflecting endings that were less successful. Participants worked hard to offer transformative experiences of endings and an overarching 'super-superordinate' theme of 'facilitating transformative endings' encompassed the findings.

CONCLUSIONS

Endings are a multi-faceted component of psychological therapy with people with intellectual disabilities and are significant for both client and therapist. We discuss implications for therapy adaptations and future research.

Exploring the social care-related quality of life outcomes of adults with intellectual disabilities through the use of Talking Mats®

BACKGROUND

Views on social care related quality of life (SCRQol) are typically gathered directly from individuals or from proxy informants. Easy-read options are available, although such methods may not be accessible to those with greater communication challenges.

METHODS

Fifteen people with intellectual disabilities were interviewed about their SCRQoL using Talking Mats® (TM). A descriptive approach was taken to exploring what people had to say.

RESULTS

Participants reported high levels of satisfaction with living conditions and personal care routines. They were mostly satisfied with the level of choice and control they had and with their carers.

CONCLUSIONS

People with intellectual disabilities who have greater communication challenges can make meaningful contributions to the assessment of the care they receive. Talking Mats is one tool which can be used to support people with intellectual disabilities to give their views.

People with intellectual disabilities' experiences of psychological therapy: A systematic review and meta-ethnography

The effectiveness of a range of psychological models adapted for use with people with intellectual disabilities has been well documented. A number of studies have used qualitative methods to examine people with intellectual disabilities' experiences of these adapted interventions. Such research is important for identifying service users' views on the helpful and challenging aspects of psychological interventions to ensure that they meet the needs of people with intellectual disabilities. To consolidate this research, a systematic review using a meta-ethnographic approach was undertaken. A systematic search identified 16 relevant studies. These studies were reviewed, critically appraised and key themes were extracted. Five key concepts were identified: adapting to therapy, the therapeutic environment, group dynamics, the therapeutic relationship and the impact of therapy on life. The need for further consideration of power differentials within the therapeutic relationship and further adaptations to ensure accessibility of therapy for people with intellectual disabilities is discussed.

Experiences of dialectical behaviour therapy in a community setting for individuals with intellectual disabilities

Background There is growing interest in the application of dialectical behaviour therapy (DBT) for individuals with intellectual disability (ID) and recent qualitative studies have explored their experiences of DBT in inpatient and forensic settings. This article aimed to explore experiences of DBT in a community setting for people with ID. Method Eleven individuals recruited from two NHS Trusts were interviewed about their experiences of DBT. Interview data was analysed using interpretative phenomenological analysis (IPA). Results Four superordinate themes and eight subordinate themes emerged from the data. The first superordinate theme 'experience of power' captured participants experience of power within DBT. The second theme 'differences in therapy contexts' highlighted how participants had made sense of different therapeutic contexts. The third theme 'the experience of a positive therapeutic relationship' focused on the qualities and attitudes of the therapist. The fourth theme 'a new way of being' described the impact DBT had on participants' everyday lives and the shift in their sense of self. Discussion This study provides insight into the lived experiences of people with ID receiving DBT. Therapeutic processes including the interplay between factors unique to DBT and features common across therapies are discussed.

Is it possible to use interpretative phenomenological analysis in research with people who have intellectual disabilities?

BACKGROUND

This paper examines the appropriateness of using interpretative phenomenological analysis (IPA) in research with people who have intellectual disabilities, focussing on quality.

METHODS

We conducted a systematic search to identify published studies. We assessed the quality of the studies using a bespoke framework, adapted from previous reviews, and articles on indicators of "good" IPA work.

RESULTS

Twenty-eight papers were reviewed. The studies were of varying quality: 6 (22%) papers were rated as "good" quality; 16 (57%) were "acceptable", and 6 (21%) were "poor." This ratio was comparable to that found in assessments of IPA papers in other domains, suggesting that issues of quality reflect researcher competence, rather than challenges with the population.

CONCLUSIONS

IPA can be an appropriate methodology to use with people with intellectual disabilities. We encourage researchers to develop more detailed analyses, to provide more transparency about their sampling strategies, and more detail of the characteristics of their samples.

The views of service users on the accessibility, acceptability, and effectiveness of psychodynamic psychotherapy

PURPOSE

This study aimed to assess how accessible, acceptable, and effective psychodynamic psychotherapy (PP) is perceived to be by service users.

METHOD

Interviews were conducted with 10 participants, who had finished, or were attending, PP. Transcripts were analyzed using thematic analysis.

RESULTS

Most participants understood how they had accessed PP. However, a minority were unsure. Some found traveling to sessions anxiety-provoking and appreciated a friendly greeting upon arrival. Participants highlighted feeling listened to. However, many participants were unhappy about therapy ending and struggled to share what they had learned. Some were surprised by the content of sessions. Finally, most participants highlighted problems that had improved because of therapy.

IMPLICATIONS

Clinicians should ensure that service users understand the nature of PP before starting sessions and identify clear goals. Support traveling to sessions may improve attendance, Finally, the importance of planning the ending of therapy was highlighted.

ORIGINALITY VALUE

The paper captures the views of those with ID on the accessibility, acceptability, and effectiveness of PP.

Dialectical behaviour therapy in an inpatient unit for women with a learning disability: Service users' perspectives

There is a general lack of self-report data from service users with an intellectual disability (ID) about their views of psychological interventions. This research explored the views and experiences of female inpatients, with a diagnosis of a personality disorder and an ID, about dialectical behaviour therapy (DBT). Semi-structured interviews were used with 10 women, recruited from two independent mental health hospitals. The interviews were analysed using interpretative phenomenological analysis. Participants showed varying levels of understanding of DBT. Findings highlight the need for a standardized approach with a suitably adapted structure and curriculum to meet the needs of inpatients with an ID. Factors such as the therapeutic relationship were identified as playing a role in participants' motivation, engagement and participation in DBT.

Using qualitative methods in research with people who have intellectual disabilities

BACKGROUND

JARID has a long and positive association with qualitative research dating back to its first issue. This paper looks at the development of qualitative methods and their application in the field of intellectual disability (ID).

METHOD

When invited to make a contribution on qualitative research for the 25th Anniversary of JARID, the present authors considered the options. We examined the frequency with which qualitative studies have been published in three major intellectual disability journals over a decade, and we considered attempting a systematic review or a meta-synthesis.

RESULTS

The volume of published studies has increased, but there were too many across a diverse range of topics for a systematic review of qualitative research in general; but not enough for a systematic review or meta-synthesis with a particular focus. However, there were many issues that needed to be aired. This paper therefore contains some critical reflections on the use of qualitative methods.

CONCLUSION

If we want to hear the voices of people who have ID then we need appropriate ways to do this. Qualitative methods are playing an increasing role in bringing the unknown about people who have ID into the known. The approach plays a valuable role in informing us about the experiences and lives of people who have ID. However, we have identified many methodological issues which will need to be further explored. At the same time, we need to develop methods to enable increased participation of people who have ID in some aspects of research. The participatory paradigm is more established in qualitative approaches as it lends itself to participation in generating research questions, developing interview questions, conducting interviews and even stages of the analysis. There are clearly areas that need to be addressed by trained researchers and the whole process will need some facilitation and support. Writing up for journals is one aspect that could be very problematic: so other forms of dissemination need to be explored.

Cognitive behavioural therapy from the perspective of clients with mild intellectual disabilities: a qualitative investigation of process issues

BACKGROUND

Clinicians working with clients who have mild intellectual disabilities (IDs) have shown growing enthusiasm for using a cognitive behavioural approach, amid increasing evidence of good treatment outcomes for this client group. However, very little is known about the views and experiences of clients with IDs who have undergone cognitive behavioural therapy. This study aims to explore the perspective of these clients.

METHODS

Fifteen participants with borderline to mild IDs and problems of anxiety, depression and anger were interviewed regarding their experience of cognitive behavioural therapy (CBT). Two semi-structured interviews were carried out in the first phase of therapy between session four and session nine. An interpretive phenomenological approach was taken to seek out themes from participants' own personal accounts.

RESULTS

Participants valued the opportunity to talk about problems with their therapist and benefitted from therapeutic relationships characterised by warmth, empathy and validation. Participants identified areas of positive change; however, many thought that this may be short lived or not maintained beyond discharge.

CONCLUSIONS

The supportive aspects of therapeutic relationships were particularly important to participants undergoing CBT. The clinical implications are considered.