DClinPsy Portfolio Volume 1 of 3 - University of Hertfordshire ...

Another issue related to empowering the individual is giving them responsibility. This is
potentially a challenging dilemma i.e. in the case of violence, should individuals with
learning disability be responsible for displaying their emotions using violence? Fidell
(2002) asks whether it is equitable to encourage them to take responsibility for their
actions with all the distress and grief this may entail, when they have few rights to go
alongside these responsibilities, a lower tolerance to stress and frustration and fewer
coping resources (Janssen, Schuengel & Stolk, 2002). Conversely it may be empowering
for people with learning disabilities to think that they are actually in control of their
violence rather than their violence being in control of them.
Adapting therapeutic skills and techniques is vital for overcoming some challenges in
using psychotherapy with this client group. Giving the clients a voice and making them
feel empowered may be difficult due to both their cognitive and language limitations and
to them not ever having had a voice. Using simplified language, finding out how the
client will make it known when they want the session to end/ want to take a break, using
drawings and role-plays may facilitate understanding. Moreover the pace of therapy is
normally slower; this is not always due to the level of understanding of the client but to
numerous other factors such as the amount and quality of the issues presented e.g.
multiple losses (Goldberg et al 1995).
Although it is purported that the systemic approach has much to offer (Baum and
Lynggaard, 2006), appropriate ways of evaluating its theoretical ideas and therapy
outcomes need to be developed. Research into the systemic approaches will need to
satisfy the demands of clinical governance and the evidence based culture of clinical
psychology services, and to help develop ethical services for individuals with learning
disabilities. Randomised controlled trials have been complicated by issues such as
obtaining consent and capacity in this client group (Oliver, Piachaud, Done, Regan,
Cooray and Tyrer, 2002). Furthermore, clients may have difficulty understanding
questionnaires, a higher tendency to acquiesce or say what they think the listener wants to
hear (Fidell, 2000).
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