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Purpose: This paper aims to underline the importance of using a collaborative approach when designing and adapting a post diagnostic psychosocial intervention of cognitive stimulation therapy (CST) for people with intellectual disability and dementia. Design/methodology/approach: As part of a service improvement, a manual of CST was adapted, for delivery in clinical practice. A qualitative co-production method allowed participants with a lived experience to provide regular feedback relating to the development of the adapted CST manual and intervention programme. This feedback was used to make continual development changes to the CST manual. Findings: The study demonstrated co-production with those who provide care is valuable in adapting psychosocial therapies for people with an intellectual disability and dementia. Additional findings identified the need for carer education in ageing, dementia care and the physical health needs for older people with intellectual disability. Originality/value: To the best of the authors' knowledge, this is the first study that has used a co-production approach with families and carers in adapting a group therapy programme for people with an intellectual disability. This paper underlines the need for post diagnostic clinical interventions for people with dementia and those who provide care. [ABSTRACT FROM AUTHOR]

Purpose: There is growing literature on the application of Dialectical Behaviour Therapy (DBT) with adults with intellectual disabilities (IDs). To draw upon the evidence-base from mainstream approaches, adapted interventions must remain true to their theoretical foundations and retain key components. The purpose of this paper was to establish the extent to which DBT has been adapted for adults with ID, and whether existing adapted protocols can still be considered DBT. Design/methodology/approach: The theoretical underpinnings and key components of DBT were identified. Six DBT studies were critiqued according to these criteria. Findings: In terms of content, only one intervention comprised all necessary elements. All of the remaining interventions included a skills group; two included individual therapy and another two included group consultation. None of the remaining interventions provided 24-h telephone support. Furthermore, none of the studies explicitly described using dialectical strategies. Originality/value: To the best of the authors' knowledge, this is the first paper to critically examine the evidence-base for the use of DBT in ID, particularly its fidelity. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to explore the extent to which principles of recovery-oriented practice are evident in the published perspectives and experiences of health professionals and service users on seclusion in adult mental health services. Design/methodology/approach: A systematic review informed by PRISMA guidelines was conducted, drawing from four databases, which were searched in August 2018 and August 2022. Only original empirical studies rated as having "major" relevance were included. Data were extracted from 31 studies and qualitatively synthesised through deductive analysis using recovery principles as themes. Findings: There was limited evidence of perceptions of seclusion being being consistent with recovery principles, with greater evidence of perceptions that directly opposed them. Studies of service user perspectives highlighted this more often than staff perspectives. The findings highlight paradoxical relationships between care and control and conflicting rights and emphasise the need to openly acknowledge the complexity of seclusion and its interface with recovery. Research limitations/implications: This review was developed in line with international best practice and the protocol was registered. Using a search string with only three components maximised sensitivity during searches and minimised the risk of relevant literature being missed. Limitations include the focus on studies where the full text was published in English. Originality/value: This review makes a unique contribution, highlighting that, to the best of the authors' knowledge, no studies to date have explicitly explored the perspectives and experiences of staff and service users on the use of seclusion in the context of recovery-oriented practice. The findings are relevant to clinical practice, policy and future research, including amending procedures and practices to partially reconcile seclusion and recovery where the seclusion is deemed necessary. [ABSTRACT FROM AUTHOR]

Purpose: Services are increasingly exploring the use of remote conferencing to deliver psychological interventions, which have become particularly important given the COVID-19 pandemic and infection control guidelines. This paper aims to explore the feasibility, acceptability and preliminary effectiveness of delivering psychological therapy remotely to adults with intellectual disabilities (ID). Design/methodology/approach: As part of routine practice within an adult ID community health service, this paper develops a six-session programme based on compassion-focused therapy (CFT) and delivered it to six clients. Clients completed the psychological therapy outcome scale for ID 2nd edition, at assessment, pre- and post-therapy, as well as a feasibility and acceptability measure. Findings: Six clients engaged in telephone therapy; four clients individually, while the remaining two were supported by their caregiver. Most clients found the intervention helpful, enjoyable and were pleased that they received telephone-delivered psychological therapy. A reduction was observed at post-therapy in distress (g = 0.33) and risk (g = 0.69). No difference was reported in psychological well-being. Five clients were subsequently discharged from psychological therapy. Originality/value: To the knowledge, this is the first study examining the use of telephone therapy (including CFT) for individuals with ID. Findings add to the growing evidence suggesting individuals with ID can benefit from receiving adapted psychological therapies. Research is required to further explore the effectiveness of remote-therapies, who would most likely benefit from this approach and how remote treatments could be used within existing pathways. [ABSTRACT FROM AUTHOR]

Purpose: The novel coronavirus and associated restrictions have resulted in mental health services across the UK having to adapt how they deliver psychological assessments and interventions. The purpose of this paper is to explore the accessibility and prospective acceptability of providing telephone and videoconference-mediated psychological interventions in individuals with intellectual disabilities. Design/methodology/approach: As part of a service evaluation, a mixed-methods questionnaire was developed and completed by clients who had been referred for psychological therapy at an adult intellectual disabilities' community health service in the north of England. All clients were assessed using the Red/Amber/Green (RAG) system by a consultant clinical psychologist for risk and potential suitability for indirect service delivery given their ability and needs. Findings: Overall, 22 clients were invited to take part, of which, only seven (32%) were accepting of telephone or videoconference-mediated psychological therapy. Most of the clients were unable to engage in video-conference therapy and therefore, only suitable for phone therapy. This paper presents the remaining findings and discusses the clinical implications and unique considerations for intellectual disability services drawing on the existing literature. Originality/value: This is the first paper that the authors are aware of, examining videoconference-mediated psychological therapy in this population. It is hoped the data will be used to help inform practice or policy when using such therapeutic approaches in adults with an intellectual disability. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to assess the quality of systematic reviews on the effectiveness of psychological therapy for adults with intellectual disabilities (ID) and mental health difficulties. Design/methodology/approach: Four electronic databases were used: Cochrane, PsycINFO, PubMed and Scopus. Studies were included if they were a systematic review focused primarily on psychological therapy for adults with ID and mental health difficulties. Systematic reviews focused on anger were also considered for inclusion. These reviews were rated for quality on the Amstar-2, a quality rating tool designed to evaluate systematic reviews. Findings: Twelve relevant systematic reviews were identified, which included seven reviews focused primarily on cognitive behavioural therapy, two on psychodynamic therapy and three on third-wave therapies. The AMSTAR-2 indicated that all 12 reviews were of "critically low" quality. Thus, there are significant problems with the evidence base. Originality/value: To the best of the authors' knowledge, this is the first systematic review of systematic reviews of the effectiveness of psychological therapies for people who have ID. It provides an overview of the quality of the evidence base into one place. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to provide an update on the effectiveness of psychotherapy with persons with intellectual disabilities.Design/methodology/approach - This paper focused on summarizing the conclusions of other reviews published in the last ten years, including a recent review by the authors.Findings - The paper concludes that there is evidence that psychotherapy with persons with intellectual disabilities is at least moderately effective. Further, there is evidence of effectiveness of psychotherapy for both child and adolescent, and adult populations. There is also evidence that a range of therapeutic interventions are effective and that a spectrum of problems can be addressed via psychotherapy.Research limitations/implications - This area has received relatively little attention in the research literature and the area lacks a large base of methodologically sound and rigorous studies. There is a need for well-designed studies, particularly randomized controlled trials (RCTs), and a need for better specification of treatments (e.g. manualized), better outcome measures, and clearer specification of diagnostic categories within the intellectual disability population.Practical implications - This review provides continued support for the use of psychotherapy with persons with intellectual disabilities.Originality/value - This review appears to represent the most current overview of research in this area. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to describe service user experiences of an art psychotherapy group which drew on occupational therapy perspectives to help adults with severe and enduring mental health difficulties move forward in their recovery. Design/methodology/approach: A case study approach incorporating outcome data was used. The data gathered comprised attendance, facilitators' clinical notes, photographs of participant artworks, the Psychological Outcome Profiles questionnaire (PSYCHLOPS: www.psychlops.org), a post-therapy feedback form, discussion at post-therapy individual review sessions and participants' achievements post-group. Findings: All but one participant scored the group as "very helpful" or "helpful" and all felt that the group had helped them with the personal aims they had identified. The PSYCHLOPS questionnaire yielded a large average effect size, indicating positive change in terms of problems, functioning and well-being. Participants identified several ways in which the group was helpful, and their artwork and reflections indicate how they used the art making in the group to pursue their recovery goals. The service user experiences and outcomes suggest that this group was effective in facilitating recovery for these adults with severe and enduring mental health difficulties. Originality/value: This group was innovative in integrating approaches from the different professional specialisms and the findings encourage further investigation into this way of working. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper, a qualitative study, is to explore service users' experiences of attending clinical psychology within a public community adult mental health service. Design/methodology/approach: Six individuals who had completed at least 16 sessions of psychotherapy participated in semi-structured interviews. Data were transcribed and analysed using interpretative phenomenological analysis. Findings: The results showed the following overarching domains: the relationship and its impacts, structure and focus, and participant factors – timing/readiness. The importance of the use of language was also identified. Participants appeared to value a sense of humanity within the relationship. Interestingly, the personal impact of therapy as perceived by the participants was not focussed on symptom reduction, but on broader changes. The results are discussed in relation to the relevant literature. Practical implications: Suggested principles for practice include maintaining attentiveness to relational factors, to client factors such as readiness for change and to the use of structure and flexibility. The use of recovery focussed and alliance measures are recommended. Originality/value: For clinical psychologists providing psychotherapy within the public system, there are valuable lessons we can learn from asking the service users directly about their experiences, in terms of focussing on the human element of the relationship, and striking a balance between professionalism and humanity. [ABSTRACT FROM AUTHOR]

Purpose: There are few publications on personality disorder in adults with intellectual disability (ID), and on borderline personality disorder (BPD) specifically. Publications concerning treatment are sparse, despite the high symptom burden in these patients. This paper aims to discuss these issues. Design/methodology/approach: Six patients with BPD and ID were recruited from the same inpatient unit. Behaviour problems and mental health symptoms were scored on admission and discharge. Information about treatment, length of stay, etc. was taken from case files. Findings: Both mental health symptoms measured by the SCL-90-R, and behaviour problems measured by the Aberrant Behaviour Checklist were significantly reduced on discharge. In the active treatment period, the two main aspects of treatment were validation and practicing new solutions when emotional and behavioural problems occur, i.e. skills training. Research limitations/implications: The limitations related to this study are that the study is conducted in one milieu only. Another limitation is that the patients were admitted over a five-year period, where, some changes were made in the treatment approach. Practical implications: Inpatient treatment of this patient group seems to be effective if individually adjusted to the patient's psychopathology, ID and communication style. Close co-operation between the individual therapist and milieu therapists is essential. Originality/value: There is a need for intervention studies on BPD in ID. This study may be a valuable contribution. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to present outcomes of mixed practices including use of ideas from narrative therapy (NT) in a case of mild intellectual disability (ID) and personality disorder. The formulation, therapy adaptation and outcomes are presented.Design/methodology/approach The study is a single case report describing patient presentation, assessments, psychological formulation and the mixed interventions approaches used, including ideas from NT. Adaptations to meet the needs of patients with ID were described, and therapy outcome measured using Health of the Nation Outcome scale and Psychiatric Assessment Schedule for Adults with Developmental Disorders was presented.Findings The ideas used from NT suggest this is potentially a useful approach in practice for people with intellectual disabilities and personality disorder. However, adaptation is needed for it to be used successfully in practice as a therapeutic intervention.Research limitations/implications A single case study has its limitations, and further work on using ideas from NT, its adaptation and use in this population will be needed.Originality/value There is no previous case of use of NT among patients with ID and personality disorder. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of this paper is to explore the effectiveness of Eye Movement Desensitisation and Reprocessing (EMDR) therapy in an individual with mild intellectual disabilities currently compulsorily detained in secure care. Design/methodology/approach - The intervention utilised the EMDR eight-phase protocolised psychotherapeutic approach. Sessions utilised symbol cards to explore the impact of the client's experiences in relation to his thoughts, emotional feelings, physical feelings and behaviour. Drawings were also utilised to assist the client to develop a picture of the traumatic incident. A "safe place visualisation technique" was also utilised at the end of every session to manage any distress. The Posttraumatic Stress Diagnostic Scale (PDS) with some minor adaptations for use with people with intellectual disabilities was utilised as a pre- and post-measure. Findings - The study identified reductions in symptoms in all three core clinical subgroups of the PDS: re-experiencing, avoidance and arousal, with outcomes being maintained at one-month and six -month follow-up. Reduction in the strength of ratings was most evident in the avoidance domain. Originality/value - There are limited studies exploring the effectiveness of EMDR with individuals with intellectual disabilities. [ABSTRACT FROM AUTHOR]

Purpose – Offenders who have intellectual disabilities like any one else may deny their offence. This paper reports a case study of a man who admitted his offence and them accepted probation with a condition of treatment. However, when he attended treatment he denied the offence. Thus do those providing treatment send them back into the criminal justice system or work with them try and help them accept what they have done and provide appropriate treatment to help them reduce future risk of offending. Design/methodology/approach – In this case study the assimilation model was used to understand the process of change and monitor change through exploratory psychotherapy. The psychotherapeutic model was psychodymnamic. Findings – The client demonstrated gains through the stages of the model toward acceptance of his problematic behaviour and continued to work on this through further psychotherapy. Originality/value – The assimilation model offers a useful approach to monitor change in psychotherapy; but especially when the client does not accept the problem the rest of the world feels they have. [ABSTRACT FROM AUTHOR]

Purpose – This paper charts the development and practice of disability psychotherapy for the author and for services. Design/methodology/approach – A personal account relating events to the development of thinking and practice. Findings – The author suggests that a paradigm shift has occurred over the 30 years to a position of "doing with" as opposed to "doing to". Originality/value – This has not previously been put forward as a way of understanding present day services. [ABSTRACT FROM AUTHOR]

Purpose – People with learning disabilities want and value friendships and close, intimate, or romantic relationships. However, many people with learning disabilities are socially and emotionally lonely. The purpose of this paper is to describe a novel intervention, using a narrative therapy based group approach, which aimed to ameliorate the negative effects of loneliness in adult men with a mild learning disability. Design/methodology/approach – This study explored the group process, examined participants' experiences of the narrative therapy approach, and used an amended version of the UCLA loneliness scale (3rd ed.) to evaluate the effectiveness of a narrative therapy group approach. Findings – The group enabled participants to develop "experience near" descriptions of loneliness and its effects and to identify and strengthen their abilities, strengths, and resources. Qualitative feedback from participants indicated that the group was experienced positively and helped participants to feel less lonely. Quantitative feedback from an adapted version of the UCLA loneliness scale suggested that most participants felt less lonely following the intervention. Research limitations/implications – There are several limitations of the current study. Most importantly, because of the small sample size (n=5), the results of the current study lack generalisability. Future, larger-scale research should be carried out to address these limitations. Originality/value – The current study draws attention to a significant problem experienced by many people with a learning disability. It also adds to the emerging evidence that narrative therapy approaches may be useful within learning disability contexts. [ABSTRACT FROM AUTHOR]

Purpose: This literature review aims to ascertain the outcomes and perspectives of community-based compassion-focused therapy (CFT) for adults with intellectual disabilities. Design/methodology/approach: A comprehensive search of five databases was conducted systematically, with one additional study identified manually, yielding eight relevant studies. Methodological quality was appraised using two tools to account for heterogeneity in study designs. Findings: Two studies conducted a CFT-derived task while six studies conducted full CFT interventions, of which two delivered group interventions. Qualitative findings were favourable towards CFT, though some quantitative outcomes were inconsistent across the literature and with qualitative results. It is concluded that CFT is perceived as valuable and appears to produce positive outcomes for adults with intellectual disabilities. However, larger, randomised control trials are required to establish CFT as an efficacious, evidence-based intervention. Originality/value: This review provides insight into the outcomes and perspectives of CFT for individuals with an intellectual disability which has not been explicitly explored prior. Therefore, a holistic and specific examination of community-based CFT for individuals with intellectual disabilities is introduced to the literature. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to provide a commentary on Stacey and Edwards' article on a narrative therapy approach to working with men with learning disabilities who are lonely. Design/methodology/approach – The article reflects on the issues raised by Stacey and Edwards, in the light of other theoretical and empirical literature on loneliness and friendship. Findings – It is important to consider problems of loneliness in the context of a social model of disability. People with learning disabilities are often excluded from the networks of relationships that are so important to the maintenance of emotional well-being. Originality/value – Overcoming loneliness is likely to require a range of strategies including group action by people with learning disabilities, the development of non-disabled people's ability and willingness to establish relationships with disabled people and developments in our understanding of how social systems can be designed to be more inclusive. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the current study is to conduct a systematic review of peer-reviewed work on culturally tailored interventions for alcohol and drug use in Indigenous adults in North America. Substance use has been reported as a health concern for many Indigenous communities. Indigenous groups experienced the highest drug overdose death rates in 2015, the largest percentage increase in the number of deaths over time from 1999 to 2015 compared to any other racial group. However, few Indigenous individuals report participating in treatment for alcohol or drug use, which may reflect the limited engagement that Indigenous groups have with treatment options that are accessible, effective and culturally integrative. Design/methodology/approach: Electronic searches were conducted from 2000 to April 21, 2021, using PsycINFO, Cumulative Index to Nursing and Allied Health Literature, MEDLINE and PubMed. Two reviewers classified abstracts for study inclusion, resulting in 18 studies. Findings: Most studies were conducted in the USA (89%). Interventions were largely implemented in Tribal/rural settings (61%), with a minority implemented in both Tribal and urban contexts (11%). Study samples ranged from 4 to 742 clients. Interventions were most often conducted in residential treatment settings (39%). Only one (6%) intervention focused on opioid use among Indigenous people. Most interventions addressed the use of both drugs and alcohol (72%), with only three (17%) interventions specifically intended to reduce alcohol use. Originality/value: The results of this research lend insight into the characteristics of culturally integrative treatment options for Indigenous groups and highlight the need for increased investment in research related to culturally tailored treatment across the diverse landscape of Indigenous populations. [ABSTRACT FROM AUTHOR]

Purpose – Psychological therapies are increasingly being made available to adults with intellectual disabilities. However, little is known about service user satisfaction with this type of intervention. The aim was to ascertain quantitative and qualitative data on user satisfaction with the psychological therapy they had received. Design/methodology/approach – In total, 20 recipients of psychological therapy completed the Satisfaction with Therapy and Therapist Scale – Revised (STTS-R; Oei and Shuttleword, 1999) and the Experience of Service Questionnaire (Commission for Health Improvement, 2002). The scales were adapted for language and administered in an assisted completion format by an independent researcher after a course of psychological therapy had been completed. Descriptive statistics were used to analyse the quantitative data and thematic analysis was used to analyse the qualitative data. Findings – Generally, recipients were highly satisfied with their therapist and the therapy they received. Originality/value – The results confirm previous findings from two small-scale qualitative studies. Service user satisfaction is a key quality outcome measure and can be collated in routine practice for people with intellectual disabilities. The collation of qualitative responses in addition to quantitative measures is important to enable the expression of dissatisfaction and greater detail in order to inform service improvement. [ABSTRACT FROM AUTHOR]