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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. [ABSTRACT FROM AUTHOR]

Purpose: A biopsychosocial case formulation is an important tool for understanding complexity and guiding treatment for people with intellectual disabilities. It has been suggested that formulation meetings develop staff understanding of individuals they support. This study aims to explore the change processes that occur as a result of professional team formulation meetings, and the mechanisms that facilitate and hinder these events. Design/methodology/approach: Eight clinicians who took part in multi-disciplinary team-based formulations in an inpatient mental health service for adults with intellectual disabilities were interviewed. Interviews were examined using thematic analysis. Findings: The key themes identified were: "gaining information", "altered thoughts" and "focused goals". These themes were supported by "collaborative working" and "time for reflection" and were hindered by "poor communication and interaction" and inconsistent "staff attendance". Originality/value: Multi-disciplinary team formulation meetings may have a number of change processes that affect staff knowledge and perception of the people that they support. The facilitation of these processes should be a focus for further development. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to explore the applicability of Bordin's model of therapeutic alliance in talking therapies for people with intellectual disabilities. Design/methodology/approach: People with intellectual disabilities and therapists in six therapy dyads were interviewed using a qualitative methodology. Data were analysed using thematic analysis to explore how people with learning disabilities constructed the dimensions of therapeutic alliance. Content analysis was then used to focus on therapy bond, therapy tasks and goals to explore the agreement on these dimensions between the therapist and client. Findings: People with intellectual disabilities reported their experience of therapy in a way that initially validates the alliance dimensions of Bordin's model. There was clear overlap within most dyads in the description of the characteristics of the bond, the tasks undertaken and the goals of therapy. Some therapists described additional goals based on their therapeutic model that were not clearly described by the client working with them. Research limitations/implications: This study is limited by only including six therapy dyads; however, the results suggest further research on the impact of therapy alliance and how goals and tasks are agreed would be valuable. Originality/value: Very few studies have explicitly examined the client's view of therapy alliance. [ABSTRACT FROM AUTHOR]

Background: This study explored understandings that service‐users with intellectual disabilities and challenging behaviour held around their behaviour, what shaped these understandings, and the relationship between how behaviours are managed and well‐being. Methods: Eight participants (three female, five male) partook in individual semi‐structured qualitative interviews. Interviews were transcribed and analysed using interpretative phenomenological analysis. Results: Three master themes emerged from this analysis: (a) challenging behaviour can be explained via an internal or external frame of reference, with each framework having different implications for how participants attempted to manage behaviour. (b) Positive relationships provide a long‐term buffer to challenging behaviour, with positive relationships with family, staff and peers operating through different mechanisms to achieve this. (c) A greater ability to exert power and control in day‐to‐day life was perceived to reduce challenging behaviour in the long term. Conclusions: Implications for practice are discussed. [ABSTRACT FROM AUTHOR]

Background: No studies have explored the acceptability of Behavioural Activation and Guided Self‐Help interventions for depression with people who have intellectual disabilities. Method: Twenty‐five participants were purposively sampled from participants taking part in a trial comparing Behavioural Activation with a Guided Self‐Help intervention. A framework analysis was used to analyse interviews covering participants' expectations and views of therapy. Results: Participants were largely positive about both interventions. However, they identified specific aspects of each intervention which they had found helpful. All participants valued the therapeutic relationship. The participants also had a number of criticisms and suggestions for improving the therapies. A common concern was the time‐limited nature of the interventions and a wish for longer‐term help. Overall, both sets of participants felt the interventions had relevance for their wider lives. Conclusions: The participants reported having positive engagement with the therapies but expressed a wish for longer‐term supportive relationships. [ABSTRACT FROM AUTHOR]

Background: Clinicians recommend including carers or others in a supporting role in the therapy as an important adaptation of psychological therapies for people with intellectual disabilities. This nested qualitative study from a larger trial explored supporters' experiences of supporting people with intellectual disabilities receiving behavioural activation or guided self‐help therapies for depression. Method: Twenty‐one purposively sampled supporters were interviewed. The semi‐structured interviews were subject to framework analysis, covering expectations of therapy, views of therapy sessions, relationships with therapist and participant, and perceived changes. Results: Supporters were positive about both therapies and reported both therapy‐specific and nonspecific therapeutic factors that had significant positive impacts on people's lives. Most supporters reported their involvement contributed to the interventions' effectiveness, and helped establish closer relationships to the people they were supporting. Conclusions: The presence of supporters within psychological therapies for people with intellectual disabilities can be an effective adaptation to therapies for this population. [ABSTRACT FROM AUTHOR]

Background: Current policy in the England suggests that people with intellectual disabilities should, where possible, access mainstream mental health services; this should include access to mainstream therapy services. It is likely that mainstream therapists will need training and support to work with people with intellectual disabilities. Method: Sixty‐eight therapists working in an English Improving Access to Psychological Therapies (IAPT) service received one‐ or 2‐day training on working with people with intellectual disabilities. Measures of confidence, general therapeutic self‐efficacy and attitudes to people with intellectual disabilities’ use of mainstream mental health services were completed pre‐training, post‐training and at 3‐month follow‐up; at which time, 12 participants were interviewed about the impact of the training on their practice. Results: There was a significant positive change in all measures immediately post‐training which was maintained at 3‐month follow‐up. Conclusions: Training considerations for mainstream therapists who may work with people with intellectual disabilities are discussed. [ABSTRACT FROM AUTHOR]

Objectives: There is a growing body of evidence revealing emotion regulation difficulties are a common factor in the development and maintenance of mental health problems in the general population, however relatively little is known of the emotion regulation strategies used by people with intellectual disabilities. Method: A qualitative approach was used to explore the emotion regulation strategies used by adults with a mild intellectual disability in interpersonal experiences. Semi-structured interviews were conducted with 11 participants with the transcripts analyzed using Thematic Analysis. Results: Three main-themes, each with two sub-themes were identified; regulatory talk (sub-themes of ‘self-talk’ and ‘talking about emotions in beneficial’), avoidance (sub-themes of ‘avoidance is bad’ and ‘avoidance can be good’) and cognitive strategies (sub-themes of ‘cognitive distraction’ and ‘cognitive reappraisal’). Conclusions: The main-themes and sub-themes suggest people with intellectual disabilities can use a range of strategies in different contexts. Research and clinical implications are discussed. [ABSTRACT FROM AUTHOR]

Background The role of support workers and other professionals in the psychotherapeutic process has been commented upon but not as yet been systematically investigated. Method To explore their views and expectations of cognitive behaviour therapy ( CBT) for adults with intellectual disabilities, eleven paid support workers and professionals were recruited and interviewed before the CBT sessions commenced for their service users and nine took part in the second interview that took place after nine sessions. Results Thematic Analysis of the interview transcripts indicates that staff members do not perceive CBT as a long-term solution for psychological problems have little knowledge of CBT and do not feel included in the process. Nevertheless, after nine sessions, most participants reported improved psychological well-being for their service users and expressed a wish for longer-term involvement of the therapist. Conclusions The results suggest that for CBT to be effective in the longer term, the therapist is required to consider a wider systemic approach including staff training and supervision, staff and management consultancy and creating a delicate balance between confidentiality and sharing the psychological formulation with 'significant others' to ensure maintenance and generalisation of improved psychological well-being. [ABSTRACT FROM AUTHOR]

Background This study compares how people with and without intellectual disabilities talk about events, beliefs and emotions in dialogues about real-life, emotive events and in a structured task assessing understanding of cognitive mediation. Materials and Methods A cognitive-emotive interview was used to assist 19 adults with intellectual disabilities and 19 adults without disabilities in generating an account of an emotive, interpersonal event. Participants also completed a cognitive mediation task and an assessment of intellectual and verbal ability. Results Between-group analyses indicated that participants with intellectual disabilities scored significantly lower than those without disabilities on the cognitive-emotive interview and the cognitive mediation task. Participants with intellectual disabilities generated fewer beliefs within their dialogues and were less likely to provide alternative perspectives on events. Within-group comparisons showed no significant association between the ability to talk about events, beliefs and emotions within a dialogue and performance on a cognitive mediation task, or with Full Scale or Verbal IQ scores. Conclusions Participants with intellectual disabilities had more difficulties than those without disabilities in talking about events, beliefs and emotions. Within a therapeutic context, they are likely to require assistance to reflect on events and consider alternative interpretations, which take into account individual and environmental factors. Future therapeutic developments may benefit from placing greater emphasis on emotional understanding and the intuitive links that people make between events and emotions. [ABSTRACT FROM AUTHOR]

Objectives. Transition to adulthood can be a challenging time for all young people. However, this period of change is likely to be more difficult for those with mild intellectual disabilities (IDs) because they are often more socially marginalized, remain more dependent upon their family, and have fewer options for future careers than their typically developing peers. Therefore, this study examines the content and salience of worries experienced by young people with mild ID during transition to adulthood, and whether the above disadvantages are associated with the level of reported anxiety and their sense of self-efficacy. Design and Methods. Fifty-two participants (17-20 years) took part; 26 with mild ID and 26 typically developing adults. Of interest were potential differences between groups in (1) worries described; (2) salience of worries; and (3) associations between self-efficacy, anxiety, and worry within groups. Participants completed a 'worry' interview, the General Self Efficacy Scale-12 and the Glasgow Anxiety Scale-LD. Results. It was found that the ID group's most salient worries (being bullied, losing someone they are dependent upon, failing in life, followed by making and keeping friends) were largely different from their non-disabled peers (getting a job, followed by not having enough surplus money, failing, and having to make decisions about their future choices) at this stage of transition. Not only was there a difference in the nature of worries expressed, but the intellectually disabled group also reported ruminating significantly more about their worries and being more distressed by them. Conclusion. Obtaining insight into worries at transition may help to target efforts at increasing these young people's resilience. Clinical applications of the findings are discussed. [ABSTRACT FROM AUTHOR]

Background This paper examines the application of Weiner's attribution model to the responses of mothers to the challenging behaviour of their children who have an intellectual disability. It was expected that the attributions, assignment of responsibility and emotional and behavioural responses of mothers of children with an intellectual disability would vary as a function of the child's behavioural topography and level of intellectual disabilities. The paper further examines whether, as suggested by Weiner's model, anger mediates the effect of attribution of responsibility on likelihood of punishment as an intervention. Method Fifty-six mothers of children with an intellectual disability rated their attributions, assignment of responsibility and emotional and behavioural responses to three vignettes describing challenging behaviours. Results Mothers rated their children as significantly more in control of, responsible for, and felt significantly more angry about aggressive behaviour than stereotypic behaviour and were significantly more likely to punish aggressive behaviour than self-injurious or stereotypic behaviour. Regression analysis suggests that mothers who assign more responsibility to their child were more likely to consider punishing their child and that this relationship is mediated by anger. Conclusions The study offers support for some aspects of Weiner's attribution model with this group of parents. Implications for clinical work with parents of children who have an intellectual disability are discussed. [ABSTRACT FROM AUTHOR]