Table Of ContentCounselling Adults
with Learning
Disabilities
Sally Hodges
BASIC TEXTS IN COUNSELLING
AND PSYCHOTHERAPY
COUNSELLING ADULTS WITH LEARNING DISABILITIES
BASIC TEXTS IN COUNSELLING AND PSYCHOTHERAPY
Series Editor: Stephen Frosh
This series introduces readers to the theory and practice of counselling and psy-
chotherapy across a wide range of topic areas. The books will appeal to anyone
wishing to use counselling and psychotherapeutic skills and will be particularly
relevant to workers in health, education, social work and related settings. The
books in this series are unusual in being rooted in psychodynamic and systemic
ideas, yet being written at an accessible, readable and introductory level. Each text
offers theoretical background and guidance for practice, with creative use of
clinical examples.
Published
Jenny Altschuler
WORKING WITH CHRONIC ILLNESS
Bill Barnes, Sheila Ernst and Keith Hyde
AN INTRODUCTION TO GROUPWORK
Alex Coren
SHORT-TERM PSYCHOTHERAPY
Emilia Dowling and Gill Gorell Barnes
WORKING WITH CHILDREN AND PARENTS THROUGH
SEPARATION AND DIVORCE
Gill Gorell Barnes
FAMILYTHERAPYIN CHANGING TIMES
Sally Hodges
COUNSELLING ADULTS WITH LEARNING DISABILITIES
Ravi Rana
COUNSELLING STUDENTS
Paul Terry
COUNSELLING THE ELDERLYAND THEIR CARERS
Jan Wiener and Mannie Sher
COUNSELLING AND PSYCHOTHERAPYIN PRIMARYHEALTH CARE
Shula Wilson
DISABILITY, COUNSELLING AND PSYCHOTHERAPY
Invitation to authors
The Series Editor welcomes proposals for new books within the Basic Texts in
Counselling and Psychotherapyseries. These should be sent to Stephen Frosh at
the School of Psychology, Birkbeck College, Malet Street, London, WC1E 7HX
(email [email protected]).
Basic Texts in Counselling and Psychotherapy
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C A
OUNSELLING DULTS
L
WITH EARNING
D
ISABILITIES
S H
ALLY ODGES
with contributions from NANCY SHEPPARD
Forewords by
SHEILA HOLLINS and VALERIE SINASON
© Sally Hodges 2003
Chapters 6,7 and 8 © Nancy Sheppard 2003
Forewords © Sheila Hollins and Valerie Sinason 2003
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C
ONTENTS
Forewords viii
Acknowledgements xii
Introduction 1
1 Historical Contexts, Settings and Common
Presentations 5
Historical approaches to people with learning
disabilities 5
Documented approaches 6
The Welfare State 9
Current social and political contexts 9
The power of images and representation in the media 10
Developments in theoretical approaches 11
Who might benefit from a counselling approach?
Settings and presenting problems 12
Summary 20
2 Theoretical Developments 21
The unconscious 21
The beginning of a psychodynamic approach 22
Countertransference 23
Transference 27
Klein’s contributions to psychodynamic counselling 28
Object Relations Theory 29
The paranoid–schizoid position 30
The depressive position 31
Defences 33
Bion and the development of thinking 34
Psychodynamic counselling and learning disabilities 36
The work of Sinason and colleagues 37
Summary 41
v
CONTENTS
3 Assessment and the Beginnings of a Therapeutic
Relationship 43
Assessment in different settings 44
Formal assessment for counselling: referrals and the
aim of assessment 45
History taking 48
Observation 52
Communication considerations and settings 54
Evaluating a client’s response to the assessment 56
Summary 60
4 From Infancy to Old Age: Thinking about
Life Stages 62
Families and a life cycle perspective 64
Birth and the early days 65
Managing separation and independence 67
Sexual development and the Oedipus complex 71
Pre-adolescence 75
Adolescence 75
Relationships in adulthood 77
Relationships with keyworkers 78
Growing older with a learning disability 81
Summary 83
5 Consideration of Specific ‘Presenting Problems’,
How Can a Counselling Approach be of Use? 85
Abuse 85
Bereavement and loss 90
Challenging behaviour 95
Mental health difficulties 99
Sensory impairments 105
Summary 109
6 Relationship Issues: Families and Intimate
Relationships (by Nancy Sheppard) 110
Early family relationships 110
Later experiences 113
Sibling relationships 118
Intimate relationships 121
People with learning disabilities as parents 125
Summary 129
vi
CONTENTS
7 Relationship Issues: Friendships and Group
Dynamics (by Nancy Sheppard) 130
Theories of group dynamics 130
Formal groups 136
Other groups for people with learning disabilities 137
Issues pertinent in setting up groups for people with
learning disabilities 138
Informal groups and friendships 141
Living in a group home 145
Summary 147
8 Working with Care Staff and Organisations
(by Nancy Sheppard) 149
Residential care workers 149
Supporting staff to allow therapy to take place 154
Consultation to staff groups 156
Formal training with staff 161
Summary 164
9 Research and Evaluation 165
Published outcome research into therapy with people
with learning disabilities 166
The Beail Studies 167
The Tavistock Study 168
Difficulties in outcome research in learning disabilities 169
Recommendations for research 173
Summary 175
References 177
Index 191
vii
F
OREWORD
Sheila Hollins
As Sally Hodges says in page 55, ‘counselling is not just about
language and words, but about understanding’. The major barrier
in the way of competent counselling provision for people with
learning disabilities is not the presence of a learning disability,
but the lack of understanding of the relevance of counselling by
potential referrers. The pathway to specialist help for people with
learning disabilities is so often dependent on a third party such
as a relative or a paid carer. Few people with learning disabilities
refer themselves for counselling or therapy and few counselling
services advertise directly to this client group. Sally Hodges has
written for a wide range of professionals who work with people
with learning disabilities, and introduces theoretical concepts in
an accessible way by using clinical vignettes to illustrate each
point.
For example, paid carers need to understand how and why
their own emotional reactions to the people they support can help
them to understand each person better. An introduction to theory
and some time spent thinking about different life stages, personal
histories, presenting problems and relationship issues will
provide an invaluable introduction to the emotional worlds of
people with learning disabilities. Many specialist learning
disability health and social care professionals have trained in cen-
tres where counselling and therapy have not been recognised as
valid interventions. Fortunately many such professionals are now
seeking post-qualifying courses in counselling or therapy to fill
this gap. Mainstream counsellors and therapists whose own train-
ing denied them access to people with learning disabilities will
welcome the chapters on the historical context, on life stages and
relationship issues and on specific presenting problems. The clini-
cal vignettes will bring it to life for them and encourage them to
consider a more inclusive approach to service delivery.
viii
FOREWORD
How appropriate that a basic textbook on counselling and
learning disabilities should emerge from the Tavistock! Pioneer-
ing therapeutic work at the Tavistock in the 1980s by Neville
Symington, Valerie Sinason and Jon Stokes – among others –
paved the way for the present clinical team to develop it further.
Much encouraged by colleagues at the Tavistock, Joan Bicknell
and I were simultaneously introducing psychodynamic ideas
into our developing mental health services for people with
learning disabilities in South London. Other psychodynamically
orientated psychologists working in the United Kingdom began
to evaluate therapy with people with learning disabilities – these
were, notably, Nigel Beaill and Pat Frankish, while elsewhere in
Europe and the USA similar work was beginning. In May 2000
the Institute of Psychotherapy and Disability was launched at a
public meeting at St George’s Hospital Medical School, London,
attended by nearly 100 interested therapists and professionals.
The Institute has started the painstaking work of defining the core
competencies of disability psychotherapists. This book will make
a significant contribution to these exciting new developments and
plans.
Sheila Hollins
Professor of the Psychiatry of Learning Disability
St George’s Hospital Medical School
University of London
ix
