PSYCHOLOGICAL INTERVENTIONS/NON-PHYSICAL INTERVENTIONS

These types of interventions do not fall into the traditional medical model that historically has been the way to care for people with mental health needs; there is an explicit taboo on physical contact, which is very different from the previously mentioned interventions. This provides an immediate appeal to the service users, as these types of intervention may be seen as less intrusive. Some ‘body therapies’ are the exception to this taboo, but any touching is always consented to and must be justifiably therapeutic in its nature; examples would be foot massage in relaxation therapy or compresses in aromatherapy (Grant et al. 2004).

There are many interventions in use of this type and they continue to grow in number and popularity, i.e. good examples are dialectical behavior therapy (DBT) and early development therapy (EDT), which are held in high regard within mental health (Linehan et al. 1994). It could be argued that the sheer number of options within this fi eld make it very complex for non-therapists to understand and appreciate how they can help and the differences between them. Many health and social care workers within learning disabilities and mental health find this area very confusing, as do the service users themselves. Much of this confusion, again, stems from the multiple terminologies used, much of which, when analyzed, have very similar meanings (Gates 2003).

The most well-known psychodynamic interventions are individual or group psychotherapy sessions and, in learning disabilities, these are often manifested in a creative therapy, such as art, drama and music therapy. Psychodynamic treatment methods are directed towards the underlying problem rather than the symptoms. For example, an art therapist receives a referral for a person with severe learning disabilities who has been presenting with some aggressive behavior; s/he would aim to use the art as a medium to expose the cause of the behavior. Art, drama and music therapy work very well with all levels of learning disability, but especially with those who have serious communication difficulties (Kuczaj 1994). Hollins (2001) suggests that there are several key areas of difficulty or ‘secrets’ that people with learning dis abilities typically experience, which they are likely to bring to individual or group therapy if given the opportunity. These could be the disability itself, loss, dependency.

Gates (2003) advocates art therapy’s suitability for people with learning disabilities and highlights its flexibility as a major reason for their success. It is ‘tailor made’ for the service user’s individual needs and each intervention is different – typical processes for typical problems do not exist. The pace of the session is dictated by the service user and, more often than not, the sessions are ongoing and only finish if the service user wishes it or the therapy is complete, as opposed to therapy in more generic settings, which it is likely to offer a certain number of sessions only (Gates 2003).

In contrast to psychotherapies, behavioral therapies operate by focusing on the behavior, rather than its causes, and aim to modify it. Using the same example, if a behavioral therapist received the referral of the person with severe learning disabilities and aggressive behavior, s/he may not be concentrating on the causes but more on the behavior itself. However, behavior therapy in its purest form is largely no longer used. Carers and professionals who have worked within the fi eld of learning disabilities for many years will be very familiar with the terms ‘behavior modification’ and ‘token economy systems’; these are based upon B. F. Skinner’s (1904–90) theory of operant conditioning, which can be described as learning by consequences. The aim is to increase desirable behavior through manipulating the consequences of that behavior. Positive reinforcements for desirable behavior exist alongside negative reinforcements to undesirable behaviors; it is the negative reinforcements that would too often carry punitive measures which have seen this form of intervention largely discredited in today’s practice. An example would be that when a service user with destructive behavior broke a piece of furniture, she or he would have a favorite item taken away from him/her. The general consensus appears to be that good practice involves practitioners’ rewarding good behavior, but not punishing poor behavior (Hollins 2001).

There are more recently developed interventions that adopt the behavioral model, such as relaxation therapy and anger management therapy; these have cognitive as well as behavioral components. Cognitive approaches are based on the idea that mental health problems are caused by problems in the way we think. In other words, how we think determines how we feel; therefore, cognitive therapy addresses an individual’s negative thoughts and beliefs. It has been shown to be very successful with mental health problems, especially depression; some would argue that it is as effective as medication (Grant et al. 2004).

Contemporary practice suggests that behavioral and cognitive approaches are used concurrently and the most frequently used is cognitive–behavior therapy (CBT). It is important to clarify that CBT is not a single therapy but is more of an umbrella term for many different therapies, of which the number seems to grow continuously. Priest and Gibbs (2004) indicate that its significance within mental health stems from its ability to deal with both the symptoms and the behavior. CBT aims to confront negative feelings and reform them in a more positive light. An example would be a service user struggling to come to terms with a bereavement; the CBT therapist may aim to move the thoughts of negativity such as ‘I miss them’ or ‘I need them’ to ‘We had some great times together’. However, CBT requires the ability to understand the reasoning behind the changes in thinking and articulate those thoughts so that service users can work together with the therapist; it is argued that without this insight, it cannot be successful, i.e. people with learning dis abilities or psychotic patients may find this intervention fairly limited in its achievement. Similarly, the problems of poor communication with people with learning disabilities can hinder the effectiveness of counselling; however, given the correct environment and a skilled counsellor, people with learning disabilities are shown to develop emotionally with its help. Clarke (1994) suggests that the root of counselling is the principle that all human beings seek to grow, develop, expand, maintain and restore themselves. It is therefore the prime task of the therapist to create those conditions which will be conducive to their growth. The approach must be person-centered and relies on a genuine and unconditional acceptance of the service user.

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مواضيع ذات صلة

DIAGNOSING EPILEPSY

CAUSES OF EPILEPSY

PREVALENCE

Epilepsy and Adults with Learning Disabilities

Mental Health Issues and Adults with Learning Disabilities CONCLUSION

ELECTROCONVULSIVE THERAPY (ECT)

ANXIOLYTIC MEDICATION

MOOD-STABILISING AGENTS

ANTI-DEPRESSANT MEDICATION

ANTI-PSYCHOTIC MEDICATION

PSYCHOTROPIC MEDICATION

THERAPEUTIC INTERVENTIONS