People with intellectual disabilities have been and still are surrounded by a stigma. Wider population and some scientists have questioned the effectiveness of psychological therapies upon the disabled individuals. This led to a lack of adjustment of psychological methods, assessments, and understanding of their mental health. However, over the decades the high number of intellectually disabled people living in institutions started to drop. Nowadays they rather live in community care, with their families or in small community based-housing. This caused more questions to be raised about their mental health and about ways how to meet their needs (Hatton, 2002).
The questions are being slowly and partially answered. Concerning the mental health, researchers have found that adults with intellectual disabilities seem to have a higher prevalence of mental illness in comparison to average population (Whitehouse, Tudway, Look & Kroese, 2006). In addition, if the individual psychotherapy is appropriately altered, they can benefit from it and improve their mental well-being (Beail, Waarden, Morsley & Newman, 2005). This is very important notion and current studies are trying to design suitable methods and treatment for the patients with special needs.
Currently, there are no established methods. Most clinics utilize questionnaires and self-report format for collecting information. People with intellectual disability are struggling with this type of assessment because of their reading and verbal communication deficits. The altered measures, which have been already used in practice by Beail and Warden (1996), are the SCL-90 and the Rosenberg self-esteem scale. Both scales are commonly used for assessing psychological symptoms and self-esteem of patients respectively. Making the questionnaires shorter, with simplified language or in an interview form are just a few techniques, which can make the measures more efficient.
Because we are lacking the important data, the effectiveness of individual therapy with intellectually disabled patients has not been fully determined. Some studies have been conducted to investigate the effectiveness of psychotherapy approach to understand its effectiveness and benefits over behavioural approach. Beail and Warden (1996) described an effect of regularly provided psychotherapy without any specific alternations to the procedure and did observe some positive reflection of the treatment upon the mental health of the intellectually disabled patients. Further reflexion on the procedure of the therapy is needed because as Whitehouse et al. (2006) pointed out, the confusions in communication is an often-occurring barrier between the clinicians and the client, caused by the lack of appropriate training.
Recruiting participants from clinics where they have been already treated is preferred method in the literature. Beail et al. (2005) argued that the selected sample of patients from clinical practice, accurately represents the population, and thus the results have greater generalisability and application for practice. However, the accessibility of treatment to intellectually disabled causes the number of suitable participants to be very low across the studies.
Thus, it is important to reflect on past studies and cover their limitations to provide more sufficient outcomes for the clinicians and the patients to benefit from. Improvement of these factors could lead up the psychotherapy to improve the well-being of intellectually disabled people since there are over 1.7 Million people in the United Kingdom living with this disability and the number is expected to increase (Hatton, 2002).
Aims and Hypotheses
Our research is going to investigate the effect of psychodynamic psychotherapy on the mental health of adults with intellectual disability. We expect the psychodynamic psychotherapy to have a positive effect upon the self-efficacy of the patients and reduce the psychological symptoms of depression and anxiety connected to intellectual disorder. We are also going to be interested in the magnitude of the improvement in groups of severely and moderately intellectually disabled people because such comparison has not been done before. We aim to begin with a larger sample of participants, as we take in consideration the large drop out or necessary exclusion from the research which were mentioned in the past studies (Beail & Warden, 1996; Beail et al.,2005; Whitehouse et al., 2006). Our research is going to be mainly exploratory in nature and the data obtained from this research can be used in the further training of clinical specialists and add more resources to this area of research.
The methods of our research are going to remain similar to those in the study conducted by Beail and Warden (1996). We are going to recruit 50 participants from clinics across the United Kingdom, where are the patients already registered and have been assessed by comprehensive assessment to determine the level of their intellectual disability. For the purpose of our experiment, we are going to sort our participants into two groups labelled: moderate and severe. This categorization is going to be based on the severity of their intellectual disability.
The Rosenberg Self-Esteem scale in the interview format, which is modified for people with intellectual disability, is going to be used as an assessment of self-esteem. To measure the needed range of psychological and physical symptoms, we are going to use the Brief Symptom Inventory, which is the concise version of the SCL-90R. The language used is going to be tailored to the individual’s level of understanding. And as an intervention technique, we are going to use the psychodynamic psychotherapy provided in regular clinical practice.
The general sensitivity index and Rosenberg self-esteem scores are going to be measured at the beginning of the treatment, after every 8 sessions, at the end of the treatment and after 3 months the termination. The data from the different time-points are going to be analyzed by repeated measures ANOVA.
We are looking for a significant difference between the different scores measured before, during and after the intervention. The measure of Rosenberg Self-Esteem scale should reflect the gradually improving self-esteem of the patient during the study. The psychodynamic psychotherapy should decrease the negative psychological symptoms of depression and anxiety, which should be indicated by the Bried-Symptom inventory scores. Our expectations are based on the outcomes of the study by Beail and Warden (1996).
With regards to the severity of disability, we are going to be mainly observing, whether the intervention has equal impact on both groups or if there is going to be any improvement at all. This aspect of our research is going to provide extensive information about the aspect of the therapy which might work only for certain level of the intellectual disability.