The effectiveness of therapy

by Katherine Haines

Therapy for people with learning disabilities remains a relatively new field since, for a long time, people with learning disabilities have been considered unsuitable candidates.

It has been a generally held view that if a client has a lowIQ and difficulties in communicating verbally then they cannot use a treatment that requires thought and is a "talking cure".

The psychoanalyst Valerie Sinason, however, states that even patients with profound disabilities can benefit from psychoanalytic psychotherapy because communication takes place on more than one level.

Facial expression, tone of voice and quality of silence all facilitate interaction. Furthermore, the increasingly used term "emotional intelligence" is an important indicator of clients' ability to engage in what is more often an emotional process than an intellectual one.

Dr Amory Clarke, who has been conducting research into Respond's therapy provision, looked at previous research into therapy with people without learning disabilities, predominantly in the States.

Historically, the US government only supported health interventions in the 1970s if they have proven to be effective. This prompted a wealth of research into the efficacy of psychotherapy. The overwhelming weight of research pointed to counselling and therapy as being treatments that aided recovery for patients experiencing the effects of trauma and depression.

Dr Clarke then devised a questionnaire that was sent to referrers of Respond's clients from the past three years. Where possible, clients themselves helped complete the document. The questionnaire was modelled on research published by consumer reports in the USA in 1995 that Martin Seligman had deemed to be the "most extensive, carefully done" study of the effectiveness of psychotherapy reported in psychology literature.

Respond's questionnaire focused on demographic, longitudinal and mental health issues, in addition to assessing the value of Respond's therapy service. One hundred and ten questionnaires were sent out with approximately 50% being returned.

In assessing the change in the emotional state of clients, respondents were asked to indicate the client's emotional state at the outset of therapy compared to that after therapy. 62% of clients were identified as being in the "very poor" to poor range at the outset of therapy. Following therapy, this had fallen to 19%.

We also assessed changes in behaviour specifically self-harm and sexual offending behaviours. Again, the results of this part of the research are encouraging. At the outset of therapy, 60% of clients were considered to be in the "very poor" to "poor" range of managing inappropriate behaviour. While following therapy over 40% had experienced improvement in their dangerous behaviour.

Despite the misconceptions about the value of psychotherapy to people with learning disabilities, one of the key findings is that people feel better about themselves through engaging in a therapeutic process, and this helps them to manage behaviours that harm themselves and others.

We would be very interested to hear from anyone who has attempted similar pieces of research in the past, so that we may compare our findings with others.