'But will it really help me get better?'

By Tamsin Cottis, Community Living, Vol. 17, 3 (2004)

Tamsin Cottis describes how the therapist wins the client's trust so they can talk about their experiences.

"Will it help me get better?" This is something Karen said when she first visited Respond. She had been sexually abused by a care worker and this had made her feel scared and upset. She had become too anxious to live in her flat and had moved back in with her mum. Because she was unhappy she wasn't able to go out with her friends anymore and she found she was thinking about the abuse all the time. She was eating too much and not looking after herself well.

Karen came to Respond for three years for weekly psychotherapy. Although her life is not perfect and she still has bad times, she has moved back into her flat and now has a part-time job.

During the therapy Karen talked a lot about the abuse and how she felt she had been so badly let down. At first, she had trusted her care worker and it had been a terrible shock for Karen when he abused her.

As she got to know her therapist better, Karen also used the sessions to talk about what it was like to have learning difficulties and how sad she felt that, unlike her sisters, she did not have children, or a partner.

Sometimes the therapy made her feel cross and upset and she didn't feel like coming. Her support workers were understanding and encouraged her, but they never forced her to come. At Respond, we will only work with people if they want to come. Sometimes, events in the past have affected a person so badly that it's hard for them to make the most of their lives. Like Karen, they feel unhappy and stuck.

Over time she came to realise that the therapist was a reliable person who felt sorry about what happened to her and whom she could trust.

Going into therapy is a big decision for anybody. It can be hard to know if it will help and how it will help. We've been providing psychodynamic psychotherapy for people with learning difficulties for more than ten years now and have seen over 150 people in that time. Everybody's story is different and each partnership between therapist and client is unique. Whilst everyone who comes has learning difficulties and has experienced trauma (usually sexual) we have worked with people from many backgrounds and with an enormous variety of experiences.

So how can we know that therapy is a good idea? When someone is referred for therapy, we'll first meet with keyworkers and make sure there is funding, and someone to bring the client to sessions if necessary. We'll talk to staff about what the therapy will involve. Then the client has a chance to try a session - or several sessions if they're not sure. In the assessment sessions the therapist will ask them some questions about their life and their feelings and the client will have a chance to find out what being with a therapist feels like. If the client can participate willingly in this process, and then wants to come back again, we will go ahead and set the treatment up.

Therapy can feel strange at first. The therapist will be concentrating hard on all the things the client says with words and with their body language as well. The therapist will ask herself, "how does this person make me feel?" to try and understand how the client is feeling inside. Sometimes people at Respond do drawings to show what has happened and the therapist will think hard about what these may mean.

No therapist can undo the painful things that have happened but they can let their client know how sorry they are that they have been through a bad time. Karen's therapist was able to help her understand how her troubled behaviour had its roots in things that had happened in the past. A few years ago, we did some research at Respond and found that a majority of the people who came to us were feeling happier and managing better by the time their treatment ended.

Therapy is private and the sessions won't be interrupted (unless there's an emergency of course!) but we don't keep it a secret if we think a client is in danger, or may hurt someone else. We sometimes talk to other carers too, when there are difficult decisions to be made about the future or if the client wants us to help them put their view across. Usually it is a Respond manager and not the therapist who goes to meetings or talks to the staff. We have found this helps to keep the therapy sessions special and private.

At Respond we believe that serious problems take a long time to get better so most people come to weekly sessions for at least a year and the average time is three years.

Paying for therapy may be a problem because it can be expensive. At Respond, clients don't usually pay for the sessions themselves (though they may make a contribution). Usually, their care manager or doctor finds the money from their care budget.

Therapy isn't right for everybody. If something difficult or sad happens it can be enough to be supported by your friends and family. But sometimes, especially if you are going through a bad patch or if you are isolated, you may need more help. Therapy gives you an extra space to think about what's happened and how you feel and your therapist is an extra person to think with - someone whose only job is to try and understand how you are feeling.

It's important that there is an assessment before therapy starts. At Respond we've worked hard to get a good system in place so that we can be careful to make sure therapy is available to people who need it and who can benefit from it.

It can be hard to find a good therapist who has experience of working with people with learning difficulties. We're compiling a register of therapists around the country and each year we run a variety of training courses for people who want to work as therapists with people who have learning difficulties. We feel that if someone can make good use of therapy, then the treatment should be available to them, whatever their experience or disability.