working with intellectual disability as a therapist – You have got what it takes!

How to work with people with an intellectual disability. You have got what it takes. It’s you!

• Do you have a loved one or a person you are supporting who lives with an intellectual disability? Are you needing help too?
• Do you think there is more going on inside them that they could be helped by seeing someone? NDIS is about giving choice and control.
• What issues are they having? Common issues are grief and loss, managing anger, living with a disability and relationship issues. Did you know they can often be helped?
• Has enough been done? Remember they will very rarely ask for themselves.
• Why aren’t they accessing help they need? Ask yourself. Have we raised our sights or settled with low assumptions? Don’t forget support for yourself either.
• I respect people as they already are, not a disability, and for who they may be becoming. Explain good options, let them have a say.

Registered NDIS counselling therapy for people who have an intellectual disability

I continue to be amazed by the depth, strength, adaptability, humour, high standards of morality, tenacity and survival skills displayed by the people with an intellectual disability with whom I work. To me it is so important to treat each one as an authentic person not a disability. I always assume that people are taking in much more than I may realize, with more capacity than I may yet know. To me it is about respect beyond labels or assessments. I usually find my assumptions to turn out pleasantly correct as people sense your respect and acceptance for who they are and the values they carry. People with an intellectual disability may not know it; they inform all of my work. I am a Registered NDIS Provider serving Ipswich, Springfield and nearby regions at our therapy centre or mobile to you. I support both participant and carers and support workers as needed in an individual or wholistic way.

People with an intellectual disability have lives like any person

They experience the same range of emotions as anyone else; they experience emotions with the same intensity. They know the rush of happiness and well as the depth of grief, loss, rejection and frustration. They appreciate connecting with others, to seek friends, have an intimate partner. They value being part of a family or group.

However, people with an intellectual disability can struggle to understand concepts and put words around their experiences. The challenge to processing information can lead to complexity in their lives. For example, in forming, maintaining and finishing relationships. Often they do not have the countervailing benefit of partner, close friends, satisfying work or support a family that other people in the community find helps manage personal difficulties.

It is unusual for participants to request counselling therapy themselves

Usually people come to see me as a result of someone else with a certain purpose in mind of that person. This means I need to check that NDIS participants are happy for the stated purpose to be a focus or if there are also issues that they themselves also want to talk about. I find it important for participants to be clear about why they are here, that they are willing to come and they have choice and control to know they can stop at any time they wish to.

I find the common issues NDIS participants come with are grief and loss, managing anger, living with a disability and relationship issues.

Contents

Why counselling therapy helps people who have an intellectual disability

Understanding communication

Who inspired me to work with people with an intellectual disability?

How I work with people with an intellectual disability

Useful ways I find for me to communicate are:

Example of what happens in a first session

It is rare for me to see a person on their own

I do not work with all people who have an intellectual disability

Why counselling therapy helps people who have an intellectual disability

Counselling therapy helps people to acknowledge difficulties. Therapy is able to help them to find their own way of understanding, develop skills and improve capacity to manage their lives with greater ease and confidence.

I try to be a sensitive NDIS therapist who makes good connections, is creative, flexible and careful to observe what is happening for the other person so they feel comfortable with me.

Understanding communication

Spoken language is not the main way people who have an intellectual disability communicate. I find they are great observers – they need to be. They are often better at picking up signals that another person is open of closed to them, confident or uncertain, enjoys being with them or doesn’t like them.

They are also much more natural and spontaneous in their body language. They are much more transparent in how they feel and will indicate what is happening for them than non-intellectually impaired people. It is easy to tell when they are bored or interested in something else or feeling tired.

However it is common for them to pretend to understand something when they do not. This is in a way a self-protective device they have learned to do and are considerably skilled at. I manage this by regularly checking my understanding and as needed presenting a concept of idea in a number of different ways.

Who inspired me to work with people with an intellectual disability?

I have been positively influenced by the work Crossroads that I volunteered at years ago. And of the work of Carol Llewelyn- Scorey. Much of what I have written here has drawn on her work in the past as a Family Therapist and specialist in over 30 years working with people with an intellectual disability. I first saw her call to action to say to therapists like me that you’ve got what it takes to work in this field some 19 years ago and it has always inspired me to remember what she taught me, and take what opportunities I could to work with people, no matter their background.

How I work with people with an intellectual disability

I always comment positively on a participants skills and abilities. I never adversely comment on mistakes they make. Instead I ignore that, encourage the person to try again or I say that what I’m asking them to do is actually hard, which of course it is. I watch for signals of their ability to handle this or not. I usually find this self-protective device mentioned earlier usually disappears and the participant is more confident about having a go.

It is very common to get no response if I ask what would you like to talk about today. So I handle this by listing out issues (or guesses) I believe are current for them. I check in with them about this using a list or making a drawing for each matter. In this way, the person can be clear about what they want to talk about.

Carol inspired me to realize that participants are highly tolerant of my mistakes and in fact use them to demonstrate my fallibility or that I have not been “using my brain”, “concentrating” or “taking my time” (concepts I use regularly).

Useful ways I find for me to communicate are:

• Keeping language simple, sentences short and saying talk to rather than communicate
• Starting sessions with language and concepts I assess they understand. I may challenge their understandings later
• Observing and matching their language including slang
• Asking them to “help me to understand”, “say it again”, “draw it” or “write it” if I do not understand them
• Being patient, not rushing
• Being careful to check, and recheck where the person is at
• Taking time at each step allowing plenty of time for repetition and practice
• Regularly checking understanding, “can you remember what I just said?” or “what does the word…mean?”
• Using visual materials little figures of people, photos, pictures, cartoons, comic strips and diagrams
• Taking a box of things that participants can make things with like felt pens, paper, glue, sticky tape and pipe cleaner.
• Using two phones to role play a phone conversation, and recording the participants speech and my speech as a way to practice options for saying things in new ways that may work better for people
• Being aware of my facial expression and whether it matches what I am trying to convey
• Speaking slowly and pausing at the end of each phrase allows people time to take in what is being said.
• I try to remember to keep things light as seriousness may come across as disapproval. I too have discovered how much intellectually impaired people can laugh readily, laugh heartily, much more than I ordinarily used to. I love this aspect of our work.

Example of what happens in a first session

I usually use the first session to start getting to know the person, their personality and the way  they communicate. I do this by observing, listening to what they say what they say and how they say it, asking them to read, write or draw, and noting what takes their attention. All these help me assess their level of cognitive competence. It is also time for them to start to get to know me. They are much more interested in me as a person as opposed to my talking to them about what a counsellor. I talk about my family and show them photos. I invite them to bring in their photos to their next meeting.

I write a one-page letter to every intellectually impaired participant after every session. This letter is simply written, encouraging and highlighting of things which they did well. It also helps the person review what happened. The letter is also a source of information to family and support workers, if the client is happy for others to see the letter. Tasks coming out of the counselling are recorded. The previous letter is usually read in each session; this provides a link to previous work. For many people this is the only personal mail they receive.

I find the letter is a good way for me to record information and to professionally review my counselling role in a given session.

It is rare for me to see a person on their own

Participants usually attend with a support worker or family member bracket usually the mother in bracket. I always check if they are happy for the support person to sit in on the session. I regularly work with people on their own to part of the session but include the support person to the other part. It is essential that the participant feels comfortable with the presence of the support person.

The support person is valuable to the participant for a number of reasons. They can;

• help the person express themselves including explaining the reason for coming to counselling
• assist where the participants speech is unclear
• be part of a conversation with me when I feel the person needs a rest or is feeling stressed
• enables me to provide information to the participant in an indirect way, by engaging the support person in conversation, for example talking about the many good things I’ve noticed about the participant that day
• take part in role-plays bracket if they are brave enough bracket so that the participant can observe interaction taking place, for example the person using the brain to manage anger instead of being out of control (participants love me role-playing a full-blown anger outburst)
• review what took place in counselling, in the client’s day-to-day life assist the participants to practice certain skills for example using a strong voice and sticking up for themselves, and
• give use of how things have been since the last meeting and which is over and above what the participant has already said

The support person often gets new insights into the participant during the sessions. This can assist them in their contact with the participant outside of the counselling. Some aspects of the counselling therapy are deliberate strategies to enhance or modify the support person’s interaction with the participant.

It is not uncommon for the support worker to be included in the counselling. I regard this as a form of family therapy. If a family member accompanies the participant, this often becomes family therapy as opposed to individual counselling.

I do not work with all people who have an intellectual disability

At a minimum, the person needs to have some capacity to convey information to me, e.g. yes, no, or I don’t know. This may include their using symbols, signs or facilitated communication. In these circumstances I always expect a support person skilled in that clients communication patterns to attend. At a minimum, the person needs to understand simple concepts expressed by me.

I work in an area I call personal development to improve capacity for improved daily living as a registered NDIS provider. Participants need to be able to sit for a period of time and stay in the room in which I work for a period of time. I refer significant behavioural issues elsewhere.

My sessions last for one hour excluding time for the letter summarising the work we did that day. I continue to be amazed that clients almost always manage to cope with that time span. I prefer to see clients weekly and usually for around 24 sessions. It is rare for me not to use all of these.

Please contact me if you have further queries, or are considering working in this area and would like some help. I would be happy to help.

Owen