Do specific adaptations need to be made to IAPT interventions to make them more accessible to patients with a learning disability?

Whittaker, Max (2023) Do specific adaptations need to be made to IAPT interventions to make them more accessible to patients with a learning disability? Doctoral thesis, University of East Anglia.

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Abstract

Background: There is a growing interest in how people with intellectual disabilities (ID) experience psychotherapy, and the extent to which mainstream psychotherapies may need to be adapted for people with ID. However, it is currently unclear whether models of the therapeutic alliance, largely developed based on the experiences of clinicians and mainstream populations, effectively describe the experiences of people with ID. The empirical basis upon which to base decisions regarding therapeutic adaptation for people with ID likewise remains nascent.

Methods: A qualitative meta-synthesis using a best-fit framework analysis examined how the therapeutic alliance is experienced by people with ID. The review specifically examined whether Bordin’s model (1979) of the therapeutic alliance accurately fits the experiences of people with ID. An empirical study was also conducted to examine which factors predict recovery for people with ID accessing NHS Talking Therapies (NHSTT), (previously Improving Access to Psychological Therapies – IAPT) and whether these factors are similar or dissimilar to those which predict recovery for people from the mainstream population.

Results: Twenty studies met the inclusion criteria for the qualitative meta-synthesis. All studies were conducted in the United Kingdom (UK). The analysis found broad areas of agreement between Bordin’s model (1979) and how people with ID experience the therapeutic alliance, though people with ID assigned more importance to interpersonal aspects of therapeutic processes. In the empirical study, data from 250 participants were included across two matched groups of ID (n = 125) and non-ID (n=125) participants who had accessed NHSTT services since 2013. Results suggest that the total number of sessions and disagreement on discharge were associated with recovery outcomes for both groups. Results also suggest that baseline GAD-7 score, social deprivation, referral duration and wait to second treatment were additionally associated with outcomes for people with ID.

Conclusions: The systematic review suggests that people with ID assign greater importance to the interpersonal aspects of psychotherapy. The primary importance of interpersonal factors is not necessarily reflected in Bordin’s model (1979). Further research is also needed to determine whether Bordin’s model, which is predicated upon the concept of individual responsibility, can be applied as a “best fit” to people whose lives are more likely to be characterised by impaired abilities to make autonomous decisions, reduced quantity and quality of interpersonal connections, and reduced opportunities across personal, social and professional domains. The empirical study found that the factors which predict recovery for people from the general population accessing IAPT also predict recovery for people with ID. However, there appear to be factors which additionally predict recovery for people with ID. Further research is required to determine whether these findings can be replicated across a larger sample.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Chris White
Date Deposited:	27 Mar 2024 11:05
Last Modified:	27 Mar 2024 11:05
URI:	https://ueaeprints.uea.ac.uk/id/eprint/94784
DOI:

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