DAFT Workshop: Working systemically with people with a learning disability

1. DAFT Workshop: Working systemically with people with a learning disability Martha Laxton-Kane Consultant Clinical Psychologist & Team Lead for LD CAMHS, North Derbyshire Martha Laxton-Kane, Consultant Clinical Psychologist

2. Aims 1. Consider some of the issues for young people (YP) with learning disabilities (LD) and their families 2. Consider how we include YP with LD in using family therapy approaches Martha Laxton-Kane, Consultant Clinical Psychologist

3. LD and Family Therapy Martha Laxton-Kane, Consultant Clinical Psychologist There is growing literature to support it’s use. However still a reliance upon mainstream literature and case studies. First dedicated book published in 2007, some small scale research and a high number of individual case. In LD often a focus upon incompetence and inability, so FT can help to focus upon themes of competence and abilities People with severe LD not often present at sessions, but ways can be considered to keep them present. Specialist LD-CAMHS

4. Part 1: What is the impact on the family of having a child with an LD? Martha Laxton-Kane, Consultant Clinical Psychologist

5. LD and Family Therapy:Common Issues • Major themes for families: Adapting to the learning disability / Loss and bereavement and coping Family life cycle stages Become experts with professional • Social / Environmental factors will have a big impact • Communication and cognitive impairments Martha Laxton-Kane, Consultant Clinical Psychologist

6. Goldberg hypotheses • That families have long experience of working with professionals over many years. • That the family has difficulty in moving to the next life cycle stage and that this is related to issues of protection. • That patterns of grieving are related to intergenerational patterns of relationships over the years. • That each life cycle transition involves loss as well as gain. Martha Laxton-Kane, Consultant Clinical Psychologist

7. Part 2: People with learning disabilities Martha Laxton-Kane, Consultant Clinical Psychologist Experience the same kind of emotions and feelings as people without LD. Will have the experience of life, however old they are (functional age not necessarily helpful) Will have some form of communicating even if we are not familiar with it. The same kind of principles apply for people with ASD as they do for LD Specialist LD-CAMHS

8. General principles of working with people with ld Martha Laxton-Kane, Consultant Clinical Psychologist YP with LD often described behaviourally* It will take more time – very repetitive, need smaller steps and realistic aims Need to make abstract concepts more concrete – drawing, writing, play dough, genograms with pictures, concepts into metaphors Do ask others how to respond and observe others interactions… & ask Speech and Language Therapy advice All people with LD will have different levels of ability and understanding. *challenging behaviours can mask physical causes Specialist LD-CAMHS

9. More general principles of working with people with ld …… • Help retention of information with simple letter / summary. • Simple agenda and cross off to help YP keep focused / concentrate. • Accept going off at a tangent at times / muddled concepts. Martha Laxton-Kane, Consultant Clinical Psychologist

10. Adapting Family Therapy • Give the person with LD more time and opportunity • Use visual supports to make concepts more concrete • It is suggested that for people with more severe LD may have to invite others to give them a voice / adopt their position if they cannot be included. • Managing questions / conversations with different family members – clearer who asking questions to and recap frequently. • May have to go into the home environment – be flexible about work Martha Laxton-Kane, Consultant Clinical Psychologist

11. Videos ……. Martha Laxton-Kane, Consultant Clinical Psychologist

12. Thank-you martha.laxton-kane@chesterfieldroyal.nhs.uk Martha Laxton-Kane, Consultant Clinical Psychologist

13. What I love about people with learning disabilities • A challenge to social rules • Small changes are very important • A lack of chips and judgements • Honoured to be part of families lives • Honesty • Laughter • Learning how other people overcome marginalisation and challenges Martha Laxton-Kane, Consultant Clinical Psychologist

14. A learning disability:what do we really mean? Martha Laxton-Kane, Consultant Clinical Psychologist There is enormous variability between individuals – different skills Difficulties with: Communication (verbal and non-verbal methods) Abstract concepts (time, question styles, ideas) Problem solving skills Learning new information & generalising learning Some daily living skills Likely to need some level of support in future Specialist LD-CAMHS

15. Solution-Focused Research 7 mothers & 1 father, qualitative interviews about first session experience - themes: • Make the best of it (no point dwelling) • Wishful thinking – a constant dilemma about what could have been. All did not like the miracle question. • Therapeutic relationship – time to think, amplified self-efficacy Martha Laxton-Kane, Consultant Clinical Psychologist