The Counselling Clients with Intellectual Disability: A Look at What Works Mental Health Academy CPD course endeavours to show which therapies may be effective with populations who have intellectual disability and how they can best be utilised clinically. Where research exists with such clients, outcomes are summarised. There is, however, another aspect to making therapy genuinely available to those with intellectual disability.

That is the question of what the therapist does in session to make any therapy more intellectually attainable, or user-friendly, to someone who has at least cognitive limitations, but who also may be struggling with communicative deficits, sensory impairment, and/or psychological conditions. In a nutshell, some writers have advocated “Go slow, be concrete, repeat” as a useful formula regardless of the therapeutic approach used (Prout & Strohmer, 1998).

Fleshing out that advice, Morasky (2007) proposes a series of dimensions along which strategies can be evolved to adapt counselling and therapy (and he says, also vocational and life skills instruction) for persons with intellectual disability. The adaptations revolve around the central question: what makes an intellectual activity difficult? He discusses four parameters which commonly impact intellectual tasks: speed, number, abstraction, and complexity. In this article, we look at them in turn.

Speed

The poles for this continuum are fast to slow. The faster an intellectual task must be performed, the more difficult it is and the more intelligent someone is deemed to be when they can perform it fast (think about all those timed intelligence tests you took in school where there were so many items you knew no one could finish before the time was up!). When we are exposed to a stimulus for a short period of time, memory storage and retrieval are both more difficult. Also, having to retrieve items quickly increases the difficulty level of an intellectual activity. So with clients with intellectual disability, the idea is to slow the pace way down, allowing as much as twice the time a non-disabled client would take to respond.

Number

This continuum goes from few to many. The more components one has to process, the more difficult the task. We see this with memory. It is said that a person can remember seven items more or less; eight or nine might be possible for some. 39 items would probably challenge anyone! Decision-making also becomes more difficult as the number of possible options increases. Consider, for instance, how much harder it is to choose a meal from a long restaurant menu than from one that has only two or three choices for mains.

Abstraction

Here our poles go from concrete to abstract. Concrete concepts or items are generally tangible, meaning that we can see, hear, touch, taste, or smell them, whereas abstract concepts are usually intangible: not available to detection from the five senses. Consider the difference between discussing, say, a cloud and cloud computing. The intellect works harder to comprehend abstract notions than concrete ones. The sentence, “Conscientious people are well thought of” is more difficult to logically process than “The boss praised George for getting the report in on time”.

Complexity

Ha! This is a topic that in itself is complex! One way to characterise this continuum, especially for clients with intellectual disability, is to think of going from simple to complex. Complexity can then be defined as the number of relationships encountered. Simple systems have fewer components and these have few to zero relationships between them. More complex systems have greater numbers of components and these have relatively more relationships between them (Morasky, 2007).

Imagine, for a moment, that you are trying to work out how to organise your day. You really would like to go ice-skating, and you can get there by bus (you don’t drive), but if you go do that, you will get back too late to go grocery shopping, and you have nothing to eat in the house. Grocery-shopping is therefore a priority, but you realise that today you would be dependent on your friend being free to take you to the shops, as you need too many items to go by bus and carry them home. By the time your friend can take you grocery shopping, you would miss the ice-skating. Because the free pass to the ice rink expires today, you would not be able to afford to go skating for some time if you don’t go today.

Another option is to join your cousins – who are in town just a short time – for a planned walk and swim in the ocean followed by lunch out. Your cousins might wait while you do the grocery shopping and then drop you home, but if you go out to lunch, you will not have enough money for the groceries you need. What to do? The relationships between the various options make the situation more complex, and thus more difficult to work through for someone who has intellectual disability.

What types of intellectual tasks are difficult?

Morasky also asks the question of which intellectual tasks are inherently difficult, reminding the reader that memory, reasoning, generalisation, decision-making, planning, and problem-solving are often reported as tough intellectual operations for people with intellectual disability (Morasky, 2007).

Counsellors and other mental health helpers will do well to examine how the difficulty levels of the above tasks requested of clients with intellectual disability clients are impacted by the parameters of speed, number, abstraction, and complexity. Where possible, the word is to go for slower, fewer, more concrete, and simpler.

This article was adapted from the MHA CPD course “Counselling Clients with Intellectual Disability: A Look at What Works”. The aim of this course is to examine which approaches and ways of working may be more fruitful with clients who have intellectual disability.

References

• Morasky, R.L. (2007). Making counseling/therapy intellectually attainable. NADD Bulletin, Volume X, No 3, Article 3. Retrieved 14 Jan., 2014, from: hyperlink.
• Prout, H.T. & Strohmer, D.C. (1998). Issues in mental health counseling with persons with mental retardation. Journal of Mental Health Counseling, 20, 112-120.