Significant therapy events: An interpretative phenomenological analysis of psychotherapy with clients with intellectual disabilities

Background: Gradually, over the years, the type of treatments provided to clients with intellectual disabilities (IDs) has changed, with increasing access to different types of psychotherapy. Given the high prevalence of mental health difficulties of people with IDs, it is key to explore how to make psychotherapy more effective for this client group. There is a growing evidence base of studies investigating the use of psychotherapies for people with IDs, with the level of evidence varying from case studies for less established studies, to small scale randomised controlled trials (RCTs). However, most studies have focused on adapting interventions, and efficacy, rather than exploring the process of psychotherapy, which is in stark contrast to the literature on non-ID populations. Exploring significant events in therapy provides opportunities to gain insight into the therapeutic process; using a video recording of the session to prompt participants’ memory of the session enables such insights to be explored. Research exploring significant therapy events involving clients without IDs has shown there to be a link between significant events in therapy and positive therapy outcomes. However, to date, no significant therapy events research could be found involving clients with IDs. Aims: To examine client-identified significant events in psychotherapy and to explore the lived experience of psychotherapy with clients with IDs.Methods: Four therapy dyads of adults with IDs and their therapists were recruited. Semi-structured interviews focused on helpful events in psychotherapy, using videos of particular sessions as a stimulus to help prompt participant recall of that session. A modified version of interpretative phenomenological analysis was used to identify emerging themes.Results: Five super-ordinate themes were identified that related to the research questions. The first four themes described the process leading up to and surrounding the significant therapy events, comprising of: 1) The Uniqueness of the Therapeutic Relationship; 2) Using Adaptations to Express Emotions; 3) Client Behaviour/Therapist Behaviour; and 4) Hope and Paternalism. The final theme: 5) Meaning Making, depicted how clients and therapists made sense of the identified significant therapy event.Implications for counselling psychology: This study highlights the need for therapists to work in such a way as to facilitate significant events in therapy with their clients through building a strong therapeutic relationship, making appropriate adaptations to ensure their clients can express themselves, being mindful about instilling hope, and adopting a clientled approach. It may be helpful to have more flexibility within therapeutic contracts to enable clients with IDs to have more sessions in order for a strong therapeutic relationship to be built, as well as providing the space for a client-led approach to foster client independence and moments of insight. Furthermore, therapists could use supervision to reflect on balancing empathising, protecting and helping in order to promote the process of empowerment. Indeed, the use of video-recording sessions could be helpful, not only for therapists to reflect on their practice during supervision, but also as a means of training therapists, working in mainstream psychotherapeutic services, to be able to confidently work with clients with IDs. In addition, the research makes an important contribution by demonstrating the feasibility and importance of undertaking process research with clients with IDs in order to explore the process of change.Conclusion: This is the first known study to move the ID research field forward into exploring the process of therapy for clients with IDs rather than utilising the wellrehearsed case study and outcome research methodologies. The current findings suggest that clients with IDs do experience significant therapy events. Furthermore, the research enabled insights to be gained about the process of therapy for this client group and for exploration of therapeutic factors that may be involved in facilitating a significant therapy event. The findings highlight areas where further research is required

Making training more cognitively effective: making videos interactive

The cost of health and safety (H&S) failures to the UK industry is currently estimated at up to £6.5 billion per annum, with the construction sector suffering unacceptably high levels of work-related incidents. Better H&S education across all skill levels in the industry is seen as an integral part of any solution. Traditional lecture-based courses often fail to recreate the dynamic realities of managing H&S on site and therefore do not sufficiently create deeper cognitive learning (which results in remembering and using what was learned). The use of videos is a move forward, but passively observing a video is not cognitively engaging and challenging, and therefore learning is not as effective as it can be. This paper describes the development of an interactive video in which learners take an active role. While observing the video, they are required to engage, participate, respond and be actively involved. The potential for this approach to be used in conjunction with more traditional approaches to H&S was explored using a group of 2nd-year undergraduate civil engineering students. The formative results suggested that the learning experience could be enhanced using interactive videos. Nevertheless, most of the learners believed that a blended approach would be most effective

Significant therapy events with clients with intellectual disabilities

© 2018, Emerald Publishing Limited. Purpose: The purpose of this paper is to explore significant events in psychotherapy with clients with intellectual disabilities (IDs). Design/methodology/approach: Four therapy dyads, each consisting of one client and one therapist, were recruited. Following the brief structured recall procedure (Elliott and Shapiro, 1988), semi-structured interviews focused on helpful events in psychotherapy, using video of particular sessions as a stimulus to help prompt recall of that session. Findings: Using interpretative phenomenological analysis, five super-ordinate themes were identified: “The Uniqueness of the Therapeutic Relationship”; “Using adaptations to Express Emotions”; “Client Behaviour/Therapist Behaviour”; “Hope and Paternalism”; and “Meaning-Making”. The results provide additional evidence that significant therapy events occur for clients with IDs. Furthermore, the research enabled insights to be gained about the process of therapy for this client group and for exploration of therapeutic factors that may be involved in facilitating a significant therapy event. Research limitations/implications: This study highlights the need for therapists to work in such a way as to facilitate significant events in therapy. Whilst this study was a necessary first step, owing to the non-existence of research in this area, the sample size and qualitative design may limit any wider generalisation of the findings. Originality/value: Significant events have not previously been explored in psychotherapy with clients with IDs. This research could therefore make an important contribution to our understanding of the process of psychotherapy for this client group

Neurogenesis in the dentate gyrus of age-matched calcium ion channel mutant mice, leaner and tottering

Homozygous leaner and tottering mice have a mutation in the alpha-1A subunit, which cause a decrease in calcium ion current through these channels leading to altered calcium homeostasis. These channels are highly expressed in several areas of the brain including the hippocampus. Neurogenesis in adults happens only in two specific areas: the dentate gyrus of the hippocampus and the subventricular zone of the lateral ventricles. Since P/Q-type channels are highly expressed in the hippocampus, we expect altered calcium homeostasis might affect neural proliferation in the mutant mice. The aims of this thesis were: (1) to determine if there was a decrease in neural proliferation in the dentate gyrus of adult leaner and tottering mice when compared to age-matched wild-type mice and (2) to determine if the new cells are neurons or glial cells and if there is a difference in proportion when compared to wild-type mice. We used bromodeoxyuridine (BrdU) to label the new cells. We examined proliferation rates in 100-150 day old mice and in 42-50 day old mice. We doublelabeled some newly formed cells using two different fluorescent tags to determine if the cells were neurons or glial cells. These studies showed that cell proliferation is indeed decreased in leaner and tottering mice at three months of age when compared to the wild-type mice. However, when we looked at mice that were 42-50 days old, we found a significant increase in cell proliferation in leaner and tottering mice compared to agematched control mice. When we looked at the proportion of double-labeled cells (neurons versus glia), there was no difference among genotypes for either age group. For both age-groups, there were about 90% new neurons and 20% new glial cells for the P100-150 mice and 85% new neurons and 10% new glial cells for the P42-50 mice. Since we do not see a change in proportion of double-labeled cells at either age group, it is probable that differentiation patterns are not being affected. Based on these observations, we predict that the altered calcium homeostasis that is probably occurring in the mutant mice is affecting cell proliferation, but not differentiation

Televised Political Advertising as a Strategic Tool to Positively Affect a Candidate\u27s Chances of Winning an Election A Case Study: The 1994 California U.S. Senate Election: Televised Advertising in the Michael Huffington Campaign

Before Michael Huffington declared his candidacy for the 1994 U. S. Senate race in California, Dianne Feinstein, the incumbent, was predicted to win re-election with possibly the largest vote in the history of Senate elections. However, after spending $28 million dollars on a televised advertising blitz, Michael Huffington was able to come within two percentage points of winning the election. Because of his money, Huffington turned the California race into a high-stakes cliffhanger after it had been considered by most Washington insiders to be one of the surest Democratic bets in the country (How They Voted)

A Review of the Fife Circles of Support and Accountability Project Commissioned by SACRO - Final Report

SCCJR was commissioned by Sacro in March 2013 to conduct an independent review of its Circles of Support and Accountability (CoSA) project running in Fife. CoSA make use of community volunteers to form a circle around socially isolated, high risk offenders offering them support while also monitoring. SCCJR team Dr Sarah Armstrong and Ms Diane Wills (PhD student and Criminal Justice Social Worker) conducted the research between March and July 2013. This report is the product of that review and includes background on the research on CoSA generally; a description of the organisation of the Fife CoSA (the first such project to be funded in Scotland); perspectives of key stakeholders (core members, volunteers, Sacro staff, Criminal Justice Social Workers, local authority funders, police); and an analysis of operations

Assessment of culture and environment in the Adolescent Brain and Cognitive Development Study: Rationale, description of measures, and early data.

Neurodevelopmental maturation takes place in a social environment in addition to a neurobiological one. Characterization of social environmental factors that influence this process is therefore an essential component in developing an accurate model of adolescent brain and neurocognitive development, as well as susceptibility to change with the use of marijuana and other drugs. The creation of the Culture and Environment (CE) measurement component of the ABCD protocol was guided by this understanding. Three areas were identified by the CE Work Group as central to this process: influences relating to CE Group membership, influences created by the proximal social environment, influences stemming from social interactions. Eleven measures assess these influences, and by time of publication, will have been administered to well over 7,000 9-10 year-old children and one of their parents. Our report presents baseline data on psychometric characteristics (mean, standard deviation, range, skewness, coefficient alpha) of all measures within the battery. Effectiveness of the battery in differentiating 9-10 year olds who were classified as at higher and lower risk for marijuana use in adolescence was also evaluated. Psychometric characteristics on all measures were good to excellent; higher vs. lower risk contrasts were significant in areas where risk differentiation would be anticipated

Generation, maintenance and tissue distribution of T cell responses to human cytomegalovirus in lytic and latent infection.

Understanding how the T cell memory response directed towards human cytomegalovirus (HCMV) develops and changes over time while the virus persists is important. Whilst HCMV primary infection and periodic reactivation is well controlled by T cell responses in healthy people, when the immune system is compromised such as post-transplantation, during pregnancy, or underdeveloped such as in new-born infants and children, CMV disease can be a significant problem. In older people, HCMV infection is associated with increased risk of mortality and despite overt disease rarely being seen there are increases in HCMV-DNA in urine of older people suggesting that there is a change in the efficacy of the T cell response following lifelong infection. Therefore, understanding whether phenomenon such as "memory inflation" of the immune response is occurring in humans and if this is detrimental to the overall health of individuals would enable the development of appropriate treatment strategies for the future. In this review, we present the evidence available from human studies regarding the development and maintenance of memory CD8 + and CD4 + T cell responses to HCMV. We conclude that there is only limited evidence supportive of "memory inflation" occurring in humans and that future studies need to investigate immune cells from a broad range of human tissue sites to fully understand the nature of HCMV T cell memory responses to lytic and latent infection

Synthesis of polycyclic furans via the generation and rearrangement of strained heterocyclic allenes

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Chemistry, 1998.Includes bibliographical references.by Melanie Sarah Bartow Wills.Ph.D