DAFT Workshop: Working systemically with people with a learning disability Martha Laxton-Kane Consultant Clinical Psychologist & Team Lead for LD CAMHS, North Derbyshire Intro self: post: LD – work, home; FT Martha Laxton-Kane, Consultant Clinical Psychologist

Martha Laxton-Kane, Consultant Clinical Psychologist 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 Lots of different things could focus on – term LD……. But these are two common issues / themes – just give a flavour. Talk through, with your thoughts… also share a video as a main talking point. Martha Laxton-Kane, Consultant Clinical Psychologist

Martha Laxton-Kane, Consultant Clinical Psychologist LD and Family Therapy 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. Best evidence for mental health problems / challenging behaviours – behavioural approaches / some CBT – clinically useful. Also about working with the family, can’t affect change elsewhere until family ready to take on / use interventions. Martha Laxton-Kane, Consultant Clinical Psychologist Specialist LD-CAMHS

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

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

Martha Laxton-Kane, Consultant Clinical Psychologist 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. In the Goldberg model there are 5 recursively linked hypotheses. That families have long experience of working with professionals over many years. So it is important to explore what these relationships have been like and what that might mean for your work with this family/system. 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 there is a relationship between patterns of grieving and life cycle stages. That each life cycle transition involves loss as well as gain. Martha Laxton-Kane, Consultant Clinical Psychologist

Part 2: People with learning disabilities 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 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 Specialist LD-CAMHS

General principles of working with people with ld 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 Impairments with communication and abstract thinking e.g. why is import to turn off light ……. Go on holiday, Turkey in the sky….., can over estimate skills Martha Laxton-Kane, Consultant Clinical Psychologist Specialist LD-CAMHS

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

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 Play dough Visual scales / pictures Martha Laxton-Kane, Consultant Clinical Psychologist

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

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

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

A learning disability: what do we really mean? 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 Martha Laxton-Kane, Consultant Clinical Psychologist Specialist LD-CAMHS

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