Exploring the Use of Family Therapy with Adults with a Learning Disability

Clients with a learning disability have received little attention so far from psychotherapeutic services. Systems thinking seems to have obvious potential for this group, given the stresses which such a disability puts on the client and his family and the variety of different organizations with which they become involved. This paper describes the use of family therapy within a clinic setting and considers similarities to and differences from general family therapy practice. Ways of overcoming communication difficulties are highlighted, as is the need to redress the power imbalance within the therapeutic situation.     

Using the Nominal Group Technique to Identify the Problems Experienced by Persons Living with Severe Physical Disabilities

Changes in health care have dramatically curtailed services to people with severe physical disability and their families. This has placed a greater burden of responsibility on those who live with these conditions and have ongoing care needs. Yet little is known about the subjective problems, challenges, and solutions reported by these people. We demonstrate how the nominal group technique can be used to obtain consumer-oriented information germane to these individuals and their concerns. We conducted nominal group technique meetings with 2 groups for persons with physical disability and a third with a group for family members in caregiving roles. We demonstrate how focus groups can be conducted with the nominal group technique to identify problems experienced by individuals who live with severe physical disability. Recommendations for using the nominal group technique with client populations are presented, and implications for clinical practice are discussed.     

Talking about Disability in Prenatal Genetic Counseling: A Report of Two Interactive Workshops

Women are commonly offered testing in pregnancy to determine the health of their baby. An important component of informed decision-making about prenatal testing is provision of relevant, accurate, meaningful information concerning the conditions that are being tested for—many of which, such as Down syndrome, are associated with a varying degree of physical and intellectual disability. A range of health professionals, including genetic counselors, may provide information and support throughout the testing process, but available data suggest that discussion of disability is frequently absent or limited. To investigate genetic counselors’ perceptions of this situation and identify potential barriers to discussion we facilitated interactive workshops at the 2007 National Society of Genetic Counselors Annual Education Conference (NSGC) and the 2008 European Meeting on Psychosocial Aspects of Genetics (EMPAG). Working groups identified relevant psychosocial issues and impediments to discussion (NSGC) or used a two-part scenario to promote discussion (EMPAG) and reported findings in notes and a closing plenary discussion. Inductive content analysis revealed that participants considered informed decision making to be a major reason for presenting information about disabilities in prenatal genetic counseling and endorsed the value of including information about daily life with Down syndrome and other disabilities. However, they identified three broad types of impediments to such discussion: counseling issues concerning the most appropriate manner to discuss disability under the complex circumstances of prenatal genetic counseling, less than optimal training and experience in addressing these issues, and perceived limitations in the participants’ knowledge and understanding of life with disability. Our analysis of the responses from the workshop participants and additional thoughts on these issues have led us to develop recommendations for further research, training and clinical practice.     

Special Issues in Psychotherapy with Minority Deaf Women

Abstract

Minority Deaf women have been traditionally underserved by mental health professionals, and specifically, therapists are unaware of issues unique to this population. It would be highly unlikely for a minority Deaf woman to have a therapist who matches her in racial background, hearing status, and communication mode. Therefore, the therapy process will be completely cross-cultural. Therapists who provide psychotherapy services to minority Deaf women need to be aware that their clients are members of a community where deafness is a culture and not a disability. Minority Deaf women are also likely to report feeling forced to choose between competing identities in order to get important needs met. In the following article, case examples are provided which illustrate some of the major issues that are likely to arise in therapy with minority Deaf women. These issues include: access to important information; communication, support and level of involvement with biological families; competing cultural demands; health concerns; and coping with chronic mental illness.     

The role of interference control in working memory: a study with children at risk of ADHD

The study aimed to test whether the impairment in a working memory task observed in children at risk of ADHD was due to a lack of control of interfering information being processed whilst carrying out the memory task. Two groups of children at risk of ADHD with or without a learning disability (reading impairment) were compared to a control group in a working memory task. Activation of irrelevant items was tested with a lexical decision task presented immediately after the final recall in about half of the trials. Results showed a poor working memory performance in children at risk of ADHD and reading disability associated with a larger activation of irrelevant information than that of control children. Results indicated that the to-be-excluded and interfering items are still highly accessible to working memory in children that fail the working memory task. The examination of working memory and interference control of children at risk of ADHD with a learning disability revealed a counterintuitive picture of children with poor working memory showing better recall/activation of processed information. This picture is consistent with a view of working memory related to an efficient inhibitory control that influences cognitive functioning.     

Work engagement and task performance within a global Dutch ICT-consulting firm: The mediating role of innovative work behaviors

The information and communication technology (ICT) sector within the Netherlands is a major driver of globalization, the country’s economic growth and innovation. The Dutch ICT sector’s performance is increasingly becoming dependent upon employee driven innovations in order to address the needs of the sectors they service. In other words, the ICT sector within the Netherlands is largely dependent upon the performance and innovative capacity of its employees; both of which are functions of employee engagement. Given the high demand, and low supply of talent within this sector, ICT organizations need to develop innovative ways to enhance the performance capacities of its people. Developing an engaged and highly innovative workforce seems to be an efficient way to activate employees’ performance. As such, the aim of this paper was to investigate the mediating function of employee driven innovative work behaviors in the relationship between work engagement and task performance within the a Dutch ICT consulting firm. A cross-sectional survey-based research design, employing a census-based sampling method, was employed to obtain data from a global ICT consulting firm within the Netherlands (n = 232). The Utrecht Work Engagement Scale, the Innovative Work Behavior Scale and the Task Performance Scale was used to assess the associative subjective experiences of ICT employees. The results showed that work engagement is a significant driver for innovative work behaviors, which in turn affects the task performance of employees. Further, innovative work behaviors are therefore important to translate the engaging energies of employees into performance. This paper discusses the theoretical and practical implications of these findings.

     

Creative Self‐Efficacy and Innovative Behavior in a Service Setting: Optimism as a Moderator

Creativity research on the personality approach has focused on the relationship between individual attributes and innovative behavior. However, few studies have empirically examined the effects of positive psychological traits on innovative behavior in an organizational setting. This study examines the relationships among creative self‐efficacy, optimism, and innovative behavior as well as the moderating effect of optimism. Longitudinal data across two periods were collected from 120 spa employees of a diet and beauty salon company in Taiwan. After controlling for the effects of job tenure and the Big Five personality traits, this study found that employees with a high level of creative self‐efficacy demonstrate a high level of innovative behavior at work, and optimism does not have a direct effect on employees' innovative behavior, but it does play a moderating role. When employees' creative self‐efficacy is high, those with greater optimism exhibit greater innovative behavior at work. Toward the end, this paper offers suggestions for future research and discusses the practical implications of this study.     

Attitudes toward genetic counseling and prenatal diagnosis among a group of individuals with physical disabilities

Few studies have been published on the attitudes of people with physical disabilities toward genetic counseling and prenatal diagnosis. Articles in the lay press and social science literature on this topic, mainly written by disability rights activists and advocates, imply opposition to prenatal diagnosis and the field of clinical genetics by the physically disabled population. In this study, 15 adults with physical disabilities were interviewed regarding their attitudes toward genetic counseling and prenatal diagnosis. Genetic counseling and prenatal diagnosis were generally viewed favorably by this sample of the disability community. Only a small percentage of the sample perceived genetics to be eugenic. Implications for genetic counseling and future research are discussed.     

The promise of the internet for disability: a study of on-line services and web site accessibility at Centers for Independent Living

The Internet provides individuals with disabilities numerous tools to live independently. In the convenience of the home, a person can access an abundance of information, an electronic community, updates on the latest disability advocacy news, education through distance-learning classes, and on-line shopping for books, clothes, assistive technology, and a host of other consumer goods. Centers for Independent Living (CILs) are consumer-run, non-profit grassroots disability service organizations at the forefront of the disability rights movement. Providing services to individuals across the range of disabilities, CILs have begun to use the Internet as a complement to their traditional service delivery methods. This article examines the emerging trend of independent living services on the web. The investigation examines 200 CIL Internet sites across the United States during the period of April to August 2001. Information is collected and analyzed about how CILs are using the Internet to provide their services and programs. In addition, the article examines the technological accessibility of their web sites. Implications of the findings for CILs, consumers with disabilities, and disability policy are examined.     

The effect of video observation on warmth and competence ratings of individuals with a disability

ObjectivesThis study examined whether a video featuring an adult with a physical disability engaging in either sport, exercise, or an activity of daily living (ADL) can mitigate negative stereotypes of disability held by people without a disability.DesignThis study used a pre-post design, involving three participant groups.MethodsParticipants (n = 212) read a vignette describing an adult with a disability (target). Consistent with the stereotype content model, participants judged the target's warmth and competence. One week later, participants viewed a video of the target participating in sport, exercise, or an ADL and judged the target's warmth and competence.ResultsJudgements of competence but not warmth changed over time. The greatest increases occurred in the sport condition. At follow-up, the typical high warmth low competence stereotype of disability was reversed; the character was judged as being more competent than warm especially in the sport condition.ConclusionVideos of adults with a disability engaging in physical activity, particularly sport, have potential to mitigate negative stereotypes of disability.     

Adversarial Growth in Patients with Multiple Sclerosis and their Partners: Relationships with Illness Perceptions,Disability and Distress

The purpose of this study was to investigate whether patients with multiple sclerosis (MS) and their partners show adversarial growth and to examine which psychological and disability variables contribute to this in patients and their partners. The study also investigated the relationship between growth and distress. Seventy-two patients with MS and their partners provided demographic information and completed measures of posttraumatic growth, illness perceptions, depression, cognitive function and disability. Both patients and partners showed adversarial growth, with patients reporting significantly higher growth than partners. The only significant predictor for patient growth was partner growth, and vice versa. Dissimilarity in illness representations between patients and their partners on the consequences of MS dimension, patient mood and patient growth accounted for significant variance in partner growth. The findings support the idea of a ‘communal search for meaning’ where patients and their partners experience the trauma of having a chronic illness and subsequently find positive aspects together.     

Enabling Action: Reflections upon Inclusive Participatory Research on Health with Women with Disabilities in the Philippines

People with disabilities experience health disparities arising from social, environmental, and system-level factors. Evidence from a range of settings suggests women with disabilities have reduced access to health information and experience barriers to screening, prevention, and care services. This results in greater unmet health needs, particularly in relation to sexual and reproductive health. Women with disabilities are also more likely to experience physical and sexual violence than women without disabilities, further undermining their health. Community-based participatory research (CBPR) can generate knowledge and underpin action to address such health disparities and promote health equity. However, the potential and challenges of disability inclusion in CBPR, particularly in contexts of poverty and structural inequality such as those found in low- and middle-income countries, are not well documented. In this paper, we reflect on our experience of implementing and evaluating W-DARE, a three-year program of disability-inclusive CBPR aiming to increase access to sexual and reproductive health and violence-response services for women with disabilities in the Philippines. We discuss strategies for increasing disability inclusion in research and use a framework of reflexive solidarity to consider the uneven distribution of the benefits, costs, and responsibilities for action arising from the W-DARE program.     

Preterm outcomes research: a critical component of neonatal intensive care

While early preterm outcome studies described the lives of preterm survivors to justify the efforts required to save them, subsequent studies demonstrated their increased incidence of cerebral palsy, mental retardation, sensory impairments, minor neuromotor dysfunction, language delays, visual-perceptual disorders, learning disability and behavior problems compared to fullterm controls. Because infants born at the lower limit of viability require the most resources and have the highest incidence of neurodevelopmental disability, there is concern that resources have gone primarily to neonatal intensive care and are not available for meeting the followup, health, educational and emotional needs of these fragile infants and their families. Despite many methodological concerns, preterm outcome studies have provided insight into risk factors for and causes of CNS injury in preterm infants. Nevertheless, it remains difficult to predict neurodevelopmental outcome for individual preterm infants. Perinatal and neonatal risk factors are inadequate proxies for neurodevelopmental disability. Recent randomized controlled trials with one to five year neurodevelopmental followup have provided valuable information about perinatal and neonatal treatments. Recognizing adverse longterm neurodevelopmental effects of pharmacological doses of postnatal steroids is a sobering reminder of the need for longterm neurodevelopmental followup in all neonatal randomized controlled trials. Ongoing longterm preterm neurodevelopmental studies, analysis of changes in outcomes over time and among centers, and evaluation of the longterm safety, efficacy and effectiveness of many perinatal and neonatal management strategies and proposed neuroprotective agents are all necessary for further medical and technological advances in neonatal intensive care.     

Disability in the family: a life span perspective

This article provides an overview of disability in families. The goal of the article is to raise awareness of the status of people with disabilities and their families to develop culturally relevant psychological support. Families have widely varying perspectives on disability; those perspectives influence responses to disability from the preconception and prenatal developmental stages through old age. An international literature review is provided with consideration of cultural meanings of disability, preparation for dealing with disability, coping strategies, support, developmental dynamics, competing needs of family members, and ethics. Voices of people with disabilities and their families are included.     

Developing a research tradition consistent with the practices and values of counselling and psychotherapy: Why Counselling and Psychotherapy Research is necessary

Despite the general acknowledgement that it is important for counselling and psychotherapy practice to be informed by research, it is clear that in recent years a widening gap has emerged between research and practice. This paper briefly reviews some of the factors responsible for the current crisis in therapy research and offers a number of reasons why a healthy relationship between research and practice is necessary. It is suggested that, at present, there exists within psychology and social science a level of acceptance of pluralistic and innovative approaches to research, which may facilitate the emergence of a new genre of practitioner‐oriented inquiry in the field of counselling and psychotherapy. Some of the ways in which Counselling and Psychotherapy Research intends to contribute to this movement are described, for example the promotion of new forms of writing, use of information technology, and the creation of knowledge communities. Readers are invited to participate in this endeavour.     

Mother Positivity and Family Adjustment in Households with Children with a Serious Disability

Only limited attention has been given to parent coping resources in the positive adjustment of families of children with a disability. This study is the first to explore maternal positivity as a psychological coping resource related to family adjustment in these families. Consistent with broaden-and-build theory and prior positivity research, positivity was operationalized through a ratio of positive to negative affect scores. We employed longitudinal tracking over a 1 year interval. Children’s diagnostic categories included developmental conditions or impairments, mental health disorders, complex health conditions, physical/motor conditions or impairments, sensory impairments, and provisionally diagnosed conditions or impairments. We used a computer assisted telephone survey to gather psychological, family, and demographic information from 152 mothers in Alberta, Canada. Hierarchical regression analysis indicated mothers’ level of positivity and age, when controlled for family adjustment at Time 1, accounted for 46% of the variance in family adjustment at Time 2. That is, older mothers with higher positivity scores were found to live in households with higher levels of family adjustment after 1 year. These findings provide promising support for broaden-and-build theory, which posits that positive experienced emotions can offset and diminish the negative health and relationship impacts of chronic stress. Study findings support the salience of mothers’ positivity as a psychological coping resource, which is related to enhanced family adjustment in situations of childhood disability.     

A Study of Health Perception,Disability Acceptance,and Life Satisfaction Based on Types of Leisure Activity Among Koreans with a Physical Disability

Leisure studies provide evidence that leisure engagement serves as a vehicle for improving life satisfaction among individuals with a physical disability. However, a dearth of research addresses which types of leisure activities are associated with specific psychological benefits. This study sought to capture three aspects of psychological benefits: acceptance of disability, life satisfaction, and health perception, and to explore how leisure activities are related to these psychological benefits. Using data released from the 2011 Panel Survey of Employment for the Disabled in Korea, this study found that individuals with a physical disability who participate in social activity, religious activity, and Internet use reported high health perception, life satisfaction, and disability acceptance. In particular, findings of this study provide evidence that social activity participation plays an important role in increasing health benefits among individuals with a physical disability.     

Growth in emotional intelligence. Psychotherapy with a learning disabled girl

This paper describes the once-weekly psychoanalytic psychotherapy of a girl, called Ellie, aged eight at the start of her treatment. Ellie had a learning disability and displayed difficult behaviour at school and at home. In her therapy, Ellie grew in emotional intelligence, more in touch with and able to express her feelings. Her behaviour improved and so did her capacity to learn. In the therapy there were certain limitations to progress and this is discussed in terms of how Ellie's disability affected the basic achievements of emotional development, including a mind with a solid ‘reality ego’, able to contain anxiety, and able to maintain depressive functioning. The importance of parallel parent work, to share observations and understanding of the child's functioning is discussed. Difficulties for both child and parents in dealing with the pain of difference and how this limits emotional intelligence are discussed. The author hopes that this paper will encourage the offering of psychoanalytic psychotherapy to children and young people with learning disabilities, who are significantly more likely to suffer from mental health problems than their peers.     

Don't ask,don't tell: a systematic review of the extent to which participant characteristics are reported in social anxiety treatment studies

Background and Objectives: This study examined the extent to which social anxiety treatment studies report the demographic characteristics of their participants. One hundred and 56 treatment studies published in English between 2001 and 2012 articles were collected. Methods: Each study was evaluated on whether or not it reported information on gender, age, race, relationship status, education, socioeconomic status, sexual orientation, and disability and also the extent to which the racial composition of the sample was described. Results: The majority of studies reported information on age (96.2%) and gender (94.2%), but the percentage of studies that reported anything else is much lower: race (50.0%), education (42.3%), relationship status (37.8%), socioeconomic status (5.1%), disability (2.6%), and sexual orientation (1.3%). One third (34.0%) of studies reported the race of all participants in their samples, while the remaining reported no information or information for only a subset of participants (e.g. “mostly white”). Conclusions: Participants of social anxiety disorder treatment studies generally are not described beyond their age and gender. Standards for reporting participant characteristics of treatment studies (similar to standards for reporting the methodology of treatment studies) could improve clinical researchers’ and clinicians’ ability to evaluate the external validity of this body of work.     

Disclosure of a physical disability--an informal look

To gain some insight as to how people feel about the disclosure of a hidden physical disability to a potential employer, 821 students were queried. The results suggest that about 15 percent would disclose the disability initially, 30 percent would divulge the information only when they felt secure on the job, while 30 percent would not disclose the disability at all.