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wetrain

Role of Psychodynamic Psychotherapy In LD ?

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Hi,

Does anyone knows about the role of Psychodynamic psychotherapy in Learning Disability Psychiatry.

Is it useful ?

Is there any evidence for it?

It was an Interview Question for which i had no answer, hope to hear from the forum regarding this.

Cheers

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It's used frequently where I work, and I understand that Sheila Hollins and Valerie Sinasson have written substantial literature on this topic. Bereavement work is an example where psychodynamic work in LD can be useful. The evidence for it is always going to be of the case study/group type (you would never get ethical approval for anything more substantial), but given that people with LD are particularly likely to experience difficulties in their interaction with those around them whilst growing up, and that the work you're doing is based around emotions and attachments rather than cognitive schema, it's easy to see how it may be quite helpful in this group

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Glad that someone replied, thanx for ur reply.

Cheers

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First of all should I acknowledge that my answers are not evidence based and are based on my own views and past clinical experience. Currently I am working in LD and in last 6 months I was in General Adult where I saw a couple of people with mild intellectual disability. Last week I discussed this issue with my senior registrar. Following are my and / or my SpR's  views:

MILD LEARNING DIABILITY

People with learning disability have huge difficulties in expressing things. If they are genuinely distressed by their childhood and past events and are having significant probnlems due to this, there is no harm in going to a psychodynamic psychotherapy. These people usually do not open up, so do not push them hard to open up about their conflicts especially if they are not distressed by those. If they are, go very very gradually and put the patient at ease.  

MODERATE LEARNING DISABILITY

Little role, however supportive counselling especially bereavement counselling when their parents or siblings die, has a role.

SEVERE LEARNING DISABILITY

No role. Acknowledge patient's distress and behave in an operant way like postively reinforcing desired behaviour and negatively, the undesired one. Acknowledge if they are bereaved and empathise with them.

Suggestions are welcome.

Kamran

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