Counselling with special groups: Intellectual disability

 Intellectual Disability (ID) 

            Intellectual disability, also known as intellectual developmental disorder (IDD). ID is a neurodevelopmental condition characterised by limitations in cognitive functioning and adaptive behaviour. It is typically diagnosed in childhood or adolescence and persists throughout the individual's lifespan. ID has replaced the earlier term mental retardation. It can be mild, moderate or severe depending upon the obstructions in daily functioning.

            Patients with ID need extra care and meticulous professionalism from counsellors. A counsellor who engages in providing psychological services to clients with ID is expected to have a deep understanding of:

-        Characteristics of ID clients

-        Behavioural manifestation of ID clients

-        Potential symptoms of ID clients

-        The cultural background of the client

-        Causes and etiology of ID

-        Diagnostic criteria and possible interventions

-        Testing and assessment of ID clients

Definition of Intellectual Disability (ID)

According to DSM V “Intellectual disability is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. The following three criteria must be met:

1.        Deficits in intellectual functions, such as reasoning, problem-solving, planning, abstract thinking, judgment, academic learning, and learning from experience, confirmed by both clinical assessment and individualised standardised intelligence testing.

2.       Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in one or more activities of daily life, such as communication, social participation, and independent living across multiple environments, such as home, school, work, and community.

3.         Onset of intellectual and adaptive deficits during the developmental period.

Counselling of Intellectual Disability (ID)

            Counselling ID clients is a challenging task. At the outset, the counsellor has to come down to the cognitive level of the ID client, which is known as levelling strategy. It means the counsellor needs to match, identify and synchronise with the ID client’s thinking and perceptive pattern. The levelling strategy enhances the sense of belongingness in the client, which helps in compliance and acceptance. The common strategies for counselling ID are:

1. Behaviour therapy
2. Cognitive behavioural therapy
3. Social skills training
4. Client centered therapy
5. Play therapy.
6. Visual communication techniques
7. Family therapy
8. Group therapy.

Brief Process of Administering Counselling Techniques

1. Behaviour therapy – Identify the target behaviour that needs modification and use behavioural paradigms such as rewards and punishments to modify the targeted behaviour.
2. Cognitive behavioural therapy – Identify the distorted/defective cognition (thought, perception, obsession, a memory of a traumatic event) and use CBT paradigms such as the realignment process, realistic approach for quicker adaptation, cognitive flexibility and acceptability to modify the distorted cognition. 
3. Social skills training – Skilling is the key to quality life. ID clients are assessed for deficiency of social and life skills. Post identification of social skill deficiency, the counsellor, along with the family, offers skill training.
4. Client-centered therapy – After rapport, give sufficient time (as given by Shri Krishna to Arjuna in chapter 1 of Gita) listen to the client carefully, accept in totality, make notes, assess the narrative style, minimum or almost no suggestions or advice, pick up the inconsistency in the narrative, gently raise the inconsistency, seek clarification of inconsistency and keep going till the client feels at ease. 
5. Play therapy – After rapport, create a playful environment, assess the choice and feasibility of the game to be played by the client, engage positively, use different games (psychological and physical). For play therapy, the counsellor can appoint an assistant or family member to play enthusiastically with the client. Remember, the game should offer learning with fun.
6. Visual communication techniques – After rapport, use visual communication techniques such as sign language, non-verbal communication tools, images, multimedia prompts, pictorial sequence, facial gestures, and body language to communicate with the client. Remember, the success of this strategy depends upon how much the client enjoys it. Visual communication tools should have minimum advisory clues.
7. Family therapy – After rapport, inquire about the role of the family in the client’s life (for assessing the client’s viewpoint in the context of family), call on family members, discuss with them the significance of the role of the family in managing the client’s life, include cultural and spiritual aspects, family values and ethos, family veterans can be essential mediators who can deliver therapeutic interventions such as sharing anecdotes, experiences, coping strategies, handling of problems, adjustment strategies with the client. The most valuable effect of family therapy is its ability to reinforce and strengthen family bonds.   
8. Group therapy – After rapport, the client can be placed in a group of individuals with similar conditions and asked to discuss with each other. Sometimes, counsellors can create artificial groups consisting of confederates who can act as ID clients. The actual ID client is placed in such groups where a deliberate attempt is made to provide psycho-socio relief to the client. Apart from that group yogic breathing (Pranayama), asana can be undertaken to improve the psycho-motor abilities of the client.

Alternative Strategies

1.               Regulated diet

2.               Regular physical exercise

3.               Multi-dexterity (alternatively using both hands)

4.               Weight loss

5.               Resilience building exercises

6.               Patience enhancing exercises

7.               Positive self-talking

8.               Expressive art therapy

9.               Enhancing acceptance

10.            Spirituality

11.            Reading and understanding scriptures such as Gita

12.            Physical touch therapy

 

 

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