Are talking therapies effective with adults with language disorders and cognitive impairments? Many would assume that this would render them unsuitable for therapy. Although non neurotypical clients do present therapists with unique challenges, the rewards can be great for both client and therapist.
Counselling and therapy works by giving language to emotional experience. Thus, working with adults with varying degrees of learning disabilities can bring fresh light to old problems. Traditionally, psychotherapy has often deemed this group unsuitable for the work of reflection. In my experience, this just simply isn’t the case. The challenges that disability places on them and their families can be hard to bear. Counselling offers a unique opportunity to process this grief and frustration. These are the challenges that come in addition to the myriad other human emotions that may seem perplexing until made clearer through the process. Often this involves interpreting behaviour, body language and the relationship to the therapist in a clearer, more overt way. This brings emphasis to the primacy of these aspects of the work over more abstract content of sessions. Being clear about what the client might be trying to communicate in the here and now becomes illuminating.
Often the client may hate their special needs and blame all frustrations and set backs on it. Indeed, struggling with language and the many ways the disability affects life can feel overwhelmingly painful and having someone name this can be a real relief. What can be more complicated is the way the intolerance of the difference can be projected onto other disabled people. So, a man with with autism and learning difficulties may not want a partner with similar difficulties which in turn compounds loneliness. Part of the work may then be about understanding and accepting difference.
Familiar developmental milestones such as becoming more independent can seem insurmountable and indeed an impossibility. This brings frustration and a reminder for all of us of the many things in life that are beyond our control. We are surrounded by messages that we can do anything if we put our mind to it which paradoxically can become more possible if we accept our limitations. If you are so angry with everyone because they remind you of everything you can’t do, it becomes difficult to ask for help.
Often clients with these difficulties are brought for help because of a problem behaviour that causes difficulty for them and the people who care for them such as compulsions or obsessions, tics or twitches. Indeed, learning how to manage these can bring real relief. Sometimes however, the behaviour serves a function. It releases frustration or manages anxiety. The attention evoked from the behaviour reinforces it and makes it hard to give up. Being able to talk about feelings of exclusion, anger and naming anxieties can render the problem behaviour less necessary. However, this may make the client less cooperative and less compliant. This feels better but may not be welcomed by caregivers. A balance needs to be struck between what is best for the client and for those around him.
Working with this client group highlights the complex juggling between society’s needs to compartmentalise people and make everyone fit in and an individual’s need to express who they are. Talking with them about complex feelings about who they are and how they fit into the world can be a real support for people with special needs. As therapists, we need to find ways of making the process more accessible for them.