2023 Psychotherapy Practice Guidelines: Working with Adults with Intellectual Disability and Co-occurring Mental Health Conditions
These practice guidelines are the result of a 5-year systematic research process funded by the National Institute on Disability, Independent Living, and Rehabilitation Research. The PDF is free and available for download.
The suggested citation: Witwer, A.N., Cary, E., Chapman, R., Arnold, L.E., Havercamp, S. & Nisonger RRTC on Health and Function. (2023). Psychotherapy Practice Guidelines: Working with Adults with Intellectual Disability and Co-occurring Mental Health Conditions https://nisonger.osu.edu/adult-psychotherapy-guidelines/
The guidelines themselves are separated into a section on Person-Centered Practices, Foundational Concepts of Therapy, the Therapeutic Process, Medical Considerations and Future Considerations and Resources.
The Person-Centered Practices includes:
- Cultural and intersectionality considerations, which includes disability as a component of diversity, intersectionality of disability with other marginalized identities, and resources on diversity equity and inclusion as it intersects with ID.
- Ethical Considerations. Topics discussed include understanding current and previous guardianship status and implications, the importance of obtaining informed consent and permission to release information to other team members, the risk of diagnostic overshadowing, and aspects of ableism and discrimination that clinicians should guard against.
- Empowering clients to self-advocate and promoting self-determination. Self-determination and self-advocacy are defined. Strategies to support and promote self-determination in therapy and supporting and promoting self-advocacy, and accompanying resources are provided.
- Including Support People (i.e., parents, guardians, direct support staff, etc.) in therapy closes out the section on person-centered practices. Included is a definition of individuals who might be considered support people, special considerations prior to the inclusion of support people and ways to include them in the therapeutic process.
Foundational Concepts of Therapy includes:
- Assessment, which covers the many considerations related to assessment with adults with ID in psychotherapy. This includes discussion of who the informant(s) should be, when to conduct assessment, and what should be assessed. A section on available standardized instruments provides information on a number of standardized assessments tools.
- Communication begins with a discussion on the importance of communication assessment, the use of inclusive language, and considerations related to ableist language. It also covers concepts such as such as identity- or person-first language usage and communication strategies to consider in therapy.
- Build and Maintain Clinical Relationship which discusses potential barriers to the therapeutic relationship and considerations on how to build an alliance with clients with ID. Accommodations and Support within Therapy includes examples of visual, auditory and multi-sensory supports and accommodations and examples of plain language.
Therapeutic Process section provides practical information on
- how to Structure Therapy and Goals and
- the consideration of Trauma History.
- Medical Considerations such as collaborating with other medical professionals and medication management are discussed.
A clear language version is available on the Nisonger RRTC Website: Clear Language Products – CAN YOU HEAR ME NOW? (rrtcnisonger.org)