The balance of power in therapeutic interactions with individuals who have intellectual disabilities.

OBJECTIVES: Establishing a collaborative relationship is a cornerstone of cognitive behavioural therapy (CBT). Increasingly CBT is being offered to people with intellectual disabilities who may have problems with receptive and expressive communication, and a history of disadvantage or discrimination in their relationships with those in positions of power. Consequently, they may have difficulty establishing a collaborative interaction with their therapist. This paper uses a novel method of interactional analysis to examine if collaboration increases as therapy progresses. DESIGN AND METHODS: Fifteen participants with borderline to mild intellectual disabilities and significant problems of depression, anxiety and anger were recruited from specialist clinical services to participate in this study. Verbatim transcripts of therapy sessions 4 and 9 were coded using an initiative-response method of analysing power distribution in dialogue, to investigate collaboration at the level of therapeutic interaction. RESULTS: The initiative-response scores indicated that power was relatively equally distributed between clients and therapists. On this measure there was no significant increase in collaboration as therapy progressed, as the dialogues were relatively equal from session 4. Analyses of the pattern of interaction showed that whilst the therapists asked most questions, the clients contributed to the flow of the analysis and played an active part in dialogues. CONCLUSIONS: The implications of these findings are discussed, along with the possible uses of such interactional analyses in identifying barriers to communication and ways of establishing effective therapeutic dialogue.

Perturbations in the development of infants with Rett disorder and the implications for early diagnosis.

The gene discovery in Rett disorder has opened the way for the development of clinical intervention. Initial recognition of affected infants will depend on observation by clinicians and the development of key diagnostic criteria is of crucial importance. Perturbations in the development of very young infants are emerging in studies of home videos. Observations from experienced health practitioners and home video transcriptions are presented which indicate the nature of early clues to the disorder and their fluctuating nature. Early diagnosis is likely to be available before the development of effective treatment. Most children are not diagnosed before regression and, currently, no therapies are equipped to offer support to pre-regression infants and their families. When earlier diagnosis becomes available, parents of the newly-diagnosed infant will be aware of their infant's difficult future before her problems are fully apparent. Practitioners in regular contact with families will have the sensitive task of supporting infants in early infancy and into regression.