Is there a counseling or therapeutic role in the context of these disorders, or is the role of the counselor primarily a social/educational one? It’s a complex question regarding a complex disorder; there are no simple solutions. Within the context of learning disabilities (LD) and mental retardation, there are a number of different roles we, as human services or mental health professionals, can fill in the multidisciplinary model of treatment for clients with LD. Our expertise is needed not only by the clients themselves, but also by the families who endeavor to provide support for special needs individuals. Finally, we should not discount our role in supporting other professionals, as we can have an impact, even if indirect, by allowing them to continue to function effectively in those sometimes challenging roles.
Direct treatments of clients with LD are most often focused on adaptation skills “since problems in adaptation are more likely to improve with remedial efforts than is the cognitive IQ, which tends to remain a more stable attribute.” (American Psychiatric Association, Diagnostic and statistical manual of mental disorders, 2000, p. 42) Traditional interventions for children with learning and coordination disorders include: (1) general educational management of learning-disabled children eligible for special education services in the public schools; (2) specific methods of instruction; (3) cognitive-behavioral techniques to teach efficient problem strategies and to improve attitudinal/motivational problems, and (4) mental health approaches with children who have co-occurring social-emotional disorders. (Netherton, Holmes, & Walker, 1999, p. 40)
A contemporary program that extends the boundaries of more traditional interventions is the “treatment mall.” The programming (in the treatment mall model) is the result of a collaborative process involving the patient, his or her treatment team, a program design team (which has participant representation), and group facilitators from the many disciplines that practice in the treatment mall. The emphasis of psychosocial rehabilitation programming is improving functional level, increasing capacity for recovery, and instilling hope. Psychosocial rehabilitation treatment malls use a multidisciplinary team approach. Nurses, psychologists, rehabilitation therapists, social workers, nutritionists, physical therapists, physicians, community college educators, and community support providers work together to teach patients with serious mental illness or mental retardation and developmental disabilities the skills and adaptive behaviors needed to live successfully in a community setting following discharge from the hospital. (Ballard, 2008, expression Program Description) The sidebar of the Ballard article specifically recognizes psychology staff as contributing to courses designed for short stay participants, including courses titled Legal Issues/Focus, Understanding Your Illness, Competency Restoration, Building Your Brainpower, and Building the Life You Want. (Ballard, 2008, expression Sidebar)
Our contributions to the learning disabled community as mental health professionals are not confined to treatment malls. High levels of frustration, with associated performance anxiety and depression, are not uncommon in LD children. (Netherton, Holmes, & Walker, 1999, p. 45) Accurate diagnosis provides a clear direction for interventions. (Costello & Bouras, 2006, expression abstract) Although substantially increased in recent years, research evidence about the prevalence of mental health problems in individuals with intellectual disabilities and the risk factors for developing specific psychiatric disorders is limited and often conflicting. Most estimates of the prevalence of psychiatric illness in people with intellectual disabilities range from 10-39%. (Costello & Bouras, 2006, expression Prevalence) This suggests that our role isn’t simply confined to teaching problem solving techniques and life skills, but more importantly, addressing the underlying psychological issues that impact the learning disabled community as a whole. Large numbers of individuals with intellectual disabilities living in the community exhibit psychiatric or behavioral problems arising from mental health problems. Together the joint contributions of mental illness and intellectual disabilities indicate a group of individuals whose needs are considerable, and whose quality of life will be seriously impaired if the illness is not effectively identified and treated. (Costello & Bouras, 2006, expression Implications)
So, to answer the question… Is there a counseling or therapeutic role in the context of these disorders, or is the role of the counselor primarily a social/educational one? Yes, all of the above. As we continue to define our roles, inevitably we will continue to develop new models of treatment and rehabilitation for our LD clients. I contend that mental health professionals play a critical role at every point of entry, and should continue to play a significant role into the foreseeable future.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
Ballard, F. A. (2008, Feb). Benefits of psychosocial rehabilitation programming in a treatment mall. Journal of Psychosocial Nursing & Mental Health Services, 46(2), 26-33. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1422243211&sid=6&Fmt=3&clientId=4683&RQT=309&VName=PQD
Costello, H., & Bouras, N. (2006). Assessment of mental health problems in people with intellectual disabilities. The Israel Journal of Psychiatry and Related Sciences, 43(4), 241-252. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1254155791&sid=6&Fmt=3&clientId=4683&RQT=309&VName=PQD
Netherton, S. D., Holmes, D., & Walker, C. E. (1999). Child and adolescent psychological disorders: A comprehensive textbook. Oxford, NY: Oxford University Press.