Posted by Melissa Demir
The first time I accompanied a client who had Intellectual and Developmental Disabilities (I/DD) to a counseling session I was 18 years old, working as a direct care staff. In our 15-minute session, the majority of questions were directed to me. As we exited that office I wondered: why weren't the therapist's questions directed towards the person receiving treatment? Why was the session so short? Did the client feel respected and listened to during the session?
A shift has taken place in the world of mental health for clients with I/DD. Treatment manuals and workbooks for clients with I/DD are published in greater frequency and I receive emails on a weekly basis about webinars regarding mental health services for clients with I/DD. Despite this, there continues to be a very small number of clinicians who provide individual therapy to clients with I/DD.
When a client with I/DD or their parent reaches out to me, we discuss the reasons for seeking treatment and the client's methods of communication and information processing. For example: How does your son or daughter communicate – how does he or she verbally and non-verbally convey when an experience arises that causes discomfort, happiness, confusion, etc.? How does he or she best process information? What level of involvement by family, friends, and/or staff has been most effective in comprehensively meeting the needs of the client? I then consider how conversation and materials can be modified based on individual needs and abilities: whether it may be helpful to include pictorial representations, allow for writing or typing on assistance devices, and include technology such as audio-recorders to capture key points to be reviewed at home.
When Joel* transitioned out of high school and into a competitive job, his parents asked if treatment might be effective for his symptoms of depression and anxiety. Joel, who is 24-years-old, wished to feel better, which for him meant having fewer stomachaches due to worry and feeling more confident about his life post-high school. Together we came up with treatment interventions that included writing one story per session so Joel could reflect on previous experiences, integrate language about coping techniques, and plan for how he would like to handle future situations. Joel also wished to include meditation (for self-soothing) into his sessions; we first practiced the foundation of deep breathing, and worked towards Joel leading us both in a three-minute guided breathing practice. By taking on a directive role, Joel was able to feel comfortable practicing independently at home.
Through my experience at JF&CS, I have come to appreciate the depth, complexity, and sensitivity of the client-clinician relationship. Working with individuals with I/DD and their families has allowed me to truly understand what is meant by ‘participation.' It is essential for a person with I/DD seeking treatment to choose his or her own treatment goals, develop meaningful means of monitoring those goals, feel comfortable and listened to via communicating with me, and be provided with tools to use in everyday life.
* Name changed to protect privacy.
Melissa is a Licensed Independent Clinical Social Worker providing counseling to individuals with intellectual and developmental disabilities (I/DD) at Jewish Family & Children's Service Mental Health Clinic. Melissa also serves as the Interventionist for Project TEAM, a NIDRR-funded study run by Dr. Kramer at Boston University. In this role, she co-leads a self-advocacy group for teens and young adults with disabilities in accordance with research protocol. In 2013, Melissa completed a one-year LEND (Leadership and Education in Neuro-Developmental Disabilities) fellowship with Boston Children's Hospital. Melissa also has former direct care and managerial experience supporting individuals who have I/DD.