When supporting persons with intellectual and developmental disabilities with challenging behavior, the intervention should have a risk/benefit assessment that considers what interventions are…
Often it seems that counseling is the option of last resort for many interdisciplinary teams. Lets take a look at how counseling fits in the options for helping support individuals with challenging behavior.
Least Restrictive – counseling is often the least restrictive option compared to having their schedule set, things they love made contingent, medications prescribed, and programs written. Counseling is a good first start at demonstrating that less restrictive options have been (and are being) tried!
Most Effective – before assuming the person is simply having a behavior, consider what it would mean if that person was actually depressed and becoming angry because they can’t do depressed behavior that most depressed people do? What if they can’t verbalize complex emotions of “guilt & worthlessness” (symptoms of depression) and just assume they are guilty and worthless? A behavior plan for anger related to depression is not likely to be as effective alone as one integrated with therapy to discuss the thinking that drives the depression.
Least risk to health – medications have side effects, restraining someone is risky, and managing an extinction burst can be a struggle. Talk therapy on the other hand is typically considered to be minimally risky. That isn’t to say it is without risk, and your therapist should explain this. Risks may include time lost in session (if no improvement is made), bad feelings as issues are uncovered, and feelings of helplessness (hopefully temporary) as denial is stripped away.
Person specific – therapy is all about the person. The therapeutic alliance starts with a “not knowing” stance and builds the relationship to the point that change can happen. That change is focused on the client’s goals, not the team’s – though often they are not as far apart as people would assume. Notably, because clients are often referred by others, they often take more time to build a therapeutic alliance and get to the action stage of change. Waiting for a crisis means that relationship may not build fast enough. Start counseling as early in the process as possible.
Teach new skills –therapy is a great time to learn and practice new skills. A therapist who is familiar with intellectual disabilities knows how to use their relationship in order to help that person learn normalized social skills, feel valued for taking risks on new social skills, learn (appropriate) self advocacy skills, and work through disagreements and disappointments rather than act out aggressively. When was the last time that person had 50 minutes of one on one conversation with someone modeling good social skills through reflective listening and problem solving?
Using counseling as a least restrictive alternative prior to behavior plan changes and medications should considered. It is typically cheap for the provider (if the therapist can come to the client) and demonstrates an important step in the ladder of least restrictive alternatives!
Related posts:
J. Kipp Lanning, LIMHP
[...] a behavior plan model – Mental Health Counseling is a great support that should be considered a least restrictive option prior to medications and/or behavior [...]