Helpful coping strategies are learned as disordered thought and behavior patterns are eliminated. As a quick, personal aside, when I first realized that people with disabilities in the Triangle were in sore need of a therapist who understood them, I had some important choices to make.
First among these was what kind of therapist would be most helpful to the people I wanted to serve. It was their depression, or their anxiety, or their communication in social settings and relationships.
In some cases, it was something more severe, like alcohol dependence. For others, they were simply feeling ill at ease about a transition coming up, like moving into their own apartment, finding a community job, or going to college. Maybe their challenges in comprehension made it tough for them to identify what needed to change. To be sure, difficulty communicating their needs made it tougher to get the help they so desperately wanted.
In short, disability made treatment trickier, yet, as I thought about the people I wanted to help, I saw that …. But because of their disability, no therapists felt they could help them with their stress. But there were no therapists using other therapeutic modalities to help people with disabilities deal with mood disorders, relationships, addictions, or anything else outside of their disability.
I wanted to be that therapist. And so I set about learning how to provide the most effective Cognitive Behavioral Therapy to people with developmental and intellectual disabilities.
So, the burning question…how does a therapist make a cognitive based therapy work for people with cognitive limitations? Experiential therapy makes CBT accessible to my clients with disabilities by giving them tangible ways to think about their cognitive processes and how their thoughts affect their emotions.
His father made a new rule. The first day under the new rule, the boy beat 30 nails into the piece of wood. This took great effort. It made his eyes sting with sweat, and gave him blisters on his hands. Over the next few days, he thought twice before allowing himself to reach a pinnacle of anger, and considered whether his anger was worth the pain and hassle of pushing a nail into a board. When the boy was done, the board was riddled with holes.
The father explained to the boy that his words had weight. That moving forward he could choose his words more wisely, but that hurtful things cannot be unsaid. They will always leave a mark. Just as the nails could not be removed from the board without leaving behind evidence that they were once there; anger can be forgiven, but not so easily forgotten.
I keep this old parable in mind often as I consider what techniques will be most meaningful for my clients with intellectual disabilities. Something real, and tangible, that will be a visual reminder that they have choices, or that they have made progress.
Usually, a stone or two will fall to the ground as they try to keep them all together. I then give my client a homework assignment. Each day, they should take their baggie and stones with them. Just like worries that are not addressed. Similarly, I may also give them a daily log to track their experiences, such as how many stones they collected, what worries they represented, how relieved they were to unburden themselves of the stones at the end of the day, etc.
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