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Working Therapeutically with someone with a Learning Disability

There are 42,000 people living with a learning disability in Northern Ireland. The implications of having a learning disability are different for each individual and learning disabilities range from mild to profound. 

However, in general there is likely to be issues with learning, comprehension, expression and difficulties communicating effectively. There may also be issues around becoming more independent, caring for themselves, or physical health issues such as cerebral palsy and medical conditions such as epilepsy. 

Some counsellors may think that counselling someone with a learning disability would be the same as for any other client, or they may even think that using a ‘childlike’ approach would work. This is not the case, and in fact can come across as patronising.  Being respected is incredibly important to people with learning disabilities and they do not need pity!  Up to 90 per cent of people with learning disabilities have some form of communication issues so it is imperative to understand the nature of these difficulties and to tailor counselling to fit their needs.  

For example, someone with cerebral palsy may have dysarthria, which means that their speech is unclear.  Whilst they may have something important to say, they may struggle to express themselves. Without the necessary skills and correct approaches, it can be very easy for a counsellor to miss important information or misunderstand the client. 

Another common communication difficulty is echolalia, a language difficulty where the person repeats words that someone has said.  For example, a counsellor may say to a client “Were you feeling sad?”, and the person may reply “Feeling sad”. The counsellor may think the person has confirmed the feeling - but in fact they have just repeated the words.  In many cases the client may not know the meaning of the words and have just repeated the phrase like we might do if someone asked us to repeat a word in a foreign language. 

People with learning disabilities may also experience other difficulties such as word finding problems, poor concentration and lack of knowledge of emotional vocabulary, meaning they may struggle to explain how they are feeling.  

As a counsellor working with clients with learning disabilities, I understand how to overcome these communication barriers.  

For example, a client may need verbal information simplified or they may need specific communication support such as pictures, symbols or alphabet charts. Another important tool is Makaton – which is a language programme using signs and symbols to help people communicate. It is designed to support spoken language and signs and symbols are used with speech. Makaton is taught in most schools that people with learning disabilities attend and therefore it is a very important way to communicate. I am trained to the enhanced level in Makaton and have had many clients that predominately use this signing method to communicate. 

People with learning disabilities do not want to draw attention to their communication issues and sometimes find clever ways to cover up their difficulties. Counselling someone with a learning disability requires a level of knowledge and experience to identify and overcome communication barriers and ensure maximum comprehension and expression to aid the therapeutic process.  

I gained specialist knowledge in my role in Speech and Language services. These skills greatly improved my ability to overcome barriers to communication and added to my skills as a counsellor that enable me to provide this service.  In addition to one-to-one counselling, I also facilitate a range of group programmes for people with learning disabilities –see Learning Disability Group Work