The Experiences of High Intensity Therapists Delivering Cognitive Behavioural Therapy to Individuals with Learning Disabilities in IAPT Services

Recent legislation has set the way for a new policy shift emphasising the need for increased access to mainstream services for people with learning disabilities. Services are now required to demonstrate how they are making ‘reasonable adjustments’ in order to facilitate equal access.
The Improving Access to Psychological Therapy programme (IAPT) is a government initiative aiming to increase access to psychological therapies to adults experiencing mental health problems. They have produced practice guidelines indicating how IAPT services should be flexible in responding to the needs of individuals with learning disabilities. IAPT offer interventions based predominately on cognitive behavioural models, and whilst there is a growing evidence-base for the use of cognitive behavioural therapy (CBT) with people with learning disabilities, it is unclear how effective CBT is for this group when delivered within IAPT.
Ten high intensity therapists, who had delivered CBT to at least one person with learning disabilities in IAPT, took part in semi-structured interviews regarding their experiences. Interviews were transcribed verbatim and analysed using thematic analysis.
Findings suggested that therapists felt uncertain about how to modify CBT for people with learning disabilities, and they identified a need for improved training opportunities and specialist supervision to support them in their roles. On a systemic level, it appeared that the rigidity of the IAPT model often provided a poor fit with people with learning disabilities. Consequently, therapists faced additional challenges when attempting to adapt CBT and make necessary reasonable adjustments for this service user population. Implications of the findings for future research, policy and practice are considered. A critical review of this study is provided in the final part of this thesis.