When counseling individuals in the general population we are engaging in a luxurious world where our clients can present a number of issues to us through detailed stories and identify themes with our guidance. Clients are typically capable of understanding abstract concepts, and with support, they are able to take new skills rehearsed in therapy and apply them to various aspects of their lives. Clients in Counseling 101, right? But what happens when you are working with clients who do not have the cognitive ability to neither identify common themes, nor apply a new skill to different scenarios? What happens when you are working with someone who is diagnosed with Mental Retardation?
I work with adults who have Intellectual and Developmental Disabilities (formerly termed Mental Retardation) and I have adapted my basic therapeutic techniques in order to deliver more effective counseling to this population. I consider my approach more aggressive when working with these clients. Not verbally or physically, but aggressively focused to staying in the "right here, right now" state of mind, and attacking issues as they are presented.
These clients already have a difficult time connecting a single emotion to an action, so if you wait for them to finish a story before stopping to address an issue at the beginning… they've already moved on and you've missed that window to make a bridge. I find that to be most effective you need to be aggressive and jump in quickly before they can move on to the next sentence. If they say they had a disagreement with a peer in the residence and they yelled, screamed, and slammed doors. I immediately isolate this issue, clarify, and then ask them to jump up right away and do a role-play with me. We won't discuss another issue until this one is addressed. These role-plays are used to reenact the specific situation and practice better for moments like this in the future. We continue to do these role-plays in the current session until they understand the skills. We are able to move forward only after they have demonstrated the new techniques and can bridge these alternatives to the previous issue. Talk therapy can be difficult, being active, concrete, and in the moment is key.
This aggressive mentality in sessions allows the clients with IDD to present an issue, and immediately pair it with alternative positive techniques for that specific issue. If you wait too long they will miss the opportunity to make that connection and they will have moved on. Its like when Indiana Jones has a short window to escape before that stone door fully closes. If he doesn't get out in time he may be stuck in there forever. Our clients (Indiana Jones) need our guidance to get out of that room before that stone door (their disability and/or presenting issue) closes them off for good. Their disability and/or presenting issue does not have to be a block, as counselors we can help them discover the way out.
Have you ever needed to modify a particular technique for a specific type of client? How does your mentality as a counselor change from one client to the other?
Jaime Castillo is a counselor who works for a non-profit agency in New York City.