Integrative Therapy Focused on Trauma for People with Intellectual Disability (TIT-ID): A Therapeutic Answer to Abuse and Intellectual Disability Experience in the Individual and the Family
DOI:
https://doi.org/10.6000/2292-2598.2016.04.01.4Keywords:
Intellectual disabilities, abuse, trauma, PTSD, attachment, systemic approach, Integrative Therapy.Abstract
Persons with Intellectual Disabilities (ID) have ten times more risk of suffering abuse than persons without ID. When somebody is born with ID, his/her story is printed by trauma of ID (primary trauma). If we add the trauma from disability to the trauma from abuse (secondary trauma), we find very vulnerable population with a high probability of being re-victimised. Victim Support Unit for Persons with Intellectual Disability (UAVDI) proposes an Integrative Therapy focused on Trauma for people with ID (TIT-ID). This therapy is focused on trauma, including the victim and their families and professionals, through different approaches. It intervenes from individual pathoplasty, taking into account side effects caused by abuse. It also works from a systemic perspective of the primary trauma due to ID and primary grief in the individual and his family. It includes a person-centre intervention with attachment theory and organised through phases from theory of structural dissociation. It is very important to do a rigorous analysis of variables involved in the impact of grief (primary trauma) and later in the impact of abuse experience (secondary trauma). The goals of therapy will be planned according to the individual diagnosis. The cross-cutting objectives are the establishment of consistent links to enable the person to restore their feelings of security and sense of self-worth, and also the development of a resilient personality.
References
Sobsey D, Gray S, Wells D, Pyper D, Reimer-Heck B. Disability, sexuality, and abuse: An annotated bibliography. Baltimore: Paul H. Brookes 1991.
Levy H, Packman W. Sexual abuse prevention for individuals with mental retardation: considerations for genetic counselors. Journal of Genetic Counseling 2004; 13(3): 189-205. http://dx.doi.org/10.1023/B:JOGC.0000028158.79395.1e DOI: https://doi.org/10.1023/B:JOGC.0000028158.79395.1e
Reiter S, Bryen DN, Shachar I. Adolescents with intellectual disabilities as victims of abuse. Journal of Intellectual Disabilities 2007; 11(4): 371-387. http://dx.doi.org/10.1177/1744629507084602 DOI: https://doi.org/10.1177/1744629507084602
Marini Z, Fairbairn L, Zuber R. Peer harassment in individuals with developmental disabilities: Toward the development of a multidimensional bullying identification model. Developmental Disabilities Bulletin 2001; 29: 170-195.
Vig S, Kaminer R. Maltreatment and developmental disabilities in children. Journal of Developmental and Physical Disabilities 2002; 14(4): 371-386. http://dx.doi.org/10.1023/A:1020334903216 DOI: https://doi.org/10.1023/A:1020334903216
Curry MA, Renker P, Hughes RB, Robinson-Whelen S, Oschwald M, Swank PR, Powers LE. Development of Measures of Abuse Among Women with Disabilities and the Characteristics of Their Perpetrators. Violence Against Women 2009; 15(9): 1001-1025. http://dx.doi.org/10.1177/1077801209340306 DOI: https://doi.org/10.1177/1077801209340306
Valenti-Hein D, Schwartz L. Sexual abuse interview for those with developmental disabilities. Santa Barbara, CA: James Stanfield Company 1995.
Muntaner JJ. La sociedad ante el deficiente mental: Normalización, integración educativa, inserción social y laboral, Madrid: Narcea 1998.
Núñez B. La familia con un hijo con discapacidad: sus conflictos vinculares. Archivos Argentinos de Pediatría 2003; 101(2): 133-142.
Paniagua G. Desarrollo psicológico y educación. Madrid: España 2001.
Recio M, Pozo P, Rodríguez M. Las dificultades de ser adolescente hoy. Un panóptico en la familia. En R, Pereira (ed.), Adolescentes en el siglo XXI: entre impotencia, resiliencia y poder (150-161). Madrid: Morata 2011.
Barudy J. El dolor invisible de la infancia. Una lectura ecosistémica del maltrato infantil. Barcelona: Paidós 1998.
Finkelhor D, Strapko N. Sexual abuse prevention education: A review of evaluation studies. In D. Willis, E. Holder, & M. Rosenberg (Eds.). Child abuse prevention. New York: Wiley 1992.
Verdugo MA, Alcedo MA, Bermejo B, Aguado AL. El abuso sexual en personas con discapacidad intelectual. Psicothema 2002; (14): 124-129.
Santín LV. Abuso sexual y discapacidad intelectual. Estudio de 5 Casos de jóvenes con discapacidad intelectual con presunción de abuso sexual 2012. Come from: http://dspace.ups.edu.ec/handle/123456789/5590
Ghaziuddin M, Alessi N, Greden JF. Life events and depression in children with pervasive developmental disorders. Journal of Autism and Developmental Disorders 1995; 25(5): 495-502. http://dx.doi.org/10.1007/BF02178296 DOI: https://doi.org/10.1007/BF02178296
Ryan R. Post-traumatic stress disorder in persons with developmental disabilities. Community Mental Health Journal 1994; 30(1): 45-54. http://dx.doi.org/10.1007/BF02188874 DOI: https://doi.org/10.1007/BF02188874
Howlin P, Clements J. Is it possible to assess the impact of abuse on children with pervasive developmental disorders? Journal of Autism and Developmental Disabilities 1995; 25(4): 337-354. http://dx.doi.org/10.1007/BF02179372 DOI: https://doi.org/10.1007/BF02179372
Stavrakaki C, Mintsioulis G. Anxiety disorders in persons with mental retardation: diagnostic, clinical and treatment issues. Psychiatric Annals 1997; 27: 182-189. http://dx.doi.org/10.3928/0048-5713-19970301-10 DOI: https://doi.org/10.3928/0048-5713-19970301-10
Hardan A, Sahl R. Suicidal behavior in children and adolescents with developmental disorders. Research in Developmental Disabilities 1999; 20(4): 287-296. http://dx.doi.org/10.1016/S0891-4222(99)00010-4 DOI: https://doi.org/10.1016/S0891-4222(99)00010-4
McCarthy J. Post-traumatic stress disorder in people with learning disability. Advances in Psychiatric Treatment 2001; 7: 163-169. http://dx.doi.org/10.1192/apt.7.3.163 DOI: https://doi.org/10.1192/apt.7.3.163
Peckham NG. The vulnerability and sexual abuse of people with learning disabilities. British Journal of Learning Disabilities 2007; 35(2): 131-137. http://dx.doi.org/10.1111/j.1468-3156.2006.00428.x DOI: https://doi.org/10.1111/j.1468-3156.2006.00428.x
Lovell A. Learning disability against itself: the self-injury/self-harm conundrum. British Journal of Learning Disabilities 2007; 36(2): 109-121. http://dx.doi.org/10.1111/j.1468-3156.2007.00477.x DOI: https://doi.org/10.1111/j.1468-3156.2007.00477.x
Sinason V. Psychotherapy with profoundly handicapped children. In S. Ramsden (ed.), Psychotherapy – Pure and Applied: Papers and Workshops Presented at the ACPP Study Day (38-42). London: Association for Child Psychology and Psychiatry 1992.
Mevissen L, Jongh A. PTSD and its treatment in people with intellectual disabilities: A review of the literature. Clinical Psychology Review 2010; 30(3): 308-316. http://dx.doi.org/10.1016/j.cpr.2009.12.005 DOI: https://doi.org/10.1016/j.cpr.2009.12.005
Reiss S, Szyszko J. Diagnostic overshadowing and professional experience with mentally retarded persons. American Journal of Mental Deficiency 1983; 87(4): 396-402.
Royal College of Psychiatrist. DC-LD: diagnostic criteria for psychiatric disorders for use with adults with learning disabilities/mental retardation, London: Gaskell Press 2001.
Fletcher R, Loschen E, Stavrakaki C, First M. Diagnostic manual-intellectual disability (DM-ID). A clinical guide for diagnosis of mental disorders in persons with intellectual disability. Kingston, NY: NADD Press 2007.
Mollica RF. Healing invisible wounds: paths to hope and recovery in a violent world. Nashville, TN: Vanderbilt University Press 2006.
Shatan CF. Trastorno de estrés postraumático: entrevista con Chaim F. Shatan. Reunión de la Sociedad Española de Psicotraumatología y Estrés Traumático, S.E.P.E.T. Aperturas Psicoanalíticas. Revista de Psicoanálisis junio 2000, 9. Come from: http://www.aperturas.org/articulos.php? id=184&a=Trastorno-de-estres-postraumatico-entrevista-con-Chaim-F-Shatan
Recio M, Alemany A, Manzanero A.L. La figura del facilitador en la investigación policial y judicial con víctimas con discapacidad intelectual. Siglo Cero. Revista Española sobre Discapacidad Intelectual 2012; 43(3): 54-68.
Vallejo AR, Terranova LM. Estrés postraumático y psicoterapia de grupo en militares. Terapia psicológica 2009; 27(1): 103-112. http://dx.doi.org/10.4067/s0718-48082009000100010 DOI: https://doi.org/10.4067/S0718-48082009000100010
Klarić M, Kvesić A, Mandić V, Petrov B, Frančišković T. Secondary Traumatisation and Systemic Traumatic Stress. Medicina Academica Mostariensia 2013; 1(1): 29-36.
Dekel R, Solomon Z. Marital relations among former prisoners of war: contribution of posttraumatic stress disorder, aggression, and sexual satisfaction. Journal of Family Psychology 2006; 20(4): 709-12. http://dx.doi.org/10.1037/0893-3200.20.4.709 DOI: https://doi.org/10.1037/0893-3200.20.4.709
Cooper SA, Bailey NM. Psychiatric disorders amongst adults with learning disabilities: prevalence and relationship to ability level. Irish Journal of Psychological Medicine 2001; 18, 45-53. DOI: https://doi.org/10.1017/S0790966700006315
Emerson E, Kiernan C, Alborz A, Reeves D, Mason H, Swarbrick R, Hatton C. The prevalence of challenging behaviors: a total population study. Research in Developmental Disabilities 2001; 22(1): 77-93. http://dx.doi.org/10.1016/S0891-4222(00)00061-5 DOI: https://doi.org/10.1016/S0891-4222(00)00061-5
Martorell A. Discapacidad intelectual y Salud Mental. Autonomía personal 2011; 5: 38-43.
Martorell A, Tsakanikos E, Pereda A, Gutiérrez-Recacha P, Bouras N, Ayuso-Mateos JL. Mental health in adults with mild and moderate intellectual disabilities: the role of recent life events and traumatic experiences across the life span. Journal of Nervous and Mental Disease 2009; 197(3): 182-186. http://dx.doi.org/10.1097/NMD.0b013e3181923c8c DOI: https://doi.org/10.1097/NMD.0b013e3181923c8c
Cottis T. Intellectual disability, trauma and psychotherapy, London: Routledge 2009 (Taylor and Francis Group). DOI: https://doi.org/10.4324/9780203926826
Herman JL. Trauma and Recovery, Glenview, IL: Basic Books 1992; (Harper Collins).
Bowlby J. Attachment and Loss: Vol 3. Loss: Sadness and Depression, Basic Books, New York 1980.
Finkelhor D, Browne A. The Traumatic Impact of Child Sexual Abuse: A Conceptualization. American Journal of Orthopsychiatry 1985; 55(4): 530-541. http://dx.doi.org/10.1111/j.1939-0025.1985.tb02703.x DOI: https://doi.org/10.1111/j.1939-0025.1985.tb02703.x
Schalock RL, Verdugo MA. Quality of life for human service practitioners. Washington, DC: American Association on Mental Retardation 2002/2003.
Schalock RL, Verdugo MA. El concepto de calidad de vida en los servicios y apoyos para personas con discapacidad intelectual. Siglo Cero 2007; 38(4): 21-36.
Minuchin S, Fishman HC. Técnicas de terapia familiar. Barcelona: Paidós 1984.
Carter EA, McGoldrick M. Etapas de ruptura de la relación marital. En J. Navarro, Técnicas y programas en Terapia Familiar. Barcelona: Paidós 1992.
Núñez B. El hijo adolescente con discapacidad en el seno de la familia. El Cisne, 2010.
Bowlby J. Attachment and Loss: Vol. 1. Attachment, New York: Basic Books 1969/1982.
Bowlby J. Attachment and Loss: Vol. 2. Separation: Anxiety and Anger, New York: Basic Books 1973.
Ainsworth MDS, Blehar MC, Waters E, Wall S. Patterns of attachment: A psychological study of the strange situation. Hillsdale, NJ: Erlbaum 1978.
Dio Bleichmar E. Manual de psicoterapia de la relación entre padres e hijos. Barcelona: Paidós 2005.
Bowlby J. A secure base: Parent-child attachment and healthy human development. New York: Basic Books 1988.
Hughes J. Violence and health: The challenges of how we talk about, conceptualize, and address violence. The Canadian Journal of Nursing Research 2006; 38(4): 27-30.
Marrone M. La teoría del apego: Un enfoque actual. Madrid: Psimática 2001.
Steele K, Van der Hart O, Nijenhuis ERS. Tratamiento secuenciado en fases de la disociación estructural en la traumatización compleja: superar las fobias relacionadas con el trauma. Journal of Trauma & Dissociation 2005; 6(3): 11-53. http://dx.doi.org/10.1300/J229v06n03_02 DOI: https://doi.org/10.1300/J229v06n03_02