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I’m a consultant clinical psychologist working in Gateshead in the North East of England.  I had completed a PhD in Psychology (1996) and completed Counselling training (1995) at the University of Warwick.   I was interested in the value of the pre-world war II work of psychoanalyst Melanie Klein with children who had autism, and its cross-over with the modern theories of symbolic play.

After completing clinical training at the University of Surrey in 1998 I returned to working with people with Intellectual Disabilities (ID).  Inspired by Nigel Beail, Valerie Sinason, and Pat Frankish I undertook Diploma in Psychodynamic Approaches to Intellectual Disabilities at the Tavistock Clinic in 2000-2001.

I have always been bemused at the ‘unoffered chair’ – the failure to offer psychotherapy to people with disabilities and their families – and so have spent some time completing research on outcomes of this kind of working.  Suffice to say the results have always been encouraging.   However this work has also uncovered multiple traumas and rejections in many of the lives of those I work with, without this ever having been adequately addressed.  I have also worked to increase awareness of Attachment Theory – Attachment behaviours being very susceptible to trauma, as well as the road to addressing it – and for this to be applied in the lives of people with ID.  I had the good fortune to be involved in writing the Faculty’s 2017 Clinical Practice Guidelines on Attachment.  It’s been great talking to colleagues about how this has influenced their practice.

Currently I am promoting the need for Trauma- and Attachment-Informed Care to enter the policy arena for people with ID.  Together with Professor Beail and Dr Frankish, I am editing a book entitled Trauma and Intellectual Disabilities: Acknowledgement, Assessment and Intervention which is due to be published by Pavilion this year. 

Good Attachment-Based Practices in Intellectual Disability Services: Maintaining Bonds

This presentation follows the triple themes of Acknowledgement of Trauma, Assessment of Trauma and Attachment, and Effective Interventions.   I seek to demonstrate that people with Intellectual Disabilities are scandalously exposed to maltreatment in every country where this is investigated.  Yet they are systematically excluded from important policy guidelines such as NICE NG26: Children’s Attachment. 

Clinical Psychologists may be wondering how they should address this.  For example, people are often moved suddenly or with cursory goodbyes and introductions, worsening any Attachment Difficulties they may have already.  They may also find their understandable anxieties and trauma symptoms treated by medication in the first instance.  I will suggest that we oppose such practices, and promote placement and relationship stability as with other care groups.

It is also important to consider Emotional Development in determining a person’s need for support, as over-estimation can be disastrous.  Psychologists should consider Attachment in formulation, bearing in mind that Attachment Disorganisation is strongly associated with significant trauma. 

I will also draw attention to the past (and sometimes current) practices of psychologists such as electric shock treatment, aversive therapies, and forced sterilisation based on IQ, so that we do not view our work as politically or ethically neutral.  I will mention several psychological approaches, including Routine Enquiry of ACEs, the SECURED model, applying Hughes and Baylin’s Blocked Care, and specifically for carers, the CAPDID model.  However, I will emphasise that case work and even transforming our teams, is not enough; we need to influence commissioners and policy makers, putting Trauma- and Attachment-Informed Care front and centre of practice.