Defining the characteristics of an effective psychological therapist for people with intellectual disability and mental health problems: a Q-sort study
| Date | 17 May 2023 |
| Pages | 137-147 |
| DOI | https://doi.org/10.1108/AMHID-07-2022-0024 |
| Published date | 17 May 2023 |
| Author | Charlotte Clarke,Nigel Beail,Stephen Kellett |
Defining the characteristics of an effective
psychological therapist for people with
intellectual disability and mental health
problems: a Q-sort study
Charlotte Clarke, Nigel Beail and Stephen Kellett
Abstract
Purpose –There is little consensus regardingwhat constitutes an effective therapist when workingwith
adults with intellectual disabilities (ID) who have a mental health problem. This study aims to explore
whether clustersof clinical psychologists (CPs) could be differentiatedwith regards to beliefs as to what
defines an effective therapist for adults with ID experiencing psychological distress and seeking
treatment.
Design/methodology/approach –Four interviews with CPs and an associated thematic analysis
created the49-item Q-set. These items were then sortedinto a forced quasi-normal distributionby N=27
CPs via an onlineQ-sorting task.
Findings –Three participant clusters were identified in the principal components analysis that
accounted for 49% of thevariance. These clusters were labelled the creativecollaborator, the reflective
expertand the system integrator.
Research limitations/implications –Differences exist regardingbeliefs as to what the psychotherapeutic
approaches effective therapists working with ID and comorbid mental health problemsshould take. These
differences approximatedto preferred psychological therapy models. This study is critiqued to enable future
research on this topicto progress.
Originality/value –To the best of the authors’ knowledge, this is the first study to explore what
constitutesan effective psychologicaltherapist for people who have ID.
Keywords Effective therapists, Intellectual disability, Psychotherapy, Q-methodology,
Psychological therapy, Outcomes
Paper type Research paper
Psychotherapy is a complex relational process and researchers have attempted to
disentangle the therapist factors contributing to positive change, deterioration, no
change occurring or the intervention being harmful (Linden, 2013). Multi-level
modelling (MLM) studies consistently report that between 5% and 8% of therapy outcome
can be attributed to the therapist (Johns et al., 2019;Norcross and Lambert, 2018) and this
is termed the “therapist effect”. Some therapists are significantly and consistently more
effective, achieving almost double the amount of client change each session (Firth et al.,
2015). Johns et al. (2019) suggested that further research is needed to identify what it is
about effective therapists practices that specifically differentiate them. It is worth noting that
that “therapist effects” research has typically been conducted in adult mental health
settings using MLM and therefore not typically in intellectual disabilities (ID) settings.
Wampold (2011) indicated 14 core qualities of effective therapists, including sophisticated
interpersonal skills, being able to develop a therapeutic relationship across a broad range
Charlotte Clarke is based at
the Department of
Neuropsychology,
Rotherham Doncaster and
South Humber Mental
Health NHS Foundation
Trust, Doncaster, UK.
Nigel Beail is based at the
Adult Specialist Learning
Disabilities Health Service,
South West Yorkshire
Partnership NHS
Foundation Trust, Barnsley,
UK and Department of
Psychology, University of
Sheffield, Sheffield, UK.
Stephen Kellett is based at
the Grounded Research
Hub, Rotherham Doncaster
and South Humber NHS
Foundation Trust,
Doncaster, UK.
Received 25 July 2022
Revised 20 February 2023
Accepted 22 February 2023
The authors would like to thank
the British Psychological
Society’s Division of Clinical
Psychology’s Faculty for
People who have Intellectual
Disabilities for their support
with the project.
DOI 10.1108/AMHID-07-2022-0024 VOL. 17 NO. 32023, pp. 137-147, ©Emerald Publishing Limited, ISSN 2044-1282 jADVANCES IN MENTAL HEALTH AND INTELLECTUAL DISABILITIESjPAGE 137
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