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-   -   CT and intellectual ability/literacy (http://www.behavior.net/bolforums/showthread.php?t=1033)

James D January 18th, 2007 02:24 AM

CT and intellectual ability/literacy
 
Hi all,
I'm curious about peoples thoughts on the use of CT with differing levels of intellectual ability and literacy. A quick look at the literature indicates it can be useful with learning disorders when the material is adapted; not much on intellectual disability though and I did not see anything on comparing the utility of CT for people below average IQ, average, above average, etc. Is it more effective with super smart people than your average Joe? A quick search on CT and literacy pulled up no results.

In speaking with colleagues (psychologists and non-psychologists), the assumption seems to be that those who are 'below average IQ' are inappropriate for any cognitive work and all interventions must be behavioural. This is usually based on the assumption that the person is 'below average' - no real evidence to back it up.

My thoughts are it can be useful with a variety of people but must be adapted to the individual. There are, after all, CT programs for children so why can't these methods be applied to adults also. There are going to be limits of course to the utility of CT but my feeling is it is a pretty flexible approach - just a matter of being creative.
(PS. I'm just using 'IQ' for descriptive purposes)

Janet Doron January 18th, 2007 01:20 PM

Re: CT and intellectual ability/literacy
 
Hi, James,

I think another factor that weighs in, is the degree of faith people have in your approach. The more literate/intellectual people tend to believe in reason, and would trust a CT approach to therapy (and trust you). This in itself, introduces an element of hope and a positive attitude. It would be harder to achieve this among people who are not used to a more analytical way of thinking, and simply aren't in the habit of applying reason as a tool and relying on it. Having said that, I agree with your sentiments that some level of CT can be creatively applied to suit a range of IQ's and literacies, but I tend to think it can't be as heavily relied on in the lower ranges, and will need more supplementing, if only because of the hope/trust factor, and the habits/approaches that are already established.
In the higher intellectual and literacy range, CT sessions are enjoyed (the intellectual "challenge"), and new insights appreciated. This generates faith and hope, because it's easier to rely on a tool one is brought up to work with.

Just my two-cents' worth :)

Janet

James Pretzer January 23rd, 2007 10:21 AM

Re: CT and intellectual ability/literacy
 
It is important to remember that CT includes a broad range of interventions, not just thought sheets and rational responses. Thought sheets and rational responses are not likely to be very useful with clients who are of limited intellectual ability or who are illiterate.

However, this doesn't mean CT isn't helpful with these individuals, it means that appropriate adjustments need to be made in the treatment approach. In general, self-instructional training, problem-solving training, modeling, role-play, and behavioral interventions are more useful when the client has significant intellectual limitations. Also, office-based treatment may inadequate unless there is significant coordination with family members, case managers, job coaches, house-parents, and others who play important roles in the client's life.

For example, I am currently working with a young man who experienced a traumatic brain injury as an infant. He was in special education classes through high school and is now able to hold janitorial jobs with some supervision and coaching. CT for anxiety, depression, anger, and OCD has been quite helpful to him. Treatment has required coordination with his psychiatrist and telephone contacts with family members. A good case manager and the client's involvement in social programs for persons with developmental disabilities have been quite helpful. If it is possible to get him into an appropriate group home or supported living situation, that will be really helpful. We're doing CT but we aren't using thought sheets and we are combining office-based treatment with case management, consultation with family members, and a number of supportive services.


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