Exploring How People With Intellectual Disabilities Experience the Therapeutic Alliance: A 'Best Fit' Framework Analysis Using Bordin's Model.
Max Whittaker, Andrew Jahoda, Dani Lewis and 1 others
PMID 41577569WHAT IT FOUND
Adults with intellectual disabilities described therapy as working when it felt like a distinct, safe, and trusting relationship.
They valued confidentiality and a non-judgmental stance, often needing therapists to coordinate with their wider support networks. Goals frequently emerged during therapy rather than being set at the start.
Key findings
01Trust, a distinctive relationship, and safety (confidentiality and no negative evaluation) were central to the therapeutic bond.
02Patients valued therapists who actively coordinated with their wider support systems, acting as a bridge to appropriate care.
03Therapy goals were often emergent and developed during the course of treatment, rather than being explicitly defined at the outset.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The original studies were not primarily designed to investigate therapeutic alliance, so data on this specific concept may be incomplete or indirect. The synthesis combined experiences from individual and group therapies, which may have different dynamics that were not separated in the analysis. The review focused on adults; findings may not apply to children or those in creative therapies.
Declared interests
The authors declare no conflicts of interest. The review was not funded by a specific grant mentioned in the text, though it builds on previous work.
The easy way to misread this
Do not assume that the presence of a support worker or family member in a session always helps the alliance. While many patients valued therapists coordinating with their support network, others felt their safety and confidentiality were compromised when others were present.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →