Mental Retardation: Psychotherapies, Behavioral Treatment

Psychotherapies

Psychotherapy in this population is not different in nature from psychotherapy in persons with average intelligence and is similar to treating children, inasmuch as in both cases the techniques and the therapist have to adapt to the developmental needs of the patient. The treatment should be driven by the patient’s needs and responses and not by the therapist’s theoretical orientation. The indications are: the presence of concerns and conflicts, especially about oneself; impairments in interpersonal skills; or other mental disturbances that are known to improve through psychotherapy. The prerequisites include communication skills permitting a meaningful interchange with the therapist, an abil-ity to develop even a minimal relationship, and the availability of a trained, experienced and unprejudiced therapist who is com-fortable working in a team setting.

Behavioral Treatment

This treatment should optimally use rewards which should be age appropriate, preferably social, and the frequency of reward-ing should be adapted to a person’s cognitive level, so that he or she can understand why they are given. Consistency and gen-eralization among different settings are essential. Thus, if such techniques are successfully used at the school, the family or other caregivers should be trained to use them at home as well. The fo-cus should not be on elimination of objectionable behaviors only but on teaching appropriate replacement behaviors. Aversive techniques involving active punishment (electric shocks, spray-ing of noxious substances into a person’s face) are not used except in a few controversial settings. There is a professional consensus that these techniques should not be used at all, or only when all other techniques have failed and the patient’s behavior poses se-vere danger to herself or himself or to others (such as intractable SIB). Even then, these techniques should be used only if proved effective and for a limited time