Narrative therapy in a learning disability context: a review

Abstract

Purpose – Narrative therapy is aligned with government priorities for learning disabilities as it promotes inclusion and seeks to empower. While research on narrative therapy in learning disability services is emerging, it has not been critically evaluated. The purpose of this paper is to identify, summarise and critique the extant literature that has explored narrative therapy for adults with learning disabilities, and consider the implications for research and clinical practice. Design/methodology/approach – A literature search identified seven relevant case studies that described individual narrative therapy interventions for adults with learning disabilities. A qualitative review of these studies was carried out. Findings – Overall, the reviewed studies offer tentative evidence for the short-term usefulness of narrative therapy for difficulties with anger and qualitative benefits for ritualistic behaviour, social anxiety and stealing behaviour. Research limitations/implications – A number of methodological issues are identified, particularly concerning the use of outcome measures and the generalisability of findings. The research is limited due to a reliance on case study evidence and outcome measures that lack validity and reliability. Both larger scale and more robust research, and high quality practice-based evidence, are required. Practical implications – Learning disability services could consider providing narrative therapy for people with learning disabilities experiencing anger problems and other psychological difficulties. Clinical practice suggestions are identified, such as choosing relevant metaphors and including the individual’s wider system. Originality/value – This paper provides an up-to-date, comprehensive review of the literature on narrative therapy for people with learning disabilities that will be of use to clinicians providing therapeutic support and to people commissioning such services.

Transforming identities through Transforming Care: How people with learning disabilities experience moving out of hospital

“…The findings indicated that in their new homes, people were given opportunities to widen out the stories they and others held about them, rather than focus on a problem‐saturated narrative (McParland, ). Guidance on the use of Positive Behavioural Support (PBS) to work with behaviours which challenge (NICE, ) similarly emphasises proactive improvements to the person's environment and daily life as a way of situating such behaviours within environmental contexts rather than relying on purely internalised explanations (Banks et al., ).…”

“…The findings indicated that in their new homes, people were given opportunities to widen out the stories they and others held about them, rather than focus on a problem-saturated narrative (McParland, 2015).…”

Adapting and evaluating a tree of life group for women with learning disabilities

“…Outcome measurement is challenging within the context of evaluating the tree of life approach and narrative therapy generally, particularly where there is not one specific ‘difficulty’ being addressed and the focus is rather on the ‘thickening’ of positive stories about oneself (McParland, ). This study reports outcomes from only one group with four participants; therefore, caution must obviously be taken in terms of generalisability of any results.…”

“…Within this, there are several examples of narrative therapy groups being run to support people with learning disabilities, two of which focus specifically on supporting people to understand and manage the feelings of anger (Baxter & Wilcox, ; Hoole & Morgan, ), and a more recent study outlining a narrative therapy group for people with learning disabilities who are gay, lesbian, bisexual or transgender (Elderton et al ., ). In addition, a recent review of individual narrative therapy for people with learning disabilities also concluded that there was some evidence for its usefulness, particularly in relation to difficulties with anger, but that further larger‐scale research is still required (McParland, ).…”

How do lesbian and gay people experience dementia?

“…Interviewees externalised dementia; this indicates that narrative therapy involving problem externalisation may be a useful approach (White, 1998). There is emerging evidence for adapted narrative therapy with individuals with learning disabilities (McParland, 2015), which may suggest a potential usefulness for those with other cognitive difficulties such as dementia. For those with advanced dementia, emphasising character traits and resources related to sexual orientation could be an alternative to sequential narratives (Young, 2010).…”