The First Stage of Therapy

  • Andrew Jahoda
  • Biza Stenfert Kroese
  • Carol Pert


This chapter concerns the first phase of therapy when the client should develop a sense of the structure and purpose of sessions, if not an understanding of the CBT model itself. Communication is the core of a talking therapy like CBT and techniques and approaches that therapists can use to help foster a therapeutic dialogue and overcome communicative barriers are discussed. These include role play and the use of visual materials. Moreover, talking with the client about salient emotive events may be the most immediate and least abstract way of helping clients to make sense of the CBT model. By the end of this first phase the therapist should present the client with a formulation, helping to explain their difficulties. The formulation should take account of the wider context of the client’s life and the very real challenges they may face. CBT should not be used as a panacea for social disadvantage faced by people with intellectual disabilities.


  1. Bruce, M., Collins, S., Langdon, P., Powlitch, S., & Reynolds, S. (2010). Does training improve understanding of core concepts in cognitive behaviour therapy by people with intellectual disabilities? A randomized experiment. British Journal of Clinical Psychology, 49, 1–13.CrossRefPubMedGoogle Scholar
  2. Crabtree, J. W., Haslam, S. A., Postmes, T., & Haslam, C. (2010). Mental health support groups, stigma, and self-esteem: Positive and negative implications of social identification. Journal of Social Issues, 66(3), 553–569.CrossRefGoogle Scholar
  3. Cuthill, F. M., Espie, C. A., & Cooper, S.-A. (2003). Development and psychometric properties of the Glasgow depression scale for people with a learning disability. British Journal of Psychiatry, 182, 347–353.CrossRefPubMedGoogle Scholar
  4. Dagnan, D. (2007). Psychosocial interventions for people with intellectual disabilities and mental ill-health. Current Opinion in Psychiatry, 20, 456–460.CrossRefPubMedGoogle Scholar
  5. Dagnan, D., & Chadwick, P. (1997). Cognitive-behaviour therapy for people with learning disabilities: Assessment and intervention. In B. Stenfert Kroese, D. Dagnan, & E. Lumidis (Eds.), Cognitive behaviour therapy for people with learning disabilities (pp. (162–(181). London: Routledge.Google Scholar
  6. Damasio, A. (2003). Feelings of emotion and the self. Annals of the New York Academy of Science, 1001, 253–261.CrossRefGoogle Scholar
  7. Goffman, E. (1963). Stigma: Notes on the management of a spoiled identity. Englewood Cliffs: Prentice Hall.Google Scholar
  8. Greenberger, D., & Padesky, C. A. (1995). Mind over mood: A cognitive therapy treatment manual for clients. New York: Guilford Press.Google Scholar
  9. Hebblethwaite, A., Jahoda, A., & Dagnan, D. (2011). Talking about real life events: An investigation of the ability of people with intellectual disabilities to make links between their beliefs and emotions within dialogue. Journal of Applied Research in Intellectual Disability, 24, 543–553.CrossRefGoogle Scholar
  10. Ingham, B., Clark, L., & James, I. A. (2008). Biopsychosocial case formulation for people with intellectual disabilities and mental health problems: A pilot study of a training workshop for direct care staff. The British Journal of Developmental Disabilities, 54(1), 41–54.CrossRefGoogle Scholar
  11. Jahoda, A., & Markova, I. (2004). Coping with social stigma: People with intellectual disabilities moving from institutions and the family home. Journal of Intellectual Disability Research, 48(8), 719–729.CrossRefPubMedGoogle Scholar
  12. Jahoda, A., Wilson, A., Stalker, K., & Cairney, A. (2010). Living with stigma and the self-perceptions of people with mild intellectual disabilities. Journal of Social Issues, 66(3), 521–534.CrossRefGoogle Scholar
  13. Kirk, J. D., Jahoda, A., & Pert, C. (2008). Beliefs about aggression and submissiveness: A comparison of aggressive and nonaggressive individuals with mild intellectual disability. Journal of Mental Health and Intellectual Disability, 1, 91–204.CrossRefGoogle Scholar
  14. Linville, P. W. (1987). Self-complexity as a cognitive buffer against stress-related illness and depression. Journal of Personality and Social Psychology, 52, 663–676.CrossRefPubMedGoogle Scholar
  15. Matheson, E., & Jahoda, A. (2005). Emotional understanding in aggressive and non-aggressive individuals with mild and moderate mental retardation. American Journal on Mental Retardation, 110, 57–67.CrossRefPubMedGoogle Scholar
  16. Moore, D. (2001). Reassessing emotion recognition performance in people with mental retardation: A review. American Journal on Mental Retardation, 106, 481–502.CrossRefPubMedGoogle Scholar
  17. McRitchie, R., McKenzie, K., Quayle, E., Harlin, M., & Neumann, K. (2013). How adults with an intellectual disability experience bereavement and grief: A qualitative exploration. Death Studies, 38, 1–7.Google Scholar
  18. Tarrier, N., & Calam, R. (2002). New developments in cognitive-behavioural case formulation. Epidemiological, systemic and social context: An integrative approach. Cognitive and Behavioural Psychotherapy, 30, 311–328.Google Scholar
  19. Tarrier, N. (2006). An introduction to case formulation and its challenges. In N. Tarrier & J. Johnson (Eds.), Case formulation in cognitive behaviour therapy: The treatment of complex and challenging cases (pp. 1–11). London: Routledge.Google Scholar
  20. Trower, P., Jones, J., & Dryden, W. (2015). Cognitive-behavioural counselling in action (3rd ed.). London: Sage.Google Scholar
  21. Westbrook, D., Mueller, M., Kennerley, H., & McManus, F. (2010). Common problems in therapy. In M. Mueller, H. Kennerley, F. McManus, & D. Westbrook (Eds.), The Oxford guide to surviving as a CBT therapist. Oxford: Oxford University Press.Google Scholar

Copyright information

© The Author(s) 2017

Authors and Affiliations

  • Andrew Jahoda
    • 1
  • Biza Stenfert Kroese
    • 2
  • Carol Pert
    • 3
  1. 1.Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
  2. 2.School of PsychologyUniversity of BirminghamBirminghamUK
  3. 3.Learning Disabilities ServiceNHS Greater Glasgow and ClydeGlasgowUK

Personalised recommendations