Page 140 - Post-traumatic stress disorder in adults with mild intellectual disability: Screening, assessment, and brief intensive EMDR therapy

Chapter 6
In the study on brief intensive EMDR therapy, participants received treatment
from a team of six therapists who worked collaboratively and alternated
sessions, a format which is known as rotating therapists. In Study 4
(Chapter 5), we examined how participants experienced this format. Two of
the three participants were positive about working with different therapists,
while one was neither positive nor negative. These findings are consistent
with those from a study in individuals from the general population by Van
Minnen et al. (2018), who found a general preference for treatment by a
rotating team of therapists rather than by a single therapist. Although two
out of three participants were positive about the rotating therapists format,
this finding may seem somewhat at odds with the concept of therapeutic
alliance. As described in the General Introduction (Chapter 1), research in
psychotherapy and trauma treatment among the general population shows
that therapeutic alliance is a key predictor of treatment outcomes (Baier et
al., 2020; Flückiger et al., 2018; Horvath et al., 2011; Howard et al., 2022).
Therapeutic alliance refers to a collaborative relationship between therapist
and client, grounded in agreement about goals, consensus on tasks,
and the development of a positive emotional bond (Bordin, 1979, 1994).
Therapeutic alliance may be particularly important for individuals with MID-
BIF and severe behavioural problems, as skills deficits and attachment
difficulties can make it more challenging to build trust and agree on goals
and tasks (Hamadi et al., 2021; Van Herwaarden et al., 2022).
Against this background, the use of rotating therapists may thus appear
at odds. As said, two of the three participants were positive about working
with different therapists, while one was neither positive nor negative. Several
factors may have contributed to the positive experiences. All therapists
were highly experienced in both EMDR therapy and working with individuals
with MID-BIF and appeared to share a professional and supportive
attitude, which was identified as a relevant adaptation in EMDR therapy for
individuals with MID-BIF (Schipper-Eindhoven et al., 2024). Moreover, the
brief intensive EMDR therapy followed a structured format using the child
and adolescent EMDR protocol (De Roos et al., 2021), which is written in
simplified language and explicitly states that clients cannot make mistakes.
In addition, a case conceptualisation was developed together with the client,
based on a list of traumatic and stressful events ordered by SUD score.
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