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Conducting Video Therapy with Adults with an Intellectual Disability: A Qualitative Study of Qualified and Trainee Psychologists' Experiences

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Title: Conducting Video Therapy with Adults with an Intellectual Disability: A Qualitative Study of Qualified and Trainee Psychologists' Experiences
Language: English
Authors: Blocksidge, Hope (ORCID 0000-0002-6986-3731), Willis, Lara, Codd, Jon (ORCID 0000-0002-3941-9701)
Source: British Journal of Learning Disabilities. Sep 2023 51(3):389-399.
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 11
Publication Date: 2023
Document Type: Journal Articles
Reports - Research
Descriptors: Counseling Techniques, Psychologists, Intellectual Disability, Counseling Effectiveness, Computer Mediated Communication, Barriers, Counselor Attitudes, Access to Health Care
DOI: 10.1111/bld.12496
ISSN: 1354-4187
1468-3156
Abstract: Background: Online therapy is becoming increasingly popular as well as necessary. There is little research regarding the experience of psychologists delivering online therapy to individuals with an intellectual disability. Method: The study used online semistructured interviews and interpretive phenological analysis to explore the experiences of five psychologists delivering online therapy to individuals with an intellectual disability. Findings: Four superordinate themes were generated from the data: Environment: "You can't control the environment"; Person centred: "I do not think it's one size fits all"; Rapport: "slightly trickier to build"; and Clinician ability and experience: "it was a bit of a learning process". Psychologists spoke of prior negative beliefs and a range of challenges to video therapy. Their discomfort with using this technology was noted; however, a motivation to continue offering therapy to clients overweighed this. All participants concluded with benefits to using video therapy, notably increased accessibility. Conclusion: A hybrid model including face-to-face and online therapy appears preferable for future ways of working. Training is recommended for professionals and individuals supporting clients, and an assessment tool for the suitability of online therapy. Further research exploring online therapy experiences of people with intellectual disabilities is required.
Abstractor: As Provided
Entry Date: 2023
Accession Number: EJ1387261
Database: ERIC
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  Value: <anid>AN0169783196;f0401sep.23;2023Aug08.03:21;v2.2.500</anid> <title id="AN0169783196-1">Conducting video therapy with adults with an intellectual disability: A qualitative study of qualified and trainee psychologists' experiences </title> <p>Background: Online therapy is becoming increasingly popular as well as necessary. There is little research regarding the experience of psychologists delivering online therapy to individuals with an intellectual disability. Method: The study used online semistructured interviews and interpretive phenological analysis to explore the experiences of five psychologists delivering online therapy to individuals with an intellectual disability. Findings: Four superordinate themes were generated from the data: Environment: "You can't control the environment"; Person centred: "I do not think it's one size fits all"; Rapport: "slightly trickier to build"; and Clinician ability and experience: "it was a bit of a learning process". Psychologists spoke of prior negative beliefs and a range of challenges to video therapy. Their discomfort with using this technology was noted; however, a motivation to continue offering therapy to clients overweighed this. All participants concluded with benefits to using video therapy, notably increased accessibility. Conclusion: A hybrid model including face‐to‐face and online therapy appears preferable for future ways of working. Training is recommended for professionals and individuals supporting clients, and an assessment tool for the suitability of online therapy. Further research exploring online therapy experiences of people with intellectual disabilities is required.</p> <p>Accessible summary: During COVID‐19, face‐to‐face therapy was not allowed in England. Psychologists were asked to give therapy on video calls. We wanted to find out what this is like for psychologists working with people who have learning disabilities.We asked five psychologists about their experience in providing video therapy.Psychologists described some things they found hard: It was hard to control the environment online. It was hard to make changes to therapy for people with learning disabilities. It was sometimes hard to communicate. It was hard to build relationships online. Psychologists did not have experience doing video therapy. They were not confident.Some ideas that could help: Training for psychologists and carers or families, an assessment tool to check if someone can do video therapy, and giving information about video therapy to people with learning disabilities All psychologists said there were good things about online therapy. They would like to keep using it.</p> <p>Keywords: community care; intellectual disability; learning (intellectual) disabilities; psychological therapy; research; staff training</p> <hd id="AN0169783196-2">INTRODUCTION</hd> <p>Before the coronavirus disease 2019 (COVID‐19) pandemic, there was encouraging research highlighting the efficacy and benefits of video therapy (Johansson & Andersson, [<reflink idref="bib11" id="ref1">11</reflink>]). In response to COVID‐19, this type of therapeutic contact is now seen as the "new normal" in countries worldwide (Berwick, [<reflink idref="bib3" id="ref2">3</reflink>]). Video therapy is defined as "the provision of synchronous psychotherapy via videoconferencing" (Knopf, [<reflink idref="bib13" id="ref3">13</reflink>]). Studies have shown that video therapy interventions are, for the most part, as effective as conventional modes of therapy (Johansson & Andersson, [<reflink idref="bib11" id="ref4">11</reflink>]). Advantages such as affordability and increased accessibility to services have been highlighted (Wong et al., [<reflink idref="bib19" id="ref5">19</reflink>]), which may indicate the convenience of video therapy.</p> <p>Apart from the logistical challenges with video therapy including miscommunication, adaptation of interventions and experience with technology (MacMullin et al., [<reflink idref="bib14" id="ref6">14</reflink>]), a common concern with video therapy is the ability to build relationships with clients with the main mode of therapy lacking physical connection (Mateescu, [<reflink idref="bib15" id="ref7">15</reflink>]). Goldstein and Glueck ([<reflink idref="bib8" id="ref8">8</reflink>]) explored the literature on rapport and building a therapeutic alliance using video therapy. Rapport was defined as "the spontaneous, conscious, feeling of harmonious responsiveness" with the therapeutic alliance referring to "the affective bond that develops between a provider and patient". Both of these components are key for therapy, with the existence of a therapeutic alliance being a strong predictor of positive outcomes for clients seeking psychological support. It was concluded in this review that it is possible to build both rapport and a therapeutic alliance over a screen; however, often the clients were more accepting of this method than clinicians. Irvine et al. ([<reflink idref="bib10" id="ref9">10</reflink>]) supported this review and highlighted that a therapeutic alliance can still be achieved through non‐face‐to‐face interventions; however, they further emphasised that clinician support for the method is crucial to effectiveness. An area that this links to is clinician attitudes toward video therapy.</p> <p>Since COVID‐19, research has been conducted exploring the attitudes and experiences of clinicians delivering therapy online. Békés et al. ([<reflink idref="bib2" id="ref10">2</reflink>]) surveyed 145 psychotherapists and found that some psychotherapists expressed positive attitudes towards video therapy. Attitudes were influenced by past experiences, modality and experience of the transition to video therapy. These attitudes significantly impacted the effectiveness of therapy and therefore this area is particularly important to explore in more detail through future research. In the United Kingdom, many psychologists were advised to work from home in line with government guidance, and consequently, psychologists rapidly transitioned from delivering psychological therapy face‐to‐face to delivering psychological therapy via a screen. Due to those with intellectual disabilities being classed as "extremely vulnerable" to the severe acute respiratory syndrome coronavirus 2 infection (Courtenay & Cooper, [<reflink idref="bib5" id="ref11">5</reflink>]), moving to this new provision was a matter of learning disability services ensuring the safety of their clients accessing psychological support.</p> <p>To the authors' knowledge, there has been little research regarding people with intellectual disabilities and video therapy and specifically examining therapist's experience (via conventional methods or video therapy). The terms learning disability and intellectual disability can be used interchangeably, and both terms refer to the same concept. Intellectual disability includes low intellectual ability, significant impairment of social or adaptive functioning and onset in childhood (NICE Guidelines, [<reflink idref="bib16" id="ref12">16</reflink>]). Historically, research has been lacking on people with intellectual disabilities, despite the prevalence of vulnerabilities, health inequalities, comorbidities and challenging behaviour (Crook et al., [<reflink idref="bib6" id="ref13">6</reflink>]). One area that has been focussed on in relation to the therapists' experience is the development of a therapeutic rapport with individuals with intellectual disabilities. Tools such as communication aids or storyboards were highlighted to be useful to build rapport along with a modification of the therapists' boundaries such as more reassurance and use of humour (Jones, [<reflink idref="bib12" id="ref14">12</reflink>]). However, these methods of rapport building can be difficult to utilise when delivering support virtually, in particular, using tools such as storyboards or communication tools.</p> <p>While there has been research conducted exploring therapists' experiences of video therapy, this has not explored psychologists' experiences of delivering video therapy for people with intellectual disabilities. The current research was conducted in a National Health Service (NHS) psychological service providing support to individuals with intellectual disabilities. The aim of the study was to understand psychologists' experience in delivering video therapy to individuals with intellectual disabilities. This is particularly important in the context of the pandemic where video therapy has been the preferred option to protect clients' safety. Psychologists were asked to reflect upon their experiences of providing video therapy to this specialised target group following the onset of COVID‐19 in March 2020. Interpretative phenomenological analysis (IPA) was deemed the most appropriate method to understand the in‐depth experience of a small homogenous sample working with intellectual disabilities in Berkshire, England.</p> <hd id="AN0169783196-3">METHOD</hd> <p></p> <hd id="AN0169783196-4">Participants</hd> <p>The study was conducted within a Psychological Service For People with Learning Disabilities within the NHS. Common referrals to the service include support for anxiety, depression and challenging behaviour. As a result of the COVID‐19 pandemic and from March 2020 onwards, the service began to deliver psychological support online using video therapy. The majority of clients receiving this input had diagnoses of mild or moderate intellectual disabilities, with those more severe receiving more indirect systemic support. It was decided in the service that trauma therapy would remain on hold during this time and would not be conducted via video therapy, due to a lack of evidence base supporting this.</p> <p>Purposive sampling was then used to recruit five participants from the Psychological Service for People with Learning Disabilities. This sample number fits the IPA method as recommended by Smith et al. ([<reflink idref="bib18" id="ref15">18</reflink>]). Participants were counselling or clinical psychologists who had delivered or were delivering psychological interventions via the online platform, Microsoft Teams, to a client(s) with a diagnosed intellectual disability during the pandemic from March 2020 onwards. Participant inclusion criteria included working towards or having a formal qualification in clinical or counselling psychology and experience in delivering therapy to an individual with an intellectual disability.</p> <p>Psychologists were recruited via email. A brief description of the study was given in the email and attachments included the participant information sheet. The lead (H. B.) and second researcher (L. W.) were involved in recruiting participants and conducting the interviews. Pseudonyms were used to protect participant identity.</p> <hd id="AN0169783196-5">Procedure</hd> <p>The current research was discussed with the service before recruitment, and it was felt by the team that psychologists would be happy to share their lived experience of delivering video therapy to individuals with intellectual disability. IPA was therefore chosen as a suitable qualitative approach, which aims to understand participants' experiences and how participants themselves make sense of these (Smith et al., [<reflink idref="bib18" id="ref16">18</reflink>]). This study was reviewed by and registered with the local NHS trust's Research Department. Ethical approval was obtained from HRA and Health and Care Research Wales (21/HRA/0086).</p> <p>Following the guidance of Smith et al. ([<reflink idref="bib18" id="ref17">18</reflink>]), the research team developed a semistructured interview in discussion with a clinical psychologist working with people with intellectual disabilities. This included open‐ended questions with prompts to encourage psychologists to reflect and discuss their experiences in detail. Questions were geared towards delivering therapy on video rather than experiences of social interactions online. Participants understood the aims of this project before consenting to take part. The interview schedule was peer‐reviewed by three clinical psychologists specialising in working with people with intellectual disabilities, including a service lead, and then piloted by a clinical psychologist to check for question comprehension and to ensure questions elicited detailed responses. This pilot interview was not included due to a change in the interview schedule to elicit a more detailed response. A question asking about psychological formulation in the interview structure was changed to ask more broadly about working collaboratively with clients online.</p> <p>The lead researcher (H. B.) and second researcher (L. W.) conducted interviews. Following the researcher obtaining full and informed verbal consent at the start of the interview, a demographic questionnaire was administered to gather data on participants' gender, ethnicity, age and professional qualifications. Interviews were conducted over Microsoft Teams in line with government and Trust COVID‐19 policies and guidance at the time. Interviews lasted 30–60 min and were conducted between April 2021 and May 2021. Participants were asked to reflect upon their lived experience of video therapy with individuals with intellectual disabilities from March 2020 onwards. A debrief sheet was provided with detailed information regarding support, in addition to the participant information sheet.</p> <hd id="AN0169783196-6">Analysis</hd> <p>Interviews were audio and video recorded and transcribed verbatim. Analysis followed IPA guidance by Smith et al. ([<reflink idref="bib18" id="ref18">18</reflink>]) (see Table 1). Five stages were established, and transcripts were read/watched and reread. Notes were made on each interview and these contained descriptive, linguistic and conceptual comments. In addition to these comments, researcher interpretation and interview "tone" was also noted. Both researchers analysed all transcripts and developed emergent themes together, which evolved into master themes. Links between emergent themes were made for each participant using abstraction, subsumption, polarisation, numeration and function. Quotes from each transcript were typed into a table to show master themes, which were then clustered into superordinate themes with patterns noted across transcripts. Subthemes were then encapsulated within superordinate themes. Credibility checks were carried out throughout the research via peer and group supervision, with one researcher, a qualified psychologist, being experienced in IPA.</p> <p>1 Table Demographics table</p> <p> <ephtml> <table><thead valign="bottom"><tr valign="bottom"><th align="left">Pseudonym</th><th align="left">Age</th><th align="left">Gender</th><th align="left">Ethnicity</th><th align="left">Qualification</th></tr></thead><tbody valign="top"><tr><td align="left">Jacqui</td><td align="left" char=".">51</td><td align="left">Female</td><td align="left">White European Other</td><td align="left">BSc, DClinPsy</td></tr><tr><td align="left">Sophie</td><td align="left" char=".">31</td><td align="left">Female</td><td align="left">White British</td><td align="left">BSc, PGcert, MBPsS</td></tr><tr><td align="left">Karen</td><td align="left" char=".">32</td><td align="left">Female</td><td align="left">White British</td><td align="left">BSc, PWP, DClinPsy</td></tr><tr><td align="left">Linda</td><td align="left" char=".">53</td><td align="left">Female</td><td align="left">White British</td><td align="left">BSc, MSc, DipCounsPsy, AFBPsS</td></tr><tr><td align="left">Debbie</td><td align="left" char=".">49</td><td align="left">Female</td><td align="left">White British</td><td align="left">BSc, DClinPsy</td></tr></tbody></table> </ephtml> </p> <p>Following the development of initial themes, a meeting was held between the lead researcher, third researcher and all psychologists in the service, including those who participated in the study. Themes were discussed and those that took part in the research agreed that themes were an accurate reflection of their interviews. At the time due to NHS pressures with the pandemic, this was deemed acceptable by the service and all who participated as a quality check.</p> <p>To encourage reflexivity, "bracketing" interviews were undertaken before data collection and during analysis (Fischer, [<reflink idref="bib7" id="ref19">7</reflink>]). "Bracketing" is a process designed to "bracket" the researcher's prior beliefs or assumptions from their involvement with the current study, thus allowing them to view data with "fresh eyes" (Hissa & Timulak, [<reflink idref="bib9" id="ref20">9</reflink>]). Reflexivity was also assured by regular supervision with an experienced researcher in IPA to allow space to reflect on the research. Reflective journals were also kept by both lead researchers throughout the research and they recorded thoughts on their previous experiences, the interviews and analysis. This enabled them to consider any biases or preconceptions.</p> <hd id="AN0169783196-7">Situating the researchers</hd> <p>The lead researcher (H. B.) is a 28‐year‐old White British female who is a Trainee Clinical Psychologist and was working at the time as an Assistant Psychologist within the Trust's Psychological Service for People with Learning Disabilities.</p> <p>The second researcher (L. W.) is a 24‐year‐old White British female who is a Trainee Clinical Psychologist and was also working at the time as an Assistant Psychologist within the same Trust. Both researchers have experience delivering assessments and interventions to individuals with a learning disability face to face and online.</p> <p>The researchers' assumptions before this study were that psychologists find working online with people with intellectual disabilities difficult in the sense of setting up a therapeutic rapport due to a lack of nonverbal communication. However, they also expected a number of benefits to video therapy, such as increasing access to those who are unable to physically travel to appointments. These assumptions may have been influenced by the researchers' views, clinical experience and discussions among colleagues.</p> <hd id="AN0169783196-8">RESULTS</hd> <p></p> <hd id="AN0169783196-9">Situating the sample</hd> <p>Five female psychologists from the south of England, working for the local trust's Psychological Service for People with Learning Disabilities, aged 31–53 (mean: 43.2) participated. Four psychologists were White British and one was White European. Three participants were clinical psychologists, one was a counselling psychologist and one was a trainee counselling psychologist.</p> <hd id="AN0169783196-10">Overview of themes</hd> <p>Four superordinate themes were generated from the data, with a high endorsement rate across the sample (see Table 2). As the current study took place during the COVID‐19 pandemic, results are likely to have been affected by the social climate at the time, specifically, by the service transitioning to video therapy rapidly, due to restrictions imposed.</p> <p>2 Table Endorsement of themes</p> <p> <ephtml> <table><thead valign="bottom"><tr valign="bottom"><th align="left">Superordinate and subordinate themes</th><th align="left">Total</th><th align="left">Jacqui</th><th align="left">Sophie</th><th align="left">Karen</th><th align="left">Linda</th><th align="left">Debbie</th></tr></thead><tbody valign="top"><tr><td align="left">Environment: "You can't control the environment"</td><td align="left">5</td><td align="left">*</td><td align="left">*</td><td align="left">*</td><td align="left">*</td><td align="left">*</td></tr><tr><td align="left">Technology: "barriers"</td><td align="left">5</td><td align="left">*</td><td align="left">*</td><td align="left">*</td><td align="left">*</td><td align="left">*</td></tr><tr><td align="left">Boundaries: "It can feel more like a social chat"</td><td align="left">3</td><td align="left">*</td><td /><td /><td align="left">*</td><td align="left">*</td></tr><tr><td align="left">Confidentiality: "a challenge"</td><td align="left">4</td><td align="left">*</td><td align="left">*</td><td /><td align="left">*</td><td align="left">*</td></tr><tr><td align="left">Risk: "a very tricky area"</td><td align="left">5</td><td align="left">*</td><td align="left">*</td><td align="left">*</td><td align="left">*</td><td align="left">*</td></tr><tr><td align="left">Person centred: "I do not think it's one size fits all"</td><td align="left">5</td><td align="left">*</td><td align="left">*</td><td align="left">*</td><td align="left">*</td><td align="left">*</td></tr><tr><td align="left">"Depends on the individual"</td><td align="left">5</td><td align="left">*</td><td align="left">*</td><td align="left">*</td><td align="left">*</td><td align="left">*</td></tr><tr><td align="left">Ability to adapt: "short‐changed the client group"</td><td align="left">5</td><td align="left">*</td><td align="left">*</td><td align="left">*</td><td align="left">*</td><td align="left">*</td></tr><tr><td align="left">Rapport: "slightly trickier to build that therapeutic rapport"</td><td align="left">5</td><td align="left">*</td><td align="left">*</td><td align="left">*</td><td align="left">*</td><td align="left">*</td></tr><tr><td align="left">Communication: "we can't see their body language"</td><td align="left">5</td><td align="left">*</td><td align="left">*</td><td align="left">*</td><td align="left">*</td><td align="left">*</td></tr><tr><td align="left">Connection: "it's that co‐regulation of nervous systems"</td><td align="left">3</td><td align="left">*</td><td /><td align="left">*</td><td align="left">*</td><td /></tr><tr><td align="left">Rapport: "Slightly trickier to build that therapeutic rapport"</td><td align="left">4</td><td align="left">*</td><td align="left">*</td><td align="left">*</td><td /><td align="left">*</td></tr><tr><td align="left">Clinician ability and experience: "it was a bit of a learning process"</td><td align="left">5</td><td align="left">*</td><td align="left">*</td><td align="left">*</td><td align="left">*</td><td align="left">*</td></tr><tr><td align="left">Previous beliefs about online therapy: "no way José"</td><td align="left">5</td><td align="left">*</td><td align="left">*</td><td align="left">*</td><td align="left">*</td><td align="left">*</td></tr><tr><td align="left">Confidence and challenges: "I feel it's not as robust"</td><td align="left">4</td><td align="left">*</td><td align="left">*</td><td align="left">*</td><td align="left">*</td><td /></tr><tr><td align="left">Service: "Are we actually doing therapy?"</td><td align="left">3</td><td /><td /><td align="left">*</td><td align="left">*</td><td align="left">*</td></tr></tbody></table> </ephtml> </p> <hd id="AN0169783196-11">Environment: "you can't control the environment"</hd> <p>This theme relates to the clinician's experiences of facilitating therapy online for people with learning disabilities, including challenges in using technology and difficulties in beginning and ending therapeutic sessions.</p> <hd id="AN0169783196-12">Technology: "barriers"</hd> <p>Psychologists reported barriers to using online mediums for therapy, including difficulties building rapport:</p> <p> <emph>Debbie</emph>: The internet being poor... meant that you had sort of ruptures</p> <p> <emph>Karen</emph>: It's harder for patients to disclose things</p> <p> <emph>Jacqui</emph>: Technology has been a barrier... and has actually increased his anxiety before we've even started</p> <p>Interestingly, Karen described feeling "like you're in another realm" from her clients. This language captures the extent psychologists' felt disconnected from their clients while facilitating therapy online.</p> <p>Psychologists also described difficulties for clients accessing therapy online. Karen commented, "it's been really tricky to actually get someone onto the platform" and emphasised the importance of having previous experience with technology and/or having support. Alternatively, some Psychologists highlighted how video therapy "improves... access for people" (Karen), for example, if clients are unable to travel.</p> <p>Psychologists often commented on the difficulty of sharing resources and working collaboratively with clients online. Karen described sharing resources as "really tricky" and Linda reported finding it "pretty unsatisfactory". The term "tricky" was frequently used by all psychologists to describe video therapy and their tone conveyed a sense of frustration. Few however were able to explain the term and instead it appeared to be used when a concept was difficult to explain in prose. This captured the complexity of the challenges experienced and conveys the difficulties of finding solutions.</p> <p>Many also reported they missed having a pen and paper and highlighted the importance of using visuals when working with people with learning disabilities:</p> <p> <emph>Linda</emph>: I'd normally sit with a pen and paper and we'd collaborate on a visual thing together, and I think for people with LD, the visual stuff is really important...but I have found that side...missing.</p> <p>Jacqui described how using the screen share function can feel "quite disjointed" because it's harder to make eye contact with the person. In contrast to the other psychologists, Sophie commented "in some ways it's meant that I'm collaborative in a different way" and said, "I found the function of sharing videos to be really handy".</p> <hd id="AN0169783196-13">Boundaries: "it can feel more like a social chat"</hd> <p>This subordinate theme encapsulates the Psychologists' difficulties with setting up appropriate therapeutic boundaries. Jacqui stated, "defining the... boundaries and the greater formality of a therapeutic relationship as opposed to a social relationship... can be very tricky". When sharing her experiences of setting up a confidential, safe space, Debbie suggested "it is much harder online unless you get those kind of parameters right at the beginning". Jacqui alluded to the challenges of the clients' setting and said, "if someone's... in their living room... it might be set up to feel like a social chat". This captures the extent to which video therapy felt different to face‐to‐face therapy, and the psychologists tone when discussing this conveyed a sense of feeling uncomfortable with these differences.</p> <p>Jacqui explored the difficulties of ending therapy sessions appropriately and highlighted her uncertainty around this by questioning "what's the appropriate body... and verbal language to end that session?". She then described her experiences of ending a session; "you have to be more deliberate about your cues... and I do fall into this, it's more likely you end it in a very informal way... (e.g.) waving and... smiling". Interestingly, "fall into this" appeared to have negative connotations, suggesting that one can inadvertently end up waving, even when it may not be appropriate or intended.</p> <hd id="AN0169783196-14">Confidentiality: "a challenge"</hd> <p>This subordinate theme refers to difficulties setting up a confidential, safe space online and the impact this has on the therapy. Jacqui suggested "you don't have control over them factors anymore" and described the client's "staff walking in and out and seeming to have no awareness of the noise they were making". Furthermore, Jacqui reflected on the potential impact of this and said "that effects my (ability) to focus... let alone him being able to do that". This theme was reinforced by other psychologists and Sophie said it is "tricky" not knowing if anyone else is in the room and described not being able to set up the appropriate therapeutic space as a "challenge". These challenges link with uncertainty and lack of control for the psychologist, which can contribute to negative views of delivering therapy and therefore more caution when considering using the method.</p> <p>Others highlighted the importance of a safe and confidential space throughout their sessions, and Sophie said, "it can potentially limit it if you...don't feel you've got a private environment". In contrast to this, Jacqui mentioned how engaging in therapy online can feel safer for some people; "they feel more comfortable in their home setting... and... maybe... more ready to start on the therapeutic work".</p> <hd id="AN0169783196-15">Risk: "a very tricky area"</hd> <p>The risk was frequently mentioned in relation to video therapy emphasising its importance. Some psychologists described assessing and managing risk online as being "very tricky" (Jacqui) and psychologists unanimously described challenges they have faced concerning risk. Sophie commented, "if I'm in the room with the person... I could pick up on their body language and contain things... whereas online I find it more difficult to challenge my clients with some of those questions". Similarly, Linda said there is "less chance to/less safe to challenge people and more difficult to assess risk". The notion of safety here is particularly interesting as psychologists appear hesitant to explore this risk with clients, which may differ from face‐to‐face practice when dialogue may be had between client and psychologist. This conveys the sense that the psychologists felt the online environment was not containing enough for risk to be explored fully.</p> <p>Psychologists noted that they have "prioritised... work differently" (Sophie) due to video therapy not feeling as safe or containing. Sophie described a piece of work stating "we've put that at the bottom of our care plan and the hope is that we will be able to do that work face to face". Sophie suggested particular types of work may be more appropriate face to face and said, "trauma work definitely, but anything that I know would trigger my clients and destabilize them". Highlighting a change in priority for those in most distress or at most risk emphasises the discomfort felt by psychologists when they were faced with this online.</p> <hd id="AN0169783196-16">Person centred: "I do not think it's one size fits all"</hd> <p>This superordinate theme encapsulates psychologists' experiences of person‐centred working while delivering video therapy, and how their experience of video therapy depends on the client.</p> <hd id="AN0169783196-17">"Depends on the individual"</hd> <p>Psychologists agreed that the effectiveness of video therapy "depends on the individual" (Karen):</p> <p> <emph>Karen</emph>: It depends on how they communicate and their ability</p> <p> <emph>Jacqui</emph>: Maybe having a video screen can make an experience less intense, and conversely for others people, probably makes it more intense</p> <p>The frequency of these comments and the unanimous opinion suggest there are many factors that need to be contemplated when considering video therapy. Karen emphasises the importance of this and suggests psychologists "use more (of) a formal assessment tool" in the future when considering video therapy. She did however highlight the complexity of this and the uncertainty of whether video therapy may work:</p> <p>It's a tricky one isn't it; you almost have to try it out and see</p> <p>Debbie reflected on how much choice clients have in whether they engage in video therapy:</p> <p>There's something about erm especially with people with learning disabilities about choice and... how much they're choosing to engage.</p> <p>That element of choice has been taken away by the virtual component.</p> <p>When commenting on choice in face‐to‐face therapy, Debbie stated "by virtue of them travelling... to see you somewhere, you would assume there's an element of choice". This highlights an important consideration for psychologists when offering video therapy to individuals with a learning disability. Despite this being a great advantage of video therapy, these statements appeared to be followed by negatives, which may highlight the psychologist's caution around using video therapy.</p> <hd id="AN0169783196-18">Ability to adapt: "short‐changed the client group"</hd> <p>Throughout interviews, psychologists emphasised the importance of being able to adapt resources for people with learning disabilities:</p> <p> <emph>Karen</emph>: it's really tricky to even ask someone with a learning disability 'now, how do you feel?' without having a mood chart, without having a emojis</p> <p>Sophie also reinforced this stance when discussing her experience of face‐to‐face therapy following a period of video therapy:</p> <p>One of the things she found really helpful is we drew her formulation out using a rollercoaster picture for the highs and lows and then we linked that to mood and now she says she's got it</p> <p>Debbie commented on the challenges in adapting resources while facilitating therapy online and discussed how this made her feel:</p> <p>It's that sense of being not very satisfied with what you've done... or that you feel like you've short‐changed the client group</p> <p>"Short‐changed" suggests some people with learning disabilities have been disadvantaged by having video therapy and emphasises the importance of considering the appropriateness of video therapy in the future. The feelings associated with "short‐changing" a group tend to include shame or guilt, and these could be heavily contributing to psychologists' attitudes to video therapy.</p> <hd id="AN0169783196-19">Rapport: "slightly trickier to build that therapeutic rapport"</hd> <p>This superordinate theme relates to psychologists' experience of the therapeutic alliance, communication, connection and rapport.</p> <hd id="AN0169783196-20">Communication: "we can't see their body language"</hd> <p>All psychologists spoke about difficulties in detecting nonverbal cues over a camera.</p> <p> <emph>Sophie</emph>: The added barrier of technology and not being able to see the entire person erm makes a big difference</p> <p>These difficulties spanned to feeling unable to attend to psychological needs. Jacqui suggested assessing and engaging in a client's emotional state "has some limit to it". Sophie appeared to find this dynamic "frustrating" and Karen suggested it's "really tricky... to build the relationship and connect when you can't see someone". Psychologists' concerns focussed predominantly on understanding the client and picking up on their distress, as opposed to them feeling misunderstood by the client.</p> <p>Despite difficulties leading to negative emotions for psychologists, Linda noted "online is a step forward to the telephone".</p> <hd id="AN0169783196-21">Connection: "it's that co‐regulation of nervous systems"</hd> <p>Jacqui, Karen and Linda described a unique physical process when engaging with a client face to face.</p> <p> <emph>Linda</emph>: I would say when I'm in a room with someone, I feel things literally in my body</p> <p> <emph>Karen</emph>: It's that co regulation of nervous systems. So, if I'm in a space where I feel safe and calm, if I'm in a room with someone, my client can pick that up</p> <p>This process appears to be difficult to replicate online with both clients and psychologists feeling unable to pick up cues necessary for this physical interaction.</p> <p> <emph>Linda</emph>: that happens to me much less when I'm not in the room with somebody.</p> <p> <emph>Karen</emph>: you can't pick that up so much virtually.</p> <p>The lack of this connection can also be a barrier when delivering therapy with Jacqui, suggesting that it leads to both the client and psychologist becoming "distracted".</p> <hd id="AN0169783196-22">Rapport: "slightly trickier to build that therapeutic rapport"</hd> <p>A popular topic raised by psychologists was "rapport". Many encountered difficulties with building rapport and Jacqui described why person‐centred planning is needed:</p> <p> <emph>Jacqui</emph>: Technology has been a barrier to building up that rapport, and has actually increased his anxiety.</p> <p>Others found rapport hindered by the client's inability to engage with the medium as "they don't find it as easy to talk" (Sophie) and consequentially, "the quality of relationships aren't quite the same" (Sophie).</p> <p>Another aspect of rapport highlighted to be impacted by a screen is the time taken to build rapport:</p> <p> <emph>Sophie</emph>: In a room.... I built therapeutic alliances with clients quicker</p> <p>Karen also reflected on how she feels being part of a therapeutic alliance built online by suggesting "it doesn't feel as honest" (p. 196). Debbie agreed with Karen and mentioned how often maintaining rapport feels easier, whereas when "you don't know the person to try and build up that relationship online initially I think can be really hard". Sophie endorsed this:</p> <p>for new clients... I found it slightly trickier to build that therapeutic rapport.</p> <p>Looking at the possibilities of rapport and video therapy, Sophie suggested that despite these hurdles, they can be overcome:</p> <p>it's means that I'm collaborative in a different way</p> <p>Jacqui also suggested opportunities to build rapport online as "sometimes people want to show you something in their home environment...and that can be quite a useful tool".</p> <p>Sophie concluded by suggesting video therapy can effectively aid rapport building, however individual differences must be considered:</p> <p>I think (rapport) in part depends on... personality types and whether the clients are confident with using the technology, whether they've been supported to have those sessions</p> <p>This stance was echoed by many and emphasises the necessity for person‐centred planning.</p> <hd id="AN0169783196-23">Clinician ability and experience: "it was a bit of a learning process"</hd> <p>The fourth superordinate theme encapsulates psychologists' experiences when transitioning to and delivering therapy online as well as views on the longevity of this mode of therapy for the service.</p> <hd id="AN0169783196-24">Previous beliefs: "no way José"</hd> <p>Previous beliefs were frequently mentioned in relation to video therapy.</p> <p> <emph>Sophie</emph>: I've been quite against it and purposely made career choices where I wouldn't be in settings where that was a feature.</p> <p>This stance was echoed among others with Debbie suggesting that "if you had said this to us a year and a half ago, we would have been adamant this was not something we would be doing". Repetition of this belief highlights the emotive reactions video therapy first elicited from psychologists. Often colloquial statements such as "no way José" were also followed by laughter, possibly highlighting how alien working online feels, or how before COVID‐19 working in this way would have been laughable.</p> <p>Debbie and Sophie introduced the concept of feeling "forced" into video therapy by COVID‐19 restrictions on social contact. Due to the uncertain and anxiety‐provoking nature of the pandemic, it is likely that video therapy was also viewed through this negative and uncertain lens.</p> <hd id="AN0169783196-25">Confidence and challenges: "I feel it's not as robust"</hd> <p>Confidence in video therapy was questioned by four psychologists. This lack of confidence spans across multiple areas of psychological work; assessment, clinical judgements and interventions:</p> <p> <emph>Linda</emph>: I don't feel as confident in my clinical judgement as I would if I was in a room</p> <p>Both psychologists suggest the lack of physical presence contributes to this feeling of unease and Jacqui highlighted the "risk of having too incomplete a picture".</p> <p>Karen also described an "anxiety‐provoking" environment when delivering an intervention or therapeutic support:</p> <p>It doesn't feel as honest it's like maybe a patient is more likely to hide things online</p> <p>Karen appeared to have a mistrust in video therapy by it allowing clients to conceal certain information necessary to a psychologist, such as information to inform risk. The notion of limited information is emphasised by Sophie suggesting the impact of this on psychological processes:</p> <p>I feel like I didn't get as much rich information which then impacted the formulation</p> <p>Other psychologists began to explain their frustration with feeling "limited", for example, Jacqui said she felt "limited as to what we could achieve...". Similarly, Sophie felt as if she "had one hand tied behind my back" and Debbie suggested that with clients she had not met before online interaction, the process was "unsatisfying". This feeling of dissatisfaction could possibly link to psychologists feeling "deskilled" or "wasted" by only using video therapy. This in turn highlights how the approach can restrict clinicians in practicing a range of skills, and questions how the method allows for person‐centred planning. It also reflects a sense of getting used to change and brings the possibility of developing confidence in new methods and eventually adopting them as the norm.</p> <p>When reflecting on the experience of video therapy compared to face to face, Debbie suggested "you don't have the sort of decompression reflection time" online, whereas this would be the case when travelling to and from clients face to face. This lack of "downtime" could be a contributor to the negative feelings mentioned above.</p> <hd id="AN0169783196-26">Service: "are we actually doing therapy?"</hd> <p>Throughout conversations, the type of support that video therapy can facilitate was questioned. Linda often returned to the idea of being supportive, but not necessarily doing the work of a psychologist:</p> <p>I feel less the psychologist and more of an advocate/social worker</p> <p>It feels less like therapy... it feels like more supportive counselling</p> <p>The concept of being able to support those with a learning disability with video therapy appears unquestioned; however, Debbie suggested instead of "therapy", the support is "more sort of checking in, catching up, reviewing and monitoring". This also endorses the aforementioned notion of psychologists feeling deskilled and it raises the importance of psychologists' well‐being within services by largely offering support online.</p> <p>When looking closer at a service delivering therapy online, many mentioned the transition from face to face to online. Linda "found it quite difficult to adjust", and this was similar to Karen:</p> <p>you've not got a team around you, so you feel a bit more isolated</p> <p>Sophie reinforced that the transition was not smooth and instead a "learning process"; however, this was interpreted as a stage in time, rather than a static state of video therapy.</p> <p>Some psychologists moved on to discuss the positives of the service to deliver video therapy:</p> <p> <emph>Sophie</emph>: we can fit more in our days when we're not traveling, so as a service benefit, I am doing more meetings in a week</p> <p>Interestingly, Debbie mentioned "time" as a benefit of video therapy for the service. However, this appeared to co‐exist with longer working hours for the individual:</p> <p>I think staff have been working longer hours and seeing more people because you don't have to the travel</p> <p>Similarly, Jacqui also suggested that video therapy can take up more time; "difficulties or barriers that can really slow down the process".</p> <p>Looking to the future, Debbie suggested "it's a great tool to have in our tool kit". All psychologists endorsed this, however, and emphasised that video therapy should be used as part of a hybrid model:</p> <p> <emph>Jacqui</emph>: it's not the full answer and needs to be used alongside being able to see people face to face</p> <p> <emph>Sophie</emph>: that hybrid model... will give the flexibility to meet client's needs</p> <p> <emph>Linda</emph>: I see it having a role definitely, but again it's about person centred thinking</p> <p>This unanimous conclusion of using video therapy in a person‐centred approach highlights both its benefits and restrictions.</p> <hd id="AN0169783196-27">DISCUSSION</hd> <p>The current study focussed on psychologists' experiences of delivering video therapy. Due to restrictions on face‐to‐face meetings, clinicians had to move to online platforms to continue delivering therapy. Four superordinate themes were identified: Environment: "You can't control the environment," Person centred: "I do not think it's one size fits all," Rapport: "slightly trickier to build that therapeutic rapport", and Clinician ability and experience: "it was a bit of a learning process." To the author's knowledge, few studies have delved into this aspect of video therapy, and therefore the current findings provide foundations for future research. Findings also equip clinicians to modify practice when working with people with learning disabilities online, to improve delivery and satisfaction.</p> <p>The themes identified suggest that psychologists experience several challenges when delivering therapy online to individuals with intellectual disabilities. Often the online environment presented barriers to access or connection as well as to concepts core to the profession but difficult to control online, such as confidentiality or risk. These barriers are similar to those highlighted by MacMullin et al. ([<reflink idref="bib14" id="ref21">14</reflink>]) and Buckman et al. ([<reflink idref="bib4" id="ref22">4</reflink>]), in which technological issues were identified as barriers to the success of video therapy.</p> <p>Furthermore, another key concern highlighted was the impact of video therapy on the therapeutic rapport. Psychologists described how rapport often took longer to build over a screen with some aspects of physical interaction unable to be replicated online, for example, transference and countertransference. Prior research mentions clinician "discomfort" related particularly with new clients as opposed to existing ones (Ribeiro et al., [<reflink idref="bib17" id="ref23">17</reflink>]). This finding is particularly relevant in the current study as discomfort was a key feeling throughout interview, and the extra time needed to build therapeutic relationships could contribute to this feeling of "discomfort". When considering person‐centred planning, this finding highlights the benefit of conducting video therapy with an individual known to the psychologist, as opposed to a client new to services.</p> <p>In the current study, the challenges highlighted contributed to psychologists' beliefs, and in turn, their confidence in the approach. Psychologists' attitudes towards video therapy are understandable given the rapid transition to video therapy from face‐to‐face therapy, and limited experiences using online mediums for therapy before the COVID pandemic. However, these attitudes are important to consider when initiating video therapy in a service as the research suggests that the therapist's attitude can impact the effectiveness of video therapy (Békés et al., [<reflink idref="bib1" id="ref24">1</reflink>]). This could also suggest if you improve attitudes towards this mode of therapy, the ability is also fostered.</p> <p>Research from Zaagsma et al. ([<reflink idref="bib21" id="ref25">21</reflink>]) highlighted that video therapy enables services to be flexible and responsive during social crises. This was echoed within the current study findings; however, participants were also able to reflect and make sense of their experience within the frame of IPA. One way they were able to do this was to think of the future, and how their experience can inform future work. All suggested video therapy has a place in services moving forward, but it must be used in a person‐centred approach. Additionally, this in‐depth exploration of experience enabled us to identify specific areas to focus upon to ensure the clinician experience remains positive. Possible areas that could indirectly impact services include isolation levels for clinicians and longer working hours despite the notion that video therapy "saves time" due to lack of travel. However, the current study was conducted during the COVID‐19 pandemic with interviews taking place between April and May 2021. Participants would have naturally reflected on their experiences of conducting therapy online during the pandemic and therefore well‐being and working hours could have been impacted by this. Additional research into clinician well‐being when working online is recommended to explore this further.</p> <p>Some of the themes discussed within the current study are particularly useful for developing suggestions, in particular, "person centred" and "clinician ability and experience". Not only can these findings be useful for psychologists working with individuals with intellectual disabilities, but they can aid assistant psychologists, trainees and clinical associate psychologists, as well as other professions using video interventions (Table 3).</p> <p>3 Table Suggestions for services and clinicians</p> <p> <ephtml> <table><thead valign="bottom"><tr valign="bottom"><th align="left">Suggestions</th></tr></thead><tbody valign="top"><tr><td align="left">1</td><td align="left">Training for psychologists in how to adapt resources, communicate effectively and build confidence using online platforms. This includes having access to good technical infrastructure as well as sharing new and existing research for online therapy.</td></tr><tr><td align="left">2</td><td align="left">Training and guidelines for relatives, carers and professionals supporting an individual to access and engage in online therapy. This would emphasise the importance of a confidential, quiet space during a session.</td></tr><tr><td align="left">3</td><td align="left">Development of an assessment tool for the suitability of an individual for online therapy. This can be used with new and existing clients to the service and can include criteria such as the client's historic, current, and future risk, client's environment, client's thoughts around engaging online, preferred communication type and history of psychological input.</td></tr><tr><td align="left">4</td><td align="left">Increased awareness of the client's choice to engage in online therapy. Easy‐read resources and processing time to be available to the client before engaging in online therapy to ensure they have had the opportunity to ask questions or to opt for face to face if preferred.</td></tr><tr><td align="left">5</td><td align="left">Good time management is recommended in addition to a scheduled decompression time immediately after a client session for clinicians. This allows for reflection on the session to inform future input and ideas to take to clinical supervision for further discussion.</td></tr><tr><td align="left">6</td><td align="left">Resources to be made available to the client in hard copy format, with extra effort to repeat previous session points. Workbooks or appendices could be included.</td></tr><tr><td align="left">7</td><td align="left">A hybrid model could include the first session of an intervention being face to face, with the flexibility of subsequent sessions online. This allows for faster rapport building as psychologists suggested that maintaining a rapport with an individual online is easier than initially establishing this rapport. As part of this hybrid model, the exchange of experiences of video therapy in staff meetings is helpful for ensuring good practice.</td></tr></tbody></table> </ephtml> </p> <hd id="AN0169783196-28">LIMITATIONS AND FUTURE DIRECTIONS</hd> <p>Participants were self‐selecting from a service in the South of England. Most psychologists self‐identified as White British, which is representative of the local population. However, IPA uses a small sample; therefore, the results of this study may not be generalisable to therapists working with people with intellectual disabilities in community‐based centres or male therapists. Due to the rapid transition, there was little opportunity to offer training and guidance on the delivery of therapeutic interventions, which may have contributed to anxiety for professionals embarking online for the first time. Follow‐up is required to substantiate findings and explore psychologist experience with video therapy over time, taking into consideration variables associated with COVID‐19. Furthermore, the study took a broad approach to the semistructured interview, in line with the exploratory nature of the IPA method chosen and future research could explore particular themes in more depth, such as "risk" or "rapport". Attempts were made to address credibility and rigour including peer and expert supervision, bracketing and reflective journals (Yardley, [<reflink idref="bib20" id="ref26">20</reflink>]). Finally, the present study aimed to hear experiences of psychologists delivering therapy online to individuals with intellectual disabilities. For a full understanding, a client's voice must be heard, and future research is needed to enable this.</p> <hd id="AN0169783196-29">ACKNOWLEDGMENTS</hd> <p>With thanks to those in Berkshire NHS Foundation Trust, particularly within the psychology department. Also thank you to Dr Olivia Hewitt for her input.</p> <hd id="AN0169783196-30">CONFLICT OF INTEREST</hd> <p>The authors declare no conflict of interest.</p> <hd id="AN0169783196-31">DATA AVAILABILITY STATEMENT</hd> <p>The data that support the findings of this study are available on request from the corresponding author, H. B. The data are not publicly available due to their containing information that could compromise the privacy of research participants.</p> <ref id="AN0169783196-32"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref24" type="bt">1</bibl> <bibtext> Hope Blocksidge has now left her position at BHFT and is a trainee clinical psychologist with the University of Manchester. Lara Willis has now left her position at BHFT and is now a trainee clinical psychologist at the University of Bath. The research was completed before both moved to new roles.</bibtext> </blist> </ref> <ref id="AN0169783196-33"> <title> REFERENCES </title> <blist> <bibtext> Békés, V., Aafjes‐van Doorn, K., Luo, X., Prout, T. A., & Hoffman, L. (2021). Psychotherapists' challenges with video therapy during COVID‐19: Concerns about connectedness predict therapists' negative view of video therapy and its perceived efficacy over time. Frontiers in Psychology, 12 (705699), 1 – 10. https://doi.org/10.3389/fpsyg.2021.705699</bibtext> </blist> <blist> <bibl id="bib2" idref="ref10" type="bt">2</bibl> <bibtext> Békés, V., Aafjes‐van Doorn, K., Prout, T. A., & Hoffman, L. (2020). Stretching the analytic frame: Analytic therapists' experiences with remote therapy during COVID‐19. Journal of the American Psychoanalytic Association, 68 (3), 437 – 446. https://doi.org/10.1177/0003065120939298</bibtext> </blist> <blist> <bibl id="bib3" idref="ref2" type="bt">3</bibl> <bibtext> Berwick, D. M. (2020). Choices for the "new normal". Journal of the American Medical Association, 323 (21), 2125 – 2126. https://doi.org/10.1001/jama.2020.6949</bibtext> </blist> <blist> <bibl id="bib4" idref="ref22" type="bt">4</bibl> <bibtext> Buckman, J., Saunders, R., Leibowitz, J., & Minton, R. (2021). The barriers, benefits and training needs of clinicians delivering psychological therapy via video. Behavioural and Cognitive Psychotherapy, 49 (6), 1 – 25. https://doi.org/10.1017/S1352465821000187</bibtext> </blist> <blist> <bibl id="bib5" idref="ref11" type="bt">5</bibl> <bibtext> Courtenay, K., & Cooper, V. (2021). Covid 19: People with learning disabilities are highly vulnerable. 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  Data: Conducting Video Therapy with Adults with an Intellectual Disability: A Qualitative Study of Qualified and Trainee Psychologists' Experiences
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  Data: <searchLink fieldCode="SO" term="%22British+Journal+of+Learning+Disabilities%22"><i>British Journal of Learning Disabilities</i></searchLink>. Sep 2023 51(3):389-399.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 11
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2023
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Counseling+Techniques%22">Counseling Techniques</searchLink><br /><searchLink fieldCode="DE" term="%22Psychologists%22">Psychologists</searchLink><br /><searchLink fieldCode="DE" term="%22Intellectual+Disability%22">Intellectual Disability</searchLink><br /><searchLink fieldCode="DE" term="%22Counseling+Effectiveness%22">Counseling Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Computer+Mediated+Communication%22">Computer Mediated Communication</searchLink><br /><searchLink fieldCode="DE" term="%22Barriers%22">Barriers</searchLink><br /><searchLink fieldCode="DE" term="%22Counselor+Attitudes%22">Counselor Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Access+to+Health+Care%22">Access to Health Care</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1111/bld.12496
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1354-4187<br />1468-3156
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Online therapy is becoming increasingly popular as well as necessary. There is little research regarding the experience of psychologists delivering online therapy to individuals with an intellectual disability. Method: The study used online semistructured interviews and interpretive phenological analysis to explore the experiences of five psychologists delivering online therapy to individuals with an intellectual disability. Findings: Four superordinate themes were generated from the data: Environment: "You can't control the environment"; Person centred: "I do not think it's one size fits all"; Rapport: "slightly trickier to build"; and Clinician ability and experience: "it was a bit of a learning process". Psychologists spoke of prior negative beliefs and a range of challenges to video therapy. Their discomfort with using this technology was noted; however, a motivation to continue offering therapy to clients overweighed this. All participants concluded with benefits to using video therapy, notably increased accessibility. Conclusion: A hybrid model including face-to-face and online therapy appears preferable for future ways of working. Training is recommended for professionals and individuals supporting clients, and an assessment tool for the suitability of online therapy. Further research exploring online therapy experiences of people with intellectual disabilities is required.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2023
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1387261
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1387261
RecordInfo BibRecord:
  BibEntity:
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      – Type: doi
        Value: 10.1111/bld.12496
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 11
        StartPage: 389
    Subjects:
      – SubjectFull: Counseling Techniques
        Type: general
      – SubjectFull: Psychologists
        Type: general
      – SubjectFull: Intellectual Disability
        Type: general
      – SubjectFull: Counseling Effectiveness
        Type: general
      – SubjectFull: Computer Mediated Communication
        Type: general
      – SubjectFull: Barriers
        Type: general
      – SubjectFull: Counselor Attitudes
        Type: general
      – SubjectFull: Access to Health Care
        Type: general
    Titles:
      – TitleFull: Conducting Video Therapy with Adults with an Intellectual Disability: A Qualitative Study of Qualified and Trainee Psychologists' Experiences
        Type: main
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            NameFull: Blocksidge, Hope
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            NameFull: Willis, Lara
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            NameFull: Codd, Jon
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            – D: 01
              M: 09
              Type: published
              Y: 2023
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              Value: 1354-4187
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            – TitleFull: British Journal of Learning Disabilities
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