Smith, Richard and Jeffrey, Sarah (2010) The Feelings Group: A Quantitative and Qualitative Evaluation of the Outcomes of a Smaller Anger Management Group for Clients who have a Learning Disability. Mental Health and Learning Disabilities Research and Practice, 7 (1). pp. 103-114. ISSN 1743-6885
Referrals concerning problems with anger for people with learning disability (LD) are relatively common as they are thought to be prone to difficulty in managing their anger (Willner, et al., 2002), a problem associated with aggressive behaviour (Novaco, 1994). Aggression is also prevalent in this population, with obvious inherent risks to themselves and others (Harris, 1993; Kiely & Pankhurst, 1998).
Research on direct therapy in people with a learning disability (LD) indicates that there was a period of disdain for these types of approaches (Sinason, 1992). This was followed by a period marked by doubt around the value of using cognitive principles in particular (Willner, 2006), which was eventually overcome by a more positive and less discriminatory approach (Willner, 2005). This hesitancy has delayed the generation of robust empirical evaluation, which has yet to catch up (Willner, Jones, Tams & Green, 2002). The guidelines from the NHS are then activated whereby “in the absence of well designed randomised trials, clinicians may legitimately draw upon analysis of expert opinion and past experience” (Department of Health, 1996; p26). In some ways this offers freedom to adopt novel approaches or ones adapted from principle applied in other areas of clinical work, however, it also represents a difficulty in operating using evidence-based practice (Willner, 2005), which to some may represent a ‘professional minefield’ (Mead, 2000).
In the emergent evidence-base for interventions for anger in this group, one important distinction has been made between ‘anger management’ and ‘anger treatment’ (Novaco et al., 2000), where the former is seen as a psycho educational approach whilst the latter explicitly combines assessment with treatment. Anger treatment also “centrally involves substantial cognitive restructuring and the acquisition of arousal reduction and behavioural coping skills” (Rose, et al., 2000, p172)
This article presents the results from a small anger-management group for clients with a learning disability that was to be called “The Feelings Group”, which was based on the “Self awareness group” resource pack from Willner & Tomlinson (Psychology Department, Learning Disabilities Directorate, Bro Morgannwg NHS trust). This intervention boasted effectiveness in an RCT evaluation published in an article by Willner and colleagues (2002).
The data was taken as part of service evaluation for the group. Informed consent was given by the clients involved to write about the group in an article.
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