Play Therapy and adults with intellectual Disability

Already a social worker by profession, in 2016, I decided to undertake an M.A. in Practise Based Play Therapy, accredited by PTUK, Play Therapy International and Leeds Beckett University. My appreciation goes towards the assistance offered by the Endeavour Scholarship Scheme, through which my goal for further education has been obtained.  

Driven by the strong belief that no person should be left to suffer in silence, constrained by the limitation of verbal expression, I have always been interested in the use of Play Therapy with adults who have an Intellectual Disability.

Viewing ‘Play’ as a natural form of self-expression, while regarding the therapeutic relationship as the main tool, suggests that no specific level of intellectual ability and age are required for Play Therapy to be effective. (Schafer, 2003; Fletcher et al., 2016; Gallo-Lopez and Schafer, 2005, Boik and Goodwin 2000).

No person should be left to suffer in silence, constrained by the limitation of verbal expression.

Knowing that adults with intellectual disability are not immune to the psychosocial effects of life stressor and trauma, I sought out to research the need and the feasibility of referring adults with an intellectual disability to Play Therapy.

A case study, with qualitative data was deemed as the most practical research approach. ‘Dar Tal-Providenza’, was chosen for being the largest, long standing organisation established specifically to provide residential care for persons with Intellectual Disability.

Following an argument on the applicability of Play Therapy with adults with intellectual disability, based on past research and available literature, the identification of the needs of this client group was required.

Even with the best intentions at heart, when the basic needs are being met, the underlying emotional and psychological issues can go unseen. Identifying participants through purposive sampling, and adapting data triangulation for better credibility and validity, data on the needs of the residents was collected from three different sources; the house mothers, the social worker and the coordinator.

The research methods used for this study, were a Focus Group discussion with the housemothers and semi structured interviews with the coordinator and the social worker for being the ones best informed on the logistics of the organisations. While findings cannot be generalised, they can however be transferred as findings to other contexts that meet comparable characteristics.

The findings

A residential setting, provides on-going support with daily needs, attention to physical well-being, and opportunities for socialisation. Nonetheless, findings derived from this study have shown that external professional intervention is still often required to address certain needs. Such identified needs were grouped under five specific themes; communication and comprehension, adjusting to change, psychological needs, maintaining boundaries, and limited daily skills.

Persons with Intellectual Disability are often unable to draw comfort from the interaction done with others and struggle to comprehend the suggestions verbally given by others on how to address or deal with specific situations.

Nonetheless, they are able to explore and express themselves through the therapeutic relationship established within the therapeutic process. (Barr and Gates, 2019).

Play in this therapeutic setting enables them to explore life’s difficulties and develop ways of coping with the real world (Axline (1947), Landreth (2002), Fletcher et al., 2016). Maintaining boundaries and improving daily skills could also be enhanced through the use of play and creative art techniques such as role play and drama. Play Therapy can also facilitate communication and understanding between the resident and the care giver.

Play Therapy can facilitate communication and understanding between the resident and the care giver.

Professionals at ‘Dar Tal-Providenza’ have referred residents to the Play Therapy profession and found it to be an ideal therapeutic intervention as it can be tailored to the person’s abilities. They believe that the therapeutic relationship that forms within the therapeutic process enables the person to express one’s thoughts and emotions.

These professionals have established such a high level of trust in the effectiveness of Play Therapy, that they are willing to consider such therapy again should there be the need.

Gathered data has indicated that the unavailability of such therapeutic service within the Maltese medical or welfare system limits the feasibility of having adults referred to Play Therapy.

Residents at ‘Dar tal-Providenza’ might not be in a position to sustain the financial costs for such therapeutic service, and financial support from family members might not always be possible. The Service Coordinator explicated that the organisation will try its best to meet the needs of its residents.

Nonetheless, as explained by the social worker, the organisation, has the responsibility to ensure that the expenses for the day to day running of the home is sustained. Prioritisation sometimes has to be made on which residents will be referred to Play Therapy and the amount of hours allocated to them. One can argue that such limitations go against the fundamental right for an equal opportunity to all.

Another troubling issue that emerged from this study is the lack of recognition that Play Therapy holds within the medical field. An estimation of 40 % of the residents are under psychiatric treatment and all have regular check-ups with a General Practitioner. Nonetheless, both the Service Coordinator and the Social Worker claim to have never been directed to consider Play Therapy as a therapeutic intervention for their residents’ behaviour and psychological state. 

Finding a Play Therapist has also been identified as an issue in the feasibility of referring to Play Therapy. A Maltese Association of Play Therapist has been founded, but the general public have no means of accessing any links leading to the names of the available Play Therapist in Malta.

Professionals in this field are aware that PTUK has a public register of qualified and certified Play Therapist but there is a possibility that this is not something that is known amongst the Maltese society. This has left the referring professionals limited in their choice of Play Therapists.

The publication and dissemination of this research study will optimistically raise awareness on the maybe less recognised needs of persons with an Intellectual Disability, and the option of using Play Therapy to address the psychosocial needs. Further studies into the use of Play Therapy with adults diagnosed with an Intellectual Disability is also required to increase the level of empirical evidence of its effectiveness.

I would like to take this opportunity to publically show my gratitude towards ‘Dar Tal-Providenza’ for their participation in this research and their dedication towards the well-being of their residents.

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