Clinical Psychologists’ Views of Intensive Interaction as an Intervention in Learning Disability Services

Berry, R., Firth, G., Leeming, C. & Sharma, V. (2014) Clinical Psychology & Psychotherapy, 21 (5), 403-410.

Some Background

This explored clinical psychologists’ views of Intensive Interaction as an intervention in learning disability services in terms of its theoretical underpinning and empirical support. It was also hoped that the study might illuminate significant issues influencing clinical psychologists’ adoption of the approach, including the participants’ thinking about the relevance of established psychological models and theories.

Overview of the Study

This qualitative study involved interviews with eight clinical psychologists from across the UK who were known to be working with adult clients with severe or profound intellectual disabilities, and to be using or advocating Intensive Interaction. The study utilised a grounded theory approach to analyse and categorise the resulting data.

Results & Discussion

All the participants were asked whether they saw Intensive Interaction as being concordant with any established psychological theories and were given specific exemplars. The models that were spoken about were attachment theory, developmental theory, Person-Centred Therapy (PCT), social role valorisation/normalisation, behaviourism, Ephraim’s ‘augmented mothering’, attribution theory, sensory integration, psychoanalytic models, social constructionism and humanistic psychology.

Of the six participants who spoke about attachment theory, all described Intensive Interaction as being consistent with it. Under the category of ‘theory’, one of the specific concepts was labelled ‘person-centred counselling/therapy/theory’, but little material was coded there. In contrast, there was considerably more interview data categorised under the label ‘the psychologising of Intensive Interaction’. This category contained statements in which the participants used psychological language to talk about Intensive Interaction rather than making specific reference to a theory or therapy.

To summarise: what the participants talked about when using Intensive Interaction and their comments about its benefits, can be best understood in Person-Centred Therapy terms; they described it as a means for establishing psychological contact.

First impression taken from the interviews was that the participants seemed to be acting out of character for psychologists i.e. they were perhaps deliberately using prosaic or commonplace  language to describe complex psychological issues and perspectives.

Upon reflection, the authors realised that they themselves were not fully confident about their own understanding of the psychological underpinnings of Intensive Interaction. Being limited by the dearth of psychologically based literature on the approach, they decided to re-visit Geraint Ephraim’s doctoral thesis and his subsequent publications on ‘augmented mothering’. In so doing, the authors anticipated that they would find a clear theoretical rationale for ‘augmented mothering’ against which they might compare the conceptualisations of Intensive Interaction by the clinical psychologist participants. This expectation, however, was not fulfilled.

Finally, the authors stated that what is needed from clinical psychology is a more rigorously scientific approach involving theory development and testing via clinical case studies. Without a coherent process of theory development, and the systematic generation of an evidence base for a psychological model of Intensive Interaction, the approach is open to being dismissed as more commonplace than scientific.