Trauma and Intellectual Disability – Acknowledgement, Identification & Intervention


A ground-breaking book from leading experts that considers what is now known about trauma in the lives of people with intellectual disabilities, explores trauma-informed care in support services, and presents a diverse range of therapeutic interventions now being effectively employed to achieve better life outcomes for those affected.



This book is about Trauma-Informed Care (TIC) for people who have intellectual disabilities (ID). The provision of health and social care services is becoming more trauma informed, including in services for people with ID, where the experience of trauma is being increasingly acknowledged. This book addresses a gap in resources to guide those supporting people with ID by showing how services can work in a trauma informed way. Including contributions from authoritative professionals in the field, and a powerful account of abuse from an expert by experience, the book provides an overview of the history which underpins the importance of trauma and TIC, and the impact of trauma on people who have ID. The second part of the book looks at trauma informed services and a growing and diverse range of therapeutic interventions, including positive behavioural support, intensive interaction, cognitive behavioural psychotherapy, dyadic interpersonal psychotherapy, developmental and psychodynamic approaches.


Nigel Beail is a Consultant Clinical Psychologist and Professional Lead for Psychological Services for South West Yorkshire Partnership NHS Foundation Trust, and Professor of Psychology at the Clinical Psychology Unit, Department of Psychology at the University of Sheffield. He is a Fellow of the British Psychological Society, a Trustee of the British Institute for Learning Disabilities, CPD Lead for the British Psychological Society’s DCP Faculty for Learning Disability, former President of European Association for Mental Health in Intellectual Disability, and a founder and Fellow of the Institute for Psychotherapy and Disability.  He has published extensively on practiced based research from his clinical work.

Pat Frankish is a Clinical Psychologist and Psychotherapist with many years of experience in the field of disability, emotional development and trauma. Her doctoral study established a method for measuring emotional developmental stages and this has now become the “Frankish Assessment of the Impact of Trauma (FAIT”) published by Pavilion (2019), along with a trauma-informed care guide to working with traumatised individuals and a little book called Nought to Three – Becoming Me which charts to development of the child from birth to the establishment of a secure identity. These publications together provide an explanation for distressed behaviour and a way forward.

Pat is a past President of the British Psychological Society and has always maintained a strong interest in systemic effects of policy and guidelines. She continues to speak publicly and provide training for staff working at all levels of security and community provisions, including schools. She remains committed to making a difference to the provision she witnessed as a child living with parents who worked in an old long-stay hospital.

Allan Skelly is the 2019-2021 Chair of the Faculty for People with Intellectual Disabilities (FPID) of the British Psychological Society (BPS) and Consultant Clinical Psychologist with Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust.  Allan has published articles promoting a focus on the close personal relationships of people with an intellectual disability, the heightened lifetime risk that these will be broken or strained, and how to address this in clinical work. Allan actively promotes the Trauma-Informed Care agenda and the application of Attachment Theory in doing this.

He is the author of published articles promoting psychodynamic approaches to people with an intellectual disability, as well as applying Attachment Theory-based interventions in clinical practice. Allan was chair of the working group which produced the 2017 BPS clinical practice guidelines for the integration of Attachment Theory into the work of clinical psychologists in the UK. As well as reviewing the available clinical tools for formal assessment in several publications, he has collaborated on the design and validation of specific tools for this purpose.

Sophie Doswell
Elisabeth Goad
Cathy Harding
Nic Jones
Brett Kahr
Judith Samuel
Valerie Sinason
Biza Stenfert Kroese
Roger Wilczek


Publication Date: June 2021

ISBN: 9781914010590


Chapter 1        Introduction to trauma and intellectual disability: Why this book is needed
Nigel Beail

Chapter 2        Please stop people going through what I went through – and am still going through
Roger Wilczek

Chapter 3        The history of disability is a history of trauma
Valerie Sinason

Chapter 4        Freud, psychoanalysis and trauma
Nigel Beail

Chapter 5        Early development affected by early trauma
Pat Frankish

Chapter 6        Finding out about trauma in the lives of people with intellectual disabilities; and what to do about it
Allan Skelly

Chapter 7        Trauma informed Care in a service-related context
Elisabeth Goad

Chapter 8        Providing emotionally aware care in the Positive Behavioural Support framework
Cathy Harding

Chapter 9        The use of Intensive Interaction in trauma informed care for people with severe and profound Intellectual Disabilities
Judith Samuel and Sophie Doswell

Chapter 10      Adapting Dyadic Developmental Psychotherapy (DDP) to support adults with an intellectual disability who experience complex developmental trauma
Nic Jones

Chapter 11      Trauma Informed Psychodynamic Psychotherapy
Nigel Beail

Chapter 12      Interventions based on the Mahler Model of Emotional Development
Pat Frankish

Chapter 13      Insults and spears: The tribulations of forensic disability psychotherapy
Brett Kahr

Chapter 14      Trauma informed Cognitive Behavioural Psychotherapy
Biza Stenfert Kroese

Chapter 15      Some concluding comments; acknowledge, identify and intervene
Allan Skelly




  1. Devon Rodwell Trainee Clinical Psychologist

    This book promotes the acknowledgement and identification of trauma in the lives of people who have an intellectual disability (ID), emphasising the importance of adopting a trauma-informed care (TIC) approach when working with this population. It is written for families, healthcare professionals and service providers alike, indicating that anyone who offers support to people with ID would benefit from reading it. The book comprises 15 chapters written by different authors, who each consider the profound impact of trauma upon people with ID from a range of perspectives.

      • The opening chapter, written by Nigel Beail, offers valuable context for the book. This chapter discusses the high prevalence of trauma experienced by people with ID and how trauma-related difficulties may present within this population. I would have liked a definition for the term “ID”, and further explanation of how challenging behaviours may emerge would have been valuable. Distinguishing between what constitutes a “mild”, “moderate” and “severe” ID may have also helpfully contributed to succeeding chapters and encouraged readers to think critically about why trauma is often overlooked by care professionals.

        Throughout the book, a social-constructionist stance is drawn upon to consider social and cultural influences of vulnerability in people with ID to experiences of trauma. Roger Wilzcek’s perspective in Chapter 2 provides valuable insight into the extensive abuse they experienced, and observes how their voices are rarely heard within important discussions about care delivery and service provision. In Chapter 3, the detailed attention to social exclusion experienced by people with ID throughout history portrays how the psychological effects of trauma within this population are often transferred generationally. These preliminary chapters discuss how stigmatisation and discrimination is reinforced within cultural and social power systems, even today. The descriptions of society’s treatment towards people with ID are shocking to read, and the inclusion of such narratives will inspire readers to initiate conversations around systemic and organisational issues, in order to introduce cultural shifts within services.

        In Chapter 5, Pat Frankish discusses how trauma can be identified in people with ID through consideration of their early development. Frankish uses non-blaming language to portray how trauma can be disregarded and reinforced by those caring for this population. Case examples demonstrate ways in which care, educational and employment systems can liaise to support people’s needs more comprehensively. Furthermore, Chapters 6 (Allan Skelly) and 7 (Elizabeth Goad) provide valuable information about how trauma can be assessed for people with ID using TIC principles. The recognition throughout the book that trauma can be conceptualised equally with diagnosis, or as a process within relationships or social experiences, is very welcomed.

        The subsequent chapters of this book present how TIC can be integrated into different psychological frameworks, highlighting that service user relationships with care professionals, as well as the wider system, have the potential to retraumatise. This is particularly emphasised in Chapter 8, by Cathy Harding, who promotes a positive behavioural support (PBS) framework within the TIC approach. Harding suggests a PBS framework will enhance understanding of the functions underlying challenging behaviour, and enable services to meet the needs of this population in “healthier and developmentally appropriate ways” (p110). In Chapter 9, Judith Samuel and Sophie Doswell make important reference to the impact of the Covid-19 pandemic on people with ID, describing how contextual factors that may be overlooked by others (eg, masks and social distancing) can significantly heighten their distress. These reflections are particularly valuable when considering the continuously shifting guidelines within services in response to Covid-19 restrictions.

        Nic Jones emphasises the benefits of dyadic developmental psychotherapy (DDP) for people with ID in Chapter 10. In recognition that “repeated experience of poor or frightening care informs our attachment patterns” (p139), Jones proposes that strengthening resilient connections within caregiver relationships can address difficulties experienced by people with ID. Nigel Beail provides a helpful introduction to TIC psychodynamic psychotherapy in Chapter 11, using case examples to demonstrate how trauma can be addressed within psychotherapy. Pat Frankish also uses psychodynamic concepts in Chapter 12 to describe the Frankish assessment of the impact of trauma, an approach used to identify an individual’s emotional developmental stage and inform their care planning. A psychodynamic framework is likewise drawn upon in Chapter 13 (Brett Kahr) to present the complexities of therapeutic work with forensic patients with ID. Kahr’s detailed case example helpfully portrays how psychotherapy can “provide an opportunity to verbalise hidden and repressed secrets and aggression, helping to turn unbearable affects into words rather than actions” (p187).

        The conceptualisation of trauma within psychodynamic theory and how it should be used to treat people with ID is very clearly presented throughout this book. Other psychological interventions for trauma are additionally considered by Biza Stenfert Kroese in Chapter 14, which highlights that, for many people, a symptomatic approach to treating trauma-related disorders can be beneficial and a strong evidence base is available to support this. The authors of these final chapters advocate that core principles used within psychological therapy should be also applied to service-level and organisational interventions in order to implement crucial positive change for people with ID.

        Overall, Trauma and Intellectual Disability presents an important and empirically supported argument as to why TIC principles should be adopted when caring for people with ID. The book fosters hope for its readers that early trauma-informed interventions can support people with ID to overcome undisclosed trauma-related difficulties and enhance their quality of life.

  2. Oili Sauna-aho, PhD, Clinical neuropsychologist, KTO – Support and Expert Center for Persons with ID, Paimio, Finland

    The book Trauma and Intellectual Disability gives a good overview on trauma-informed care (TIC) for persons with intellectual disability (ID). For the last two decades traumas have been acknowledged to have a major effect on one’s mental wellbeing. Despite the well-known history of abuse and adverse life experiences of persons with ID, it is only recently that the issue of TIC has had its first steps among professionals.
    The book enlightens on the tragic history of traumas that persons with ID have encountered and still do. It also gives examples of how traumas of people with mild and moderate ID can be cared for and how important the involvement of the carers is in this process. Both psychoanalytical and cognitive approach in the care of traumas is introduced, though more research is still needed among persons with ID. The experts emphasise the importance of attachment and emotional development in TIC with persons with ID and give practical examples how to do it. The book is important to all working in the field: awareness of the multiple traumas with persons with ID is still minor and their traumas are treated too often only with medication.

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