Thank you for publishing Beail's (2003) perspective on what works for people with mental retardation. Beail made valid arguments for (a) his conclusion that the absence of evidence in support of cognitive behavior therapy does not necessarily indicate that it is an ineffective approach and (b) his advocacy for a full range of mental health treatment for people with mental retardation and mental health needs.
There was, however, an essential factor absent from Beail's (2003) discussion, namely, that the unique presentation of many people with intellectual disabilities often requires special clinical skills in both diagnosis and treatment (Bouras, Kon, & Drummond, 1993; Bregman, 1991; Campbell & Malone, 1991; Criscione, Kastner, Walsh, & Nathanson, 1993; Dosen, 1993; Evangelista, 1988; Hurley, 1996; Jacobson, 1990; Sovner, 1986). This does not necessarily suggest that individuals with intellectual disabilities cannot benefit from most treatment modalities; rather, it indicates that clinicians providing treatment must have the training and ability to provide care in the context of the person's intellectual capabilities.
Unfortunately, most mental health professionals who treat individuals with intellectual disabilities have had little to no training in applying their specific treatment modality to people with co-occurring intellectual disabilities and mental health needs. The dearth of both formalized training approaches and training opportunities for clinicians in the provision of psychotherapy for individuals with intellectual disabilities most likely negatively affects treatment outcomes and should be considered an obstacle to accurately test the benefits of specific treatment modalities.
Author: Joan B. Beasley, PhD, Consultation and Training Services, 184 Bonad Rd., Chestnut Hill, MA 02467. email@example.com