Negotiation of problem definition in the clinical psychology appointments of a learning disability service

Government policy (Valuing People Now, DoH, 2007a) has emphasised the need to promote the empowerment of people with learning disabilities and to enable them to have choice and control over the services they access. Literature has highlighted how power issues play an important role in the lives of people with learning disabilities (Gillman, Heyman & Swain, 2000). The current research explored the process of problem definition in the appointments of a psychology service for people with learning disabilities. Aims were also to examine power issues and to consider the ways in which the people present contributed to decisions made. A discourse analytic approach (Potter & Wetherell, 1987) was used to examine naturalistic data from audio recordings of appointments. Participants included psychologists carrying out appointments, people with learning disabilities and their family members or carers. The analysis revealed a number of common processes involved in the negotiation of problem definition in this setting. Psychologists were often powerful in influencing the content of sessions and the ways in which difficulties were discussed. Problems were frequently defined according to criteria that fit with the institutional setting in which the appointments took place. However, people with learning disabilities were also assertive in directing the conversations at times. Discursive techniques used by the people present in the process of discussing problems included: recruiting the opinions of others, constructing problems as internal to a person or as environmental factors and negotiating constructions of knowledge or competence. The research adds to the literature on the continuing challenges to empowering people with learning disabilities. The findings show that attempts to facilitate choice and control for people with learning disabilities compete, and are potentially incompatible with other functions of the discourses in this context. There were a number of important clinical implications for how psychologists and other professionals approach work with people with learning disabilities.