Many people with intellectual disability are highly concrete thinkers. This can result in misunderstandings due to their literal interpretation of verbal communication and general difficulty understanding abstract concepts. The following examples of abstract thinking commonly cause difficulty:
It is useful for practitioners to increase their awareness of what is abstract, and the unconscious ways they employ abstract concepts and language in their communication with clients. Critical reflection ‘in action’ and after sessions is an important strategy to increase this awareness.
People with intellectual disability often speak using their ‘own language’ and might use humour and conceptual schemas that are not always obvious in meaning to the counsellor. Exploring the meaning of statements and keeping a record or ‘dictionary’ of phrases commonly used by the person can be a useful way of improving rapport and communication. This is also highly beneficial for both the counsellor and client during periods of staff turnover.
Using drawing and artwork in counselling is an important tool in helping clients with intellectual disability to gain concrete understanding of abstract concepts. For example, ‘relationship’ can be explored through drawings of people and visual representations of how they relate to each other. Drawing and artwork can also assist counsellors to understand what a client means when they use of particular sayings or phrases. (For more information, see the sections: ‘Exploring feelings through art’, ‘Sand tray therapy’ and ‘Art work therapy’.)
Understanding emotions can be a big challenge for people with intellectual disability, especially given that the language used to describe emotions is abstract, yet the reality of the emotions they experience can be very concrete. People with intellectual disability often experience intense physical or behavioural responses to unexpressed emotional states, due to their limited means for identifying and expressing feelings. This is often compounded by a high level of experience of trauma through abuse and exploitation.
Understanding ‘emotions’ by connecting the abstract label of the emotion to the corresponding physical experience in the body can help people to talk about their emotional experiences and find ways to recognise and respond when emotions are disturbing. For example, a person may not be able to talk about their ‘nervousness’, but can talk about ‘feeling sick’. It is helpful for counsellors to ask questions like ‘Where do you feel that?’ or ‘How do you feel that in your body?’ to help the person identify what they are feeling and when. Counsellors need to approach this work with a sense of patience, commitment and curiosity – it can take a long time to uncover the understanding and experiences of emotions of each client.
Many difference factors influence the ways that people create meaning, use the English language and respond to abstract language. It is vital to take cultural background and experience into account as well as the presence of intellectual disability. Comprehension and understanding need to be assessed for each individual, and practitioners need to ensure that their stereotypes of people with intellectual disability do not impose limited expectations on the person’s ability to communicate.