is important to note that, there are limits to using CBT, and
findings suggest that CBT has the potential to have positive outcomes
only with people who have mild to moderate learning disabilities
(Taylor et al., 2008; Hassiotis et al., 2013). As, research suggests
that people with mild to moderate learning disabilities have the
fundamental skills needed for the cognitive element of CBT, such as
oral communication skills (Pert et al., 2013; Hartley et al., 2015).
This is significant as Samara has a mild to moderate learning
disability, thus it can be argued that the skills associated with
Samaras’ diagnosis are harmonious with the CBT structure (Pert et
al., 2013).

show that CBT can have positive effects, however, many argue that
this may be short-lived or not maintained beyond discharge (Pert et
al., 2013; Unwin et al., 2016). CBT clients are generally assigned a
homework task, which many people with learning disabilities may
struggle to complete. Thus, researchers suggest that long-term
effects may be seen with carer involvement in reinforcement
activities such as homework tasks (Lindsay et al., 2013; Hassiotis et
al., 2013). Furthermore, involving carers in the therapy process
would place them in a better position to identify and acknowledge any
early indications of relapse (Beail and Jahoda, 2012; Lindsay et al.,
2013). This can also help prevent ‘diagnostic overshadowing’ by which
clinicians attribute the symptoms presented to learning disabilities
(Nash, 2013). Additionally, studies demonstrate that the inclusion of
carers could benefit people with learning disabilities by reinforcing
and maintaining the techniques learnt, transferring skills to life at
home and support client engagement in therapy, which ultimately
improves the quality of life of service users (Darbyshire and Kroese,
2012; Unwin et al., 2016).

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relation to Samara, she has recently moved houses and is supported by
support workers, therefore it can be argued that involving Samara’s
carers may increase the chances of positive outcomes and can reduce
the risk of relapse (Unwin et al., 2016). Thus, the learning
disability nurse can facilitate training for Samara and her carers to
understand the benefits of involving caregivers in CBT. However,
although there are benefits to carer involvement research indicates
concerns regarding confidentiality and privacy (Pert et al’s., 2013).
Hartley et al. (2015), as well as Unwin et al. (2016), suggest that
further research is required to examine the benefits of involving
carers in treatment and the impact on CBT outcome. Therefore, it is
important to note that if Samaras’s carers are involved in the CBT
sessions, confidentiality should be maintained and involvement should
be optional. 


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