Itis important to note that, there are limits to using CBT, andfindings suggest that CBT has the potential to have positive outcomesonly with people who have mild to moderate learning disabilities(Taylor et al., 2008; Hassiotis et al., 2013). As, research suggeststhat people with mild to moderate learning disabilities have thefundamental skills needed for the cognitive element of CBT, such asoral communication skills (Pert et al.

, 2013; Hartley et al., 2015).This is significant as Samara has a mild to moderate learningdisability, thus it can be argued that the skills associated withSamaras’ diagnosis are harmonious with the CBT structure (Pert etal., 2013).Researchersshow that CBT can have positive effects, however, many argue thatthis may be short-lived or not maintained beyond discharge (Pert etal., 2013; Unwin et al.

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, 2016). CBT clients are generally assigned ahomework task, which many people with learning disabilities maystruggle to complete. Thus, researchers suggest that long-termeffects may be seen with carer involvement in reinforcementactivities such as homework tasks (Lindsay et al., 2013; Hassiotis etal., 2013). Furthermore, involving carers in the therapy processwould place them in a better position to identify and acknowledge anyearly indications of relapse (Beail and Jahoda, 2012; Lindsay et al.

,2013). This can also help prevent ‘diagnostic overshadowing’ by whichclinicians attribute the symptoms presented to learning disabilities(Nash, 2013). Additionally, studies demonstrate that the inclusion ofcarers could benefit people with learning disabilities by reinforcingand maintaining the techniques learnt, transferring skills to life athome and support client engagement in therapy, which ultimatelyimproves the quality of life of service users (Darbyshire and Kroese,2012; Unwin et al., 2016).Inrelation to Samara, she has recently moved houses and is supported bysupport workers, therefore it can be argued that involving Samara’scarers may increase the chances of positive outcomes and can reducethe risk of relapse (Unwin et al.

, 2016). Thus, the learningdisability nurse can facilitate training for Samara and her carers tounderstand the benefits of involving caregivers in CBT. However,although there are benefits to carer involvement research indicatesconcerns regarding confidentiality and privacy (Pert et al’s., 2013).

Hartley et al. (2015), as well as Unwin et al. (2016), suggest thatfurther research is required to examine the benefits of involvingcarers in treatment and the impact on CBT outcome. Therefore, it isimportant to note that if Samaras’s carers are involved in the CBTsessions, confidentiality should be maintained and involvement shouldbe optional. 

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