Posted 11.07.2025

Clinician Reflection: Facilitating Behavioural Family Therapy with a family member who has learning difficulties.

Elisa Silva and Katy Ryan work in an at risk mental state service with Northamptonshire Healthcare NHS Foundation Trust. Elisa is in the process of completing our Family Intervention for Psychosis and Bipolar Disorder course.  As part of the course Elisa has completed training in Behavioural Family Therapy (BFT) and is now working with families using the BFT model. Here, Elisa and her co worker Katy reflect on their experiences of adapting BFT for a service user with learning difficulties due to brain damage.  Katy has also completed training in BFT via the 5 day course.

“At one of our BFT sessions together – with one of us leading and the other shadowing – we drew on our combined experience supporting individuals with learning disabilities over the past few years and noticed that our service user needed some time to process and respond.

Using phrases such as “expressing pleasant feelings” or “making a positive request” seemed too complex. The service user would often copy the role play examples used, which highlighted a difficulty in picking up on the underlying aim of the task, and raised the question of whether the language used to present the task was accessible to them. They were clearly very capable, but the way the information was presented may have been a barrier to their engagement and progress. In response, we decided to adapt the materials to better meet their individual needs.

The easy reads created had some key characteristics – the use of emojis not only made the content engaging and as it was tailored to their age, but also clearer and easier to understand. We also included specific examples personalised to them to support their comprehension. The pictures were positioned on the left to enhance clarity, with large font size, familiar vocabulary, fewer and simpler words, and short sentences, all with the goal of supporting independence.

We presented the materials to them, which they looked at and read through. They then advised that they found them easier to understand and that they now understood what the skill meant. Throughout the session, we encouraged them to use the materials as a point of reference. We often pointed to the pictures and checked their understanding. They used them during the role plays and seemed able to respond more independently and with greater confidence.

We have taken this learning on board and are now working with a second family using the adapted handouts.”

Elisa Silva & Katy Ryan

At-Risk Mental State (ARMS) Service

Northamptonshire Healthcare NHS Foundation Trust