“i’m Just Kind of Talking to My Screen and It Responds Back”: A Thematic Analysis Exploring the Experiences of Adults With an Intellectual Disability Who Received a Virtual Cognitive Behavioural Therapy-based Intervention During the Covid-19 Pandemic

People with intellectual disabilities (PWID) were disproportionately impacted by the rapid switch to virtual delivery of mental health support necessitated by the COVID-19 pandemic from March 2020, yet their needs are frequently overlooked in this research area. This thesis aims to understand the experiences of PWID and the professionals that supported PWID during the pandemic in order to inform policy and training as we navigate the post-pandemic world.

Paper one is a literature review which explores what is known about the experiences of psychological professionals (PPs) who provided psychological support to PWID during the COVID-19 pandemic. Eleven papers were identified, critically appraised and thematically synthesised. Four themes were synthesised from research data: Impact at service level, The emotional impact on PPs, The limitations of virtual support, and Unexpected gains. PPs shared the impact of remote working on their psychological well-being, with contributing factors of increased pressure, feeling abandoned by management and difficulties managing work-life balance. Increased flexibility and the benefits of virtual psychological support for autistic people were also raised. Future research exploring the experiences of PWID receiving virtual therapy is recommended.

Paper two is an empirical research paper which explores the experiences of adults with an intellectual disability who received a virtual CBT-based intervention during the COVID-19 pandemic. Eight participants completed a semi-structured interview which was analysed thematically (Braun & Clarke, 2022). Four overarching themes were identified: Power, Therapy process, Therapeutic relationship, and Safety in the virtual environment. This empirical study highlights the importance of psychological safety for PWID when receiving virtual support as a lack of psychological safety impacted the quality of therapeutic relationship and engagement in intervention. The unique challenges faced by PWID, such as reliance on non-verbal communication and confidentiality in residential environments, must be considered. Future research exploring the development of therapeutic alliance when working virtually is recommended.

The final paper in this thesis is an executive summary which provides an overview of the completed empirical paper. There is a Brief and Extended version of the executive summary included. Both have been written with PWID in mind and have been reviewed by service users.