Key Points
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Some people with Down syndrome benefit from psychotherapy.
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Therapists work with individuals with a variety of skills, needs, and goals.
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Psychotherapy is often one part of a treatment plan that may include other types of therapy and/or medications.
What is psychotherapy?
Psychotherapy is also called talk therapy or counseling. It can help people with a variety of mental, emotional, or behavioral concerns. The goals of psychotherapy are to:
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Treat symptoms of concern
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Help the person feel better
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Help the person function more effectively in their daily life
Is therapy beneficial for people with Down syndrome?
Many people with Down syndrome benefit from talking to a non-judgmental, safe, and attentive provider. We know that some people with Down syndrome have a somewhat small social circle. It can be helpful to have someone to talk to who is not within their family or friend group.
How long does a therapy session last?
Session length depends on the person’s ability to maintain attention and be engaged. A typical session is scheduled for an hour.
How many sessions do individuals with Down syndrome need?
The number of sessions will vary as well. It is important to understand that changing the way we think and behave takes time. It may take even longer for a person with Down syndrome. Families should anticipate that (depending on the issue) it is likely to take multiple sessions to see changes happen. We know that in the general population, some people are in therapy for years. This can also be the case for people with Down syndrome.
Do families participate in the sessions?
Sometimes, family members are present. Some individuals with Down syndrome attend the session alone. Sometimes, we split the session, and the family comes for only part of the session.
Having family members present can help with clarifying timelines, giving context of situations, or helping with the person’s communication if needed. Family members can also gain insight and learn strategies to help their loved one at home.
Having the person with Down syndrome participate on their own can allow for more independence. They may talk more freely about certain subjects. It is up to the individual and family, although the provider may make suggestions about what they feel would be most beneficial.
What happens during a therapy session?
Sessions look a bit different for each person. Sessions are guided by the person with Down syndrome. If they have an issue they would like to discuss, that is where we start. It often ties in to concerns that the family has brought up, but sometimes it does not. We want to respect and validate the thoughts and feelings of the person with Down syndrome by giving them time to talk about topics that are important to them.
What areas are worked on during therapy?
Areas worked on in therapy may include:
Providers can also help people with Down syndrome analyze how they think and behave. Self-determination and respect for autonomy are big guiding principles in therapy. I don't tell the individuals with Down syndrome who I work with what they should do in any given situation. We use problem-solving strategies to discuss their options/choices so that they can make positive decisions for themselves.
At times, there is psychoeducation or direct teaching of skills. Some people with Down syndrome may struggle in certain areas due to a lack of knowledge or experience. For example, some social skills like boundaries may require clear instruction to learn.
What tools or strategies are used during sessions?
We use visuals in therapy sessions. Visuals are an important tool for people with Down syndrome. We write things down, draw pictures, look at diagrams, and use other visual aids. They reinforce concepts and make things more concrete. Visuals can also be brought home to help the person with Down syndrome use strategies in places outside of the therapy office.
Can therapy be beneficial for people with Down syndrome with limited verbal communication skills?
Psychotherapy is not always the appropriate intervention for all people. For individuals who do not want to engage in therapy or do not have a means of communication, other therapeutic options might be preferred. However, strategies can often be provided for families to use at home. Behavior strategies (such as visual schedules, reward charts, or environmental changes) and/or the support of a behavioral therapist might be recommended for some individuals. Depending on the needs of the individual, occupational therapy, art therapy, or music therapy may also be effective options.
What about medications?
Some individuals may need medication in addition to psychotherapy. Some people cannot effectively participate in therapy or other non-medicinal treatments until they start medication. The medication can help them get to a place where they can participate in psychotherapy or other types of therapy.
It can take time to find the appropriate medication and dosage for each person.
Some people need medication for a limited amount of time. Our Weaning Off Psychotropic Medications article has more information. Some people use medication for the rest of their life. Their mental health condition may need ongoing treatment. Just like people who take medication for diabetes or arthritis, they may take medication for the rest of their life.
Medications can help address a variety of symptoms like impulsivity and mood, but many people with Down syndrome might need therapy to learn new skills or change behaviors. For example, medications may help reduce irritability or outbursts, but the individual may still need support in navigating situations that cause them irritation or frustration.
Additional resources
Finding a Mental Health Provider (article)
Mental Wellness in Adults with Down Syndrome (Chapter 16 of the book, available as a free PDF)
Wise Counsel: Supporting Mental Health in Adults with Down Syndrome .png "opens in new window")
(episode of the LowDown podcast)