Do people with learning disabilities have a concept of Reciprocal Roles?

What aspects of intelligence are needed to understand the concept of Reciprocal Roles?

If RRs are descriptions of a fundamental component of how people live their lives, then is the acquisition of this device linked to specific aspects of intellectual capacity?

Why conduct this research with people who have severe learning disabilities?

  • Many people with learning disabilities are willing to participate in research.
  • Psychological treatments are seriously under-developed in services for people with learning disabilities. Would CAT be relevant and useful?
  • Little is known about the socially derived internal worlds of people with learning disabilities. Direct observation of people with learning disabilities indicates they do have patterns of behaviours that elicit reciprocations from staff.
  • As CAT works through the therapeutic relationship, involving activity and emotion, this approach may be more useful than the type of psycho-educational therapy that depends on verbal skills.
  • Psaila and Crowley, (2005), elicited 9 common RRs for people with learning disabilities, from CAT practitioners’ notes.
  • This research asks, can people with severe learning disabilities match up pictures to make both poles of these RRs and if so, what intellectual capacities is this ability related to?

Is the capacity to match pairs of RRs related to verbal mental ability?

British Picture Vocabulary Scale Short Form was used to assess verbal mental age. This is a test designed to measure receptive vocabulary in children aged 3-16. The child indicates which of a set of line drawings best illustrates the meaning of a stimulus word pronounced by the researcher. When assessing adults, this scale is used to produce a verbal mental age.

Can participants match feelings to events?  Is this capacity related to recognising pairs of RRs?

Makaton symbols depict the five main emotions, disgust, happiness, anger, sad and fear, and five black and white line drawings depict events; dog faeces, a Christmas Tree, a man hitting a dog with a stick a grave, and a ghost.

Is the capacity to match pairs of RRs related to perceptual relationships?

Ravens Coloured Progressive Matrices (1947) was used to assess non-verbal IQ, aimed at 5-11 year olds. It aims to assay the ability to infer rules, to manage a hierarchy of goals, and to form high-level abstractions and is believed to be a ‘‘paradigmatic’’ measure of fluid intelligence. Recommended uses include measurement of a person’s ability to form perceptual relations and reason by analogy in research settings.

The 9 RRs explored are:

  • Abusing to Abused
  • Rejecting to Rejected
  • Rescuing/Caring to Rescued/Cared for
  • Damaging to Damaged
  • Abandoning to Abandoned (Unloving to Unloved)
  • Special/Perfect to Learning Disabled
  • Controlling to Controlled/Fragile
  • Blaming to Blamed
  • Overwhelming to Overwhelmed

Using cartoon-style drawings to illustrate these reciprocal roles, the stimulus pole of the Reciprocal Role was offered together with three other cartoons. One was the anticipated response pole, another was an antonym and the third a distracter. Participants were then asked to select which of the three possible response cards fitted the stimulus scene best. Using the five emotion pictures, they were also asked how the responding person might feel.

Results using linear regression

From BPVS to RR identification

There were no significant associations between scores on the BPVS and recognition of RRs.

From feeling-action matching to RR identification

There was no relationship between the ability to assign feelings to action pictures and the ability to spot RRs from the pictures.

Linear Regression from matrices score to RR identification

Overall, there was a highly significant contribution made by scores on Matrices to the ability to spot RRs (p = .01) and to assign feelings correctly to those RR (p = .001).
Furthermore, scores on Matrices highly significantly predicted the overall tendency to assign an antonym to the stimulus pole of the RR (p = .004)


Results show the ability to recognise drawings representing both poles of RRs draws on fluid intelligence, general reasoning and the capacity to form abstractions, as assessed by Matrices.

Recognising RRs is not dependent on language ability, but on the capacity to observe and synthesise image patterns. This makes sense as we relate pre-linguistically via gestures, mime, tone, posture and facial expression which we abstract into felt relationships.

The significance of antonyms may be because they are related to both poles of a RR as the other side of the coin; as positions around one central RRP.

People with learning disabilities report that SDRs assist internalisation better than prose (Wells 2009). Perhaps this is because as a visual map drawing the sequence of difficult roles being explored in therapy; it taps into the cognitive resources they use to appreciate intuitively RRs.

Julie Lloyd || August 2010

Published in a book in 2013.

Lloyd, J. and Clayton, P. (2013). Cognitive Analytic Therapy for People with Intellectual Disabilities and their Carers.

ACAT Calendar for November
1212th November 2020
CPD Event: ACAT: Process mapping in therapy and reflective practice
1616th November 2020
CAT Introductory Event: ACAT: Two Day Introduction to CAT
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CAT Supervisor Training: ACAT: Relational Skills in CAT Supervision
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2727th November 2020
CAT Introductory Event: Two Day Introduction to CAT - offered by Sussex Partnership NHS Foundation Trust
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More information:

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