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The purpose of this paper is to examine the outcome of psychodynamic psychotherapy for people with intellectual disabilities (ID), which has a limited but supportive evidence base.

The study is a systematic open trial of flexible-length psychodynamic therapy offered in an urban community to 30 people with mild and moderate ID, presenting with significant emotional distress on the Psychological Therapies Outcome Scale for people with intellectual disabilities (PTOS-ID). Allocation to therapy was made according to an established stepped care approach according to need, and the mean number of sessions was 22.03 (range 7–47). Treatment fidelity was checked via notes review and cases excluded from analysis where there were other significant psychological interventions.

On both self-report (PTOS-ID) and independent ratings (Health of the Nation Outcome Scales-Learning Disability (HoNOS-LD)) recipients of therapy: did not improve while waiting for therapy; improved significantly during therapy, with large pre–post effect sizes; and retained improvements at six-month follow-up.

While it is important to conduct further controlled trials, the findings provide support for previous studies. High rates of abuse and neglect were found in the sample, suggesting that more trauma-informed and relational approaches should be explored for this client group.

No other study of this size has been completed which used dedicated standardised outcome measures, with this therapy type, with both waiting list and follow-up control and with account of model fidelity.