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Individual psychodynamic psychotherapy for people with learning disabilities has been more available since the 1980s, with numerous case studies and reports of effectiveness, yet little is know about the history of psychodynamic psychotherapy. This paper is a historical account of the international development of psychodynamic psychotherapy for people with learning disabilities. It discusses some of the clinicians' case reports, views and conclusions. It is important that, as therapists, we continue to learn and develop. This is a story of ‘opportunities lost’. Although a number of therapists were well‐placed to develop psychotherapy as a valuable treatment option, it did not happen. The paper discusses the reasons, ranging from widespread therapeutic pessimism to inability in the therapist to process the ‘disability transference’. It outlines the various British contributions before and since the ground‐breaking and well‐known work of Valerie Sinason, whose 1992 book is still the most influential contribution. Psychodynamic psychotherapy has developed more of a tradition than other therapy approaches in this field, but there is still only sparse literature on and recognition of this work.

The purpose of this paper is to report effectiveness of disability psychotherapy with a male adult with a mild intellectual disability presenting with complex emotional and behavioural problems.

An individual case study was used with repeated analytic, quantitative and qualitative measures. This reported progress from individual weekly disability psychotherapy of psychodynamic orientation within an emotional disability framework.

Disability psychotherapy led to a reduction in emotional and behavioural problems, reduction in emotional disability and facilitated protective psychological growth. In total, 88 sessions resulted in cessation of problem behaviours when other approaches did not. Given this therapy is likely to be reserved for the most complex and severe of cases, this study suggests more sessions of psychotherapy are needed than inferred from previous studies of effectiveness (Beail et al., 2007). This is to promote a sense of self which facilitates psychological well-being.

Limitations of a single case study include generalisability, controlling other factors in real life settings and subjectivity from inclusion of analytical measures. Further studies and follow-up would determine longevity of benefits. Nevertheless disability psychotherapy can be effective and should be available in a culturally appropriate service to meet the diverse needs of people with intellectual disabilities.

This case study adds to the limited body of evidence on effectiveness of psychotherapy for people with intellectual disabilities. It is novel to report formal outcomes from an emotional disability model (Frankish, 2013a) and the use of analytic and attachment outcome measures.

The purpose of this paper is to report the evidence base for the practice of individual psychodynamic psychotherapy with adults with intellectual disabilities (IDs).

Literature review.

In total, 14 papers were reviewed. From these, one existing review and seven individual papers provided enough evidence to support effectiveness of individual psychodynamic psychotherapy for people with IDs.

This research indicates individual psychodynamic psychotherapy to be of benefit. Indeed, all studies reviewed supported individual psychodynamic psychotherapy, but methodological shortcomings weakened the confidence placed in findings for some studies. Limitations of this review include methodological shortcomings of studies reviewed, a small number of existing studies and reliance on case studies.

Therapists and commissioners of services should routinely make individual psychodynamic psychotherapy available as part of a spectrum of therapies available to people with IDs who experience emotional and behavioural problems. This is because it is needed for some clients and they benefit.

Individual psychodynamic psychotherapy for people with IDs adds to the range of therapies available to alleviate emotional distress and enhance well-being. These are necessary to provide a foundation for meaningful contribution to society, particularly for those who have experienced psychological trauma (Frankish, 2016).

This review includes more relevant studies than previous reviews and adds to a limited number of reviews in this area.

After a varied and confused period from the days of Freud to the 1980s, psychotherapy for people with disabilities began to be recognised as having value. Several strands of development occurred at the same time and came together in the early 1980s. These strands will be discussed, the way they came together and what has happened since.

Long‐term psychodynamic psychotherapy is a costly service to provide, but many clinicians believe it is of benefit for people who have learning disabilities and psychological problems. There is also now some evidence for its effectiveness. However, the views of recipients is unknown. In this study, recipients of more than two years of psychodynamic psychotherapy were interviewed about their experiences and views. Themes emerged about the referral process, the experience and the outcome. Areas of strength were identified, as well as areas for improvement. The findings concur with previous findings on group therapy and help inform current and future provision of long‐term psychodynamic psychotherapy.

Psychodynamic psychotherapy is increasingly adapted and used with individuals with intellectual disability (ID) and mental health difficulties. However, the evidence base is still small and largely based on case studies and small trials whose participants mainly have mild to moderate ID. This paper aims to review and critique the literature in regards to the adaptations; and the effectiveness of psychodynamic psychotherapy for those with severe and profound ID.

A systematic literature search of PsycINFO, Social Policy and Practice, Medline, Cumulative Index to nursing and allied health literature and applied social sciences index and abstracts was conducted. Six studies met inclusion criteria and underwent a quality evaluation and critical review.

Six papers (all case studies) met inclusion criteria and underwent a quality evaluation and critical review. Some adaptations to therapy were reported, such as a more flexible therapeutic frame and increased use of the physical environment as a therapeutic tool. Due to significant methodological weaknesses of the included studies, it is yet unclear whether psychodynamic psychotherapy is an effective intervention for individuals with severe and profound ID.

Only a small number of case studies met the inclusion criteria. Further research should use more robust outcome measures, larger samples and compare psychodynamic psychotherapy to alternative interventions.

This paper is the first to review the psychodynamic psychotherapy literature with regard to its effectiveness as a treatment specifically for individuals with severe and profound ID and mental health difficulties.

This paper aims to discuss the work of Dr Valerie Sinason and her contribution to working with people with an intellectual disability with psychotherapy.

Dr Valerie Sinason is a psychoanalyst, and the author is trained in psychoanalytic psychotherapy.

The author believes there is important value in reading Valerie Sinason's contribution to the literature of psychotherapy with people with intellectual disabilities.

It is a review of Sinason’s contribution, and the author believes she's very original and important thinker.

This paper charts the development and practice of disability psychotherapy for the author and for services.

A personal account relating events to the development of thinking and practice.

The author suggests that a paradigm shift has occurred over the 30 years to a position of “doing with” as opposed to “doing to”.

This has not previously been put forward as a way of understanding present day services.

This article describes a short‐term psychodynamic treatment of a learning disabled adult male, referred to a community psychology service with social withdrawal and refusal behaviours. It explains the nature of the intervention, progression through the therapeutic process, development of hypotheses and the emergent formulation, and therapeutic outcomes for the client.The article identifies the suitability of short‐term individual psychodynamic psychotherapy for cases such as this, and demonstrates how such interventions can be documented through structured accounts of treatments, which link theory to practice.

The purpose of this paper is to focus on the theory and practice of disability psychotherapy (DP) using the integrative Frankish model (2013a). This draws on the model’s use with a 28-year-old male with a mild intellectual disability (ID) who presented with a range of emotional and behavioural problems.

A case study reporting on the practice of DP of psychodynamic orientation.

Adaptations useful in providing DP with people with IDs and the type of issues which arise are reported.

DP is possible and beneficial in community settings. Limitations of a single case study include generalisability of findings.

Existing papers focus on the model (Frankish, 2013a), development of the emotional development measuring tool (Frankish, 2013b) and contextual issues (Frankish, 2013c). This case study provides novel information on the practice of DP, and analysis of manifestations of white supremacy (Ani, 1994) in psychotherapy with people with IDs.