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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.

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.

This paper seeks to report upon psychiatric trainees' experience of providing psychodynamic therapy for the first time and their experience of group supervision.

A total of five trainees, undertaking training in psychodynamic therapies, were interviewed on multiple occasions over an 18‐month period – before, during, and after undertaking their first case of psychodynamic therapy. A semi‐structured, qualitative interview approach was used to explore providing psychodynamic psychotherapy and participating in psychodynamic supervision groups. Interviews were transcribed in full and data analysed following the conventions of thematic analysis.

Trainees' anxieties about working psychodynamically and their concerns for developing new competencies are recognised. Personal and professional challenges associated with this therapeutic approach are identified and the importance of ”looking after” trainees is stressed; the role of trainee supervision groups in this is advocated. The potential challenges of integrating psychodynamic thinking into general psychiatric practice are discussed and suggestions to address these difficulties are proposed.

The small sample size reflects the total number of trainees participating in training at the time of the study; for future work, a larger sample drawn from multiple training centres would be recommended.

Training in psychotherapy is now mandatory for all trainee psychiatrists and this is something which many trainees find daunting; training in psychodynamic techniques is particularly challenging. A fuller awareness and understanding of trainees' experiences is important in nurturing clinicians who are competent in psychodynamic thinking, and who might consequently apply these skills clinically.

The paper aims to describe and understand the gap between the psychodynamic literature on groups and the social psychological perspective on group dynamics.

As Wilfred Bion is the most influential group dynamics representative of the psychodynamic tradition the authors performed a citation analysis of Bion's work to find out whether it influenced the social psychological research on group dynamics. They compared three domains of literature: therapy/clinical, management/organization studies and social psychology. Moreover, they depict (by drawing on interviews with European pioneers in social psychology) the historical context in which European social psychology developed to explain the gap between the psychodynamic and social psychological approaches in the study of group dynamics.

The results clearly indicate the existence of a gap between the social psychological and psychodynamic perspectives on group dynamics. Moreover, the authors show that Bion did influence scholars studying or working with real-life groups and is cited more by American than European scholars. The attempt to build a legitimate scientific identity for social psychology provides a context for understanding of the neglect of the psychodynamic tradition.

The authors conclude by exploring ways in which the psychodynamic tradition may fertilize the social psychological tradition in studying groups.

The paper is one of the first to address the discrepancy between the social psychological and psychodynamic perspectives in the study of group dynamics.

Recent governmental policy has emphasised the need for greater choice and inclusion for people with learning disabilities. Accordingly, learning disabilities services are increasingly offering a greater choice of psychological interventions to people with learning disabilities. A growing body of research has examined the use of psychodynamic interventions for people with learning disabilities. The purpose of the this paper is to identify, outline, and evaluate research on the efficacy of psychodynamic approaches with people with learning disabilities and to consider the implications for clinical practice.

A systematic search identified 13 relevant studies. A qualitative review of these studies was carried out.

Overall, the reviewed studies offer some preliminary support for the use of psychodynamic approaches with people with learning disabilities.

A number of methodological issues are identified (particularly concerning the influence of extraneous variables and the generalisability of findings) and further, larger scale and more robust, research is required.

Learning disabilities services should consider providing psychodynamic psychotherapy for people with a mild learning disability experiencing mental health, behavioural, and/or offending problems.

This paper provides an up-to-date, comprehensive review of the literature on the efficacy of psychodynamic psychotherapy for people with a learning disability that will be of use to services providing therapeutic support to people with a learning disability and to people commissioning those services.

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.

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.

Some psychodynamic approaches conceptualise female violence as a communication of experiences too difficult to think about. As practitioners, understanding what may be too painful to be thought about is incredibly important in assessment and treatment of forensic populations. Incorporating psychodynamic concepts such as splitting, transference, projection and counter-transference into formulation can be extremely helpful in understanding and formulating women’s risk of violence. The purpose of this paper is to introduce how psychodynamic concepts can be incorporated into understanding, assessment, formulation and treatment with this complex client group. This paper will also outline treatment approaches with this population.

This paper will review existing psychodynamic literature and apply this knowledge to working with violent female offenders. Translating theory into reflective practice will be presented.

This paper presents the value of incorporating psychodynamic considerations into existing strategies of understanding and working with violent female offenders. Ways forwards and research directions are proposed.

This paper is focussed primarily on psychodynamic approaches to understanding this population

Psychodynamic concepts can add an additional dimension to formulation, supervision and treatment approaches with this population. Examining the meaning of violence perpetrated by women as well as enactments can improve practitioner’s depth of understanding. Empirical research examining the benefits of psychoanalytic supervision would be extremely useful to explore the impact on formulation, treatment approaches, treatment effectiveness, staff well-being and staff retention.

There is a lack of literature considering the application of psychodynamic constructs to help formulation of complex female offenders in the Offender Personality Disorder Pathway for women.

Single case experimental design (SCED) has a long, well‐respected tradition in evaluating the effectiveness of behavioural interventions for people with learning disabilities and challenging behaviours. However, shift the focus to other psychological modalities (such as psychodynamic psychotherapy) or differing presenting problems (such as interpersonal problems) and the use of SCED methodologies is severely curtailed. This paper describes the application of SCED methodologies in the evaluation of treatment of three clients: the psychodynamic psychotherapy of hypochondriasis in an A/B design, psychodynamic psychotherapy of ambulophobia in an A/B design, and cognitive‐behavioural therapy of anger and aggression in a shifting criterion design. Visual and statistical analysis of the time series data revealed that the hypochondriasis and the anger cases responded to treatment, whereas the ambulophobia case showed some deterioration during the intervention. The cases are discussed in terms of the strengths and weaknesses of the methodologies applied and the relative merits of accruing SCED evidence in the evaluation of the plethora of psychological modalities now being made available to learning disabled clients.

This purpose of this paper is to outline how a combination of different psychological models may inform formulation and treatment, and the benefits for the client and the therapist of working in this way.

This is a single case study, describing an integrative approach in which psychodynamic ideas were used to inform cognitive-behavioural treatment.

The integrated approach reported here not only allowed the client to develop his skills in problem solving and taking different perspectives, but also to take a more active role in decisions about his life.

Integrative approaches may be of particular use for individuals who have not shown a full response to interventions based on a single theoretical model. Malan's triangles of insight provide a clear structure to psychodynamic formulation that is easily accessible to emerging psychodynamic practitioners.

Little previous research has described integrative approaches for psychological difficulties in people with an intellectual disability. The approach outlined in this study describes reasons for using an integrative approach, provides one example of how different models may be combined in practice, and describes ways in which the integrative approach enriched the intervention.