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The purpose of this paper is to report the evidence base for the practice of individual psychodynamic psychotherapy with adults with intellectual disabilities (IDs).
Abstract
Purpose
The purpose of this paper is to report the evidence base for the practice of individual psychodynamic psychotherapy with adults with intellectual disabilities (IDs).
Design/methodology/approach
Literature review.
Findings
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.
Research limitations/implications
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.
Practical implications
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.
Social implications
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).
Originality/value
This review includes more relevant studies than previous reviews and adds to a limited number of reviews in this area.
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Keywords
Psychodynamic psychotherapy is increasingly adapted and used with individuals with intellectual disability (ID) and mental health difficulties. However, the evidence base is still…
Abstract
Purpose
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.
Design/methodology/approach
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.
Findings
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.
Research limitations/implications
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.
Originality/value
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.
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Keywords
Nicky Phillips, Paul Leighton and Rhona Sargeant
This paper seeks to report upon psychiatric trainees' experience of providing psychodynamic therapy for the first time and their experience of group supervision.
Abstract
Purpose
This paper seeks to report upon psychiatric trainees' experience of providing psychodynamic therapy for the first time and their experience of group supervision.
Design/methodology/approach
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.
Findings
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.
Research limitations/implications
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.
Originality/value
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.
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Keywords
Charlotte Merriman and Nigel Beail
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…
Abstract
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.
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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…
Abstract
Purpose
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.
Design/methodology/approach
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.
Findings
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.
Research limitations/implications
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.
Originality/value
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.
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Hannah Richardson, Julian Ernst, Rebecca Drill, Annabel Gill, Patrick Hunnicutt, Zoe Silver, Mikaela Coger and Jack Beinashowitz
This study aims to examine what patients say is helpful in psychodynamic psychotherapy by analyzing responses to an open-ended question at two time points: three months into…
Abstract
Purpose
This study aims to examine what patients say is helpful in psychodynamic psychotherapy by analyzing responses to an open-ended question at two time points: three months into treatment and termination.
Design/methodology/approach
Participants in this naturalistic study were a diverse group of patients seeking treatment at a psychodynamic psychotherapy training clinic (within a public hospital system). The authors used thematic analysis to categorize patient responses to an open-ended question about what is helpful in their treatment.
Findings
The authors found that a majority of patients found their psychotherapy helpful, and patient responses broke down into 16 categories. Themes that emerged from categories were what patients experience or feel, what therapists/therapy provides and what patients do in therapy. The most frequently endorsed category at both three months and termination was embedded within other categories, “mention of an other,” which captured when patients specifically mentioned another person (i.e. the therapist) in their response. The next most frequently endorsed categories were “talking/someone to talk with,” “feeling better/experiencing well-being/improved functioning” and “having regularity/structure” (at three months) and “having attention directed at experience,” “having regularity/structure” and “experiencing the professional role of the therapist” (at termination).
Originality/value
Findings shed light on factors contributing to helpful psychotherapy from patients’ perspectives in their own words. While previous research has shown that the therapy relationship is an important factor in effective therapy, the findings of this study highlight this ingredient in a personal, spontaneous way.
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Allan Skelly, Caoimhe McGeehan and Robert Usher
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.
Abstract
Purpose
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.
Design/methodology/approach
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.
Findings
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.
Research limitations/implications
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.
Originality/value
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.
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Offenders who have intellectual disabilities like any one else may deny their offence. This paper reports a case study of a man who admitted his offence and them accepted…
Abstract
Purpose
Offenders who have intellectual disabilities like any one else may deny their offence. This paper reports a case study of a man who admitted his offence and them accepted probation with a condition of treatment. However, when he attended treatment he denied the offence. Thus do those providing treatment send them back into the criminal justice system or work with them try and help them accept what they have done and provide appropriate treatment to help them reduce future risk of offending.
Design/methodology/approach
In this case study the assimilation model was used to understand the process of change and monitor change through exploratory psychotherapy. The psychotherapeutic model was psychodymnamic.
Findings
The client demonstrated gains through the stages of the model toward acceptance of his problematic behaviour and continued to work on this through further psychotherapy.
Originality/value
The assimilation model offers a useful approach to monitor change in psychotherapy; but especially when the client does not accept the problem the rest of the world feels they have.
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The results of empirical research on the patient–psychotherapist relationship have led to the fundamental conclusion that the therapeutic alliance is one of the key factors…
Abstract
Purpose
The results of empirical research on the patient–psychotherapist relationship have led to the fundamental conclusion that the therapeutic alliance is one of the key factors ensuring the positive outcomes of psychotherapy. The main aim of the present study is to determine what variables pertaining to the context of psychotherapy (type of treatment applied in accordance with the psychotherapist’s modality/orientation, type of disorder diagnosed in the patient) differentiated the alliance.
Design/methodology/approach
Participants for the main study were recruited from public and private psychotherapy offices across Poland. The working alliance was assessed based on 262 psychotherapist–patient dyads. The sample consisted of 428 participants. To assess the quality of therapeutic alliance, the author used the full version of the Working Alliance Inventory as adapted into Polish.
Findings
The results of analyses led to several basic conclusions. The study revealed a differentiating effect of type of psychotherapy on the quality of therapeutic alliance. Alliance quality was not differentiated by the type of disorder diagnosed in patients and treated in the psychotherapeutic process.
Originality/value
The results of analyses presented in this empirical study allowed for exploring the quality of the therapeutic alliance with contextual variables related to the psychotherapeutic process taken into account.
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Mental health problems are increasing in society. To deal with these problems effectively, it is imperative that appropriate treatments are delivered. Some evidence suggests that…
Abstract
Mental health problems are increasing in society. To deal with these problems effectively, it is imperative that appropriate treatments are delivered. Some evidence suggests that patients often do not complete the full course of many psychotherapy treatments. The aim of this study was to estimate the average length of treatment for patients referred to the adult specialty of a large clinical psychology department. A stratified sampling strategy was chosen to obtain an unbiased and precise estimator of the average treatment length for the population of patients whose files had been closed in one calendar year (n = 3021). The stratified sampling mean estimator for the population mean was 3.9 appointments; standard psychotherapy treatments are often planned to be more than ten appointments. These results suggest that many patients are failing to receive the full treatment planned by mental health professionals. Perhaps more psychotherapy treatments need to be delivered in a smaller number of appointments. Stratified sampling could be used to estimate treatment duration in particular contexts, thereby allowing treatments to be designed to meet local needs.