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Article
Publication date: 4 July 2016

Erica E. McInnis

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.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 10 no. 4
Type: Research Article
ISSN: 2044-1282

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Article
Publication date: 1 April 2020

Julian Himmerich

Psychodynamic psychotherapy is increasingly adapted and used with individuals with intellectual disability (ID) and mental health difficulties. However, the evidence base…

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.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 14 no. 3
Type: Research Article
ISSN: 2044-1282

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Article
Publication date: 9 December 2011

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.

Details

Mental Health Review Journal, vol. 16 no. 4
Type: Research Article
ISSN: 1361-9322

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Article
Publication date: 16 July 2009

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…

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.

Details

Advances in Mental Health and Learning Disabilities, vol. 3 no. 2
Type: Research Article
ISSN: 1753-0180

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Article
Publication date: 7 March 2016

Erica Elaine McInnis

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…

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.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 10 no. 2
Type: Research Article
ISSN: 2044-1282

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Article
Publication date: 5 November 2018

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.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 12 no. 5/6
Type: Research Article
ISSN: 2044-1282

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Article
Publication date: 9 September 2013

Nigel Beail

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.

Details

Advances in Mental Health and Intellectual Disabilities, vol. 7 no. 5
Type: Research Article
ISSN: 2044-1282

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Article
Publication date: 1 September 2006

Timothy Carey

Mental health problems are increasing in society. To deal with these problems effectively, it is imperative that appropriate treatments are delivered. Some evidence…

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.

Details

Journal of Public Mental Health, vol. 5 no. 3
Type: Research Article
ISSN: 1746-5729

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Article
Publication date: 10 December 2009

David O'Driscoll

Individual psychodynamic psychotherapy for people with learning disabilities has been more available since the 1980s, with numerous case studies and reports of…

Abstract

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.

Details

Advances in Mental Health and Learning Disabilities, vol. 3 no. 4
Type: Research Article
ISSN: 1753-0180

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Article
Publication date: 10 December 2009

Stephen Kellett, Nigel Beail, Alick Bush, Graham Dyson and Mark Wilbram

Single case experimental design (SCED) has a long, well‐respected tradition in evaluating the effectiveness of behavioural interventions for people with learning…

Abstract

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.

Details

Advances in Mental Health and Learning Disabilities, vol. 3 no. 4
Type: Research Article
ISSN: 1753-0180

Keywords

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