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The use of data in the twenty-first century to improve expert decision-making has radically transformed what it means to be an expert in multiple fields, including behavioural healthcare. This chapter summarises the impact on information technology on the field, including use of digital platforms to enable video therapy and online cognitive behavioural therapy programmes. The chapter is intended for practitioners seeking information on how to be a twenty-first century expert, where years of education and experience matter less compared to evidence of performance in the form of solid outcome data. Key to the use of outcome data is expertise in how to use questionnaires in therapy and how to interpret results, both at the individual client level as well as overall results across multiple clients. A twenty-first century expert measures are not simply to measure outcomes but to improve results over time. Failure to incorporate the use of data into routine practice ignores an evidence based practice with decades of evidence as to its effectiveness, potentially resulting in suboptimal care.

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.

Deliberate practice (DP) is an innovative training method for improving psychotherapy skills acquisition and expertise in the twenty-first century. I introduce the reader to the principles and processes of DP and the rationale for its use. The concept of DP is not new, indeed it is used to support the improvement of performance in diverse areas, from sport to music. However, its application to psychotherapy is still in its infancy. Firstly, I provide the rationale for including DP as a method of therapist training based on research that illustrates that many of the current criteria that we use to identify expertise have little to no added impact on client outcomes. Additionally, some of the limitations of current traditional training regimes are outlined, along with the emerging evidence base for DP as a training method that can help improve the acquisition of therapeutic skills and expertise.

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.

In the previous chapter, I introduced the reader to the ideas and research of the common factors. The common factors are varied and have demonstrated to have small to large effect sizes depending on what variable is being examined. In this chapter, I categorise four more evidence based relationship variables which tend to be more task orientated and aligned to the therapeutic alliance. Indeed, the therapeutic alliance, goals and collaboration, alliance rupture–repair, and feedback-informed care are four trans-theoretical factors that can contribute greatly to outcomes. At the same time, when poorly established they can and do impact negatively on client outcomes. This is not an exhaustive overview of the literature, rather each variable is briefly discussed, the evidence supporting the effectiveness is highlighted, and Top Tips are provided to assist the development of the practitioner.

Psychotherapy and clinical supervision outcomes are influenced by client and supervisee factors, one of which is cultural identity. Those with diverse racial and ethnic minoritised identities often experience disparities in therapy outcomes. Therapists and supervisors need to be responsive to the identity of those they support. The multicultural orientation (MCO) framework is an emerging concept in psychotherapy and clinical supervision that may offer these practitioners a framework to be responsive.

A preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews was conducted. Six databases, PubMed, Scopus, Embase, Academic Search Complete, Web of Science and PsychInfo, were searched for peer-reviewed literature published in English between the years 2000 and 2023.

A total of 1,553 sources were identified, of which (n = 42) are included in this review. Findings suggest that MCO is still in its infancy as applied to therapy and clinical supervision. Most of the research has been conducted in America, using quantitative methodologies with white western populations. Cultural humility is the most studied MCO pillar, and variables such as reductions in psychological stress, the working alliance and microaggressions are reported on as outcomes. MCO applied to the group therapy process is an emerging finding of interest. However, more research is needed, especially experiential designs across different and diverse populations and contexts.

MCO is an emerging therapy and clinical supervision process that has the potential to improve the outcomes for therapy clients and supervisees. Further research is needed to replicate current studies, and further research with diverse populations, countries and contexts should be undertaken as a priority.

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.

Supervision is considered the signature pedagogy and after direct client practice it is rated as the number one learning and development method by practitioners. However, as we set out in this chapter, the relationship between supervision and client outcomes is not a strong one. Drawing on the use of routine outcome data, we demonstrate how clinical supervision can be improved when both practitioner and supervisor demonstrate an attitude of humility and a willingness to learn from the data they collect. Using these data to enhance supervision by improving client outcomes and to inform deliberate practice (DP) is the hall mark of the effective twenty-first century practitioner and supervisor.

In the previous chapter, we explored in a broad sense, the idea of various types of expectancy related to processes involved in the delivery of treatment, and the desire of the client for treatment approaches and other important preferences. In this chapter, I discuss four more variables that we can consider to align to the theme of inner experiences, of the practitioner, with a lesser focus on the client. The relationship between outcomes and emotional expression of the client and practitioner, and outcomes related to the practitioner’s counter-transference (CT), self-disclosure (TSD), and use of immediacy (Im) are discussed. As with previous chapter, definitions are provided, the research base is explored, and Top Tips for each variable are outlined for the developing and seasoned practitioner.

Psychotherapy is perhaps the most known and identifiable with one of the field’s originators Sigmond Freud who is often accredited as being the inventor of the talking cure. However, it was many decades after psychoanalysis was first used by Freud that robust research and evidence was applied to psychotherapy, and its findings used to support practice in various contexts. While psychoanalysis is still practiced, the field has moved on and includes many hundreds if not thousands of approaches to healing. What has not improved, in general, is the between school rivalry regarding the efficacy and effectiveness of the different approaches. While it is now accepted that in general terms all approaches are about equally effective, certain research is often provided with more legitimacy than others. Mainly, the randomised control trial (RCT) is considered the gold standard in research terms, especially when it comes to establishing the efficacy and effectiveness of different psychotherapies. Empirically supported treatments (ESTs) are in prime position to take advantage of these political decisions, and this chapter will introduce the reader to these debates.