An open trial of psychodynamic psychotherapy for people with mild-moderate intellectual disabilities with waiting list and follow up control
| Pages | 153-162 |
| Published date | 05 November 2018 |
| DOI | https://doi.org/10.1108/AMHID-04-2018-0022 |
| Date | 05 November 2018 |
| Author | Allan Skelly,Caoimhe McGeehan,Robert Usher |
An open trial of psychodynamic
psychotherapy for people with
mild-moderate intellectual disabilities
with waiting list and follow up control
Allan Skelly, Caoimhe McGeehan and Robert Usher
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
significantlyduring therapy, withlarge pre–post effect sizes;and retained improvements at six-monthfollow-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.
Keywords Psychotherapy, Psychodynamic, Intellectual disabilities, Follow up, Open trial, Waiting list
Paper type Research paper
Introduction
The practice of psychodynamic psychotherapeutic interventions in people with intellectual
disabilities (ID) is the subject of a small but supportive literature. Prosaic early attempts at
psychoanalysis with people likely to have ID date back as early as Clark (1933), without clear
definition of the disability, clarity on the mechanics of treatment or systematic quantification of
outcome. Sinason’s(1992; Revised, 2010) MentalHandicap and the Human Condition described
several people who seemed to make better sense of their worlds during psychotherapy, and felt
less distressed following this process.
A small evidence base has since developed. A range of studies now exist, including case studies
with outcome data (Newman and Beail, 2002; Kellett et al., 2009; Alim, 2010), case series
reporting outcomes (Frankish, 1989; Newman and Beail, 2005), and open trials of groups of
people with pre–post comparison data (Beail, 1998; Beail et al., 2005, 2007).
Recipient experience seems to be positive. Merriman and Beail (2009) evaluated the views of
individual participants in long-term psychodynamic psychotherapy. Using interview transcripts
Received 14 April 2018
Revised 20 May 2018
Accepted 29 May 2018
Allan Skelly and
Caoimhe McGeehan
are both based at
Psychological Services,
Northumberland, UK and
Tyne and Wear NHS Foundation
Trust, Gateshead, UK.
Robert Usher is based at the
University of Sunderland
Faculty of Applied Sciences,
Sunderland, UK.
DOI 10.1108/AMHID-04-2018-0022 VOL. 12 NO. 5/6 2018, pp.153-162, © Emerald Publishing Limited, ISSN 2044-1282
j
ADVANCESIN MENTAL HEALTH AND INTELLECTUAL DISABILITIES
j
PAGE153
To continue reading
Request your trial