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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).

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 is a commentary on “The effectiveness of psychodynamic interventions for people with learning disabilities: a systematic review” by Chris James and James Stacey. The purpose of this paper is to illustrate the thesis that standardised ways of evaluating health care interventions may have the inadvertent effect of undermining the case that people with intellectual disabilities should be offered the same opportunities to address their emotional and mental health difficulties as other citizens.

The commentary argues that while the evidence base focuses on the outcomes of orthodox one-to-one interventions, sometimes broader “contextual reformulation” and systemic interventions are called for. However, family- or service-based interventions tend not to feature in studies.

The commentary illustrates these issues by discussing two case studies, which demonstrate how relational issues tend to be unhelpfully focused on the person with intellectual disabilities to the detriment of family members or direct care staff, who may be struggling to make sense of the person's behaviour or distress.

The commentary supports the argument put forward in the longer paper and also argues for mental health services to be offered on a non-discriminatory basis to people with intellectual disabilities and to their family members. But it also suggests that one of the additional impacts of service level psychotherapeutic interventions is to re-establish respect for the work of direct care staff whose work is often presented as if it is little more than domestic drudgery when in fact it involves negotiating and responding to people and their issues with great sensitivity and balance.

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.

People with learning disabilities want and value friendships and close, intimate, or romantic relationships. However, many people with learning disabilities are socially and emotionally lonely. The purpose of this paper is to describe a novel intervention, using a narrative therapy based group approach, which aimed to ameliorate the negative effects of loneliness in adult men with a mild learning disability.

This study explored the group process, examined participants' experiences of the narrative therapy approach, and used an amended version of the UCLA loneliness scale (3rd ed.) to evaluate the effectiveness of a narrative therapy group approach.

The group enabled participants to develop “experience near” descriptions of loneliness and its effects and to identify and strengthen their abilities, strengths, and resources. Qualitative feedback from participants indicated that the group was experienced positively and helped participants to feel less lonely. Quantitative feedback from an adapted version of the UCLA loneliness scale suggested that most participants felt less lonely following the intervention.

There are several limitations of the current study. Most importantly, because of the small sample size (n=5), the results of the current study lack generalisability. Future, larger‐scale research should be carried out to address these limitations.

The current study draws attention to a significant problem experienced by many people with a learning disability. It also adds to the emerging evidence that narrative therapy approaches may be useful within learning disability contexts.

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.

Decreasing revenues among local governments across the country have placed an increased focus on governmental financial practices. For states with local government financial oversight organizations, the ratios and other benchmarks used to assess fiscal stability face increased scrutiny. This study examines financial reports sent to North Carolina’s financial oversight body, the Local Government Commission (LGC), to determine the types of operational and policy practices that can lead to fiscal stress based on guidelines established by the LGC. Findings indicate that lowering levels of fund balance, increased salaries, increased debt service levels, and the presence of a countywide water system all increased the probability of a county government receiving notice of potential financing problems requiring immediate action.

Since 1934, the federal government has provided a process for municipalities to declare bankruptcy, and approximately 500 governments have done so. In recent years, an average of less than one city government declares bankruptcy each year. In this article, the authors identify five factors that contribute to financial distress for cities which, if left unattended, can lead to municipal bankruptcy. This discussion is followed by an examination of the events that led to the bankruptcy of the City of Prichard, Alabama, once a prosperous suburb of Mobile. The authors conclude that this municipal bankruptcy occurred, in large part, because Prichard failed to face the factors of financial distress identified by the authors in the years prior to filing for bankruptcy.

Cognitive behaviour therapy (CBT) is currently one of the recommended treatments for depression for the general population and guidance recommends that people with a learning disability should have access to the same treatments as people without a learning disability. The purpose of this paper is to identify, outline and evaluate current research on the effectiveness of CBT for depression for people with a learning disability. The clinical, service and research implications are considered.

A systematic search was conducted and five relevant articles were identified for critical review.

There is a limited but promising evidence base for the use of CBT for depression with people with learning disabilities.

The current review identified a number of methodological issues and future research should attempt to overcome these (e.g. small sample sizes and lack of controls). In particular, research should focus on determining the relative contribution of cognitive and behavioural techniques in producing a change in depressive symptoms.

Services (including those provided as part of Improving Access to Psychological Therapies) should be offering CBT-based interventions for people with learning disabilities who are experiencing depression.

This paper provides a comprehensive and up to date review of the current literature regarding the use of CBT for depression for people with a learning disability. This will be of value to clinicians working with people with a learning disability as well as those commissioning services.

The purpose of this paper is to appraise “transference” and “countertransference” when working with people with intellectual disabilities (PWID).

A review of the literature was conducted, followed by a discussion.

No research articles were found. Potential reasons for this are discussed. Historical influence, complexity of the topic and resistance among professionals may be contributing factors. Despite this, these phenomena are important for several reasons. These include the high levels of trauma these clients experience; the manner in which they have been marginalised by mainstream society; the strong likelihood of PWID evoking difficult countertransference from therapists; and the myriad of coping mechanisms and defences that these clients may employ.

Research is needed to further current understanding of these issues.

An awareness of these issues amongst practitioners and other key members of a PWID’s system is important.

This is the first review and commentary on these issues.