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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‘There is no greater agony than bearing an untold story inside you’ (Maya Angelou)This brief paper considers how trauma and attachment can be present in the lives of people with intellectual disabilities (ID). Trauma of a serious nature in childhood is both a heightened likelihood, and strong predictor, of negative outcomes for people with ID. However, it can also be addressed through psychological assessment and interventions, and is mediated through attachment bonds with others.

The HoNOS-LD seems reliable and sensitve to change when used as a team generic outcomes measure. In this paper we examine the factor structure of HoNOS-LDs administered at the end of assessment and prior to intervention (N=155). Four hypothesised factors were proposed as externalising behaviour problems, internalising behaviour problems, loss of skills, and loss of community presence. Factor analysis with Varimax rotation yielded four sizaeble factors accounting for 48 per cent of the variance. However, the hypothesised factors were only partly identified. The actual factors meeting Eigenvalue >1 were described as: (1) communicative-cognitive competence; (2) behaviour disturbance incorporating relationship breakdown; (3) loss of adaptive behaviour incorporating acute physical illness; and (4) internal dysregulation. The implications for more specific and partial analysis of HoNOS-LD ratings are briefly discussed.

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The process of psychoanalytic change can seem intangible. One way that psychoanalytic therapists from the Object-Relations school conceptualise the desired change in therapy is a change from the predomination of the infantile Paranoid-Schizoid Position to the predomination of the Depressive Position in the thoughts and feelings of their client. We used the Personal Relatedness Profile (Hobson et al., 1998) to rate whether six people with mild to moderate intellectual disabilities presented with lower ratings of paranoid-schizoid functioning over the course of their treatment. We found that the ratings for co-therapists were surprisingly reliable, with a measureable and significant reduction in ‘paranoid-schizoid’ functioning observed across the year of therapy. We contend that psychoanalytic processes are quantifiable and central to lasting personal change for the better.

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