The Dose–Effect Relationship in Psychodynamic Psychotherapy with People with Intellectual Disabilities

Abstract

Background Although there is an established body of evidence attesting to the dose-effect relationship in psychotherapy with non-disabled adults, the issue as to whether such a relationship exists for persons with intellectual disabilities has not been previously examined. Dose-effect essentially concerns the amount of psychotherapy required to produce positive results. Method The current study used a naturalistic design to examine and compare the outcomes of three groups of participants with co-morbid psychological problems undergoing treatments of differing lengths (i.e. 'doses') with psychodynamic psychotherapy. Three measures of psychopathology were completed at assessment and at subsequent eight-session intervals until the conclusion of treatment. Each patient received a 3-month follow-up appointment, at which time the measures were again completed. Three treatment duration groups were subsequently constructed and compared via anova: eight sessions (n = 8), 16 sessions (n = 5) and 24 plus sessions (n = 7). Results Results were supportive of a dose-effect relationship, in that outcomes were generally equivalent regardless of treatment duration. Conclusion In short, most change appears to occur in the first eight sessions of treatment, with subsequent outcomes trailing off over time. The clinical implications of the study are discussed in the context of the methodological limitations identified.

The effectiveness of psychodynamic interventions for people with learning disabilities: a systematic review

“…They found that there was a statistically significant positive effect of therapy across all treatment durations and that longer therapy was not necessarily related to better outcomes, but tended to be associated with greater mental health needs. Beail et al (2007) acknowledged the validity issues concerning their findings, with the statistical design being somewhat underpowered due to a small number of participants.…”

“…In all, 13 studies were identified. The studies identified within this review offer some support for the use of psychodynamic therapy with adults with a learning disability experiencing a range of problems including anger, aggression, and behavioural problems (Alim, 2010;Beail, 1998;Beail et al, 2005Beail et al, , 2007Berry, 2003;McCormack, 1991;Summers and Witts, 2003), offending behaviour (Beail, 1998(Beail, , 2001, sexually inappropriate behaviour (Beail et al, , 2007, social withdrawal (Salvadori and Jackson, 2009), bereavement (Summers and Witts, 2003), and hypochondriasis (Kellett et al, 2009). There was also some very preliminary evidence from case studies (King, 2000;Lloyd, 2007) to suggest that CAT may be a useful therapeutic modality in this context, although further, more robust, research is required.…”

“…Positive outcomes (assessed using formal outcome measures) appeared to be maintained at short-term follow-up and longer-term (Beail, 2001), compared to those not receiving treatment (Beail, 2001). Nearly half of participants completed treatment in six months or less (Beail, 2001), with good progress after just eight sessions (Beail et al, 2007), lending support to the application of shorter-term psychodynamic psychotherapy for people with learning disabilities.…”

The Trajectory of Change for Children and Youth in Residential Treatment

“…More specifically, the common usage of the term 'dosage effect' in the adult outpatient mental health literature suggests that patient improvement occurs as a log-linear function based on the number of treatment sessions, with the greater extent of improvement occurring at an early point in treatment while slowly decelerating over time [12]. Subsequent research from the adult outpatient literature has demonstrated the dose-effect relationship for cases of depression [13], interpersonal problems [14], and for therapy in clients with intellectual disability [15]. As previously cited, however, little research or theory exists to examine such a relationship for children within residential treatment [9].…”

Suicidal Individuals and Mental Health Treatment: A Novel Approach to Engagement

“…This finding is clinically significant as engagement in treatment is directly related to entry, participation, and retention, each of which has an impact on the level of symptom relief that can be achieved. For example, research has demonstrated a ''dosage-effect'' in relation to receipt of outpatient mental health treatment, with 25 % of clients experiencing some symptom relief after 1 session, 50 % of clients experiencing measurable improvement after 8 sessions, 60 % after 13 sessions, and 75 % after 26 sessions (Beail et al 2007;Howard et al 1986;Kadera et al 1996). Thus, while it is recognized that other factors, such as the kind of treatment received, play an important role, for thousands of individuals afflicted with mental health problems, helping to facilitate access to and retention in treatment are essential components of the risk prevention process (WHO 2001).…”