Carers struggled to cope with both the environmental and interpersonal impacts of the hoarding. Lacking both formal and informal networks of support, carers are in need of information and treatment options for themselves and their families. Possible avenues for future clinical and theoretical research are suggested.

Accessible summary Cognitive analytic consultancy involves mapping the dysfunctional procedures and relationships that exist between team and patient using cognitive analytic theory. The study showed no impact on patient outcomes, but a significant organizational impact in terms of team practices and relationships. Cognitive analytic consultancy offers promise in helping in‐patient and community clinical teams manage those patients not suitable for individual or group psychotherapy. Abstract The objective of this study was to evaluate the clinical and organizational efficacy of formulation‐based consultancy to clinical teams using a randomized control trial methodology. Patients in an Assertive Outreach Team (AOT) were randomized into cognitive analytic consultancy (CAC; n = 10) or treatment as usual (TAU; n = 10). CAC consisted of three consultancy sessions with individual team members to formulate and map the dysfunctional roles and procedures adopted by both patient and team. Subsequent changes to practice were then supported via team supervision. Measures of patient and team functioning were taken across four discrete study phases; (1) baseline team training, (2) case consultation, (3) team supervision and (4) 3‐month follow‐up. Team members were additionally interviewed before and following the trial. No differences were evident between CAC and TAU in terms of patient outcomes. However, the climate of the AOT significantly improved longitudinally over the course of the trial, with CAC facilitating enhanced clinical and team practices. The results are discussed in terms of methodological limitations, the advantages/disadvantages of team consultation and the potential for the further development of the CAC model.

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.