Single case experimental evaluations of psychodynamic and cognitive‐behavioural psychotherapy: examples of methods and outcomes

Abstract

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.

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

“…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.…”

“…The client with ambulophobia also completed the Brief Symptom Inventory (Derogatis, 1993), the Inventory of Interpersonal Problems-32 (Barkham et al, 1996;Kellett et al, 2003), and the Rosenberg Self-Esteem Scale (Rosenberg, 1965;Newman et al, 2003) at the start and end of treatment. Kellett et al (2009) reported statistically significant reductions in "somatisation", "stating well", and "refusal to engage" and statistically significant increases in "willingness to engage" for the client with hypochondriasis following psychodynamic intervention. For the individual presenting with ambulophobia, data showed that the intervention was ineffective -there was no significant change in any of the target variables following psychodynamic intervention.…”

“…Single-case quasi-experimental design studies Kellett et al (2009) used an A/B (baseline vs treatment) design to evaluate the effectiveness of psychodynamic psychotherapy for a woman with a mild learning disability and hypochondriasis and for a man with a learning disability (severity not stated) with ambulophobia (fear of walking). For the client with hypochondriasis, the staff team recorded the frequency of "aggression", "somatisation", "refusal to engage", "willingness to engage", and "stating well" (e.g.…”

How service‐users with intellectual disabilities understand challenging behaviour and approaches to managing it

“…This would safeguard against potentially harmful processes associated with over‐reliance on one style (e.g., self‐blame, learned helplessness) and would enable change strategies to be implemented with greater effectiveness. There is a body of literature demonstrating that psychotherapeutic models such as cognitive analytic therapy, narrative therapy, solution‐focused therapy and cognitive‐behavioural therapy can be successfully applied with individuals with intellectual disabilities (Beail, ; Foster & Banes, ; Hartley et al, ; Kellett, Beail, Bush, Dyson, & Wilbram, ; Oathamshaw & Haddock, ; Smith, ; Vereenooghe & Langdon, ). Change strategies derived from these understandings could then be implemented either in continued individual therapy or in some of the group skills training models described above.…”

Expanding the Single-Case Study: A Proposed Psychoanalytic Research Program

“…As noted earlier, an important aspect of using single-case time-series research for psychodynamic psychotherapists is that it is a way for psychotherapists working in private practice (or any clinical setting for that matter) to contribute to research on psychotherapy effectiveness due to its ease of use and implementation (Borckardt et al, 2008;Borckardt & Nash, 2002;Fonagy & Moran, 1993;Kellett et al, 2009). Using clinical practice as a source for research has been encouraged since at least the 1950s, and the first reported use of it was by a psychodynamic psychotherapist (Heil brunn, 1966).…”