Forty-four worthwhile interventions: Clinician-rated attachment style and outcome of psychodynamic psychotherapy for people with intellectual disabilities

An individual’s internal model of attachment security or insecurity can be judged by clinicians during assessment. When clinicians judge clients’ style to be characterised by security, there may be lower case severity (Skelly & Reay, 2013).This study is an examination of the relationship of clinicians’ attachment classification to outcome of psychodynamic psychotherapy in people with intellectual disabilities, measured through change in HoNOS-LD scores over time. We examined 44 cases of psychodynamic psychotherapy provided within two specialist community psychology services in the Tyne area over a two-year period.Results suggest that preoccupied or unresolved attachment was indicative of high case severity at assessment, but also predicted greater gain during therapy. A dose effect was observed, with more sessions given to clients rated as preoccupied or unresolved. Although some clients required more than 20 sessions, the average session number was markedly lower than that. There was no effect of age or gender, but higher IQ was associated with more change on one of the HoNOS-LD Factor Scores (Loss of Adaptive Functioning).This study provides preliminary evidence that psychodynamic psychotherapy for distress and personality conditions may be differentially effective for people with secure and insecure attachment ratings. Preoccupied or unresolved attachment styles may have resource implications in requiring longer psychological interventions, at least with this therapy orientation.