British Journal zyxwvutsrq of Medical Psychology zyxwvutsrqp (1997), 70, 35-49 zyxwvut 0 1997 The British Psychological Society Printed in Great Britain 35 zy The treatment of chronic post-traumatic nightmares using psychodynamic-interpersonal psychotherapy: A single-case study Stephen Kellett* and Nigel Beail Department zyxwvutsr o f Psychology, University of Sbefild, Western Bank, Shefild SlO 2TP, UK This article presents a single-case experimental study of a woman suffering a traumatized reaction to a road traffic accident (RTA). In addition to meeting the DSM-IV (APA, 1994) criteria for the diagnosis of PTSD, the client suffered recurrent bizarre nightmares. The client reported at assessment, that each night her dreams were dominated by a terrifying hooded cloaked faceless figure. The central aim of the study therefore was to assess the efficacy of a psychodynamic-interpersonal (PI) style psychotherapy in the context of an unusual PTSD reaction. The methodology employed an zyxwvuts A/B multiple baseline time series design, with six month follow-up. A and B represent a series of dream diary observations under two conditions: assessmendbaseline (A) and treatmenthtervention (B). Treatment consisted of a manualized psychody- namic-interpersonal (PI) psychotherapy to facilitate insight into the content and meaning of the nightmares. The intervention reduced the frequency and associated distress of the nightmares to zero. Follow-up at six months noted the long-term efficacy of the psychotherapy. The study is discussed with reference to the assimilation model of psychotherapeutic change. A close linkage between traumatic events and the production of psychological distress has been acknowledged in society for many hundreds of years. The two world wars produced synonyms for the psychological distress such as shell shock, war neurosis, soldiers’ heart, combat exhaustion and flight fatigue. Studies on non-combat populations such as survivors of fire (Cobb & Lindemann, 1943), explosion (Leopold & Dillon, 1963), flood (Titchener & Kapp, 1976) and concentration camps (Trautman, 1964) illustrated that survivors reported remarkably similar symptoms to veterans of combat situations. As a result of these studies, some clinicians and researchers assert that there is a single post- traumatic syndrome, which may be experienced after exposure to a wide variety of relatively severe stressors. However, the concept of a spectrum of post-traumatic disorders has been suggested in recent years (e.g. Kolb, 1989) as more clinical and research evidence enters the literature. Niederland (1968) observed that ‘the concept of post-traumatic neurosis does not appear sufficient to cover the multitude and severity of clinical manifestations’ of PTSD. Similarly Brown & Fromm (1986) speak of ‘complicated PTSD’. Clinical observations have noted three broad areas of psychopathology which demarcate simple from * Requests for reprints.