DClinPsy Portfolio Volume 1 of 3 - University of Hertfordshire ...

Introduction
Historically there has been little psychotherapeutic work using either systemic or
psychodynamic models with people with learning disability. Learning disability is
defined as ‘a state of arrested or incomplete development of mind which includes
significant impairment of intellectual and social functioning, an IQ below 70 with
childhood onset or before’, (ICD-10, 1993). This dearth was largely due to the prevalent
view for the majority of the twentieth century that talking treatments were not appropriate
or relevant for people with learning disability due to their limited intellectual/verbal
abilities (Hodges, 2003). Therefore until recently a learning disability diagnosis was
most often an exclusion criterion for psychotherapy, despite many of the estimated
300,000 children and adults with severe learning disabilities in the UK, and the one
million with a mild learning disability having co-existing difficulties with a psychological
basis or consequence. For example biological issues include cognitive deficits and
additional physical disabilities; emotional/ psychological difficulties include adjustment
to the disability for the individual and the system, attachment issues, abandonment,
rejection, grief and trauma; social issues may include powerlessness, stigmatisation and
poverty (Hollins, 2000).
Over the past ten years psychotherapy for people with learning disabilities has been
increasingly advocated and a survey of the interventions used by clinical psychologists
working in learning disabilities in the UK found that 31% of respondents used
humanistic/person centred and 17% used psychodynamic methods. Moreover, 41%
considered themselves to have some competency in working psychodynamically with
these clients (Nagel and Leiper, 1999). A survey carried out by the Royal College of
Psychiatrists' working group on psychotherapy in learning disability (2002) found that
83% of respondents said that there was a moderate or high demand for psychotherapy for
people with learning disabilities. Despite this advance it still remains the case today in
Britain that provision of psychotherapeutic services, such as systemic therapy, offered to
this client group remain patchy (Baum and Lynggaard, 2006).
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