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

There are many issues that the psychodynamic perspective may be of value for. These
include working on the existence of the disability itself within the individual, loss of the
normal self, sexuality, dependency, attachment and fear (being part of a group that
society wishes to eliminate) (Hollins, 2000). Furthermore, much has been written from
this perspective on grief and trauma. Hollins (2000) describes how emotional distress or
mental illness may be disguised or expressed behaviourally. Hence experience and skill
are needed to put into words what someone cannot say for themselves and a willingness
to see whether the person can understand more than they can communicate in words is
essential.
The psychodynamic model holds that past trauma has a major role in shaping the person
with learning disabilities’ interpersonal behaviours (Sinason, 2002). Trauma is common
in learning disability and includes physical, sexual, emotional and financial abuse as well
as neglect and discrimination (Emerson, Hatton, Felce and Murphey, 2001). The
perceived difference between ‘them’ (with learning disability) and ‘us’, allows the
development of negative projections. The process of ‘being there’, holding and
containing the person’s experience and providing the opportunity for a non-abusive
attachment is thought to allow the person to introject this ability (Corbett, Cottis and
Morris,1996). Corbett et al identified the therapeutic task in this case to be to ‘witness,
protest and nurture’. To witness is to bear to hear or think about the client’s experiences,
to protest is to clearly acknowledge and communicate that the abuse is wrong and to
nurture is to provide a safe and secure new relationship. Moreover, often the pattern of
responses following a disclosure of abuse is similar to those following bereavement, such
that denial, anger, weeping and numbness are all common responses.
This perspective holds that the person's psychological and emotional development is
affected by the presence of intellectual impairment and by the sensory and physical
disabilities that may accompany this. The quality and reciprocity of communication and
physical contact with the primary care-giver can be impaired to varying degrees,
potentially resulting in fragility of emotional attachment, delayed development of self and
object constancy and impairment of symbol formation and of separation-individuation of
self from care-giver (Banks, 2003).
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