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

Furthermore a common tendency in people with learning disability “is to feel bound to fit
in with a view of themselves that originates in their parents’ minds as handicapped but
perpetually child-like…in this state, curiosity and knowledge are prohibited” Simpson et
al (2004) p81.
Working with people with learning disability requires that the therapist is receptive to the
primitive feelings evoked in themselves, such as the wish to be rid of the patient, feeling
invaded or overwhelmed, deadened or cut-off, and to face their limitations and feelings of
despair when there is no hope of change (Simpson et al (2004) p132). Simpson likens this
situation to that of the mother with a disabled infant.
Another potential difficulty may be the ending of therapy or of the relationship developed
between the therapist and the person with learning disability. The process of grieving can
be particularly important for these individual’s, who may be sensitised to loss because of
multiple losses in the past. This may make these individual’s feel wary of forming new
relationships. A sensitively planned ending whereby the ending is talked about well in
advance is essential for clients to be able to trust and become close to others (Matttison
and Pistrang, in Simpson et al, 2004). This may be difficult to do if the individual has
severe learning disability or autism whereby they may not have a clear sense of time.
If the person with learning disability has not experienced maternal containment and its
internalisation during infancy, this is thought to have profound implications for therapy
(Lee, in Simpson, 2004). Containment (of the patient’s anxieties) therefore becomes a
crucial aim of therapy allowing the person to develop the capacity to recognise
themselves and their emotional experience. A fragile sense of self that people with
learning disability often have, together with the two-dimensional alliance (i.e. when there
is no space to reflect and develop insightful interpretations) they often create makes
understanding and interpretation difficult (Lee, in Simpson, 2004). There are many
factors relevant to individuals with learning disability that make them more likely to be
dependent on the therapist leading to a two-dimensional alliance.
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