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

Conclusion
Although systemic and psychodynamic therapies are used more widely than ever before
with individual’s with learning disability, there are many potential challenges. These
include the primary issue of dependency which is perhaps more relevant to this client
group than to others. The psychodynamic perspective holds that the term learning
disability itself renders the person in a position of inferiority and dependence. The
systemic approach would add that if the position of dependence has been the most
familiar one to a person it will lead the therapist into a constant struggle to reach a
balance between giving the individual a voice and not perpetuating the stigmatisation and
scapegoating that may already be a problem in the system versus not alienating the family
or wider system. The therapist will need to be mindful of the power shifts at all times.
The issue of dependency can have implications for the therapeutic relationship,
transference/counter-transference i.e. what the individual with learning disability may
engender in the therapist due to the projections of their parents and societies treatment as
well as endings which may trigger grieving.
The psychodynamic idea of a fragile sense of self and the two-dimensional alliance
makes reflection and interpretation difficult. This may occur more often for those with
learning disabilities because their lives are more often marked by abandonment, abuse,
social stigmatisation and inadequate development of coping mechanisms that in turn
result in fragile emotional states. These factors again relate to dependency where the
therapist and client become stuck in an alliance where there is no capacity for meaning. If
the individual is therefore considered to be at an increased risk of having less ability to
contain their feelings it becomes difficult for the psychodynamic therapist to know how
much they should challenge the defences of and make interpretations of these
individuals’ processes, as the risk may be a catastrophic and perhaps overwhelming
anxiety.
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