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  • Cited by 3
  • Print publication year: 2007
  • Online publication date: December 2009

21 - Psychodynamic approaches to people with intellectual disabilities: individuals, groups/systems and families

from Part III - Treatment and therapeutic interventions



There have been many barriers preventing people with intellectual disabilities (ID) from accessing psychodynamic treatments. Therapists, notably Freud in the early 1900s and later Carl Rogers in the 1960s, believed that people with ID were unsuitable for psychodynamic therapies, as they did not have the intelligence seen as a prerequisite for this mode of treatment. There were also assumptions that people with ID were immune to emotional distress or did not understand emotional pain and suffering, and so were not affected by it. Until relatively recently, treatments have tended to be social (e.g. institutionalization), behavioural, or pharmacological, despite the growing trend towards more talking treatments in the non-ID population.

What is psychodynamic psychotherapy?

The term psychotherapy includes any type of talking therapy. The Department of Health's review of strategic policy on National Health Service psychotherapy services in 1996, advised that every mental health professional should be able to offer supportive and psycho-educational therapy as part of a combined package of care. This should include engaging the person sufficiently so that they return for follow up, asking exploratory questions if they don't understand, and listening to their difficulties.

Essentially, any type of treatment that involves talking to the person – either individually or in a group, as part of a care network or family – can be approached psychodynamically.

Arthur, A. (2003). The emotional lives of people with learning disability. British Journal of Learning Disabilities, 31, 25–30.
Beail, N. (1998). Psychoanalytical psychotherapy with men with intellectual disabilities: a preliminary outcome study. British Journal of Medical Psychology, 71, 1–11.
Beail, N. (2001). Recidivism following psychodynamic psychotherapy amongst offenders with intellectual disabilities. The British Journal of Forensic Practice, 3(1), 33–7.
Beail, N. & Warden, S. (1996). Evaluation of a psychodynamic psychotherapy service for adults with intellectual disabilities: rationale, design and preliminary outcome data. Journal of Applied Research in Intellectual Disabilities, 9(3), 223–8.
Bichard, S. H.Sinason, V. & Usiskin, J. (1996). Measuring change in mentally retarded clients in long-term psychoanalytic psychotherapy. The National Association for Dual Diagnosis 13, 6–11.
Brown, H. & Turk, V. (1994). Sexual abuse in adulthood: Ongoing risks for people with learning disabilities. Child Abuse Review, 3(1), 26–35.
Department of Health (1996). A Review of Strategic Policy on NHS Psychotherapy Services in England. London: NHS Executive.
Department of Health (2001). Valuing People: A New Strategy for Learning Disability for the 21st Century. London: Department of Health.
Department of Health (2004). Organising and Delivering Psychological Therapies. London: Department of Health.
Frankish, P. (1989). Meeting the emotional needs of handicapped people: a psycho-dynamic approach, Journal of Mental Deficiency Research, 33, 407–14.
Goldberg, D., Magrill, L., Hale, al. (1995). Protection and loss: working with learning-disabled adults and their families. Journal of Family Therapy, 17 (3) 263–79.
Hollins, S., Horrocks, C. & Sinason, V. (1998). I Can Get Through It. Books Beyond Words. London: Gaskell Press and St. George's Hospital Medical School.
Hollins, S. & Sinason, V. (2000). Psychotherapy, learning disabilities and trauma: new perspectives. British Journal of Psychiatry, 176, 22–36.
Hollins, S. & Sireling, L. (2004). When Mum Died, 3rd edn. London: Co-published by Books Beyond Words, St. George's Hospital Medical School and Gaskell Press.
Macdonald, J., Sinason, V. & Hollins, S. (2003). An interview study of people with learning disabilities experience of and satisfaction with group analytic therapy. Psychology and Psychotherapy: Theory, Research and Practice, 76, 433–53.
Parkes, G., Mukherjee, R. A. S., Karagianni, al. (2004). Characteristics and outcomes of referrals to a psychotherapy service for people with intellectual disabilities. Journal of Intellectual Disability Research, 48, 291.
Prout, H. T. & Nowak-Drabik, K. M. (2003). Psychotherapy with persons who have mental retardation: an evaluation of effectiveness. American Journal of Mental Retardation, 108(2), 82–93.
Royal College of Psychiatrists (2004). Psychotherapy and learning disability (Council Report CR116). London: Royal College of Psychiatrists.
Roth, A. & Fonagy, P. (1996). What Works for Whom? A Critical Review of Psychotherapy Research. New York: The Guildford Press.
Sequeira, H., Howlin, P., and Hollins, S. (2003). Psychological disturbance associated with sexual abuse in people with learning disabilities. British Journal of Psychiatry, 183, 451–6.
Sobsey, D. (1994). Violence and Abuse in the Lives of People with Disabilities: The End of Silent Acceptance?Baltimore, MD: Paul H. Brooks.
Sinason, V. (1992). Mental Handicap and the Human Condition: New Approaches from the Tavistock. London: Free Association Books.
Sinason, V. (2004). Learning Disability as Trauma and the Impact of Trauma on Learning Disability. Unpublished Ph. D. thesis, Senate House, London.