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This paper aims to discuss the work of Dr Valerie Sinason and her contribution to working with people with an intellectual disability with psychotherapy.

Dr Valerie Sinason is a psychoanalyst, and the author is trained in psychoanalytic psychotherapy.

The author believes there is important value in reading Valerie Sinason's contribution to the literature of psychotherapy with people with intellectual disabilities.

It is a review of Sinason’s contribution, and the author believes she's very original and important thinker.

After a varied and confused period from the days of Freud to the 1980s, psychotherapy for people with disabilities began to be recognised as having value. Several strands of development occurred at the same time and came together in the early 1980s. These strands will be discussed, the way they came together and what has happened since.

Historically, professionals did not consider that people with learning disabilities could make use of psychoanalytic psychotherapy because of limitations of intelligence (Symington, 1981; Symington, 1993; Sternlicht, 1965). Additionally, many believed that people with learning disabilities enjoyed immunity from emotional stress and psychiatric disturbances (Fletcher, 1993). Maladaptive behaviours were perceived as a manifestation of the condition of learning disability and not as a possible sign of psychiatric disorder or emotional problems. However, over the last decade there has been a growing realisation that people with learning disabilities have emotional problems in the same way as others, but are in some ways more vulnerable to developing psychiatric and psychological disturbances. Psychoanalytic practitioners wishing to undertake outcome research have experienced difficulties in finding a measuring device that understands the subtleties of change in the internal psychological structure over time. PORT and DMT (the Percept‐genetic Object Relation Test and the Defence Mechanism Test) are two projective tests that have been extensively validated in Sweden. This paper explores the use of the PORT and DMT outcome measures in the context of Anglo‐Swedish psychotherapy research.

Individual psychodynamic psychotherapy for people with learning disabilities has been more available since the 1980s, with numerous case studies and reports of effectiveness, yet little is know about the history of psychodynamic psychotherapy. This paper is a historical account of the international development of psychodynamic psychotherapy for people with learning disabilities. It discusses some of the clinicians' case reports, views and conclusions. It is important that, as therapists, we continue to learn and develop. This is a story of ‘opportunities lost’. Although a number of therapists were well‐placed to develop psychotherapy as a valuable treatment option, it did not happen. The paper discusses the reasons, ranging from widespread therapeutic pessimism to inability in the therapist to process the ‘disability transference’. It outlines the various British contributions before and since the ground‐breaking and well‐known work of Valerie Sinason, whose 1992 book is still the most influential contribution. Psychodynamic psychotherapy has developed more of a tradition than other therapy approaches in this field, but there is still only sparse literature on and recognition of this work.

This paper charts the development and practice of disability psychotherapy for the author and for services.

A personal account relating events to the development of thinking and practice.

The author suggests that a paradigm shift has occurred over the 30 years to a position of “doing with” as opposed to “doing to”.

This has not previously been put forward as a way of understanding present day services.

The purpose of this paper is to investigate the experiences of psychologists in considering the barriers to people with intellectual disabilities being able to access mainstream mental health services.

The information relating to participant experiences was gathered by conducting two focus groups: one with psychologists working in the adult mental health service and the second with psychologists working in the learning disability service. A thematic analysis was used to determine the main themes from each of the focus groups.

The overarching themes for the psychologists in the adult mental health service related to: service restrictions; confidence in their ability/skills; and resistance to change. The overarching themes for the psychologists in the learning disability service reflected: future thinking; protection; pessimism; and clarification around mental health and learning disability.

The discussion includes consideration of the dynamic positions of the two services and recommendations for an integrated system of working.

The purpose of this paper is to reflect on putting a paradigm shift into practice to become a disability psychotherapist (Frankish, 2013a).

A personal reflective account.

The author suggests seven conditions necessary or advisable for growth of disability psychotherapy (DP) within the workplace.

Strategies to help implementation of DP have not been published to date.

This article emphasises the importance of meeting the counselling and therapy needs of people with learning difficulties who have been sexually abused, citing a case study example of the themes, issues and benefits which this way of working can generate.