Treatment of self-harm in a learning-disabled woman using a combination of psychoanalytic and mentalization-based psychotherapy

Abstract

Learning disability is a debated term that nevertheless refers to a group of people who may at times need psychological intervention. This paper reviews the meanings given to this group of people and the impact on the parents and the child when the child is known to have a learning disability. Psychotherapeutic work with a patient with severe mental health difficulties on an in-patient unit is described. The theoretical work that supported the treatment was derived from two divergent approaches: psychoanalytic and mentalization-based. These were used at different points during treatment and the paper aims to demonstrate how this way of working can be of use with this type of presentation.

Keywords:

• learning disability
• self-harm
• mentalization-based treatment
• psychoanalytic psychotherapy
• severe mental health problems

Acknowledgement

I would like to thank Jack Nathan, Consultant Psychotherapist at the Maudsley Hospital, for his valuable supervision of the treatment of this case and his support and help in writing the paper.

Notes

1. In this paper, I have used the descriptive terms employed by the authors of the works that are cited.

2. A cognitive assessment at the termination of therapy resulted in a ‘low average’ IQ figure of 80 using the WAIS III UK (1997). This is statistically significantly higher than the earlier assessment and is consistent with the clinical experience of the staff. Her abilities in writing and her capacity to think are reflected in this higher figure. It means that Joan, technically, no longer had a learning disability. This result confirms Sinason's concept of ‘secondary handicap’ and Simpson's view that a mild learning disability may be the result of psychological factors.