A little learning is a dangerous thing

Abstract

This paper examines the relationship between therapeutic progress and the patient's family or residential situation with reference to the intensive treatment of an adolescent boy who had a severe learning disability and moved placement five times within four years. The idea is explored that the capacity to be thoughtful about emotional distress and to be engaged in learning about one's own mental processes is dependent in part on the human context surrounding the individual. It is illuminated by detailed clinical material using in particular Winnicott's concept of the facilitating environment and Sinason's concept of secondary handicap. The paper also discusses the dilemma for the therapist of whether a thoughtful state of mind and emotional connectedness are always in the interest of the patient's mental health when the external context is so at odds with this and whether retreating into psychic ‘suspended animation’ may sometimes be an adaptive response. Despite this, the author hopes that the paper will contribute to a growing understanding of the potential of psychoanalytic psychotherapy as an intervention for children and young people with severe learning disabilities.

Keywords:

• Frequent placement moves
• professional network
• severe learning disability
• facilitating environment
• emotional awareness
• secondary handicap

Acknowledgement

I remain indebted to Jenny Kenrick for her supervision and help with this case.

Notes

1. It is worth noting that although Pete did grow physically during the period of his therapy, emotionally his sexual development appeared delayed so that his preoccupations remained much more in the latency rather than the adolescent domain.

2. In addition our work benefited unequivocally from expert weekly supervision.