You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Both these original books take as their starting points the paucity of psychotherapeutic work with mentally handicapped people; they convincingly challenge the view that learning disabilities render psychoanalytic approaches inapplicable. Both show, with many illustrations, how people with various forms of handicap and disability can benefit from therapy that offers thought and reflection, how meaning can be found and restored in ‘stupid’ manifestations. Their demonstration of psychotherapeutic commitment and imagination is impressive and inspiring. It is also extraordinarily painful in what it reveals about the experience of handicap and disability, the defences elaborated to deal with unbearable realisations, and the many assaults, blows, traumas and failures dealt by inadequate or hostile environments. This is compounded by the constant reminder of the many factors that prevent or limit access by mentally handicapped people to psychotherapy. The financial and institutional resources needed to ensure that a severely handicapped person can attend sessions over a significant period of time are considerable, even where the value of such work is recognised and not felt as useless or threatening.
Valerie Sinason's book will undoubtedly be a landmark in this area for many years to come. Much can be learned from the range, depth and clarity of her case studies which vividly describe many different patients, most with handicaps of long-standing duration but including one patient with Alzheimer's disease. The detail with which she presents the progress (or otherwise) of the therapeutic work, including many of her comments and interpretations, is compelling and illuminating. We are enabled to see, for example, how the noises and actions of someone with no verbal speech at all can be responded to and interpreted, in ways that allow communication and meaning to be established and extended, with the consequent improvements in self-regard. We are shown how the commonly met pheno