Introduction

Intellectual disability is an intersubjective phenomenon. The troublesome, confusing weight of a cognitive deficit comes into sharpest relief within the confines of a relationship. ‘A’, who has an intellectual disability, seeks to communicate with ‘B’, who does not. The success of the communication is not dependent on A's relatively low IQ, his problems with retaining memory or his struggle to form a narrative. For the communication to have meaning relies largely on B's capacity to recognize the limits of A's verbal skills, and to take active steps to compensate for them. If B does not recognize the disability, or is simply uninterested in it, the communication will falter and A will feel even more disabled and misunderstood than before. If B thinks carefully about, for example, the number of syllables A can bear a word to have, A may end the conversation feeling heard and less disabled.

In collating three papers to illustrate the use of psychoanalytic psychotherapy with patients with disabilities, I approached three practitioners whose long clinical histories encompass the salient points of disability psychotherapy. Disability psychotherapy refers to psychotherapy where the patient has a recognized disability and the therapist takes active steps to ensure that the disability does not prevent something therapeutic from happening. A question I sought to explore in approaching this journal concerned specialism and niche. In creating a term to describe this work, are we implying or declaring that it lies outside the parameters of conventional psychotherapy? My hope is that each paper describes a psychotherapeutic process that has notable diversions from the mainstream but that still belongs within it. Valerie Sinason's paper introduces the concept of an analytic boundary that can breathe - a far cry from the notion of a static frame that constricts rather than allows therapeutic movement. The insecurity that underpins an overly rigid boundary may be thought about, in th