This piece considers disablism with particular reference to the physical, clinical spaces often used to practice psychoanalytic psychotherapy, and psychotherapy more broadly. We ask, where exclusionary and disabling clinical, teaching, working and training spaces continue to be used, how might we think about the states of mind that sustain this? We suggest that this in part reflects unconscious anxieties in action around impairment (which we differentiate from the process of disablement) which act to impair thinking and assist us to accept, tolerate or minimise the significance of such practices. In relation to this specific focus, we note that while a psychosocial understanding of disability has been emerging from the work of a small minority in recent years, disability and disablism remain often ignored or pathologised, and a medical model remains implicitly influential. In a limited way, we consider the policy approaches of registering organisations. We argued for further research, understanding, promotion and upholding of disability access standards.