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.