ABSTRACT
Freud (1904) declared that ‘a certain measure of natural intelligence’ was required of patients entering psychoanalysis. This misconception went largely unchallenged throughout much of the twentieth century. It began to crumble in the 1980s, challenged by the pioneering work of clinicians such as Valerie Sinason and Anne Alvarez in the UK and authors such as Johan De Groef and Evelyn Heinemann (1999) in wider Europe. As already acknowledged in this book, Valerie Sinason (1992) is, arguably, the foremost theoretician and practitioner in this field, gifting us with invaluable concepts such as those of primary and secondary handicap, disability as a defence against trauma, and the handicapped smile. All of these concepts have a particular relevance to the work I wish to discuss in this chapter, namely psychoanalytic psychotherapy with people with severe intellectual disabilities. I will explore the growth of such work and examine ideas of psychological mindedness and intellectual capacity as indicators of readiness to engage in an analytic process. The emerging notion of mentalization will be considered, with particular references to a man with severe intellectual disabilities and Down’s syndrome, and I will introduce here the concept of the disability transference. I will also touch on some issues relating to the psychoanalytic frame in which this work is conducted.
