ABSTRACT
Valerie's early work showed that a client does not need cognitive intelligence in order to benefit from psychotherapy and that an intellectually disabled client is likely to make considerable improvements in linguistic and emotional functioning following treatment with psychoanalytic psychotherapy. Secondary handicap can take the form of severe personality maldevelopment which is linked to, and added to, the original disability. Secondary handicap can also serve as a psychotic defence against trauma. Secondary handicap as a psychotic defence against trauma is also evident in the aggressive cuddling by Down's Syndrome children through which they enjoy the violence of abusive physical contact whilst showing ostensible affection. Valerie was particularly concerned at the high proportion of her intellectually disabled clients who had been sexually abused. There are significant challenges for the psychotherapist treating an intellectually disabled client because of the particular demands of this group.
