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It is worth reading Sinason here on the Because of this, she has not continued
ever-changing terminology around in the tradition of brilliant but isolated
learning disability. “It is doing a grave disability pioneers. The impact of her
disservice to past pioneers to point thinking on my development as a long-
contemptuously to their chosen terms. standing disability psychotherapist
Within another five years, the process of working currently in the NHS is an
euphemism will already be affecting the example of this.
brave new words,” she wrote in 2010. There are criticisms that psychological
This smile is a fixed grin: “People who therapies do not address the underlying
are close to grief and cannot bear it injustices that people experience and that
encourage happiness and smiling.” It is a the emphasis should be on health
defence against the knowledge of trauma promotion. In my view, this is not an
in the patient and the therapist. either-or choice.
An example is society’s guilt about Sinason described her therapeutic
collusion and the creation of defensive Valerie Sinason wrote that disability can be approach as a kind of psychoanalytic
myths about people with learning experienced as a trauma advocacy, in that disability therapists, by
disabilities who are seen to be always understanding their clients’ experiences,
smiling, always happy – yet there is clear Her view is that working are in a privileged position to give voice to
evidence that they are not. psychoanalytically with people with their needs. This may mean that
“Some handicapped people behave like learning disabilities is clinically important psychotherapists play a more active role
smiling pets for fear of offending those and part of a wider struggle for equality, in countering injustice in the lives of
they are dependent on… when people justice and empowerment. This may people with learning disabilities.
depend for their lives on cruel regimes, involve advocating on their behalf in I believe Sinason’s theories are having a
they need to cut their intelligence and some situations. profound impact both on how services
awareness,” she wrote. Sinason became aware of sexual are run and, more crucially, on how lives
abuse during her time at the Tavistock are led.
Secondary handicap and self-injury Clinic and noticed a high rate of these Sinason has written that while
Sinason describes secondary handicap as referrals. Out of 200 referrals, 140 were the psychoanalytic pioneers have
having a protective function in shielding for sexual abuse. been blamed for exclusion and have,
the self from the unbearable memory As a result of these clinical experiences, arguably, hindered the continuity of
of trauma. she put forward that sexual abuse was progress of psychotherapy for people
“I also learned how self-injury in some more likely to lead to psychological with learning disabilities, it is the
children and adults could represent a disturbance in learning-disabled than responsibility of the upcoming generation
‘secondary handicap’ – a displacement cognitively more able victims. to question and develop the thinking
activity that covers up the fear and the Through this work, Sinason has played a around this.
shame around the original difference,” significant role in highlighting this issue
she wrote. and bringing it to greater attention.
This can be linked to the person, who In her writing about how Sinason suggested that violent
can experience the disability as a trauma: psychoanalytically informed
“Opening your eyes… to the realisation psychotherapy helps patients with behaviour can be an attempt
that you will not be an Austen, Einstein, learning disabilities who have been to manage the helplessness
Madonna or Picasso can be painful abused, self-harm could be understood as inherent in trauma
enough to the ordinary adolescent. an attack on the client’s despised body for
Opening your eyes to admitting you look, being unable to prevent the abuse.
sound, walk, talk, move or think differently Sinason put forward the view that
from the ordinary, average person… takes violent and aggressive behaviour, such as This is a philosophy that Sinason has
greater reserves of courage, honesty and kicking, biting and headbutting, can be never hesitated to put into practice
toleration of one’s envy.” understood as an attempt to manage the herself and I remain hopeful that the
Sinason suggested that the therapeutic helplessness inherent in trauma. coming decades will see a blossoming of
task was to get behind the secondary One of the central dynamics the ethos of humanity, respect and
handicap – the angry hurt and painful underpinning the development of equality, that she has espoused through
feelings. This can be explored in disability psychotherapy has been its all her work with patients. n
psychotherapy sessions with the individual. stop-start nature. There have been
If the sessions can be maintained, there is brilliant pioneers across the decades, but Further reading
often an improvement in internal and very little development from one Corbett A. Intellectual disability and
external functioning. generation to the next, with minimal psychotherapy. The theories, practical and
The other key area was sexual abuse. In written theory to develop future thinking. influence of Valerie Sinason. Routledge; 2019
the 1990s, a number of studies However, through her writing, O’Driscoll, D. A short history of psychodynamic
psychotherapy for people with learning
highlighted the vulnerability of people Sinason has developed core theoretical disabilities. Advances in Mental Health and
with learning disabilities. Sinason opened concepts that are continuing to be Learning Disabilities. 2019;3(4): 4-9. https://
the door to providing this kind of support developed by the next generation. doi.org/10.1108/17530180200900032
and therapy to people with learning Perhaps her highly relational therapeutic Sinason V. Mental handicap and the human
disabilities who have experienced the style is as important, which stems from condition: an analytic approach to intellectual
trauma of sexual abuse. her personal characteristics. disability. 2nd edn. London: Karnac; 2010

www.cl-initiatives.co.uk Community Living Vol 35 No 4 | Summer 2022 29