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Learning Disability Section

As in other fields government cuts to funding of social care have led to difficulties for people with learning disabilities. Dr Valerie Sinason ran an evening seminar called "The Unkindest Cuts" in July 2016 at the Freud museum.

Reducing length of hospital stay remains a priority in NHS services and recently a drive to reduce antipsychotic prescribing. These initiatives might have resulted in more funding for psychotherapy but instead positive behaviour support (PBS) is the favoured approach being pushed into services by various initiatives. This is essentially using a behavioural model and a care plan used to modify behaviour. It is an indirect approach through care home staff, changing their responses. Psychoanalytic approaches are still essentially undervalued in LD.

David David O’Driscoll has written several articles and opinion pieces over the year and Georgina wrote an opinion piece published in 'Learning Disability Practice' aimed mainly at nurses on 'The Value of Psychodynamic Psychotherapy'.

Georgina Parkes had also been asked to collaborate on a chapter on psychotherapies for the upcoming 'Oxford textbook of the Psychiatry of Learning Disability'. There will certainly be a section on psychoanalytic psychotherapy.

The Institute of Psychotherapy and Disability has been working on a monograph series of books through Karnac. The first book is likely to be called Being Human around the influence of the work of Valerie Sinason. It is in press with hope to be published later this year. Both Georgina and David have contributed chapters. Sadly, the series editor and a leading thinker and practitioner in the field of psychoanalytic therapy for people with learning disabilities Dr Alan Corbett died at the end of last year. It is a great loss to our field.

Section Lead David O’Driscoll 

Conference Report

No Going Back: Psychodynamic Perspectives on Community Living for People with Learning Disabilities

4 October 2013, Hatfield, Herts

The HPFT trust, in partnership with the Centre for Learning Disability Research, Hertfordshire University and the APP, organised this conference. The event was well attended, with over seventy delegates; the majority from within our trust, but also from as far away as Bristol, Manchester, and Derbyshire.

Tom Cahill opened the day with an historical account of how services have developed in Hertfordshire, from the impersonal wards of the many long stay hospitals to the exciting future development at Kingsley Green. Tom’s themes were followed up in the keynote speech by Professor Jan Walmsley, an independent researcher with an honorary position at the Open University, who gave an overview of where we are now in regards to learning disability services after the long stay institutions have closed and people moved into community services. Walmsley made a number of telling observations, such as how in the majority of the literature people with learning disabilities are portrayed as happy and smiling, which leaves us wondering how people can then express their sad or difficult feelings.

The self advocate, Carole Lee, then discussed her experiences of receiving services in a community setting, including her mental health experiences. Carole was very positive about the help she received from the trust’s specialist learning disability psychotherapy service after her mother died. She also discussed her work in 2001 for the Government White Paper, Valuing People, as part of the self advocate team, work for which Carole received a CBE. Carole talked about moving to live in her own flat and how she had had to become used to the silence. She talked about the current difficulties of recruiting self advocates now.

Professor The Baroness Sheila Hollins discussed both presentations as well as her own multi-faceted role, not only as a learning disability professional but as a mother of a child with a disability and now as a politician.  Baroness Hollins, former professor of Psychiatry of Learning Disability and president of the BMA and Royal College of Psychiatrists, is an independent cross bench peer in the House of Lords; she makes good use of her role to advocate for people with learning disabilities by putting her hand up and asking: what about people with learning disabilities? She talked about the stigma people with learning disability face, including more subtle forms such as when faced with articulate people when you have no similar ability to respond, using the example of her son. She founded and chairs ‘Beyond Words’, publishing a series of picture books e.g. ‘Sonia feels sad’.

In the afternoon sessions, after the workshops, Jon Taylor, Consultant Forensic Psychologist and Psychotherapist, gave an entertaining and optimistic presentation on working in a forensic setting, Rampton National High Secure Hospital for people with learning disabilities, where he has set up a therapeutic community. Taylor discussed the challenges of such an approach within such a challenging setting, including staff swapping shifts because they did not want to attend groups and listen to often painful topics under discussion. Professor Nigel Beail, a clinical psychologist at the University of Sheffield and head of psychological services in Barnsley, gave an overview of the practice of psychodynamic psychotherapy with people with learning disabilities, and how to adapt the practise of psychotherapy. This presentation was a key state of the art overview of what we know about working with this client group and the psychoanalytic method. Beail’s presentation was based on not only his research but his clinical work as a psychoanalytic psychotherapist. He talked about the client directing all their efforts to maintaining their own psychic equilibrium, which, by the time they reach therapy, is dysfunctional; and the purpose of therapy is to disturb this and ultimately bring about change. He discussed the basic techniques of listening and observing, information giving and education which are not often part of traditional psychoanalytic techniques, exploring, reflecting, confronting and attending to the countertransference.

The afternoon was chaired by Jackie Kelly, Hertfordshire University’s head of the department for Nursing. We are now hoping that a major outcome of the conference will be an opportunity to develop a postgraduate short course on psychodynamic thinking at the University of Hertfordshire, Centre for Learning Disability Research.

This was also summed up by the evaluation forms with a general theme of wanting more, either more time for each speaker, more discussion and more events like this. Delegates found it useful and helpful in their work and inspiring. One person gave emotional feedback that the day had helped them to find a way forward in terms of their current job, saying they had a lump in their throat. ‘Thank you for an inspiring day,’ another said. ‘I work in residential care and do not fully understand your language but found the day interesting, insightful, and somewhat motivating, very good day.’ And lastly, ‘Should be delivered to every psychiatry trainee at the beginning of their training and every year after that. Please, please persevere and do it again.’

David O’Driscoll, Psychotherapist
Dr Georgina Parkes, Consultant Psychiatrist