This report details the assessment and intervention carried out with a couple, Paula* and Bob*, who both had a moderate learning disability. Paula was referred to the Psychology Service for some work focussing on difficulties in controlling her responses to anger. This report discusses the assessment and offers a formulation from a cognitive behavioural perspective, also drawing on ideas from psychodynamic and systemic theories. It was necessary to work within the system that supported Paula, which included some joint work with Paula and Bob and work with their carers. The assessment and intervention were not straightforward and flexibility was required throughout in order to gain an understanding of the situation and offer an appropriately focussed intervention. The outcome and reflections on the work are discussed.