Using systemic and psychodynamic psychotherapy with a couple in a community learning disabilities context: a case study



Accessible summary

  • • Systemic practice is about working with all the people who are important in someone’s life. Important people, such as friends and family, are seen as the ‘system’ around a person. This way of working does not see the problem as belonging to one person, but as belonging to the whole system.
  • • Psychodynamic psychotherapy is about trying to understand what’s happened in someone’s past and how this might be affecting their life today. People sometimes find themselves getting into the same difficulties in relationships again and again. This way of working tries to understand why the person has become ‘stuck’ in this way. The therapist will think about the client’s feelings and wishes about their life and their relationships. They will also think about the relationship that grows between therapist and client. Talking about the relationship between therapist and client can help people to understand problems that they have in other relationships.
  • • This case study shows how psychological theory can help the therapist to decide what to do in therapy and how best to work with the client/s in understanding the problem.


This paper describes the process of couple therapy with a client who has a mild learning disability and cerebral palsy, and her partner, who also has cerebral palsy (all information has been anonymised and pseudonyms are used throughout). Informed consent was gained from both individuals for the purposes of writing about their case. Therapy spanned twelve sessions and was informed by systemic and psychodynamic ways of thinking. Formulations are discussed, and psychological theory is linked to what happened in the therapy room. The current study takes a reflective stance and discusses the process of therapy, which includes successes as well as pitfalls. Pertinent issues for people with learning disabilities are discussed in terms of power dynamics, the impact of physical disability, capacity to consent to therapy and the effects of abuse.