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Yorke, C. (1980). Some Comments on the Psychoanalytic Treatment of Patients with Physical Disabilities. Int. J. Psycho-Anal., 61:187-193.

(1980). International Journal of Psycho-Analysis, 61:187-193

Some Comments on the Psychoanalytic Treatment of Patients with Physical Disabilities

Clifford Yorke


In a recent paper Earle described her application of psychoanalytic knowledge to the task of helping children who undergo amputation for bone cancer. In this work she examines the 'coping mechanisms' developed by these children in dealing with a painful reality. Where these mechanisms are effective she supports them; where they are ineffective she helps the child to modify them.

In discussing the psychoanalytic treatment of patients with physical disabilities, the present author describes a group of patients who believe that the physical disability itself is responsible for every anxiety and every internal disturbance. It is argued that the analysis proper of such patients can only begin after the analyst has successfully undermined the 'coping mechanisms' which underlie the patient's need to ascribe all his difficulties to his disabilities.

A second group of cases presents difficulties of a different kind. Here the handicap is consciously or unconsciously excluded altogether from the patient's problems. Some of the technical problems involved in working with such patients are briefly described.

The third group presents a different technical challenge. These are the patients who develop a physical disability in the course of analysis but who begin treatment without any such difficulty. A discussion of some of the attendant technical problems includes a brief consideration of those analyses where the aim of the treatment has to be modified.

Lastly, in some cases the disability (blindness, deafness, restriction of motility, etc.) has arisen in early life and has so ensured that the ego which the patient brings to analysis is itself deviant or arrested in certain respects, and may thus affect both technique and prognosis.

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