The doctor working with people with mental handicap may need to develop entirely new techniques. Interpretive therapy is more difficult. There is a need to be very clear and simple in the conversation. It may be that the doctor is in the role of sex educator (Fraser, 1991), and needs to explore what is really going on in the relationship. People who have been institutionalized have quite often been strongly indoctrinated with the idea that they must not have sex before marriage. They may not know what this means. If marriage occurs it can be very confusing and people often feel guilty. For instance, after a long engagement, maybe up to as much as 10 years, it can be incomprehensible that it is now all right to have intercourse: indeed it is expected. A whole mixture of feelings, including naughtiness and fear of punishment, may exist.
If the doctor endeavours to continue with his or her usual technique, he or she may feel at a loss when inconsequential remarks are made, like, ‘I am going to tea with Jack today’ or ‘Look at my new shoes’. A new style has to be developed where the comment is acknowledged, but then the doctor is able to pull back to the matter in hand.