Learning Disabilities and Psychological Development in Childhood and Adolescence

Jonathan Cohen

Psychological Counselling Service Columbia University New York, New York

The relationship between learning disabilities and psychological development is a complex, ongoing intrapsychic and psychosocial process. The results of two clinical-psychological investigations about a group of learning-disabled child- ren and a group of learning-disabled adolescents is summarized. Although the learning-disabled youngsters were psychologically more heterogeneous than homogeneous, several common configurations emerged that characterized these children and adolescents: (1) problems in work and learning (due to the learn- ing disability itself and to psychogenic factors related directly and/or indirectly to the disability); (2) chronic, low-level depression and relatively high, free floating anxiety; (3) characteristic unconscious concerns about self and others. In addition, learning disabilities organize psychological development in deter- mining strengths, weaknesses, interests, and defensive strategies. And, the intermittent nature of mild to moderately severe learning disabilities seems to contribute to a sense of being traumatized and to character riqidity. The edu- cational and clinical implications are briefly discussed.

Introduction

In this paper, I will describe how the experience of being learning disabled affects psychological development in a group of children and adolescents with whom I have worked. Parents and educators have long known that the psychological and social difficulties that charac- terize learning-disabled children and adolescents are often as prob- lematic as the disability itself. In fact, this is commonly the case in late childhood and adolescence. Psychosocial problems further complicate

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learning, school work, relationships, and the process of psychological development.

Recent research suggests that being learning disabled contributes to a sense of "learned helplessness" which undermines children's motivation to achieve (Licht 1983). It is also well known that learning disabilities result in frustration and failure, which in turn contribute to low self-esteem and even self-loathing (Rome 1971). Learning dis- abilities adversely affect the child's developing sense of mastery and competence as well as contribute to parental feelings of frustration and inadequacy. The sometimes tragic consequences of such feelings on the child have been noted (e.g., Gardner 1968, 1979). This seems to be particularly the case when the parents (and then later, teachers) do not recognize that the child is learning disabled. Reviews of the psycho- logical effects of learning disabilities have also illustrated how these children and adolescents may develop a remarkably wide range of psychological symptoms, disorders, and maladaptive coping strat- egies, which include avoidance, withdrawal, regression, dis- placement, phobias, somatization, paranoia, impulse disorders, pas- sive aggressiveness, clowning, and depression due to internalized frustration and anger (cf. Silver 1974).

To further understand how being learning disabled affects de- velopment, I studied a group of children and adolescents with whom ! worked in intensive psychotherapy and/or in comprehensive neuro- psychological diagnostic evaluations. I wanted to see what common configurations, if any, emerged in the learning-disabled children and adolescents, how these were similar and different from a group of non-learning-disabled children and adolescents, and how the experi- ence of being learning disabled became interwoven with development. I was particularly interested in the unconscious life of these young- sters, as well as their conscious experience.

After briefly reviewing my clinical method of study and the characteristics of the students studied, ! will summarize the common configurations and several developmental themes that emerged re- garding learning disabilities and personality. And finally, I will briefly discuss some of the implications of these findings.

Method of Study The present report is a clinical investigation based on ten learning-

disabled boys and 15 learning-disabled adolescents (12 male; three female). Details about who these youngsters were diagnostically can be found in Cohen 1985, 1986). In brief, these 25 youngsters came to me for comprehensive neuropsychological diagnostic evaluations and/or psychotherapy. All of their parents were interviewed as were their

PSYCHOLOGICAL DEVELOPMENT IN CHILDHOOD AND ADOLESCENCE 289

current and past teachers. I saw 16 of these youngsters in psycho- therapy (ranging in length from. three months to four years), which provided an opportunity for me to unders tand them in an ongoing and more in-depth manner.

Diagnostically, all were of at least average intelligence: in fact, 17 of them were in the "high average" or "superior" range of intellectual functioning. They evidenced a range of types of specific learning disabilities, severity of the disability, and psychopathology. None evidenced any psychotic or major psychiatric disorders (e.g., affective illness).

In my evaluations and reevaluations of these students, I have at tempted to compare them to a roughly similar group of non-learning- disabled children and adolescents I have seen. I have done this to aid my attempt to understand, clinically and systematically, the unique developmental ramifications of learning disabilities. However, these studies are certainly not a controlled experiment, but rather a clinical analysis designed to generate a series of hypotheses or proposals.

Common Configurations It is well known that psychological, social, and biological factors

are intrinsically interwoven: we are biopsychosocial beings. Although too many investigators, clinicians, and educators have focused on either the psychological or the biological aspects of learning disabilities in a polemical fashion (see Rothstein 1982), the experience of being learning disabled is naturally only one element in the child's develop- ment. It is etiologically useful to differentiate concerns, conflicts, and coping strategies that initially sprung from the disability from those that did not. However, the effects of a learning disability inevitably become interwoven with other concerns, conflicts, interests, strengths, weaknesses, wishes, and adaptive strategies. In time, it becomes increasingly difficult to distinguish the neuropsychological from the psychological and the reactive aspects of the person from the characterological. As I will now describe, being learning disabled not only has a significant effect on various aspects of self-experience and the emotional life of the person, but acts as an organizer of develop- ment. Although these configurations consistently characterized the learning-disabled children and adolescents studied, it is important to note that, overall, they were a more heterogeneous group than homogeneous.

Problems of Work and Learning

The learning-disabled youngsters showed two particular con- figurations of problems with work and learning: (1) problems due to

290 STuoi~s, COMPARISONS, AND CASES

the cognitive disability itself, and (2) problems owing to psychological factors that are directly and/or indirectly related to being learning disabled.

The variety of educational problems due to learning disabilities in childhood are fairly well known (see Benton and Pearl 1978 for review). Because there has been much discussion about the ongoing edu- cational effects of learning disabilities in adolescence and beyond (e.g., Cohen 1983; Cruickshank, Morse, and Johns 1980; Rudel 1981), I will not detail these problems here.

Work and learning problems owing to psychological factors varied tremendously in the children studied. Although the children did evidence a variety of work and learning problems that were psycho- genic, no consistent patterns were observed. However, there seemed to be three psychologically problematic implications of being learning disabled in adolescence: (1) difficulty working in an increasingly inde- pendent manner; (2) difficulty defining what they (rather than what parents or teachers) want to study; and (3) difficulty in being able to compete without undue anxiety (see Cohen 1985a for details).

In the following discussion of the more internal, and often uncon- scious, experience of being learning disabled, it will be easy to see how a variety of concerns, conflicts, and wishes about themselves and others interferes with a realistic assessment of strengths, weaknesses, interests, and ability to learn.

Emotions

The learning-disabled children and adolescents studied evi- denced two major emotional configurations: (1) a low level, chronic depression; and (2) an unusually high propensity to experience dis- tress, anxiety, and panic anxiety. These emotional characteristics were uniquely interwoven into the larger fabric of each youngster's personality.

Virtually all of the learning-disabled children over the age of seven evidenced a chronic, low-level depression. These depressive feelings were not related to internalized frustration, anger due to frustration, as Silver (1974) has described, but rather to the sad feelings of having lost a valued part of self. Often (but not always), this sense of loss was related to part of their "head/brain."

The sad feeling that there is a discrepancy between what one "is" and what one "ought" to be, and the ensuing frustration characterized both groups of youngsters studied. However, only the learning- disabled youngsters showed a low-level, chronic depression and the fantasy that they had lost a valued part of themselves.

It is Unclear how this low-level depression or sad sense of having lost part of oneself is related to learning disabilities. Their learning

PSYCHOLOGICAL DEVELOPMENT IN CHILDHOOD AND ADOLESCENCE 291

disabilities were life-long: they never had "it" to lose. However, their experience may very well have been that they could not do what they sometimes could. As I will describe below, the intermittent nature of mild to moderately severe learning disabilities may contribute impor- tantly to this experience and other psychological difficulties.

I suspect that this low-level, chronic depression reflects a psycho- logical response to the experience of being learning disabled. Recent research is, however, beginning to show that there sometimes seems to be a link between learning disabilities and biologically-based de- pressive illness (Brumback and Staton 1983). Although this did not appear to be the case with the children studied, future research needs to investigate the psychobiological relationship between learning dis- abilities and depression.

Why did this low-level depression only consistently become evi- dent in late latency? Perhaps the dramatic maturation and develop- mental surge that occurs at 7 + I years of age (Shapiro and Perry 1976) allows the child to reflect on experience in new ways.

It has often been said that learning-disabled youngsters are anx- ious. Interestingly, the conscious anxiety and distress about not measuring up to peers was not unique to the learning-disabled chil- dren and adolescents studied: the youngsters with purely psycholog- ically-based learning problems were also plagued with these feelings. However, the learning-disabled students did consistently evidence a variety of worries that were outside of awareness, that is, unconscious, that the others did not. Unconsciously, they imagined that per- formance (academic and otherwise) was a danger situation: that is, one in which they would humiliate themselves, fail, and be helpless.

It seems that learning disabilities always result, to a greater or lesser extent, in moments of helplessness, confusion, and, as a result, feelings of humiliation and failure. These moments are repeated but cannot be predicted or anticipated due to the intermittent nature of most mild to moderately severe learning disabilities. Their unpre- dictable nature can only underscore the youngster 's experience of helplessness and, as a result, suffering and the anxious anticipation of failure and humiliation. In fact, many of the learning-disabled children and adolescents evidenced a tendency toward panic anxiety. In other words, when they became anxious, for whatever reason, a sense of panic rapidly ensued. This tendency reflects a developmental failure to be able to modulate anxiety.

A Note on Learning Disabilities: An Intermittent or Constant Problem?

Specific cognitive deficits vary in terms of frequency: intermittent versus constant. Although rarely discussed, mild to moderately severe learning disabilities (e.g., a language disability or visual processing

292 STUDIES, COMPARISONS, AND CASES

disability) interfere with functioning (e.g., word retrieval or reversal and rotation of percepts) in an intermittent manner. More severe cognitive disabilities tend to inhibit functioning in a more constant manner. The process of assessing the severity of learning disabilities in childhood and adolescence is complex and inexact. However, the frequency of a disability in conjunction with the extent to which the disability interferes with learning (delimited versus total), extent of discrepancy between achievement and intelligence, overall IQ (Verbal and Performance), and psychological factors all need to be evaluated and synthesized to determine severity.

The intermittent and hence unpredictable nature of mild to mod- erately severe learning disabilities has critical psychological conse- quences. A disability that is constant (e.g., blindness) may be more debilitating, but much easier to anticipate and hence to understand, accept, and integrate. On the other hand, an unpredictable event is much more threatening, confusing, and difficult to unders tand realistically.

The Internal Experience of Self and Others

As Silverman and Zigmond (1983) found, there was no significant difference between the learning-disabled and the non-learning- disabled youngsters ' conscious concerns about themselves. They all showed feelings of incompetence, inadequacy, low self-esteem, and they anxiously believed that they would fail. However, there was one aspect of self-experience that did characterize uniquely many of the learning-disabled youngsters studied. A consistent and core aspect of the youngster 's unconscious self-representation was that of being pain- fully damaged, inadequate, stupid, and vulnerable. These negatively- colored, disparaging, unconscious self-representations crystallized and were becoming an integral aspect of the childrens' characters by the age of seven or eight. It was not observed in the younger children studied.

Importantly, these negatively-colored aspects of their self- representation were strikingly unintegrated, and the older children and adolescents evidenced uneven psychological development.

Many have noted and described the importance of understanding the learning-disabled child's experience with others: parents, peers and teachers (e.g., Blanchard 1946; Buxbaum 1964; Gardner 1968; Silver 1974). There is no question that the response of others to the child be it empathic support or critical, humiliating, demanding insensitivity, to note two extremes--plays a critical and central role in psychological development.

The parents of the children and adolescents studied varied widely in terms of what their child's problems meant to them and how they

PSYCHOLOGICAL DEVELOPMENT IN CHILDHOOD AND ADOLESCENCE 293

responded to their child's struggles (i.e., from quite patiently and empathically to rigidly, punitively and quite insensitively). The non- learning-disabled youngster 's expectations (conscious and particularly unconscious) of others were consistently linked to actual experience with parental figures. However, this was significantly less so for the learning-disabled students. Regardless of how parents and teachers responded to them and their difficulties, the children, and particularly the adolescents, showed the anxious concerns, low level depression and self-representations I have noted above and a sense of conflict, rigidity, and trauma that I will describe below. Certainly, the children who grew up in environments where parents and teachers knew about the disability and responded in a supportive and empathic fashion had significantly less difficulty than those who did not. But it was sur- prising to discover that, even in the seemingly best situations, the older children and the adolescents were still plagued by the psycho- logical concerns and struggles I am describing. This finding can only be a tentative one, as I do not know what really happened in all aspects of their lives. Recollections from the youngsters themselves, their par- ents, past and present reports from teachers, diagnosticians, and psychotherapists provide only an incomplete picture of what life was really like.

Learning Disabilities and Personality Development: Major Themes I will now turn to several major themes that emerged regarding

learning disabilities and personality development. As noted previously, each learning-disabled child experiences

frustration, failure, and a sense of helplessness. But each child attrib- utes his or her own meaning to these experiences. There is no one-to- one relationship between being learning disabled and having a given s_~t of psychological features.

The relationship between learning disabilities and psychological development is a complex and ongoing intrapsychic and psychosocial process. It is interwoven with other concerns, conflicts, strengths, weaknesses, coping strategies, dreams, wishes, and the various psy- chosocial factors of each developmental stage. However, being learn- ing disabled is an element that seems to organize psychological de- velopment in a subtle but significant fashion and is experienced as an ongoing strain. In fact, the experience of being learning disabled is akin to what has been called a strain trauma (Kris 1956) or a cumulative trauma (Khan 1963).

Learning Disabilities and Cumulative Trauma The relatively intermittent nature of mild to moderately severe

learning disabilities contributes to the belief that frustration and failure

294 STUDIES, COMPARISONS, AND CASES

are unpredictable and uncontrollable. These repeated moments of frustration, failure, and helplessness often are accompanied by a painful lowering of self-esteem and by negative self-representations. Gradually, these repeated moments (and the anxious anticipation of them) may result in trauma.

The notion of trauma usually refers to a wound, produced by sudden physical injury or an emotional shock that creates substantial and lasting damage. Being learning disabled is not a shock in this sense. In fact, the effects of a learning disability are virtually never acute, sudden, or shocking. Rather, in the youngsters studied, the experience of being learning disabled was characteristically subtle and ongoing. But their self-esteem and sense of stability were stressed repeatedly throughout childhood and adolescence. These repeated moments of helplessness come to be associated with painful feelings of distress, anxiety, humiliation, and loss.

Usually parents and teachers can buffer the child from repeated experiences of helplessness. When a child, for whatever reason, is not protected from repeated moments of helplessness, the cumulative result is a feeling of trauma (Khan 1963). It was quite striking to discover that even in the best of situations (i.e., where the child, seemed to have been empathically raised and supported at home and school), none of the youngsters studied completely escaped these repeated moments of helplessness and a sense of stress and trauma.

This experience of feeling emotionally injured resulting from repeated moments of helplessness, inadequacy, and pain does not seem to be an immediate response. I did not observe it in most learning-disabled children under the age of seven or eight. Rather, it seems to be a much more gradual and subtle process that does not manifest itself until the mid-latency years or later. As such, it is perhaps similar to the psychological concommitants of other physical handicaps (Burlingham 1961) or constitutional sensitivities (Escalona 1953) that make it impossible for the parents (and later, teachers) to protect the child from the repeated and frightening experience of helplessness.

It is not clear from the present investigation how this cumulative trauma interacts with the various developmental tasks of childhood. In continuing to examine psychological development and the experience of being learning disabled, this will be an important area of study.

Learning Disabilities as an Organizer of Development

One of the important, al though perhaps not surprising, findings that emerged was that learning disabilities are a developmental or- ganizer. The ongoing effect of the disability itself and the meanings

PSYCHOLOGICAL DEVELOPMENT IN CHILDHOOD AND ADOLESCENCE 295

attributed to it is a biopsychosocial process that organizes experience by being a determinant of strengths, interests, weaknesses, and of the development of adaptive strategies.

Learning disabilities are cognitive weaknesses. Weaknesses are always a determinant in the person's unfolding sense of self and identity. We learn through experience and when a given process or task is difficult, we tend to react in one of two ways: either we avoid (and in a related fashion come to feel that we are "bad" at that) or we do the opposite; we expend a tremendous amount of energy and time on becoming "very good" at what was initially a difficult task. A common example of the latter response is the dyslexic child who becomes an avid reader. In either case, the weakness shapes behavior and our experience of self. This is particularly true when a given weakness interferes with an ongoing process (e.g., the learning process) that has powerful emotional as well as practical consequences.

Learning disabilities may also contribute to the child's and ado- lescent's strengths. Characteristically, if the learning disability is not too severe, and if teachers and parents empathically support the child, the child may view difficulty in learning as a challenge to be overcome. Although this does not make the disability go away, it does tend to make the person feel effective and competent ("I am a good reader, I like to read . . . . I learn a lot through reading"). Feeling effective and competent provides a foundation for achievement.

Learning disabilities may contribute to accelerated or precocious development in other psychological abilities and interests. A number of recent studies have shown that many dyslexics have superior talents in a number of nonverbal (right hemisphere) areas, such as art, archi- tecture, engineering, and athletics (Geschwind 1982, 1983; Porac and Coren 1981). Geschwind (1982) has suggested that there is a genetic basis to this which may be evolutionarily advantageous. Apparently, in spite of the disadvantage of being learning disabled, there are significant advantages (i.e., superior talents in other areas) for the dyslexic him- or herself. In addition, unaffected relatives who share the same genetic predisposition often have the high talents in the absence of serious difficulty with language acquisition (Geschwind 1983). Although unrelated to language, these talents are clearly ben- eficial to society.

This accelerated development may also represent a psychological compensatory response to the disability. The experience of inade- quacy, helplessness, strain, and failure usually fosters the wish to become competent and accomplished. In any case, accelerated de- velopment in other areas (i.e., nonverbal) characteristically leads to individual strengths which, like weaknesses, are virtually always

296 STVDIES, COMPARISONS, AND CASES

personality determinants. We become interested in and like to do what we do well, and hence we usually do that more often. This further reinforces and supports the development of that skill.

Learning Disabilities and the Compensatory Process The ways that the children and adolescents compensate for their

learning disabilities is directly related to important aspects of their self-representation in general, their work identity in particular, and various concerns and conflicts. It is well known that the experience of being learning disabled may result in the child's development of compensatory strategies, including the discovery and use of coping mechanisms that allow the student to circumvent the area of disability. A child who confuses b and d will read slowly to check and recheck the letters or discover that a b looks like his left hand, thumb up, fingers closed into a hitchhiking sign. Children adapt to their disabilities automatically with compensatory maneuvers, and teachers often in- struct learning-disabled children to do just this. In the children and adolescents studied, these compensatory strategies gradually become generalized or characteristic adaptive patterns. And how we cope or adapt to difficulty directly or indirectly affects our sense of self; in fact, it is a psychologically central trait.

For example, a number of students I studied adapted by working quite slowly. In fact, this was an educationally adaptive strategy, for when they read or performed mathematics quickly (e.g., due to exter- nal time pressure or anxiety) their disability was much more likely to be evident. Working slowly allowed adaptive, hypervigilant checking and rechecking. This process of checking and rechecking occurs auto- matically, outside of the youngster 's awareness. However, being "slow" was more than adaptive in that task. It also had become an important aspect of sense of self as a worker and a person. On projective tests and in psychotherapeutic explorations of their experi- ence, pejorative feelings of being "slow," not being "quick enough," and related anxious concerns about what others would think about them in this regard emerged repeatedly. Furthermore, these young- sters evidenced painful and conflicted feelings about this.

A large number of the students evidenced a much less adaptive compensatory strategy: avoidance. Again, feelings of being an "avoider," a "manipulator," "not being what one appears to be" loomed large in the images these youngsters held of themselves. In addition, avoidance was a characteristic psychological defense. For example, instead of writing a paper to the best of their ability, they often plagiarized. Or, when hurt and angry at a friend, they withdrew.

It seems that compensatory strategies and psychological defenses

PSYCHOLOGICAL DEVELOPMENT IN CHILDHOOD AND ADOLESCENCE 297

became significantly interrelated. It was striking to observe repeatedly that the compensatory strategies seemed to predict psychologically central characteristics in the learning-disabled students studied. The development of compensatory strategies creates a model for a variety of other types of defensive and adaptive patterns.

Rigidity One of the most striking and consistent findings that emerged

from this investigation was that the children, and particularly the adolescents, employed defensive and coping strategies in a relatively rigid fashion. They tended to rely on a limited number of defensive operations which they used with little regard for the actual situation. However, acting rigidly also was often an important aspect of their emerging character. That is to say, they tended to show an exaggerated and tense deliberateness of behavior. Their purposiveness often be- came intense and did not allow for deviation, distraction, or spon- taneity. Such a continuously deliberate, purposive, and tense self- direction involves a special kind of self-consciousness (Shapiro 1981). This rigidity was not a manifestation of any one character structure (e.g., obsessive-compulsive); it was an important aspect of functioning regardless of character type.

The learning-disabled children need continuous reinforcement of a sense of mastery. In fact, they felt (again, to varying degrees) that they were engaged in a special kind of battle to achieve a sense of mastery and to avoid the experience of losing control, being inade- quate and helpless. Rigidity often is the outcome of this battle and the solution to the struggle.

But why? This is a complex question that I do not fully under- stand. Being learning disabled clearly contributes to doubts of one's ability to be in control and to finding ways to avoid the repeated experience of helplessness. Acting in a rigid manner in the ways I have just described may help the learning disabled feel more in control. In addition, it is possible that as learning-disabled children anxiously struggle and then gradually learn what helps them to compensate for the disability and to defend against the experience of helplessness, distress, and depression, they then tenaciously and rigidly maintain these coping strategies.

In addition, the experience of being damaged and inadequate may contribute to despairing that one can ever be loved and accepted. As Coen (1986) has described, this may inhibit curiosity and questioning about basic assumptions, memories, and expectations and may lead to character rigidity. A more hopeful and secure child will be less anxious about questioning himself and his experience. On the other hand, a

298 STUDIES, COMPARISONS, AND CASES

child who anxiously and sadly feels damaged and fears abandonment , rejection, or criticism is much more terrified to question and examine.

To the extent that this is a generalized finding among learning- disabled children, it is an important one because rigidity always significantly interferes with development, educational and psycho- logical. Being rigid, by definition, is limiting and maladaptive. In fact, this rigidity is commonly a major educational and psychotherapeutic obstacle and needs to be a focus in remedial, educational, and psycho- therapeutic work with these youngsters. It is not uncommon for educational and psychotherapeutic achievements to be made with these children and adolescents. But if the rigidity is not identified and worked with, it will undermine integration and development.

Summary

In summary, a learning disability is initially only one develop- mental element. But it is an element that sets in motion a series of on-going psychological processes that may become interrelated with various aspects of psychological and social functioning and develop- ment. Not only does the cognitive deficit directly and adversely affect psychosocial processes, but they, in turn, work to organize the child's and adolescent's interests, strengths, weaknesses, identity, experi- ence of self, and rigidity. In the learning-disabled youngsters studied, there is a complex interaction between the cognitive deficit itself, the actual frustration and failure that it engenders, conscious and uncon- scious interpretations and anticipations of these events, self- experiences and emotionally-related repercussions. This set of events and responses are often mutually reinforcing and become interwoven into the character and evolving identity of the person.

Special education and remedial experts have tended to focus on the nature of the youngster 's learning disability and on helpful and effective learning strategies. However, the motivational and psycho- logical problems that often characterize learning-disabled youngsters need to be addressed as well. In fact, by lat6 childhood and early adolescence, the types of psychological factors described here are often as problematic, if not more so, than the cognitive disability itself.

Psychological reactions to being learning disabled (e.g., a low level depression) can easily become a further source of scholastic failure and poor adjustment. We need to develop programs that help the person cope not only with the disability, but with its effects. For example, if it is often true that these youngsters act rigidly, we must develop psychoeducational programs to help them recognize this tendency and to function in a more flexible manner. Teaching a

PSYCHOLOGICAL DEVELOPMENT IN CHILDHOOD AND ADOLESCENCE 299

youngs te r to analyze a task, to consider various solutions, and then to act flexibly in the solving process and appraisal of results is not an easy or simple goal to achieve. But it is, I think, a particularly impor tant e lement of a psychoeducat ional p rogram that seeks to address some of the findings p resen ted here, as well as the psychological problems that often characterize these children.

Unless learning disabilities are d iagnosed and remediat ion is under taken , these bewi ldered youngs te rs are at risk for emotional problems. The present findings suggest that these youngs te rs are at risk even w h e n they seem to have been helpful ly and comprehens ive ly diagnosed and treated. Educators, parents , mental health pro- fessionals, and, perhaps most important ly , the youngs ters themselves must unde r s t and not only wha t specific weaknesses and strengths exist, but ho w the learning disability becomes interrelated with the conscious and unconscious aspects of expectations, memories , fears, images of self and others, and characteristic styles of coping.

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