Intellectual disability has a history of exclusion from traditional talk therapies and research. This paper reviews the growing body of research in the use of psychotherapy with this unique client group. Research has shown that people with an intellectual disability have an increased risk of mental health difficulties and emotional distress which is often mistaken for a symptom of the intellectual disability. The first part of this paper explores the number of difficulties faced by these clients in their development and how they are often denied the necessary milestones needed to develop a full sense of self. This paper further explores the process of psychotherapy with intellectually disabled clients, looking at communication issues that can arise and the importance of flexibility on the therapists part and use of alternative communication. Working with this client group evokes strong transferencial responses as therapists face their own issues with ability, illness and loss. There is a need for reflective practice on the therapist part and good supervision. This paper concludes that given the wide range of difficulties that these clients face, often from the moment of birth, there is a need of psychotherapy with this group however more research is needed in order to understand the specific issues that arise when working with this client group.