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The British Journal of Developmental Disabilities
BOOK REVIEWSWITNESSING, NURTURING, PROTESTING
Alan Corbett, Tamsin Cottis and Stephen Morris London: David Fulton Publishers
This book is an account of the work of RESPOND, a psychoanalytically based service for people with learning disabilities who have been sexually abused. It details the first five years of the service's existence and seeks to provide ‘a template for good practice in work with survivors of sexual abuse who have learning disabilities'. After an introduction by Valerie Sinason, Chapter 1 details the development of RESPOND, emphasising its roots in advocacy and counselling for people with learning disabilities. Chapter 2 articulates a basic set of approaches to the role of the therapist in supporting learning disabled survivors. Therapists are seen as adopting four advocacy roles in relation to their clients: the role of witness, the role of protester, the role of nurturer and the role of translator. Each of these basic orientations are part of a consistent approach to survivors that emphasises that they are believed; that what has happened to them is wrong; that they will be consistently supported; and that they will be assisted in making sense of what happened to them. The fundamental theoretical perspective is drawn from attachment based psychoanalytic psychotherapy, but also draws on the work of Alice Miller. Chapter 3 sets out a framework for working with disclosure, emphasising the core approach to the client, but also the necessity of adequate therapist supervision and support. Central to this approach is the therapist's messages to the client of belief - ‘I believe you'; guiltlessness - ‘it's not your fault'; security - ‘I'm glad you told me'; empathy - ‘I'm sorry this has happened to you'; and support - ‘I'm going to help you'. The chapter also includes an index of suspicion. Chapters 4 and 5 set the experience of sexual abuse within the wider context of the stigma and rejection common to people with learning disabilities. This draws extensively on attachment theory, and sets out schematically a framework for exploring the impact of broken attachment bonds on the individual. The authors explore a number of ways in which societal rejection, and the experience of abuse combine to produce characteristic ways of responding to trauma, from a perception of the self as ‘damaged goods', through anger and fear to reduced self-esteem and lowered boundaries. Chapter 6 offers three clinical examples of work with survivors, which makes heavy use of Sinason's (1992) concept of ‘secondary handicap'. Chapter 7 presents an account of a group of women survivors, suggesting how the group can take on the core tasks of witnessing, protesting, nurturing and translating. The book concludes with some guidelines for individuals intending to explore this area of work, and makes sensible suggestions about boundaries, supervision and policymaking. There is much to admire in the book - we have a picture of compassionate, committed workers, struggling to find creative ways to work alongside very traumatised individuals: workers who are prepared to stay with clients over extended periods of time as they offer the security to make sense of events that were otherwise overwhelming. The clinical examples, and the description of the women's group are valuable, and add to the slowly growing stockpile of therapeutic case material that has become available over the last few years. I also valued the attempt to link together material from individual trauma with
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