On 11 February 2011, Respond and the International Association for Forensic Psychotherapy hosted a one-day workshop at the Directory for Social Change in London, to consider the work of psychotherapy with people with intellectual disabilites with forensic needs.
The room was full and buzzing when Richard Curren, CEO of Respond, welcomed us all to the day. It was affirming to see a room bustling with psychotherapists, art therapists, analysts, psychiatrists, psychologists, social care workers and more who had all come together to meditate on the work of disability psychotherapy. Psychotherapy is not always the treatment of choice for people with intellectual disabilities. This client group is not often seen as good candidates for this treatment and often psychogical supports focus on behavioural or cognitive behavioural interventions. It is the belief of the disability psychotherapist that one’s emotional intelligence is intact despite any cognitive impairments the person may face. With this in mind, attendance at this event was especially meaningful for me, as it provided a space to meet and think with other clinicians in this field, and most importantly to be surrounded by my peers and colleagues.
The first session was ‘How to be the subject of fascination: Bob and Pat’, by Kate Rothwell. This was followed by ‘How to be a disability forensic psychotherapist’ by Dr Valerie Sinason. Then we heard Dr Earl Hopper’s ‘Supervision and consultation in gorensice settings providing disability psychotherapy: Challenges to the capacity to think, link and hope’. The last session was ‘Why such fascination?’, by Alan Corbett, Tamsin Cottis, Simon Hackett and Kate Rothwell. The final hour was a plenary session, convened by Christopher Scanlon, that offering participants the opportunity to think about and reflect on the day.
With that very impressive panel of speakers, I soaked up the day, busily taking notes and losing myself in the thought provoking and reasonating clinical work that was shared in the sessions.
In the first session, Kate Rothwell, an art therapist, provided two detailed segments of her clinical work using clips of videoed sessions showing the creation of an art piece in a final session. It reminded us of the importance of working with creative mediums with people who may struggle to express themselves in the conventional way. Although her clinical work spoke of distress and horror of the experiences of the two men who had consented to be part of the presentation, it honoured the nurturing aspects of the psychotherapeutic relationship and that people with intellectual disabilities can be supported to make sense of their experiences and move forward in their lives.
Dr Valerie Sinason shared her journey of becoming a disability psychotherapist and the importance of working within the relationship, in order to hold and face the client’s painful experiences to support greater understanding. We were given a treat as she read out a transcript of a session early in her career. She was able to convey to the audience the complexities of working with perpetrators and asking us to reflect on the role of the victim, perpetrator and society. She made cases for all to be taken into consideration when working with these clients. We were reminded that the fact that people with intellectual disabilities can be seen as the bottom of society can lead a painful existence. People with intellectual disabilities can be discriminated against and abused. This abuse often hidden with the victim not having the words or ability to voice these experiences. This can come full circle with the victim taking on the role of the perpetrator. We thought about how victim and offender cannot be easily separated. Work with these clients is multilayered and long term.
After the lunch break, Dr Earl Hopper provided an opportunity to reflect on trauma, the dynamics of organisations and those working in disability services, with an emphasis on the work of the psychotherapist. We thought about the parts of ourselves that are painful but alive in the therapeutic relationship. He reminded us that this client group is vulnerable and often when they reach the consulting room they have little hope. He encouraged us to remain hopeful so that we can carry the hope of those who feel hopeless. He spoke of how organisations are made up and the dynamics of the stakeholders in providing services to this client group. He advocated for the use of supervision to service providers as an essential part of service delivery.
The tone of the workshop then shifted to the question of ‘Why such fascination?’ The four speakers (Alan Corbett, Tamsin Cottis, Simon Hackett and Kate Rothwell) gave a brief introduction to how they came into this field and then discussion opened up from the floor. The main points I took away from this session were that the client may have experienced a sense of ‘psychic homelessness’. A vacancy within the self as a result of not having experienced safety and trust in their lives. The clinicans used clinical examples and thought about how society maintains a contempt of need—a hidden wish that the person with a disability did not have the disability, that the disability and the person did not exist.
After this very full session and a quick coffee break we returned to reflect on the day and what it had stirred within us. This provided the opportunity for people to share personal experiences, theoretical understanding and to return to any points raised in the day. The day had left a impact on the participants, some which could be discussed in that final session and some that could only be taken away and digested.
The work of a disability psychotherapist is rich and complex. It pushes the practitioner to the depths of themselves as they engaged in work with the forensic client. It brings up questions about victims, perpetrators and society and it challenges us to think in fresh ways. The collaboration between Respond and IAFP is of great importance as it highlights the work being done with this client group and challenges therapists to work not only with individuals with intellectual disabilities, but also with the individual with intellectual disabilities and forensic needs.