A study of the impact of abuse on children, adult survivors and practitioners, and the implications for service delivery and therapeutic interventions. WQ, Moira Walker, Doctor of Philosophy 2005 . DAMAGED TEXT N ORIGINAL BEST COPY AVAILABLE Variable print quality Contents Author's declaration Author's confirmation ii Title page Abstract 2-3 Chapter 1 (5124 words) 4-19 Introduction 4-6 The journey towards research 6-9 Surviving Secrets 9-11 Choice of methodology 11-13 The research process 13-15 From 'Surviving Secret'to 'Hidden Selves' 15-18 Abuse: questions and answers for counsellors and therapists 18-19 Chapter2 20-246 Title page 20 Introduction to publications 21 Features of counselling work with adult survivors 22-27 Womenin Therapy- two chapters 28-74 The aftermath of abuse 75-81 Working with abusedclients in an institutional setting 82-98 Working with abusesurvivors: the recovered memory debate 99-115 Feminist psychotherapyand sexual abuse 116-138 The inter generational transmission of trauma 139-155 Hidden Selves -two chapters 156 -178 The impact of abuse 179-184 Supervisingpractitioners working with survivors 185-206 Surviving Secretstranslation 207-210 Reviewsof Womenin Therapy 211-218 Reviewsof Surviving Secrets 219-236 Review of Hidden Selves 237-238 Citations 239-246 Chapter3 (10179 words) 247-281 Introduction 247-249 Education 249-260 Training 260-268 Practice 268-272 Service development 272-276 Conclusion 276-281 Appendices 282-316 - Appendix A: completelist of publications 282-286 Appendix B: selectedlist of publications 287-289 Appendix C : dissemination via education 290-292 Appendix D: dissemination via training events 293-296 Appendix E: Course figures and course outline 297-308 Appendix F. MIND book of the year 309-313 Appendix G: 314-316 confirmations . References 318-327 Author's declaration I declare that all the work presentedin this thesis within my body of work is my own, with the exception of the jointly edited Hidden Selves. In this jointly editedwork I clearly indicateand include in Chapter2 the chapters solely written by myself Moira Walker October 2005 This is to confirm that the work submitted here for a Ph.D. by Publication has not been submitted for any other qualification Moira Walker October 2005 A STUDY OF THE IMPACT OF ABUSE ON CHILDREN, ADULT SURVIVORS AND PRACTITIONERS, AND THE IMPLICATIONS FOR SERVICE DELIVERY AND THERAPEUTIC INTERVENTIONS. MOIRA WALKER A thesis submitted in fulfilment of the requirements of Bournemouth University for the degreeof Doctor of Philosophy (by publication) November 2005 BournemouthUniversity Abstract This thesis presented for a Ph.D. by publication traces the progress of my work from 1988-2004. The portfolio and narrative herein developed demonstratesthat the publications and their dissemination constitute a contribution to knowledge equivalent to that of a traditional doctorate. This portfolio aims to demonstratehow my original contribution to knowledge has been a cumulative process developed from my on-going integration of practice and academic work and that this has substantially impacted on the understanding of childhood abuseon children and on the adult survivors they become, on practitioners working in the field, and on the implications for service delivery and therapeutic interventions. I consider how practice has fed and focussed my thinking on areas subsequently studied, explored and described in these publications; and that these are fundamentally deeply rooted in and with survivors, but significantly extend to consideration of issuesfor practitioners. I examine how in order for survivors to be truly heard, their voice has to be communicated effectively and be translated into the development of appropriate responses.I have therefore demonstrated not only the intrinsic necessity of survivors of abusebeing core to the whole process, but that educating practitioners is of parallel and equal importance, ensuring and facilitating safe and effective practice. I show how my work has made an effective contribution in these respects. The thesis is presented in three chapters: Chapter 1 describes and overviews the selected publications and contextualises these; explores the researchjourney; examines the methodological base and rationale, and considers the influence of practice. The twelve cited selectedpublications (Appendix B) are intertwined within the developing narrative, with particular focus on specific 2 key publications, notably the single authoredSurviving Secrets (1992) and the jointly edited Hidden Selves (1999). Throughout, I reflect on my own learning and development academically and clinically, demonstrating the crucial significance of the interrelationship between thesetwo. I refer to my publications to illustrate the progress of my development, how thesehave drawn on and fed back into practice, and essentially how survivors of abusehave continually remained at the very heart of my work. Chapter 2 is the body of the work containing the cited articles and book chapters, including the most relevant chaptersfrom Womenin Therapy and Counselling : Out of the Shadows and Hidden Selves. The four books cited. Surviving Secrets: the experience of abusefor the child the adult and the helper; Hidden Selves:An Exploration of Multiple Personality, and Abuse: Questions and Answersfor Counsellors and Therapists, are attachedseparately. Chapter 3 summarisesthe results of the published works demonstrating their original contribution to knowledge. As this portfolio extends over 16 years, and considerable work has taken place, for the sakeof clarity I trace the impact of this body of work, and the contribution it has made, in respect of the four most significant pathways: education, training, practice, policy and service development. The chapter concludes by reflecting on both strengths and weaknessesof this body of work, including further consideration of the methodology used. 3 Chapter 1 Introduction This chaptercontextualises the twelve cited works and,where relevant, explores the methodologyused. The selectedlist of relevantpublications is includedas Appendix B (and included in Chapter 2) and a complete list as Appendix A. Discussion of all the publications, and my reflections, will be intertwined within the developing narrative, with particular focus on key publications- the single authored Surviving Secrets (1992) and the jointly edited Hidden Selves (1999). Both use differently, but 1 have at their core, a narrative approach to research with abuse survivors and this will be illustratedand described. The earliest publication (1988) Features of Counselling work with Adult Survivors of Childhood Abuse marked a tentative beginning, but triggered considerable interest encouraging further work leading to Women in Therapy and Counselling in 1990. This contained one chapter based on clinical experience of working with survivors and victims of violence (included in Chapter 2). The positive and extensive responses from survivors and service users2,students and professionals encourageda major project leading to the publication of Surviving Secrets: the experience of abusefor the child the adult and the helper. This was based on in depth interviews with survivors of abuse and practitioners in the field. The responseto this book was considerable, resulting in its widespread dissemination (Chapter 2). Other published work, notably `Working with abuse survivors: the recovered memory debate'(1996) in Bayne, R. and Horton, I. (Eds.) New Directions in Counselling, I The term 'survivor' is used to describe an adult who has experienced childhood abuse. It is used in preference to the term 'victim', reflecting the preference expressedby those abusedas children. It celebrates their struggle as adults to overcome the pain of the past, when the child was indeed a helpless victim. 2 It should be noted that not all survivors are also service users, although many are or have been either as children or as adults. Service user is here defined as a person who has used either statutory or voluntary services to assist them in difficulties they have experiencedas a result of childhood abuse. These would include social services, clinical psychology and other mental health services. 4 `Working with abusedclients in an institutional setting: holding hope amidst despair' (1996) in E. Smith (ed.) Integrity and Change: Mental Health in the Market place, and'Feminist Psychotherapy and Sexual Abuse' (1997) in Bruna Seu and Heenan (eds.) Feminist and Psychotherapy continue to incorporate the service user/client and 3 the practitioner perspective. This is combined with a theoretical analysis, questioning existing thought and practice, aimed at developing an integrated approachbased on accurate understanding of survivors issues. Other work has developed specialist themes present in the publications cited above: `The inter-generational transmission of trauma' (European Journal of Psychotherapy, Counselling and Health, 1999) studies the impact of trauma across generations; the consequencesof childhood abuse4on later parenting, and on children of survivors. The links between childhood abusesurvival and holocaust survival were also explored. My inter- generational interest has been present since writing Women in Therapy and Counselling which incorporated a chapter (see Chapter 2) on three generations,and the patterns and influences identifiable across a century. `Supervising practitioners working with survivors of childhood abuse: counter transference;secondary traumatization and terror'. (Psychodynamic