This book represents a life-times work with people with learning disabilities, from a number of perspectives, but chiefly as a psychotherapist. From early experience of a long-stay hospital to community supported living, I have been struck by the resilience of people with learning disabilities, their response to being heard, but, more sadly, to the degree of trauma they have suffered. Sometimes this has been at the hands of family, but more frequently by the system that is designed to support them. It is good to see that they have more visibility now and better services but there are still too many instances of cruelty and neglect, abandonment and loss.
The aim of the book is not only to raise awareness, but to offer a model of understanding and working that can truly make a difference. Recognising the impact of past trauma informs present care and support, enabling people, who have become very complex in response to their life experiences, to have a better quality of life.
The preface describes the life experience of the author that led to her becoming a pioneer in the world of disability psychotherapy, learning from the long-stay hospital and her training, being alert to the hidden messages in behaviour, and applying theory and practice to the development of a way of working. The following chapters provide the theoretical underpinnings of the model, followed by the application and research to establish the validity and reliability of a measurement tool for emotional development. This theory is now taught to front-line staff to enable them to be more effective in their work.
Trauma-informed care is both necessary and desirable for people with learning disabilities who have experienced trauma in the form of abandonment, abuse, loss and cruelty. Many of the people now supported by staff trained in the model have good lives, after years of being labelled as challenging and kept in institutional settings. Individual psychotherapy with people with all degrees of learning disability is shown to be effective and is added where needed to the provision of an emotionally nurturing environment.
This book provides a model of understanding and some useful information on how to deliver trauma-informed care. It is a must read for anyone seeking to redress the balance for people who have been de-humanised by services that seek to control and manage, when understanding and meeting attachment needs are what is needed.
Pat Frankish is a clinical psychologist and psychotherapist with many years of experience in the field of disability. Her doctoral study established a method for measuring emotional developmental stages in people who had suffered trauma and consequent interference in the developmental process. She is from Lincolnshire and after working in a range of settings and spending six years in North Yorkshire and Teesside, she has settled back in Lincolnshire with her own business in partnership with her daughter. They specialise in providing services for people with complex needs, using the model that Pat has developed. They offer direct support, training, and therapy, either as a package or one component. For those who need it they also provide accommodation. Pat has been President of the British Psychological Society, was a founding member of the Institute of Psychotherapy and Disability, and is an active member of her local Church and community. Her recent book, Disability Psychotherapy: An Innovative Approach to Trauma-Informed Care, is published this week by Karnac.
Reviews and Endorsements
‘Patricia Frankish has been developing a way of providing psychotherapy to people who have intellectual and development disabilities for over thirty years. In this book she brings together the influences that have shaped her approach and the model she has arrived at. The most significant influences in her work have been psychoanalytic thinkers and developmental practitioners, notably Bowlby, Winnicott and Mahler. She illustrates the applicability and usefulness of these models in providing a psychotherapeutically-informed approach to helping and supporting people who have disabilities. When the author started this work in the 1980s she was working against the perceived wisdom of the psychoanalytic schools which then, as now, struggle with disability issues. However, along with others, she has had to work outside of them and became a key player in the formation of the Institute for Psychotherapy and Disability. Her model and approach is not just about individual psychotherapy but also about working with systems. She has also long argued for the recognition of trauma as a key issue in the lives of people who have disabilities and it is no surprise that her approach is trauma-informed.’
– Professor Nigel Beail, Professional Lead for Psychological Services, South West Yorkshire Partnership NHS Foundation Trust; Professor of Psychology, University of Sheffield
‘This is a very long-awaited book. Dr Patricia Frankish has not only been a disability therapy pioneer, but also a key theoretician, clinician, organiser, strategic thinker, teacher, presenter and researcher. She has created the only psychotherapy disability training in the UK and provides bespoke specialist residential care for those no-one else can treat. It will be no surprise for readers to realise that some of Patricia’s knowledge comes from her lived experience of parents living and working in a “mental” hospital. Whilst she helpfully and generously educates us as to her main theoretical influences, it is her personal application of Margaret Mahler’s theories that have provided the disability field with the greatest tools. This book is clear, accessible, seminal and rich with lived experience.’
– Valerie Sinason, President of the Institute of Psychotherapy and Disability, and editor of Trauma, Dissociation, and Multiplicity