Counseling People With Developmental Disabilities Who Have Been Sexually Abused. Sheila Mansell and Dick Sobsey. Kingston, NY: NADD Press, 2001.
All of us who have ever been involved—whether as professionals, family members, or friends—with people who have disabilities and who are survivors of sexual abuse, should celebrate the publication of these materials, even as we deplore the need for them. Mansell and Sobsey of the Abuse and Disability Project at the University of Alberta in Canada have culminated their collaborative efforts across many years of study and practice in this area by summarizing research findings and presenting proven strategies for counseling people with developmental disabilities who have been sexually abused. With funding from the Joseph P. Kennedy, Jr. Foundation and Health Canada and in association with the National Association on Dual Diagnosis (NADD), they have produced a book and videotape that help to move us at last from discussion of how to identify abuse to consideration of how to treat it. Given the general reluctance of professionals and laypersons alike to address issues of sexuality (much less those of abuse, assault, and exploitation), we need not be surprised that materials such as these have been such a long time coming.
In a foreword to the ground-breaking early work Vulnerable, published by the G. Allen Roeher Institute, Marcia Rioux noted how “layers of denial and camouflage obscure the sexuality and abuse of people with an intellectual disability” (Senn, 1998, p. i). Once again, in this book and tape, Canadians have led us out of the darkness to improve our knowledge and skills in this challenging area of service delivery for people with mental retardation and other developmental disabilities.
The authors acknowledge the preliminary nature of their work and the emerging nature of best practice in this area. Mansell and Sobsey are only too aware of the limitations in our present approach to this problem based on the empirical research now available or the wisdom of the few therapists who now engage in clinical practice. To help us make sense of new findings, their discussion is grounded in the broader professional literature in special education and disability services. For example, an early chapter begins with consideration of short-term and long-term effects of abuse in children and adults without disabilities and uses these concepts to interpret current research on sexual abuse of individuals with disabilities. A later section on working with families opens with a review of family systems theory and relates ideas about coping and support to the stress experienced when a child has been sexually abused. This approach will help even readers unacquainted with these topics orient themselves and relate new ideas to familiar ones.
The book is divided into four parts: one chapter as an introduction; two chapters addressing causes and effects; three chapters offering ideas for individualizing therapy; and three chapters describing specialized therapies. In the first chapter the authors define sexual abuse, introduces key terms, and present an overview of therapy for abuse survivors. Two related chapters describe research on risks, patterns, and effects of abuse. In the next set of chapters they outline factors therapists must address in evaluating people for therapy, communicating with clients throughout therapy sessions, and making modifications to accommodate special needs. The final three chapters offer techniques for involving family members in the therapeutic process, ideas for conducting play therapy with children, and suggestions for developing treatment plans for individuals who are both victims and offenders. Several key themes run throughout the book: the heightened vulnerability of people with disabilities, the unique nature of the therapeutic relationship when working with individuals who have mental retardation and other developmental disabilities, and the need to empower individuals to take charge of their lives through counseling and other therapeutic activities.
A 54-minute color videotape in VHS tape format portrays interviews with professionals who are engaged in research and practice involving sexual abuse of people with developmental disabilities, featuring leaders in this area from Canada, England, and the United States. This videotape is divided into six parts that roughly parallel the sections of the book, beginning with an overview of sex abuse and its effects, proceeding with suggestions for therapies, and ending with a consideration of professional issues for therapists. The tape is intended as an introduction to topics and issues, rather than a demonstration of specific strategies, so the focus is on ideas and opinions, although a few of the interviews are illustrated with cut-away footage showing counseling activities.
The book's comprehensive coverage of central and related topics, thought-provoking discussion of key issues, and extensive list of references make it a rich resource for those of us who engage in research and other scholarly activities or in program planning and implementation for people with developmental disabilities who have been sexually abused. Nevertheless, this is a most accessible book—the authors' clear, simple writing, engaging narrative style, and detailed examples will appeal to a variety of professional and lay readers. Sobsey and Mansell achieve an appropriate balance between the use of clinical terminology and simplified explanations that make it easy to follow their logic and appreciate their arguments. In addition, they do not shy away from confronting the controversial issues associated with sex abuse therapy. A good example is their treatment of the use of facilitated communication in sex abuse disclosures in the chapter on communication. Their unbiased account and fair consideration of the pros and cons of this and other issues provide us with sufficient information to arrive at our own opinions.
The value of the videotape lies perhaps not so much in the information it presents as in the values it represents for us. Viewers have the opportunity to hear the personal perspectives of people who confront these issues and practice these techniques on a daily basis. This practitioner-to-practitioner approach promises to be especially effective in persuading counselors to take on clients who have mental retardation and other developmental disabilities and are in need of therapy for sexual abuse or assault. Perhaps the most interesting aspects of this video are the brief glimpses we get of actual therapy sessions with clients who have disabilities, which provide us with some idea of how the many excellent ideas are put into play in real world of therapist and client. However, viewers who are looking for more elaborate demonstrations of therapeutic techniques and individual adaptations will be disappointed not to find them in the tape.
The book is by no means a “light read” and the video is not easy viewing; both the density of the information and the seriousness of the subject make these materials that deserve to be read and watched with deliberation and time for reflection. In fact, the sheer amount of ideas offered in the book and tape may be overwhelming to some readers. Even as someone who has read and presented extensively on these topics and been involved in clinical practice for many years related to this topic, I found myself making extensive notes, re-reading sections, and taking additional time and care to digest the concepts, data, and cases presented in each chapter and section. This heaviness, however, is enlivened by the authors' respect and compassion for people with disabilities as victims and survivors of abuse. Mansell and Sobsey (and their interviewees) help us feel with and for these people as they relate stories of their struggle to cope with the effects of sexual abuse.
Despite the overall excellence of these materials, there are a few minor changes that I (and no doubt others) would like to see in future editions or companion volumes. A summary chapter highlighting key topics and issues and clarifying relationships would assist readers in making sense of the book at the end. Some appendices providing lists and outlines of risks, effects, strategies, and adaptations would allow the book to serve as a handy reference guide for busy professionals. The usefulness of the videotape would be enhanced by the addition of scenarios, whether real situations or role plays, documenting and explaining specific counseling strategies for future use.
At first glance, a review of the contents of the book and tape tempts me to recommend it as most appropriate for professionals who work directly with individuals who have been abused, such as psychologists, counselors, or social workers. These practitioners clearly will welcome the wealth of concrete suggestions for planning and implementing therapy with clients who have disabilities. A closer reading, however, reveals that many other readers will be interested in these materials. Researchers and scholars will be pleased to have such a thorough summary of the extant literature to inform their own studies and writings. Educators can glean ideas for sex education and abuse prevention programs at various age levels. Even direct service staff and family members may inform themselves about sexual abuse as it relates to clients and family members. I am convinced that this is an important new work that deserves a wider audience than its title suggests; these ideas may finally help us to break through those “layers of denial and camouflage” surrounding the topic of sexual abuse and disability and to offer much-needed support to individuals who have been abused as they make the long journey from victimization to survival.