Deliberate self-harm represents a significant, yet it can be argued, a poorly theorized area of concern with respect to women who have learning disabilities -particularly in the context of secure service provision. Utilizing ideas from social constructionism we explore how some ways of understanding dominate the professional literature and, thereby, restrict how such women can be understood. We recognize that despite this, multiple understandings about why women with learning disabilities self-harm do exist and are drawn upon by practitioners and the women themselves. In order to identify how women with learning disabilities who self-harm are understood a Q-methodological study was conducted with patients and professionals in a medium secure unit. Six distinct accounts of why women self-harm emerged. These accounts emphasized that self-harming behaviour is meaningful and that women with learning disabilities are understood to have complex needs and a range of strategies for coping with these. The study, therefore, suggests that when working with such women consideration should be given to how they understand and manage their experiences, cognitions and emotions.
This article draws on feminism and post-structuralism to theorize a narrative framework for developing and critiquing therapeutic practices with women who have experienced child sexual abuse. I argue that both objectivism and relativism provide poor guides for conducting therapy and that it is only through situating our knowledges precisely that more liberatory therapy practices may be developed. This approach, termed 'visible therapy', is used to directly and explicitly challenge normative constructions of women, child sexual abuse and therapy. I argue that it is necessary to explicate the embedded assumptions produced through practices of abuse, and which serve to construct children's experiences of that abuse, in order to ward against their reproduction within therapy relationships. I demonstrate that it is through situating and explicating the operations of power that the authenticity of experience and identity may be questioned and women's ongoing positioning as guilty victims may be challenged. Thus, I am concerned not with who women 'really are' but with how they come to know and be known through practices of both abuse and therapy. This, then, is about making the tactics of abuse and therapy visible. Problems are not located within individuals, but rather within the narratives which situate both past and current relationships but which, through reiteration, obscure their own social production. I conclude that it is only when categorical identity is no longer assumed that progressive therapy practices with women who have been sexually abused can be developed and maintained.
This paper critically examines the development of the concept of borderline personality disorder (BPD) in terms of the assumed centrality of abnormal early environments and abusive relationships. It is suggested that if BPD is conceptualized as an expression of past experiences in adult life, information regarding early histories can assist in 'making sense' of later behaviour. The aim of this review therefore is to explore how histories of women diagnosed as BPD, within a High Secure Psychiatric Hospital, may facilitate an interpretation of the 'adaptive' nature of presenting 'symptomology'. Case note material is utilized to gain insight into specific aspects of childhood experiences that have been documented, and are thus deemed significant. These findings support the perception that the role of the early environment and associated relationships are significant within written accounts of women diagnosed as having BPD. By exploring the links between trauma and BPD, this article suggests that an understanding of the effects of trauma and the importance of relationships can offer a way forward for self-reflection and future care.
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