Trust and Betrayal in the Treatment of Child Abuse

Rating:
Summary: A valuable resource for family therapists.
Review: Trust and Betrayal in the Treatment of Child Abuse is a rich and profound examination of an area of thought and work fraught with complexity. MacKinnon maps a clear path through the dilemmas of child abuse, combining a depth of theoretical approach with clear practice guidelines. What is so appealing about MacKinnon's writing is its clarity and accessibility in the midst of a gritty analysis of socio-political discourses. Her ideas are conceptually satisfying and include constant reference to case examples that are helpful illustrations of the theoretical ideas explored.

Trust and Betrayal provides a framework to examine the many difficulties emerging when dealing with issues of child abuse. MacKinnon presents thoughtful solutions to inherent systemic problems that inevitably result when attempts at social control and therapeutic gain intersect. It is at the point of intersection of a number of different discourses, especially the discourses within family therapy and child protection that this book offers a more complex understanding of the position of the individual, the family and the wider system. For those working with families, the book challenges us to a depth of understanding of our clients, which involves a consideration of gendered, powered relationships and ideas of class. MacKinnon places the client's subjectivity within those discourses showing how it develops out of the particular underlying premises and beliefs within a family.

The first part of the book deals with "Child Abuse in Context". There is no simplistic analysis here. Clinical problems are explored in combination with an understanding of various contexts which families bring to therapy. These include the context in which families are referred, in which they live their lives, and the context in which premises and beliefs held by the family and by child protection workers continue to exist unchallenged.

The chapter on the "Genealogy of Relationships" is worth particular mention. Here MacKinnon introduces a new discourse around child abuse that in our opinion creates a space for therapeutic change without minimising the seriousness of abuse. There are some fascinating ideas here suggesting a new conceptualisation of relationships involving the "dominant account" of family relationships and the importance of eliciting the "hidden account". This genealogical approach "seeks and allows for each person's account of relationships. It can be a guide to how therapists can approach the story of abuse from family members and effect a change in underlying network premises held by family members" (P.97).

The last half of the book is essential reading for therapists working with families who have become intertwined with the Child Protection Department. The approach outlined is based on years of research and a therapy project undertaken by the author. The crux of the approach is that it effectively engages families and gives them a different experience of working with professionals.

MacKinnon's feminist-informed approach is radically different from a position that assumes, even before therapy begins, that it is not useful to work with perpetrators. She creates a space for the therapist to be positioned which may allow for the parent who abuses to work towards safe contact with the family/child. She argues that the task of the therapist is to sit in the space that names abuse as abuse. Whilst holding the abusing parent accountable, the therapist works to negotiate a safe way for relationships in the family to continue. She describes the therapist's role as that of a "power broker". What stands out in this approach is a deep respect for all family members and their significant relationships within a context of accountability.

The account of "the working class" in Chapter 4 is perhaps more homogeneous than we would expect. We think other accounts exist which are not included here. We are also left wondering why MacKinnon does not explore the issues that exist for therapists in dealing with child abuse, when the most therapeutic position may be to decide not to continue with, or even start therapy.

What we do not doubt is that MacKinnon brings to her writing an ability to see the world through her wealth of experience as a therapist, supervisor and consultant. Her work is respectful and compassionate, including the voice of each party in the web surrounding child abuse, with a rich interweaving of comments from parents and workers who have entrusted her with their opinions.

Trust and Betrayal brings a refreshing breath to a discourse that does not usually self-reflect, namely the discourse around relationships between clients of the Child Protection Department, the Departmental workers themselves, and therapists. It is valuable reading not just for family therapists but for those entering the field of child protection and those working with families and individuals where there have been allegations of abuse.