The term ‘survivor’ is used to acknowledge the strength of an individual who is ‘recovering as an adult [from] what they have endured as a child’ (NHS Scotland 2009, p.2). In
Scotland, a number of charitable agencies help survivors overcome childhood trauma, supporting people in their journey to recovery so that they can 'go beyond simply surviving’ and live fuller, happier lives (Ainscough and Toon 1993, p.4). I have the opportunity to work with female survivors of childhood sexual abuse (CSA) at a Glasgow-based charity which supports young women on their recovery journeys. I propose to facilitate art and crafts sessions with the service users in the charity offices, framing this opportunity as an informal adult learning space. From this, I intend to involve the women in participatory, Arts-Based Research for my doctoral thesis, in which wider themes of identity, self- perception and place will be explored.
Survivors accessing the charity could be considered inherently vulnerable and therefore have the right to be protected from exploitation, re-traumatisation and/or un-ethical work practices. It is likely that those accessing the support organisation will have physical and mental health issues in adulthood, stemming from the trauma experienced as children. Some service users will present with additional issues and vulnerabilities, such as drugs and alcohol abuse, employment and housing problems (many will have experienced recent homelessness due to their history of abuse), relationship breakdowns, financial concerns and other (yet) unknown factors which can lead to varying levels of disruption in their adult lives. A key challenge in undertaking this work is circumnavigating the ethical constraints imposed by the academic community to safeguard and protect vulnerable people in the research process. This paper considers my reasons for wanting to involve female adult survivors in this research, my proposed ‘empowering’ art-based methodology and the important ethical considerations I need to consider when involving CSA survivors in the research process.
The impact of childhood sexual abuse on women's learning
Although estimates vary, there is a general consensus that women are more likely to be
victims of sexual abuse (Cawson et al. 2000). The most recent Crime Survey for England
and Wales, for example, found that 'women were 4 times as likely as men to be a survivor of sexual abuse during childhood (11% compared with 3%)' (Flatley 2016, p.3). Globally, the World Health Organisation (WHO) estimate higher numbers, with one in five women in comparison to one in 13 men reporting sexually abuse as a child (WHO 2016).
CSA is known to have wide ranging impacts on a survivor’s physical and mental health (Radford et al. 2011). Those with a history of childhood sexual abuse are more likely to experience mental health problems, including 'post-traumatic stress symptoms, borderline personality disorder, depression, problems with food, suicide/attempted suicide and self- harm, severe substance misuse, anxiety disorders and loss of self-esteem' (NHS Scotland 2009, p.5). The adverse psychological, emotional and physical consequences of child sexual abuse can impact on a survivor's adult life, long after the abuse has stopped (Kane
and Bamford 2003). As adults, CSA survivors are likely to present with a variety of psychological, emotional, social and physical difficulties, which range in severity
dependent on the complex needs of the individual (Chouliara et al. 2011). Recovery from
childhood trauma can be a complex undertaking (Jacobson and Greenley 2001) and is often understood in relation to an individual’s medical, social and psychological support needs for recovery (Hermann 2016). This research is significant because it considers the recovery process through an adult learning lens, rather than a more medicalised or psychological perspective.
Trickett and colleagues (1994) argue that it is reasonable to expect that children who have experienced CSA to exhibit academic problems in the school classroom, because of the psychological trauma of the early abuse,
‘That is, high levels of depression, anxiety, and dissociation should affect a student's ability to concentrate and pay attention within the classroom and have a deleterious effect on the motivation to learn.' (Trickett et al. 1994, p.184).
Links have been made between CSA, poor cognitive performance and lower academic achievement in women by young adulthood (Noll et al. 2010; Robst 2010). In Thomas and Hall’s (2008) examination of the life trajectories of women abused in childhood, women reported struggling with 'distractibility, social bullying, and isolation' and the ability to learn was 'impaired by the maltreatment they were experiencing at home' (Thomas and Hall 2008, p.154). Although being a survivor of CSA does not automatically determine academic success or failure in school, survivors often have to cope with deep-rooted feelings of shame, crippling low self-esteem and complex trust issues (Robst 2008, p.408). Exposure to childhood abuse can therefore impact on the adult sense of identity and contribute to negative perceptions of self, often in relation to their perceived abilities and lowered self-confidence. If they have a negative experience of school, this can have an enduring impact on an adult's attitude to education (NIACE 2014, p.7).
Engaging marginalised adult learners through art activity and arts-based research Enabling more marginalized communities to engage with adult learning is a complex task. NIACE, the UK’s ‘National Voice for Lifelong Learning’, recognise that harmful early educational experiences could form rigid dispositional barriers to learning (NIACE, 2014). Such psychological dispositional barriers (often involving negative perceptions, attitudes and assumptions) can affect confidence and motivation of the would-be learner. Art may provide a pathway to learning for such marginalised adults. Learning through the arts is often promoted as an active, social, and ‘fun’ activity for people to engage with, rather than the more passive, more rigid and assessed formalised processes of education. Studies have shown that 'individuals directly involved in creating or organizing artistic activity may learn skills that they did not previously have and may demonstrate greater creativity' (Guerzkow 2002, p.11). The beneficial impact of participation in the arts is widely recognized, but extremely difficult to evidence (Long et al. 2002). Links between
participation in the arts, learning and positive social and psychological outcomes are much celebrated, as this author illustrates,
The arts have been said to improve health, mental well-being, cognitive functioning, creative ability and academic performance (Guetzkow. 2002, p.10)
In Scotland, novel steps have been taken using the 'arts' with the prison population to engage marginalised adults with learning (Holt and Duff, 2012). Visual image creation, 3-D modelling, dance and drama have all been taken into Scottish women's prisons. These educational art activities have been used to 'improve self-esteem and mental wellbeing,
and provide ways for participants to look at their self-image and relationships with others' (Holt and Duff 2012, p.8). The art activities are framed as part-rehabilitation, part-learning, part-therapeutic expression. Such initiatives are encouraged by the Scottish prison service with the hope that involvement in creative arts may enhance the participant’s engagement with learning, challenge harmful self-perceptions and help tackle internalised negative identities (Tett et al. 2012). This link to creativity, skill development and helping challenge learner’s more damaging self-perspectives is of particular interest to me in my research. I would like to explore further with survivors the notion that learning can be transformative, as stated by Fergus McNeill and colleagues (2011) in their reflections on the creative work undertaken in Scottish prisons,
‘…learning is not only about acquiring new skills and practices but is also about changes in people's identity' (McNeill et al. 2011, p.2).
I intend to use an innovative, qualitative, Arts-Based Research (ABR) approach, which will involve conversation and visual art production (including drawing, painting, photography and sculpture). ABR uses the arts, and ABR practitioners argue that this is beneficial because of the strengths of the visual. There are a range of benefits, but uppermost it is thought that the highly engaging nature of the arts mean that ABR approaches have the capacity to evoke strong positive emotions, to ‘jar’ people into action, to create empathy, and to enable change, thought and action (Cole and Knowles 2008, Leavy 2015, Sinding 2008). ABR is framed as a research approach with a social and moral dimension. It is likened to Participatory Action Research and is viewed as one of the ‘transformative framework’ models in which ‘disempowered groups, communities and individuals are empowered’ (Kara 2015, p.45). A core value of ABR therefore is the involvement of
participants to shape the inquiry, to control the research process, and to be empowered as a result of their contribution. I have purposefully selected this methodology for two
reasons. Firstly, it will allow the participants to utilise their newly developed arts skills. Secondly, I want to explore the wide claims made about using this methodology and seek to understand how empowering a research process it can be for these participants. Ethics of inclusion
There are complex ethical dilemmas to negotiate when involving those deemed vulnerable in qualitative research. Academics have considered the potential risks and sensitivities of involving women that have experienced abuse and/or trauma in research, including those
to the participant and the researcher (Brzuzy et al. 1997; Alderidge 2015; Bahn and
Weatherhill 2013). Jo Aldridge (2015) argues that it is important to consider the impact(s) of involvement in research for women who are deemed ‘multiple vulnerable’ or
marginalized due to their lived experience of violence and abuse. Alderidge encourages the participatory researcher to identify safeguards to protect vulnerable respondents from current or further abuse, and to work to ensure that the research process does not in any way further endanger the lives of participants.
The potential vulnerability of the participant
Brzuzy and colleagues (1997) recommended that the researcher meet the participants beforehand to build rapport and decrease any potential discomfort. The researcher and participant should discuss the 'possible anticipatory reactions the survivors may
experience - anxiety, reduced concentration, flashbacks, and generalised anticipatory distress - as a means of both fully informing the survivor of the potential consequences of participation and normalising these feelings in advance of their occurrence' (Brzuzy et al.
1997, p.80). It is important to recognise these trauma responses, but my research will not specifically ask people to recall their abuse or focus on their traumatic histories. However, I
do appreciate that through the group work and creation of art the women may experience 'triggers' which lead to them feeling upset, emotional, angry and unable to cope. To
counter this, before each session, the women will be reminded that if they feel any of these things during the art making process they can leave the room, seek assistance from a staff member or take some time away and then return when ready. The participants will be reminded that the session is a safe place to create art and if any issues do develop through dialogue or art work, I will attempt to utilise my supportive, enabling role to allow the participant to voice their concerns and seek the right level of support for their needs. When involving vulnerable people in research, consent should be considered as an ‘ongoing process’. To counter participant vulnerability, I propose to adopt this form of ‘rolling consent’ in my research; Throughout the year the women will be asked about consent and their feelings about the research process.
Care of researcher
‘In order to delve into the participant’s intimate worlds to collect data, researchers need to establish trust and rapport with participants as well as empathy and understanding.’ (Bahn and Weatherill 2013, p.21). Even the most experienced interviewer may experience
distress of discomfort when speaking to respondents who have lived experience of trauma. Brzuzy and colleagues (1997) speak of the need of the interviewer to attend to their own emotional needs when working with survivors. This is particularly important if the
researcher is a witness of the impacts of trauma or if unhappily, the interviewer is also a survivor. I am not a survivor of CSA, but have an interested in working in this area as an intellectual advocate for women that have experienced abuse. I go into this research aware of the potential impacts on shaping my future opinions as a researcher and as a woman; as a witness to the long-term impacts of abuse on vulnerable people’s self- perceptions and perceived self-worth.
Bahn and Weatherhill (2013) warn that researchers can feel tired and exhausted due to the emotional strain of interviewing vulnerable participants (p.22). The need for
researchers to care for themselves, as well as their participants is a key consideration for my proposed research as although the women will be encouraged not to divulge any 'trigger' information about their experiences in the art sessions, there is the possibility of my feeling distress as a result of exposure to stories of violence or other trauma. I am prepared to draw on support services for my own well-being, and have put in place three female professionals who work with survivors of CSA to support me throughout the process. This support network should provide an outlet to discuss the work and its wide- ranging impacts, whilst protecting the confidentiality of the participants. I also intend to record my emotions, seek to understand the ramifications of research process on my well- being and apply emotional insights into my ongoing research. Finally, I intend to work reflexively and will keep a written and visual research journal throughout the process. This will give a further insight into the impacts of the research on my mental health, wellbeing and wider social perspectives.
Conclusion
My ideas are not yet fully formed, but I am very aware of the need to consider what precautions I can take at every stage of the research, in order to ‘maximise the possible benefits and minimise the potential risks’ (Seedat et al. 2004). I intend to work with female survivors of CSA in order to explore adult learning and arts-based research approaches. The participants will be service users of a Glasgow-based charity, where support staff will be available to the women through the lifetime of the research project. However, even when the research is taking place in a secure, supportive environment, I must carefully
consider how the participants could re-traumatised through the research and work to counter this throughout the process. I also need protect myself from harm and clearly articulate the risks and the benefits of the research to my research participants, their support workers and to the wider academic community.
ABR provides a rich and diverse approach in the rehabilitation of many victim groups. In this short article, I have explored the ethical implications surrounding ABR with vulnerable, abused women and I have made mention of ABR applied with the Scottish prison
population. In the literature, there are many different instances of the application of the ABR approach which discuss the ethics of inclusion. Akesson and colleagues (2014) review ABR and the ethical considerations as researchers when working with war affected children. Many of the points that they draw attention to are common to my own work. A key question set by the authors is whether art can be used as a tool for social change, and if so ‘what are the ethical implications of employing methods that seek transformation where such a transformation can be in no way guaranteed?’ (p.83). This is a dilemma for the qualitative, ABR researcher. The authors conclude that there are four key critical ethical issues when using ABR and vulnerable groups, which are ‘(1) informed consent; (2) truth, interpretation, and representation; (3) dangerous emotional terrain; and (4) aesthetics’ (Akesson et al. 2014, p.79). I have reflected on the first three points raised by the Akesson study. The fourth point linking aesthetics and ethics is perplexing. Who gets to determine what is ‘good’ artwork? Do we need to analyse the end product? In this paper, I have aimed to illustrate the many complex considerations when including vulnerable adult learners in the research process, yet highlighted the importance of providing such opportunities and creative platforms from which often-silenced groups can speak. References
Ainscough C & Toon K (1993) Breaking free: Help for survivors of child sexual abuse, Sheldon Press.
Akesson B, D’Amico M, Denov M, Khan F, Linds W & Mitchell C (2014) ‘“Stepping back” as researchers: Addressing ethics in arts-based approaches to working with war-
affected children in school and community settings’, Educational Research for Social
Change, 3, 1, pp.75-89.
Alderidge J (2015) Participatory research: Working with vulnerable groups in research and
practice, Policy Press.
Bann S & Weatherhill P (2012) ‘Qualitative social research: A risky business when it comes to collecting ‘sensitive’ data’, Qualitative Research, 13, 1, pp.19-35.
Brine J & Waller R (2004) ‘Working class women on an access course: Risk, opportunity and (re)constructing identities’, Gender and Education, 16, 1, pp.97-113.
Brzuzy S, Ault A & Segal EA ‘Conducting qualitative interviews with women survivors of trauma’, AFFILIA, 12, 1, pp.76-83.
Busher H, James N, Piela A & Palmer AM (2014) ‘Transforming marginalised adult
learners’ views of themselves: Access to Higher Education courses in England’, British
Journal of Sociology of Education, 35, 5, pp.800-817.
Cawson P, Wattam C, Brooker S & Kelly G (2000) Child maltreatment in the United
Kingdom: A study of the prevalence of child abuse and neglect, London, England, National Society for the Prevention of Cruelty to Children (NSPCC), retrieved at:
www.nspcc.org.uk/inform (accessed 14th May 2017)
Chouliara Z, Karatzias T, Scott-Brien G, Macdonald A, MacArthur J & Frazer N (2011) ‘Talking therapy services for adult survivors of Childhood Sexual Abuse (CSA) in
Scotland: Perspectives of service users and professionals’, Journal of Child Sexual Abuse, 20, 2, pp.128-156
Flatley J (2016) Abuse during childhood: Findings from the crime survey for England and
Wales, year ending March 2016, retrieved at:
https://www.ons.gov.uk/releases/abuseduringchildhoodfindingsfromtheyearendingmarch
2016crimesurveyforenglandandwales (accessed 14th May 2017)
Guetzkow J (2002) ‘How the arts impact communities: An introduction to the literature on arts impact studies’ Taking the Measure of Culture Conference, Centre for arts and cultural policy studies, Princeton University working paper, 7-8 June 2002,
http://www.mvgeorgia.org/wp-content/uploads/2015/07/art-and-community.pdf
(accessed May 11th 2017)
Hermann J (2015) Trauma and recovery: The aftermath of violence – from domestic abuse
to political terror, Basic Books, Perseus Books group, New York.
Holt L & Duff C (2012) Creating change: Effective arts practice in prisons, Creative Scotland online Publication, retrieved at:
http://www.creativescotland.com/__data/assets/pdf_file/0007/21400/Creating-
Change.pdf (accessed May 11th 2017)
Jacobson N & Greenley D (2001) ‘What is recovery? A conceptual model and explication’,
Psychiatric Services, 52, 4, pp.482-485.
Kane D & Bamford D (2003) ‘A review of education/support groups for adult survivors of child sexual abuse: A qualitative analysis’, Practice, 15, 4, pp.7-20.
Kara H (2015) Creative research methods in the social sciences: A practical guide, Policy
Press, University of Bristol.
Knowles JG & Cole AL (2008) Handbook of the arts in qualitative research: Perspectives, methodologies, examples and issues, Sage publications.
Leavy P (2015) Method meets art: Arts-based research practice (2nd ed), Guildford Press,
New York.
Long J, Welch M, Bramham P, Butterfield J, Hylton K, Lloyd E, Bowden K & Robinson P
(2002) Count me in – The dimensions of social inclusion through culture and sport,