132 . British Journal of Learning Disabilities Vol.
27 (1999)
Group Work with Women with
Learning DisabiIities
Margaret Domey, Waylands Day Centre, Croydon.
The intention of this paper is to give an insight into the
way in which group work offers women with learning
disabilities the opportunity to (a) see what they have
in common with other women and (b) enable them to
develop a positive sense of themselves and their sex-
uality. The paper contains a summary of the author's
role and the context in which this group work takes
place. Descriptions of group recruitment, referral pro-
cess, group criteria, group work practice and methods
are offered. The key themes which women with learn-
ing disabilities consistently raise within the groups are
explored and examples are given to illustrate how the
women's group responds to these. The paper concludes
by listing some of the important factors which facili-
tators need to be mindful of when setting up groups
for women with learning disabilities.
Introduction
Women who have learning disabilities have much in
common with those who do not (Williams, 1992). For
example, whilst developing their individuality they may
experiment with image and appearance and explore
relationships - for some, albeit the minority, to the
point of marriage and motherhood. They may face the
challenge of low self-esteem or eating disorders and may
have to manage fluctuations of their emotions as a result
of bodily changes, for example PMT and the menopause
(Corbettef al., 1996).They may experiencephysical/sexual
violence in the home or work place, have a negative self-
image and experience pressures to conform to an oppres-
sive agenda for women set by society at large (McCarthy,
1998). Despite these and many other commonalties, the
shared experience of being a woman is not often high-
lighted in the literature. The impression is often given of
women with learning disabilities as a distinct group (see
Brown, 1996).However, increasingly there are exceptions
to this (Bums, 1993; McCarthy, 1999).
It is the intention of this paper to give insight into the
way in which group work within a day centre context,
can serve two primary purposes for women with learn-
ing disabilities. Firstly, to enable them to see what they
do and do not have in common with other women,
secondly to develop a positive sense of themselves and
their sexuahty.
Waylands Day Centre is run by Croydon Social Ser-
vices and my full-time post there is Day Centre Officer.
Since 1994, along with a male colleague, I have been
responsible for developing and facilitating groups which
address the social/sexual need of adults with learning
disabilities, and I also run a self-image group specifically
for women. This paper is based on experience, observa-
tion, analysis, feedback and learning from groups which
have run during this time.
The Referral Process
Group descriptions
Adult Awareness Programme Level 1 & 2 is a closed
group which runs once a week for approximately ten
months. The Adult Awareness support group is also a
closed, on-going group which runs once a week. The
Self-image group is open-ended and runs four times a
week. All sessions last for two hours.
Group recruitment
Adult Awareness groups are advertised using leaflets
which are written and pictorial and which explain the
aims of the groups. Below are some examples of illus-
trations from the pictorial leaflet.
Figure 1 Adult awareness is about ...
However, recruitment is not dependent on advertising
alone, as the groups are well known to the members of
Waylands Centre, staff, parents/carers and other profes-
sionals in the Borough. Women with learning disabilities
can refer themselves or be referred by parents/carers, key-
workers or care managers. In practice, most referrals come
from key workers who work closely with the women
on a daily basis. Women are referred for a variety of
reasons, most commonly displays of inappropriate sex-
ualised behaviour, a need to develop assertiveness and
self-confidence within relationships and to gain more
awareness of themselves and their sexuality. For a broader
overview of reasons why women with learning disabili-
ties are referred for sex education, see McCarthy, 1996.
 British Journal of Learning Disabilities Vol. 27 (1999) . 133
When setting up an Adult Awareness group the facili-
tators set the following criteria:
the women should have mild/moderate learning
disabilities;
they need to be able to communicate verbally;
they need to have a low level, or no challenging
behaviour (as this presents difficult management
issues).
The other factors facilitators take into account are the
reason for referral, the compatibility of group members
and achieving an optimum group size of between six
and eight (McCarthy & Thompson, 1998).
Parents and families are encouraged to be a part of the
process. They receive assessment reports and are also
encouraged to visit the centre to look at resources, dis-
cuss group programmes and to have on-going communi-
cation by phone or letter to talk through any queries and
concerns they may have.
There have been occasions when parents have been reti-
cent about the idea of sex education for their daughters.
For example, one mother reported to me that her daughter
did not have sexual feelings and therefore could not be
at all interested in sex. In such instances it is important
to emphasise the ’keeping safe’ aspect of sex education,
good and bad touch, personal safety rules and assertive-
ness training. This should be shared sensitively with the
carer/parent, since their concerns are important and,
unless they are acknowledged, the effectiveness of the
groupwork experience could be hindered (Rose & Jones,
1994). If the carer continues to reject this opportunity,
our day centre policy is that adult clients’ rights and
choices need to be respected. If they have made a clear,
informed choice to attend the programme then our
responsibility is to help them to understand the possible
consequences of their decision (Rose & Jones, 1994).
Group Methods
The methods used within the Adult Awareness groups
are explained to women on a individual basis before
they join the group and then again in the first session.
Careful monitoring of the women throughout the group’s
life-span is carried out by the facilitators to ensure they
are comfortable with the style of working and want to
continue. A fact that a woman looks forward to coming
and turns up for the group is a good indicator that she is
comfortable with the process. As each group tends to be
quite different, space does not permit going into detail
about a typical session or other considerations like ethics
and confidentiality, however, the literature on both group-
work practice (Benson, 1987)and my experience suggests
that the following factors are important:
Preparation for group ’session’:
liaison with key people in client’s life;
create comfortable environment;
use developmentally appropriate, accessible material;
allow sufficient planning and preparation time;
incorporate all institutional policies and procedures;
review previous session records.
During group session:
be aware of group limitations and when it becomes
necessary to refer on, e.g. to individual counselling/
therapy;
have a tea break for refreshment, personal reflection,
toilet breaks and renewal of group’s attention span.
Outside group session:
maintain detailed record keeping and constantly;
evaluate group learning and process;
establish facilitator accountability through line
management;
maintain safe working practice through the support
of specialist supervision (e.g. Respond, Consent);
networking with other sexuality workers, secure on-
going relevant training.
From listening to women with learning disabilities, it
appears that for some of them, previous sex education,
e.g. in school, had been delivered in a cognitive manner
in keeping with the education curriculum. At the start of
this work in Waylands, my own teaching approach was
similar. However, as my experience has grown, my
method of teaching has now changed and integrates
aspects of a more therapeutic model (Gobat, 1994).
The therapeutic model works with the group process,
the unconscious, transference and counter transference
(Sinason, 1992).In other words, the facilitator uses thera-
peutic insight to understand what is happening under-
neath the behavioural functioning of the group. The
groups continue to have educative aims but also provide
space for the emotional impact of learning more about
sexuality and relationships.
Within the groups I need to be clear about my role
of facilitator and my limitations. In working with the
material presented by group members I have drawn on
a range of ideas from creative and person-centred therapy
and psycho-dynamic and psychoanalytical approaches.
I have found that blending these approaches has proved
effective. A polarising of models would not be useful.
Like many who run groups, I am not a qualified thera-
pist, but I have learnt to use therapeutic skills. These
have been developed through on-going supervision with
a psychotherapist, counselling training, and group work
training (see list at end for details of relevant organisa-
tions).
Because of the nature of people’s learning disabilities,
it is important to work in a concrete and multi-sensory
way, using slides, pictures, videos, specialised board
games and other fun learning activities (see list of recom-
mended resources at the end). Clients benefit from having
a well-defined group with a beginning, middle and end
(Brown, 1992). For example, beginning the session with
one group member welcoming others individually. This
helps those women who find it difficult to speak in a
group (due to shyness, lack of confidence, etc.). In this
way, each person is acknowledged in the group, which
is in itself valuing. For many clients just being part of a
group is an enriching experience. It gives opportunities
to develop social skills such as turn taking, patience,
negotiating, listening, and commitment to others. The
learning of such skills is a key factor in this work.
 134 . British Journal of Learning Disabilities Vol. 27 (1999)
In addition, art work and role play have proved enjoy-
able for the group members and motivates them to get
involved. They offer a therapeutic and effective way of
enabling women to express their feeling and emotions.
Many lack the vocabulary to describe emotions and simple
techniques and materials can help improve their ability
to recognise their own and others’ feelings (Holland et
al., 1998). Pictures like these have helped women to
develop and express a new emotional vocabulary.
Figure 2
Having worked with individuals to develop a vocabu-
lary of emotions, it becomes important to ensure that the
group offers the space and time for these feelings to be
expressed. Frequently, people with learning disabilities
are not listened to. For example, they may attend meet-
ings about them which are conducted in a language which
they cannot access, or which explores the most intimate
details of their lives at a pace which they cannot always
respond to (Camaby, 1997). It is important to ensure that
the groupwork does not mirror this. This is clearly diffi-
cult for women who are not articulate, but skilled group-
work and the right resources can enable some people to
achieve this. What follows is an example of how the
group enabled one woman with learning disabilities to
make considerable progress in her personal life.
Joan (not her real name) used the group really well to
work through important issues in her life. She has a mild
learning disability, lives with her family who are very
close and caring towards each other. Joan attends the
day centre five days a week and has a boyfriend, Alan,
with whom she wanted to spend more time, both soci-
ally and in private. Although Joan was very in touch
with how she felt and was well able to share this in the
group, she seemed quite unable to express her needs and
feelings to her family. They did not consider Alan to be
a ’proper’ boyfriend and their belief was that Joan could
not understand what a boyfriend/girlfriend relationship
entailed. Joan’s perspective was:
They wouldn’t see it from my point of view. Some-
times they don’t listen. You know they will say ’No.
Figure 3 Beyond talking about it
Restricted Social Opportunities
Lack of knowledge of menstrual cycle
- -< + / Lack of privacy
Unhappy with their appearance < > Low self-esteem
Unmarried no children < Common factors
in the lives of
Sexual frustration < women with LD
Fantasies of being normal < > Institutionalised
History of abuse 4
\L
Loneliness
What do you want a boyfriend for?’ Maybe they try to
read my mind and I read their minds to see their point
of view. I said to my mum ’You must have had love
with dad’ ’cause you had me’.
In the group we spent time discussing relationships
and how the women wanted to be treated and how they
treated others. We talked about appropriate and inappro-
priate behaviour, public and private places and acknowl-
edged that for some there are few opportunities to
develop relationships on a more intimate level. Whilst
nothing can take away the pain and the feeling of loss
when central life experiences are denied, nevertheless,
talking about desires and feelings is helpful and healthy
and enables the women to understand that facing up to
limitations in life is difficult but possible. My experience
suggest that many women with learning disabilities are
as capable as non-disabled women in facing up to limita-
tions in their lives, bodies and families.
Within the group, Joan practised what she wanted to
say to her family using video role play and art work.
Eventually, after about a year, Joan was able to talk with
her family about her needs and desires using pictures she
had drawn. Her keyworker, who witnessed this exchange,
reported that it was a powerful and moving occasion.
Joan said of this experience:
I had butterflies in my tummy but I was determined to
live my life how I want to live it and not how they
want me live it. I was shocked that they agreed to let
me see Alan. They overprotect me but I don’t want to
know ’cause I am an adult.
Joan’s family were able to respond in many ways and
this has brought about many positive changes in her life.
Joan now sees Alan at weekends, and at times during the
week. They do have some opportunities to have some pri-
vacy but they are still working towards negotiating more.
Despite these successes, there are still areas of Joan’s life
which are restricted and which cause her on-going frus-
tration. However, through the support she is receiving,
Joan is coping with these limitations and is working
through them at her own pace. Together, with her partner
she was referred on for additional counselling and support.
Other examples of significant changes in women’s lives
have included a reduction in the instances of challenging
behaviour due to their better understanding and man-
agement of PMT. Many women are generally more asser-
tive, have a stronger sense of self and are more in control
of their lives. Through monitoring the progress of women
in other areas of their lives this finding seems to be
backed up by parents/carers, other professionals and by
the women themselves.
> Low self-worth
> Loss
> Stigmatism by Society
 British Journal of Learning Disabilities Vol. 27 (1999)
When they are asked to talk about important parts of
their lives, certain issues arise again and again for women
with learning disabilities. This diagram is my own visual
representation of these key themes communicated to me
by the women I have worked with. Readers will note
that these issues are all negative ones, and indeed my
experience is that very few positive features are raised
by the women. This is a depressing state of affairs which
only highlights the necessity for giving the women oppor-
tunities to explore both the issues and their feelings. Many
of the issues are complex and overlap with one another
and space dose not permit going into detail about them
all. However, a few examples will demonstrate how we
tackle these issues in a group.
Many women with learning disabilities have low self-
esteem and low self-worth. To help women to find ways
to feel better about themselves, a group was formed to
specifically look at promoting self image. In this group
women can not only talk about how they look and dress
(McCarthy, 1998 ), but they can learn practical skills such
as personal hygiene, skin care, make-up, dress and per-
sonal presentation.
Links have been developed with a local beauty school
to enable the women to have facials and massages. As
well as improving their appearance these are experi-
ences which are by their nature sensual and relaxing and
the women enjoy them. Positive changes do happen for
some women. Those who develop skills such as apply-
ing make-up are helping their friends to do the same and
thus experience improved self-esteem. Others feel they
have a more 'grown-up' or age appropriate look. The
Looking Good board game (see resource list) has proved
to be a useful resource for such groupwork.
Many women, and indeed men, with learning dis-
abilities live restricted lives, not solely because of their
learning disability (although this is of course a factor),
but because of a lack of opportunities and resources.
Whilst there is, of course, a limit to what difference a
women's group can make to women's lives, we do, and
have done, the following:
taught assertiveness skills and helped women find
their voice;
liaised with, and put women in touch with, other
groups that may empower them, e.g. People First;
assisted women to make complaints;
enabled them to express their feelings and helped
them move from being passive to being in control;
liaised with other colleagues and agencies to provide
supplementary support, e.g. Occupational Therapy,
FPA, etc.
helped women to develop their self-esteem and
express themselves and their sexuality.
As well as these groups being a learning experience for
the women, I also have learnt a lot as group facilitator.
One of the ways in which I believe I can enhance group-
work is to continue formulating new and innovative
teaching methods. Further training and increased level
of resources would be very beneficial in developing my
role as facilitator. 1
135
Conclusion
This paper has described the many positive benefits
which sexuality and personal development groups can
offer women with learning disabilities. However, these
benefits will only be experienced by women, if group
facilitators are:
(1) Always aware that women come to the group with
an entire history of experiences, many of which will
be confusing. It is important not to overload them
with too many pieces of information that they may
not be able to make sense of. Value small change in
individuals and the group, as and when they happen.
(2) Realistic about the women's capability for new learn-
ing. Some may not learn very much on an intellec-
tual level, but may nevertheless benefit from the
group experience.
(3) Honest about their own level of skill and know their
limitations within the group. Facilitators should
always seek on-going specialist training and super-
vision.
(4) Aware of the lack of opportunities open to many
women with learning disabilities. Attempting to
change all aspects of women's lives is likely to be
futile, but it is nevertheless important to remember
the things which can be done to bring about change,
and that small changes can sometime have big effects.
Research, anecdotal evidence and personal experience
suggests that by setting up groups for women with leam-
ing disabilities we give them the opportunity to work
together towards shared goals (Millard, 1994).They learn
new skills, have access to knowledge and information and
a chance to discuss issues that are important to them.
To conclude, group work gives women with learning
disabilities the opportunity to develop a healthier sense
of themselves and their sexuality.
Correpondence
All correspondence should be sent direct to Margaret
Domey, Day Centre Officer, Waylands Day Centre, 487
Purley Way, Croydon CRO 4RG.
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BJLD - Special Issue

Witnesses in the Criminal Justice System
In the context of recent proposals (Speaking Up for Justice and the Youth Justice & Criminal Evidence Bill), we
are repeating an earlier request for contributions for a special issue on witnesses, or potential witnesses (for
example, victims of alleged offences whose cases do not reach court), with learning disabilities.

Very little is known about how people with learning disabilities themselves feel about being witnesses so we would
particularly welcome submissions from men and women who have had this experience. These may include:
treatment by the criminal justice system (police, court, etc.);
support from service providers, families, and others, including people with learning disabilities;
what was helpful or unhelpful at any stage, and the implication for ‘good practice’ for other witnesses.

Witnesses do not need to be victim-witnesses: the account could relate to an alleged crime to another person.
Contributors may wish to produce their accounts with others. We are happy to accept joint work as long as all the
authors are acknowledged. If the contribution is about the experiences of someone with a learning disability, we
would expect his or her name to be put first. Contributions should be typed or on audio-tape.

We would also welcome contributions from practitioners, carers, and others, about supporting a witness or a
group of witnesses at any stage of the process, from reporting the alleged offence to the police, to dealing with
the aftermath of a court case. This might involve a report of specialised work, such as assessing the witnesses’
need for support in court, or a description of more informal assistance. We are particularly interested in des-
criptions and evaluations of any formal schemes to maximise access to justice for witnesses with learning
disabilities.

We would like to discuss possible contributions before the end of November, 1999. The deadline for submissions
to the journal is July, 2000.

The editors of this special issue are Ms. Isabel Clare, Professor Glynis Murphy and Dr Tony Holland.
To discuss possible contributions, please contact Isabel Clare at the Department of Psychiatry, University of
Cambridge, Douglas House, 18b Trumpington Road, Cambridge CB2 2AH (telephone: 01223-746100; email:
ichc2Q hermes.cam.ac.uk).