Advocating Co-Productive Engagement with Marginalised People: a specific perspective on and by survivors of childhood sexual abuse

Advocating Co-Productive Engagement with Marginalised People: a specific perspective on and by... Abstract Co-production is gaining ground as a key dimension of public policy reform across the globe. This paper argues in favour of social welfare shaped by the principles of co-production and suggests that the promotion of democratic relationships is more likely to enable the agency and recovery of victim-survivors of childhood sexual abuse. The paper, based on an autoethnographical approach, is likely to be of relevance to social care practitioners who work with a range of marginalised people, particularly in liberal states that promote organisational cultures shaped disproportionately by risk. Cultures of risk, it is argued, promote power balances and othering—arguably an institutional perpetuation of the original abuse. Co-production, on the other hand, has the potential to legitimise expertise by experience, enabling victim-survivors to be reinstated as citizens with associated rights of participation. The paper subsequently draws out some of the benefits of co-production for practitioners whose professional engagement may be stifled. We suggest that co-production potentially points towards practice based on the valuing of expertise by experience and social solidarity. Co-production, critical practice, victim-survivors, social welfare, empowerment Introduction The starting point of this paper is that understandings of professionalism should be reconfigured by addressing the power differentials that prioritise professional knowledge over ‘expertise by experience’. This is particularly important when working with marginalised groups whose views often remain unacknowledged, ignored or unheard (Fisher and Freshwater, 2014). As things stand, professional practice tends to be based on a zero-sum understanding of power that perpetuates and entrenches the privileging of professional knowledge over other forms of knowledge, particularly the expertise of experience acquired by members of marginalised groups (Fisher, 2012). All three authors have over many years directed considerable attention, personally and professionally, to the question of how to constructively address, if not entirely resolve, the harm incurred through suffering violence and abuse and its impact on a person’s sense of self. Our shared interests prompted us to collaborate in 2016 to consider this question in relation to the experiences of adult victim-survivors of childhood sexual abuse (CSA) as recipients of social welfare services. On the basis of personal and professional experiences, we concurred that recovery from CSA requires the redressing of power imbalances between social welfare ‘providers’ and ‘recipients’. Two of the authors (Bob Balfour and Sally Moss) had extensive experience of adult services for victim-survivors of CSA. Starting with testimonies written by Bob and Sally, we turned our attention to whether othering, ostensibly related to imbalances of power, might be addressed through co-productive approaches to social welfare. Our research question, which is addressed by drawing on an autoethnographic methodology, can be summarised as follows: ‘What is the potential of co-production to combat the power differentials and associated othering that adult survivors of CSA experience as recipients of social welfare?’ This paper is itself an enactment of co-production between authors with diverse backgrounds and expertise who have engaged in an iterative and dialogical process. The paper is timely given the growing international recognition that areas of professional jurisdiction should be opened up to greater public scrutiny, debate and power sharing (Dzur, 2008; Boyle et al., 2010; Dominelli, 2016; Plotnikov, 2016). Co-production is gaining ground as a key dimension of public policy reform across the globe (OECD, 2011); it is viewed variously as the route to public-service reform (Nambisan and Nambisan, 2013), as a response to the democratic deficit inherent in the delivery of public services (Pestoff, 2006) and as a way forward to galvanise active citizenship (Department of Health, 2010). We acknowledge that the term ‘co-production’ lacks conceptual clarity—it has been identified as a ‘woolly-word’ in public policy (Osborne et al., 2016, p. 640). Crucially, we are aware of the potential for co-production to be co-opted as a tactic to progress the dismantling of the welfare state and to accelerate the drive towards marketisation (Boyle et al., 2010; Philips et al., 2013). People, especially disadvantaged groups, could thus be abandoned to fend for themselves within a consumer model of welfare based on rugged individualism. In response, we argue that co-production must be aligned with social solidarity. Background Worldwide prevalence rates of CSA range between 8 and 31 per cent for girls and 3 and 17 per cent for boys (Barth et al., 2013). Inevitably, people working within social welfare will often find themselves helping victim-survivors of CSA, although CSA may not be acknowledged or identified as being at the root of the problem at hand. As mentioned above, two of the authors are victim-survivors of CSA and are able to provide ‘insider’ insights as service recipients. We contend that, although the experiences associated with being a victim-survivor of CSA will bear a resemblance to those experienced by other marginalised groups, CSA is associated with constellations of feelings unique to sexual victimisation. These feelings include betrayal, powerlessness and stigmatisation, which others may respond to with disbelief, denial and attributions of responsibility and guilt (Feiring et al., 1996). Adult victim-survivors of sexual abuse are represented amongst the most marginalised groups in society (Lew, 1993; Herman, 1997). Some experience a form of powerlessness that is internalised into their very sense of self, as a ‘victim’ (Balfour, 2012), as evidenced in Learning the Lessons: Operation Pallial (Children’s Commissioner for Wales, 2015). The urgency of redressing cultural and institutional complacency is manifest and, drawing on Herman (1997), we suggest that social action through co-production might be regarded as a key element enabling survivors to regain the power they lost through the violation of their initial abuse—and its entrenchment through subsequent cultural and social forces. We consider the discovery or rediscovery of agency as key to reinstating marginalised people as citizens, and we are guided by Bourdieu’s (1984) insight that the most damaging forms of social suffering are those experienced by people ‘on the margins’: in other words, the suffering of those who are less likely to receive empathy, respect and social recognition from others—a theme which has been taken up in an extensive literature (see e.g. Reay, 2005; Wilkinson, 2005; Frost and Hoggett, 2008; Fisher and Lees, 2016). Suffering is partly tied up with a sense of ‘being done to’ or a lack of agency (Frost and Hoggett, 2008). This can lead to a person experiencing the power that someone else has over them as natural and legitimate and to their suffering being internalised into their sense of self. People no longer see themselves as citizens with legitimate expertise and knowledge (Fisher, 2012). The challenge, therefore, is to develop services for victim-survivors that enable them to regain a sense of agency and a sense that they can co-shape the future positively—for themselves, and for other survivors, who, we suspect, await the safe spaces that will allow them to contribute. As Dominelli (2016, p. 387) writes, ‘Exercising agency renders invisible groups visible, and facilitates their involvement in collective expressions of solidarity’. Methodological approach Autoethnography is a methodology which blurs the distinctions between ethnography and literary studies by placing the emphasis on the value of personal testimonies, often produced by author researchers (Ellis et al., 2011). Given that CSA is inextricably entangled with the abuse of power, the authors were drawn to autoethnography as it addresses power differentials by collapsing the researcher/research participant binary and legitimises expertise by experience. As Chase (2005, p. 423) points out, autoethnography challenges the power dynamics inherent in ‘traditional social science’. Autoethnographers express differing views regarding whether personal testimonies stand on their own as data, revealing truths obscured in traditional science (Ellis and Bochner, 2000), or whether testimonies should be regarded as a complement to more traditional social science data derived from realist ethnography (Anderson, 2006). These contrasting approaches create, in our view, false dichotomies between the emotional/rational and the personal/scholarly. We suspect that boundaries between feeling and thinking are less well defined than is often assumed in traditional science (see Burnier, 2006; Damsio, 2006). Our approach reflects that proposed by Vryan (2006), who argues in favour of analytical autoethnography that is both evocative and analytical. We believe that personal testimonies can provide access to knowledge and experience that are sometimes obscured in traditional science. At the same time, we recognise that an individual’s meaning making cannot be viewed in isolation from social relations, institutional contexts and broader cultural and structural dimensions. Crucially, our starting point is to recognise the reality of sexual violence against children and the reality of the harm that it perpetuates. The testimonies included in this paper are personal evocative accounts written by two of the authors in response to their experiences of being othered and of feeling obliged to perform an inauthentic self in order to avoid being othered. The testimonies provided the data used as the focus for our initial discussions, forming the basis for our subsequent reasoning on the potential value of co-production. The testimonies express the lived reality that othering impedes recovery by reinforcing the sense of powerlessness associated with CSA. These key insights stem from the recall of direct experience saturated with emotional responses and would not have been arrived at merely through detached observation. The recall of the experiences provided the motivation for formulating and engaging with our research question. As outlined above, the focus of our collaboration hinged on the question of how othering undermined recovery, and the extent to which othering was a product of power imbalances that might be addressed by co-production. Wary that challenges to systems can inadvertently lead to new forms of othering, we decided that it was vital that we consider how practitioners are embedded in social relations that either enable or restrict meaningful engagement with their clients. Our analysis was therefore subjectively informed by the lived experience of othering and, equally, by our professional and research experience considered in light of academic contributions on risk and co-production. Two of the authors had a pre-existing interest in co-production: Balfour (2012) in his work supporting men who had suffered CSA, and Fisher (2012, 2016) through her research with marginalised communities. We engaged in an iterative process, as is generally the case with autoethnographical studies (Hoppes, 2014), involving a back-and-forth movement between the discussion of painful and personal experiences of vulnerability and observation and analysis of the broader context of those experiences, informed by sociological analysis. The boundaries between data and analysis are blurred: the testimonies were generated by the authors and then analysed through shared reflections informed by life experiences acquired in professional and research roles, and by scholarly engagement. We acknowledge that the study lacks generalisability as the term is usually applied in social scientific research that draws on large random samples. In addition, autoethnographies do not provide validity in the normal sense, but we hope that our study achieves verisimilitude: that is, the reader feels that the experiences described are believable and lifelike and finds our conceptual framework sufficiently convincing to merit further empirical exploration. The brief autobiographies below are intended to provide the reader with an insight into the processes that have shaped our respective interests in developing the position outlined in this paper. Bob Balfour is an internationally known, UK-based activist and has worked for twenty years developing and delivering innovative projects for victim-survivors of CSA. His own personal experiences of childhood sexual trauma during the 1960s and 1970s, both extra-familial and within ‘looked after’ institutional contexts, have shaped his passion for better societal responses to victims of sexual crimes. Bob’s interest in co-production stems from his own experience of feeling ‘co-opted’ by the agendas of public agencies during these twenty years. This has sometimes felt like perpetuation of ‘abuse’: some interventions he has experienced have failed to address the needs of victim-survivors as an oppressed minority but have exploited the emotional need for personal validation of individuals who have been consulted at a tokenistic level (Balfour, 2012). Sally Moss is a CSA survivor who has been in contact with statutory, private- and voluntary-sector support services since adulthood (approximately twenty years) and who has been most supported in her recovery by books, private counselling services, CSA activists and the informal support of fellow survivors of CSA (and of other adverse childhood experiences), online and face to face. She is interested in approaches that encourage self-awareness in professionals in service hierarchies and harness the expertise by experience of CSA victim-survivors. Pamela Fisher’s interest in approaches that combat the abuse of power, intended or otherwise, came about through her lived experiences of an abusive domestic situation as well as through extensive research experience with people marginalised because of social disadvantage, disability, mental health and political stigma. Her awareness that people, whose identities are constantly devalued in their interactions with others, can become fixed in positions of helplessness (Fisher, 2012) prompted her interest in ‘professional’ practices and research methodologies based on co-production, understood as authentic power sharing (Fisher, 2016). Having provided a brief outline of the personal and professional experience underpinning our reflections and analysis, we present our current reasoning on how othering can potentially be remedied through co-production. We begin with a historical overview of co-production. This is followed by a section that draws out the value of co-production for victim-survivors by merging the evocative/personal with the conceptual. Subsequently, we draw on the extant literature to discuss how co-production might be ideally enacted, following this with a consideration of the benefits of co-production for those working in social welfare. Our view is that co-production must, in order to be authentically co-productive, provide mutual benefits. Finally, we suggest a way forward towards cultural change. The origins of co-production The concept of co-production originated in the USA through the work of a political economist, Elinor Ostrom, and her research team at the University of Indiana (see Carr, 2016). Ostrom and her colleagues conducted a series of research studies of the Chicago police. They noted that, when the police abandoned ‘the beat’ in communities and became more distant through their increased use of patrol cars, crime rates increased. The term ‘co-production’ was used to identify the missing element that could only be provided by the public. Ostrom’s research established that successful policing required the informal engagement of the public and ‘on-the-ground’ relationships between communities and the police in order to keep crime in check. The police needed the community as much as the community needed the police. The concept of co-production was subsequently taken up by Edgar Cahn (2004), who applied it to develop a practical agenda of system change. According to Cahn, the concept of the ‘core economy’ should be viewed as key to the reform of public institutions. The core economy (sometimes termed the non-market economy) is where goods and services are produced and exchanged in transactions that are primarily driven by relationship (family, neighbourhood, community and so forth). Whereas the market economy functions on the basis of monetarised transactions, the core economy is reliant on people’s skills, experience, knowledge and wisdom, which are embedded in their everyday lives. Qualities and processes that are embedded in relationships—in particular love, empathy, watchfulness, care, reciprocity, teaching and learning—are central to the core economy. Similar to the role played by the operating system of a computer, the core economy is the basic, yet essential, platform upon which the market economy and public services run. Employers, for example, assume that employees should manage their lives in families and neighbourhoods where they look after older people and sick and disabled people and bring up children who will in turn contribute to the market economy. Institutions, businesses and enterprises in the market economy are highly reliant on the often unacknowledged ‘invisible’ work undertaken within the core economy. In this paper, however, whilst we adopt the concept of the core economy, we choose an expanded definition of the core economy that incorporates trauma and expertise by experience. Whilst these experiences are shaped by the very opposite of love, empathy and care, the authors believe that they deserve to be heard and to be central to the development of meaningful interventions with victim-survivors. Why co-production matters for victim-survivors Excluding people from and subordinating them to the dominant group is captured by the term ‘othering’, and othering is inextricably entangled with an ideology of risk (Webb, 2006). Throughout social welfare provision in the UK and other neo-liberal states, there is a preoccupation with risk management, risk-assessment and risk-governance strategies to avoid blame, culpability and litigation (McLaughlin, 2007; Pollack, 2010). As Webb (2006) argues, neo-liberal social work has essentially become a profession focused on risk avoidance and risk regulation. Within this context, marginalised social groups are constructed through a discourse of risk as the stigmatised and risky ‘other’ (Lupton, 1999). According to Said (1978), a distinctive aspect of being the ‘other’ is that one is not a subject with agency and voice. This is often the experience of victim-survivors, and of recipients of social welfare more broadly, who are generally subject to a range of disciplining practices that aim to control and reform and to prevent harm, either by them or to them. Conventional service delivery tends to be based on an imbalance of power, which eradicates risk through limiting people’s agency. In response to his own experiences as a victim-survivor and service recipient, in 2001, Bob founded Survivors West Yorkshire (2006), which in 2005 commissioned the first in a series of reports under the banner A View From Inside The Box. Its objective was to scope the service needs of male and female survivors across the metropolitan area of Bradford in West Yorkshire. As Bob testifies below, overcoming powerlessness and discovering agency can be a turning point in recovery for people who have suffered CSA: I have travelled a long road from anger, at what was done to me, to new insights regarding the need to change the paradigm surrounding sexual violence victims. I regard changing the paradigm as both a personal feat of will and a willingness to unpack the self within a cultural conflict surrounding a taboo—a conflict rooted in fear, in my experience—fear of shaming from disclosure. In 2006 the first A View From Inside The Box was published (Survivors West Yorkshire, 2006, p. 2) and I wrote the following: ‘This is not Pandora’s Box with a lid on, it is a cultural “solitary confinement” with no key available and no parole board to review the sentence!’ I was speaking of the silencing othering that many survivors encounter when disclosing or campaigning for change. The othering has the effect of reinforcing the sense of injustice you feel; and of course if you get angry then the othering is reinforced. You find yourself positioned as ‘damaged’ and for some an object for their amusement. Powerlessness can feel overwhelming: when survivors act out, remember it is because they are human. Often the acting out happens in encounters with ‘professionals’ who claim to understand. One of my ancestors was a released slave who came to Liverpool in the mid-nineteenth century from the West Indies and married a white woman who worked with her harbourmaster father on the docks. A slave freed into the world of slave-masters with the added public profile of marriage to a woman from the slave-owning society. My experiences of disclosure tell me my great-grandfather and great-grandmother must have been resilient to forge a life together. I have held on to the memory of Mr and Mrs Padmore during times when I have experienced painful othering as it gives me a sense of identity rooted in resilience. All forms of othering should be acknowledged for what they are—bullying and intimidation. In my experience, othering mostly takes place on a micro-aggressive level and, if challenged, the perpetrators often ‘gaslight’ you with the myth-ridden narratives that surround male survivors in particular. Myths are powerful and in the case of male survivors they range from our all being homosexuals (we wanted the sexual contact as children) to the ‘vampire’ effect: once bitten, we all go on to bite others. Such myths seep into common-sense understandings and support unconscious bias that permits othering (Balfour, 2012). You would think you would get used to othering, but you don’t; it’s like cancer eating away at you and the best you can hope for is to get better at navigating between wanting to rage and wanting to accept yourself as an equal human being, not the ‘disordered’ individual you have been labelled as. This is the label you acquire when you dare to challenge denials of victims’ invisibility, made by professionals who hold ‘power’ and yet reject evidence-based approaches if they find these uncomfortable. It’s been a journey, as they say, and I suspect I will pay a price at some stage. However, I wouldn’t change a thing about this journey, as change is needed across our society. That said, we need to reduce the price paid by survivors for speaking truth to power. By doing so, we can work smarter, harnessing the expertise of survivors. Expertise by experience must be incorporated into professional practice, not silenced by it. So for me, co-production offers a vehicle for the redistribution of power. This does not involve taking it back as survivor owned, exclusively, nor allowing a continuation of the tokenistic game played by the current holders of power. Co-production potentially offers opportunities for shaping democratic and innovative solutions based on the valuing of survivor and professional knowledge with the objective of achieving constructive and transparent survivor-informed change. Sally, a survivor of CSA, describes how ‘her reason, her courage and her value’ are sometimes discounted when she discloses this experience. As Sally’s testimony demonstrates, people are encouraged, particularly in neo-liberal societies, to attain a personal sense of invulnerability by disparaging those on the margins of society, including people who are subject to social exclusion and abuse (Tyler, 2013): This doesn’t reflect the whole of my experience, of course: many people have responded with reason and courage of their own, and deep compassion, to the disclosure of my CSA history. But at times I can be viewed as being inherently weaker, less capable, than the norm. Some find it easier to believe that bad things happen to those who are a good fit for suffering anyway. The victim of an abhorrent crime might (in some cases) not strictly be to blame, but she must at least be matched to it in some distinguishing way. For example, one person found it so challenging to learn, once I was an adult, that I’d been sexually abused in childhood by someone close to both of us that she protested ‘How were we supposed to tell you’d been abused? You always were a whingy child!’ Because I was not kept safe, I am often viewed as being unsafe. I am unsafe because I am ‘unclean’, tainted by what I have been a victim of. I am especially unsafe when I break taboos by truthfully answering the question ‘How are you?’. In so doing, I trigger strong reactions in listeners who haven’t yet processed their own various shame burdens: many in society, professionals included, regard the silence that taboos grant as protective, when of course it is Miracle-Gro for further dysfunction and abuse! ‘Unsafe’ and ‘unreliable’ are close relations: whatever I say after I say I’ve been abused can be seen as merely symptomatic of compromised mental health rather than as expression of a valid world view. Then again, I sometimes hear that I must be ‘special’ to have survived this. If I am at all well-balanced or worthy of admiration, it is because I have special powers of immunity to ‘evil’. It is implied that I did not work at my well-being, it did not cost money or tears, and there is no rhyme or reason to how things turn out. Thus, others are protected from knowing that supporting vulnerable citizens to heal takes hard work and that this healing requires relationships, including professional relationships, that do not perpetuate the abuse of power. The work survivors do in processing and detoxifying the burden of abuse in society, whether by surviving, learning to thrive, providing early warnings and protection, or raising consciousness, is some of the hardest emotional labour around, and it’s rarely recognised. In fact, it’s usually done under conditions of inadequate resources, limited encouragement and, occasionally, outright vilification. The sexual abuse of a child is the ultimate in othering. I was treated as something other than a child, worthy of protection, love and connectedness, and even as something other than a human being. My experience of it deprived me of a secure emotional foundation in life and a solid identity, problems I have had to work hard to resolve. All of the negative reactions I’ve described make recovery harder still; however unwittingly, those who react in these ways actually revictimise me. As Sally’s and Bob’s testimonies illustrate, ‘expertise by experience’ is arrived at as a consequence of hard work and struggle, and therefore deserves much greater respect and recognition. For Bob and Sally, the importance of including personal testimonies was to draw attention to how abuse may be perpetuated through the silencing inherent in shaming, othering and co-option. As highlighted above, our methodology sees the cognitive and the emotional as intertwined and, in what follows, we present our ideas on co-production, discussing its potential significance for victim-survivors, and the principles that should underpin it if it is to offer a constructive response of social solidarity. How should co-production be enacted? Survivors of sexual violence in all situational contexts struggle to find platforms from which to co-shape ‘reality’ and ‘truths’. Dominant cultural and social narratives construct understandings of the crimes committed against them that shape practices in criminal and therapeutic justice. The outcomes from this silencing can be seen emerging in the discourses around victim experiences now playing out across the media: cultural narratives that reinforce victim blaming; the stories that society tells of survivors’ lived experiences. There is growing evidence (van der Kolk, 2014, p. 348) that the stories told within the dominant culture create secondary trauma for many survivors. Co-production offers survivors the possibility of re-authoring the narratives that hinder change, potentially offering instead spaces where power is shared in ways that influence what may be said (and thought), and thereby challenging the othering of victim-survivors across all domains of society. As exemplified by the American social worker Sanford (1991) in Strong at the Broken Places, the possibilities that arise in relation to co-production involve individual and societal transformation. Sanford (1991, p. 181) cites a survivor’s perspective on the meshing of personal and societal interests: ‘I’ve paid my dues—the hard way. Now I want membership in the club.’ Sanford calls this being ‘welcomed home’ and, by allowing such social integration, we affirm that the nightmare is over and liberation from silencing has arrived. We suggest that co-production, inspired by six key principles or values, may offer a ‘welcome home’. With reference to the People Powered Health Co-production Catalogue (PPCC) (NESTA, 2012), we outline the six key principles associated with transformatory co-production. The first five are (i) seeing people as assets rather than as the passive recipients of services; (ii) developing people’s capacity by moving away from a deficit approach to one that encourages people to employ their skills, knowledge, wisdom and experience as an individual and as part of a social group or community; (iii) encouraging mutuality so that relationships are rewarding to service users/clients and professionals alike; (iv) blurring traditional boundaries that separate the producers and consumers of services; and (v) developing networks that enable the transfer of knowledge between all partners. The final principle within co-production is that public-service agencies are called upon to act as catalysts—that is, to act as facilitators rather than functioning as unique providers of services themselves. Co-production is at its most authentic and transformative when all six come together. The six principles have been identified as key to trauma-informed working (Brooks et al., 2016). Bracken and Thomas (2009, p. 237) note the importance of forging spaces that allow those experiencing mental distress to participate actively as citizens by ‘politically’ shaping their own identities. To facilitate this shaping and the development of services in a mental health context, Bracken and Thomas advocate the adoption of ethical spaces where people can explore alternative perspectives in order to reshape paradigms that limit outcomes for the powerless in a postmodern world. We would add that openness should constitute a seventh principle for co-production. Whilst calling for openness may seem obvious, openness is often extremely difficult to achieve—painful, even. Practitioners may need to be open to perspectives that confront professional ‘regimes of truth’ central to their sense of self. ‘Received wisdoms’ would not necessarily be overturned but might be viewed as revisable in ways that cannot be anticipated. ‘This would be lived co-production in action’ (Fisher, 2016, emphasis in original). Why co-production is good news for professionals too The zero-sum approach to power is shored up by two distinct and yet related agendas: New Public Management (NPM) and risk management—two overlapping branches of governance that have flourished within (neo)liberal societies and that have introduced private-sector logic and accounting tools into public-service organisations (Hood, 1995; Lapsley, 2009). Both NPM and risk management rely on processes abstracted from the specific and varying concerns of people’s lives and their surrounding contexts (Ahlbäck Öberg and Bringselius, 2015). Instead, the aim is to establish formal procedures based on standardisation and categorisation (Hood and Miller, 2009). The processes of standardisation and categorisation extend most notably to the construction of identities. As a result, risk becomes attached to individuals, who are variously categorised as dangerous, vulnerable, resilient, dependent, independent, guilty and innocent (Stanford, 2010). Social welfare clients are mainly identified as either capable of posing a risk, or vulnerable and therefore ‘at risk’, although victim-survivors are often simultaneously identified as both. As a result of an exaggerated preoccupation with risk, public-service work is saturated by fear (Furedi, 2003), which undermines the potential for meaningful engagement (Titterton, 2006). Safety is sought in technical and professional knowledge that aims for ‘completeness’ (Durose and Richardson, 2016). This is another way of saying that policies and practices should work out in advance what the problems are and exactly how they should be addressed, and by whom. Completeness therefore favours technocratic approaches that offer blueprints produced to satisfy calculative regimes of audit and risk assessment. Attentive responsiveness is less important than navigating the demands of risk-assessment practices that may be used as forensic sources for allocating blame when things go wrong (Douglas, 2003). Within this context, the personal testimonies and associated expertise of victim-survivors lack legitimacy (O’Leary and Barber, 2008; Balfour, 2012; Sigurdardottir and Bender, 2012). As illustrated by Bob’s and Sally’s testimonies, denying people epistemological legitimacy is, arguably, a perpetuation of abuse. Addressing the abusive power relations that sustain the victimhood of people who have suffered CSA requires significant cultural change in public-service organisations. This may require the rethinking of utilitarian concerns with promoting the good of the majority (Mill, 1867), which can exclude marginalised groups and individuals, if co-production is to render visible those individuals and groups that are invisible. We suggest that embedding co-production into social welfare will be contingent on a new form of professional engagement—one that is currently difficult to maintain in risk-averse public organisations characterised by fear. To illustrate our point, we draw on Frank’s (2005) concept of the ‘artificial person’ (Frank, 2005). The artificial person is an individual who is alienated from themselves; they speak and act, not for themselves, but in the name of others. An artificial person speaks on behalf of the rules and procedures of an organisation, where they entrench a culture of compliance. Artificial persons are no longer true to their own authentic sense of self. Their original motivations for entering public service might well have included an altruistic orientation, but this has been lost in a context that promotes compliance through the application of surveillance procedures. For this reason, artificial persons are not generally equipped to engage in therapeutic alliances or in relationships of equality. Bob and Sally understand how it feels to be on the receiving end of care from people who bear some of the hallmarks of artificial persons, who work to a script without listening and without engagement. Artificial persons are unable to engage because their practice is based on ‘completeness’. Particularly amongst social workers, there are growing pleas for more engaged and ethically informed practice (Banks, 2010; Stanford, 2011). Discussion: a possible way forward Currently, collaborative governance practices are emerging in the public services that are designed to enable diverse stakeholders to be involved as active citizens in dealing with complex issues such as welfare policy and service innovation (Bryson et al., 2015). The new focus is on collaboration or co-production across public, private and voluntary organisations (Christensen and Laegreid, 2011; Plotnikov, 2016). This is identified as part of the New Public Governance (NPG), which is contrasted with, although it works alongside, NPM. In short, this is a ‘post-NPM governance’ paradigm, which places far more emphasis on partnership, networking and lateral modes of organising than the vertical ‘command and control’ forms typical of NPM (Ferlie et al., 2003, p. 10). Whilst this slowly evolving terrain is much more conducive to co-production between stakeholders and, crucially, with clients, a cultural change is needed that replaces fear with inclusiveness. From a relationship-centred perspective, therapeutic and productive relationships between professionals and victim-survivors are only fully realised when the relationships enrich the lives of professionals and victim-survivors alike. Once relationships are viewed as mutually rewarding, a redistribution of power is likely to follow. In stating this, we are not advocating the transgression of personal and professional boundaries. We are, however, suggesting that practitioners and clients should be encouraged to learn from each other’s expertise. It is important to emphasise that co-productive designs do not reject professional expertise or empirical evidence about what is most likely to be an effective approach (Durose and Richardson, 2016). Put differently, co-production should not be about reordering a hierarchy of expertise by privileging experiential and lived experience over other forms; however, it requires a more fluid perspective on professional expertise—one based not on an ideal of completeness, but more on a process of development achieved in democratic partnerships, with clients as equal partners. Nolan et al. (2003), who developed relationship-centred practice in dementia, argue in favour of a ‘senses framework’. The senses framework incorporates the aspects of care that both victim-survivors/clients/patients and professionals should benefit from: a sense of security, belonging and purpose, and a sense of fulfilment and/or achievement. Professionals will only be able to create these senses for others when they too benefit from them. At its core, relationship-centred practice forms the bedrock for co-production by opening up a way forward to the creation of more human and humane cultures. Although some may fear that co-production will lead to de-professionalisation, it is in practice more likely to instigate a revival of professionalism (Fisher and Lees, 2016). Crucially, co-production underpinned by the senses framework may offer a route towards recovery associated with participation and agency, which, as argued in this paper, promote the recovery of victim-survivors. Conclusion Co-production potentially provides opportunities to address the othering involved in traditional service delivery, enabling people to discover a sense of their own agency—that is, their ability to act on and change the world (nef, 2013). Co-production might, in addition, lead to a revitalisation of professional morale by enabling practitioners to ‘speak back’ to the neo-liberal ideology of risk (Rose, 2000; Kemshall, 2010; Stanford, 2010, 2011). We recognise that the ideas presented in this paper require further investigation through empirical enquiry, although appropriate research sites may be difficult to identify and are currently most likely to be found in some of the more peripheral areas of the voluntary sector (Amin, 2009). Crucially, we hope that our study will prompt interest in further research and that this will ultimately contribute to the reconfiguring of public services so that they promote democratic and reciprocal relationships. Revising social work education will be key to this enterprise. Organisational cultures less shaped by fear are likely to encourage the development of practitioner dispositions that are open to learning with people, rather than regarding them as merely recipients of services. 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( 2006 ) ‘ Expanding analytic autoethnography and enhancing its potential’, Journal of Contemporary Ethnography , 35 ( 4 ), pp. 405 – 9 . Google Scholar CrossRef Search ADS Webb S. A. ( 2006 ) Social Work in a Risk Society , Houndsmills , Palgrave Macmillan . Google Scholar CrossRef Search ADS Wilkinson I. ( 2005 ) Suffering: A Sociological Introduction , Cambridge , Polity . © The Author(s) 2018. Published by Oxford University Press on behalf of The British Association of Social Workers. All rights reserved. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The British Journal of Social Work Oxford University Press

Advocating Co-Productive Engagement with Marginalised People: a specific perspective on and by survivors of childhood sexual abuse

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Oxford University Press
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© The Author(s) 2018. Published by Oxford University Press on behalf of The British Association of Social Workers. All rights reserved.
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0045-3102
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1468-263X
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Abstract

Abstract Co-production is gaining ground as a key dimension of public policy reform across the globe. This paper argues in favour of social welfare shaped by the principles of co-production and suggests that the promotion of democratic relationships is more likely to enable the agency and recovery of victim-survivors of childhood sexual abuse. The paper, based on an autoethnographical approach, is likely to be of relevance to social care practitioners who work with a range of marginalised people, particularly in liberal states that promote organisational cultures shaped disproportionately by risk. Cultures of risk, it is argued, promote power balances and othering—arguably an institutional perpetuation of the original abuse. Co-production, on the other hand, has the potential to legitimise expertise by experience, enabling victim-survivors to be reinstated as citizens with associated rights of participation. The paper subsequently draws out some of the benefits of co-production for practitioners whose professional engagement may be stifled. We suggest that co-production potentially points towards practice based on the valuing of expertise by experience and social solidarity. Co-production, critical practice, victim-survivors, social welfare, empowerment Introduction The starting point of this paper is that understandings of professionalism should be reconfigured by addressing the power differentials that prioritise professional knowledge over ‘expertise by experience’. This is particularly important when working with marginalised groups whose views often remain unacknowledged, ignored or unheard (Fisher and Freshwater, 2014). As things stand, professional practice tends to be based on a zero-sum understanding of power that perpetuates and entrenches the privileging of professional knowledge over other forms of knowledge, particularly the expertise of experience acquired by members of marginalised groups (Fisher, 2012). All three authors have over many years directed considerable attention, personally and professionally, to the question of how to constructively address, if not entirely resolve, the harm incurred through suffering violence and abuse and its impact on a person’s sense of self. Our shared interests prompted us to collaborate in 2016 to consider this question in relation to the experiences of adult victim-survivors of childhood sexual abuse (CSA) as recipients of social welfare services. On the basis of personal and professional experiences, we concurred that recovery from CSA requires the redressing of power imbalances between social welfare ‘providers’ and ‘recipients’. Two of the authors (Bob Balfour and Sally Moss) had extensive experience of adult services for victim-survivors of CSA. Starting with testimonies written by Bob and Sally, we turned our attention to whether othering, ostensibly related to imbalances of power, might be addressed through co-productive approaches to social welfare. Our research question, which is addressed by drawing on an autoethnographic methodology, can be summarised as follows: ‘What is the potential of co-production to combat the power differentials and associated othering that adult survivors of CSA experience as recipients of social welfare?’ This paper is itself an enactment of co-production between authors with diverse backgrounds and expertise who have engaged in an iterative and dialogical process. The paper is timely given the growing international recognition that areas of professional jurisdiction should be opened up to greater public scrutiny, debate and power sharing (Dzur, 2008; Boyle et al., 2010; Dominelli, 2016; Plotnikov, 2016). Co-production is gaining ground as a key dimension of public policy reform across the globe (OECD, 2011); it is viewed variously as the route to public-service reform (Nambisan and Nambisan, 2013), as a response to the democratic deficit inherent in the delivery of public services (Pestoff, 2006) and as a way forward to galvanise active citizenship (Department of Health, 2010). We acknowledge that the term ‘co-production’ lacks conceptual clarity—it has been identified as a ‘woolly-word’ in public policy (Osborne et al., 2016, p. 640). Crucially, we are aware of the potential for co-production to be co-opted as a tactic to progress the dismantling of the welfare state and to accelerate the drive towards marketisation (Boyle et al., 2010; Philips et al., 2013). People, especially disadvantaged groups, could thus be abandoned to fend for themselves within a consumer model of welfare based on rugged individualism. In response, we argue that co-production must be aligned with social solidarity. Background Worldwide prevalence rates of CSA range between 8 and 31 per cent for girls and 3 and 17 per cent for boys (Barth et al., 2013). Inevitably, people working within social welfare will often find themselves helping victim-survivors of CSA, although CSA may not be acknowledged or identified as being at the root of the problem at hand. As mentioned above, two of the authors are victim-survivors of CSA and are able to provide ‘insider’ insights as service recipients. We contend that, although the experiences associated with being a victim-survivor of CSA will bear a resemblance to those experienced by other marginalised groups, CSA is associated with constellations of feelings unique to sexual victimisation. These feelings include betrayal, powerlessness and stigmatisation, which others may respond to with disbelief, denial and attributions of responsibility and guilt (Feiring et al., 1996). Adult victim-survivors of sexual abuse are represented amongst the most marginalised groups in society (Lew, 1993; Herman, 1997). Some experience a form of powerlessness that is internalised into their very sense of self, as a ‘victim’ (Balfour, 2012), as evidenced in Learning the Lessons: Operation Pallial (Children’s Commissioner for Wales, 2015). The urgency of redressing cultural and institutional complacency is manifest and, drawing on Herman (1997), we suggest that social action through co-production might be regarded as a key element enabling survivors to regain the power they lost through the violation of their initial abuse—and its entrenchment through subsequent cultural and social forces. We consider the discovery or rediscovery of agency as key to reinstating marginalised people as citizens, and we are guided by Bourdieu’s (1984) insight that the most damaging forms of social suffering are those experienced by people ‘on the margins’: in other words, the suffering of those who are less likely to receive empathy, respect and social recognition from others—a theme which has been taken up in an extensive literature (see e.g. Reay, 2005; Wilkinson, 2005; Frost and Hoggett, 2008; Fisher and Lees, 2016). Suffering is partly tied up with a sense of ‘being done to’ or a lack of agency (Frost and Hoggett, 2008). This can lead to a person experiencing the power that someone else has over them as natural and legitimate and to their suffering being internalised into their sense of self. People no longer see themselves as citizens with legitimate expertise and knowledge (Fisher, 2012). The challenge, therefore, is to develop services for victim-survivors that enable them to regain a sense of agency and a sense that they can co-shape the future positively—for themselves, and for other survivors, who, we suspect, await the safe spaces that will allow them to contribute. As Dominelli (2016, p. 387) writes, ‘Exercising agency renders invisible groups visible, and facilitates their involvement in collective expressions of solidarity’. Methodological approach Autoethnography is a methodology which blurs the distinctions between ethnography and literary studies by placing the emphasis on the value of personal testimonies, often produced by author researchers (Ellis et al., 2011). Given that CSA is inextricably entangled with the abuse of power, the authors were drawn to autoethnography as it addresses power differentials by collapsing the researcher/research participant binary and legitimises expertise by experience. As Chase (2005, p. 423) points out, autoethnography challenges the power dynamics inherent in ‘traditional social science’. Autoethnographers express differing views regarding whether personal testimonies stand on their own as data, revealing truths obscured in traditional science (Ellis and Bochner, 2000), or whether testimonies should be regarded as a complement to more traditional social science data derived from realist ethnography (Anderson, 2006). These contrasting approaches create, in our view, false dichotomies between the emotional/rational and the personal/scholarly. We suspect that boundaries between feeling and thinking are less well defined than is often assumed in traditional science (see Burnier, 2006; Damsio, 2006). Our approach reflects that proposed by Vryan (2006), who argues in favour of analytical autoethnography that is both evocative and analytical. We believe that personal testimonies can provide access to knowledge and experience that are sometimes obscured in traditional science. At the same time, we recognise that an individual’s meaning making cannot be viewed in isolation from social relations, institutional contexts and broader cultural and structural dimensions. Crucially, our starting point is to recognise the reality of sexual violence against children and the reality of the harm that it perpetuates. The testimonies included in this paper are personal evocative accounts written by two of the authors in response to their experiences of being othered and of feeling obliged to perform an inauthentic self in order to avoid being othered. The testimonies provided the data used as the focus for our initial discussions, forming the basis for our subsequent reasoning on the potential value of co-production. The testimonies express the lived reality that othering impedes recovery by reinforcing the sense of powerlessness associated with CSA. These key insights stem from the recall of direct experience saturated with emotional responses and would not have been arrived at merely through detached observation. The recall of the experiences provided the motivation for formulating and engaging with our research question. As outlined above, the focus of our collaboration hinged on the question of how othering undermined recovery, and the extent to which othering was a product of power imbalances that might be addressed by co-production. Wary that challenges to systems can inadvertently lead to new forms of othering, we decided that it was vital that we consider how practitioners are embedded in social relations that either enable or restrict meaningful engagement with their clients. Our analysis was therefore subjectively informed by the lived experience of othering and, equally, by our professional and research experience considered in light of academic contributions on risk and co-production. Two of the authors had a pre-existing interest in co-production: Balfour (2012) in his work supporting men who had suffered CSA, and Fisher (2012, 2016) through her research with marginalised communities. We engaged in an iterative process, as is generally the case with autoethnographical studies (Hoppes, 2014), involving a back-and-forth movement between the discussion of painful and personal experiences of vulnerability and observation and analysis of the broader context of those experiences, informed by sociological analysis. The boundaries between data and analysis are blurred: the testimonies were generated by the authors and then analysed through shared reflections informed by life experiences acquired in professional and research roles, and by scholarly engagement. We acknowledge that the study lacks generalisability as the term is usually applied in social scientific research that draws on large random samples. In addition, autoethnographies do not provide validity in the normal sense, but we hope that our study achieves verisimilitude: that is, the reader feels that the experiences described are believable and lifelike and finds our conceptual framework sufficiently convincing to merit further empirical exploration. The brief autobiographies below are intended to provide the reader with an insight into the processes that have shaped our respective interests in developing the position outlined in this paper. Bob Balfour is an internationally known, UK-based activist and has worked for twenty years developing and delivering innovative projects for victim-survivors of CSA. His own personal experiences of childhood sexual trauma during the 1960s and 1970s, both extra-familial and within ‘looked after’ institutional contexts, have shaped his passion for better societal responses to victims of sexual crimes. Bob’s interest in co-production stems from his own experience of feeling ‘co-opted’ by the agendas of public agencies during these twenty years. This has sometimes felt like perpetuation of ‘abuse’: some interventions he has experienced have failed to address the needs of victim-survivors as an oppressed minority but have exploited the emotional need for personal validation of individuals who have been consulted at a tokenistic level (Balfour, 2012). Sally Moss is a CSA survivor who has been in contact with statutory, private- and voluntary-sector support services since adulthood (approximately twenty years) and who has been most supported in her recovery by books, private counselling services, CSA activists and the informal support of fellow survivors of CSA (and of other adverse childhood experiences), online and face to face. She is interested in approaches that encourage self-awareness in professionals in service hierarchies and harness the expertise by experience of CSA victim-survivors. Pamela Fisher’s interest in approaches that combat the abuse of power, intended or otherwise, came about through her lived experiences of an abusive domestic situation as well as through extensive research experience with people marginalised because of social disadvantage, disability, mental health and political stigma. Her awareness that people, whose identities are constantly devalued in their interactions with others, can become fixed in positions of helplessness (Fisher, 2012) prompted her interest in ‘professional’ practices and research methodologies based on co-production, understood as authentic power sharing (Fisher, 2016). Having provided a brief outline of the personal and professional experience underpinning our reflections and analysis, we present our current reasoning on how othering can potentially be remedied through co-production. We begin with a historical overview of co-production. This is followed by a section that draws out the value of co-production for victim-survivors by merging the evocative/personal with the conceptual. Subsequently, we draw on the extant literature to discuss how co-production might be ideally enacted, following this with a consideration of the benefits of co-production for those working in social welfare. Our view is that co-production must, in order to be authentically co-productive, provide mutual benefits. Finally, we suggest a way forward towards cultural change. The origins of co-production The concept of co-production originated in the USA through the work of a political economist, Elinor Ostrom, and her research team at the University of Indiana (see Carr, 2016). Ostrom and her colleagues conducted a series of research studies of the Chicago police. They noted that, when the police abandoned ‘the beat’ in communities and became more distant through their increased use of patrol cars, crime rates increased. The term ‘co-production’ was used to identify the missing element that could only be provided by the public. Ostrom’s research established that successful policing required the informal engagement of the public and ‘on-the-ground’ relationships between communities and the police in order to keep crime in check. The police needed the community as much as the community needed the police. The concept of co-production was subsequently taken up by Edgar Cahn (2004), who applied it to develop a practical agenda of system change. According to Cahn, the concept of the ‘core economy’ should be viewed as key to the reform of public institutions. The core economy (sometimes termed the non-market economy) is where goods and services are produced and exchanged in transactions that are primarily driven by relationship (family, neighbourhood, community and so forth). Whereas the market economy functions on the basis of monetarised transactions, the core economy is reliant on people’s skills, experience, knowledge and wisdom, which are embedded in their everyday lives. Qualities and processes that are embedded in relationships—in particular love, empathy, watchfulness, care, reciprocity, teaching and learning—are central to the core economy. Similar to the role played by the operating system of a computer, the core economy is the basic, yet essential, platform upon which the market economy and public services run. Employers, for example, assume that employees should manage their lives in families and neighbourhoods where they look after older people and sick and disabled people and bring up children who will in turn contribute to the market economy. Institutions, businesses and enterprises in the market economy are highly reliant on the often unacknowledged ‘invisible’ work undertaken within the core economy. In this paper, however, whilst we adopt the concept of the core economy, we choose an expanded definition of the core economy that incorporates trauma and expertise by experience. Whilst these experiences are shaped by the very opposite of love, empathy and care, the authors believe that they deserve to be heard and to be central to the development of meaningful interventions with victim-survivors. Why co-production matters for victim-survivors Excluding people from and subordinating them to the dominant group is captured by the term ‘othering’, and othering is inextricably entangled with an ideology of risk (Webb, 2006). Throughout social welfare provision in the UK and other neo-liberal states, there is a preoccupation with risk management, risk-assessment and risk-governance strategies to avoid blame, culpability and litigation (McLaughlin, 2007; Pollack, 2010). As Webb (2006) argues, neo-liberal social work has essentially become a profession focused on risk avoidance and risk regulation. Within this context, marginalised social groups are constructed through a discourse of risk as the stigmatised and risky ‘other’ (Lupton, 1999). According to Said (1978), a distinctive aspect of being the ‘other’ is that one is not a subject with agency and voice. This is often the experience of victim-survivors, and of recipients of social welfare more broadly, who are generally subject to a range of disciplining practices that aim to control and reform and to prevent harm, either by them or to them. Conventional service delivery tends to be based on an imbalance of power, which eradicates risk through limiting people’s agency. In response to his own experiences as a victim-survivor and service recipient, in 2001, Bob founded Survivors West Yorkshire (2006), which in 2005 commissioned the first in a series of reports under the banner A View From Inside The Box. Its objective was to scope the service needs of male and female survivors across the metropolitan area of Bradford in West Yorkshire. As Bob testifies below, overcoming powerlessness and discovering agency can be a turning point in recovery for people who have suffered CSA: I have travelled a long road from anger, at what was done to me, to new insights regarding the need to change the paradigm surrounding sexual violence victims. I regard changing the paradigm as both a personal feat of will and a willingness to unpack the self within a cultural conflict surrounding a taboo—a conflict rooted in fear, in my experience—fear of shaming from disclosure. In 2006 the first A View From Inside The Box was published (Survivors West Yorkshire, 2006, p. 2) and I wrote the following: ‘This is not Pandora’s Box with a lid on, it is a cultural “solitary confinement” with no key available and no parole board to review the sentence!’ I was speaking of the silencing othering that many survivors encounter when disclosing or campaigning for change. The othering has the effect of reinforcing the sense of injustice you feel; and of course if you get angry then the othering is reinforced. You find yourself positioned as ‘damaged’ and for some an object for their amusement. Powerlessness can feel overwhelming: when survivors act out, remember it is because they are human. Often the acting out happens in encounters with ‘professionals’ who claim to understand. One of my ancestors was a released slave who came to Liverpool in the mid-nineteenth century from the West Indies and married a white woman who worked with her harbourmaster father on the docks. A slave freed into the world of slave-masters with the added public profile of marriage to a woman from the slave-owning society. My experiences of disclosure tell me my great-grandfather and great-grandmother must have been resilient to forge a life together. I have held on to the memory of Mr and Mrs Padmore during times when I have experienced painful othering as it gives me a sense of identity rooted in resilience. All forms of othering should be acknowledged for what they are—bullying and intimidation. In my experience, othering mostly takes place on a micro-aggressive level and, if challenged, the perpetrators often ‘gaslight’ you with the myth-ridden narratives that surround male survivors in particular. Myths are powerful and in the case of male survivors they range from our all being homosexuals (we wanted the sexual contact as children) to the ‘vampire’ effect: once bitten, we all go on to bite others. Such myths seep into common-sense understandings and support unconscious bias that permits othering (Balfour, 2012). You would think you would get used to othering, but you don’t; it’s like cancer eating away at you and the best you can hope for is to get better at navigating between wanting to rage and wanting to accept yourself as an equal human being, not the ‘disordered’ individual you have been labelled as. This is the label you acquire when you dare to challenge denials of victims’ invisibility, made by professionals who hold ‘power’ and yet reject evidence-based approaches if they find these uncomfortable. It’s been a journey, as they say, and I suspect I will pay a price at some stage. However, I wouldn’t change a thing about this journey, as change is needed across our society. That said, we need to reduce the price paid by survivors for speaking truth to power. By doing so, we can work smarter, harnessing the expertise of survivors. Expertise by experience must be incorporated into professional practice, not silenced by it. So for me, co-production offers a vehicle for the redistribution of power. This does not involve taking it back as survivor owned, exclusively, nor allowing a continuation of the tokenistic game played by the current holders of power. Co-production potentially offers opportunities for shaping democratic and innovative solutions based on the valuing of survivor and professional knowledge with the objective of achieving constructive and transparent survivor-informed change. Sally, a survivor of CSA, describes how ‘her reason, her courage and her value’ are sometimes discounted when she discloses this experience. As Sally’s testimony demonstrates, people are encouraged, particularly in neo-liberal societies, to attain a personal sense of invulnerability by disparaging those on the margins of society, including people who are subject to social exclusion and abuse (Tyler, 2013): This doesn’t reflect the whole of my experience, of course: many people have responded with reason and courage of their own, and deep compassion, to the disclosure of my CSA history. But at times I can be viewed as being inherently weaker, less capable, than the norm. Some find it easier to believe that bad things happen to those who are a good fit for suffering anyway. The victim of an abhorrent crime might (in some cases) not strictly be to blame, but she must at least be matched to it in some distinguishing way. For example, one person found it so challenging to learn, once I was an adult, that I’d been sexually abused in childhood by someone close to both of us that she protested ‘How were we supposed to tell you’d been abused? You always were a whingy child!’ Because I was not kept safe, I am often viewed as being unsafe. I am unsafe because I am ‘unclean’, tainted by what I have been a victim of. I am especially unsafe when I break taboos by truthfully answering the question ‘How are you?’. In so doing, I trigger strong reactions in listeners who haven’t yet processed their own various shame burdens: many in society, professionals included, regard the silence that taboos grant as protective, when of course it is Miracle-Gro for further dysfunction and abuse! ‘Unsafe’ and ‘unreliable’ are close relations: whatever I say after I say I’ve been abused can be seen as merely symptomatic of compromised mental health rather than as expression of a valid world view. Then again, I sometimes hear that I must be ‘special’ to have survived this. If I am at all well-balanced or worthy of admiration, it is because I have special powers of immunity to ‘evil’. It is implied that I did not work at my well-being, it did not cost money or tears, and there is no rhyme or reason to how things turn out. Thus, others are protected from knowing that supporting vulnerable citizens to heal takes hard work and that this healing requires relationships, including professional relationships, that do not perpetuate the abuse of power. The work survivors do in processing and detoxifying the burden of abuse in society, whether by surviving, learning to thrive, providing early warnings and protection, or raising consciousness, is some of the hardest emotional labour around, and it’s rarely recognised. In fact, it’s usually done under conditions of inadequate resources, limited encouragement and, occasionally, outright vilification. The sexual abuse of a child is the ultimate in othering. I was treated as something other than a child, worthy of protection, love and connectedness, and even as something other than a human being. My experience of it deprived me of a secure emotional foundation in life and a solid identity, problems I have had to work hard to resolve. All of the negative reactions I’ve described make recovery harder still; however unwittingly, those who react in these ways actually revictimise me. As Sally’s and Bob’s testimonies illustrate, ‘expertise by experience’ is arrived at as a consequence of hard work and struggle, and therefore deserves much greater respect and recognition. For Bob and Sally, the importance of including personal testimonies was to draw attention to how abuse may be perpetuated through the silencing inherent in shaming, othering and co-option. As highlighted above, our methodology sees the cognitive and the emotional as intertwined and, in what follows, we present our ideas on co-production, discussing its potential significance for victim-survivors, and the principles that should underpin it if it is to offer a constructive response of social solidarity. How should co-production be enacted? Survivors of sexual violence in all situational contexts struggle to find platforms from which to co-shape ‘reality’ and ‘truths’. Dominant cultural and social narratives construct understandings of the crimes committed against them that shape practices in criminal and therapeutic justice. The outcomes from this silencing can be seen emerging in the discourses around victim experiences now playing out across the media: cultural narratives that reinforce victim blaming; the stories that society tells of survivors’ lived experiences. There is growing evidence (van der Kolk, 2014, p. 348) that the stories told within the dominant culture create secondary trauma for many survivors. Co-production offers survivors the possibility of re-authoring the narratives that hinder change, potentially offering instead spaces where power is shared in ways that influence what may be said (and thought), and thereby challenging the othering of victim-survivors across all domains of society. As exemplified by the American social worker Sanford (1991) in Strong at the Broken Places, the possibilities that arise in relation to co-production involve individual and societal transformation. Sanford (1991, p. 181) cites a survivor’s perspective on the meshing of personal and societal interests: ‘I’ve paid my dues—the hard way. Now I want membership in the club.’ Sanford calls this being ‘welcomed home’ and, by allowing such social integration, we affirm that the nightmare is over and liberation from silencing has arrived. We suggest that co-production, inspired by six key principles or values, may offer a ‘welcome home’. With reference to the People Powered Health Co-production Catalogue (PPCC) (NESTA, 2012), we outline the six key principles associated with transformatory co-production. The first five are (i) seeing people as assets rather than as the passive recipients of services; (ii) developing people’s capacity by moving away from a deficit approach to one that encourages people to employ their skills, knowledge, wisdom and experience as an individual and as part of a social group or community; (iii) encouraging mutuality so that relationships are rewarding to service users/clients and professionals alike; (iv) blurring traditional boundaries that separate the producers and consumers of services; and (v) developing networks that enable the transfer of knowledge between all partners. The final principle within co-production is that public-service agencies are called upon to act as catalysts—that is, to act as facilitators rather than functioning as unique providers of services themselves. Co-production is at its most authentic and transformative when all six come together. The six principles have been identified as key to trauma-informed working (Brooks et al., 2016). Bracken and Thomas (2009, p. 237) note the importance of forging spaces that allow those experiencing mental distress to participate actively as citizens by ‘politically’ shaping their own identities. To facilitate this shaping and the development of services in a mental health context, Bracken and Thomas advocate the adoption of ethical spaces where people can explore alternative perspectives in order to reshape paradigms that limit outcomes for the powerless in a postmodern world. We would add that openness should constitute a seventh principle for co-production. Whilst calling for openness may seem obvious, openness is often extremely difficult to achieve—painful, even. Practitioners may need to be open to perspectives that confront professional ‘regimes of truth’ central to their sense of self. ‘Received wisdoms’ would not necessarily be overturned but might be viewed as revisable in ways that cannot be anticipated. ‘This would be lived co-production in action’ (Fisher, 2016, emphasis in original). Why co-production is good news for professionals too The zero-sum approach to power is shored up by two distinct and yet related agendas: New Public Management (NPM) and risk management—two overlapping branches of governance that have flourished within (neo)liberal societies and that have introduced private-sector logic and accounting tools into public-service organisations (Hood, 1995; Lapsley, 2009). Both NPM and risk management rely on processes abstracted from the specific and varying concerns of people’s lives and their surrounding contexts (Ahlbäck Öberg and Bringselius, 2015). Instead, the aim is to establish formal procedures based on standardisation and categorisation (Hood and Miller, 2009). The processes of standardisation and categorisation extend most notably to the construction of identities. As a result, risk becomes attached to individuals, who are variously categorised as dangerous, vulnerable, resilient, dependent, independent, guilty and innocent (Stanford, 2010). Social welfare clients are mainly identified as either capable of posing a risk, or vulnerable and therefore ‘at risk’, although victim-survivors are often simultaneously identified as both. As a result of an exaggerated preoccupation with risk, public-service work is saturated by fear (Furedi, 2003), which undermines the potential for meaningful engagement (Titterton, 2006). Safety is sought in technical and professional knowledge that aims for ‘completeness’ (Durose and Richardson, 2016). This is another way of saying that policies and practices should work out in advance what the problems are and exactly how they should be addressed, and by whom. Completeness therefore favours technocratic approaches that offer blueprints produced to satisfy calculative regimes of audit and risk assessment. Attentive responsiveness is less important than navigating the demands of risk-assessment practices that may be used as forensic sources for allocating blame when things go wrong (Douglas, 2003). Within this context, the personal testimonies and associated expertise of victim-survivors lack legitimacy (O’Leary and Barber, 2008; Balfour, 2012; Sigurdardottir and Bender, 2012). As illustrated by Bob’s and Sally’s testimonies, denying people epistemological legitimacy is, arguably, a perpetuation of abuse. Addressing the abusive power relations that sustain the victimhood of people who have suffered CSA requires significant cultural change in public-service organisations. This may require the rethinking of utilitarian concerns with promoting the good of the majority (Mill, 1867), which can exclude marginalised groups and individuals, if co-production is to render visible those individuals and groups that are invisible. We suggest that embedding co-production into social welfare will be contingent on a new form of professional engagement—one that is currently difficult to maintain in risk-averse public organisations characterised by fear. To illustrate our point, we draw on Frank’s (2005) concept of the ‘artificial person’ (Frank, 2005). The artificial person is an individual who is alienated from themselves; they speak and act, not for themselves, but in the name of others. An artificial person speaks on behalf of the rules and procedures of an organisation, where they entrench a culture of compliance. Artificial persons are no longer true to their own authentic sense of self. Their original motivations for entering public service might well have included an altruistic orientation, but this has been lost in a context that promotes compliance through the application of surveillance procedures. For this reason, artificial persons are not generally equipped to engage in therapeutic alliances or in relationships of equality. Bob and Sally understand how it feels to be on the receiving end of care from people who bear some of the hallmarks of artificial persons, who work to a script without listening and without engagement. Artificial persons are unable to engage because their practice is based on ‘completeness’. Particularly amongst social workers, there are growing pleas for more engaged and ethically informed practice (Banks, 2010; Stanford, 2011). Discussion: a possible way forward Currently, collaborative governance practices are emerging in the public services that are designed to enable diverse stakeholders to be involved as active citizens in dealing with complex issues such as welfare policy and service innovation (Bryson et al., 2015). The new focus is on collaboration or co-production across public, private and voluntary organisations (Christensen and Laegreid, 2011; Plotnikov, 2016). This is identified as part of the New Public Governance (NPG), which is contrasted with, although it works alongside, NPM. In short, this is a ‘post-NPM governance’ paradigm, which places far more emphasis on partnership, networking and lateral modes of organising than the vertical ‘command and control’ forms typical of NPM (Ferlie et al., 2003, p. 10). Whilst this slowly evolving terrain is much more conducive to co-production between stakeholders and, crucially, with clients, a cultural change is needed that replaces fear with inclusiveness. From a relationship-centred perspective, therapeutic and productive relationships between professionals and victim-survivors are only fully realised when the relationships enrich the lives of professionals and victim-survivors alike. Once relationships are viewed as mutually rewarding, a redistribution of power is likely to follow. In stating this, we are not advocating the transgression of personal and professional boundaries. We are, however, suggesting that practitioners and clients should be encouraged to learn from each other’s expertise. It is important to emphasise that co-productive designs do not reject professional expertise or empirical evidence about what is most likely to be an effective approach (Durose and Richardson, 2016). Put differently, co-production should not be about reordering a hierarchy of expertise by privileging experiential and lived experience over other forms; however, it requires a more fluid perspective on professional expertise—one based not on an ideal of completeness, but more on a process of development achieved in democratic partnerships, with clients as equal partners. Nolan et al. (2003), who developed relationship-centred practice in dementia, argue in favour of a ‘senses framework’. The senses framework incorporates the aspects of care that both victim-survivors/clients/patients and professionals should benefit from: a sense of security, belonging and purpose, and a sense of fulfilment and/or achievement. Professionals will only be able to create these senses for others when they too benefit from them. At its core, relationship-centred practice forms the bedrock for co-production by opening up a way forward to the creation of more human and humane cultures. Although some may fear that co-production will lead to de-professionalisation, it is in practice more likely to instigate a revival of professionalism (Fisher and Lees, 2016). Crucially, co-production underpinned by the senses framework may offer a route towards recovery associated with participation and agency, which, as argued in this paper, promote the recovery of victim-survivors. Conclusion Co-production potentially provides opportunities to address the othering involved in traditional service delivery, enabling people to discover a sense of their own agency—that is, their ability to act on and change the world (nef, 2013). Co-production might, in addition, lead to a revitalisation of professional morale by enabling practitioners to ‘speak back’ to the neo-liberal ideology of risk (Rose, 2000; Kemshall, 2010; Stanford, 2010, 2011). We recognise that the ideas presented in this paper require further investigation through empirical enquiry, although appropriate research sites may be difficult to identify and are currently most likely to be found in some of the more peripheral areas of the voluntary sector (Amin, 2009). Crucially, we hope that our study will prompt interest in further research and that this will ultimately contribute to the reconfiguring of public services so that they promote democratic and reciprocal relationships. Revising social work education will be key to this enterprise. Organisational cultures less shaped by fear are likely to encourage the development of practitioner dispositions that are open to learning with people, rather than regarding them as merely recipients of services. 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