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People with learning difficulties who manage on their own often find it harder to cope when they become parents and may have to face the trauma of their children being taken into care. Now a specialist psychotherapy service can help them to survive. Rachel Downey reports

Losing a child to the care system is a devastating experience for any parent. When you have a learning difficulty and becoming a parent has re-ignited painful memories of childhood abuse, the trauma intensifies.

But there is an organisation that provides support for parents with learning difficulties whose children have been taken into care, and those who are about to lose their children - the Respond Parenting Project.

Tamsin Cottis is assistant director of Respond, a charity that offers counselling and psychotherapy to people with learning difficulties, many of whom have suffered abuse. Respond established the parents project a year ago after staff were coming into contact with parents whose children were taken into care and who were returning again and again after having more children.

Statistics are lacking, but a small research study and anecdotal evidence suggests that slightly less than half of all parents with learning difficulties lose their children to the care system. Behind this figure lies one of the most difficult and complex dilemmas faced by the social care profession - the rights of a person with learning difficulties to parent versus the rights of a child.

"It's terribly difficult, and perhaps the most complex and emotional areas of the Human Rights Act 1998 - the fact that to make these rights available to people with learning difficulties may bring us into conflict with the rights of the child," says Cottis.

The working assumption is that if the parent has learning difficulties, there will be problems, she says. Some people with learning difficulties can parent, some need support to parent, and some find it impossible. Often people with mild learning difficulties have never used any services but when a child is born, they cannot cope. Sometimes they do not want to acknowledge their own learning difficulties but are forced to when they become parents. And some parent successfully for many years until some incident strikes. One woman was referred to the project after bringing up her two children for a decade. When they were 9 and 11, she met and married a man. Her husband then became friendly with another man who raped him and her.

While professionals understand the need to pass practical information on to new parents, there is less awareness of the emotional needs of the parent and how these can affect their parenting ability. When there are no practical difficulties, professionals often do not look for emotional difficulties, says Cottis.

The scale of mental health problems the project has uncovered is far greater than it anticipated, she adds.

Jake Spencer is a psychotherapist and provides most of the therapy. "It is not normal psychotherapy," she explains. "You cannot just allow someone to open up a can of worms. We tread on a tightrope between allowing them to continue functioning while talking about their trauma. It's a bit like working with sex offenders; you cannot afford for them to fall apart, because that's when they are most vulnerable to reoffending. The difference is that we put in a positive impact. We provide ego support and containment. It is more directive. We give recognition about how it feels from their point of view - what it feels like when people call you stupid."

A primary function of the project is to assess parenting ability. "We are used to the most severe cases that are causing the most worry for professionals, where there are complications and severe child protection issues. Often the learning difficulty has not been taken into account - that knowledge base is not there," says Spencer.

Referrals come from a range of professionals, and discussion takes place before someone begins therapy. How long the therapy continues is a source of contention. In its general work, Respond usually refuses to begin therapy that will continue for less than one year, but with the parents project there is more flexibility. Pressurised social workers coming up to a final court decision over the fate of a child can usually secure only three months' funding to cover the period just before, during, and after the court ruling. "The pressure to begin work with someone for only three months is enormous," says Cottis.

The level of support received by parents with learning difficulties in the community is also a contentious issue. Spencer argues strongly that support has to be long-term. "There's often a time limit, or people want one to be put on. The thinking around this has to change."

Spencer is frustrated at times, primarily when delays occur. But she has never disagreed with the decision of the social workers to remove a child.

"I cannot imagine a trauma worse then losing a baby. I am working with a woman who has just lost her fifth child. It's a grief situation without the history of a death. It means you are constantly affected by things that are very difficult. In some ways it's what the children and families social workers are dealing with every day. But in a children and families team, there's a need to switch off from how you are feeling. In this setting, your job is to stop and think about feelings." Spencer herself receives substantial support and supervision from the organisation and also from outside - monthly supervision sessions with a child psychologist.

The dilemma takes its toll on the professionals involved, usually children and families social workers and community nurses in learning difficulties teams. "It's an enormous emotional impact, and most professionals do not have the support to help them think about that," says Spencer. The professionals that arrive at the project "look completely done in", according to Cottis. "They are on the edge. You can see in their face and body language that they are just exhausted by it."

The project provides training, advice and support to all professionals involved. "I was surprised at how emotionally demanding it is," says Cottis. "I was sure of the political and service context, but there's something about a small child having a catastrophic childhood that affected me."

Spencer agrees. "It's not calculated cruelty that I see. It's the fact that children are not having the kind of experiences they should have. And the pain of parents for the loss of their child. When you sit in the room and hear them describing their feelings of loss, it's terrible."

Both see demand growing for the project because of a range of factors: the government's new learning difficulty strategy; the fact that more people with learning difficulties live in the community, form relationships and have children; and the advent of the Human Rights Act. They want the project to expand so it can be self-funding. Currently it can offer a reduced rate for its service because of a grant from the Department of Health.

The project can help some parents with learning difficulties cope with having their child removed but the staff realise that there are no easy answers to the dilemma.

"I sometimes feel so sad," says Cottis. "There's no good outcome for anyone. If you work with adults with learning difficulties, your professional credo is the individual, and that's very much in conflict with the credo of a children and families worker. You cannot change that - you can only work with it constructively and try to meet people's needs. You cannot work to a happy ending but you do have to work as thoughtfully and thoroughly as possible."

Project profile

Project: Respond Parents Project

History: Set up in October 2000 by Respond, a charity that provides counselling and psychotherapy to people with learning difficulties. The project provides therapy to people with learning difficulties that have issues around parenting. It also undertakes specialist parenting assessment where child protection concerns arise. Staff also offer training and support to workers dealing with learning difficulties and parenting. The idea for the project came from the referrals to Respond.

Funding: Department of Health - about £150,000 over three years.

Staff: One full-time worker but use of sessional psychotherapists, and plenty of support from other staff at Respond.

Clients: Anyone with a learning difficulty who has concerns to do with parenting.

Contact: Jake Spencer, Respond Parents Project, Third Floor, 24-32 Stephenson Way, London NW1 2HD, telephone: 020 7838 0700. E-mail: parents@respond.org.uk. The helpline is on 0845 606 1503.