Confidentiality and disclosure
- Explain at the start what we can and cannot offer in terms of confidentiality concerning sexual abuse in聽user-friendly, age-appropriate words.聽
- Say clearly that we will disclose any new information in order to keep them and other children safe from聽sexual abusers. (How this is done depends on our counselling situation.)
- It鈥檚 far better to be clear and honest at the beginning concerning the limits of confidentiality than to shock young clients by letting them tell us about abuse and then explaining we need to pass that information on.
- Consider a young client鈥檚 wellbeing within any breach of confidentiality scenario. We have a duty to our聽particular client as well as child protection responsibilities.1
Session management
- Discuss ways for young clients who have been abused to manage between sessions. Be specific: include聽phone numbers of helplines or trusted people on a list. Talking about sexual abuse can seriously raise聽anxiety levels.
- Tell young clients what we already know about them when we first meet them.2 Never pretend we don鈥檛聽know they have been sexually abused, even if a parent or teacher has told us rather than our client themselves. Inform our client what we have been told about them, using general terms eg 鈥業 hear from your聽teacher that your uncle has been arrested for sexually abusing you. You don鈥檛 have to talk about what聽happened. You can if you want to, or you may want to talk about how you are right now.鈥�
- Recognise that contact may be frightening. Eye contact may come and go. Don鈥檛 push young clients or try to make them 鈥榯ell鈥�; give them plenty of time to speak of other matters while building trust.
Skilful presence with sexual abuse issues
- Believe the story of the abuse. Don鈥檛 doubt it. It is important to accept disclosures. Parents, teachers and others may disbelieve or be actively trying to make a child retract. Young clients who have been abused within the family, for example, and disclosed this, can be told by other family members to say it鈥檚 not true. I have met this particular situation many times. The child retracts and discloses again years later, having suffered greatly in the intervening years. Counsellors can help by believing young clients and leaving other professionals to fulfil their roles in protecting the child or young person and verifying their story.
- Sexual abuse may have taken place in the dark. There may have been deliberate attempts to confuse and聽manipulate the child or young person. Our client has probably been lied to, deceived and blamed. They may have been given alcohol or other substances to reduce their resistance. Recognise that confusion and聽dissociation are normal responses to this. Clients develop survival mechanisms to help them through聽the invasion and hurt.聽
- Memories and dreams, flashbacks or a sense of terror may be present. These can be very frightening.聽Explain that these are recognised as 鈥榥ormal鈥� responses to sexual abuse and that many children and young people experience them.聽
- Young clients鈥� symptoms are likely to lessen, but we may need to consider a referral to other psychological services, probably via the GP, if their abuse memories are very intrusive and debilitating.
- Remember that some children and young people who have been sexually abused will present with very聽few symptoms. They may be coping well and enjoying their everyday lives. Symptoms sometimes arise much later. It鈥檚 not our job to make them feel or think a certain way.
What to include in counselling
- Young clients need to be made aware that sexual abuse is wrong and that adults should never behave聽like that towards children or young people.聽
- Offer clear information. Children and young people often don鈥檛 know facts about matters such as who is聽responsible for the abuse.聽
- Do Say: 鈥榊ou didn鈥檛 do anything wrong鈥�
鈥業t wasn鈥檛 your fault鈥�
鈥業t wasn鈥檛 because you were pretty/naughty/sat on his or her lap etc鈥�
鈥楢dults shouldn鈥檛 behave like this towards children鈥�
鈥榊our body belongs to you鈥� (see NSPCC 鈥榯he underwear rule鈥�)3
鈥業 am sorry this happened to you鈥�
鈥楳any adults know sexual abuse is wrong and there are adults who want to help stop this.鈥� - Play may reveal aspects of the abuse; allow this to be non-directed as far as is possible, within the limits of your counselling environment. Join in and have fun together. This is reparative, as childhood is tainted by聽sexual abuse and play will help in recovery.
- Encourage young clients to trust others whom we know to be trustworthy. Help them to use wider support systems.
- Remind young clients to say no to unwanted touching or inappropriate online requests. Explain we cannot聽be there for them all week or forever in the future.聽
- Develop a toolkit. This could be a journal with older children or a container etc. Offer strategies to deal with flashbacks or panicky moments 鈥� such as taking mindful moments. Anchor a safe place that they can聽return to, a memory of being safe.4 Or suggest distancing techniques, such as looking through the end of a telescope to make everything seems smaller and further away.5听
- Young people may return to therapy later in their lives, especially when they form relationships or have聽children. A good-enough first experience of a therapeutic relationship now will enable them to use聽services later in life.
- Don鈥檛 expect to cure or eradicate the sexual abuse. Many adults who have been sexually abused recover聽and live productive, healthy adult lives. But invisible scars may always be present.
Managing own feelings/responses
Strong feelings may arise in counsellors who have witnessed stories of sexual abuse. Make sure to get聽supervision and support. It鈥檚 possible to want to rescue children and young people, and feel furious with聽abusers or with social and legal systems that are slow to respond. Sexual abuse is, unfortunately, quite common. Our responses simply show decent humanity. We can be present with young sexually abused clients and get appropriate support outside the counselling room.
Lorraine Sherman is a lecturer, supervisor and therapist in West Wales. She has offered counselling to young survivors of childhood sexual abuse for over 20 years and is author of Skills in Counselling and Psychotherapy with Children and Young People (Sage, 2015).
References
1 Daniel D, Jenkins P. Therapy with children: children鈥檚 rights, confidentiality and the law. London: Sage; 2010.
2 Sherman L. Skills in counselling and psychotherapy with children and young people. London: Sage; 2015.
3 http://www.nspcc.org.uk/preventing-abuse/keepingchildren-safe/underwear-rule/ (accessed 9 January 2015).
4 Levine P. In an unspoken voice. Berkeley CA: North Atlantic Books; 2010.
5 Ainscough C, Toon K. Breaking free: help for survivors of sexual abuse. Second edition. Sheldon Press; 200