Pre-trial therapy (PTT) for adult and child witnesses has been very much in听the media spotlight since the tragic death of Frances Andrade in 2013. Frances was a key prosecution witness in the criminal听trial, and later conviction, of her former music teacher, Michael Brewer, and his wife, Kay Brewer, for abuse dating back to her teenage years. After undergoing a gruelling cross-examination, which claimed that her allegations of abuse were mere fantasies, Frances subsequently took a fatal overdose.

Media coverage at the time focused on an apparent lack of pre-trial support and counselling, and the subsequent Serious Case Review1 concurs with this view. This now seems symptomatic of a possibly widespread reluctance to provide PTT for vulnerable witnesses on the grounds that it might undermine prosecution evidence via听the twin evils of 鈥榗oaching鈥� and 鈥榗ontamination鈥�.2

In her concluding remarks in the Serious Case Review of the death of Frances Andrade,1 Professor Hilary Brown recommended that criminal justice agencies听鈥榠mprove their practice in supporting survivors of sexual abuse鈥� the police should promote (not merely dissuade) victims from seeking timely counseling鈥�.听She added that 鈥榮teps should be taken to ensure that mental ill-health is not seen as a barrier to participating in and/or receiving, justice including following听Crown Prosecution Service (CPS) guidelines on听pre-trial counselling鈥�. In addition, 鈥楴HS commissioners should ensure that there are adequate specialist services within their catchment areas to meet the needs of people who are survivors of childhood
trauma and abuse鈥�.

Practice guidance

In fact, the legitimate concerns of the legal system about the potential impact of PTT on the trial process seem somewhat misplaced. Practice guidance issued by the CPS3,4 makes it clear that both child and vulnerable witnesses can receive PTT before and during a criminal trial of their alleged abusers. However, there are recommendations for good practice:

  1. the CPS should be informed of any PTT taking place
  2. PTT should begin after the client has given their statement of evidence to the police
  3. detailed factual records of therapy should be kept and made available to the CPS as required
  4. PTT should focus on the client鈥檚 current responses and coping, rather than on the original abuse
  5. certain types of therapy are preferred as supporting this kind of 鈥榗urrent鈥� focus
  6. the CPS needs to focus on the welfare of the client, rather than simply on the pending court case.

Research survey into pre-trial therapy

Given this context, the results of a recent survey听of practitioners providing PTT for clients makes for interesting reading. This possibly unique survey was carried out by counsellors at St Mary鈥檚 Sexual Assault Referral Centre (SARC) in听 Manchester, following their successful conference in July 2014. There is a lack听of research into this key topic, so this survey was an attempt to learn more about the experiences and views of practitioners. Research into the parallel experiences of clients is also now being planned.

This was a small survey (n=35) of practitioners attending the conference, who had at least some awareness and interest in the complex issues surrounding PTT for children and adult vulnerable witnesses facing a criminal trial. The survey was carried out as a service evaluation under NHS trust policies. This convenience sample was composed of听25 counsellors, four service managers, five respondents who were Independent Sexual Violence Advisors (ISVAs) or who were carrying out similar roles,听and one barrister.

Experienced practitioners

The demographic characteristics are interesting: almost 90 per cent of practitioners were female, with an average age of 60 years. Two-thirds were members of 香港六合彩精准资料, with several also holding membership of UKCP, and others being members of other professional organisations such as HCPC听(Health and Care Professions Council) and BPS (British Psychological Society). There was a wide spread of employment and practice patterns, including working in SARCs or other specialist agencies. Over half of the sample (60%) had between four and six years鈥�, or more than seven years鈥�, post-qualifying experience. The听data suggest an older, relatively experienced set of counselling practitioners working in the field of PTT, perhaps pointing to an emerging specialism within the field of sexual trauma.5 However the survey is not necessarily representative of the wider range of practitioners involved in providing PTT, as there will presumably have been an element of self-selection in choosing to attend the conference and then respond to the survey questionnaire.

The sample showed a relatively assured and competent grasp of many of the main issues relating to PTT. For example, responding to the question, 鈥楢fter reporting听a crime to the police, can a client access counselling?,鈥� over 90 per cent responded 鈥榊es,鈥� while 10 per cent were 鈥楿nsure.鈥� In the main, respondents were clear about听the appropriate forms of counselling that can be provided for clients, according to the CPS good practice guidance.3,4 They could identify sources of advice听and were aware of the potential limits to counselling imposed by the legal system. However differences and uncertainties were more evident regarding access听to client notes for legal purposes by other agencies such as the police, CPS, and the courts. These issues will be explored in more detail below.

Practice issues in providing pre-trial therapy

Working with clients receiving PTT can raise complex legal, ethical and therapeutic dilemmas for practitioners, such as:

  1. informing the client of the potential for access to records of therapy by prosecution and defence solicitors
  2. keeping the client鈥檚 best interests in mind throughout the therapy and throughout any ensuing court proceedings
  3. balancing client autonomy and wellbeing, therapy and justice
  4. separating out the roles of advocate and therapist 鈥� for example, by the use of ISVAs and therapists working in distinct, but complementary roles
  5. working to CPS PTT guidance and avoiding forms of therapy likely to compromise evidence in the criminal trial.

Sources of advice

Given this complexity, the survey sought to identify the main sources of advice used by practitioners.听香港六合彩精准资料 was the most frequently cited source, with 15 mentions, followed by managers/employers at nine mentions and supervisors, also with听nine mentions. The CPS was referred to by six respondents. Perhaps surprisingly, professional indemnity insurance providers received only three mentions, as did employers鈥� and NHS trust legal departments. Lawyers were also mentioned relatively infrequently, with four mentions. This suggests a heavy reliance on 香港六合彩精准资料 for advice, although this would necessarily be of an ethical and professional nature, rather than constituting legal advice as such.

Forms of pre-trial therapy

CPS good practice guidance3,4 identifies certain forms of therapy which are seen to be potentially problematic in relation to a client鈥檚 evidence in a criminal trial. This list is, admittedly, based on expert opinion, rather than on evidence-based practice. Practitioners were mainly听well aware that therapy deemed to be appropriate for PTT should be generic and non-directive and 听can include forms of therapy such as person-centred听counselling and CBT. One respondent stated that PTT could include 鈥�any form of counselling that avoids anything that can be construed as coaching, rehearsing or influencing the client鈥�. Another responded that it could include 鈥榓ny form of counselling which explores feelings about the incident or concerns around attending court鈥�.

There was less certainty about forms of therapy that are contraindicated for PTT. Respondents referred to therapies perceived as being problematic as including intensive psychotherapy and psychodynamic therapy, with one referring to using 鈥楥BT with some caution鈥�.听Four respondents specifically identified hypnotherapy as being seen to be problematic, with others referring variously to group therapy, psychoanalysis and dramatherapy in these terms.

Limitations on counselling available

Of those responding, the overwhelming majority signalled a high level of awareness of the limitations applying to pre-trial counselling. One specified the limits in the following way: 鈥楢void discussing evidence. Avoid any leading questions. Avoid anything that could be considered as coaching or rehearsing.鈥� Another simply described the focus for PTT as being 鈥榬ecovery and coping鈥�. Overall, this seemed to demonstrate an accurate level of understanding of the limits imposed on PPT by the CPS guidance.

Role of SARCs

Respondents were also asked if PTT should be provided by a specialist agency such as a SARC. Views were mixed about this, with less than a third responding positively.听One response indicated that 鈥楽ARC-endorsed counsellors听may be in the best position to offer counselling pre-trial鈥�. Another respondent disagreed, stating that 鈥�not all clients go through SARCs though, so other avenues need to be available鈥�. Other respondents referred to the role of听other agencies in providing PTT, such as Mind and CAMHS. Others saw this issue very much in terms of client choice and preference, rather than primarily in terms of whether it should be a specialism for SARCs:听鈥�It should be more about what the client feels comfortable with.鈥� Another respondent saw the issue in terms of potential client demand overloading SARCs: 鈥�As long as all therapists are aware of how working with clients going through the legal process can be done, this should not be limited to SARCs. With the increasing numbers coming through SARCs (specifically historic), this would put pressure on service.鈥�

Access to counselling notes by other agencies

There seemed to be less clarity and agreement among respondents about access to client counselling records by other agencies such as the police and the CPS. Briefly, the client can consent to the release of their听notes to other agencies, such as the police and the CPS, or the courts can require their release via a court order.

Asked, 鈥楢s a counsellor, what are your obligations if you receive a request for counselling notes from the police, CPS or another agency?,鈥� six respondents were unsure of how to respond, with one commenting: 鈥�I believe official听notes must be handed over but own anonymised process notes need not be but I鈥檓 not sure.鈥�

Ten respondents highlighted a perceived need to obtain client consent prior to releasing counselling notes to 听the police or CPS. One commented: 鈥�Meet with client to allow sight of content鈥� client to sign consent to disclose form鈥� notes copied鈥� originals forwarded as requested.鈥�

A further 10 respondents emphasised that disclosure of client counselling notes should only be on the basis of a court order, rather than via simply seeking client听consent. One of these respondents said: 鈥�As a counsellor听I would not acknowledge a request for notes from the above [police or CPS]. It听 would need a judge to state my notes were required. I would then discuss this with my client and gain their written consent for release of confidential information.鈥�

A smaller group of respondents saw the issue primarily in terms of responding to agencies such as the police 听or CPS, but without clear reference to obtaining prior client consent, or responding to a court order. These听responses suggest a degree of different practice, or even confusion among some practitioners about their legal and procedural responsibilities for sharing client information within the context of PTT.听

Other issues arising within pre-trial therapy

A number of other significant professional and therapeutic issues were identified by respondents. Issues relating to work with children were noted by one: 鈥楥hildren find it difficult not to be able to talk about the incident.鈥� Another stated: 鈥�Feeling client pressurised into giving consent for access to notes. 鈥淲hy wouldn鈥檛 she, we鈥檙e on her side.鈥� Prof indemnity insurer telling me听14-year-old couldn鈥檛 give consent for access: 鈥淪he has no legal status鈥�.鈥�

Another responded in terms of the problem inherent in anticipating whether therapy would entail a shift into PTT and its very specific boundaries: 鈥�...often there is an element of the unknown in so far as, until therapy starts, there is often no clear indication of where a client is going and the depth. Some clients are reluctant to disclose... want to avoid the legal side of abuse.鈥�

Other counsellors emphasised the very real human cost of abuse, as a precursor to PTT: 鈥楶resenting can impede their recovery as limited work can be done with them pre trial鈥�. Another provided a more detailed critique: 鈥�Clients are often traumatised and struggling with panic, PTSD symptoms etc prior to court case which can take place听a long time after the incident or be delayed. They are asking for help and it can feel frustrating (and cruel) not to be able offer treatment until court case has ended.鈥�

Conclusion

This small survey of practitioners working in the听field of PTT suggests that there is a core of older, often relatively experienced counsellors providing therapy for clients. In the main, they are confident about understanding the limits to counselling required by the CPS practice guidance and the potential impact on the choice of therapy appropriate for this form of work. However, there seems to be less agreement about the processes for disclosing client records to agencies such as the police or CPS. Counsellor opinion seems to be divided between the need to obtain prior client consent and the option of avoiding disclosure unless legally required to do so by a court order, and then seeking client consent.

One respondent perhaps summed up the need for a dramatic shift overall in counsellors鈥� orientation听towards the criminal justice system, from deference to a more assertive stance: 鈥�Professionals have to be prepared to鈥渙wn鈥� their work and advocate on behalf听of vulnerable client groups鈥� keep the child as the person central to our concern.鈥�

The issue of PTT, meanwhile, continues to steadily gain prominence within the media. Ann Coffey MP has called for society to tackle attitudes and a prevailing culture that allows child sexual exploitation to take place.6听The Labour Party has proposed a new victims鈥� law, co-written by former Director of Public Prosecutions Sir Keir Starmer with Lady Doreen Lawrence, that would enable judges to protect vulnerable witnesses from excessive cross-examination.7听Professor Brown has asked NHS commissioners to ensure adequate access to specialist services for victims of childhood sexual abuse.1听The Ministry of Justice, in turn, has announced a doubling听of funding, from 拢12 to 拢24 million, to Citizens Advice, for improving support services to witnesses in court.8听This research suggests there is now a cohort of experienced practitioners already grappling with听the complexities of providing pre-trial therapy, while the system itself is clearly under growing pressure 听to change.

鈥婸eter Jenkins is a Senior Lecturer in Counselling听at the University of Manchester and the author听of Counselling, Psychotherapy and the Law听(Sage, Second edition, 2007).

Joanne Muccio is Lead Counsellor, a supervisor and a听crisis worker at St Mary鈥檚 Centre (SARC), Manchester.听She specialises in working with sexual assault.

Nicky Paris is a counsellor at St Mary鈥檚 Centre (SARC) in听Manchester and is also Managing Editor of Counselling听& Psychotherapy Research (CPR).

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References

1 Brown H. The death of Mrs A: a serious case review. Surrey:听Surrey County Council Safeguarding Adults Board; 2014.
2 Jenkins P. Pre-trial therapy. Therapy Today 2013; 24(4): 15鈥�17.
3 Crown Prosecution Service, Department of Health and Home Office.听Provision of therapy for child witnesses prior to a criminal trial:听practice guidance. Bolton: CPS; 2001.
4 Crown Prosecution Service, Department of Health and Home Office.听Provision of therapy for vulnerable or intimidated witnesses prior to听a criminal trial: practice guidance. London: Home Office听Communications Directorate; 2002.
5 Swindells J. Counselling victims and witnesses of crime 鈥� are they a听specialist group requiring specific knowledge and expertise? Degree听dissertation (unpublished). Warwick; University of Warwick; 2012.
6 Coffey A. Real voices: child sexual exploitation in Greater Manchester:听an independent report by Ann Coffey, MP. [Online.] Report of Independent听Coffey Inquiry; 30 October, 2014. http://anncoffeymp.com/wp-content/uploads/2014/10/Real-Voices-Final.pdf (accessed 28 March 2015).
7 Bowcott O. Labour publishes proposals for victims鈥� law. [Online.]听The Guardian 2015; 24 February. http://www.theguardian.com/law/2015/feb/24/labour-victims-law-child-abuse-crime-criminal-justice听(accessed 28 March 2015).
8 Ministry of Justice. 拢24 million grant to support witnesses at court.听[Online.] Press release. London: Ministry of Justice; 2014; 15 November.听www.gov.uk/government/news/24-million-grant-to-support-witnesses-at-court听(accessed 5 February 2015).

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