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Listen

Chapter Two: Barriers to 'Opening the Can of Worms'

There are many barriers, for survivors and those who work with them, to broaching the issue of a sexual abuse history - even if people wish to do so. This has a range of repercussions. For instance, it means many services and projects do not collect basic data on how many survivors use their service; what their needs are; and how best to provide support.

Survivors

There are lots of different feelings and reactions that survivors may have that prevent them telling, or make it hard for them to tell. These may include:

Barriers for staff and volunteers

Numerous reasons for reluctance to raise, or discuss, sexual abuse with service-users have been given, including:

• Survivors' claims of abuse may not be true, or might be part of their illness
• We might encourage false memories - see the section below on Recovered and False Memories
• We don't have enough skills, knowledge or training
• We don't have the resources or staffing
• Not part of our work remit; we're not funded for this; it's not on our list of outcomes
• The person would break down/self-harm/destabilise/become much more distressed if it was mentioned
• We've been trained not to go there, that it would do more harm than good
• They might commit suicide and we could be sued
• He/she has been assessed as too vulnerable
• Not 'proper' psychiatry: "we deal with severe and enduring mental illness"
• No one has proved CSA causes mental illness: there are many other influencing factors
• No treatment shown to work; no evidence base; not sure it's helpful
• She's always talking about it, but I think it's attention-seeking
• It would involve lengthy counselling/therapy and we don't have the time
• Government policy is to move people quickly out of inpatient care - patients would have to stay longer
• It's not the right time to start now, another time would be better
• The physical environment here isn't suitable/isn't private enough
• There's no competent service to refer them on to, so it wouldn't be fair
• It's not really that serious - not much happened - wouldn't it be more damaging to make a fuss?
• It's better 'to put the past behind you'
• People will only tell us when they're ready to
• Questions would be intrusive, harming my relationship with the client
• We don't want to trigger child protection guidelines and start a chain of events which could involve police, judiciary and/or court appearances
• We don't want to trigger child protection guidelines because of the clients' previous bad experiences with the child protection system (especially for young people)
• Opening the can of worms in small communities is a big step because the abuser might prove to be your patient, friend, colleague, boss or a relative
• There is no support and supervision available
• Sexual abuse is so common that if we started a service we'd be overwhelmed

Additional reasons for not wanting to raise the topic of sexual abuse with service-users include:

• Feeling embarrassed, or awkward, about dealing with CSA, or with sexual matters generally
• Unresolved personal issues, e.g. unaddressed history of abuse
• Being involved in sexual abuse oneself; either alone, or as part of a group or sex ring

'Recovered' and 'false' memories

There has been a great deal of debate around the question of 'false' and 'recovered' memories with respect to childhood sexual abuse. Staff have reported this as one reason for reluctance to enquire about possible abusive experiences.

The phrase 'recovered memories' refers to memories of events which have been lost to conscious recall over a period of time, and are subsequently remembered. There is a large international research literature on issues of traumatic memory and traumatic amnesia, not simply in relation to childhood sexual abuse, but to many other traumatic events. You may wish to read some of this literature and some of the debate, and decide for yourself where the most informed, accurate and scholarly opinion lies.

There have been occasions when some therapists working with regression or suggestion techniques may have inadvertently created memories of things which did not happen, resulting in false memories, and in some cases in the prosecution of innocent individuals. Such techniques would not be used by frontline staff anyway and if in doubt you should seek skilled supervision and advice.

We know that there can be many different causes for any particular set of problems a survivor might experience and that we should not make instant assumptions about the cause of these problems. Memory is sometimes unreliable, inaccurate or confused, and can sometimes be influenced by suggestion - this can be true for anyone. Some people without clear memories of the past are also able to make significant improvements in their lives. Having said that, we should not let these caveats stand in the way of offering appropriate help. Part of being client-centred in the work we do is to be guided by and sensitive to clients' individual needs.

It is helpful to remember the following:

• Many people who disclose a history of sexual abuse will not have lost it to conscious recall at any point in their lives, and the question of 'recovered' memories will not be an issue.
• It is good practice routinely to give clients the opportunity to talk about their past experiences by asking simple, diplomatic questions, as suggested in chapter 3. There is no evidence that this can trigger or create false memories.
• There is no evidence that listening sympathetically and supportively to a client who wants to talk about the details of their experiences will create false memories.
• People may find it upsetting where memories of abusive experiences emerge during any type of work or support and may not be sure themselves whether the recovered memories are true. It may be helpful to focus on supporting the client in tolerating the ambiguity of the situation they find themselves in, and on reducing their distress. It is important to seek skilled supervision and advice.

What is helpful to overcome the barriers?

Reading through this chapter, we might wonder how the issue is ever addressed at all! Considering the barriers to disclosure and discussion for survivors, staff and volunteers, it is not surprising that after decades of publicity, there still remains a problem about "breaking the silence" when it comes to sexual abuse.

Do abuse survivors confirm the beliefs and anxieties listed, or not? What do they say they find helpful in staff, or volunteers, who work with them? The next chapter considers some of these questions.

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