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Listen
Chapter Four: Positively Supporting Survivors
Drawing on the information already discussed in this booklet, we summarise what we believe are some of the most important ways you can help, support and work with survivors of childhood sexual abuse. We can only repeat that these are not superhuman qualities and skills, but basic human ones. No-one should be afraid of learning to use them.
Facilitating disclosure, setting the environment, 'tuning in' to the right signals
Because of their experience of sexual abuse, and the resulting difficulty in trusting others, many survivors are very sensitive to how people react. They have an acute ability to tune in to others, and can sense if workers are able, available, and willing to go the course with them. The survivor picks up on our verbal and non-verbal cues, and decides whether they can trust us enough to disclose. Workers, in turn, send out messages about how comfortable they are. So the reactions of workers to disclosure (or even the impression they give when survivors are considering disclosure) can determine whether that survivor is able to seek further help to begin the process of healing. If handled badly, it will hinder further discussion.
As we have seen, the reluctance people can feel about working with survivors is often because of a fear of harming them, of saying the wrong thing, or of making things worse. But what survivors need is to be able to talk and to receive good practice. A lot of what is required is simply about you as a person: how you are with the survivor; your personal approach, warmth and acceptance. These are far more important than detailed knowledge and training, although it is important to remember that those working with clients with moderate to severe mental health problems associated with sexual abuse should also have adequate training.
Workers need to feel confident about the skills, abilities and personal qualities they can offer which help to create a safe environment in which discussion of sexual abuse can take place. Your understanding, warmth and acceptance are of the utmost importance in establishing trust. It is also important to have some knowledge about sexual abuse. Training is an enormously helpful way to feel more confident about your ability to deal with sexual abuse and is essential to improve your knowledge and awareness.
It is also important that you explore your own history in relation to abuse, so that your own things do not get in the way. For instance, if you are yourself a survivor (as many professionals will be), this can prove a great source of understanding, skills and experience. But you also need to be sure you feel in a strong enough place at the moment, that you have the support you need to do this stressful work, and that you do not try to resolve unaddressed issues of your own through other survivors. To take another example, if you, or someone close to you, has been wrongly suspected of child abuse, you need to ensure your understandably angry feelings do not affect your perception of the credibility, or good faith, of the survivors with whom you work.
Being open to the possibility of CSA also means having leaflets, books, and posters around your workplace; anything that could make it easier for survivors to identify themselves. It might be part of your routine assessment procedure, or could be mentioned sensitively as a possibility as you work with people, such as asking 'Did anyone hurt you when you were a child?'. It is important that people know that you are offering the opportunity to tell you if they want to, and that you are ready if, and when, they choose to talk. For those who are uncertain, it is helpful to tactfully and sensitively be aware of the signals you may be offered, and to respond positively, conveying your willingness to work alongside them wherever that may go.
Have faith in your own strengths
People often react fearfully to the prospect of someone revealing sexual abuse, almost as if the survivor (or even the entire room) might spontaneously combust! If a survivor chooses you to confide in for the first time - in whatever setting and for whatever reason - they may well become distressed or tearful (even with relief). But this is natural. If you are an empathetic person and skilled listener, and especially if you work in a caring profession and often encounter distressed people, you would be able to cope with a newly-bereaved person, with someone whose child is seriously ill, someone crying with shock after a road accident or many other situations. There's no reason for fear of this disclosure or distress: just use the same skills, personal warmth and means of comfort that you would normally use.
Acceptance
It is important that you accept the survivor and what they may tell you: that they feel valued and respected for their courage in disclosing, and for what they have endured. The acceptance of an understanding other can break through low self-esteem and worthlessness. Your consistent acceptance, conveyed with warmth, (not just the words you may use but your whole approach, your gestures and tone) if genuinely meant, will affirm the survivors' worth and help them feel they are not judged. This will help them to accept themselves (maybe for the first time in their lives). This is both strengthening and freeing, and can enable them to go further.
Belief
Often the survivor will feel that they won't be believed, or they may have tried to disclose previously and been met with disbelief. This reaction perpetuates the cycle of abuse, and maintains the silence that they are attempting to break. When survivors disclose it can be so horrific that it is hard to believe, but this is not a reason to disbelieve and it may be necessary to 'suspend disbelief'. As listeners, staff are there to validate and listen to what they are being told. It is important to remember that it is not up to you to judge whether precise details of the content are true, or accurately recalled, but rather you should respond respectfully to what is said. The circumstances where this is important ( e.g. in a court case) will fall within the remit of other professionals (for instance, police officers investigating a crime.) Where there are child protection issues there are limitations of confidentiality, see Appendix Three, pages 64 to 66 for guidance on this.
Understanding
For someone to be understood accurately in what they are saying is enormously important - it helps survivors feel they are no longer isolated or alone with this.
Respect and dignity
Survivors have generally not felt they have any power or control in their lives and many consequently have low self-esteem. Survivors have the right to be treated with respect and dignity, and to feel that they are worthy of this. This means respecting the choices survivors want to make about their recovery, and respecting their values. It includes examining your own beliefs (religious or any other kind) and making sure they don't negatively affect your perception of the worth of the person you are supporting. Nor should you impose your beliefs on the person you are supporting.
Being genuine
You need to be honest with the survivor. They would rather you told them if you do not know, or do not understand what they say to you. Responding humanely and being genuine helps. If you can tell them you're not perfect, then they too can feel OK about being genuine. Survivors value human reactions: it's alright to show you are shocked at something survivors may tell you, as long as your own fears don't take the focus away from the survivor or make them feel they have to protect you from further distress.
Going at their pace
It is very important to respect the time this can take. Each person has their own way of dealing with abuse and a need to go at their own pace. There may be times when this is slow, or they may need to take breaks and return when they feel able. Keeping the door open and maintaining trust that they will not be pushed is vital to being able to finish the work.
Men in our society are expected to be strong and in control, to be macho, not to be vulnerable or victims. These stereotypes can keep men silent about their abuse. This needs to be taken into consideration when working with males, as it can mean it can take longer to disclose, that there can be a great deal of shame for men around disclosure, and there can be the added fear that they will be thought of as homosexual if they are heterosexual, or that they will face homophobia if they are gay.
Anticipating and planning for temporarily increased distress
Although most survivors feel relieved to address their abuse issues, often after decades of silence, it is also true that they can often experience worsening of distress symptoms in the short term.
This is natural and to be expected: it is a feature of work with other kinds of trauma too, and is not a reason to stay stuck behind the starting-blocks. But it does mean that you need to plan, in consultation with the survivor, some extra support during that time, and also some self-help resources, which they may need to help deal with issues like panic attacks or dissociation.
If you are someone who works with survivors in the medium and longer term, this planning is also important for other crises, or for temporary setbacks, because progress is rarely linear and straightforward. Extra support can take many forms. To give one example, SAMH's Redhall Walled Garden Project in Edinburgh (not a CSA project, but one which many survivors have found valuable) described how helpful it could be if people who were going through distressing material with a counsellor in the morning could find support and space in the peaceful setting of the garden in the afternoon.
Being able to stay with them
Because of the nature of abuse, it can be very painful and frightening for a survivor to talk about their experiences in detail. They need you to be able to listen to them, and to reassure them that you will stick with them whatever they tell you, no matter how hard. If you leave because you are unable to face what they are telling you, you will simply be reinforcing their negative feelings about themselves and the perceived hopelessness of their situation. It is also important that you have adequate personal and professional support if you are listening to graphic and distressing material.
Validating their anger
It is important that survivors' anger at the abuser is expressed, heard, and seen as a natural, healthy response.
Taking their health seriously
Many survivors have physical health problems as a result of their past abuse, or their lifestyle following abuse. They may also have injuries, or infections, relating to more recent sexual assault. Often part of not valuing themselves is not valuing their right to good health. Make sure that you do. Take their problems seriously. Encourage them to get health checks, and be prepared to talk over their fears of doing so. Let them know if you are aware of particularly sympathetic and understanding services, or medical professionals.
Support and supervision
We have emphasised throughout this booklet that asking tactfully about a CSA history, or responding constructively to initial disclosures, does not have to be frightening for workers. Many survivors will feel great relief and will not wish to go further than having their history acknowledged, explaining what needs they would like to follow up on, or discussing with you what other agencies could offer particular support and advice. You may, however, be someone who works regularly and in more depth with survivors on their abuse issues, or someone whose job could involve hearing, at any time, painful and difficult revelations. If so, it is essential that you have regular supervision; either within your organisation, or from an external supervisor.
This work is hard, and can be very emotionally demanding as survivors are often remembering distressing childhood memories which can be very frightening for them, or recalling the emotional reactions they had at the time of the abuse, which can be equally gruelling. You will require support and supervision to be able to work effectively, and intimately, through very challenging and difficult histories, with people who are very often on the edge. Working with this level of fragility cannot help but touch you emotionally.
For you to be able to remain in close contact with the survivor (which is what is required), you cannot afford to hold this on your own. If you are unsupported, you will risk failing the survivor; there is a risk of vicarious traumatisation and identification with the survivor, where you become less helpful as a result of experiencing some similar feelings to the survivor themselves and, as a result, seeing things from a limited perspective. We cannot emphasise enough that, throughout this process, it is essential that you, like the survivor, have a safe place to go to discuss the work confidentially, to offload your feelings, and receive ongoing, consistent support. The form that the support takes needs to be one-to-one supervision, peer supervision, or both.
It is worth noting here that it is an ethical requirement for all professional counsellors to have adequate regular supervision, with the level based on the number of clients and intensity of work undertaken. This requirement clearly recognises the level of complexity involved in such work. Although not all workers are necessarily trained counsellors, many are fulfilling a similar task. Although we are not saying they have to meet exactly the same requirements, your organisation needs to see adequate supervision support as a pre-requisite for undertaking medium to longer-term work with survivors of child sexual abuse.
Your manager or senior in your organisation should ensure that you have adequate supervision and support in place for dealing with child sexual abuse. It is also important that local authorities and health boards, who commission such services, build in funding for adequate supervision. Workers who are dealing with stressful client-work, such as this, have the right to demand adequate supervision from an appropriate person, as the organisation has a responsibility to protect staff from work-related stress. Adequate supervision time focused on the client-work, rather than the line management issues, is a helpful way to monitor and assess the impact of the work on staff, and to make sure that everyone is OK. Proper supervision helps ensure that the survivor, as well as the worker, is supported.
…Don't forget to ask two simple questions!
Finally - in the midst of trying to follow all the advice in this chapter, and turning into a superhuman (or just human!) being - check that you haven't forgotten actually to consult the survivor on two very practical questions:
- "What problems, if any, do YOU think the abuse has left you with?"
- "What are the main things YOU would welcome help with now?"
These questions are an essential part of planning for the kinds of support and interventions - if any - which survivors might need in the short, medium and the longer term. The final chapter makes a few important considerations about that process.
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