Working with Trauma and Abuse

Abuse  Can you name the four categories of abuse?

Physical Abuse Physical abuse may involve hitting, shaking, throwing, poisoning, burning or scalding, drowning, suffocating, or otherwise causing harm to a child. Physical harm may also be caused when a parent or caregiver fabricates or induces illness in a child who they are looking after. All Wales Child Protection Procedures 2008

Emotional Abuse Emotional abuse is the persistent emotional ill- treatment of a child such as to cause severe and persistent adverse effects on the child’s emotional development. All Wales Child Protection Procedures 2008

Sexual Abuse Sexual abuse involves forcing or enticing a child or young person to take part in sexual activities, whether or not the child is aware of what is happening. The activities may involve contact activities, and non-contact activities, such as involving children in looking at, or in the production of, pornographic material or watching sexual activities, or encouraging children to behave in sexually inappropriate ways. All Wales Child Protection Procedures 2008

Neglect Neglect is the persistent failure to meet a child’s basic or physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. For example: failing to provide adequate food, shelter and clothing, failing to protect a child from physical harm or danger, or the failure to ensure access to appropriate medical care or treatment. All Wales Child Protection Procedures 2008

Other forms of trauma and abuse: Gender Based Violence & Domestic Abuse Rape and sexual assault Abuse against vulnerable adults such as someone with a learning disability financial or material abuse, including theft, fraud, exploitation, neglect and acts of omission, including ignoring medical or physical care needs ( by individuals or institutions) Other forms of trauma such as witnessing an accident, torture, experience of war, discriminatory abuse, including racist, sexist, that based on a person’s disability, and other forms of harassment, slurs or similar treatment.

Discussion point 1: As I described the various types of abuse and what they might involve: How did you find yourself reacting? What was going on in your body as you listened? What were you thinking and feeling? Consider how these responses you experienced might impact on your counselling relationship with a client who was discussing abuse?

Discussion point 2: Some clients may discuss their positive feelings towards the perpetrator of their abuse. They might have feelings of love for them. They may grieve for them if they are dead. How would this be for you as a counsellor? Would you be able to have unconditional positive regard for what the client is bringing?

Discussion point 3: Some clients may have enjoyed or physically responded to the childhood sexual abuse they experienced in some way. They may have become aroused or at times instigated the abuse. Again, how will it be for you as a counsellor to offer unconditional positive regard for your client who shares this with you? How do you think it may be for the client to share this aspect of the abuse they experienced with you?

Discussion point 4: Clients may not have been believed when they have talked about their abuse, or fear that they will not be believed – by their parents, families and friends, by the police, perhaps even by you. Notice your own response to this statement and consider what it would be like for your client to come to counselling carrying this burden.

Discussion point 5: Clients may feel great shame and guilt in relation to their abuse: They may feel that they were somehow responsible for their own abuse That it is their fault that others were abused because they did not speak out about their abuse at the time They may feel guilty about the implications of speaking out for the family of the perpetrator – especially if the client knows these people personally Consider how it will be for you to work with these themes and what it might be like for your client to discuss these feelings with you.

Discussion point 6: Some clients may develop a suspicion or fear of certain types of people who remind them of their abuser: If their abuser was the same gender as them they may develop a fear or dislike of gay or lesbian people – even assuming them all to be abusers If their abuser was of the opposite gender to them they may feel uncomfortable around men or women Depending on the age, ethnicity, height, weight, hair-colour, religion of their abuser – they may develop a dislike or fear of people who have these same characteristics. Consider the above in relation to who you are and the personal values you have. How will it be to work with a client who may have some of these fears, dislikes or even hatreds?

Discussion point 7: Often if there has been sustained abuse, or if the client comes from a chaotic background with poor attachment, presenting issues may be complex and varied: Clients are bringing the abuse they experienced which often will include emotional, physical and sexual abuse Clients may have had adult relationships that were abusive, possibly involving sexual violence Clients may have or have had an addiction Clients may have periods of being highly sexed and / or periods where sex and intimacy is very challenging for them Clients may be self harming, have suicidal feelings or plans, or have previously acted on suicidal feelings Clients may have experienced bullying, social isolation, or extreme anger and / or violence to others. Some clients may be ex-offenders Consider how it may be for your client in coming to counselling and what it would be like for you as a counsellor working with this client.

Discussion point 8: Some clients may wish to discuss the abuse they experienced – other may not: A client may want to tell you the story of their abuse. This at times might be graphic and difficult to witness Other clients may avoid discussing their abuse, change the subject to ‘safer’ topics, or only share glimpses of their abuse Consider how you feel about these different ways a client might present the abuse they have experienced. Why might client’s bring their experience of abuse in such different ways?

Discussion point 9: Clients may have very limited experience in life of feeling safe in a relationship, in trusting someone, in feeling fully accepted by another. Some clients may come to develop strong feelings for their counsellor – friendship, familial feelings, love, attraction. How might it be for you to work with a client who begins to feel this way about you? Consider how it might feel for the client to begin to develop these feelings towards you.

A dilemma How do you reconcile the following: Confidentiality is a fundamental ethical principle in the counseling process, which allows a trusting relationship to develop. If a counsellor decides to break confidentiality, counsellors need to be confident that they are acting in the best interests of the person If any person has knowledge, concerns or suspicions that a child (or vulnerable adult) is suffering or is at risk of harm; it is their responsibility to ensure that concerns are referred to authorities (social services, police, NHS, NSPCC) who have the statutory duties and powers to make enquiries or intervene where necessary.

Agency Safeguarding Policy  What is your agency’s policy on Safeguarding and Disclosure?  What would you do if you had concerns about a client’s safety or had concerns that they might harm someone?  Who would you get support from?  What action might you take to minimise the impact of a disclosure on the relationship with you client.

Some other aspects of working with abuse : Flashbacks Nightmares Why me? Questioning own sexual orientation Eating disorders Anxiety and depression Anger Loss – who might I have been? The frightened inner child Dissociation

Are the core therapeutic conditions sufficient ? A client called Jennifer says the following: “…if you are troubled by disturbing memories, dreams or behaviours that just don’t feel right somehow, think about talking it over with a therapist, and I would recommend a person-centred one; but you may find someone with a different approach. But at the end of the day, I’m not sure whether it’s the approach or the person that matters most. But make sure they are a good listener, they ring true and authentic and that they convey the sense of genuinely caring about you as a person” (2003) Bryant-Jefferies, R.

Counselling a Survivor of Child Sexual Abuse – A Person-Centred Dialogue By Richard Bryant-Jefferies Radcliffe Medical Press Ltd, Abingdon, 2003