Recovering from trauma. A child’s journey.

What will the journey look like for the survivors of Rotherham?

In order to comprehend the recovery journey for a child such as those in the recent sexual exploitation cases in Rotherham, this paper shall paint a picture of the journey for a child victim from the point of disclosure.

The first disclosure

For a child to disclose abuse of any nature, it takes immense courage and usually requires them to have a relationship with an adult that they know cares for them deeply. In the context of this trusting relationship, a child may feel able to question the events in their life that are causing a sense of confusion and pain and if the listener is actively listening rather than being dismissive, the child may begin to disclose a few crucial details. These details are often mentioned with tension and nervousness to test the adult, to explore if that adult will respond or dismiss with mocking, blaming words. If the exploration is facilitated gently in a warm and respectful environment the child will feel safe and believe that the adult will ‘make things better.’ Sadly, for many children, they test the waters in conversations with trusted adults to find that they probably won’t be believed- or worse still- they will be reprimanded for any suggestions that another adult has done anything so awful. For many children, the right environment to share their concerns was never facilitated and shame and fear silenced them, often for years.

Disclosure to appropriate professionals

Following the initial disclosure the child then has to find the courage to speak to many different professionals about the events that are too horrific to share. Trauma shuts down the broca area of the brain that is responsible for speech and language, so to ask a traumatised person repetitive questions about the most awful experiences that words would struggle to describe, can further re traumatise a child unless there is great effort made to enable them to feel a sense of safety. The use of small hand held toys to enable them to squish, fiddle or puzzle while they speak softens the clinical questions of a professional who needs details in order to fulfill their role of protection of children and prosecution of the perpetrator. A warm, engaging, empathetic approach can make the difference between the child remaining in a state of shock and horror or feeling understood and cared for. The need for forensic medical examinations exacerbates the stress levels of the child, but a caring adult bringing reassurance can reduce the horrific intensity of the traumatic invasion.

Facing the everyday world

Often a whirlwind of appointments and professionals can materialise and then stop just as suddenly. The child is often left to ‘get on with life’ as if nothing has happened. School seems like a different world, full of noise and chaos; laughter and innocence. The child can feel dirty, different, ashamed, awkward and isolated in the midst of the happy faces. Panic can rise quickly and without warning, for example when a teacher shouts, because that angry face resembles other abusive adults shouting commands or sly manipulating requests. Flashbacks, panic attacks, the sound of internal screams all become things to be managed whilst attempting to avoid being told off for fear of more anger and pain. If the school grasps these challenges the smallest things can transform the child’s experience. If the child has a teacher greet them kindly, warmly and say something gentle such as ‘if you need some time out, if you need to chat, if you need to find somewhere safe, just come and find me in room 2 and I’ll/ or Miss R will be there for you.’ If the child could find school to be a place of understanding, with staff who are kind, non-judgemental, accepting and with genuine warmth, this can lower the stress levels of the child immediately which in turn reduces the intensity and quantity of trauma symptoms that develop to enable the child to survive.

A child needs support

The CPS Guidelines on Prosecuting Cases of Child Sexual Abuse recognizes that children need support.

‘Children and young people who have been the subject of sexual abuse are likely to require a very high level of support. The police will be responsible primarily for facilitating this, although they will not be responsible for delivering emotional or psychological support.’

The DSM-5 lists the reasons that emotional support will probably be needed. Trauma symptoms could become part a child’s narrative having experienced traumatic, abusive experiences that render a child powerless. These symptoms range from dissociative reactions such as flashbacks, persistent avoidance of stimuli associated with the traumatic event, avoidance of or efforts to avoid distressing memories, or external reminders that arouse distressing memories, thoughts or feelings closely associated with the traumatic event(s). The child could experience frightening dreams, marked physiological reactions, persistent and exaggerated negative beliefs or expectations about oneself others or the world. Persistent negative emotional state, markedly diminished interest or participation in significant activities, feelings of detachment or estrangement from others, persistent inability to experience positive emotions, irritable behaviour and angry outbursts, reckless or self destructive behavior, hypervigilance and so the list goes on.

These symptoms generally do not subside with time. They can become more entrenched as behavior patterns that protect and enable a child to survive in the harshness of a world that would allow such horrific things to happen to them. The CPS guidance ‘Provision of Therapy for Child Witnesses Prior to a Criminal Trial’ is clear that the best interests of the victim or witness are the paramount consideration in decisions about therapy. There is no bar to a victim seeking pre-trial therapy or counselling and neither the police nor the CPS should prevent therapy from taking place prior to a trial.

The United Nations Convention on the Rights of the Child (UNCRC) 1989 says that is essential ‘to take all appropriate measures to promote the physical and psychological recovery and social reintegration of child victims of violence’.

Therapy as an essential intervention for recovery

The NSPCC report in 2001 discovered an estimated 55,000 children who have been sexually abused received no therapeutic support each year due to a short fall in the availability of therapeutic services. Yet it is recognized that;

Long term therapeutic work for children who have been abused is a necessary and important way of helping with issues of confused feelings, including those of boundaries, intimacy, anger, abandonment, control and lack of control.’ (Murphy. J. 2001.p123)

Children need a safe place to process their experiences in an environment that doesn’t rush them and gives them time and space to go at their pace. The three phase treatment plan of most trauma therapy intervention begins with the stabilization and safety phase and this can take time as the children learn how to build trust with another adult having had that trust shattered through the abuse experience. The focus is on building safety for the child and often the first piece of work is identifying and reflecting on the very concept of ‘safe’. Often therapeutic provision stops at this stage and doesn’t allow the time to progress into the processing of the experiences to enable the memories to be become part of the child’s narrative, with emotional appropriate language and an understanding of the experience. The feelings of shame, guilt, confusion, distrust, powerlessness and negative belief patterns need to be processed. The final stage is the rebuilding and future focused work where the child no longer feels their identity is the abuse experience but rather has a greater and richer sense of who they are in the world. This can take years but prevents long term mental and physical health challenges in their future.

Other helpful recovery aids

Every child benefits from supportive, warm, genuine, kind adults who are safe, playful, curious and affirming. Children also find recovery is faster if they develop hobbies and interests that build resilience, such as sport, music, or art based activities experienced in safe, group times. They need their basic needs met of exercise, rest, play, healthy food, positive routines and a sense of belonging to a family and a community.

 

Recovery is possible

We need to prioritise the recovery journey for children who experience trauma. A recovered child is a child who is confident, at ease and has a voice. For this to happen there needs to be an increased investment into therapeutic services for children, increased parenting support projects and increasing training for professionals such as social workers, police, doctors, barristers and teachers on the impact of trauma on a child.

Betsy de Thierry

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