This is a copy of the response I submitted to the government’s recent call for evidence. If you want this as a .pdf you can download it here.
About the Research
This submission is based upon Wellcome Trust funded research involving 140 adult survey respondents and 21 detailed interviews, in which participants were asked what helped and hindered their recovery from childhood sexual abuse (CSA). Most respondents were from the UK (82%) aged between 18-70 and included 6% responses from ethnic minorities. The survey respondents were 85% female, 14% male and 1 trans. 8% were disabled when abused. 20% had experienced child sexual exploitation (CSE) and 19% were not sure (possibly being too young to comprehend). 49% were abused by a family member, 42% by an acquaintance and 9% a stranger. 67% of survey respondents had reported the crime to police and 33% had not. This submission will explain what worked well for the respondents, what did not work well and what needs to change.
Victim, Survivor or me?
There was no consensus about terminology used to describe people who have experienced abuse. Some actively chose the words victim or survivor but others did not like being defined by what had happened to them.
Recovery or Recovering?
Recovering is ‘the shift from being a big bundle of trauma with just a bit of person on the side, to a person with an amount of trauma on the side’
There was agreement that people did not like the term ‘recovery’ because it suggested an end point, whereas ‘recovering’ acknowledged lifelong consequences, encompassed the idea of ongoing effort and did not exclude anyone. You are not always recovered but you can always be recovering.
What Hinders Recovering
Under Funded Services
‘10 weeks here and there with the NHS or a charity meant that you felt as if you were jumping from life raft to life raft.’
76% viewed talking therapies as a positive influence upon recovering but there were many examples given where people struggled to access professional support, particularly longer-term help.
Poor Responses from Professionals and Others
‘After I took an overdose the doctors and nurses said I was an attention seeker’
The overwhelming message from participants was that was that their abuse was compounded by the way individuals and the wider community responded to it. 46% of survey respondents said that the main factor affecting their recovery were the stigma and stereotypes around abuse. Most participants in this research reported poor reactions when they spoke about it, including some extremely bad reactions from close family members. A poor response can silence people and prevent them from reporting the crime, accessing services and results in a lack of awareness about the effects of abuse. Thus, stigma and stereotyping enable abuse.
What Helps Recovering
In many ways, recovering is the opposite of being abused. It is about reclaiming rights, voice, choices and bodily autonomy.
Every Disclosure is Important
‘[My GP] got up from behind her desk and she knelt on the floor with me and she held my hand, talked to me and calmed me down and told me exactly what she was going to do.’
Talking about abuse is hard, and disclosure is not a single event but a multiple one. Kindness is vital. A warm, understanding, caring and non-judgemental response validates their courage. Participants talked about important interactions with professionals that changed their lives for the better. These were characterised by clear, respectful communication which took them seriously. Because the initial response is crucial, all health, care and educational professionals need to be trained in supporting those who’ve experienced CSA
A Strengths-Based Approach
Abuse involves denying the child the right to choose. Recovering is most effective when the individual makes their own choices. Denying the right to choose or infantalising the individual echoes the abuser’s actions and can be damaging. Mapping the individual’s strengths, likes and dislikes then building on them will empower them in their recovering.
‘I haven’t really felt safe to be open about what happened to me very much.’
Safety is vital for recovering, not just in the therapist’s room but in the individual’s life. Many people who have experienced abuse do not feel safe and this need to be addressed. However, some people really are not safe. Some participants reported that they became involved in abusive relationships in adulthood, others were bullied or harassed at home or work. Being safe is the bedrock of recovering. It is hard to focus on recovering when you are not safe.
Participants reported that the most important factor that both helped and hindered recovering was other people. Supportive friends, partners, professionals and communities were very important. Finding those avenues for support is vital for recovering.
Nearly three quarters found creative activities helped, such as art, reading, writing, gardening, design, poetry and gaming. It can be any activity as long as it is challenging but achievable, absorbing and fun. This creates a mental state called flow (Csikszentmihalyi, 2002). During flow you feel less anxious, in control and safer. These benefits can carry over into everyday life.
Abuse creates a mental severance between body and mind, so the body is an important area where recovering is created and expressed. Nearly half of the people who filled in the survey said they found touch and movement helped, such as sport, yoga, massage, walking and dance. These activities bring many benefits, including creating flow, releasing emotions and creating a feeling of safety.
There needs to be an overarching effort to change the dialogue around CSA/CSE. Victim blaming and stigmatisation means that people are reluctant to disclose abuse because of the very real prospect of being rejected and disbelieved. This benefits perpetrators. Secondly the image of perpetrators as evil monsters, whilst illustrating people’s understandable horror of such abuse, results in individuals being reluctant to accept that their relative, partner, friend or colleague could be a perpetrator. This again benefits perpetrators.
Trauma Informed Responses
Evidence shows that the majority of people who have experienced child sexual abuse have some form of traumatic disorder (Maikovich et al., 2009). Complex Post-Traumatic Stress Disorder (cPTSD) triggers can cause extreme anxiety or fear and thus affects the individual’s ability to engage with services or give evidence in court. Taking a trauma-based approach is essential for professionals helping people who have been abused. Anyone likely to hear such disclosures should be trained in sensitive, trauma informed responses.
Individuals approaching services should be tested for cPTSD (by the NHS) as a matter of course and individuals approaching other services should be treated as though they have cPTSD, in the absence of such an assessment. In practice, this means understanding the individual’s needs and requirements and making all possible attempts to accommodate them. Furthermore,cPTSD and the effects of cPTSD should not invalidate an individual’s credibility in criminal cases but in fact be seen as evidence of trauma.
Improved Support Services
Many children who are abused live in families where other issues (addiction, domestic violence, mental health issues) are ongoing. Proper social care and support will benefit those children, their family and may prevent or limit abuse. As adults, people who have experienced abuse may require long term therapy and support to recover from addictions and/or eating disorders. This research suggests that taking a strengths-based approach will be most effective.
Csikszentmihalyi, M. (2002). Flow: The Classic Work on how to achieve Happiness (2nd ed.). Random House, London.
Cunnington, C. (2020) Adults recovering from Childhood Sexual Abuse: A Salutogenic Approach. PhD Thesis.University of Sheffield, Sheffield.
Maikovich, A.K., Koenen, K.C. & Jaffee, S.R., (2009). Posttraumatic Stress Symptoms and Trajecturies in Child Sexual Abuse Victims: An Analysis of Sex Differences Using the National Survey of Child and Adolescent Well-Being. J Abnorm Child Psychol, 37, pp.727–737.
I agree that available support of trauma informed care is not what it should be. My best advice to clients is to keep looking until you find someone that feels like they are listening. Of course this is not always possible for survivors to do for a number of reasons; lack of energy, lack of money, being disbelieved reinforces their trauma (gaslighting on top of gaslighting) so I encourage people to take breaks, do what they can and to keep going. People are not being difficult when they request new therapists, different doctors, or a different approach, they are attempting to find stable ground from which to grow. We also need to keep going educating medical professionals about trauma so that they are less triggering or survivors and offer empathy and support.