Truth and trauma
Therapy Today, November 2021

The Independent Inquiry into Child Sexual Abuse (IICSA) was launched in 2015 to investigate how a wide range of public and private sector institutions have failed to protect children from sexual abuse, and make recommendations to Government and other institutions. Its remit was wide-ranging, consisting of 15 investigations, plus research and analysis programmes, and it is due to publish its final report next year. Perhaps the most unique aspect of the Inquiry is the Truth Project, which invited survivors to share their experiences and propose suggestions for change. More than 6,000 came forward before it closed last month.

We are three counsellors who worked within the Support and Safeguarding team, a multidisciplinary team of psychologists, psychotherapists, counsellors and social workers. All the services we offered were developed collaboratively by the team, led by the Chief Psychologist to the Inquiry. As counsellors, we provided emotional support to those engaging in Inquiry investigations and, in addition, a unique part of our role was providing trauma-informed consultations to other teams across the Inquiry. This required us to take our counselling skills and knowledge of trauma into a whole new setting.

Embedding trauma-informed principles

Public inquiries are established in response to public concern about a particular event, or set of events, that are usually traumatic, such as abuse, deaths and accidents.¹ The Inquiry adopted a trauma-informed approach, working with five principles.² These principles covered all aspects of the Inquiry’s work, while remaining realistic and achievable within a legal framework, rather than the more traditional healthcare setting. The Inquiry aimed to:

• respect individuals’ experience of child sexual abuse and accept that it is subjective
• foster trust, rather than taking it for granted
• empower victims and survivors in their interactions with the Inquiry
• prioritise the safety and wellbeing of victims and survivors and work to prevent retraumatisation
• acknowledge the impact of hearing about child sexual abuse and institutional failures.

To embed these principles, our team focused on three areas: supporting victims, survivors and witnesses in their engagement with the Inquiry, providing Inquiry teams with trauma-informed consultation, and staff wellbeing. A key part of our work was ensuring that those who engaged with us were not retraumatised and that we did not replicate the institutional failings they have often experienced in the past.

Below we set out five examples of our work within these three areas, including clinical vignettes that are fictional composites of many different client interactions and consultations with staff where we used our counselling skills outside of the typical setting.

1. Supporting victims and survivors of child sexual abuse and witnesses in their engagement with the Inquiry

Terri describes an experience of working at public hearings, co-ordinating a team of support workers and providing support to a member of the public in attendance:

‘It is the third day of a public hearing. The contracted support workers have arrived at the Hearing Centre for the morning briefing. We discuss support needs for those in attendance, and witnesses are allocated support workers. While the hearing is under way, I get a call from security. There is a man who is distressed about the security processes. As I walk down the stairs I can hear raised voices. “I am not a f***ing terrorist,” the man shouts. “I am a victim!” The security team are doing their best to deal with the situation but it is escalating. They have to ensure the safety of everyone in the building, and all bags need to be scanned.

‘I approach the man calmly, asking if he would like to sit down for a moment, noticing that he looks flustered and angry. I acknowledge his feelings and ensure he feels heard, validating his frustrations and acknowledging that being searched can often make you feel vulnerable and exposed. He explains that he has a bag full of his social care notes, which he carries with him everywhere; he is fearful they will be damaged in the scanning process. We reassure him that this will not be the case and he agrees to put his bag in the scanner. “I just get angry when I feel I am being judged or controlled. It’s what the abuse has done to me, you know?”

‘Our interventions as counsellors often helped to de-escalate challenging situations and ensure that people were not harmed or triggered by our procedures. It is the understanding of how trauma impacts on a person and how this can be triggered that allows us to slow things down and provide a space for reflection. By providing this man with a listening ear, some understanding and a calm presence, he was able to feel regulated again and able to attend the hearing.

‘Often our work was about assisting other professionals in understanding behaviour from a different perspective, as well as understanding their own reactions, through a trauma lens. While the Hearing Centre staff were experienced and skilled in working in a trauma-informed way, our consultation on occasions was helpful to them. Helping staff to understand why someone may present in a certain way, as well as providing psychoeducation about their own feelings and responses to these displays of emotions, could help staff to further understand the dynamics that can be experienced at a hearing. These interventions gave staff a greater capacity to pause, reflect and take time to respond sensitively. The work we did at the Hearing Centre was an example of how providing a two-pronged approach of support for victims and survivors, as well as support for staff, ensured that the Inquiry could operate in a trauma-informed way.’

2. Ongoing support for investigation witnesses

Sally describes how she worked with Sam, in one of the Inquiry’s investigations:

‘Sam was a victim and survivor witness who I was supporting for more than a year. Our phone calls were fortnightly, usually lasting around 20 minutes. Early on in the work, the focus was on building the therapeutic relationship, offering the core conditions in order to provide a safe, empathic and non-judgmental space for Sam. It was about me getting to know Sam and the impact her childhood experiences have had on her life, and understanding Sam’s feelings about her engagement with the Inquiry. She spoke of the relief she would feel when the Inquiry reached its conclusion, which she felt would mark a new chapter in her life.

‘We covered a lot over the year, including the virtual hearing that took place as part of the investigation in which Sam was a witness. The support at the time of the hearing was more frequent and intense. Sam had to give evidence from her own home, and had to manage the anxiety that focusing on traumatic childhood events provoked. As Sam’s support worker, I found it difficult that I could not meet Sam in person, as I would have done usually, in pre-pandemic times.

‘In one call, Sam expressed gratitude, and said she felt she could talk to me a bit like she might talk to a friend. This was not the first time Sam reflected on our relationship in this way. I discussed this with my supervisor, considering boundaries, transference and countertransference. Sam had little contact with her family, although she mentioned meeting up occasionally with a friend, and I sensed a feeling of isolation and loneliness as she spoke. Sam recognised that I could not be an actual friend, but perhaps she was expressing her need for friendship. It was possible that the relational traumas of the past meant that she had difficulties with trust and establishing relationships in the present. Our phone calls seemed to offer a safe space and person-to-person connection, making her feel that she was valued.

‘When there has been relational damage, relational repair is so important. Several features of the emotional support we offered supported relational repair. Flexibility was important, in both the frequency and duration of support calls. Individuals could opt in and out of support at any time. If they missed a few calls, we would still be there for them if they wanted to resume support. This helped create a sense of control over the help they were receiving, empowering them to make choices about their level of engagement. I believe this positive experience also served as a stepping stone for some towards engaging with other therapeutic services.’

3. Providing trauma-informed consultation to Inquiry teams

Sally describes working on a bespoke training session for one of the Inquiry teams, to ensure they were equipped to communicate and respond in a trauma-informed way:

‘Alongside an Inquiry psychologist, I delivered complex communication training to an Inquiry team who engaged directly with victims and survivors. The purpose was to discuss the challenges the team might face when working in the area of sexual abuse and factors that might affect the way in which we communicate with victims and survivors. It was common for staff to report feeling worried that they might say the wrong thing, make things worse, or cause upset when engaging with victims and survivors.

‘As part of the training, we discussed and explored the Trauma Quadrangle,³ an expansion of Karpman’s Drama Triangle.⁴ In addition to the three roles that are often present in traumatising relationships – the victim, the perpetrator and the rescuer – the quadrangle includes the role of the bystander. This is someone who fails to become involved, often a neglectful, unavailable parent or relative who knew about the abuse but did not protect the child, often because of their own traumatic experiences. It could also be a teacher, social worker or any adult who failed to protect the child from harm. Often adult survivors carry feelings of hurt and rage towards the bystander, similar to their feelings towards the abuser. Due to the nature of the Inquiry and the work that was being undertaken, we were aware that we could represent the role of bystander for some victims and survivors. As a result, Inquiry staff may have become the recipients of the projected feelings of anger and frustration, helplessness and abandonment.

‘We discussed that, as staff and representatives of the Inquiry, we carried the organisational weight of responsibility to avoid accidentally recreating past institutional failings. In addition, we carried the victim and survivor’s hopes and expectations that this experience would be different. Through these discussions, we assisted in making staff aware of these dynamics, ensuring that, as a team and an Inquiry, we were not unconsciously adopting a role in the Trauma Quadrangle, and instead were communicating in a way that is empowering and trauma-informed.’

4. Case discussions and ad hoc consultations

Steven describes how he provided a support worker with consultation in her work with a Truth Project participant:

‘Support services for the Truth Project were contracted externally, but staff worked closely with the Inquiry, embedding the trauma-informed approach. Any support worker or member of staff could call on a mental health professional in our team for advice and consultation. During these consultations, I viewed the individual as the client and found using the six core conditions of the person-centred approach to be as valuable and facilitative as they are in the counselling room.⁵

‘Gill shared some concerns with me about bringing to a close a support relationship with a participant, Simon. Gill was an experienced support worker for the Inquiry, as well as being a trained counsellor, but found supporting Simon challenging. This left her questioning and losing confidence in her role. Simon had been prone to outbursts of anger during their phone calls that were triggered by memories of his abuse. He seemed unable to keep himself emotionally boundaried, and there were concerns that he was developing a dependency on Gill’s short-term support. It was agreed that a case discussion involving me, Gill, the duty safeguarding officer and a senior manager from the Truth Project team would be useful to agree how best to support Gill and Simon to work towards ending his support from the Inquiry.

‘During the meeting, we discussed how Simon had described support through statutory services as impersonal and unhelpful, and that he felt that Gill “got” him in a way he had not experienced before. He was understandably unhappy that Gill’s support was ending and we acknowledged that this might also be chiming with Simon’s experience of abandonment in his childhood. Simon’s risk to himself or others had already been assessed when he initially engaged with the Truth Project, and it was agreed that this remained low, despite his angry verbal outbursts. During a previous call to Simon, Gill had offered some psychoeducation on the fight/flight response and how to manage it, which he said he found reassuring and helpful.

‘Because he had little other support in place, and access to psychological support was proving difficult due to the pandemic, it was suggested that we extend Simon’s support for a limited and specific period while working with him towards engaging with a specialist third- sector counselling service that he had tentatively expressed an interest in contacting during a support call. This would give Gill the chance to conclude her role appropriately while offering Simon some continuity of specialist support. Over the next few weeks, with Gill’s support, Simon contacted the specialist service and agreed to a weekly check-in call from them while he waited to begin counselling. While Gill and Simon’s support relationship ended, Simon continued to feel listened to and supported and was grateful for the additional help he had received.

‘Viewing this issue through a trauma-informed lens meant that we could respect and respond to Simon’s subjective experience of his support and maintain his trust in the Inquiry. It also empowered him to seek further support elsewhere without retraumatisation. Similarly, Gill was able to bring the support relationship to a positive conclusion while enhancing her sense of integrity and confidence within her role.’

5. Supporting staff wellbeing

Sally and Terri describe working with Inquiry staff to provide psychoeducational sessions and reflective learning on secondary trauma, promoting staff wellbeing and normalising conversations around the impact of the staff’s work:

‘As part of the trauma-informed approach the Inquiry took, staff were encouraged to reflect on the impact of this work on their wellbeing. The Inquiry ran for six years, which meant that some staff experienced the cumulative effect of having been exposed to traumatic material over a long period of time.

‘During the final year, we had to adapt our working style because of the pandemic. We also had to face the inevitable destabilising effect of organisational change as the Inquiry reached its conclusion. As a result of these factors, we delivered “discovery sessions” for all staff to raise awareness of the risks of secondary trauma and to act to prevent it. The Support and Safeguarding team was only a small part of the organisation and the majority of staff at the Inquiry were drawn from the Civil Service and legal and other professions. The sessions included an overview of secondary trauma, and we introduced polyvagal theory to discuss the nervous system and how, when working in an environment where there is exposure to traumatic material, an awareness of the potential to feel dysregulated and knowledge of how to come back into a regulated place were important.

‘As clinicians, we were able to bring our experiences of times when the work impacted on us and how we coped. The feedback from staff was that this helped them to normalise and manage their reactions and enabled them to become more self-aware. These discovery sessions were followed up with a series of small reflective practice groups, facilitated by our clinicians, which provided staff with the opportunity to reflect on the impact the work had on them, and to focus on self-care and resilience.’

Future opportunities

Our aim with this article is to demonstrate how we used our theoretical knowledge and counselling skills to provide a trauma-informed environment for the legal Inquiry process to take place. We used our understanding of person-centred and psychodynamic theory to inform our engagement with all our ‘clients’.

We hope we have illustrated the challenges we have faced as clinicians, balancing the needs of witnesses alongside the Inquiry’s legally defined remit. We could not offer therapy but, through our direct work with individuals, we aimed to offer a positive experience of a support service and, indeed, a supportive relationship, which in itself had therapeutic value. As counsellors, we believe our skill set and experience made a significant contribution to ensuring the Inquiry enabled those who engaged with it to be taken care of, reducing the risk of retraumatisation. When working with Inquiry staff, our job was to provide psychoeducation and, leading by example, offer a non-judgmental, reflective and supportive environment in which our colleagues could deliver their work. Alongside this, we helped our colleagues recognise the impact of working in the field of child sexual abuse on each and every one of us, by raising awareness of the risk of secondary trauma and promoting the value and importance of self-care.

There has been considerable interest in the trauma-informed approach that the Inquiry adopted from a variety of sectors, including other inquiries. With increasing understanding of trauma and, in particular, the risks of retraumatisation and vicarious trauma, it is our belief that there will be a growth in the opportunities available to counsellors to take their skills and experience outside of the therapy room and into organisational settings.