There are monsters with teeth, with claws, with wings, and always with lots of eyes. They hide behind the curtains at the windows, they pretend they are shadows behind the door and they hide in wardrobes. There might not be words that can explain the fear of what has happened or might happen. And yet we are here, and together we are finding our way among the many voices, to the voice of this child and what they need in order to feel safe.
The children’s counselling provision within East Kent Rape Crisis Centre (EKRCC – currently working with a total of 200 clients a week) is funded by the Kent Police and Crime Commissioner (PCC). One year’s funding was initially awarded in 2017 for a specialist counselling service for children (five to 13 years) within the agency, with a close link to the Children’s Independent Sexual Violence Advisor (CISVA). Her role is long term, from the point of disclosure through the criminal justice system – the average length of time for her support being two years. Also funded by the PCC, she offers consistent support to enable children to access the services they need in the aftermath of sexual abuse. This includes visits to the child, either at home or at school, telephone support, and being able to be present for them during court hearings. The fact of us working collaboratively with the CISVA has proven successful in achieving positive outcomes for the children – and, via joined-up working, the direct work that she does is supported by the therapeutic relationship between the child and their counsellor that we provide.
We are now in our second year, having been awarded a further year of PCC funding for this service. I’m fortunate to be with a team of dedicated people, who are passionate about the work we do. In my role as coordinator for five- to 13-year-old children, and a child counsellor, I’m supported by two colleagues who are both studying for their Level 5 CYP psychotherapeutic counselling qualification. Both of them are experienced counsellors in adult client work at EKRCC. We have also been supported by a psychotherapist in her final stages of training, who has been able to join us for a time to work with children. We benefit enormously, too, by having a very experienced supervisor, who has worked with children and children’s services, including child and adolescent mental health services (CAMHS) and social services, for many years.
While a core flow of our referrals comes from the CISVA service, we also receive referrals from a range of other services, including CAMHS, social services and Early Help, schools, healthcare professionals, and directly from parents and carers. One of my first priorities was to establish our processes for referral, assessment, monitoring and outcomes. The forms I designed were aligned within the agency while being specifically focused for this age group. I then set about contacting agencies, services and schools so that they were aware we existed as a service they could refer in to for support. By now, I was also gathering in what resources I could find for the children. There were a few suitable resources already, shared between the three counselling rooms the agency had. But we moved premises in August 2017 to a bigger building, and this enabled us to create a children’s counselling room. I have really enjoyed creating this space: it is deliberately versatile, as I also work with young people and adult clients in the room, and the room needs to work equally for them as a consistent and safe space.
Provisioning the ‘dolphins’ space
I have used soft colours and tried to make the most of the shaping and angles in the room to provide a welcoming and safe feel to the space. People have been generous in donating resources, and I’m able to replenish renewable items such as paints, pens and play dough from our budget. I have also focused on maximising the use of different levels in the room, so that it is as comfortable to work in when on the floor as when sitting on the chairs, and that age-appropriate resources are easily within reach of children of different ages.
I can now also book out a valuable additional room, as needed, where parents, carers and siblings can wait. While this space is also used for meetings, supervision and training, I have been able to put some children’s resources in one corner to help make sure that the room feels friendly for young children. It’s poignant for me when, at the end of their therapy, several children have brought in some toys to give to the room for other children who will be coming along. This reflects an evolving process of enabling the participative role of the children in developing the service. Intrinsic to this has been collecting suggestions from the children for a specific name for the children’s counselling provision. Although this sits fully within EKRCC, the very real struggle with the word ‘rape’ for both children and parents/carers has led to wanting to enable the children to ‘own’ more of the language for their counselling provision. A seven year old’s idea of ‘dolphins’ has been chosen (hence our article title!) and we are now in the process of designing a picture that expresses her idea, which we’ll integrate into the children’s paperwork and show on the door of the children’s counselling room. I also put leaflets about children’s local arts events, wildlife centres etc in the reception area so that children feel there are things there for them as soon as they come into the building.
I’m collecting suitable children’s books, as it’s so important that they each offer something meaningful in terms of the themes we’re working with, and at the same time reach out from within the world of children’s stories for them to connect with. A significant number of our clients have some developmental delays in one way or another from experiencing trauma, so different sensory elements in the room offer potential ways to connect into possible movement again. I have also become aware that there is very little written about recovery from abuse for children themselves, so I’m working on writing a children’s book for our clients. A local artist/illustrator who has an interest in therapy is working with me on this, and I hope that together we can create something that is a helpful resource.
Forward plans
In our second year, I’m beginning to look at support for children between three and five years of age, as referrals to the CISVA service come in and there seems to be little specific support for this age group. Our own referrals include some for two or three siblings who have been abused within a family, and there is often a younger child who is too young to access our counselling, but who has also been affected by the distress in the family. I’m presently in discussions with my supervisor and director about exploring a relational, attachment-based intervention that may offer support through working with the family.
And now that the children’s sessions are established as our core work, I’m also developing ways of supporting families. I began by thinking about a leaflet for parents and carers to help them understand the effects of sexual abuse on a child, and this has now grown into a list of nine topic areas for a series of linked leaflets. One of my colleagues and I intend to create these later in the year. I’ve just begun to offer some parent/carer support sessions, and while this is at an early stage of development, I feel that we can create something that reflects and supports our approach to counselling in a consistent way.
If we were to be able to secure additional funding, I have prepared a plan for outreach counselling sessions to take place in schools. This work is specifically focused on sexual abuse and being able to offer support to vulnerable children. All of the schools I contacted to outline the project and ask whether they would consider taking part were interested, and could immediately identify children they had concerns about. They highlighted both children who had received some support already but who were still having significant difficulties, and children who had not disclosed abuse but were showing signs in their behaviours of having experienced sexual abuse.
Challenges and learning
Of course, being given an initial year’s funding, which enabled the service to be created and exist, and then a second year’s funding, which enabled us to develop the service, is also what presents us with challenges regarding forward planning. I’ve tried to keep a balance of now and future possibilities by focusing on a core provision of children’s sessions at the centre and working outwards from here in a way that can be as flexible as possible while still reflecting a holistic idea of the service. One element within this is how we manage time. Between us, as a team, we have three weekdays, including after-school session times, and Saturdays, when we have two counsellors available, leaving only two days when there is one. I’m grateful to my colleagues for their flexibility here, as it is vital that we can meet needs, not only in terms of accessibility regarding school and family commitments and transport issues, but especially in terms of referrals when there are two or more siblings.
The complexity of working with children who have experienced trauma and sexual abuse is often intense, and strong support between us as a team and through our supervision is essential. The range of presenting difficulties, while not always given diagnostic categories at these ages, in some ways reflects the trauma presentations of adult clients, while being specific to a child’s experience in others. We’re working with hypervigilance, high levels of anxiety in different forms, depressive feelings, anger, self-harm/injury including a significant level of disordered eating/body-image difficulties, suicidal thoughts and attempts, dissociative symptoms, hearing voices, nightmares and sleep difficulties. Over half of the children have significant physical health issues, including physical damage from the abuse they’ve experienced and a range of somatic symptoms, often held in painful tummy and bowel conditions. Some of the children have toileting difficulties, especially with night-time wetting. I feel that the physical, mental and emotional effects are also reflected in the consequences of family fragmentation, moves of home and school, and hence key relational losses within family and friendships – all of which frequently result from the turmoil of abuse. During our first year, 85 per cent of our clients had experienced significant levels of difficulty in coping with all of this.
There are two other particular issues that we’re also working with at times. Children with sexualised behaviours, as a result of experiencing abuse, have often experienced deep confusion, isolation and self-blame from a complex range of coercive and manipulative behaviours used by a perpetrator, and this can leave them withdrawn, not only from any sense of trust in relationships, but also from a confused sense of their existing relationships, and a disconnection from themselves that can mirror a young person or adult’s searching for existential meaning. This resonates with many of the children’s core fears of being taken away, especially at night, or of their primary, close people being taken away from them, or of these carers abandoning the child. It’s delicate work, and one that takes time, to help the child to trust that reaching out for connection can be safe, healing, and restore a sense that their relational needs and sense of integrity of self can be recognised, understood, accepted and met within a safe relationship. The challenge of this process within the therapeutic relationship is expressed perfectly by Janina Fisher, when she says: ‘The lived experience of traumatised individuals has created an unavoidable and painful paradox: closeness cannot be trusted, but distance or aloneness is also not safe. Their experience was that being alone and without protection created greater vulnerability, while being in proximity was also not safe.’1
We also work with pre-trial cases. This is another challenge and requires great care but is another aspect of how well the complementarity of the CISVA service works with the children’s counselling provision. The criminal justice system can take one or two years to reach completion, despite best efforts to fast-track children’s cases. Although we’re sensitive to concerns about the possibility of therapeutic work influencing or even jeopardising case material, our priority is to work with great care and proceed, as a child/ young person may be in distress and need support now (and, of course, through some or all of this period of time). The time frame places an immense strain on children and young people. We also work with a very clear safeguarding policy/ process that includes contact with our supervisor as needed.
While I feel that being able to sit with the unknown is perhaps a particularly accentuated aspect of counselling work with children, this is especially relevant where a child has experienced trauma in their very early years and this could not be processed into words. Instead, it is held within the body in traumatic patterns that express survival-based adaptive attempts to cope with overwhelm on all levels of being. I’ve now worked with several cases at Child in Need and Child Protection Plan levels, where a child has made a clear disclosure but the safeguarding process is complicated by different and conflicting perspectives held by the adults around the child. I need to be as sensitively attuned to the child as I can, as further disclosure statements can be made directly in dialogue, and just as easily emerge when working with sand tray, art, story and movement modalities of creative work, with the child suddenly moving to the direct self of ‘I’ from the relational world of the metaphor and the play.
This ‘sitting with the unknown’ when there may be risk present is, for me, always the most challenging aspect of the work. We work with some very complex family situations and changing relational dynamics that affect children on multiple levels: in our first year, 94 per cent of perpetrators were known to the child (within the family or a friend of the family), a small number were another trusted young person or adult, leaving only six per cent as not known. Some 91 per cent of perpetrators were male, and nine per cent female. The relational complexities are complicated by corresponding factors, when emotional and physical abuse and neglect, for example, have also been an intrinsic part of the child’s experience of abuse.
Looking forward
Something I’m keen to work on as an area of focus for the service is how we are developing our work as a team, in terms of a child-focused trauma model. I want to continue to integrate more fully the different strengths and training approaches shared between us into a creative and flexible approach that enables us to work from a holistic centre of shared understanding – while also enabling each of us to continue to develop as individual practitioners with our own interests and directions in our continuing professional development.
We have now established a strong foundation, and I feel that the second year has enabled us to strengthen this. For example, we manage to keep our waiting list small through flexible case management. We are achieving very positive outcomes on both the broad level of relational and social elements, such as integration, participation, friendships and family relationships, as well as managing day to day etc, and these are reflected in therapeutic levels of improvement measured on the CORE-YP and an aligned EKRCC form for younger children. I also collect feedback from the children, young people and parents/carers.
One element of this approach in meeting these challenges is collaborative working. Sometimes, due to the nature of the effects of sexual abuse, the range of responses by involved adults can leave a child without the help they need on many levels, for example needing referral to paediatric or GP support or CAMHS. There is a protective factor for some very vulnerable young clients with the involvement of a universal or more targeted support service. At the same time, as we are an independent charity, some clients will engage with us who have not engaged with other services, and we can contribute to this protective role for them. One way this is working well is through links with local CAMHS teams. We’re developing a way of working collaboratively with some cases – a well-thought-out plan is developed with the child/young person and family for us to work together. This is carefully monitored and has worked very successfully for young clients.
I feel that the heart of my work is as a practitioner, and, particularly with children, I feel that I’m always in the process of developing my work further. Spontaneity, warmth, creativity and vitality are discovered, recovered and embodied as children find their own way into their voices being heard. The first moment of movement into the world of the play, the moment of inviting me into the metaphor, and then the most subtle moment of connection when I watch them spring into being with themselves, their whole selves – each expresses aspects of the therapeutic process. At some point, there is always a question, which might be something like a whispered, ‘Do you believe in unicorns?’ – searching to see if I really do trust in the transformative power of hope for them. And the answer? Well, this is when the monsters begin to fade, move away and disappear.
Jenny Edwards is the coordinator for five to 13 year olds, and a child counsellor, at East Kent Rape Crisis Centre. She is also a counsellor in a primary school and a tutor with Community Counsellor Training in Canterbury.
Reference
1 Fisher J. Healing the fragmented selves of trauma survivors: overcoming internal self-alienation. New York: Routledge; 2017.