In the August edition of the Webmag, we explained that a study of social work files covering the last three or four decades had suggested that there were lessons for today’s practitioners. Six topics have been chosen, and in each case, David Lane describes what he has found out from the files, and Chris Durkin comments from the viewpoint of current practice and teaching about social work. The first three Lessons covered the need for good standard practice, the value of comprehensive assessments and forms of abuse. It should be emphasised that the Lessons will all focus on general issues, and will not disclose any confidential information.

David Lane :

The Impact of Abuse

Helping children to overcome their experience of abuse is difficult work, but unless action is taken, it can be a time-bomb which can go off unpredictably at any time. It may show up during childhood, leading to behavioural problems in adolescence, for example. Other people who were abused as children find that when they form close relationships, their memories undermine their ability to trust and relate. Again, if they become parents, they may start to relive their childhood and find difficulty in ensuring that their children do not suffer as they had done. Some, of course, replicate the abuse and impose their suffering on others.

In some of the cases with which I have dealt, people who were abused as children survived by burying their experiences and denying them. As children, some of them refused to give evidence against their abusers, denying that anything had happened. Indeed, the recent process of preparing statements for the court case and the questioning by solicitors, psychiatrists etc. itself triggered unhappy memories on the part of some claimants. In a few cases the upset even broke up relationships with partners or induced feelings of suicide.

It was only in the 1980s that sexual abuse received the attention which it currently has, though there was awareness of incest before then. The damage caused by sexual abuse was not recognised as fully, and it was dealt with as one of a range of problems which children face.

Treatment

What could have been done? It is questionable what sort of treatment would have been available for some of the children, though there were Child Guidance Clinics where psychiatrists and psychologists assessed and treated disturbed children. There were also adolescent psychiatric units in mental hospitals, and in some forms of residential child care, psychological and psychiatric help were available. There were also therapeutic residential schools and homes which offered various forms of treatment, though none of these figured in the cases in which I was involved.

Abuse ignored

However, some case files betrayed a lack of concern that help might be needed, once the practical and legal measures had been taken to protect the children and ensure their safety.

In particular, I have come across a number of cases of abused girls who kept quiet and were biddable during pre-teen latency, and it seemed as if their pleasant passive behaviour was interpreted as a sign that the abuse they had suffered had not had an impact on them. Unhappily, they then proved to be highly disturbed in adolescence, missing school, running away, getting involved in sexual activity, stealing, and so on. Quite a number became young mothers.

Once they were going off the rails as teenagers, there was often little that the social workers and residential staff could do for them. One or two were placed in secure units to contain their anti-social behaviour, but these placements ran the risk of accentuating their problems, for example in enabling them to learn inappropriate or destructive forms of behaviour from other young people, such as self-harm.

Otherwise, social workers appeared to look on rather helplessly, hoping that the children would settle down and come to terms with their predicaments, encouraging them to stay in their placements, but being quite incapable of exerting any control or establishing a settled life-style for the child. It seemed a matter of waiting for the young person to mature.

Looking back, the lesson is that the opportunity to help during the placid earlier years had been lost. It may not have been apparent that there were concealed problems brewing at that time, but there will be children going through similar patterns of behaviour now, and today’s social workers need to be alert.

Since I am not a therapist, I do not know precisely what could have been done - play therapy perhaps, or counselling, or involvement in activities such as drama for self-expression, or the development of close trusting relationships?

The Efficacy of Caring Relationships

Certainly, where there was success, it was because of a caring relationship, often built up over time. Where the children were in foster care or residential care, they were able sometimes to settle sufficiently to be able to disclose abuse and start to talk about it. Sometimes teachers were used as confidantes.

The outcome was not always successful, but social workers and other professionals who saw children only occasionally were rarely able to build up the consistency of relationship required to develop real trust, even when they talked about important matters. Where there was success, it was the combination of close carers, supported by the other professionals.

Chris Durkin :

Individual Reactions

In looking at David’s article there are a number of themes that come out. The first thing I would say in looking at any area of abusive behaviour is to recognise that each case is different, and that although some of the literature talks about the impact issues for victims of sexual abuse we are talking about an individual experience. Although abuse has an emotional component and sexual abuse, in particular, can have lasting effect we have to be very careful not to make assumptions - how people cope is by definition individual depending on a variety of things including their own resilience and inner strength.

The individuality of each case means that we have to personalise every individual experience. We must, therefore, be careful and be led by the individual. Some children I have worked with do not want to look at what happened, they just want to

Tags: Case management, Child abuse, Treatment, Working Together