Latest / Inside The Consulting Room - Understanding the Child Behind the Behaviour / Sexualisation and Trauma — When The Body Speaks

Transcript

Sexualisation and Trauma — When The Body Speaks · Inside The Consulting Room - Understanding the Child Behind the Behaviour

• 0:00
  SPEAKER_00: This is Kim Lee, child and adolescent psychotherapist.
• 0:03
  SPEAKER_00: And this is the second episode in the three-part series on sexualization trauma.
• 0:13
  SPEAKER_00: And in this episode, I want to talk about one case.
• 0:18
  SPEAKER_00: And I've entitled it When the Body Carries the Story.
• 0:24
  SPEAKER_00: And I wanted to do that because or choose that title because it isn't just about behavior.
• 0:32
  SPEAKER_00: Sometimes it's about physical presentation and restriction and something that is conveyed in the way the person is.
• 1:04
  SPEAKER_00: And a girl who came to me when she was seventeen years old.
• 1:12
  SPEAKER_00: When I met her for the first time, I felt a sense of shock.
• 1:18
  SPEAKER_00: This girl was almost like the stereotypical rabbit caught in the headlights.
• 1:28
  SPEAKER_00: Painfully thin, hesitant, avoiding eye contact and picking at her fingers.
• 1:39
  SPEAKER_00: Now, there are experiences that people have, and certainly where children are concerned, that can't be easily processed by children, not because they are unwilling, but because they're overwhelming.
• 1:55
  SPEAKER_00: So in this episode, in talking about Rachel, I want to think about and communicate something of trauma, and I don't want to be too explicit in this.
• 2:07
  SPEAKER_00: I want listeners to picture her and picture the situations that she encountered.
• 2:17
  SPEAKER_00: I'm doing this because I think sometimes things come to life and can be more meaningful when we see them.
• 2:27
  SPEAKER_00: In my work, this is something of a curse because I hear things which I can then see.
• 2:35
  SPEAKER_00: It's sort of helpful in one sense, but it's hard in another.
• 2:41
  SPEAKER_00: Imagining the scene, as it were, when a child is telling me something, or for that matter, a parent.
• 2:49
  SPEAKER_00: And I don't quite know what the mechanism that triggers that.
• 2:54
  SPEAKER_00: It may be quite ordinary, but it does two things.
• 2:58
  SPEAKER_00: It sort of exposes me to the reality of the other person's experience, but it also gives me a sense of context and a sense of what the emotional atmosphere must have been like in various situations.
• 3:17
  SPEAKER_00: And that's useful.
• 3:19
  SPEAKER_00: Nonetheless, it's still difficult.
• 3:23
  SPEAKER_00: Trauma is not only what happens to the child, it's what happens inside them as a result, and where that goes.
• 3:36
  SPEAKER_00: So with Rachel, something very powerful emerged, and it was a disclosure that she'd been sexually abused when she was eight.
• 3:47
  SPEAKER_00: And this hadn't been spoken about before.
• 3:51
  SPEAKER_00: Now, in disclosure, situations like this tend to come in parts rather than a single sentence.
• 4:02
  SPEAKER_00: And this girl began to talk about those times when she was looked after by a family friend when her parents had gone to work.
• 4:10
  SPEAKER_00: Now being known to the family, he was trusted and seemed to be a good choice insofar as he was attentive to the child, would come and visit the family, always bringing a present for her, and he lived close by.
• 4:27
  SPEAKER_00: Both parents were involved in quite demanding work, and often they would be out of the house for for long periods.
• 4:40
  SPEAKER_00: But then one day she stopped going to school and she stopped speaking.
• 4:46
  SPEAKER_00: She began to be very selective with the food that she ate, and she wouldn't leave the house without her mother.
• 4:54
  SPEAKER_00: She was referred to Cams, who wanted to pay attention to what they regarded as her selective mutism and social anxiety, which, as part of a clinical formulation, is understandable, but once again, mind mantra.
• 5:13
  SPEAKER_00: Paying attention to the behavior in isolation misses the point entirely.
• 5:20
  SPEAKER_00: Anyway, this didn't go particularly well, and during the following months, her parents decided to separate.
• 5:52
  SPEAKER_00: Sometimes in my work, when I meet a patient for the first time, a sort of unscientific instinct comes to the surface.
• 6:04
  SPEAKER_00: And it's often in the form of a question, but it's not a question I voice.
• 6:09
  SPEAKER_00: So when I met Rachel, I immediately thought, My God, what has happened to you?
• 6:15
  SPEAKER_00: And it was a it was very powerful.
• 6:19
  SPEAKER_00: Now there was just something that touched me straight away, and I had to be careful not to then assume that I was right.
• 6:31
  SPEAKER_00: But I suppose experience, instinct, it's almost like sometimes you can see things immediately before a word is spoken.
• 6:40
  SPEAKER_00: Nonetheless, I don't assume that therefore I know.
• 6:46
  SPEAKER_00: Now she was seventeen by this time, and having taken a full case history, I could see that there were some very significant pieces of the picture that were just missing.
• 6:59
  SPEAKER_00: And I remember seeing both parents together before I met Rachel, and her mother was an extraordinarily kind but extraordinarily anxious woman, and her protectiveness of Rachel had become something which served as an impediment.
• 7:14
  SPEAKER_00: So there was a powerful codependency between her and her daughter.
• 7:19
  SPEAKER_00: Now, by which I mean the daughter couldn't cope without the mother, and the mother couldn't cope without the daughter because her fear of separation meant that Rachel would fall apart.
• 7:30
  SPEAKER_00: Therefore, developmentally, she had been unable to graduate into full adolescence.
• 7:38
  SPEAKER_00: And this creates its own very significant problems.
• 7:42
  SPEAKER_00: Entirely understandable.
• 7:49
  SPEAKER_00: And that's entirely understandable.
• 7:54
  SPEAKER_00: Her father was different.
• 7:57
  SPEAKER_00: He was abrupt, struggled with the expression of empathy, and demonstrated some very limited insight and awareness.
• 8:08
  SPEAKER_00: So we had these two extremes, and somewhere Rachel was sort of in the middle, although gravitating understandably towards her primary caregiver, her mother.
• 8:20
  SPEAKER_00: And it was hard work because my instinct told me that trying to work with the parents together was probably not going to yield very much because of their polarized positions.
• 8:32
  SPEAKER_00: But my clinical head told me to at least try.
• 8:36
  SPEAKER_00: Well, my instinct was correct.
• 8:40
  SPEAKER_00: Over the months we were able to go back to that time when Rachel was seemingly okay and apparently happy.
• 8:49
  SPEAKER_00: And then to the point where she withdrew and what had happened beforehand.
• 8:56
  SPEAKER_00: It was then that I learned of the babysitter.
• 9:00
  SPEAKER_00: Not the detail, but the fact that he was a piece of the picture and a significant one.
• 9:07
  SPEAKER_00: Little by little I discovered that he would come to the house daily, almost always after the parents had left for work, and this was something that had been agreed.
• 9:18
  SPEAKER_00: And that they were they, he and Rachel would play particular games that he designed, but they were always played in her bedroom.
• 9:29
  SPEAKER_00: And I remember asking her if these were games that she wanted to play, and she just shook her head and became very agitated.
• 9:41
  SPEAKER_00: Now there are two significant crossover points here.
• 9:46
  SPEAKER_00: Where disclosure is concerned, we have to be very careful.
• 9:50
  SPEAKER_00: We have to be careful as clinicians not to re-trigger and overwhelm the patient with their experiences of trauma.
• 9:59
  SPEAKER_00: We tread carefully.
• 10:01
  SPEAKER_00: Now, when I say this, it's not difficult to work out that you can't just take a person back to the scene of the crime, so to speak, because they're likely to become overwhelmed.
• 10:13
  SPEAKER_00: Rachel had developed some incredibly powerful defenses, and it was for me to respect those because they were there for a reason.
• 10:21
  SPEAKER_00: Nonetheless, it was my responsibility to try and help her navigate back to those situations bit by bit.
• 10:33
  SPEAKER_00: But the other crossover point is legal, and this is very important because I, like all clinicians, have to consider the implications of prosecution in terms of should the case go to court.
• 10:52
  SPEAKER_00: And that anything which names what the therapist may think has happened is not something we can do.
• 11:07
  SPEAKER_00: And this is because in the event that the case eventually goes to court, we will be called to give evidence.
• 11:16
  SPEAKER_00: And under cross-examination, our testimony, our testimony can be immediately discredited.
• 11:22
  SPEAKER_00: Should it be the case that we've spoken about the offence to the patient and named it before the patient has disclosed it to us.
• 11:33
  SPEAKER_00: And I've sat with some cases for months knowing the picture that the person uh is having great difficulty portraying has to do with an offence, very likely, but not being able to do any more than just acknowledge the pieces I see.
• 11:53
  SPEAKER_00: It's very delicate work, but in the long run, this is the best course of action for both clinical and legal reasons, but it's an incredibly difficult position to hold.
• 12:06
  SPEAKER_00: Eventually Rachel was able to quietly voice that the babysitter would touch her and make her own dress.
• 12:17
  SPEAKER_00: This was now in the room.
• 12:20
  SPEAKER_00: But once again, the clinical and the legal come into conflict.
• 12:24
  SPEAKER_00: Clinically, we now had something we could pay attention to delicately and with very great care.
• 12:32
  SPEAKER_00: Legally, given her age, and given the fact that this is something which she disclosed after she had turned 18, and therefore was not a safeguarding concern under the Children Act, and also because the man who was responsible had moved away from the area and didn't pose a risk to her, there was nothing I could do with the disclosure.
• 13:02
  SPEAKER_00: I often wondered if Rachel had known that telling me after she was 18 meant that there was the material, the information had to stay in the room.
• 13:15
  SPEAKER_00: I discussed Rachel and supervision many, many times, and I felt the most powerful indignation on her behalf, but there was nothing I could act upon.
• 13:32
  SPEAKER_00: Not outside of the room, so to speak.
• 13:34
  SPEAKER_00: It would be a breach of confidentiality.
• 13:39
  SPEAKER_00: Patients who disclose and then go on to decide to take legal action do so at great cost.
• 13:53
  SPEAKER_00: The risk of going through a process where there will be cross-examination, there will be efforts to discredit the testimony of the victim.
• 14:04
  SPEAKER_00: We know of cases that have made the headlines, which are to do with some victims who who who become re-traumatized, and whose desire for recognition of what has happened to them results in them feeling and becoming overwhelmed and ill.
• 14:31
  SPEAKER_00: I like to think that Rachel made some progress in therapy because uh she was able, became more able to communicate with others, and she was more able to engage with others as she began to re-enter life and took on a part-time job.
• 14:52
  SPEAKER_00: Now, to my knowledge, she never disclosed to the police what had happened to her, and maybe she never will.
• 14:59
  SPEAKER_00: On the other hand, maybe one day she will.
• 15:51
  SPEAKER_00: I mean, whilst this is necessary in therapeutic work, from another point of view, it's an example of how trust could go disastrously wrong.
• 16:04
  SPEAKER_00: Recounting this case arouses some very strong and quite painful feelings.
• 16:11
  SPEAKER_00: My abiding hope is that by being with Rachel through what might be regarded as some kind of recovery, she experienced that it was okay to be in a room with someone who could manage her distress and vulnerability without further damaging it.
• 16:31
  SPEAKER_00: A difficult episode.
• 16:39
  SPEAKER_00: Always be aware that beneath the surface is something which is very, very meaningful.
• 16:48
  SPEAKER_00: I suppose I would rather inevitably say if this is something that resonates, talk to someone.
• 17:00
  SPEAKER_00: It's okay.
• 17:01
  SPEAKER_00: Do it in your own time and in your own way, but it is actually helpful to do that because I call it uttering the unutterable.
• 17:13
  SPEAKER_00: And actually, once we do that, it stops being unutterable.
• 17:17
  SPEAKER_00: Thank you for listening, and I will be back surely with the next episode.