Speaking the unspeakable

How did you become involved in the Truth Project?
It feels pretty unusual to be a psychologist working in a public inquiry; the novelty and sense of opportunity still hasn't worn off. I'm a clinical psychologist by trade, with a specialism in trauma. I have often been struck by a strong sense from victims and survivors of child sexual abuse that conspiratorial systems have let them down, both as children and subsequently as adults seeking support. As a clinician, I found myself deeply moved by the sense that 'the system' was failing children.

'I felt let down at all levels – from the point of first disclosure when a teacher told me to stop "trying to be an adult" age 15, to multiple self-inflicted injuries, including broken bones and burns not being recognised as a cry for help… Everything from the flawed police investigation to my medical records being paraded in court in an effort to discredit me, simply heaped unnecessary trauma upon trauma.'

When I first heard about the Inquiry, my first thought was: about time, and my second thought was: how on earth will they engage safely with trauma survivors and do no harm? I was drawn to the principles of the Inquiry's Truth Project because of its fundamental aim to give survivors both a voice and an opportunity to feed into recommendations across systems and organisations to help keep children safe. 'Speaking truth to power' is not just a literal record of that person's account… it has the potential to become a symbolic action, speaking the unspeakable and giving a platform for survivors' voices to be heard. Amplifying these voices helps to address society's reluctance to discuss child sexual abuse; addressing that reluctance is part of the commitment made by the Inquiry's Chair, Alexis Jay, to better protect children in the future.

I have spoken to so many people who felt the long and dark shadow of perpetrators keeping them in silence, still shrouding them in shame years later and stopping them from lifting the lid on what happened. So there is potential for a restorative experience for each survivor who speaks out to the Truth Project, and many people have told us that being heard was an important step in their recovery journey.

'When I first went to therapy four years before the Truth Project, I wanted to face the reality of my childhood. My goal was to reach a place of authenticity and peace, where I no longer lived in two parallel worlds – the outer one telling everyone I was fine, whilst my inner world was one of depression, self-blame and self-doubt.

'Speaking the truth out loud about the abuse was a vital part of removing that incongruence and being able to do so within such a formal setting as the Truth Project was a whole new level of collective belief and validation… It offered me a hugely cathartic opportunity to explain the lifelong and devastating impact of the abuse, and allowed me to recognise and own that impact too, which I had never really done before.'

Is there any typical route or time for a survivor to participate in the Truth Project?
There is no typical route for a survivor to come forward to the Truth Project and we understand disclosure as an iterative process, rather than an event (Alaggia et al., 2017). This also applies to people's decision-making process in coming to the Truth Project, which is highly personal as an individual weighs up the decision to share information with the Inquiry. The decision is a big one, as people consider a number of questions: Will I be believed? Do I feel ready? What details am I willing to share? What will I get from it? How might I feel afterwards? These are important questions for each person to engage with.

People are motivated to come for different reasons, such as seeking to make a difference to children in the future, wanting their account to be on record and wanting to make recommendations to the Inquiry.

Often we hear from survivors who disclosed the abuse as a child, but were met with disbelief or dismissal. This response is hugely damaging to self-esteem and trust in authority. Some survivors told us it took a long time to feel worthy of a Truth Project session, having internalised a sense of being 'not good enough' or of minimising the true nature of the abuse perpetrated against them, which Esme speaks to below. This self-doubt and low self-esteem is a common legacy of child sexual abuse.

We know that it takes a huge amount for people to trust us and share their experiences. That is why we provide as much information as we can beforehand about what a session involves, what it means for survivors and how we use their data. We also provide an emotional support offer to help people consider these important questions, to prioritise their wellbeing and to make an informed decision about whether the Truth Project is right for them. 

How are you using your psychological background in this work?
At the Inquiry, we apply psychological theory and practice, including taking a trauma-informed approach to engaging with survivors. We know that child sexual abuse is inherently traumatic and we use this knowledge of trauma to shape how we can be sensitive in our engagement with survivors and to think through a 'trauma lens' (Sweeney et al., 2018).

My sense is that the evidence-base for the efficacy of trauma-informed practice is growing and becoming increasingly influential in how services are designed and commissioned. There is no single model of trauma-informed practice, but some of the core themes are: nurturing a felt sense of physical and emotional safety, providing choice, being transparent, working collaboratively, being trustworthy as an organisation and nurturing trust (see Harris & Fallot, 2001).

How do you ensure survivors feel heard?
Through the Truth Project and the evidence from survivors at the Inquiry's public hearings, we know that many survivors were met with little overt action when they reported the sexual abuse. This knowledge directly informs how we respond to survivors, taking a trauma-informed approach that helps to ensure that people feel heard, believed, and their recommendations put front and centre of the Truth Project.

'Having had the abuse minimised since I first disclosed at 15, I have spent my whole lifetime believing that what I experienced was not serious enough to "complain about" or to get help for. This has led to excruciating self-blame and reproach for being mentally unstable. It has taken almost 40 years for me to realise that my difficulties have been the result of trauma and PTSD.'

As a team, we also keep in mind the adverse effects of child sexual abuse – 82 per cent of survivors have told the Inquiry's Truth Project that the abuse had an impact on their mental health, contributing most commonly to anxiety and depression (tinyurl.com/truthdashboard). The capacity for services and organisations to inadvertently retraumatise survivors through recreating dynamics of abuse is a difficult concept to think about, but is something that we hear a great deal about through the Truth Project when people talk of their experiences of 'the system'. Support workers listen carefully to survivors to understand individual risks, create support plans and to minimise triggers in the session environment, such as specific smells or colours. We facilitate these conversations with people not just to tailor the session to their needs but as part of this wider principle of listening and not assuming, so reducing the risk of the organisation itself causing iatrogenic harm (see also tinyurl.com/undawaw).

Our clinical experience, empirical and theoretical knowledge, and direct feedback from participants, are all drawn upon to create a culture of trauma-informed thinking at the Truth Project. This looks like:

• Recognising that sexual abuse is inherently traumatic and seeking to minimise the risk of retraumatisation. We offer emotional support for the session, listen to survivors' preferences around gender of staff and location of session and ask about potential triggers to provide an environment that is welcoming and supportive. The physical environment of the session locations were also carefully considered – the colour scheme, for example, was specifically chosen by the Victims and Survivors Consultative Panel (VSCP). We know that 'small' things like layout and colours can make a big difference to how comfortable or on edge someone feels when walking into a room (see also Danny Taggart's blog post). People's contact with the Truth Project is relatively brief, whether it is in person at a session, by telephone session or sharing in writing, but we work with them to understand how we can engage in a safe, non-retraumatising way. We understand that often what people commonly think of as symptoms of a mental health problem are also adaptive strategies for survival that people have developed in the wake of trauma. This respectful stance is at the heart of our approach.
• Treating people as unique individuals because we know that each person's experience of trauma is distinct and a one-size-fits-all isn't going to resonate. We don't interview people or pressure them to tell us anything they don't want to – the session belongs to them and we work hard to adapt to how they want to share. Many people choose to focus less on the sexual abuse itself but on its impact – how they were let down by others and what they think should be different – but every session is different because every person coming to see us has a unique story. Participants sometimes come alone or bring a supportive companion or a professional involved in their lives; some people have brought in artwork to facilitate our understanding of their experiences. We will always endeavour to adapt to what people need.
• Knowing that trust needs to be fostered, not taken for granted. We provide training for our staff to understand the impact of these failures of trust and take an empathic and thoughtful stance. We nurture trust by offering people as much choice as we can and not seeking to control the content or direction of the Truth Project session.
• Seeking to create the conditions whereby people feel empowered in their interactions with the Inquiry by asking what people need and offering choice.

This is manifest in different ways, including options for how to share with the Truth Project – survivors can share experiences in writing, over the phone and in person. 

We know from research and from our own personal experiences that working with the horrors of child sexual abuse – described by Jirek as causing pain to the workers' soul –  needs a proactive plan around self-care and 'team-care' (see also Newell & MacNeill, 2010). Taking a trauma-informed approach means valuing staff wellbeing and acknowledging the dynamics and personal impacts of working with trauma. We have sought to foster a psychologically informed culture across the Truth Project through our offers of consultation, training and reflective discussion that increases reflexivity skills and work at multiple levels of 'system'. We also ensure the availability of reflective practice across all Inquiry teams and encourage the use of other wellbeing offers such as mindfulness.

This in turn ensures that we, as Inquiry staff, are able to maintain our compassion and our capacity to bear witness to the suffering of survivors of child sexual abuse, to hear how the system failed them and to listen to their recommendations for change.

'Having "official" compassionate witnesses recognises and validates the seriousness of both the abuse and the impact of the abuse. The whole process was sensitively and professionally handled and was a liberating experience for me.'

Survivors of child sexual abuse can find out more via www.truthproject.org.uk

Photo: Tina Vedrine

Key sources
Alaggia, R., Collin-Vézina, D. & Lateef, R. (2017). Facilitators and barriers to child sexual abuse (CSA) disclosures: A research update. Trauma, Violence & Abuse. Advance online publication.
Harris, M. & Fallot, R.D. (Eds.) (2001). Using Trauma Theory to Design Service Systems. New Directions for Mental Health Services. San Francisco: Jossey-Bass.
Newell, J.M. & MacNeil, G.A. (2010) Professional burnout, vicarious trauma, secondary traumatic stress, and compassion fatigue: A review of theoretical terms, risk factors, and preventive methods for clinicians and researchers. Best Practices in Mental Health, 6(2), 57-68.
Jirek, S.L. (2015). Soul pain: The hidden toll of working with survivors of physical and sexual violence. SAGE Open. https://doi.org/10.1177/2158244015597905
Sweeney, A.C., Filson, B., Kennedy, A. et al. (2018). A paradigm shift: Relationships in trauma-informed mental health services. BJPsych Advances, 24(5), 319-333.
Truth Project. (2019). Dashboard. Available via www.iicsa.org.uk/key-documents/15087/view/truth-project-dashboard-october-2019.pdf