By: Nicole Thomson, LMSW, and Jason S. McKinney, LMSW
The topics of belief systems, values, and spirituality are becoming increasingly accepted by the social work profession as important domains on which social workers should be educated (Hugen & Scales, 2002). The source of these value or belief systems may be an external higher power, an internal conviction, or some other source. This article is intended to begin a discussion about a new type of belief in social work, differentiating between belief in and belief from. Specifically, we are concerned with the power of belief in terms of receiving belief from others, especially those who are in positions of higher power. We want to raise awareness of the power of belief for a victim of sexual abuse and the potential for the present system for pursuing justice in sexual abuse cases to either foster the victim’s feelings of belief or to undermine these feelings. In the following paragraphs, a case scenario will be used to present the following: how (dis)belief can be implied by process, how a child can be affected by implicit messages, the intervention used to mediate the adverse affects of perceived disbelief, and the treatment process as a space for receiving the necessary validation to comfortably put language to experience.
A Case Scenario
Jennifer is an 11-year-old Hispanic girl. She disclosed to her adult sister that her biological father had engaged her in vaginal sex on one occasion in his apartment while he was intoxicated. Jennifer, like many victims of sexual abuse, did not disclose the incident of sexual abuse immediately after it occurred. When she did finally disclose, she began the all-too-familiar experience shared by many victims of sexual abuse, retelling and retelling and retelling her story. The number of complete strangers who would soon be asking her to tell her story is beyond belief. Consider the steps that Jennifer had to go through and the many strangers involved. Jennifer’s initial disclosure was ultimately made to her adult sister. She was then interviewed by a criminal investigator. She was then interviewed by a child protective worker, who also asked her to talk in detail about the sexual abuse. Jennifer was introduced to the assistant district attorney assigned to the case and was asked again to describe the sexual abuse. Afterwards, she was subjected to cross examination by the alleged perpetrator’s attorney. While there, she was required to answer questions in front of 23 strangers. Jennifer also had to testify about the sexual abuse in Grand Jury. Jennifer testified at Grand Jury approximately ten days after she told her sister about the sexual abuse. At this point, she had shared her story with approximately 60 complete strangers.
Absent But Implicit
To put this experience in some perspective, think about or imagine your first sexual experience. Imagine being driven to a comfortable, but unfamiliar, building where a man in a suit and tie and a woman in slacks and a blouse introduce themselves and then ask you to tell them in detail about your first sexual experience. Think about what that experience would be like if you were 11 years old. Now think about being told by the man in the suit and the woman in the blouse that you will be talking to another woman on another day, and that woman will be taking you into a room with 23 strangers and asking you to answer questions about that first sexual experience, so that the 23 people can decide whether or not a judge should hear the case. What does recurring questioning from multiple people suggest? Perhaps being required to repeatedly retell your story implies that the story was not believed the first time or second time—or possibly the story is not credible, has gaps, is inconsistent, or is not enough somehow. Imagine the pressure felt by this young lady. She was being asked to recount a painful and embarrassing situation, and although she did, it was still not enough. It was still not believed.
Now back to Jennifer—after having testified at Grand Jury where she disclosed to many strangers, Jennifer was exhibiting trauma related symptoms significant enough to interfere with her functioning at school and at home. Therefore, she was referred for mental health services. In particular, the services offered to Jennifer included Trauma Focused Cognitive Behavioral Treatment (TF-CBT). The individualized portion of the intervention includes psychoeducation, coping skills training, affect regulation, cognitive coping, creating a trauma narrative, cognitive processing, and behavior management. Concurrently, the provider will meet with the caregiver to provide him or her with information about the treatment process and also address issues that may arise relating to the child’s trauma-related symptoms. Improving parenting and behavioral management skills and the caregiver’s own emotional regulation and coping skills are often an important part of the parent sessions.
Following these individual sessions, joint sessions with the child and caregiver take place. These sessions include, among other things, the child sharing the trauma narrative with the caregiver (Deblinger & Heflin, 1996).
Jennifer began the psychoeducation and emotional regulation portions of her treatment after she had already had the experience of sharing her “trauma narrative” with others. Through this process, it became evident that Jennifer was seeking validation. She began to focus heavily on those involved in the investigation and whether or not they believed her. Jennifer informed her therapist that both the child protective investigator and the Assistant District Attorney had told her that they believed her. Jennifer then reported that the investigating police officer had not told her that he believed she was telling the truth about the sexual abuse. For Jennifer, this was what sociolinguists might refer to as the “absent but implicit.” The absence of an expression of belief from the officer implied that he did not believe her story.
Multidisciplinary teams, such as used in Jennifer’s case, offer opportunities to incorporate other team members and the court system into treatment. The multidisciplinary team in the present scenario includes a group of law enforcement officers, medical personnel, assistant district attorneys, child protective investigators, and victim advocacy staff who serve on the majority of cases. As a member of this team, Jennifer’s therapist approached the law enforcement officer who had interviewed Jennifer, explained the situation, and noted her concerns. Even though it was beyond his normal job duties, the law enforcement officer agreed to write Jennifer a letter. His letter to Jennifer explained that he did believe her and was impressed at how brave and strong she was. The officer asked the worker to keep this letter confidential, so as to prevent colleagues from labeling him as a “softie.” This is often a perception law enforcement officers, even those who work primarily with children, work hard to avoid.
Validation from the officer may not seem like an important thing to an adult, or even another kid, but Jennifer was very concerned about her safety. For her, people believing that she was telling the truth indicated their willingness to protect her. While in the process of improving her coping skills, Jennifer frequently reminded herself that people had believed and protected her as a way to help her address fears of unfamiliar or future situations. One of the situations that Jennifer was most concerned about was testifying in person against her father in open court. When Jennifer was creating her trauma narrative, she included the letter that she had received from the officer and discussed her feelings of relief in knowing that she had been believed. She also talked about her fear of testifying and how she was reassured by the fact that others were confident she could do it. In this scenario, feeling believed served as a tremendous source of empowerment, giving Jennifer the courage to face her fear of testifying.
Moving Beyond Belief
The New York State criminal court system is not conducive to meeting the therapeutic needs of abused children. No treatment model can fully incorporate the criminal court process, in part because the process is so unpredictable and varies so greatly from case to case. The good news, however, is that the multidisciplinary team in this scenario has recently changed the way that the initial criminal court process is conducted to allow children to develop more effective coping skills (and in turn be better witnesses). In the past, one of two things would happen: either an alleged perpetrator would be arrested and Grand Jury testimony would occur within three days, or there would be a preliminary hearing at which the child would have to testify in open court with the alleged perpetrator present. The process has now been modified, so that in cases in which the child can be kept safe with the perpetrator remaining in the community, the Grand Jury testimony, and indictment, is obtained before the arrest. This allows for a more flexible timeline around when the children can testify. If they are not ready, able, or willing to testify immediately, they can receive some treatment, begin building additional coping skills, and make incremental disclosures, if need be, before they are asked to give Grand Jury testimony. Previously, if a child was not able to give adequate Grand Jury testimony, the case would be “no billed” when it came before the Grand Jury, which meant the case could not be brought back in for charges at a later date. Since the testimony is such an important aspect, it is necessary to examine our approaches to working with children who have experienced trauma and strive to facilitate a smoother process for the victim.
Adults involved with disclosures of sexual abuse often react to children as if the abuse is news to the child, as well. However, the child has inevitably had knowledge of the sexual abuse before the involved non-offending adults. This is often not taken into consideration by adults who are involved. The child has had time to develop and implement coping skills in order to manage emotions regarding the sexual abuse. Often, these coping skills include working very hard to avoid any and all stimuli relating to the sexual abuse. It is not realistic to expect that all children will be able to provide a complete disclosure and only a few days later provide testimony regarding an incident or incidents that they have worked very hard to avoid thinking or talking about.
It is worth noting that the majority of disclosures come after some delay (Feiring & Cleland, 2007; Staller & Nelson-Gardell, 2005), and that it is very common for children to make incremental, or partial disclosures (Ungar, Barter, McConnell, Tutty, & Fairholm, 2009). The gradual exposure process is not intended to make the child a better witness, or to “sure up” their statements of sexual abuse. The gradual exposure process is led by the child. The therapist’s role in this process is to provide skill building, psychoeducation and support throughout the process, not to make the child a better witness or obtain evidence.
While Trauma Focused Cognitive Behavioral Treatment (TF-CBT) is not a forensic tool and should not be utilized as a forensic tool, TF-CBT can assist a child in being prepared for testimony. If a child has utilized avoidant behavior as a coping skill and does not want to discuss the sexual abuse, the gradual exposure and trauma narrative elements of TF-CBT will assist the child in developing new and more effective coping skills. It is also helpful to frame testimony as an opportunity for the child.
Jennifer’s experience was successful in many ways. The combined support of law enforcement, mental health, child protective, and victim advocacy professionals provided her with the strength to testify in front of her father and a room full of strangers. As social workers, we are often avoidant of anything court-related. There is an inherent fear that our involvement will somehow disrupt or interfere with the criminal court process. What Jennifer’s experience highlights is that social work and the judicial process can actually complement each other. Many children walk into the court experience with only what they have seen on television as a framework. Utilizing gradual exposure allows children to experience court as the culmination of their treatment and adds another aspect to the trauma narrative. If the court system cannot be restructured to better meet the needs of victimized children, then the treatment process needs to be restructured to utilize the court process in meeting the children’s needs.
Deblinger, E., & Heflin, A. H. (1996). Treating sexually abused children and their non-offending parents: A cognitive behavioral approach. Thousand Oaks, CA: Sage Publications.
Feiring, C., & Cleland, C. (2007). Childhood sexual abuse and abuse specific attributions of blame over 6 years following discovery. Child Abuse and Neglect, 31, 1169-1186.
Hugen, B., & Scales, T. L. (Eds.). (2002). Christianity and social work: Readings on the integration of Christian faith and social work practice. (2nd ed.). Botsford, CT: North American Association of Christians in Social Work.
Staller, K. M., & Nelson-Gardell, D. (2005). A burden in your heart: Lessons of disclosure from female preadolescent and adolescent survivors of sexual abuse. Child Abuse and Neglect, 29, 1415-1432.
Ungar, M., Barter, K., McConnell, S. M., Tutty, L. M., & Fairholm, J. (2009). Patterns of abuse disclosure among youth. Qualitative Social Work, 8, 341.
Jason S. McKinney, LMSW, Ph.D. candidate, is currently studying human development at the University of Rochester. Jason supervises a therapeutic foster care program at Catholic Family Center in Rochester, NY, and is an adjunct professor of social work at the Greater Rochester Collaborative, State University of New York (Brockport) and Nazareth College, and also at Roberts Wesleyan College. Nicole Thomson, LMSW, graduated from Columbia University School of Social Work. She is on the staff at Catholic Family Center in Rochester, New York, a partner agency of the Bivona Child Advocacy Center in Rochester. In this role, Ms. Thomson is a member of the IMPACT multidisciplinary team housed at the child advocacy center.