Award-winning service is a life-saver for abuse survivors

News: Maggie Schaedel (holding certificate) and The Bromley Woman's Service picking up the Partnership award at the 2010 AMM.

The single most important tool of any therapist is empathy, according to Maggie Schaedel, Consultant Lead Adult Psychotherapist with The Bromley Woman’s Service, which provides psychotherapy to survivors of serious sexual abuse.

The group which collected the winner’s award for Partnership at this year’s Annual Members’ Meeting is led by Maggie, who is also an Honorary Lecturer in Psychotherapy at The University of Kent.

Maggie has spent nearly a quarter of a century working in psychotherapy with the NHS and in universities and set up the service in 2002. The Woman’s Service started with funding for a two-year pilot scheme but was extended when Oxleas discovered the huge demand.

Under the scheme everyone is assessed and experts try to work out what approach to take within a range of recognised psychotherapies. For the abuse survivor to gain from the service they need to build up a relationship with their psychotherapist and that is why the treatments are long term, usually over a year.

After a year with the service a follow up assessment is made so the patient’s needs can be reviewed – they may be discharged or take up further therapy.

Sometimes an abuse survivor will be offered two to three years of therapy and may still need help to improve self-confidence, reduce isolation and to look to the support of other women to explore and share ways of moving forward.

Maggie said: “The experience of child sex abuse affects many levels of existence, including physical health”, she added. There are high rates of irritable bowel syndrome (IBS), gynaecological problems, not to mention the mental health issues such as borderline personality disorder and anti-social personality disorder, psychosis, multiple personality disorder, post traumatic stress disorder, depression, anxiety, suicide attempts, eating disorders, addictions, and rates of self harm are particularly high. There are often difficulties with intimate relationships. There is also inconclusive evidence of a link with schizophrenia.

“The prime task is to learn to trust another human being where previously the adults were not trustworthy.”

When victims were abused as babies or infants it can be difficult for them to realise the nature of their troubled feelings. “Sometimes the things we can recall are the more bearable issues”, said Maggie.

Self harming involves a complex range of emotions, especially shame, rage and despair. It is also the way a victim may communicate that they have suffered abuse as they show the scars. There is also medical research which has shown that self harming will release endogenous opiates from the pituitary gland and hypothalamus in the brain, which act as a self soothing anaesthetic – a way to cope with unbearable pain. Many women think they are going mad, but underneath the symptoms it is an attempt to cope with pain, Maggie went on, adding: “When a person is suicidal and self harming a clinician should be alert to the possibility that she may have been abused as a child.”

In 2007 a survey covering 40 countries and with 2,000-3,000 responses, showed that abuse is endemic. The accounts were very similar from country to country including rape, torture, trafficking and pornography. The survey showed that individual psychotherapy was the number one most helpful of the longer term therapies as opposed to short term treatments. Maggie again: “Professionals need to be careful to contain any anxieties exposed by such short term therapy leaving the victim frightened, vulnerable and overwhelmed, and that takes time.”

Occasionally The Woman’s Service has had a male therapist, although there are none at present. They have found that some women will be helped by a man but in the vast majority of cases the abuser was a man and most women request a female therapist.

The group sees an average of 60-70 new referrals in a year and has a caseload of 50 women, who are seen by a therapist every week, with each session lasting about 50 minutes.

About 500 women so far have been referred and from among those offered psychotherapy are several heart-rending letters of thanks.

At the awards ceremony this year The Woman’s Service was said to be “a real example of clinical excellence, successful partnership agreements and with a strong user focus.”

One patient’s emotive comments were read out in the presentation ceremony at the O2 by Oxleas Chief Executive, Stephen Firn. This woman in her mid 40s who came from a difficult background has given permission for her letter to be published.

The survivor stated: “For the past 41 years I have existed with the devastating effects of being physically, emotionally and sexually abused as a child. There are no easy words to describe that violation of my very being and caused a self loathing forcing that part of me to exist in a non-place. A place so bleak and scary that I could never imagine finding the courage to visit what was locked inside and wouldn’t have but for the support of The Woman’s Service ... My developing sense of self is fragile and I struggle to keep hold of it but with the ongoing relationship with my therapist through The Woman’s Service I believe I will get there.”

Therapists can have a dilemma weighing up patient confidentiality with the need to protect other children in the household of an abuser – but usually women want to ensure the safety of other children if the abuser is still alive.

Another difficult situation is when women want justice and for others to know about the abuse, but in some of the more complex cases the abuser is someone that they love dearly. For some clients their relationship with the abuser was their only attachment figure and it is a “complex process to disentangle the weave of emotions and experiences,” explained Maggie. There have been occasions in the past where the service has considered reaching out with family members to seek understanding and some form of reconciliation, but it is not something that is currently offered.

“Recovery from betrayal trauma is often the hardest, where a child was exploited by someone to whom she was attached or who she loved and needed. Recognising one’s helplessness and vulnerability can cause a flood of grief and despair,” said Maggie.

The vast majority of sexual abuse cases involve the family or extended family where the abuser has engaged a level of trust or through grooming, and the child begins to accept this abusive atmosphere as part of what happens to feel accepted or loved. Sometimes because grooming can begin so early the victim will blame themselves and feel they must have consented, said Maggie.

But she stressed: “There is no such thing as consent in child abuse, but believing this the child can feel that in some way she agreed, in reality it is an abuse of power”.

In 2008 the five-year anniversary of The Woman’s Service was celebrated with a meeting attended by Susie Orbach, a high profile psychotherapist and author of the groundbreaking Fat is a Feminist Issue (1977). She was so impressed and thought the scheme could be used as a model for Woman’s services across the NHS.

Statistics show that roughly twice as many women as men have been revealed that they are a survivor of sexual abuse. There is no equivalent service for men, but that is because there was only funding and a remit to treat women. Maggie hopes that consideration can be given to setting up a men’s service on similar grounds in the future. “It has been clear that men who had often had a history of traumatic childhood abuse find it very hard to reach out and seek help.”

Photo caption

Maggie Schaedel (holding certificate) and volunteers from The Bromley Woman's Service picking up the Partnership award at the 2010 AMM.

Published on 24th January 2011