What NOT to say to a patient who discloses a history of childhood sexual abuse

By Warrior1

After YEARS and I mean YEARS of dealing with the after effects of the childhood sexual abuse I had suffered, I finally reached out.

I had always gone it alone. When I was only offered 6 sessions of counselling I had paid for it privately. I had fought for years against anti-depressants, taking St John’s wort instead.

I had been on antidepressants for a number of years when I finally went to the drs to discuss my history. It was a really big deal. The man that abused me, used to turn up unexpectedly. When I was moody he would say “what’s the matter with you?” He made me feel like I was going mad. So going to talk to a Dr about all of this in detail was massive.

We were in the throws of the criminal justice system, waiting for him to be found when I reached out. I was falling apart. I needed support.

The GP was really surprised when I told him why I was there. He didn’t know what to say or do. He said “erm, oh I don’t know, I don’t know, I’ll speak to my colleague and get back to you, and if you haven’t heard from me within a few weeks you get back to me”. So I waited and waited.

I called the surgery a few weeks later and arranged a telephone appointment. This was it, I was finally going to get some help. “Oh yes, I spoke to my colleague and she told me about the survivors trust, so if you just go on onto the internet, and look at that”.

I was speechless. And so upset. I was being asked to go away and sort it out myself. If I had come in with a broken leg I wouldn’t have been asked to do this. So why was I for mental health?

I went away and looked. The survivors trust are an umbrella organisation listing the organisations across the country. There was a bit of a black hole where I lived but I contacted the nearest one and self referred.

When I heard back from them they put me in touch with a counsellor. I was on the waiting list. Every time she called me to arrange an appointment she talked all about herself. It turned out we had a common work interest. The next thing I knew she had applied to study at the same place I was studying and asking me to help her with her application. Her boundaries were all over the place. I didn’t feel safe. So I didn’t take her up on her counselling.

I referred myself to the local wellbeing team. This meant having a telephone assessment. I really didn’t want to give her all the gory details of what I had experienced. But she insisted. I could hear her tapping away at the call centre as she entered the horrific experiences I had growing up. As we reached the end of the assessment she told me she couldn’t help me as I would need more than 6 sessions. She would have known that BEFORE I had given her all the details, yet she still asked for them.

I then referred myself to the longer term counselling mental health service. I would have to pay for this, something I couldn’t really afford but if it would help then I would find a way. I was very aware that I couldn’t talk about what happened until after the trial. It would change the way I thought about it and was told it was all about “preserving the evidence”. So when I got a call from this service I discussed it with them. I told them I couldn’t talk about the abuse until after the trial. That the counselling notes could be used in court. “Oh no, it’s all confidential” I was told. “No, the court can ask to see them” I replied. “It’s all confidential” I was told again. I didn’t trust them to know what they were doing. I didn’t trust them not to do something that would put the trial at risk. So again I took myself off the list.

I went back to the GP. By this time the antidepressants really weren’t helping. I needed something stronger and this mean seeing a psychiatrist. This was terrifying for me. But if I wanted to feel better I needed to do something.

He referred me and after a short while I had another telephone assessment. This time with a community mental health nurse. Based on that one conversation, having never met me, she wanted to put me on antipsychotic medication. I was horrified. I don’t have psychosis.

I went BACK to the GP. I told him what had happened. He was equally horrified. He wrote a letter insisting that I see the psychiatrist. This was scary but it was what I needed. I was finally going to get some help.

I arrived at the appointment, finally I was going to see someone.

I was really nervous when I arrived. It was a big deal. I got called into the office and sat down.

The psychiatrist sat opposite. “You do realise that most of these cases don’t go to court” was her opening gambit. “And if they do, you have to go through all of that”. “It’s only once it’s over that people can start to rebuild their lives”.

Wow. What a way to start. She went on to say she could refer me to a women’s group after trial, followed by “but the waiting list for THAT has been closed for years”.

She asked about my relationships. She said she could refer us to couples counselling “but the CCG probably wouldn’t approve it”.

At one point she stopped talking and said “you look like you are going to cry” she stood up and walked out the room. She came back with a box of tissues “someone had taken mine. Here.” She shoved them towards me. “You don’t have to use them”.

She then went on to talk about the medication. She said that antipsychotics were standard for anxiety.

Well they shouldn’t be.

I said I did not have psychosis and didn’t feel comfortable taking them.

“Well, what would you like? What would you like? Anything you would like, I’ll give it to you. It won’t work though” she retorted.

I didn’t know what I wanted. How was I supposed to know? Then I remembered a friend of mine, who had PTSD was on the same medication as me and had been given another medication to take alongside it, and this combination worked well. It is known as Californian Rocket Fuel.

I asked for this.

She said she would give it to me, but it wouldn’t work and then when it didn’t, I could go back and try the antipsychotics.

Then she started asking me how I was as a child. Did I ever sit staring out of the window?

Yes. There was a lot going on.

She said sometimes people think they are a certain way because of what happened but there was actually an underlying factor that made them vulnerable.

She then gathered up all these pieces of paper and gave them to me.

I looked down at the pile she had handed me. It was all about women with ADHD.

“What do I do with this?” I asked.

“Have a look and if you are interested, get back to me”

If you are interest? In what? Having a diagnosis of ADHD?

This was one of the most bizarre interactions I have had in trying to seek help. When I left, I was so shocked I couldn’t speak. I had waited for YEARS, decades, for help, and this was the best that the NHS had to offer? No wonder they put width restrictions on her 4th floor office window. After seeing her you would want to jump.

For the record, the antidepressant combination did help. I began to feel human again. I hadn’t realised how bad I had been feeling until I started to feel better. There have been times where I have felt they were less effective, but I wouldn’t be here without them.

Over the course of the years I have been caught up in the criminal justice system, I have needed to disclose to a number of Dr’s.

Here is a handy guide, in addition to the above, of what not to say:

Laugh nervously and say nothing

To grill me “well how did he get you on your own?” What are you looking for? Tips?

Instead say:

I’m so sorry you went through this.

It was very brave of you to tell me, I will do my best to help.

And make sure you have the information. One in 4 women and girls experience sexual violence. One in 6 boys and men.

Know where the local centre is that can support them. Know how to refer to them. Have the number of the sexual violence support number. Know where your local rape crisis is.

For the record, my local rape crisis was NOT on the survivors trust website.

It’s taken so much strength and courage to come and ask for help.

Please don’t send them off to go and look at a website.