Secrecy is a potent weapon in childhood abuse because it enables perpetrators and gags the abused. Even when adulthood has physically transformed the powerless child, this part of their past is likely to be a burden rarely, if ever, shared.
But when adult survivors of childhood abuse gather in a room for specialised group therapy, they break that silence, even before saying a word. It is the first step in a potentially transforming process of recounting the effects of abuse among people who understand as only fellow survivors can.
Counselling psychologist Lorraine McColgan has seen the power of this approach over 20 years of working with survivors, both in the HSE’s National Counselling Service (NCS) and in private practice. She has developed a new model of group treatment specifically for adult survivors of childhood abuse, which is now outlined for other mental health professionals to use in a practical guide published by Routledge (Group Therapy for Adult Survivors of Childhood Abuse — A Practical Guide for Mental Health Professionals).
Boundaries, family of origin, self-soothing, grief and depression, shame, suicidality, the question of evil and the myth of forgiveness are some of the topics included in the framework for groups of six to eight to work through during weekly, 90-minute sessions over about nine months. Unlike with psychoanalytic group work, which is all about relationships and much more open in nature, the therapist needs to take a lead here, says McColgan, who is based in Navan, Co Meath.
“The task that is inherent to this group is to become clear about the dynamics of the abuse; to have witnesses to their experience so they know they are not alone.”
While people understand, theoretically at least, that others have undergone childhood abuse too, there is a different dimension to seeing normal people in the room who have had similar experiences. There is a realisation, she suggests, that “I mustn’t have this stamped on my forehead” after all.
Often survivors don’t disclose childhood abuse even to people who are quite close to them, says McColgan, because they don’t know what response they are going to get. It is not a given that they would be supported. As various abuse scandals have emerged in Ireland over recent years, survivors will have seen how some people would be more forgiving or disbelieving than others.
“They are getting a sense of the climate by proxy and they wouldn’t put themselves on the line. It is very hard to speak about and people don’t know how to handle it.” To be fair to well-intentioned friends and relatives, these stories are upsetting and disturbing, even to her as an experienced therapist, so they are hard to manage as a listener. There are also circumstances in which the topic “raises ghosts for people”, she says.
Having untold secrets may cause survivors to travel through life feeling that those around them “don’t really know me”. But within this therapeutic group, they are likely to say they have bonded in a different way to all their other relationships, “purely because they didn’t have to hold anything back”.
An adult male is the stereotypical child abuser, often from within the family circle. But the last taboo is that mothers sexually abuse children too, says McColgan. “It’s unspeakable nearly”.
The abuser has to be a person who has clear and regular access to a child, so that tends to happen in a familial context, she points out. A genetic link can bring another dimension to the distress.
“People think ‘this is part of who I am’; it infiltrates the sense of their own identity. A lot of the work is pulling apart their identity and the family identity — they have actually made a cut.” By being in that room they have shown how they have broken the generational cycle.
Choosing the members for a therapeutic group of this type is perhaps the most important and crucial aspect to get right
The types of abuse experienced may differ but the trauma of being harmed by a trusted adult is shared. Neglect, she says, is a very under-reported form of childhood abuse.
“It’s an absence of care. But there is an action in it — you are actively not caring for a child; you are actively ignoring their needs.” It is important people understand that and even survivors themselves tend to minimise it by saying, “I wasn’t hit”; “I wasn’t sexually abused”. Nonetheless, it is hugely significant.
Choosing the members for a therapeutic group of this type is perhaps the most important and crucial aspect to get right, McColgan advises fellow therapists in the book. There are a few red flags, such as active addiction; clear narcissism in their personality, possessing dogmatic beliefs that they would want to impose, or indications of a more extreme personality disorder.
“It would be too difficult for them to integrate in this sort of a group and the work of the group would get sabotaged.” Initially, she thought mixed-gender groups would be far too uncomfortable for participants but experience has proved otherwise.
“It is absolutely no problem,” she asserts and, indeed, can enrich the group. However, there tend to be more women, or exclusively women, by virtue of the fact that they are the ones who volunteer for this type of therapeutic work, both privately and within the NCS.
“I have had experience of a couple of men and it was really excellent,” she reports. It “demystified” a few things on both genders’ sides.
The need to forgive to allow healing is another “myth” posted for discussion. It is an idea that causes a lot of problems, she says.
“I think the forgiveness that is really required is that people forgive themselves that it happened, that they weren’t to blame.” We talk about situations in which forgiveness can be genuine, says McColgan, such as if remorse is genuine and the offender wants to make amends. “But if the person is remorseless, was bad and continues to be bad, where is forgiveness supposed to come from? It doesn’t really make sense.”
The nature of “evil” is also debated. “You have to be careful with words like that but if somebody is deliberately, consciously causing harm and hurt to another — and getting pleasure out of it — then it is maybe a fair word.” People are asking is that what they have experienced. While it might sound dramatic, “if that is the truth for people, maybe that needs to be acknowledged”.
Considering what is up for discussion, outsiders might think these sessions must be heavy going but “there is a lot of laughter”, she says. “There are tears as well, but you would be surprised at how high-spirited it is and the wit.”
Pretty much every time a group has ended over the past 23 years, she says, everybody has wanted to continue group therapy, which is likely to be more open in nature from then on.
It was really clear that we had made such gains. It is tangible. It is not just that people have a nice idea of what they might do, people start making changes when they are in the group— Lorraine McColgan
So what evidence is there that this therapeutic approach works?
Within the NCS, which was set up in 2000 specifically for survivors of childhood abuse but now has a wider remit, questionnaires before and after group therapy are used. These would indicate positive changes, she reports, and people talk in the room too about the difference it has made.
That, says McColgan, is what spurred her on to write up this model, so others could use it, not just in the northeast, where she is based, but throughout the country and, indeed, by services overseas.
“It was really clear that we had made such gains. It is tangible. It is not just that people have a nice idea of what they might do, people start making changes when they are in the group. They are different in relationships; people around them comment that they are different. They feel much more liberated from fear, secrecy and shame, so of course there is a change.
“We see even, physically, that people start to sit differently or dress a bit differently. How they can interact with each other is different. There is an authenticity in their being,” she adds, “that is hard to do when you come from a place of holding a secret.”