Caminos de cambio: Las vivencias en la formación

practice when working with survivors of CSA may be achieved by the following:

• Mental health professionals, including clinical psychologists, should learn about all types of childhood trauma, including CSA. Due to the prevalence of CSA, as well as its association with common presenting relational difficulties and mental health issues, it is likely most professionals will work with survivors, knowingly or unknowingly, at some stage in their careers. Learning about complex trauma, including CSA, will better equip mental health professionals, who traditionally only learn about diagnosable disorders and their treatment. As previously noted by Herman (1992a; 1992b), diagnostic criteria for these

disorders is neither designed for, nor fulfilled by, survivors of repeated trauma experienced in a child’s developmental phase.

• Learning about all types of childhood trauma, including CSA, could increase mental health professionals’ knowledge, as well as their level of comfort when working with survivors, resulting in an improved therapeutic alliance and effectiveness of disclosure and therapy.

• A comprehensive psychosocial assessment should be conducted with all clients, as this allows time for the therapeutic relationship to develop, as well as provides the survivor several opportunities to reflect on their childhood and history, and disclose any instances of trauma, including CSA.

• If disclosure of CSA occurs in therapy, mental health professionals should endeavour to continue working with the survivor in order to maintain the established therapeutic relationship, whilst seeking consultation from expert professionals or agencies, such as CASA. Should referral be deemed necessary, it is recommended it be done in a transparent and collaborative manner with the survivor, in order to reduce feelings of betrayal or abandonment.

7.4 Limitations of the Study

Several limitations of this study are acknowledged. Firstly, the sample size of CSA survivors was extremely small. In future, research of this nature could greatly benefit if it involved payment to participants and/or agency affiliation. As this study was self-funded, the initial proposal was for all participants to participate on an entirely voluntary basis, with no payment offered. However, with the lack of response from CSA survivors to participate, payment was then considered in order to compensate potential participants. After consultation with an expert in the field, it was highlighted that providing payment to survivors could potentially recreate the dynamic of CSA. It is common for perpetrators to bestow gifts or money to the children they abuse in order to maintain power and control over them for their personal gain. As this study has illustrated how mental health professionals should endeavour to be as unlike the perpetrator as possible in everything they do, it was assessed as inappropriate and unethical to provide payment to potential CSA survivors.

In addition, the study was not affiliated with any agency, despite attempts to access CSA survivors utilising agencies where participating mental health

professionals practiced. Not being affiliated with agencies precluded the researcher’s ability to employ venue-based methods of recruitment, possibly affecting participation numbers of CSA survivors. Although CASA assisted the researcher by notifying mental health professionals of the study, no direct referral to their clients was made, nor recruitment flyers placed in the agencies. This lack of affiliation occurred after consultation with experts in the field and interviewed mental health professionals, who believed that survivors seeking assistance could feel indebted, coerced or pressured to participate in order to appease their mental

health professional or the agency. Due to the dynamics of abuse, survivors may try to please others by automatically complying with what they perceive to be others’ wishes for fear or rejection or judgement (Dale et al., 1998). Again, as mental health professionals should practice the exact opposite of the abuse experience, placing recruitment flyers at CASAs was deemed to be inappropriate.

These recruitment issues resulted in a very small sample of CSA survivors, which then caused the methodological issue of lack of categorical saturation. While it was initially proposed that between 10 and 12 CSA survivors participate, only three took part in the study, resulting in insufficient data being gathered to achieve theoretical saturation. Theoretical saturation is one of many measures that ensure the rigor of qualitative studies. Whilst “saturation is the key to excellent qualitative work… there are no published guidelines or tests of adequacy for estimating the sample size required to reach saturation” (p. 147, Morse & Field, 1995). However, it is generally agreed upon that saturation is reached when no new information is identified from further gathering of data, therefore indicating that no new categories are emerging, or that existing themes require expansion (Charmaz, 2006; Morse & Field). However, qualitative research is recognised as being limiting, where findings derived from a small sample size is not considered representative, and therefore, generalisable, to the wider population. This is even more applicable to findings obtained from survivors, despite all three participants reporting similar experiences, opinions and concerns. While CSA participants provided important and exploratory insights, a larger sample would have been invaluable, as the voice of authority in regards to what is unhelpful or unhelpful practice lies with the survivors.

Finally, limitations regarding the mental health professionals who took part in the study were recognised. Those who participated may have done so due to their knowledge and confidence in working with CSA survivors, whilst it is thought that professionals who were not knowledgeable or comfortable in this area, did not volunteer. Therefore, findings about mental health professionals’ experiences of working with CSA survivors may not be applicable to the wider professional community. The overrepresentation of professionals in comparison to survivors is also problematic. As this study demonstrated, CSA survivors may not express their concern or disagreement with the mental health professional if their practice is

unhelpful, or could drop out of therapy on the pretence of having improved. Therefore, participating professionals may not be aware of their own unhelpful practice.