CONTEXTO INTERNACIONAL

An overwhelming majority of mental health professionals highlighted a lack of training, and reflected on their own education when acquiring their qualifications. As they believed training was essential, they sought other ways to gain knowledge, which is discussed later.

6.4.1.1 Mental health professionals’ own training experiences. Mental health professionals were asked about their view regarding the

adequacy of training in the area of childhood trauma during their period of education to obtain their qualification. Of the 12 who responded, 10 stated they felt their training was “very inadequate”. MHP 6, a clinical psychologist, explains how assessment, rather than therapeutic skill was emphasised during her training, and that skills particular to working with a trauma background was omitted entirely.

Clinical psychologists noted that whilst they learned about traditional posttraumatic stress disorder, they felt it was particularly important to be taught about attachment trauma experienced during development, as MHP 12 stated:

What’s the point of learning about the treatment approach for anxiety or PTSD if the issue that’s underpinning… those issues is CSA, but you haven’t actually been taught anything about that or told about its prevalence?

These opinions are consistent with literature suggesting that mental health professionals lack training about the various, long-term effects of CSA and other childhood trauma on survivors (e.g., Herman, 1992a; Read et al., 2007). While clinical psychologists, in particular, learned about traditional posttraumatic stress disorder and other DSM-IV (APA, 2000) disorders, this may be inadequate or inaccurate for working with CSA survivors (Herman).

An identified lack of training amongst interviewed professionals suggests that other mental health professionals who potentially work with survivors may also not know about the long-term effects of childhood trauma on adults. This could explain why it was common amongst survivors in this study to report that mental health professionals did not ask about CSA. When it was disclosed, survivors noted the professional appeared uncomfortable and did not engage effectively with them. This perceived lack of knowledge is consistent with literature suggesting that mental health professionals feel they are not equipped to ask about, or handle, a disclosure about CSA in therapy (e.g., Lab et al., 2000; Yarrow & Churchill, 2009).

Despite the overwhelming majority of mental health professionals citing an inadequacy in their training, two stated they felt training was “adequate”. MHP 2, a

qualified social worker, undertook electives in Women’s Studies during her training, which she thought was a good foundation to learn about issues such as sexual assault and family violence. MHP 5 felt her Diploma in Psychotherapy that focused on all types of childhood trauma its manifestations in adult survivors, was particularly useful.

6.4.1.2 Increasing skills for working with CSA.

As the overwhelming majority of professionals felt their formal study left them unequipped to work with such complex trauma, they actively sought training from other sources. As MHP 13 noted, learning about issues such as CSA was not “going to be handed on a plate for you”. Of the 12 mental health professionals who responded, an overwhelming majority noted that workshops and professional development, especially those provided by specialised services such as CASA (Centre Against Sexual Assault), were especially helpful. MHP 12, elaborated on her further learning:

[I handpicked] my professional development from then on [after formal

qualifications] because I found my psychology studies inadequate to prepare me for the sorts of issues that clients generally came with…

Many professionals continued to keep up with current research and practice by subscribing to, and reading, journal articles and new publications.

Professionals also emphasised the importance of consultation, with either CASA, peers and/or supervisors. Both supervision and personal therapy were cited as useful with process and countertransferential issues that often arose when

working with traumatic material. MHP 11 noted the importance of supervision:

I’m kind of always training to think about it in terms of supervision, because it’s such a complex issue and it has such ramifications for people’s relationships and how they experience therapy, and what they elicit for the therapist… so supervision is pretty critical…

Engaging in one’s own personal therapy was cited as important by

professionals, with MHP 4 speaking about her own therapy, and how this allowed her to develop greater insight:

I had about six years of my own psychoanalysis that I did with a really good therapist, so going inside to all the dark and light places in myself, gives you a good idea of what other people have inside them, working with the conscious and unconscious… it was very challenging, but very supportive a the same time… I personally think all therapists ought to have their own therapy at some point in their life…

The importance of mental health professionals’ own therapy to work with traumatic material being shared by CSA was an unexpected finding. Research highlights common supervision and therapeutic issues, such as that of ‘vicarious traumatisation’ (i.e., the impact of working with trauma on the mental health

professional’s level of empathy and engagement), and common countertransferential issues (e.g., Neumann & Gamble, 1995). Judith Herman (1992a) recommends that support is needed for individuals working with trauma – “Just as no survivor can recover alone, no therapist can work with trauma alone” (p. 141).