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Child Abuse Review Vol. 2: 251-262 (1993) Ritual Abuse: Consequences for Professionals Sheila C. Youngson Consultant Clinical Psychologist Counselling and Therapy Service (Children and Adolescents) Castleford, Normanton and District Hospital, Lumley Street, Castleford West Yorkshire WFlO 5LT This paper details the results of a questionnaire survey completed by 71 members of a national support group of workers in the field of ritual abuse, investigating the extent and nature of personal, interpersonal and professional stress factors involved in such work. The results indicate that professional work in the field of ritual abuse frequently gives rise to negative changes in behaviour and in physical and emotional health among workers. Support and supervision requirements are also addressed, as is the possibilitylprobability of threat and intimidation. The discussion proposes, and considers, three hypotheses: that workers in the field of ritual abuse are currently professionally isolated; that ritual abuse work is qualitatively different from other work; and that ritual abuse work may involve threat and intimidation. KEY WORDS: Child abuse, Ritual abuse, Professional stress, Therapist stress n 1989, following a child abuse conference, two social workers met with a psychiatrist, a psychiatric nurse and a lecturer in applied social studies who also had a staff support role. The purpose of this meeting was to share information and discuss the nature of two complex cases of abuse with which the professionals were involved, one involving direct work with a number of children, the other one adult. T h e clients in both cases were talking of gross emotional, sexual and physical abuse occurring in group settings that also included some kind of ritual or ceremonial activity that purported, to the clients, the involvement of supernatural or magical powers. Following the publication in a professional joumal of an article written by the two social workers that described their work with the children in their case, they were contacted by other professionals who thought they had similar cases. From these meetings grew a national support group for workers in the field of ritual abuse. This group, called FUINS (Ritual Abuse-Information Network and Support), grew steadily over the years and the membership, in March I 0952-91 36/93/040251-12$11 .OO 0 1993 by John Wiley & Sons, Ltd Accepted 18 June 1993 ‘A national support group for workers in the field of ritual abuse grew steadily’ 252 Youngson 1993, stood at over 140 professionals. Members came from most of the ‘helping professions’, ranging from psychiatrists and medical practitioners to nurses and foster carers. Members believed that they were working, directly or indirectly (e.g. supporting or supervising other professionals), with children andor adults who were or had been involved in ritual abuse, as defined by Finkelhor et al. (1988): ‘Abusethat occurs in a context linked to some symbols or group activity that have a religious, magical, or supernatural comotation, and where the invocation of these symbols or activities, repeated over time, is used to frighten and intimidate the children.’ ‘ m e author has been struck by the levels of personal, interpersonal and professional stress’ ‘A questionnaire sent to [email protected] rnembers of RAIlVS’ The overall aim of RAINS is to build up a body of knowledge about ritual abuse, its psychological consequences for victims, and the most useful and efficacious therapeutic interventions. Meetings also provide a ‘safe’ space where members who feel overwhelmed andor isolated in this area of work can talk of their feelings and hopefully receive s u p port, understanding, informal supervision and encouragement. The author has been a member of RAINS for 3 years, and has been repeatedly struck by the levels of personal, interpersonal and professional stress that seem to arise in work in the area of ritual abuse. It was decided to investigate these levels of stress, and their precipitating factors, in the hope that avenues for their amelioration would be indicated; as well as providing information and impetus for managers and supervisors who needed to know how workers were affected and how those workers, in turn, could be supervised and supported most effectively. The author is unaware of any research that has considered these issues in the field of ritual abuse. Thus in 1992 it was decided to conduct a detailed, heuristic survey, with the aim of indicating the areas and questions that more formal research could investigate and attempt to answer. A questionnaire was therefore sent to all 120 members of RAINS. This paper presents the results of that survey. The Questionnaire The questionnaire was in six parts. Part A asked for personal details-gender, age, profession, professional role in ritual abuse and time involved in ritual abuse work. Part B was concerned with changes in behaviour and emotional and physical health since beginning work in this field. Part C looked at changes in interpersonal lifesocial activities, 253 Consequencesfor Professsionals partnerships and sexual life. Part D was concerned with support and supervision issues. Part E asked direct questions regarding concerns over personal safety and any intimidation experienced. Part F asked for any additional comments/ views/opinions that individuals wished to make. Forty-three respondents did make additional comment, and some of these appear in the text that follows. The Survey Results Seventy-one compieted questionnaires were renuned, a response rate of 59%. Part A: Personal Details Gender Of the 71 returns, 56 were fiom women, 15 from men. Age All age ranges fiom 20 to 60, in decades, were represented; 94% of respondents were aged between 30 and 60 years. Profession All professional groups were represented. The four largest groups were: 29 social workers (41%) 12 clinical psychologists (17%) 10 independent counsellordtherapists (14%) 9 voluntary agency counsellordtherapists (13%) Professional role Table 1 shows that the largest group were 48 professionals who had one or more adult clients in therapy or counselling, clients that the professional believed were or had been involved in ritual abuse. Respondents were also asked for the number of ritually abused clients with whom they were involved. The total was 145,55 children and 90 adults. However, as three professional ‘networks’ involved with children are represented in the RAINS membership, the figure of 55 children may be slightly inflated, as a foster carer, social ‘Seventy-one completed questionnaires were returned’ 254 Youngson Table 1. Professional role of respondents N Therapistlcounsellorfor Ritual Abuse adults provide support/supervision to other professionals social worker for Ritual Abuse children Therapistlcounsellorfor Ritual Abuse children Foster carer for Ritual Abuse childm 48 28 10 9 5 othn 11 - Total 111* *These categories were not mutually aclusive. Some therapists and counsellors and social workem were involved both in dirrct work with clients and in supporr/supcrvisim of other professionals. worker and child therapist could have been referring to the same children. Time involved Fifteen respondents had been working in the field of ritual abuse for less than 1 year; 26 for 1 or 2 years; 25 for 3 or 4 years; and five for 5 years or more. Part B: Changes in Behaviour, Emotional and Physical Health ‘Ninety-sevenper cent of respondents showed some negative change’ A series of statements describing personal behaviour, emotional states and physical health were given. Some statements were positively expressed, some negatively (e.g. ‘I sleep well and wake rested’, and ‘I feel depressed’). A fivepoint Likert scale indicating change (i.e. much more frequently, more frequently, no change, etc.) followed each statement and respondents circled the number that applied to them since starting work in the field of ritual abuse. First, the 18 negative statements. For each statement circled ‘much more frequently’ a score of 2 was given; for each statement rated ‘more frequently’ a score of 1 was given. Ninety-seven per cent of respondents showed some negative change, the mean score being 15.5, although with a large standard deviation of 7.6. Statements fiequently reflecting negative change concerned: sleeping patterns and nightmares; loss of appetite; psychosomatic symptoms such as headaches, nausea and indigestion; and changes in affect such as feeling increased anxiety, anger, depression and sadness. Secondly, the positive statements. Fdky-eight per cent of respondents showed no increase in a positive direction. Of the 42% who did, the mean score was only 1.4, with a standard deviation of 2.6. 255 Consequences for Bofessionals Therefore, this preliminary analysis indicates that: these respondents were more likely to experience negative changes in emotional and physical health after starting work in the field of ritual abuse, and that any positive changes ia these areas were minimal or unlikely. The following are quotes from the additional comments made by respondents: ‘I feel contaminated by knowledge of ritual abuse activities, and this knowledge has altered my view of the world. I move between denid and abhorrence that such activities take place.’ ‘I find it hard to describe my initial isolation, despair, and total devastation when initially exposed to ritual abuse. I felt that my mind was raped, my innocence was taken and could never be recovered.’ ‘My work has been with adult survivors. My experience ranges from being almost overwhelmed by “blackness” from one person to shocked numbness at the experiences of another, and in between feelings of paranoia.’ ‘I feel that my emotions are still numbed, and even though it is now nearly 2 years since I had involvement, I feel that the experience has left significant scars.’ Part C: Changes in Interpersonal Life and Relationships In t h i s part respondents were again asked to rate change since starting work in this field, based on a list of statements concerned with social activities and, ifthey were in a parmership, concerned with difficulties in the relationship including sexual dficulties. A brief analysis of the retums indicated that 54% of respondents spent less time in social activities and 31% of ail respondents chose to stay at home more. Fifty-six respondents were in a partnership. Of those 56, (50%) had experienced some or serious difficulties in the relationship since beginning work in ritual abuse and 21 of the 56 (38%) had experienced sexual difIidties during this time. Further respondent comments were: ‘I felt so tired caring for her (foster-child). She demanded total honesty, and needed constant attention and reassurance, 24 hours a day.’ ‘I suffer many stress symptoms-verging on the obsessionalespecially focusing on my children, the oldest of whom now gets quite angry and hstrated at my “protective” behaviour.’ ‘After spending 2-3 hours listening to children telling me the details of gross physical and sexual abuse involving many adults and children, I could not contemplate touch or sexual activity with my panner.’ ‘54% of respondents spent less time in social activities’ ‘38% had experienced sexual d z m l t i e s ’ 256 Youngson Part D: Support and Supervision In this part a series of descriptive statements regarding the provision of support and supervision for work in the field of ritual abuse were given and professionals were asked to tick all those that applied. Table 2. Respondents’ experience of support/supervision. Agencies who offered some suppodsupvision without being asked Agencies who offered some suppodsupervision after being asked Agencies who had not recognized the need for additional support/supervision Rsspondents who had to fmd their own suppodsupervision Respondents who felt that they still did not have the necessary suppodsupervision Respondents who did not fccl that they needed additional suppodsupemision N YO 14 27 25 48 29 23* 1 44* 40* 69 41 1 Percentages based on the 61 respondents who were employed (i.e. not self-employed). No% These categories were not all mutually exclusive. ‘The support and supervision offkred was sometimes inappropiate or i m . t ’ Table 2 shows that only one respondent felt that there was no need for additional support and supervision because of work in ritual abuse. While some agencies recognized the need for extra support and supervision, either before or after being asked, the support and supervision offered was sometimes inappropriate or insufficient, and professionals then had to find additional help for themselves. Forty-one per cent of respondents felt that they still did not have the support and supervision they needed, many of them despite having been offered some extra help. Further quotes were: ‘It gets a bit easier the stronger the support network, which helps you get over the secondary trauma.’ ‘After some sessions when I have felt appalled by the memories she has recalled, I have sought a debriefing session with a colleague. If this has not been available I have often phoned a &end in the evening.’ ‘I have supported workers in four Merent local authorities. I believe that all workers involved in this need extra, confidential support from people who understand about ritual abuse. I have seen several workers close to psychiamc breakdown.’ ‘I think the issue of supemision is extremely important. I have been trying to get my boss to realize that I need someone who is experienced in this sort of work.’ Part E: Safety and Intimidation In this part professionals were asked if working with ritual abuse had made them worry more about their own safety or that of their partnedfamiliedfiiends. Eighty-six per cent of respondents said it had; 14% said it had not. Consequencesfor Professionals 257 Sixty-six per cent of all respondents had taken some extra safetyhecurity measures as a result. Table 3 details those measures. Table 3. Additional dety/security measures taken (47 respondents). checking where sigdiarnt others were Ensuring sienificant others accompaniedcollected Phoning si#caut others more often Etting ncw/cxtra locks at home Ktepins lights OII at night purchasing house alarms purdrasins car phones Respondents added that they sometimes spoke to teachers at their children’s schools to ensure that only family collected their children; others wrote that they were very cautious about talking about their work even to colleagues. Three respondents wrote that they would have bought a car phone or purchased house alarms if they had been able to afford them. Professionals were also asked if they had received threats and/or intimidation prior to w o r m in ritual abuse andor since working in ritual abuse. N o respondent had received threats or intimidation prior to ritual abuse work and none since. Five believed they had received threatdintimidation prior to ritual abuse work and since ritual abuse work, and 2 1 (30%) only since beginning work in ritual abuse. Table 4 provides a list of those threatdintimidation as indicated by these 26 respondents. N % 32 24 20 16 16 6 4 68 51 43 34 34 13 9 They were very cautious about talking about their work’ Table 4. Threats and intimidation received (26 respondents). Silent phone calls Thrcatcningkambg/abusive phone calls Vandalism to car or home Followcd when in car ThrrPtening/warning/abusiveletters W c e broken into Verbal threats passed on by adult client Home burglary *Ten of these respondents had an ex-directory phone number Discussion The results fkom this survey indicate that professional work in the area of ritual abuse frequently gives rise to sigmlicant 19 13* 5 3 3 3 3 2 73 50 19 12 12 12 12 8 25 8 Youngson I levels of personal and interpersonal stress among workers. This discussion will focus on three related hypotheses, based on themes that emerged, that future research may usefully test. Ritual Abuse Work Is Professionally Isolating ‘Manyfiont-line workers will know m w e about ritual abuse than do their fine managers and supervisors’ ‘Sometimes the therapeutic requirements of this d e n t group challenge the usuaay ascribed professional boundaries’ This hypothesis proposes that this results from at least five sources. First, the need for additional confidentiality in such cases, especially when court cases are pending, can deprive workers of their usual routes to peer group support and supervision. Secondly, there is a lack at present of expert advice and supervision, since many current front-line workers will know more about ritual abuse than do their line managers and supervisors. Thirdly, and associated, the lack of much published research and knowledge about this form of abuse, its characteristics and efficacious treatment approaches leaves workers feeling deskilled, inadequate and helpless. Fourthly, a kequent unwillineess among noninvolved peers and managers at all levels to become involved in such a contentious and potentially professionally and organizationally threatening area results in workers feeling undermined, unsupported and ostracized. This unwillingness, and sometimes disbelief in the existence of ritual abuse, can &rowinto hostility towards workers and can lead to professional marginalization, involving ridicule, scapegoating and occasionally uansfer to other parts of a service. Fifthly, the sometime therapeutic requirements of this client group challenge the usually ascribed professional boundaries and therapists can find that they need to be more active and directly responsive than they are with other clients. This, in rum, is often unacceptable to, and critidized by, peer groups. This situation and the issues involved are well described by Sakheim and Devine (1992). Some respondents’ quotes illustrative of some of these points follow: ‘The confidentiality of this type of abuse makes it quite unbearable at times. I feel the need to talk, but can’t.’ ‘I phoned a colleague, a child therapist with 20 years’ experience, to ask her advice. She said she had been about to phone me to ask mine.’ ‘I need information on: cults, satanic cults, dissociative disorders, post-traumatic stress disorder, ritual abuse, and clinical approaches to those who have suffered severe, multiple, chronic trauma.’ ‘I can get support and supervision. But I’m very conscious of how traumatizing all this is to anybody who has to hear it, even third hand. So I’m careful who I talk to, as I can’t afford to burn out my support system.’ Consequencesfor Pfofessionals 259 ‘I’ve been called “hysterical”, “self-seeking”, “over-involved”, “gullible”.’ ‘My immediate line manager was initially supportive, but when the child protection issues took the case to divisional management level, I was told to cease the work and not mention ritual abuse while at work. This pressure firom the department was one of the biggest stress factors I had to cope with.’ Ritual Abuse Work Is Qualitatively Different This hypothesis proposes that direct work with children and adults who have been involved in ritual abuse is experienced as significantlymore complex, more difficult, more challenging and more professionally ‘draining’ than clinical work with other client groups. It is suggested that this results from at least four sources. First, the prolonged, often life-long, systematic, repetitive and extreme physical, sexual and emotional trauma that ritually abused clients sufFer results in frequently equally extreme psychological and psychiatric disturbance. Workers are faced with clients whose behaviour can be aggressive, highly sexualized, self-injurious, suicidal, manipulative (a literal, not derogative term), testing; whose emotional and psychological state can be extremely variable and always vulnerable; whose therapeutic needs are many and frequently challenging to established therapeutic approachdprocedures (see again Sakheim and Devine, 1992). Secondly, and linked, clients (fiequently children) present with an inverted belief system and an associated ambivalence about therapy and the person of the therapist. An example from the author’s experience: ‘Direct work with children and adults who have been involved in ritual abuse is more compkx, more d z m l t , more chaUenging and more professionaUy ‘‘draining” ’ A 9-year-old child insisted, with excitement, that sex with adults, and the experience of pain and fear, were what she wanted, and that if she did not get those from the therapist she would know that the therapist did not care for her. This was entirely different from the child who, because of abuse, is confused over the relationship between love and care and sex,and needs to test out the safety of the therapist. The 9-year-old ritually abused client persisted in her belief for over 3 years of weekly therapy, for example shouting, for months, ‘I want to fuck you, why won’t you let me. It wilt be good. OK so then hit me, hit me, hit me really hard.’ Thirdly, it becomes clear from therapeutic contact with these clients that therapy will be long term over many years, and that is both a responsibility and a pressure. Fourthly, the details of the abusive experiences that clients recall and voice, and the concomitant emotional expression and states, can be, to the worker, personally abhorrent and homfic, profoundly moving and, on occasion, overwhelming to every sense. The author has experience, for example, of listening ‘Therapy will be long term over many years’ 260 ‘Clients talk of being ma& to abuse other children’ Youngson empathically to a 7-year-old girl describe the dismemberment of a body, and to a graphic description of eating eyeballs, then having to cope with the child’s retching and breathing difliculties and extreme fear and despair, while also coping with her own immediate feelings of nausea, disgust and fear, and professional helplessness and inadequacy. It is the author’s contention that it is the following three interrelated factors that make work in this field qualitatively Merent to work with clients who have suffered extreme, even sadistic, sexual abuse. First, clients talk of being made to abuse other children and adults from a very early age, as young as 2 or 3 years. Secondly, clients feel that they have always had choice in, and responsibility for, participation in abusive activities, and the forced choice between two abusive scenarios is not immediately evident to them; for example, an 8-year-old child who was given the choice between being sexually abused herself or sexually abusing her sister. Thirdly, before, above and through most of the abuse, and in most of the cases, lies an alternative belief system that holds that pain, sex, death and fear are revered, sought afker, valued and desired, and our notiondconcepts of care, gentleness, nurcurance and well-being are regarded as stupid, worthless, boring, irrelevant, un-understandable. Thus, many clients (often children who have been removed from the abusive setting rather than chosen to leave an abusive group) will have significant ambivalence about the ‘new’ setting in which they now live and fiequently demonstrate great conflict and confusion. Again from the author’s experience, one child asked with much desperation: Who can I believe, who should I believe. I don’t know;’ and another child said very forcefully ‘It’s boring, I hate this. I want to be sexy. It don’t make me sad or cross. I liked it. I want to go back.’ Ritual Abuse Work May Involve Threatllntimidation ‘37% of respondents believed that they had received some form of intimidation’ The survey results showed that 86% of respondents worried about personal safety or that of their family and 37% of respondents believed that they had received some form of intimidation because of their work in the field of ritual abuse. However, the hypothesis that at least one in three of workers will receive some form of intimidation needs careful evaluation. Clearly, some forms of intimidation are not open to question, for example the telephone or written threat, naming the worker and client. Others are not so clear. As one respondent wrote: Consequences for Professionals 26 1 ‘I have only had burglaries and thefts since starting this work, but I live in a high risk area, according to the police, so I am left uncertain.’ Silent phone calls are common these days. Perhaps silent calls to a worker every 5 minutes on the night before a court case are more suspicious, but they are not conclusive. Neither, in fact, is the killing of four pet rabbits at a worker’s home: ‘One beheaded-no sign of head; one drained of blood; one slit throat from ear to ear; one broken neck; no sign of any blood anywhere’. While this pet killing has ritual elements, we are at the same time hearing from the media reports of the sewal mutilation of horses around the country, and it would be erroneous to conclusively link the rabbits’ deaths to their owner’s involvement in ritual abuse work. Equally clearly, some workers do experience unequivocal ritual abuse related intimidation, and the difficulty for the others who ’wonder’ is the uncertainty, which can have a different emotional cost: ‘I spend so much emotional energy deciding it is just coincidence, calming myself down, and even then there is still doubt. It wodd almost be easier if1knew it was intimidation, then I could at least direct my energy.’ ‘The d i m l t y for the others who ccwonder”i s the uncertainty’ Concluding Remarks Ritual abuse, however it is defined and typified, is a difficult and contentious issue, and one on which opinion has frequently become polarized, which has been less than helpful. It is hoped that the results of this survey, and the hypotheses made in the discussion, will add something to the debate and usefully indicate directions for further research. One such avenue would be to compare the experiences of this group of workers with other workers in ‘high stress’ areas. The survey has shown that, at present, professionals from a variety of backgrounds and mering experiences are striving to provide a service to children and adults whom they believe have been severely traumatized by gross and repeated abuse occurring in a context linked to symbols or group activity that have a religious, magical or supernatural connotation. Those professionals experience a range of personal and interpersonal diaculties as a result of their work. Those same professionals have highlighted their need for increased acceptance and acknowledgement of the work they are undertaking; increased opportunities for information, and informed support and supervision; increased awareness and recognition of the personal and professional cost to themselves of continuing their work. ‘Professionals fiom a variety of backgrounds are striving to provide a seruice to children and adults whom they believe have been severely traumatized’ 262 ‘If ritual abuse is more accepted as a reality then some of the professional and personal stress will diminish’ Youngson It may be that, in years to come, if ritual abuse is more accepted as a reality for some children and some adults, then some of the professional and personal stress will diminish. Summit (1988) clearly and cogently described the ways in which society needs and tries to avoid acceptance of the reality of the extent of child sexual abuse and its consequences for its victims. He looks back to the early 1960s and the time it took to accept the reality of physical abuse of children and its psychological consequences and asks that there be no repetition of the same process of denial and scapegoating of those who would speak out. Now, in the 199Os, clients and their carers, therapists and supporters are talking of ritual abuse and the consequences for them. Their memories, and their experiences, and their pain need also to be heard; and they require, at the very least, to have such experiences considered, evaluated and adequately researched. Acknowledgements The author gratefully acknowledges the assistance of Sue Glover and Jan Bums, both of Bradford Community Trust, in the preparation of this paper, particularly in data analysis. References Finkelhor, D., Williams, L.M. and Bums, N. (1988). Nursery Crimes: Sexual Abuse in Day Care. Sage, London. Sakheim, D.K. and Devine, S.E. (1992). Out Of Darkness: Exploring Satanism and Ritual Abuse. Lexington, New York. Summit, R.C. (1988). Hidden victims, hidden pain: societal avoidance of child sexual abuse. In Wyatt, G. and Powell, G. (Eds), Lasting Effects of Child Sexual Abuse. Sage Focus, Londoir, pp. 39-60.