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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.
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