Improving mental wellbeing for survivors of childhood abuse and neglect: psychological healing and education course in prisons

Abstract

Since 1989, the National Association for People Abused in Childhood (NAPAC) has been working to help adult survivors of childhood abuse and neglect achieve recovery from the consequences of their trauma. NAPAC was set up to address this specific need In the absence of any existing national organisation and has developed ways of working which draw on a range of existing therapeutic and educational methods. Through experience gained by running a national free support phone line and listening to thousands of survivor accounts, NAPAC has Identified some common problems and practical ways to overcome them.COMMON PROBLEMSKey texts informing the development of NAPAC's approach were self-help books for survivors first published in the USA: The Courage to Heal1 for females and Victims No Longer2 for males. Both texts encouraged adult survivors to work through their problems at their own pace and explained many of the issues survivors face in adulthood. Some of the problems described include:*Not talking about the problems having been made to fear the consequences by the abuser(s) during childhood;*Self-blaming having been told by the abuser(s) that they were at fault in childhood;*Believing no one else shares the experience or could understand it; and*A belief in being damaged beyond any hope of recovery.Dr Judith Lewis Herman3 of Harvard Medical School brought rigorous academic analysis to the topic In Trauma and Recovery: The Aftermath of Violence by comparing the consequences of trauma on three social groups: domestic violence victims, military personnel injured in combat and adult survivors of sexual abuse during childhood. Herman Identified significant differences In the long term sequelae between these groups due to such factors as early age of onset, number of traumatic events and number of perpetrators and public recognition of the reality of the trauma. The consequences of sexual abuse during childhood were shown to be far more complex and difficult to address than combat trauma, for example, partly because the general public is less likely to believe a child's account than that of an adult member of the armed services engaged in action widely reported in the news media. For these and other reasons, Herman identified the concept of complexity In post-traumatic stress disorder (PTSD), which means that simple interventions such as cognitive behavioural therapy are less likely to be effective with survivors of childhood abuse than with personnel wounded in combat. Recovery from childhood trauma takes more time and harder work with more support than simple PTSD. Coping mechanisms learned In childhood may become deeply embedded through adulthood and therefore hard to replace; memories may have been repressed by the child and stored subconsciously causing a range of mental and physical problems.Such understanding has now become widely accepted by practitioners:The traumatic stress field has adopted the term complex trauma to describe the experience of multiple, chronic and prolonged, developmentally adverse traumatic events, most often of an interpersonal nature (e.g., sexual or physical abuse, war, community violence) and early-life onset.4More recently, the UK Government commissioned the Victims of Violence and Abuse Prevention Programme overseen by the late Dr Catherine Itzen, a very large scale assessment of the problem. Their report summarises the situation as follows in their Introduction:Domestic and sexual violence and abuse affects a very substantial minority of the population. It is largely women, and children of both sexes, who are affected, but men are also raped and experience domestic violence. Child physical, emotional or sexual abuse and neglect and domestic violence are causal factors in the mental and physical ill-health of children, adolescents and adults and affect a significant proportion throughout their lives. The high costs in prevalence and economic burden on health and social care services and the criminal justice system have pushed these issues up the policy agenda. …