Safeguarding Children in Therapeutic Settings: To Act or Not to Act?
When and how should we raise the alarm when we have concerns about a child’s welfare? In her second occasional blog about safeguarding children in therapeutic settings, independent social worker Gretchen Precey discusses ways in which children may disclose, the difference between acting quickly and acting thoughtfully – and the vital importance of a child feeling believed and received.
The most recent edition of Working Together to Safeguard Children (2018) is clear about the obligations of professionals to act on concerns about children whom they believe may be at risk:
‘Anyone who has concerns about a child’s welfare should make a referral to local authority children’s social care and should do so immediately if there is a concern that the child is suffering significant harm or is likely to do so.’
When and how to raise the alarm about vulnerable children is a difficult issue for most professionals, but when working therapeutically with troubled children it raises even more dilemmas.
The therapeutic process takes place in the relationship between the patient and the therapist; such concepts as projection, transference and countertransference are all mechanisms that are tools of the trade in the workplace of the consulting room. But with young children some of these processes might be played out in the form of fantasy, magical thinking, drawings and imaginary friends. Children who are at risk of abuse may have a confused understanding of what may be happening to them and limited vocabulary to describe it.
So, it may take time before a therapist is able to gain what they perceive to be a reliable account of what may have really happened to a child.
I was working with a mother and her two children who were in a refuge for women who had experienced domestic abuse. The mother commented to me that her six-year-old daughter only ever ate tiny quantities of food and very slowly. I spent some time with her on her own talking about things that happened while they were still living with her father. She said when she was at home she felt that she always had ‘too much in her mouth’ and was afraid she would choke. That is why she was such a slow eater now. She also drew pictures of her father with a huge mouth and many sharp teeth. It eventually emerged that her father had been orally abusing her and a criminal investigation ensued.
An eight-year-old boy asked me early on in individual sessions if ‘it was only men who could be sex abusers?’ It took many more sessions for him to eventually describe sexual abuse by his mother. He didn’t think his experiences ‘counted’ because the molestation was by a woman.
It can be very uncomfortable for a therapist to sit with anxieties that what a child may be acting out, fantasising or drawing is indicative of risk of significant harm. The guidance is to act on concerns ‘immediately’. But sometimes to act thoughtfully rather than to act quickly may elicit a better outcome for the child; even though the urge to rescue may be strong.
What should you do when you have concerns?
A considered decision not to act (yet) in the wake of increasing worries about the child’s welfare should be taken in supervision or in consultation with a clinical safeguarding specialist. A note should be made that describes the concerns, and the reasons why the therapist believes it is not the right time, in the best interests of the child, for the information to be reported to the local authority children’s social care at that point.
Sometimes therapists find themselves on the other end of the continuum and hear a very clear account from a child of abuse that is happening to them or to someone else. This can also elicit anxiety in the therapist as far as the most appropriate way to proceed.
If a child has chosen to tell a therapist something they are experiencing that seems to threaten their safety or welfare, it is important that they are taken seriously. The child needs to have someone hear what they have to say. The therapist will also need to:
- Make a written note of this – either at the time or as soon after as possible
- Keep checking back with the child that the therapist has accurately understood what the child has told them
- This note should also include the questions the therapist asked the child to elicit the information
People in this situation can be concerned that they shouldn’t be proceeding with the conversation with the child at all and refer instead to someone who is trained in evidential interviewing. The fear may be that they will ask the child a leading question and contaminate the evidence should the matter go to prosecution. This is one reason why it is important that the tone of the interaction with the child is neutral rather than inquisitorial or judgmental.
The child may well be interviewed subsequently. But feeling believed and received by the person they first choose to tell is important in giving them the confidence to cope with what may lie ahead.