Helping clients through historical trauma

Having worked with survivors of child abuse for many years, we know that it can have a significant impact on their mental health. Many of our clients suffer from serious psychiatric injuries including anxiety, depression, adjustment disorder and post-traumatic stress disorder, to name a few; and we know that child sexual abuse can also play a role in substance misuse, self-harm and suicidal thoughts. These issues can hugely affect a person’s quality of life and day-to-day functioning, as well as their ability to maintain interpersonal and professional relationships.

By the time clients come to us, they are ready to move forward and address some of the burdens – self-blame, guilt, shame and embarrassment – they have carried throughout their lives. However, the process of going through a civil claim can be retraumatising and should be handled with care. Some of these points may also be helpful for lawyers helping clients through any type of trauma.

Loss of earnings, both past and future, are often claimed where a person has been unable to work, their career has been hampered or their earning capacity has been restricted. Wasted expenditure on alcohol can also be claimed where a person has been diagnosed as suffering from alcohol dependence syndrome as a direct result of the abuse they suffered. And, of course, the most crucial element of every claim is the cost of specialist, private therapy. This is not just limited to immediate therapy needs but can also include provision for ‘top up’ therapy. An individual may require this throughout their life, especially where the prognosis is poor, the damage is likely to be permanent and there is a high likelihood of future relapse in response to psychosocial stressors. This prospect of further treatment can be a protective factor for many of our clients during the litigation process.

It is important the true impact of the abuse is understood so proper compensation can be claimed. However, monetary damages cannot redress the emotional and psychological harm caused by abuse. For this reason, we routinely seek an acknowledgment of the wrong done and a formal apology as part of the civil claim. This can play a profound, reparatory function in the healing process for survivors by validating their experience and confirming that they did nothing wrong.

Consultant psychiatrists and/or psychologists also play a key role in the civil claim process. They provide lawyers and courts with expert evidence on psychiatric condition, causation and prognosis, as well as regarding optimum psychiatric and psychological treatment for abuse survivors. Medico-legal reports provide written validation of people’s experiences. It is important for abuse victims to have their experiences validated by means of a careful account of the abuse history and a reflective assessment of the long-term consequences. A carefully considered report can be enormously helpful in terms of providing further psychological closure, as well as providing therapeutic focus for future treatment from a psychiatric and psychological perspective.  

Crucially, specialist and timely therapy can be the catalyst in addressing the many issues abuse survivors face. It can play a pivotal role in the healing process for survivors by acknowledging and validating their experience, reinforcing their moral worth and restoring self-esteem. Unfortunately, high-quality treatment may not be readily accessible from NHS services or, if it is, it is often limited to a few sessions only and there are long waiting lists. Consequently, thousands of trauma victims receive little or no psychological or psychiatric input at a time when they need it the most.

Equally, NHS Talking Therapies is unlikely to be able to cater for the psychological treatment needs of complex cases – complex post-traumatic stress disorder, for example, may require up to 30 sessions of psychotherapy with an experienced clinical psychologist. Short treatment interventions – for example time-limited cognitive behavioural therapy or eye movement desensitisation and reprocessing – may be unlikely to provide sufficient closure and care needs to be taken to avoid retraumatisation during the psychotherapeutic process.  

To ensure that survivors of abuse have specialist treatment and much-needed emotional support when they need it the most, Bolt Burdon Kemp has launched a care fund for clients, funding up to £2,500 worth of private therapy recommended by a medical expert. This will enable those most vulnerable to access mental health support without fear of any financial burden.

Treatment outcomes can be life-changing and the legal process can bring about access to many treatments which would otherwise remain elusive or inaccessible for many survivors. What is crucial is to ensure abuse survivors have access to the mental health support they need throughout their legal claim. Their legal team must be alive to the support available and how to prioritise access to therapy for people whose long-term physical and mental health detriment has been overlooked or never recognised.

Zahra Awaiz-Bilal is a senior associate in the abuse team at Bolt Burdon Kemp. This article was co-written with Dr Nick Cooling, a consultant psychiatrist and medico-legal expert