Psychosocial groups for young survivors of sexual abuse: worth the risk?
Updated: Mar 8, 2021
By Jeremy Sachs & Lindsay Starbuck
First published by The Association for Young People's Health
Lindsay Starbuck has extensive experience working with young people in the voluntary sector. She worked on the Association for Young People’s Health’s (AYPH) innovative Be Healthy project involving young people affected by sexual exploitation and also runs training for professionals based on the model.
Jeremy Sachs is the Project Manager with Healthcare Professionals at the Association for Young People’s Health (AYPH). He also runs the psychotherapeutically informed support groups at SurvivorsUK for men, boys, Trans and Non-binary people who are affected by sexual abuse.
Quotes throughout this blog come from young people effected by sexual violence engaged with the Association for Young People’s Health Be Healthy Project.
A key distinction in a child or young person’s experience of a sexual trauma as opposed to a sexual trauma survived by an adult is that children are still growing. They rely on adults and peers around them to provide a safe environment in which they can connect, grow and develop. A sexual trauma is an abrupt break in these connections, the effect of which can be devastating. Research has told us a trauma in childhood can alter the development of a child’s brain and chemistry, affecting their ability to learn and concentrate ( DeBellis and Zisk, 2014; Edwards, 2018.). This is where interventions through social work, counselling and youth work are essential to re-establish the child’s connection with their world.
In adolescence, young people often have a desire to establish safe connections and share painful experiences. Being able to engage socially with peers of their own age and similar experience can be reparative and healing.
It’s about letting go completely. As a group it helped us let go of stuff that had built up. Being able to sit and talk about stuff and be listened to was a major way to let go. - Lucy, 15
Young people naturally form peer groups in order to support each other. We see this in schools and youth groups everywhere. The importance of these groups shouldn’t be underestimated. They provide an environment that nurtures and protects, much like a family. One study illustrated this when observing how children separated from their families during the London Blitz formed peer support groups in order to provide the nurturing that their absent families could not, (Freud & Dann, 1951). When the Health Advocates (young people themselves) from the Be Healthy project ran focus groups for their Peer Support website, the other young people told them they sought out and provided support for each other on everything from exam stress to suicidal feelings without any help from adults.
These ‘peer families’ are particularly important when dealing with the psychological impact of sexual abuse. Often a young person’s own family are not the best people to support them. This can be down to a multitude of reasons; it can be too painful for family members to deal with the trauma constructively or the abuse could be familial.
A youth worker or psychotherapist in a group context can create the ideal family model. This allows the young person the chance to develop a secure attachment (Bowlby, 1988) to the adult. A healthy attachment to a safe adult after a trauma helps the young person gain perspective on the trauma, thus the trauma becomes less overwhelming and they are able to start down the road to resolution (Janoff-Bulman, 1992). In addition to this, other young people with a similar history of trauma can act as siblings who are accepting and believe the experiences of the young person. These groups potentially provide a microcosm in which young people are able to rebuild reparative connections with the world, each other and themselves.
People who’ve been through something similar can relate to me more on a personal level. It’s good to meet people like that. You don’t feel so alone and it takes away the sense of loneliness... Also I’m more confident at voicing my opinions now, even if it doesn’t match up with someone else’s. Before I used to just agree with what was being said by other people even if I didn’t! - Maisy, 18
However, some professionals have concerns about this kind of group work. Some also face barriers to undertaking group work in their roles, their organisations and in the sexual violence sector as a whole.
Common fears about group work are that it may facilitate peer-to-peer exploitation, retraumatise or trigger participants or can lead to broken confidentiality when young people know each other outside of the group. It is true that all of these could happen through group work, but they are also risks that survivors of any age navigate every day. Unlike out in the world, a facilitated group can provide a safer environment where negative ideas can be challenged and support needs can be identified and followed up.
It is important to recognise that working with groups requires a different skill set to one-to-one work. We should not expect someone with no experience to take on a therapeutic group or participation project, indeed it could be harmful to the participants if not managed well. But the sticking point is that if there continues to be a lack of support for existing staff to receive training, and a lack of prioritisation for these skills when hiring new staff, there will continue to be a lack of group work opportunities for young people who have experienced sexual violence. Services for survivors of sexual violence are often overstretched and underfunded. Some are forced to work on shoestring budgets and yet are able to provide some of the most valued support to survivors.
We have encountered some sexual violence services who are simply opposed to the idea of running groups with young people in principle. This can be the case at services where group opportunities for adult survivors or even for the parents of young people who use their service are offered. It begs the question, when professionals are risk averse and deny young survivors opportunities to work with their peers, is this actually protecting them from harm?
Through our discussions, I’ve become more aware about society and the ways people can manipulate other people. - Jessica, 16
There are also rights-based arguments in favour of peer-centred interventions. Article 39 of the United Nations Convention on the Rights of the Child states that young people have to right to recovery from trauma and reintegration, specifically health, dignity, self-respect and social life. The key phrase here is social life. Supportive relationships with professionals, family and other adults are of course important. But for a young person to meaningfully recover their social life, they must be able to develop supportive relationships with people their own age. Amy, a Youth Adviser on our We’re All Right project has written a powerful blog about the importance of Article 39 you can read here.
I’ve made friends and it feels like I’ve known people for years. I never thought I’d have met people like this. - Lauren, 18
Talking therapy directly addressing their experiences of trauma may not be beneficial to all young people. It also stands to reason that group work may not be the best route for every young person. Article 12 states that every child has the right to express their views, feelings and wishes in all matters affecting them, and to have their views considered and taken seriously. In order to express their views or make any decision, young people need to first be informed about and offered all possible options. A confident yes or no coming directly from a survivor can be a powerful sign of healing. When decisions are made for them and options limited by adults and professionals, it prevents young people from learning to stand up for themselves and claim their own rights.
Conversations about sexual abuse continue to become more prevalent in mainstream society. We see them in the media, news reports, films and TV. Better understanding of the issues surrounding abuse means better care for those who survive it. However, it is crucial that young people do not get left behind. The challenges in creating a group for young people who have experience sexual abuse are significant and need careful consideration. This however, should not overshadow the benefits that can come when bringing young people together. Creating spaces for young people to meet and share their feelings and experiences not only combats the isolation that abuse brings but ensures that their rights are being met and their voices, that may have been silenced through abuse, can be heard, believed and respected.