DRAFT VERSION FOR COMMENT
18th JUNE 2015.
DCP Guidance document on the Management of Disclosure of Historic Child
Sexual Abuse:
Contents:
Document summary/ Keypoints
1. Rationale
2. Background to the guidance
3. Core documents
4. Consent and confidentiality
5. Disclosure without consent
6. Incidence of abuse
7. Issues facing adult victims/ survivors of abuse who disclose historic abuse
8. Case examples
9. Issues facing clinicians when an historic allegation is made
10. Good practice guidelines around assessment
11. Decisions and Actions following a disclosure of historic sexual abuse
12. Special circumstances
13. Additional issues
14. Wider role of psychology
15. Summary
Acknowledgements:
to be added
Lead Authors: KR, BW, SW, to be added
Additional authors:
to be added
1
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
Document summary /Key points:

Recent cases of historic abuse have highlighted that those who sexually abuse children may
present a long term threat to other children and young people. This is the case whether an
alleged abuser has offended within or outside the family.

Clinicians who work with adult clients who disclose historic sexual abuse, should recognise
that there may be current and ongoing risks posed by the alleged abuser to other children
and young people.
Not sharing concerns beyond the consulting room could mean that other children and young
people could be at risk.

Assessments should always be thorough, but detailed assessment of information is
paramount in such cases. For instance, gathering information about the family tree will be
particularly important in helping to risk assess whether an alleged abuser has easy access to
other children.

The lack of access to children identified through familial relationships, work or volunteering
roles should not eliminate concerns about risk, given opportunities for abuse to occur within
communities

It is crucial that psychologists seek advice from colleagues, particularly Safeguarding
colleagues, within the organisation and also from other agencies tasked with leading on
safeguarding (i.e. social services).

It is always best practice to share information with the client’s knowledge and consent.

In exceptional circumstances it may be necessary to break confidentiality either with, or
without, the client’s immediate knowledge and consent. This would be the case where
there are significant risks to the client’s psychological wellbeing; where the person alleged to
have committed the abuse may be a clear current risk to others; the risk of jeopardising a
potential investigation; or where the client may be inadvertently at risk of alerting the
alleged abuser to an investigation (which could give the alleged abuser time to destroy
evidence or to silence children at risk).

Any decision to breach confidentiality cannot be taken lightly, but can be justified and
accounted for, if made in good faith because of safeguarding concerns. This is supported by
professional guidance.

There may be times when, in the interests of supporting a client’s psychological readiness
for disclosure, therapy may continue without requiring identifying details to be provided to
the psychologist. It is important that a clients’ lack of readiness to disclose does not become
an obstacle to receiving psychological help
2
DRAFT VERSION FOR COMMENT

18th JUNE 2015.
Psychologists have a key role to play in this area, as clinicians commonly work with abuse
victims/survivors. Psychologists have a wider role to play systemically to improve the
response to victims of historic sexual crime.
Rationale:
This guidance has arisen as a number of clinicians are becoming increasingly concerned about how
to respond to client disclosures of historic sexual abuse. There is a growing recognition that an
historical disclosure may mean that there are also current risks to children from an alleged abuser.
Some high profile cases show the potential extent of abuse by one individual.
Psychologists have a duty of care to their clients, but we also have a duty around safeguarding
children and young people.
This may place psychologists in complex positions when trying to negotiate and balance both these
duties and responsibilities. Psychologists are often in a unique position regarding disclosures of
historic abuse for the following reasons:

Within multi-disciplinary teams psychologists are often recognised as the most appropriate
professionals to work with people who have been traumatised;

The person may have been specifically referred for help with a history of child sexual abuse,
or the person may make a disclosure of historic abuse during assessment or intervention;

Psychologists are trained and have the time to spend with people, assessing in detail,
drawing up family trees, understanding the family system and the skills to formulate and
treat a range of presenting problems. This means that people may disclose abuse as part of
assessment and that we may be in a unique position to identify abusers and potential
victims;

Offenders may still be perpetrating offences against other children, and historic allegations
should alert us to potential current child protection/safeguarding issues.

Psychologists may also have responsibilities outside of direct clinical work, which concern
historic abuse. For instance, colleagues may raise issues around their own clients in team
3
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
meetings; psychologists may be supervising the work of others; may learn of issues through
briefer contact with clients when in in-patient settings; through consultation or even via
training others; referrals may come from staff who have heard the disclosure of abuse but
not considered or explored the potential safeguarding issues that this raises.
This guidance will provide a platform for thinking about the psychologist’s response in a variety of
settings. Although it is predominantly aimed at colleagues who are working with adults of working
age in mental health settings, the guidance may be adapted to other vulnerable clients groups, such
as work with older adults, people with learning disabilities, people with physical health problems
and those clients who may have experienced head injury and have neurological impairments.
Although work within individual therapy is emphasised, disclosures may be made during the course
of group work or within family therapy meetings.
It is emphasised that these are complex decisions and this guidance aims to help psychologists be
clearly accountable for the decisions they reach when working with clients who disclose historic
sexual abuse. All decisions must be underpinned by the use of good supervision, and shared
decision-making with senior managers and safeguarding staff within your organisation. The guidance
applies to clinical psychologists working in all settings, including private practice.
Context to this guidance:
Historic sexual abuse is defined as abuse which is non-recent or suffered in the past, for which there
may no longer be corroborating forensic evidence available, apart from the client’s disclosure. This
means that disclosures may concern abuse which occurred several years ago. In the last few years,
there has been increasing public awareness of child abuse, particularly sexual abuse. There are
several instances of high profile media coverage about historic abuse allegations by adults who have
come forward about maltreatment in children’s Local Authority care homes, such as alleged in Clwyd
and Gwynedd. Allegations have also been made within the English and Irish churches; Hansard
(2002a) reports that 3000 people reported sexual abuse within 18 churches in Ireland.
There has also been publicity about high profile cases, such as Jimmy Savile in 2012; TV presenter
Stuart Hall and singer Ian Watkins in 2013; Rolf Harris, Gary Glitter in 2015 and allegations made
against former MPs, Cyril Smith and Lord Janner. There have been high profile cases of Child Sexual
Exploitation in Rotherham, Rochdale and Oxford, which have historical elements and where
organised abuse of vulnerable children continued over a long period.
4
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
Publicity around these cases may make it more likely that people will actively disclose information
that they may have previously felt too frightened or ashamed to share. There appears to be some
evidence for this: The NSPCC reported an 84% increase in disclosures of abuse to its helpline, with
600 cases referred to the police and social services. They noted that this increase occurred after the
Savile scandal (Ramesh, 2013).
People often delay disclosure of abuse into adulthood: Read et al., (2006) found an average of 16
years delay among a community sample, though these figures vary across studies.
Statistics on the incidence of child sexual abuse (CSA) are notoriously difficult to collect, due to the
hidden nature of this crime and the psychological sequelae of this abuse impacting on the likelihood
of disclosure. Victims often feel ashamed or to blame for the abuse they have suffered and many are
also very frightened about the consequences of telling others about their experiences for a variety of
reasons. These reasons can include a fear of not being believed, being blamed for what happened or
social and familial consequences of telling (such as family break up). It is therefore probable that the
incidence of CSA is under-reported.
A disclosure made by adults of historic allegations of abuse, particularly of sexual abuse, should alert
psychologists that an alleged abuser may be continuing to harm other children. This may apply to
disclosures that are made in context of professional work, or for clinicians in independent/ private
practice or within the contexts of our personal lives and networks.
Disclosures may be made by people at a time of intense distress, and the disclosure process itself
may increase the risks of self-harm and suicide. Psychologists must also be alert to the impact of
onward discussion of disclosure on an individuals’ risk to themselves and may consider delaying
onward disclosure as a result. Such decisions should be discussed in supervision and documented.
This document seeks to address some of the dilemmas raised by people reporting historic allegations
of abuse to psychologists during assessment or therapeutic work.
This guidance outlines options for responding to disclosure, recognising that this can raise ethical
dilemmas. It is hoped that this guidance will aid the complex clinical judgments that can arise when
people disclose historic abuse, and to facilitate the psychologist’s response to be as effective as
possible in supporting vulnerable adults, as well as ensuring we meet our duty to safeguard children
and young people who may be at risk now.
5
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
Core documents:
1. Children’s Legislation: Key legislation outlines professional duties to ensure the welfare of
children is paramount, and our responsibilities to ensure that they are protected from significant
harm. These are The Children Act 1989, 2002, 2004; the Children (NI) Order (1995), The Children
(Scotland) Act (1995) and supported by Working Together to Safeguard Children (2015).
2. Mental Health Legislation: Key legislation concerning clients within mental health settings are The
Mental Health Act (1983; 2007) and The Mental Capacity Act (2005).
These Acts concern the mental health treatment, rights and competence to consent to treatment for
clients who are at risk or vulnerable, and where the client’s decision-making is severely
compromised, for reasons such as brain injury or learning disability. The Mental Capacity Act is
designed to protect individuals who may lack the mental capacity to make their own decisions about
their care and treatment. It does seek to facilitate and empower people to make their own
decisions.
3. Caldicott Principles (1997, 2012) were drawn up in response to changes in information technology
and to ensure that the duty of confidentiality was not undermined within the NHS. The Principles
can be found in the appendix.
4. Safeguarding Vulnerable Groups Act (2006): A vulnerable adult is any person aged 18 years or
over who is unable to self-care or who cannot protect him/ herself against significant harm or
exploitation. This could apply to people who have mental health problems, disabilities, sensory
impairments or are old and frail. The person may be in receipt of care at home, in the community or
in an institutional setting. The adult has the right to live a life free from neglect, exploitation and
abuse under the Human Rights Act (1998).
5. Inquiry Findings -The findings of Inquiries have highlighted the importance of information sharing
across agencies, the need for collaboration and joint working, and the importance of cultural and
attitudinal factors in decision-making. For instance, The Jay Report (2014) into Child Sexual
Exploitation in Rotherham, found the scale and seriousness of abuse was not recognised by senior
managers in social care and the police. Many young people were not considered to be victims of
crime.
The Savile Inquiry (Lampard and Marsden 2015) highlighted how Jimmy Savile had been able to gain
access to vulnerable young people though his celebrity status and charitable work. He abused many
6
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
people and there were concerns about being able to raise suspicions about his behaviour and have
these taken seriously.
Lord Laming’s Report (2003) highlighted that
‘The support and protection of children cannot be achieved by a single agency...Every service
has to play its part. All staff must have placed upon them the clear expectation that their
primary responsibility is to the child and his or her family’ (paragraphs 19.92 and 17.92
6. HCPC Code of Conduct-The Health & Care Professions Council (HCPC) states that: If you make
informed, reasonable and professional judgements about your practice, with the best interests of
your service users as your prime concern, and you can justify your decisions if you are asked to, it is
very unlikely that you will not meet our standards. By ‘informed’, we mean that you have enough
information to make a decision. This would include reading these standards and taking account of
any other relevant guidance or laws. By ‘reasonable’, we mean that you need to make sensible,
practical decisions about your practice, taking account of all relevant information and the best
interests of the people who use or are affected by your services. You should also be able to justify
your decisions if you are asked to.
Standards of conduct, performance and ethics 2012, p 5
7. BPS Safeguarding and promoting the welfare of children (2014: This Position Paper states;
As stated in the UN Convention on the Rights of the Child (1989, Article 19), it is the
responsibility of all adults to work to prevent abuse and neglect, to protect children from
harm, and to identify and report concerns about child abuse.
As psychologists we share a professional interest in people’s psychological functioning and
are, therefore, in a particularly relevant position to identify interactions or circumstances
that affect the health and development of children in any setting in which we find ourselves.
This applies not only to clinicians who undertake direct work with children and families in a
variety of settings such as early years, schools, clinics or residential care provision; it applies
equally to those who work with individual adult clients, seen, for instance, in clinics, hospitals
and prisons, who may make historical disclosures of abuse or raise concerns about child
protection within their families or communities.
Position Paper, p2. (BPS 2014);
7
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
And the Position Paper outlines the core legal requirements as:
● The child’s needs are paramount, and the needs and wishes of each child, be they a baby or infant,
or an older child, should be put first, so that each child receives the support they need before a
problem escalates.
● All professionals who come into contact with children and families are alert to their needs and any
risks of harm that individual abusers, or potential abusers, may pose to children.
● All professionals share appropriate information in a timely way and can discuss any concerns about
an individual child with colleagues and local authority children’s social care.
● Appropriately trained professionals are able to use their expert judgement to put a child’s needs at
the heart of the safeguarding system, so that the right solution can be found for each individual child.
● All professionals contribute to whatever actions are needed to safeguard and promote a child’s
welfare and take part in regularly reviewing the progress of a child against specific plans and
outcomes.
● Local Safeguarding Children’s Boards (LSCBs) co-ordinate the work to safeguard children locally
and monitor and challenge the effectiveness of local arrangements.
● When things go wrong, Serious Case Reviews (SCRs) are published and are open and transparent
about any mistakes which were made so that lessons can be learnt.
● Local areas innovate and changes are informed by wide ranging and cross-cultural evidence and
examination of data (from both clinical practice and research evidence).
p.4 Position Paper (BPS 2014)
Consent, confidentiality and disclosure without client consent:
As well as the core documents already mentioned in relation to confidentiality the BPS has outlined
the following guidance, when it may be necessary to breach confidentiality:
(vi) Restrict breaches of confidentiality to those exceptional circumstances under which
there appears sufficient evidence to raise serious concern about:
(a)the safety of clients;
(b) the safety of other persons who may be endangered by the client’s behaviour; or
(c) the health, welfare or safety of children or vulnerable adults.
8
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
BPS Code of Conduct 2009 (see appendix for fuller outline)
There are exceptional circumstances which justify overruling an individual’s right to confidentiality in
order to protect the public. Clinicians are permitted to break confidentiality in good faith, in order
to prevent serious crime or to prevent abuse or serious harm to others. Examples include disclosing
information in relation to crimes such as rape, child abuse, murder, or the prevention of terrorism.
It is recognised that these decisions are complex, should be proportionate and limited to relevant
details.
“Under common law, staff are permitted to disclose personal information in order to prevent
and support detection, investigation and punishment of serious crime and/or to prevent
abuse or serious harm to others where they judge, on a case by case basis, that the public
good that would be achieved by the disclosure outweighs both the obligation of
confidentiality to the individual patient concerned and the broader public interest in the
provision of a confidential service.”
“Wherever possible the issue of disclosure should be discussed with the individual concerned
and consent sought. Where this is not forthcoming, the individual should be told of any
decision to disclose against his/her wishes. This will not be possible in certain circumstances,
e.g. where the likelihood of a violent response is significant or where informing a potential
suspect in a criminal investigation might allow them to evade custody, destroy evidence or
disrupt an investigation”.
(NHS Code of Confidentiality, DH 2003)
Incidence of abuse:
International surveys have suggested that the incidence is between 3-36% (Finkelhor, 1994)
although establishing the true incidence of child abuse is notoriously difficult, because of its hidden
9
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
nature and under-reporting of this crime. The fact that only a tiny proportion of cases will be
successfully prosecuted makes measurement even harder.
The true extent of abuse against children is not clearly known, as the incidence of CSA is likely to be
under-reported: for instance, Read et al., 2006 in a community sample found that only15% of the
participants had disclosed childhood sexual abuse to authorities/police. The authors compared this
to other studies which ranged from 7.5%-11.9%.
Radford et al (2011) conducted a large scale survey for the NSPCC, interviewing 1,761 young
adults (aged 18-24 years) and 2,275 children (aged 11-17 years) and 2,160 parents of children aged
under 11 years old. They reported that:
•Nearly a quarter of young adults in their sample said they had experienced sexual abuse (including
contact and non-contact abuse) by an adult or by a peer
•One in six children aged 11-17 years old said they had experienced sexual abuse.
•Around one in ten children aged 11-17years old had experienced sexual abuse in the past year.
Girls between 15 and 17 years reported the highest past year rates of sexual abuse.
•One in nine young adults (11.3%) experienced contact sexual abuse during childhood.
•One in twenty children aged 11-17 (4.8%) reported contact sexual abuse.
•Two thirds (65.9%) of contact sexual abuse in under 17 year olds was perpetrated by someone aged
under 18.
•More than one in three children aged 11-17 (34%) who experienced contact sexual abuse by an
adult did not tell anyone else about it.
•Four out of five children aged 11-17 (82.7%) who experienced contact sexual abuse from a peer did
not tell anyone else about it.
Of those who do report, only a tiny proportion of cases will be successfully prosecuted. The
Ministry of Justice’s (2013) report reveals that around 90 per cent of victims of the most serious
sexual offences in the previous year knew the perpetrator, compared with less than half for other
sexual offences, which is likely to act as an obstacle to disclosure and prosecution. Of an estimated
number of victims (approximately 517, 000 for sexual offences and 95,000 who suffered rape) only a
small minority of people come forward to report the crime. Police recorded crimes for 2011/12 were
54,310 sexual offences and 15,670 for rape. By time of conviction there were 5,620 for sexual
10
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
offences and 1,070 for rape; so around half of those cases progressed to court result in successful
conviction. This means around 10% of sexual offences reported and approximately 6% of rapes
reported result in successful prosecution.
In terms of statistics on abusers, there are similar problems around clarity of figures due to underreporting. In March 2012, there were 40,345 individuals registered as sexual offenders in England
and Wales (Ministry of Justice, 2012). Of these, 29,837 were on the Register for sexual offences
against children (NSPCC, 2012). There were 17,186 sexual crimes against children under 16 recorded
in England and Wales in 2011/12 (Chaplin et al, 2012) and this accounted for 32% of all successfully
prosecuted sexual crimes recorded in England and Wales in this time frame.
Research shows us that the majority of those perpetrating sexual offences against children are men
(Bagley, 1995), and that most perpetrators are personally known to their victims (Snyder, 2000).
Although the majority of childhood sexual abuse offences are perpetrated by men, a small
proportion of childhood sexual abuse is committed by females: 3.9% (McCloskey & Raphael, 2005).
This also continues to be under-reported/unrecognised, and there are particular barriers to people
reporting sexual abuse by female perpetrators, particularly for men, due to societal gender roles. It
is recognised that figures for both genders may be under-reported due to the hidden nature of this
crime.
Only 5% of sexual assaults committed against children are perpetrated by strangers (Snyder, 2000).
The abuse will often involve the corruption of a trusting relationship through a process commonly
termed ‘grooming’, but this process of corruption can actually involve the use of violence, the threat
of violence or other forms of coercion and manipulation (e.g. Smallbone and Wortley, 2000).
Abusers can abuse for many years, and they can abuse the same victim or a number of victims over
this period of time (Salter, 2003). Abusive behaviour is now recognised to be addictive and involves a
number of cognitive distortions, such as denial, minimisation and victim blaming so that the
offender will often not see their behaviour as personally problematic at the time. It is common for
offenders to seek positions of trust, either in their personal lives or through employment, which
allow them to gain access to children and young people (Sullivan and Beech, 2004).
Issues facing adult victims/ survivors of abuse who disclose historic abuse:
Adults alleging historic sexual abuse are victims/ witnesses may be very vulnerable. If they are being
seen within a clinical setting the disclosure may be part of a complex set of circumstances; the client
may already be experiencing high levels of psychological distress and may be a risk to themselves.
11
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
The client may disclose abuse with the intention of wanting the perpetrator to come to justice, but
more commonly there can be considerable fear, guilt and shame surrounding a disclosure for which
the client simply wants to be heard, believed and helped. This may particularly be the case if this is a
first time disclosure for the client.
People who have been victims of abuse may have a range of reasons that they have been unable to
tell about their experiences, such as:

fear of not being believed

being made to feel ashamed and to blame for what has happened

fear of being blamed by others for what has happened

the victim may also love or be attached to the person who has abused them, who may be a
parental figure

being in denial about what has happened or experiencing dissociation triggered by
memories of abuse

feeling that they are the only person that this has happened to

feeling scared that the family will break-up as a result of disclosure
There are many other individual reasons that people may not disclose abuse, which can also relate
to fear of racism; fear of gender stereotyping and implied or real threats being made to the victim to
silence them.
Feelings of shame and fear may be present within the therapeutic relationship but will be
heightened by the prospect of wider disclosure to other agencies. Victims/ survivors may feel scared
of the consequences of the abuse becoming known about and the consequences of this, such as fear
they will not be heard or believed or creating disruption and conflict within family systems. They
may also fear court processes and their ability to withstand this.
Victims/ survivors may also have had difficult experiences within the mental health system, such as
having been sectioned, having worked with multiple clinicians over a long period of time, faced
social exclusion and stigma due to their mental health problems or faced other hardships, such as
trying to live on a low income. Some people may have internalised stereotypes about having mental
health issues or learning difficulties/disabilities, and feel that no-one will listen to them or take them
seriously. Some people may have disclosed abuse before and been disbelieved or silenced as a result
of trying to tell.
12
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
There is a large literature on the negative consequences of the untreated trauma of abuse, such as
post-traumatic stress, emotional problems, trauma related beliefs, shame, self-harming behaviours,
suicide (e.g. Browne and Finkelhor, 1986, Zwi et al, 2007) and personality disorder (Ross et al., 1990).
Varese et al.’s (2012) meta- analysis found a strong association between psychosis and childhood
adversity (including sexual abuse). Other studies have found a relationship between sexual abuse
and risk of hallucinations (Shevlin et al., 2007; Bentall et al., 2012) and psychosis (Read and Bentall
2012). A recent systematic review of existing reviews highlighted the medical, psychological,
behavioural and sexual difficulties for those who experienced sexual abuse as children (Maniglio,
2009). There is also research concerning the number of people in inpatient wards who disclose
childhood abuse and have received a lifelong psychiatric label such as psychosis (Read, Goodman,
Morrison, Ross & Aderhold, 2004)
However, it is also important to consider the issue of post-traumatic growth. Posttraumatic growth
refers to experiences of positive psychological change as a result of the following a traumatic event
(Calhoun & Tedeschi, 2001). Research has evidenced the potential for posttraumatic growth for
adults following child sexual abuse (e.g. Easton, Coohey, Rhodes & Moorthy, 2013; Woodward &
Joseph, 2003). The experience of disclosure can promote or hinder the potential for post-traumatic
growth. For instance, negative responses to disclosure of abuse have been found to lead to
increased psychological distress (Easton, 2013). Conversely, positive experiences of disclosure have
been identified as important in the process of growth following childhood sexual abuse (e.g.
Draucker & Petrovic, 1996). Positive experiences of disclosure allow the person to feel heard,
validated and accepted (Woodward & Joseph, 2003). Whilst it is crucial for clinicians to manage the
disclosure and adhere to procedures and guidelines in doing so, it is as important to acknowledge
and validate a person’s experience to foster rather than hinder the potential for post-traumatic
growth.
Examples of Case Scenarios:
In order to humanise this document, it is helpful to consider the kinds of case scenarios that a
clinician may be faced with in their practice. These are as follows, and they will highlight themes that
will be explored in the following sections.
Scenario 1
13
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
‘Carrie’ is in her 30s, and has been referred for treatment of her depression. She makes a disclosure
of CSA when the clinician is drawing out a family tree and asks about childhood experiences. The
assessment reveals that the alleged abuser is a family member who has access to your client’s
children. She has given you the name of the alleged abuser.
Carrie becomes very anxious and does not want to disclose any further information to you when she
realises you are concerned about what you have heard.
Scenario 2
‘Maya’ is well known to psychiatric services, with chronic and disabling symptoms is referred to you
for therapy. Her disclosure of CSA has been previously logged by other workers, but this information
has never been discussed with a Named Nurse or other professional with specific safeguarding
expertise. Maya has a very fragile mental state, a history of serious and repeated self-harm, and has
previous admissions to psychiatric hospital. She says she wants to do something to protect other
children but is terrified by the idea of having contact with the police.
Scenario 3
‘Meizhen’ has been referred for help with PTSD, and discloses that there was domestic abuse,
including sexual violence, in a previous relationship. She is no longer with that partner. The
psychologist is told that the ex-partner has established a relationship with someone else and that
there are small children in this household. The client is worried about this herself, but is very
frightened about taking the information further.
Scenario 4
‘Asima’ is from a Muslim background, and has been referred to you for help with manic depression.
She is in her mid-twenties and has a history of contact with mental health services, but not seen a
psychologist before. She has been sectioned on two occasions in recent years, when she was
depressed and at risk of suicide. You have been working with her for several months, when she
discloses that she was sexually abused by her uncle. She says that she has felt able to disclose this
within the family, as she is worried about severe consequences, including rejection from her
community and potential ‘honour’/ shame based violence. Her uncle has adult children of his own
and is well respected within the community.
14
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
Scenario 5
‘Keisha’ is in therapy with a presentation consistent with a diagnosis of borderline personality
disorder and probable addiction to pain medication. She is also diagnosed with fibromyalgia and has
mobility difficulties. She has a known abuse history, and decides, following an argument with her
mother, that she wishes to go to the police to report her father’s abuse of her as a child. She wants
you to support her in doing this. She has engaged in several high risk episodes of deliberate selfharm and concern has been expressed by her team about her current emotional state.
Scenario 6
‘Ben’ is referred to your service, with an already disclosed history of sexual abuse. It is unclear from
the GP referral whether this has ever been disclosed to other agencies. He wants help for depression
and severe anxiety. You have met for several sessions and begin to develop a formulation of how to
understand his difficulties. He begins to say more about his previous abusive experiences, and
discloses information that highlights there were several young boys who were also in contact with
the alleged abuser. He says that at least one other boy was also sexually abused by the man.
Ben no longer has contact with the alleged abuser, and is unsure of his whereabouts.
Scenario 7
‘Matida’ has been referred for treatment of OCD. English is her second language and there have
been some communication difficulties in your appointments. You have arranged to meet her again
with an interpreter. During the appointment, she talks about her contamination fears and selfcleaning. She discloses that she suffered female genital mutilation as a child. She is recently married
and is finding sexual intercourse very painful. She and her husband are trying for a baby.
Scenario 8
‘Liz’ is a thirty year old woman who is five months pregnant and is suffering with depression. Her GP
has asked if her referral can be prioritised as she is experiencing significant symptoms and is
reluctant to take medication. You meet her for extended assessment across several sessions. As you
start to explore her family history, and draw up her genogram, she discloses that her father sexually
abused her between the ages of 7 and 15 years old. She has never been able to tell anyone other
15
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
than a recent disclosure to her family GP. She is very confused and distressed about what happened,
and feels that she was to blame. She says she is worried that her baby may be a girl, and is feeling
she will ‘never be able to leave her alone with my dad.’
These are all complex scenarios that any clinician could be presented with in clinical practice. We
believe they all present dilemmas, and may present extra challenges around formulation, who to
involve in discussions, how to intervene and at what point. The clinician may also experience a
conflict of interest between the client in the room and potential victims that it may or may not be
easy or even possible to identify.
Issues facing clinicians when an historic allegation is made:
Each case will be different and will need sensitivity and careful, nuanced formulation. A person
disclosing historic abuse is a victim of a crime, and must be treated with compassion and respect.
We need to work as collaboratively as possible with them, recognising that they have had traumatic
experiences, have been frightened or shamed into silence or silenced through a lack of an interested
and accepting listener and that it may have taken many years to disclose their experiences. They
may have tried to disclose before and not been heard or believed. We must wherever possible,
demonstrate that we take the person seriously, hear and believe what they say and wherever
possible, involve them in decision-making.
If we have to take decisions which they may disagree with for the protection of children, then it is
important to explain the rationale for this clearly and respectfully. It is advisable not to go into
significant details of the actual alleged abuse so as not to prejudice potential investigation, as a
person’s disclosure is evidence. However, this is not always possible, and therapy may need to take
priority if there are concerns about safety and wellbeing. Even if therapy proceeds, it does not
necessarily have to focus on actual incidents of abuse. There is a need for ongoing supervision and
multi-agency discussion to ensure that this balance is kept in mind.
If a client discloses historic sexual abuse, then it is important for the psychologists to convey belief.
Psychologists can powerfully communicate that they have heard the client, they take their disclosure
seriously, that it was not their fault and it was not acceptable. Psychologists can also demonstrate
that it is the abuser’s behaviour that was unacceptable and that their behaviour needs to be
addressed. It may also be necessary to say either immediately, or at a later point, that in order to
16
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
ensure that the alleged abuser is not harming other young people, it may be necessary to pass on
what has been disclosed.
The timing of these discussions is crucial. It is important to discuss complex cases with colleagues. It
is better to make careful, considered and well timed decisions rather than hasty and mechanistic
decisions. The latter can lead to negative consequences, such as client disengagement from therapy
and their loss to help; potential increased risk of harm to the client; or the loss of important
Safeguarding information.
Psychologists may need to reframe their active response to child protection concerns as potentially
therapeutic. Many clinicians fear that acting will destroy the therapeutic relationship. For the client,
this may be the first time they have been heard and believed by anyone. Whilst anxiety provoking
for clients, anecdotal clinical experience indicates that many people do not want other children to
suffer the same experiences as they did, and that they are prepared to consider passing on concerns
in order to be protective of others (especially when they understand that there are options for
making allegations that do not necessarily involve going to court).
If a client discloses that they were sexually abused in childhood, the clinician’s concerns should be
heightened if

the alleged abuse has not been previously reported or there has not been previous
professional intervention from the police or social services

the alleged abuser is a family member with ongoing contact with children

the alleged abuser holds a position of trust (paid or voluntary) which is likely to bring them
into contact with children and young people

the client is aware (though they not be) that other young people were victimised

that it is clear that there was organised or ritual abuse

the adult client is continuing to be abused by the abuser
A psychologist may be unsure of how to respond to the client’s disclosure in the therapy room. It is
important that a psychologist demonstrates that s/he is listening, taking the disclosure seriously and
that they may need to think about what the client has said. In the moment, a clinician may have to
make a decision about whether to say that they are sufficiently concerned that they need to seek
advice from colleagues. If the client is disclosing at assessment, then not enough may be known
about their risks and there may be a risk of disengagement. It may be necessary to extend
assessments across several appointments, and to take a gentle approach to finding out more and
seeking advice on how to respond to what the client is saying.
17
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
A client may disclose that they were sexually abused but not go into the details of the abuse. The
clinician should not seek to elicit information about the details of the abuse, but neither should they
prevent a client talking about their abuse. All discussion should be framed within clear limits of usual
confidentiality, good note-keeping and making it clear that the clinician works as part of a team and
is in receipt of supervision.
This guidance cannot cover every clinical nuance or situation, but when an adult client discloses, the
likely scenarios are:

the client discloses abuse but does not wish it to be reported to other agencies (police
and/or social services)

the client discloses abuse and is not well enough to make their own report to other agencies
but the psychologist has sufficient information and believes the risk is substantial enough to
require reporting

the client discloses abuse and gives consent to the psychologist making an informal/
anonymous report being made to the police or social services on their behalf

the client discloses abuse and is prepared to make a formal statement to the police (i.e. to
report a crime)
This can be captured more simply in the diagram below:
1
2
disclosure but client does not want to report
disclosure and client wants to report formally
(psychologist may need to pass information on
to police and social services
without knowledge and / or consent)
information can be passed on with knowledge
and consent but client may need briefing about
not inadvertently alerting the alleged abuser
3
4
disclosure but the client is unfit or unable to
disclosure and client wants to report informally
report
to the police or social services
(psychologist passes on information with or
information can be passed on with knowledge
without knowledge and/ or consent)
and consent but client may need briefing about
not alerting off the alleged abuser
18
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
Each scenario presents its own challenges and advantages for the client, therapist and also for
safeguarding others. The most difficult scenarios professionally, are 1 and 3, where the client does
not want to report, or is unable to report. Here, the dilemma is that the client could experience the
psychologist as behaving in ways that potentially feel like re-victimisation by the client (by taking
away control from them). No psychologist is likely to feel comfortable about passing on information
without a client’s consent, or perhaps even knowledge. However, there may be instances when it is
necessary to do so for the protection of others. In these cases, it would always be advisable to
disclose professional action to the client as soon as possible, without compromising safety or an
investigation.
It is recognised also that the client may disclose abuse but be ambivalent about whether or not they
wish to report or if reporting is necessary.
Some dilemmas are outlined below:
1. Balancing the needs of the client versus needs of (potential) other victims. The adult client
may be experiencing high levels of distress and symptoms of trauma (including psychotic
symptoms and dissociation), which may be accompanied by a risk of self-harm and /or
suicide. The clinician may assess this risk as being potentially heightened by sharing
information with other agencies. This raises dilemmas about balancing the needs of the
client with the risks to others. Here, even if information is shared about allegations, it may
not be possible to proceed as the victim’s testimony may be felt to be too fragile.
2. Historic sexual abuse is not the agreed focus of therapy. Adult clients may have come to
therapy, seeking help for issues other than the consequences of child abuse. They may not
wish to deal with issues around abuse and may be unwilling to take information forward
themselves.
3. Breaching confidentiality. There may be dilemmas concerning confidentiality, knowledge
and consent about professional actions. An adult may still be in close contact with the
alleged abuser. The abuse may have stopped some time ago, and the victim may not think
others could be at risk. Here, there may be risks in telling the client that advice is being
sought in relation to the allegation. The issue of timing of telling the client what the clinician
is doing needs to be clearly balanced with the risk of adult clients inadvertently alerting
alleged abuser to multi-agency involvement. If alerted, the alleged abuser then may take
action to destroy evidence or silence children/ other witnesses.
19
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
This means that there may be exceptional circumstances where a clinician may need to
share information without the client’s initial knowledge and consent to the need to break
confidentiality.
Seeking advice about a client’s allegation without their express knowledge or consent can be
an extremely uncomfortable position for a clinician to be in and risks jeopardising the
therapeutic relationship. In such circumstances, careful consideration should be given to
how to mitigate any resulting increase in risk.
If a clinician seeks a ‘no names’ consultation with safeguarding professionals, then advice
may be given without knowing whether the alleged abuser is actually already known to
other agencies, which can mean that vital cumulative evidence may be lost, if the allegation
is not progressed further.
No breach of confidentiality can be taken lightly, and it is always advisable to be as open and
transparent with the client as possible, and as soon as possible. However, it must be
recognised that there may be times where there may need to be an initial breach, or
potentially an initially undisclosed breach, in order to safeguard others form an alleged
abuser.
4. The potential impact on the therapeutic relationship. It must be noted, that a psychologist
encouraging a client to report historic abuse can be therapeutic, especially when the timing
has been carefully considered, and the client feels involved in the decision-making process.
This must be judged on a case by case basis, with a risk assessment.
There is often a worry that reporting of abuse will destroy the therapeutic relationship.
However, it can be an opportunity for a client to feel heard and believed. Herman (1997)
draws attention to the potential therapeutic value of taking action against a perpetrator of
historic abuse in a context where successful outcomes are far from guaranteed. There is
some literature on resilience in those who are able to survive their experiences and recover
through psychological treatment (Woodward & Joseph, 2003).
Ainscough and Toon (1993) also highlight that there may be a range of reasons for survivors
wanting to confront their abusers including to protect other children from the abuser and to
break the silence and the hold the abuser may still have over them.
5. Additional factors making reporting more complex. For any person who has been abused,
there will be a wide range of reasons that the child/ young person has been pressurised not
to disclose, including being bribed, induced, tricked, manipulated or threatened and shamed
into silence. It is incredibly important to understand the reasons someone has been afraid to
tell, as this will enrich a clinician’s understanding of risk to that individual and also to other
potential victims. Silence can be induced by specific threats of harm to the victim or to
20
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
people close to that person. If clients are from shame/ honour based cultures, then this can
place them at particular risk of severe reprisals, and they may have genuine and real fears
that they might be killed for speaking out. In any case of disclosed abuse, it is crucial to
include the victim’s reasons for not telling as part of risk assessment, and to be clear with
colleagues that these risks may present real threats to the person’s ongoing safety.
These cases can be complex and may present dilemmas, and extra challenges around formulation,
who to involve in discussions, how to intervene and at what point.
Good practice guidelines around assessment:
In cases where historic abuse is disclosed, it is wise for the clinician to pay particular care and
attention to the quality of their note-keeping as:
-
information may need to be clear and specific in other to potentially safeguard other
children and young people who may be at current risk of abuse
-
notes could be called as evidence if the case proceeds to the police and potentially to
criminal proceedings
Any clinical decision-making and actions should be clearly and accurately recorded. Discussions with
other professionals should be clearly recorded, with the other clinicians job title and role noted. Any
actions should be clear, including any plans to keep the client informed of what is happening (where
appropriate). Clear recording of decisions as they unfold, are the basis of accountable practice.
The components of good record keeping are:
1. Good history taking at assessment. This is when clinicians are likely to gather information
about family history, which in cases of familial abuse should include genograms. The detailed
gathering of information for genograms should include information about dates of birth for
family members, addresses and if possible schools or pre-school if there are young children.
It is also helpful to have GP details (if possible). If this is the point at which a disclosure is
made, then it is important to note the nature of the allegations (without going into
unnecessary detail about specific incidents), the alleged abuser(s) details such as name, date
of birth, address, occupation, GP details if the client is able to provide this.
21
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
2. Accurate note keeping is extremely important, particularly ensuring that records contain
details of dates, times of disclosures and that any allegations are carefully recorded, ideally
using the client’s own words.
If information is withheld from a client for safeguarding reasons, this needs careful
consideration. If it has been necessary for the conversation to occur without the client’s
knowledge or consent, then it is important to carefully document the reasons for this action. It is
also important to locate this as third party information within the notes, so that it is restricted
from the client at that time, and so that any safety issues are not inadvertently compromised,
e.g. another clinician inadvertently disclosing that there have been safeguarding conversations
may be harmful to the client and inadvertently endanger other children. It is important to be
clear about where in the clinical record this information will be stored. It is also crucial to be
clear about how information will be labelled to ensure that there is not inadvertent or
premature disclosure to the client.
3.
It is particularly important to have clearly thought out and recorded risk assessment in
these complex cases. There may be multiple risks to the client’s care, including
disengagement from services; suicide risk; risk of mental health crisis; on-going contact with
an alleged abuser; risks of harm to others.
4. If any other professionals within or across agencies is contacted to discuss safeguarding
concerns, then it is important to keep records of the following:

The date, time, method of contact

Who you spoke to and their job title

The reason that you spoke to the professional and whether this was a consultation where you
did or did not name the client

The reason that you contacted the professional concerned

What information you discussed with the professional

What the key points of the discussion were

What actions you agreed on the basis of the discussion, and what timescale was attached to
these

Who is responsible for carrying out which action
22
DRAFT VERSION FOR COMMENT
18th JUNE 2015.

Any decisions or plans to discuss/ not discuss and further safeguarding actions with the client

Record any follow up to actions
Decisions and Actions following a disclosure of historic sexual abuse:
It is our professional responsibility to act if we believe children could be at risk. The judgements and
decisions in these cases can be complex and stressful and it is important to share information with
colleagues on a ‘need– to –know’ basis (i.e. Named Safeguarding professionals, your line manager,
your clinical supervisor and potentially across agencies).
Decision-making is a human affair and clinicians should remember that all professionals can be
prone to thinking errors, particularly under such stressful or difficult conditions.
Decisions should be embedded within an anti-discriminatory framework. In reality this means that
we should be aware of our own responses to cases, and to base our practice on clear and ethical
principles rather than attitudes. For instance, multiple inquiries have revealed that how we view
victims can influence thresholds for acting on information. Decisions may be based on not seeing
people who disclose abuse as victims, questioning the truthfulness of what they are saying or
believing them to be too fragile or not sufficiently credible in the eyes of the law to report their
experience. We may unwittingly harbour assumptions about class, gender, ethnicity, disability or age
that affect our decision-making adversely. We are also likely to have our own thinking biases, as all
people do, so it is imperative to seek advice and use ongoing clinical supervision when involved in
complex decisions that unfold over time.
It is absolutely vital that any instance of historic disclosure is discussed with relevant colleagues, so
that the clinician’s decision-making is shared, and that there is the chance for peer scrutiny. This may
be more difficult in private practice, but these guidelines are applicable to that setting too. Relevant
professionals would be the clinical supervisor, manager, Named Nurse or Doctor for the
organisation, safeguarding lead and safeguarding nurses (or similar professionals within the
organisation). It is important that the psychologist understands the criteria for potentially needing to
breach client confidentiality either with or without the client’s immediate knowledge and consent
(see appendix and the earlier section on consent).
It may be suggested that the client is encouraged to make a direct report to the police and social
services. If this is the case, psychologists should actively support the client in doing this or to verify
23
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
with other agencies that the information has been passed on. It is advised that this is framed as part
of routine practice in such cases. It is important that psychologists do not assume that victims/
survivors who are vulnerable have acted on advice to pass information on. The danger here is that if
a client feels unable to take that step, then that potentially important safeguarding information has
been lost to services, potentially increasing risk now for other children and young people.
The psychologist may decide that it is appropriate for them to be involved in discussions with social
care and police, even when the client is making their disclosure directly to these staff. There should
be discussion about the interface between adult mental health and safeguarding within Local
Safeguarding Children Boards (LSCBs), so that shared protocols can be developed to manage these
cases well.
There will also be systemic issues to consider. Our systems may need to be flexible in order to
ethically meet the needs of people who have suffered historic abuse. The person’s disclosure may
be psychologically destabilising for him/her, and their risk of self-harm or suicide may increase.
Therefore, there may be a case for clients with high need to be prioritised for help, rather than put
on a waiting list that may be many months long.
It is essential to have clear lines of reporting within organisation. It can get confusing about how
many people, and who to link with.
It is crucial to be clear about who is carrying out what action, and who has responsibility for what
action. Shared decision-making is key, but it must be clear and active, with professionals being clear
about their roles and responsibilities. Otherwise there is a danger of role confusion amongst
professionals. There is also a risk of de-individuation, where the team knows about an allegation but
professionals don’t ask key questions about whether information sharing across agencies has ever
taken place, and do not take responsibility for acting individually. This could result in professional
inertia or a failure to act on information disclosed by clients.
If there are disagreements about actions within the professional team, then colleagues should agree
to discuss these with their seniors, in order to seek further advice about how to resolve differences
of opinion.
The following options present themselves to psychologists faced with the ethical dilemma of
receiving an allegation of historic abuse about an abuser who remains alive and where sufficient
identifying information has been provided by the client: It must be noted that even when an alleged
abuser is dead, or there is not clear identifying information, there should be team discussion about
information sharing. For instance, many of Jimmy Savile’s victims came forward after he had died. A
24
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
clinician may only have the name of an alleged abuser, but if the police have a name, then they may
still be able to run checks to see if the person is already known to them.
1. No action
Clients who disclose abuse may have strong feelings about not taking action, often based on the fear
and shame generated by the experience of being victimised. The clinician should use their clinical
judgement to raise the potential risk to other children with the client, and to share information
about options for taking action in a sensitive, timely manner so that the options can be considered
over time. Caution should be exercised about initiating this kind of conversation at assessment if
follow up for therapy is likely to be delayed for many months as there is a possibility that such a
conversation will heighten self-harm risk.
The complexity of the emotional response to disclosure and acting on such disclosures should not be
under-estimated. Clinicians are unable to act if no identifying information is given and clients cannot
and should not be compelled or pressurised to supply information they do not feel ready to give. It is
reasonable for therapy to proceed in the absence of identifying information about an abuser, so long
as the psychologist is able to hold in mind the possibility of the client’s readiness to share more
information as therapy progresses.
However, difficulties can arise when a client has not provided such information but where the
psychologist is able to identify individuals involved, such as in small communities or in cases where
the alleged abuser is a family member. In such circumstances, psychologists should carefully
consider the risks of sharing the information with the risks of not doing so. Breaking confidentiality
in this situation, even without the client’s consent, would be supported by guidance on
safeguarding. If the client does not feel able to take information forward (these reasons should be
gently explored to understand what the client’s specific fears are, and whether there are any
dangers of retaliation against the victim by the alleged abuser or wider community.
The rationale for any decisions should be clearly noted within a client’s clinical record.
2. Anonymous action
Crimestoppers provide a route for anonymous allegations to be logged against named individuals. A
report of abuse to Crimestoppers (whether it is made by the client themselves, a friend or family
member, or the therapist) is noted. Single allegations of this nature are generally logged on the
system, but in the absence of additional evidence, action may not be taken. However, if the name
25
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
has been noted as involved in previous allegations, a Crimestoppers allegation could trigger an active
police investigation (for example, interviewing the alleged abuser and other family members, search
warrants being granted enabling the seizing of computers and other materials).
The NSPCC also have a helpline, and can explain various options including reporting anonymously to
their organisation.
The MASH (Multi Agency Safeguarding Hub, which is a co-located information sharing team
consisting of a number of agencies including the police, social services and health, together with
other partners such as Probation, Education, the Ambulance Service, District Councils etc. ) can also
be contacted directly by a psychologist on behalf of an anonymous client, and an allegation made.
This may follow the same response as described above: if the allegation corresponds to one or more
previous accusations, active investigation is more likely. If it is the first time a name has been logged
on a system, and if no identifiable victim is named, no action may follow. If risk is identified in
relation to a named child, this is likely to lead to an investigation of that child (and may include an
interview of the child and their family).
Clients caught in the dilemma of wanting to protect other children, but who feel unable to cope with
the stress of a police interview may feel more comfortable with the option of anonymous reporting
and is clearly most relevant where the client is confident that there have been other victims. Clinical
psychologists caught in the dilemma of wanting to preserve a therapeutic alliance and not subject
their clients to a stressful investigation process, may also appreciate the middle ground this option
appears to present, though should be prepared for the possibility that should the allegation
correspond to previous logged allegations, there may be considerable pressure for the client to
participate in an investigation. If the client’s name is provided as a victim along with details of the
alleged abuser, the client may be contacted by police to request an interview. This latter issue needs
sensitive handling.
3. Referral to the MASH
The client may be willing to make a named referral to the local Multi Agency Safeguarding Hub, as
described above. It may be that police action will not be possible, but other agencies may still be in a
position to take overt safeguarding action if necessary.
4. Supported witness statement to the police
26
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
The police have specially trained detectives available to interview victims of abuse, and when clients
are ready to do so, being interviewed by staff with the appropriate skills can be a helpful part of the
recovery process. However, alongside some of these beneficial effects, the experience may also
have the side effect of heightening distress and memories temporarily.
It is helpful to provide clients with information about what to expect when they make a disclosure to
the police or other agencies. It is important to emphasise that their allegation/ concern will be
treated seriously; that they are acting protectively on behalf of other potential victims; that their
information will be treated sensitively and carefully; that if they make a formal complaint, they
should be interviewed by specialist officers in plain clothes; that witness statements are often
recorded onto DVD, rather than written; that they can take breaks during the interview.
However, the resulting investigation and the very real risk that the allegation will not lead to
successful prosecution, along with the consequences for families when the abuse has been familial
can be highly distressing and re-traumatising. It can be unsettling for partners and families as this
may be the first time the person has spoken about abuse and other members of their system may be
unsettled by learning that the person is a ‘victim’ and have them treated as such by the police.
A survivor needs to be aware that they may face a long wait of several months if their evidence is
passed on to the Crown Prosecution Service (CPS). The CPS decides on whether there is enough
evidence to proceed a case through to court.
It may be appropriate for psychologists to be involved in supporting clients through this process, and
the police are generally supportive of this involvement. Work with people who disclose historic
abuse may involve stepping outside of the usual or typical role as clinical psychologist, and this can
very much be the case when an active investigation is ongoing.
It is helpful to set up mechanisms with the police to have case discussions, and to have information
leaflets available about what processes are involved in making a complaint.
27
18th JUNE 2015.
DRAFT VERSION FOR COMMENT
DRAFT FLOWCHART FOR PSYCHOLOGIST’S RESPONSE TO DISCLOSURES OF HISTORIC ABUSE
ASSESSMENT
THERAPY
(explain limits of
confidentiality)
(limits of confidentiality already
established)
DISCLOSURE OF
HISTORICAL ABUSE
ASSESS RISK TO CLIENT
AND OTHER
POTENTIAL VICTIMS.
Underpinned by
discussion with
Safeguarding Team,
line manager and
clinical supervisor
Are there reasons not to
share to seek client
consent now, to share
information?
CLIENT WISHES/ABLE
TO REPORT TO SOCIAL
until case resolved
SERVICES OR THE
POLICE
NO (UNABLE)
YES
POLICE
Formal
report
STATEMENT &
INVESTIGATE.
WIAT FOR
DECISION
FROM CPS.
MAY BE NO
FURTHER
ACTION (NFA)
OR MAY GO
TO COURT.
PSYCHOL
ROLE?
consent /knowledge
to pass on concern?
MASH
Informal
report
logged
Anon
Formal
report
referral
IF CHILD
AT RISK
THEN
MAY
NEED
MORE
INFO
NO (DECLINES)
MAY NEED
TO ACT TO
PROTECT
CHILDREN
OR S 47
MEET OR
STRATEGY
YES
PSYCHOL
REPORTS
MEETING
OUTCOME
DECISION?
28
NO
consent/knowledge for
worker to report?
YES
NO
DISCUSS
RISK :
TEAM &
MASH
LOG
CONCERN
BUT MAY
BE NFA
FOR NOW
PSYCHOLOGIST
REPORTS TO MASH.
MAKE CLEAR RECORD
OF ACTIONS IN
CLINICAL NOTES
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
Steps following referral to MASH
1. Once an allegation of historic abuse is passed to the authorities (MASH) then the following
diagram from Working Together 2015, illustrates the next steps in the process that social services
and /or the police may take if it is though that a named child is in danger.
Social care investigates to see whether any named children are known to them and where a child
may be in need of protection. If not known, the police will check whether the alleged abuser is
known to them already, potentially through Multi Agency Public Protection Arrangements (MAPPA).
This concerns known offenders. If there is felt to be immediate significant risk to children, then
safeguarding agencies will need to intervene.
Health Organisations may also need to consider that there may be instances when alleged abusers
may be known to mental health services, and it should be considered how to manage this
information if it is not known to MASH.
Diagram to show action taken when a child is referred to local authority children’s social care
services from working together 2015
29
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
Diagram to show action taken when a child is referred to local authority children’s social care
services from working together 2015
30
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
2. If a child(ren) may be at ongoing risk then the MASH will initiate section 47 enquiries
A section 47 enquiry is carried out in accordance with Working Together (2015) guidance. Local
authority social workers have a statutory duty to lead assessments. The police, health professionals,
teachers and other relevant professionals should help the local authority.
A section 47 enquiry is initiated to decide whether and what type of action is required to safeguard
and promote the welfare of a child who is suspected of, or likely to be, suffering significant harm.
The police should:
• help other agencies understand the reasons
for concerns about the child’s safety and
welfare;
• decide whether or not police investigations
reveal grounds for instigating criminal
proceedings;
• make available to other professionals any
evidence gathered to inform discussions
about the child’s welfare; and
• follow the guidance set out in Achieving
Best Evidence in Criminal Proceedings:
Guidance on interviewing victims and
witnesses, and guidance on using special
measures, where a decision has been made
to undertake a joint interview of the child as
part of the criminal investigations.21
Health professionals should:
• undertake appropriate medical tests,
examinations or observations, to determine
how the child’s health or development may
be being impaired;
• provide any of a range of specialist
assessments. For example, physiotherapists,
occupational therapists, speech and
language therapists and child psychologists
may be involved in specific assessments
relating to the child’s developmental
progress. The lead health practitioner
(probably a consultant paediatrician, or
possibly the child’s GP) may need to request
and coordinate these assessments; and
• ensure appropriate treatment and follow up
health concerns.
• contribute to the assessment as required,
providing information about the child and
family; and
• consider whether a joint
enquiry/investigation team may need to
All involved professionals should:
31
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
speak to a child victim without the knowledge
of the parent or caregiver.
From Working Together 2015
3. Dealing with Complex Cases
In complex cases, such as those involving historic disclosures of CSA, the authorities may not have
the names of potential children at risk. There may only be information about an alleged abuser’s
name and grounds for concern (e.g. occupational – e.g. the alleged abuser is or was a sports coach).
A strategy meeting may then be called.
The strategy meeting should be recorded in writing. It should be multi agency, and discuss both
safety and risk to children who may be at risk from the alleged abuser and make careful
consideration of the client’s health.
The psychologist may be asked to speak with the client further as the clinician who has most contact
with the client. It is important to establish roles clearly e.g. if psychologist remains involved what is
expected of their role (especially if they have needed to provide a witness statement)
The meeting should clearly agree plans; clearly establish what is known by whom and how to
manage issues regarding confidentiality, especially if it has been necessary to act without the client’s
current knowledge or consent. This can be extremely uncomfortable for a psychologist who is having
ongoing contact with their client and so it is imperative that the clinician has access to good
managerial and clinical supervision, as well as informal support if needed.
Action following a strategy discussion may of course lead to no further action at that time. If this is
the case, the information that has been supplied about an allegation will still be logged with
safeguarding agencies. If at a later date, further complaints are raised about a named alleged abuser,
then this name can be cross referenced to previous allegations.
Special circumstances
There can be additional factors which will mean that issues around safeguarding become more
complex as follows:
32
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
1. Allegations against former or current members of staff – If the alleged abuser is a public
service employee or clinician they may have ongoing access to children and young people, or
vulnerable adults. They may also have current access to medical or other confidential
records that could alert them to information having being shared with other agencies. If
such an allegation has been raised then it is important to follow LSCB policy and to
potentially involve the Local Authority Designated Officer (LADO). Your organisation will
support your referral.
2. The alleged abuser is a high profile person; ******
3. The alleged abuse has involved multiple victims; the alleged abuse appears to have been
organised as part of a ring (multiple alleged abusers and victims);
4. Allegations concern local authority residential settings. If such an allegation has been
raised then it is important to follow LSCB policy and to potentially involve the Local Authority
Designated Officer (LADO). Your organisation will support your referral.
5. Allegations concern a different Local Authority area- seek advice from Safeguarding Team
and be clear about how the information is being transferred on
In exceptional circumstances, clinicians may have concerns about the way a case has been managed,
and may have concerns about decisions that have been made. It is important to be clear about how
such concerns can be raised within and across agencies, and taken to the LSCB for review.
If significant concerns remain, it may be necessary for a clinician to refer to their Whistleblowing
Policy if services have not handled concerns following due processes or there are major concerns
which are in the public interest to disclose.
Additional issues if the client wishes to report a crime:
1. Making a formal statement to police: If the client does wish to go forward with making a
formal report, your organisation may need to involve an Appropriate Adult to support your
client during the statement process. It is important to seek advice from the Safeguarding
Team, and senior managers, including your Caldicott Guardian. The client is a vulnerable
witness (by having a mental health problem and being a victim of alleged sexual crime then
they are likely to be considered a vulnerable witness) and so may be entitled to special
measures if the case proceeds to court (such as giving evidence behind screens or on video
link for example). The police will explain what making a statement will involve. The Police
will need to speak to your client, potentially with the support of an appropriate adult. A
33
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
witness statement will be taken, either in written form, or on video. A police investigation
will follow with witnesses contacted and the suspect interviewed. Any third party material or
other evidential material will be gathered. The Police will then seek expert charging advice
from the Crown Prosecution Service who will decide if there is sufficient evidence to take
the case to trial.
2. Waiting for court and pre-trial therapy: This can be a highly challenging time for people as
they do not know whether the case may proceed to court. This can be an uncertainty for
long periods of time, and then if it does go ahead, they have to face being called as a
witness. The attrition rate from complaint to court is disturbingly high, and of those that do
get to court from their initial complaint, only between 6-10% results in conviction.
The clinician needs to have supported and frank discussions with a client who feels able to
take their complaint forward. Even under these circumstances, the court process may well
not result in a successful conviction of the abuser.
After a disclosure has been made, one must balance the responsibility of the psychologist with
the necessity not to influence legislative proceedings. Where possible therapy should be avoided
before a police statement or interview has been given. However, this should not prevent a client
getting the help they need whilst waiting for a decision from the CPS or if the case proceeds to
court (2002).
The Crown Prosecution Service may be a useful point of contact when deciding what
intervention to offer; they may be able to provide guidance on the impact of therapy on the
trial.
Barrett’s (2013) media report highlighted that many the police and other agencies are not
always well informed about guidance concerning vulnerable witnesses accessing pre-trial
therapy, and that this has led to tragic consequences for witnesses. Jenkins (2013) outlined the
case for the Government to make explicit recommendations for victims and witnesses to be
offered funded pre-trial therapy. He comments that, ‘It is important to distinguish carefully
between the different types of support available: between preparation for giving evidence in
court on the one hand, and ongoing pre-trial therapy on the other. It can also be important for
support roles to be clearly demarcated, and for the different forms of support provided by
different people to be distinguished.’
34
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
The Crown Prosecution Service (2002) and the Home Office (2002) have provided clear guidance
regarding the provision of pre-trial therapy, which address the ethical issue of not withholding a
person’s right to help but also address concerns about inadvertent ‘coaching’ of witnesses or
contamination of ‘evidence’. It also clarifies that a clinician’s notes can be called as evidence in
legal proceedings. Jenkins (2013) argues that the guidance in this area is now in need of review
and updating.
Psychologists are trained in a range of different models and so may adapt the intervention based
on the needs of the client and the system. Different forms of therapy have different potential
impacts on the legal process. The diagram below, adapted from Bond and Sandhu (2005),
summarises the different facets of therapy and their increasing levels of impact on the court
process.
This outlines that more direct focus on the incidents of sexual abuse and its aftermath can
potentially impact on the legal process.
Figure X:
Therapy focus and potential impact on legal process
Exposure / reliving
Therapy not
focussed on
incident
Hypnotherapy
/ regression /
unstructured
group therapy
Trial Support
Self
Esteem
(focus on
process not
content)
Psychologists have an ethical duty to not withhold therapy, though this comes with many challenges
within and outwith the therapists control. For example, increasing a person’s well-being and
presentation may well influence how the jury perceives the credibility of their evidence. These
dilemmas though uncomfortable, are important to engage with.
Therapists cannot offer complete confidentiality as the therapeutic relationship is not a ‘privileged’
one in a legal sense. The therapist and their notes can get called to court. It is imperative, regardless
of setting to hold case notes to a good standard.
The disclosure of an abuse which may be subject to legal proceedings, should be an additional
prompt for the clinician to re-visit the question of informed consent to ensure the client fully
35
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
appreciates the potential implications of therapeutic discussions being disclosed in court. The
psychologist should also consider again key professional questions relating to the client’s readiness
for therapy and the importance of timing in trauma-related psychological interventions.
There have been concerns expressed by some psychologists about recovered memories, and
whether these are historically accurate. Recovered memories have sometimes controversially been
considered ‘false memories’. Many people who disclose abuse are speaking about ‘never forgotten’
memories. However, psychologists are sometimes concerned about clients disclosing memories of
sexual abuse, which are fragmented /discontinuous and recently remembered (sometimes before
seeking therapy, sometimes during therapy). These appear to be previously forgotten incidents,
from which the client may have dissociated. Here, clinicians are often concerned they will be
accused of creating illusory memories in the client, or that the client has experienced ‘memories’
which are not real.
There has been controversy about recovered memories of abuse. Caution is needed about
questioning the validity of client disclosures as there are significant pressures on children and adults
who have been abused, not to tell and that they will not be believed. It is clear that abuse is still
taboo and that many people have been silenced by accusations of ‘fantasising’ or ‘lying’ about
abuse. Andrews et al (2000) report that most people who experienced recovered memories were
similar to those reported by patients diagnosed as having posttraumatic stress disorder, following an
event known to have occurred such as a car crash. The memories were fragmented but detailed,
accompanied by high levels of emotion and experienced as reliving the original event.
Psychologists concerned about the issue of ‘recovered memories’ should refer to Andrews et al
(1995), The British Psychological Society (2000) Guidelines for psychologists working with clients in
contexts in which issues related to recovered memories may arise. Wright et al (2006) debate the
evidence around whether it is possible to implant illusory memories, though it must be remembered
that a. searching for corroborating evidence of abuse memories can be very difficult – it is often the
victim’s word against the alleged abuser; b. it is unlikely that a clinician can unintendedly implant a
suggested memory if they are working within good practice guidelines and using evidence based
techniques and c. whilst still a work in progress, psychological research and understandings
regarding the nature of trauma memories has advanced since the guidelines and debates around
this issue were sparked in the mid 1990’s.
It is argued that the use of evidence based therapies should prevent clinicians appearing to have
unduly influenced a client’s memory or account of trauma. It is recommended that clinicians do not
36
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
use techniques which could be seen to have reduced reliability of memory, such as hypnosis, or lead
the client.
The need for evidence based intervention cannot be understated, though it must be acknowledged
that psychological therapy for developmental or complex childhood trauma (particularly when linked
with PTSD symptoms) is still being developed. The NICE guidelines (2005) outline that trauma
focussed CBT has the most reliable evidence base for the psychological treatment of PTSD.
Some criteria to help make clinical decisions about the timing of trauma related work are adapted
from Harned et al (2012) (MM personal communication)***
The person

Is not at imminent risk of suicide

Is not a significant risk to others

Has no recent attempts of suicide or serious self-injury

Has the ability to control life threatening behaviours when in the presence of trauma related
cues

Does not have other serious therapy interfering behaviours (e.g. major dissociation; drug or
alcohol misuse)

Feels that therapy for PTSD is the highest priority

Has the ability and willingness to experience intense emotions without escaping/ avoiding
therapy
3. Support at court and post-court: Psychologists may have a role in helping clients to
understand what to expect at court and how to manage this stressful process. It will be
useful for psychologists who remain in contact with their clients to link with court liaison
officers. Psychologists may be able to support pre- court briefings to discuss any
vulnerabilities and needs (and to ensure that the client can give evidence via video link or
behind a screen.
It may be necessary to offer support after the court has reached its decision. This could be
the case regardless of verdict. The client may have mixed feelings whether there is a
successful conviction or if their assailant goes free. Again, the clinician needs to have
supported and frank discussions with a client who feels able to take their complaint forward.
Even under these circumstances, the court process may well not result in a successful
conviction of the abuser. This is not to discourage a victim from taking their complaint
forward, but to couch it in terms of, ‘You have done the best you can. You have raised this as
37
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
much as you can. That is incredibly brave. If the outcome is ‘no conviction’ then this does not
reflect on you.’
Again post- court debriefs may help to pick up any problems that may have occurred during
the trial, in terms of procedure or support, and ensure that these don’t happen to other
witnesses in future. If the assailant has gone free, then there may need to be discussion
about witness protection; victim support; staying safe from reprisals, stalking and
harassment measures.
This all takes the psychologist outside of their usual therapeutic remit. This may need service
level discussion, as the service needs to be flexible in order to meet the client’s needs.
Wider role of psychology:
‘Primary prevention research inevitably will make clear the relationship between social pathology
and psychopathology and then will work to change social and political structures in the interests of
social justice. It is as simple and as difficult as that!’
George Albee, 1996
In the spirit of this statement, it is argued that psychologists should consider their wider role in
relation to historic sexual abuse and work systemically to help our and other professions to meet the
needs of this group more effectively. Some suggestions are made below, and it is important to
highlight that this list is not exhaustive, but a starting point:
1. Awareness raising -Helping colleagues to see that historic allegations may mean there are
live child protection issues. Psychologists could participate in the development of
organisational policies and procedures regarding historic abuse. It would also be useful to
develop information leaflets for clinicians and / or service users about historic abuse, how to
raise concerns, how to report it and what to expect if it is reported
Public awareness campaigns and stakeholder involvement of other agencies and the third
sector, would also be important in order to improve awareness and responding to the issue
of historic sexual abuse.
38
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
2. Supervision (both clinical and case management) should considering safeguarding as routine
when working with victims/ survivors of abuse. Clinicians need support with the complex
decision –making that often accompanies such cases.
3. The usual role of psychologist should be more flexible in cases where historic abuse is
reported, to include extended assessment or a discrete piece of work around facilitating the
onward sharing of important information which may help to safeguard children now, or to
involve supportive work during court proceedings. There would need to be service level
discussions with senior managers as this would have service implications. We should
consider prioritising clients for therapeutic work who present with historic sexual abuse at
assessment in order to address the issues raised.
4. Our risk assessments need to be extended to consider potential safeguarding issues raised
by historic allegations, the impact on the client’s level of risk and the risks associated with
placing a client on a waiting list during any potential investigation. The client may also be a
parent themselves, and so the impact of distress upon their parenting capacity should be
considered too.
5. Working with the Court System -The attrition rate from complaint to court is disturbingly
high, and of those that do get to court from their initial complaint, only between 6-10%
results in conviction.
Recent high profile cases also raise questions about how abuse survivors are treated during
the period of investigation of concerns and during the court process. We are unclear about
the extent of training for the CPS and the police about the psychological needs and
vulnerabilities of people going through the stress of reporting historic allegations. For
instance, training is needed for the public and judiciary to heighten awareness about
particular aspects of this crime, such as the shame based nature of the trauma experienced
by survivors, which make it hard for people to come forward and make a complaint. It is also
important to recognise that poor mental health may be the consequence of child abuse,
rather than being seen as a reason to doubt the veracity of someone’s disclosure or doubt
their credibility as a witness. It would help to raise awareness that victims often test the
waters when disclosing, by telling a bit, then telling more before making a full disclosure.
Some victims may retract their statements, and this does not mean that they are lying.
It would also help to train the police and judiciary about the effects of trauma upon mental
health and memory, and how this can lead to phenomena such as dissociation. Traumatic
39
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
memories may be fragmentary, and again, this does not necessarily mean that the allegation
is false or mistaken.
The adversarial nature of the courtroom may seem routine to those who work in it, but
words such a ‘lying’/ ‘liar’ may feed straight into distressing memories and negative core
beliefs about the self and result in a catastrophic collapse in someone’s psyche. The 2013
case of the Cheethams school abuse in which the victim committed suicide following giving
evidence in court shows the potential for tragic consequences (Walker, 2013). Our
profession could help inform that training and the Criminal Justice response to adults
reporting sexual crimes and potentially advocate for changes to a judicial system that
currently does not appear to serve survivors of historic sexual trauma well. Jenkins (2013)
also highlights concerns about the adversarial nature of the court system in relation to
sexual offence cases, and suggests that this model should change.
6. Training implications - It would be helpful for there to be regular multi-agency training at
all levels of the system, so that education, health, the police, primary care and social care
are each able to understand the parameters of each profession’s roles and responsibilities in
relation to historic allegations of abuse and some of the psychological consequences of this
type of trauma, which can make disclosure so frightening or shameful for people.
It would be useful to work with GPs, who often refer clients who have disclosed historic
allegations to their doctor. It is often unclear whether safeguarding issues have been
explored as part of this, and indeed, GPs may have key information about family members
who may potentially at risk, as well as holding ‘old’ medical evidence, without necessarily
realising its significance.
40
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
7. Lobbying for changes to the way abuse survivors are treated – It is suggested that this could be
achieved through linking with Director of Public Prosecutions, the police, LSCB, particularly focusing
on the pathway from reporting to child protection, and also to possible court action against the
alleged abuser (s). The current high attrition rate from report to court suggests that our systems are
not working effectively enough to help survivors. It is possible that changes to how victims of sexual
crime are treated could improve this situation, in a similar way to the changes that have been made
to help children and other vulnerable witnesses whose cases go through the court system.
Hawkins and Taylor (2015) have written an All Party Parliamentary report concerning services for
sexual and domestic violence. The group is a cross-party group of MPs and Peers working towards
the elimination of domestic and sexual violence through the development of public policy and cross
party collaboration. They have highlighted extremely worrying trends regarding services for women
and girls experiencing violence and abuse. They note the uncertain funding for services such as Rape
Crisis. Psychologists could work with groups in the voluntary sector, to lobby for improved funding of
these vital services.
Summary:
This document is the first substantive piece of guidance for psychologists on managing historic
disclosures of historic abuse. It is a starting point and will be reviewed in light of feedback from
within the Division and as national guidance and legislation is refined in this area.
Within the BPS, the Safeguarding Children & Young People Working Group is now leading on this
issue, with a working group within the DCP developing guidance and practice in this area.
It is hoped that it is a starting point for facilitating awareness, reflective practice and clinical
decision-making in the complex area of safeguarding.
written in draft 2015
mid term review date XXX
full term review date XXX
41
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
References:
Ainscough, C. & Toon, K. (1993). Breaking Free: Help for survivors of child sexual abuse. Sheldon
Press, London.
Albee, GW. Revolutions and counter revolutions in prevention. American Psychologist, 51, 1130-3
Andrews, B., Bekerian, D., Brewin, C. et al. (1995). Recovered memories: The report of the working
party of the British Psychological Society. Leicester: BPS.
Andrews B. Brewin C. Ochera J. Morton J. Bekerian D.A. Davies G.M. & Mollon P. (2000) The timing
triggers and qualities of recovered memories in therapy. British Journal of Clinical Psychology 39(1)
1126.
Bagley, C. (1995). Child Sexual Abuse and Mental Health in Adolescents and Adults.
Aldershot [UK]: Avebury.
Barrett, D. (2013) Frances Andrade: new scandal as police deny counselling to other rape victims.
The Telegraph, 16 February, 2013. Retrieved on 2 June 2015:
http://www.telegraph.co.uk/news/uknews/crime/9875034/Frances-Andrade-new-scandal-aspolice-deny-counselling-to-other-rape-victims.html
Bentall, R., Wickham, S., Shevlin, M. & Varese, F. (2012). Do specific early life adversities lead to
specific symptoms of psychosis? A study from the 2007 The Adult Psychiatric Morbidity Survey.
Schizophrenia Bulletin, 38 (4):734-40.
42
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
Bond, T. & Sandhu, A. (2005). Therapists in Court: Providing Evidence and Supporting Witnesses.
Sage:UK
The British Psychological Society (2000) Guidelines for psychologists working with clients in contexts
in which issues related to recovered memories may arise. The Psychologist Vol 13, No.5
British Psychological Society (2009). Code of Ethics and Conduct: Guidance published by the Ethics
Committee of the British Psychological Society. Leicester: British Psychological Society.
British Psychological Society (2010). Psychologists as Expert Witnesses: Guidelines and Procedure for
England, Wales and Northern Ireland. Leicester: British Psychological Society.
British Psychological Society (2000). Clinical Psychology and Case Notes: Guidance on Good Practice.
British Psychological Society (https://www.bps.org.uk/system/files/userfiles/Division%20of%20Clinical%20Psychology/case_notes_good_pracice_doc.pdf)
British Psychological Society (2014). Safeguarding Children and Young People Position Paper.
Leicester: British Psychological Society.
Browne, A., & Finkelhor, D. (1986). Initial and long-term effects: A review of the
research. In D. Finkelhor (Ed.) A sourcebook on child sexual abuse. California:
43
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
Sage Publications.
Calhoun, L.G., & Tedeschi, R.G. (2001). Posttraumatic growth: The positive lessons of loss. In R.A.
Neimeyer (Ed.). Measuring reconstruction and the experience of loss (pp. 157-172). Washington DC:
American Psychological Association.
Chaplin, R. Flatley, J. and Smith, K. (2011) Crime in England and Wales 2010/2011. Home Office
Statistical Bulletin: London.
Crown Prosecution Service/Department of Health/Home Office. Provision of therapy for vulnerable
or intimidated witnesses prior to a criminal trial: practice guidance. London: Home Office
Communications Directorate; 2002.
Department for Education and Skills (2015). Working Together to Safeguard Children. London:
HMSO.
Drauker, C.B., & Petrovic, K. (1996). Healing of male survivors of childhood sexual abuse. IMAGE:
Journal of Nursing Scholarship, 28(3), 325-330. doi:10.1111/j.1547-5069.1996.tb00382.x
Easton, S.D. (2013). Disclosure of child sexual abuse among adult male survivors. Clinical Social Work
Journal, 41(4), 344-355. doi: 10.1007/s10615-012-0420-3
44
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
Easton, S.D., Coohey, C., Rhodes, A.M., & Moorthy, M.V. (2013). Posttraumatic growth among men
with histories of child sexual abuse. Child Maltreatment, 18(4), 211-220. doi:
10.1177/1077559513503037
Harned, M.S., Korslund, K.E., Foa, E.B. and Linehan, M.M. (2012) Treating PTSD in suicidal and selfinjuring women with borderline personality disorder: Development and preliminary evaluation of a
Dialectical Behaviour Therapy Prolonged Exposure Protocol, Behavioural Research and Therapy, 50,
p 381-386.
Hawkins, S. and Taylor, K. (2015) The Changing Landscape of Domestic and Sexual Violence Services:
All-Party Parliamentary Group on Domestic and Sexual Violence Inquiry. Women’s Aid Federation of
England: Bristol.
Her Majesty’s Stationery Office (2010). The Children Act. London: HMSO.
Herman, J. L. (1997). Trauma and Recovery. Basic Books, USA.
Home Office/Lord Chancellor’s Department/Crown Prosecution Service/Department of
Health/National Assembly for Wales. Achieving best evidence in criminal proceedings: guidance for
vulnerable or intimidated witnesses, including children. London: Home Office Communications
Directorate; 2002.
45
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
Jenkins, P. (2013) Pre-Trial Therapy, Therapy Today, 24, 4. Retrieved on 2 June 2015 from:
http://www.therapytoday.net/article/show/3704/pre-trial-therapy/
Laming, (2003) The Victoria Climbie Inquiry Report: An Inquiry by Lord Laming. London: Her
Majesty’s Government
Lampard, K. & Marsden, E. ( 2015) Themes and lessons learnt from NHS investigations into matters
relating to Jimmy Savile Independent report for the Secretary of State for Health
Maniglio,R. (2009). The impact of child sexual abuse on health: A systematic review of reviews.
Clinical Psychology Review, 29, 647-657. doi: 10.1016/j.cpr.2009.08.003
Ministry of Justice (2012). Multi-agency Public Protection Arrangements (MAPPA) annual report
2011/12. London: Ministry of Justice.
Ministry of Justice (2013). An Overview of Sexual Offending in England and Wales. London:
Ministry of Justice, Home Office & the Office for National Statistics Bulletin.
NICE CG26 (2005) Post-traumatic stress disorder (PTSD): The management of PTSD in adults and
children in primary and secondary care. NICE. Retrieved on 14 June 2015:
www.nice.org.uk/guidance/cg26/chapter/guidance#the-treatment-of-ptsd
46
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
NSPCC (2012). Figures obtained by the NSPCC reveal sixty child sex offences a day. NSPCC press
release, 4 April 2012. London: NSPCC.
NSPCC (2012). Nearly a thousand registered child sex abusers reoffended. NSPCC press release, 18
November 2012. London: NSPCC.
Radford, L., Corral, S., Bradley, C., Fisher, H., Bassett, C., Howat, N. & Collishaw, S. (2011). Child abuse
and neglect in the UK today. London: NSPCC.
Ramesh, R. (2013, 31 August). NSPCC says reports of sexual abuse have soared after Jimmy Savile
scandal. The Guardian, p.11.
Read, J. and Bentall, R.P. (2012) Negative childhood experiences and mental health: theoretical,
clinical and primary prevention implications. The British Journal of Psychiatry, 200, pp.89-91.
Read, J., Goodman, L., Morrison, A.P., Ross, C.A. & Aderhold, V. (2004). Childhood trauma, loss and
stress. In J. Read, L. Mosher & R. Bentall (Eds.). Models of madness. Psychological, social and
biological approaches to schizophrenia (pp.223-252). East Sussex: Brunner Routledge
Ross, C., Miller S., Reagor, P., Bjornson, L., Fraser, G., & Anderson, G. (1990). Structured Interview
Data on 102 Cases of Multiple Personality Disorder from Four Centers. Journal of Psychiatry, 147:
596-601.
47
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
Salter, A. (2003). Predictors: Paedophiles, rapists & other sex offenders: Who they are, how they
operate, and how we can protect ourselves and our children. New York: Basic Books.
Shevlin, M., Dorahy, M., & Adamson, G. (2007). Childhood Traumas and hallucinations: an analysis
of the National Comorbidity Survey. Journal of Psychiatric Research, 41 222-8.
Snyder, H. N. (2000). Sexual assault of young children as reported to law enforcement: Victim,
incident, and offender characteristics. Washington, DC: U. S. Department of Justice, Office of Justice
Programs, Bureau of Justice Statistics.
Varese, F., Smeets, F., Drukker, M., Lieverse, R., Lataster T., Viechtbauer,W., Read, J., Van Os, J., &
Bentall, R. (2012). Childhood Adversities Increase the Risk of Psychosis: A Meta- Analysis of PatientControl, Prospective and Cross-Sectional Cohort Studies. Schizophrenia Bulletin, 38(4):661-71.
Walker, P. (2013, 10th February) Frances Andrade killed herself after being accused of lying, says
husband. The Guardian, [on-line] http://www.theguardian.com
Woodward, C., & Joseph, S. (2003). Positive change processes and post-traumatic growth in people
who have experienced CA: Understanding vehicles of change. Psychology and psychotherapy:
Theory, Research and Practice, 76, 267-283. doi: 10.1348/147608303322362497
Wright, D.B, Ost, J and French, C. (2006) Recovered and false memories. The Psychologist, 19,6.
p352-355.
48
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
Zwi, K., Woolfenden, S., Wheeler, D. M., O’Brien, T., Tait, P., Williams, K. J. (2007). School-based
education programmes for the prevention of child sexual abuse. Oslo: Campbell Collaboration.
Appendices
1.

British Psychological Society: Code of Ethics and Conduct
Psychologists should:
o (i) Keep appropriate records
o (ii) Normally obtain the consent of clients who are considered legally
competent or their duly authorised representatives for disclosure of
confidential information
o (iii) Restrict the scope of disclosure to that which is consistent with
professional purposes, the specifics of the initiating request or event, and (so
far as is required by law) the specifics of the client’s authorisation
o (iv) Record, process and store confidential information in a fashion designed
to avoid inadvertent disclosure
o (v) Ensure from the first contact that clients are aware of the
limitations of maintaining confidentiality, with specific
reference to:

(a) potentially conflicting or supervening legal and ethical
obligations;

(b) the likelihood that consultation with colleagues may
occur in order to enhance the effectiveness of service
provision; and

(c) the possibility that third parties such as translators or
family members may assist in ensuring that the activity
49
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
concerned is not compromised by a lack of
communication.
o (vi) Restrict breaches of confidentiality to those exceptional
circumstances under which there appears sufficient
evidence to raise serious concern about:

(a)the safety of clients;

(b) the safety of other persons who may be endangered by
the client’s behaviour; or

(c) the health, welfare or safety of children or vulnerable
adults.
o (vii) Consult a professional colleague when contemplating a
breach of confidentiality, unless the delay occasioned by
seeking such consultation is rendered impractical by the
immediacy of the need for disclosure.
o (viii) Document any breach of confidentiality and the reasons
compelling disclosure without consent in a
contemporaneous note.
(British Psychological Society: Code of Ethics and Conduct. (2009)
2.
Seven Golden Rules for Information Sharing
1. Remember that the Data Protection Act is not a barrier to sharing information but
provides a framework to ensure that personal information about living persons is
shared appropriately;
2. Be open and honest with the person (and/or their family where appropriate) from
the outset about why, what, how and with whom information will, or could be
shared, and seek their agreement, unless it is unsafe or inappropriate to do so;
3. Seek advice if you are in any doubt, without disclosing the identity of the person
where possible;
50
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
4. Share with consent where appropriate and, where possible, respect the wishes of
those who do not consent to share confidential information. You may still share
information without consent if, in your judgement, that lack of consent can be
overridden in the public interest. You will need to base your judgement on the facts
of the case;
5. Consider safety and well-being: Base your information sharing decisions on
considerations of the safety and well-being of the person and others who may be
affected by their actions;
6. Necessary, proportionate, relevant, accurate, timely and secure: Ensure that the
information you share is necessary for the purpose for which you are sharing it, is
shared only with those people who need to have it, is accurate and up-to-date, is
shared in a timely fashion, and is shared securely;
Keep a record of your decision and the reasons for it – whether it is to share information or
not. If you decide to share, then record what you have shared, with whom and for what
purpose
From Oxfordshire Safeguarding Children Board Website
3.
The Caldicott Principles - Revised September 2013
Principle 1. Justify the purpose(s) for using confidential information
Every proposed use or transfer of personal confidential data within or from an organisation
should be clearly defined, scrutinised and documented, with continuing uses regularly
reviewed, by an appropriate guardian.
Principle 2. Don’t use personal confidential data unless it is absolutely necessary 46
Personal confidential data items should not be included unless it is essential for the
specified purpose(s) of that flow. The need for patients to be identified should be
considered at each stage of satisfying the purpose(s).
Principle 3. Use the minimum necessary personal confidential data
51
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
Where use of personal confidential data is considered to be essential, the inclusion of each
individual item of data should be considered and justified so that the minimum amount of
personal confidential data is transferred or accessible as is necessary for a given function to
be carried out.
Principle 4. Access to personal confidential data should be on a strict need-to-know basis
Only those individuals who need access to personal confidential data should have access to
it, and they should only have access to the data items that they need to see. This may mean
introducing access controls or splitting data flows where one data flow is used for several
purposes.
Principle 5. Everyone with access to personal confidential data should be aware of their
responsibilities
Action should be taken to ensure that those handling personal confidential data - both
clinical and non-clinical staff - are made fully aware of their responsibilities and obligations
to respect patient confidentiality.
Principle 6. Comply with the law
Every use of personal confidential data must be lawful. Someone in each organisation
handling personal confidential data should be responsible for ensuring that the organisation
complies with legal requirements.
Principle 7. The duty to share information can be as important as the duty to protect
patient confidentiality
Health and social care professionals should have the confidence to share information in the
best interests of their patients within the framework set out by these principles. They
should be supported by the policies of their employers, regulators and professional bodies.
4.
Useful Resources
NAPAC – National Association of People Abused in Childhood
P O BOX 63632
LONDON
52
DRAFT VERSION FOR COMMENT
18th JUNE 2015.
SW9 1BF
The National Society for the Prevention of Cruelty to Children (NSPCC)
Weston House,
42 Curtain Road,
London EC2A 3NH.
Crimestoppers
https://crimestoppers-uk.org/
tel 0800 555 111
Victim Support
You and Co – a new website that explains the court process and has a tour of a virtual courtroom.
53