Throughout July FD Consultants want to highlight the diverse expertise and professionalism amongst its associates. Maddie Nixon is a BACP accredited psychotherapist and supervisor, trainer and an accredited Eye Movement Desensitisation Reprocessing (EMDR) practitioner. She has expertise in trauma care and critical incident response and has a particular interest in pre-trial therapy. Maddie has recently completed her MSc in Therapeutic Practice for Psychological Trauma. Her dissertation was ‘A qualitative exploration of therapists’ experience of working therapeutically pre-trial within the Crown Prosecution Guidelines with adult clients who have reported sexual violence’. Following this Maddie and Peter Jenkins have published an article ‘Examining the Evidence of Pre-Trial Therapy’ in the Healthcare Counselling and Psychotherapy Journal, January 2020 https://tinyurl.com/r9gt66h. Below Maddie writes about her recent work, and her experience as an associate for FD Consultants. Very early in my career as a therapist, when I was studying for my Diploma in Humanistic Integrative Counselling I took a placement in an agency that worked with adults who had been abused as children. I developed an interest in helping people who had suffered traumatic experiences and it was here that I became aware of pre-trial therapy (PTT). PTT is the term that applies to working therapeutically with a client before they appear as a witness/defendant in a criminal trial. PTT is different to generic counselling as it requires specialist training and a knowledge of the criminal justice system. In 2001 the Home Office, the Department of Health and the Crown Prosecution Service (CPS) joined together to produce a practical guide https://tinyurl.com/y782c4dl, primarily aimed to assist therapists when providing therapeutic interventions to vulnerable or intimidated witnesses in England and Wales (victims of sexual violence are defined as vulnerable by the courts) as they recognised the need for these witnesses to receive PTT. Having an awareness of the CPS guidelines is important for therapists whether they are in private practice or work within an organisation. It would also be of benefit to other professionals that work within organisations that may have to investigate allegations of sexual violence. FD Consultants specialise in trauma care and critical incident response. Fiona Dunkley, the founder of FD Consultants conducted research on critical incidents within the humanitarian sector. She reviewed 188 critical incidents concerning 89 organisations between 2014 and 2017 (Dunkley, 2018). The research concluded that sexual violent crime towards aid workers had increased by 25% over a period of two years. Research has indicated that 60% of survivors of rape and sexual assault develop PTSD and as a therapist working with a client presenting with the symptoms of PTSD the main aim would be to alleviate their symptoms. FD Consultants are trained in the recommended (WHO, APA and NICE) treatments of trauma and PTSD which are Eye Movement Desensitisation and Reprocessing (EMDR) and Trauma-Focused Cognitive Behavioural Therapy (TF-CBT). However, if you were to use EMDR or TF-CBT, according to the CPS guidelines, these forms of therapy may be seen as ‘recounting or re-enacting’ memories and the criminal case could fail as a result. Therefore, at FD Consultants we are aware of these sensitive dilemmas, and depending on what the client requests, may focus on normalisation, stabilisation and psycho-education during pre-trial therapy. Herman (2003) explained how criminal proceedings could distress the most robust person, and for those who may be experiencing symptoms of PTSD, the justice system could be described as a ‘re-victimisation’. As happened in the case of Frances Andrade, a witness in the criminal trial over indecent assault against her former music teacher, Frances was wrongly informed that she could not receive therapy prior to the court proceedings. Frances described the cross-examination process as feeling like she was being ‘raped all over again’ and took a fatal overdose a few days after giving evidence (Barrett, 2013). All the therapists interviewed in my research believed that pre-trial therapy was beneficial in some way. Janet stated “the important thing with counselling is talking about feelings and building up confidence”. James had actually used EMDR with his client before the client reported the incident, however this was not challenged in court (as has been the case in other court hearings) “I was asked about EMDR in court and interestingly I had been expecting them to try and undermine EMDR as a technique but they didn’t”. The debilitating symptoms associated with PTSD bring up the dilemma as to whether it is morally acceptable to withhold treatment that may alleviate these extremely distressing symptoms. In fact the revised NICE (2018) guidelines state “do not delay or withhold treatment for PTSD solely because of court proceedings”. It can also be argued as to how reliable a witness would be when suffering from the very debilitating psychological impact of PTSD. Neuroscience has shown that in brain scans of people experiencing flashbacks, the Broca area of the brain, responsible for speech, goes offline leaving the person unable to put their thoughts and feelings into words (van der Kolk, 2014). Therefore, it could be argued, that encouraging the witness to have treatment prior to the trial would be beneficial to the criminal proceedings. Given the recent research and developments in therapy, it may be an opportune time for a review and update of the current CPS guidelines into the provision of therapy for vulnerable or intimidated adults prior to a criminal trial. There has been concern of a potential rise in domestic abuse during the COVID-19 crises with agencies such as Refuge reporting a 25% increase in calls since lockdown began. These risks are reported to be affecting society worldwide. For professionals and organisations supporting adults who have experienced abuse, it is important to be mindful of PTT in case the victim decides to pursue a criminal case either now or in the future. At FD Consultants we support staff impacted by sexual violence. Over the last year (2019) 25% of the incidents FD Consultants managed were sexual violence cases. If you want to find out more about our services please email [email protected] or visit our website at www.FDconsultants.net If you want to find out more about Maddie’s work on PTT please email [email protected] or visit her website at www.maddienixon.co.uk. She is planning to facilitate further training on PTT in the near future, which can now be offered online. For organisations looking for employee psychological support, FD Consultants are the trauma specialists and well-being service who will best deliver a reliable, quick, and bespoke support system in the workplace. FD Consultant’s team of accredited specialists will offer ongoing support to help manage stress, prevent burnout and provide specialist trauma care where required, enabling your staff with the tools to cope, and recover more quickly.
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