Prosecuting Professionals who fail to report Child Sexual Abuse; why Keir Starmer is wrong

Posted by: Philip Stokoe at 23:10, November 4 2013.

And so another lawyer has made a contribution to the issue of understanding why the sexual abuse of children is not better reported and dealt with. I am speaking of Keir Starmer’s call for teachers and health workers to be prosecuted for failing to alert the police to allegations of child abuse as reported in the Guardian today. (http://www.theguardian.com/society/2013/nov/04/child-abuse-keir-starmer-prosecute-professionals)

I can see why people who work in academic or primarily intellectual jobs take this sort of view. Essentially the view appears to be that not reporting allegations of child sexual abuse is simply irresponsible and unprofessional and such people need to get their priorities right. It is only when one begins to think about what might be going on outside the worker’s consciousness, that might in fact distort their awareness, that one can begin to understand how these sorts of failings occur time and time again.

Putting it another way; given the number of times that professionals have failed to sound the alarm in cases both sexual and physical abuse of children, it is understandable that some people will conclude that there is a high level of bad practice amongst health and social care workers, leading to the further conclusion that they need both more training and more externally provided discipline.

On the other hand one could begin from the assumption that people who dedicate their lives to health and social care, particularly with children, might be motivated to achieve a high standard of practice. In which case one might begin to see that something must be getting in the way of good practice when it comes to dealing with cases of child abuse. i.e. there might be some emotional and/or psychological effect that interferes with the worker’s otherwise high standard of practice.

I have absolutely no doubt that professionals in health and social care and education are dedicated to the highest standards. I also believe that I understand why it is that such professionals fail to ring appropriate alarm bells.

We are all of us subject to distortions in our view of the outside world that arise from beliefs about the world that we hold unconsciously. The trouble with unconscious beliefs is that we are not aware that we have them and, insofar as they penetrate our conscious mind at all, we simply take these beliefs to be facts. Although we are incapable of knowing our own unconscious mind, we are rather good at being able to read the unconscious of others. It is for this reason that we can recognise the inevitability of our friend hooking up with the wrong kind of partner time and time again even though he or she will claim each time that this one is different.

We are also very open to unconscious communication. When Freud first discovered these processes he called it transference. He recognised that his patients saw him not as he really was but as a version of somebody from their early childhood. The first version of this phenomenon that he discovered has, like many psychoanalytic discoveries, become a cliché; the patient falling in love with his or her therapist. Now the point about this sort of transference is that it has an impact on the therapist unconsciously long before he might become aware of it with his conscious mind. Unconsciously he will feel himself drawn into an intimate loving relationship with his patient. It is because these processes are so powerful that the training to be a psychoanalytic therapist takes a long time and involves a personal psychoanalysis. Even though we are trained to expect to be “pooled into” the hidden agendas of our patients, it remains a professional commitment that we seek regular supervision so that we can get a colleague’s view of how we might be being caught up without knowing it in our work.

Now I want you to imagine two separate things. The first is how it must feel to a professional care worker who has no training in unconscious processes to become subject to these phenomena.

The second thing I want you to imagine is what kind of relationships might get “projected” or “transferred” from somebody who has been abused onto a caring professional.

The way that these unconscious “communications” occur is that they evoke feelings. We are not very good at dealing with feelings and, if those feelings are very confusing; perhaps sadistic, sexual, loving, excited and so on, we might prefer to pull ourselves away from them all together. In other words if we are with somebody who is evoking a complex array of these sorts of feelings in us, we might pull away from what they are telling us. It becomes easy to see how a child telling a professional that they are being abused whilst at the same time projecting some of those feelings into that professional might end up not being heard.

It follows that the way to improve the care of abused children is to help staff on the front line, that is teachers, nurses, social workers, health visitors and so on, to understand these unconscious impacts so that they can manage them better when they happen. It is not difficult to provide this kind of training; it is something that I specialised in during my time as a consultant at the Tavistock and Portman NHS Foundation Trust. Of course it is easy to see why this more complex way of understanding what goes wrong is rejected in favour of a mechanistic prescription. The question I ask today is how many times do successive governments come up with more and different prescriptions of this sort before they realise that it does not address the real problem?