A Journey to healing : exploring clients’ experience of services in a clinic dealing with child sexual abuse

Abstract

This research served to explore the client’s experiences of services in a clinic dealing with child sexual abuse and related issues. Addressing the issue of therapeutic interventions in clinics dealing with sexual abuse victims and their caregivers – looking at how the clients experience these treatments and services and how they have made ‘meaning’ of these on their journey to healing, is something that needs to be explored in greater depth. The aim therefore of this research is to gain insight into understanding the clients’ experiences of the therapeutic services. This study will be of specific importance due to the fact that to date no literature has been identified particularly from a South African perspective on how clients make meaning of these therapeutic services at such an agency, making it difficult to compare the findings. Much of the research identified has focused on the interventions in cases of sexual abuse and have thus typically been one-sided in approach, subsequently ignoring the voices of the child victims of sexual abuse and the non-offending caregivers. The client’s experience of the therapeutic interventions will be reviewed within the context of the Teddy Bear Clinic. An interpretive phenomenological approach was used to focus on the understanding of the participant’s subjective experiences and meanings of the therapeutic interventions. The research utilised a qualitative framework which privileged first-person descriptions as the primary sources of subjective meaning. Two case studies in an organisation in Johannesburg were investigated. The case studies comprised the child victim of abuse and the non-offending care-givers that participated with the child in the therapeutic process. Therefore two children and two caregivers were included in each case study. The recruitment of participants was, to a large extent, dependent on the assistance offered by the counsellors at the Teddy Bear Clinic. Therapeutic counsellors at the Teddy Bear Clinic identified a list of clients that had just terminated or were exiting the therapeutic process and not in need of further interventions, and fit the criteria as stipulated by the researcher. Data was gathered through semi-structured interviews of each participant. The analysis was carried out using thematic analysis which revealed the meaning of their experiences. The following themes emerged through the analysis and were used to explore the client’s experience and assignment of meaning to the therapeutic services: (1) background influences. Various sub-themes emerged from this theme: (1a) shame, guilt and fear of punishment (1b) developmental stages, (1c) relationship with stepmother, (1d) legal issues, (1e) marital and parenting difficulties, (1f) outside support structures and (1g) previous relationship with counsellor. The second main theme included; (2) the voices of children and caregivers on the therapeutic experience. The various sub-themes that emerged from this were; (2a) the therapeutic relationship, (2b) the role of the therapist, (2c) being kept in the loop – feedback and introductions, (2d) clarification and support for the caregiver (2e) giving back – peer support groups, and (2f) teddy bears and the therapeutic process. Thus the main findings that emerged from this study involves ‘background influences’, that clients present to the medico-legal clinic for rape or sexual abuse. However, background influences have a profound effect on the therapeutic relationship and the experience of the clinic’s services, as seen in the interrelationships that are interwoven with the presenting problem. A second finding emerging from the voices of the children and caregivers foresee that services could be improved in the following ways. Providing feedback and clarification of the therapeutic process; receiving an introductory brochure which highlights what services the clinic provides and resources available to the clients. Caregiver and peer support groups was another very important element that the clients expressed as a necessary and vital part of the services and interventions that the clinic could offer the clients. Finally, a positive element to the therapeutic interventions which helped the children cope and eased the caregivers anxiety were found to be the handing out of teddy bears which is symbolic of the Teddy Bear Clinic and should continue to be a cornerstone of the therapeutic intervention and introduction to the clinic. The study, while achieving its goal of providing some understanding of how the clients experience these interventions at this medico-legal clinic, highlights the need for further exploration of how clients experience these services and interventions at other clinics dealing with sexual abuse, particularly from a South African perspective.