How can you do this work ?

Responding to questions
about the experience of working with women
who were subjected to child sexual abuse

By Sue Mann

This paper explores ways of understanding the experience of therapists who work in the field of child sexual abuse. The author describes how she is regularly asked by women who consult her, ‘How can you do this work?’ The first section of this paper explores the different meanings that this question can have for those women who ask it of their therapist. The second section considers the many different experiences that the author has in counselling conversations with women who have been subjected to child sexual abuse. The final section particularly focuses on those experiences of
therapist distress that sometimes accompany this sort of work. A range of questions are provided in the hope that these will be helpful to other therapists.

When I was first asked the question ‘How can you do this work?’ by a woman who was meeting with me around the effects of child sexual abuse in her life, her question took me by surprise. It was asked in a way that suggested that it must be either ‘hard’, in an onerous way, or ‘depressing’ or ‘upsetting’ for me to be hearing about her experiences of sexual abuse. I had a sense that it implied that my experience of our counseling sessions couldn’t be anything other than difficult.
Since that time, other women have asked me the same question. Sometimes women have let me know that they are aware I am meeting with many women around these issues. They have expressed a curiosity about what it means for me to be hearing all day from women about their experience of abuse and its effects in their life.
Initially, I was surprised to realise that women meeting with me could imagine that my primary experience of this work would involve difficulty, depression and/or upset. This realisation raised further questions for me. I wondered if the women were thinking that somehow I might have to be hardened to this listening, or extraordinarily clever, or professionally detached if I was not to be affected in negative ways by hearing from them. I wondered if they imagined that finding ways not to be affected by this work was a part of doing it. These reflections have encouraged me to consider the complexities in responding to the question of ‘How can you do this work?’ This paper is an exploration of some of these complexities. In this paper I am interested in exploring two questions:
Firstly, how can I respond to women when they ask me ‘How can you do this work?’
And secondly, how can we as counselors explore the meaning of our experiences of this work?

In order to consider ways of responding to the question: ‘How can you do this work?’ it first seems important to explore what this question might mean for the women who ask it of us. I would like to begin by describing the contribution that a woman called Cathy has made to my thinking about these issues. Cathy consulted me about the effects of abuse in her childhood. When we first met, Cathy told me that she knew that she needed to tell someone about the abuse she had experienced, but she felt so concerned for me as a counsellor to hear these things that she was reluctant to begin. I heard from Cathy that she had not been able to speak to other counsellors about her experiences in the past partly because of this concern. I asked Cathy were there any questions that she might like to ask me that would support her to begin to speak about the abuse. These were her questions to me:
What experience have you had in counseling around abuse?
What is it like for you to hear about abuse?
What supports do you have in the workplace?
What are your ideas about counselling and how it works with people like me?

In responding to these questions, I also let Cathy know that I was curious about what these questions of hers might reflect about her preferences in life, and what she knew about what might suit her in telling of her experiences about the effects of abuse. Some of the questions I asked Cathy included:
Do you have some ideas about the kind of telling that would be helpful to you?
Have you experienced telling in the past that has been helpful?
What do you think makes up a helpful or not so helpful telling for you?
What kind of listening assists in the kind of telling that you would like to have?

Cathy was quick to let me know that the kind of telling that was important to her was the kind that would mean that the abuse stopped here, that her telling would not be about abuse continuing to have a destructive, harmful, negative or traumatic influence in the lives of others. This included my life
as her counsellor. We then considered other questions including:
Throughout our meetings, how can we continue to know if this telling is helpful or not?
Are there other people who might support you in the telling of these hard things?

This conversation with Cathy has stayed with me as a reminder of what it can mean for women to take the first steps in speaking out about aspects of their lives that have been so powerfully silenced. It also reminds me of the commitments that accompany women’s wish to speak out and that inform their preferences for how this sharing can take place. Within counselling sessions, concerns such as Cathy’s are quite common. I regularly hear from women about worries they have in relation to what it will be like for me to hear about the abuse they experienced. This concern is often expressed to me through questions like: ‘How can you do this work?’, ‘Doesn’t this affect you too?’, ‘How do you look after yourself?’, and so on. It is also sometimes expressed in other ways. For example, many women prepare me, in thoughtful ways, to hear what they want to speak about. Some women have let me know in advance that there are some very hard things that they want to talk about in relation to the abuse and they want to know if it will be okay for me to hear about these things. Sometimes women have also asked how I am supported in the work and occasionally I have been asked directly what it is like for me to hear about abuse from so many different women.

I would like to consider four themes in responding to the question ‘How can you do this work’.
1. The first involves trying to understand how women’s concerns might relate to their past experiences of trying to talk about the abuse and the history of silencing and disbelief that they may have experienced.
2. The second involves considerations about how therapy works.
3. The third involves understanding about how abuse can affect people’s lives and their experiences of themselves.
4. And fourthly, as mentioned above in my conversations with Cathy, what the intentions, values and commitments may be that are influencing why a woman may care about my experience of listening to her. I will now briefly consider each of these themes.

Often I hear from women who are meeting with me for counselling around the effects of abuse that they have had previous experiences of feeling responsible for causing distress to other counsellors or friends and family members. These women have a heightened sense of the possible negative effects of speaking about abuse. Some women have shared with me how others have responded to them in the past. For instance, they may have been told: ‘This is too hard for me’, or ‘I can’t listen to what you are talking about’. Some women have told me that others have become so upset in hearing about abuse from them that they have been unable to talk further about it. Hearing about these experiences from the women has led me to reflect on my own work and how the women might experience my responses to their stories of abuse. This has led me to be very interested in the meanings the women have taken from those experiences. When women ask me the question: ‘How can you do this work?’, I am interested in hearing about how their past experiences of talking about the abuse may have contributed to some of the concerns they bring to our conversations.
Frequently, women bring to these conversations a long history of being silenced in relation to the abuse – not only by the person who abused them, but by other significant adults in their lives who have not believed them, and by a more general societal discourse that tends to disbelieve women’s stories of abuse (Linnell & Cora 1993). Recognising that so many women have had these experiences in beginning to talk about abuse shapes what I hear when a woman asks me: ‘How can you do this work?’

In trying to understand the significance for women of asking about my experience of being a counsellor, I have come to realise that there are particular assumptions about counselling that contribute to women’s concerns. Many of the women who have consulted me have told me that their concern for me relates to the idea that counselling is a place where someone comes to ‘let it all out’ or ‘get it all out’. This idea that someone comes to therapy to ‘dump’ the abuse in the therapeutic space seems pervasive. It is an idea that the women have often picked up from personal experiences of counselling, or from hearing from other people about their experiences of counselling, or through books, and films. I have even had one woman apologise to me for ‘dumping all that … on you’.
In considering the many effects of this understanding of therapy, I have at times responded by describing that what is important to me in listening to them will be what Michael White refers to as ‘double-listening’ (2004). I try to let women know that, not only do I want to listen to the effects that the abuse has had in their lives, but also to some of the other stories of people’s lives that have been silenced, unspoken, unacknowledged or relegated to the sidelines. I am interested in letting the women know that I will be listening not only to the negative stories but also to stories about their beliefs and values and hopes and dreams. I want to be clear that abuse is not the only story to be told and that I will be listening for alternative stories. These may be stories of resistance – their refusal to kiss their grandfather goodbye may no longer be seen as an example of ‘a naughty girl’ but instead an attempt to resist the abuse. They may also be stories of care, protection of others, stories about loving or tolerance, stories of courage or inventiveness or imagination.

When women first speak with me they frequently describe themselves to me in ways that are about ‘worthlessness’, ‘self-doubt’ and ‘self-loathing’. They sometimes use phrases such as being ‘damaged goods’ or ‘broken’ or even ‘hateful’. In hearing these descriptions, I am aware that I am hearing the ‘voice of abuse’. I am hearing women’s descriptions of themselves as if through the eyes of the abuse.
When a woman then asks me: ‘How can you do this work?’, I try to think about what influence the voice of abuse may by playing in our conversations now. Women have told me that when they first spoke to me about the effects of abuse they were worried that I was going to confirm to them that they were ‘crazy’, or ‘mad’, or in some way responsible for the abuse. They spoke to me about the abuse despite a strong sense that there was every chance that I would think that they asked for the abuse by being ‘promiscuous’ as a child, or that they were ‘naughty’ or ‘weak’ because they didn’t tell anyone earlier, or that I would think that they wanted the abuse because they didn’t stop it, or that I would minimize its effects because it wasn’t ‘violent’ or because the person who was abusive was also kind at times.

When I hear the question: ‘How can you do this work?’, it draws my attention to what the women may have had to overcome to speak to me about the effects of abuse in their lives. It draws my attention to how the interpretations of others may still be playing a significant part in how the woman may understand herself. She may be under the influence of stories about her life that attempt to convince her that she is worthless or to blame. And these influences may also contribute to her thinking that my experience of speaking to her will necessarily be negative.
This realisation is also a source of hopefulness for me in the work. Because, despite the effects of abuse, this person has chosen to speak of her experiences and to begin to question some of the ways of seeing herself that may have adopted a truth status in her life. At these times, Michael White’s idea of the ‘absent but implicit’ is significant to me (2000). The idea that expressions of pain may represent a testimony to certain values that have been transgressed or violated, opens up directions for us to explore together. The person I am meeting with is therefore not someone who I think of as being ‘damaged’ by abuse, but instead is someone with values, hopes, dreams and commitments that have been violated by the abuse. It provides an opportunity for us to explore what those values may be, their history and why they are precious.

This leads us back to the conversation with Cathy that I mentioned initially. When a woman asks me: ‘How can you do this work?’, I am very interested to enquire about the values that inform her question. In Cathy’s instance, she was very clear that the abuse stopped here. She was committed to ensuring that the experiences she was subjected to did not continue to have a destructive, harmful, negative or traumatic influence in the lives of others, including in my life. This was very important to Cathy in how our conversations proceeded, and came to hear how this was a strongly held value in her life.
In hearing about important values that people hold, it is possible to ask more questions about them. It becomes possible to ask questions about the history of these commitments around care and concern. It becomes possible to hear stories about how these commitments have featured in other valued relationships in the woman’s life. It becomes possible to learn about territories of life that have been protected from the effects of abuse.
There are a number of things that I want to consider and keep close to mind when someone asks the question: ‘How can you do this work?’. These are considerations about the influence of histories of silencing; about the effects of certain understandings of therapy; about the effects of abuse; and also the values and commitments that may be informing the question. I am interested in not making assumptions about what this question might mean to the woman concerned.

Finding ways of responding to the question:
‘How do you do this work?’ that honour women’s intentions in asking the question, and that don’t in any way contribute to further silencing of them, has been challenging to me. At this stage, there are a range of different responses that I might give depending upon the context:
Sometimes, I may ask more about what the particular woman might need to know about my experience of the work that would assist her to talk about what is important to her. She may then ask other questions such as: ‘Do you take the stories home with you?’, ‘Who else do you talk to about this?’
These questions provide opportunities for me to talk about the ways that I experience support in my work. They also provide a chance to be transparent about organisational practices of supervision,
confidentiality, documentation, and other workplace practices in ways that assist women to make informed decisions about what they will talk to me about.
Sometimes it seems important to acknowledge that there are times when I do feel sad or distressed in relation to hearing about stories of abuse. I do not remain neutral in hearing about abuse and I try to articulate why this is important to me.
Sometimes I speak about the wide range of responses that I have to this work – responses that range from sorrow, puzzlement, delight and connection.
Sometimes I describe how much I learn from each conversation and how my consultations with one woman assist in working with others. I let them know that the conversations I am sharing with this particular woman will assist me in talking with others.
Sometimes I describe that when I listen to women I am not only on the lookout for the ways that abuse has influenced their lives, but also for the other stories of women’s lives that have been treasured and nurtured over the years but have had little opportunity to be shared with others. I mention that I am always interested in hearing about relationships that may have supported women over years.
Frequently, I acknowledge the contributions that other women who have spoken to me in the past about their experiences of abuse make to my work. I want to let the woman know how much I draw on the knowledge of these other women, and that I couldn’t be doing this work in the same way without the support of these past conversations.
I am interested in learning more about why the question is important to the women, what values and commitments it may be related to. And, if relevant, I then want to find ways to have these richly described.
Finally, I am interested in checking back with the women about the effects of my responses; whether what I have said is of interest to the woman concerned, and whether there are any other questions that may be good to talk about (Morgan 2000).

As I reflect on the question: ‘How can you do this work?’, I am aware that my experience of counselling varies on different days, during the course of one day, and even within one conversation! I am also aware that I am sometimes asked this question outside the context of therapy – by friends, family members, or new acquaintances. Whenever it is asked it makes me think about the multiplicity of experiences of hearing from women about the gross betrayals of trust, the trickery, the pain and hurt of child sexual abuse. In the course of a week, I might have the following experiences within counseling conversations:
Outrage as I hear from someone about the subtle and deliberate ways the sports coach gained the trust of adults in the family and then went on to sexually abuse all the children in the family.
Shared excitement with a woman who has embraced an understanding that she is not to blame for the abuse that was perpetrated on her.
Inspiration in relation to the commitments a young woman shares with me around a particular stand she has taken in her life to protect other children from the person who abused her, even though this may put her own safety at risk.
A sense of pleasure in noticing with women the ways that many of the people in their lives contribute to life in ethical and caring ways.
Distress in relation to how insidiously the words of the person who has abused still influence and have a say in a woman’s life fifty years after these words were spoken.
Laughter and joy in relation to the boldness and humour of some of the strategies women have developed to reclaim their lives from the effects of abuse.
Concern, worry and fear for the safety of particular women either in relation to possible acts of self-harm, or in relation to violence from which they are at risk.
Hopefulness about what speaking about the abuse might offer the women in having less of these effects of abuse in their lives.
Despair at how some people in positions of power and influence use that power to abuse the vulnerable.
Deep sadness in coming to understand what it meant to small children to have to somehow make sense of the abuse in total isolation.
Shared pleasure as a woman puts a name to another story of her life that reflects her commitments to care for herself and others, and that can be traced back to acts she took to protect herself and her siblings during their childhood. Such a story might be named ‘the great escape’ or ‘a life dedicated to protecting and caring for children’.
There are, of course, many other aspects of the work that I could describe here, but I hope this list gives some sense of the multiple meanings that my counselling work has for me. What I would like to do now is consider in more detail what it is that makes this work sustainable. To me, that is what the question: ‘How do you do this work?’ is really asking. What makes my work sustainable includes taking care with how I listen and respond to stories of trauma and abuse and how I am supported in doing so, and also finding ways to acknowledge and celebrate with others the positive stories of this work.

One of the first things I noticed in working with women who experienced child sexual abuse was the powerful effect of isolation in their lives. I heard from women how the person who perpetrated the abuse had deliberately isolated them as children. This isolation occurred through threats, manipulations and by confusing the children. The isolation took a range of forms:
It involved isolation from other supportive adults who might have protected them as a child.
It involved isolation from other children who were also being abused by the same person. If these children had been able to speak to each other about their experiences this could have contributed to different meanings being made about the abuse.
Over time, the women had been separated and isolated from any knowledge of their responses to what was being done to them (White 2004).
They had also often been disconnected and isolated from what was important to them – their key values, hopes and commitments (White 2004). Many women have spoken to me about the effects of these forms of isolation and what they have meant in their life. For children to be isolated in their attempts to make sense of events of abuse creates a context for feelings of shame, doubt, guilt, anxiety and fear to flourish. When one aspect of therapeutic practice with women who have experienced child sexual abuse involves noticing the effects of this isolation, it seems ironic that therapists can often work in contexts of isolation themselves. Therapeutic conversations often occur between two individuals. Therapists are often physically separated from each other in the workplace. And some organizational practices, such as individual supervision, tend to support an individualised approach to therapeutic work.

In saying this, I don’t mean to disregard that some women have a clear preference for seeking individual consultations. Nor do I want to downplay the ways in which therapists may engage with re-membering conversations and outsider-witness practices in their work with individuals (Mann & Russell 2002). And, of course, many organisations bring women together in therapeutic groups, ongoing support groups, shared counseling experiences, educational forums, and/or family therapy programs and/or provide peer support for workers. However, I also want to consider how some workplace processes may inadvertently perpetuate isolating practices. I have become particularly interested in being on the lookout for:
workplace practices that might contribute to therapists/counsellors being left on their own to make sense of challenging and complex work experiences;
practices that might contribute to separation and divisions between colleagues. These include comparative or competitive practices that imply that workers are required to ‘measure up’ to a particular definition of what makes a successful worker;
assumptions that might prevent workers from speaking about some of the dilemmas in the work. These include the assumption that workers individually ought to ‘have all the answers’;
practices that might separate therapists/counsellors from their own knowledge of what they bring to therapeutic conversations in terms of ideas, experiences and particular commitments, values, and so on.

For each of these workplace practices that leave room for isolation there are alternative practices that support connection in this work. For instance:
practices that create forums where it is possible for workers to speak about challenging and complex experiences of the work;
practices that enable workers to speak about and contribute to discussions around the many different ways that the work can be done;
basing a workplace culture on the idea that, rather than individuals having to ‘possess’ the answers, answers can instead be generated through conversation and collaboration;
developing workplace conversations and processes that acknowledge the unique ideas, experiences and commitments of each worker. It has been through hearing from women about the effects of isolation in their lives that I have come to appreciate that I am not exempt from the influence of prevailing cultural isolating practices that work to separate people from one another. In considering this, I have become more aware that what makes my work sustainable are practices of collaboration. Sharing a commitment with others to notice practices that might work to isolate or separate us in the workplace strongly supports me. It supports me not only in finding ways to resist isolating practices but also in considering creative ways to keep conversation and collaboration more present in my work.

I have come to appreciate even more that what is important to me in standing against isolation is the notion of community. I want to think about my work not as a singular endeavour but as part of collaborative and community attempts to address issues of abuse and violence. This notion of community also influences the attention I pay to asking questions about the relationships that sustain the women I am talking with. These might have been relationships during their childhood, or current connections with friends, children, partners or support groups. They may even be relationships with those who are no longer alive.
This orientation to community also influences my own sense of the work. In writing these words, I am reminded of the community of people who I with me in my counselling work. This community is made up of the people who have consulted me in the past, my work mates, colleagues, friends, family, and authors who have shared their thinking via the written word. This is a community of people with whom I share particular commitments to challenge the social and cultural practices that contribute to abuses of power. This is a community that I value. In keeping connected to this community, I know that I am not alone in the work. I am also constantly reminded that any attempts to respond to abuse and violence are not singular efforts, they are linked to shared knowledge, commitments, and actions that many people are taking in a vast array of contexts

Recently, I have noticed that increasing attention is being paid to the effects on counsellors, crisis workers, police, ambulance workers, etc, who listen to, or witness traumatic and/or abusive events in people’s lives (Weingarten 2003). In the counseling field, this interest has particularly focused on workers’ experiences of distress, sadness or fatigue; ways of understanding these experiences; and methods of support for workers (Richardson 2001).
This recent attention has encouraged me to think further about ways of understanding the ‘hard parts’ of this work. It has invited me to consider ideas of wellbeing and self-care in relation to hearing from women about the abuse they have experienced. It has also had me thinking about how we understand possible experiences of distress, sorrow, shock and upset that can at times accompany this work.
Before I discuss the various ways I might consider responding to these experiences of distress and sadness, I first want to acknowledge that I am working in a supportive environment, in a wellresourced organisation, in safe circumstances. The chances of me experiencing violence in my daily life are very slim. This is not true for all counsellors.
I do not want to assume that what is relevant to me in my context is relevant to those who are working in very different circumstances. In this section, I will offer some understandings that I find helpful to think about when I notice feelings of distress, burden, sorrow, or a sense of being overwhelmed in relation to my counseling work with women survivors of childhood sexual abuse. I offer them here in the hope that they may be helpful to other therapists and that this can contribute to further conversations on this topic.

An opportunity to acknowledge what is being noticed
Distress does not occur by chance. In my experience, it often reflects some new learning, or realisation that has occurred through hearing particular stories about abuse and trauma. Therefore, feelings of distress can provide an opportunity to put a name to and to reflect upon what it is that a therapist may be noticing differently. This could include a new awareness about certain understandings about life. For example, the therapist may have realised that they have gained a greater knowledge about the extent of abuse in the world, or lost an unawareness in relation to the extent of abuse and hardship in the world. Or, a therapist’s distress may relate to new realisations about the experience of those who have been subjected to abuse (for instance the extent of the fear that may have accompanied someone’s early life, or the practices of power and entrapment that they were subjected to). Alternatively, feelings of distress may relate to the ways in which a particular story has confirmed the therapist’s own experiences of life (for example, a particular story may powerfully resonate with aspects of a therapist’s personal experience). These feelings of distress can be opportunities to develop, revise and think more about our ideas about the world and about the sorts of lives we wish to lead. They are an opportunity to consider how this can be taken into conversations with others.

An opportunity to acknowledge values,wishes and hopes
A counsellor’s distress might say something about what is important to the counsellor.It might indicate that certain values, wishes and hopes that she/he has about the world have been transgressed in some way (White 2000, 2004). I am interested in understanding the meaning of this distress for a counsellor. It might have occurred in relation to hearing particular stories, or witnessing or participating in certain workplace practices. This distress can be an opportunity to hear more from the counsellor about the important values, hopes, dreams and wishes that they have for how the world should be and about the history of these values.
Experiencing distress can therefore be an opportunity to have these values, wishes and hopes spoken about and more richly storied. This, in turn, can provide a foundation for further action that is in accordance with these values and wishes. Creating opportunities to understand the distress they may
experience as related to certain cherished values they hold provides different avenues for conversation, support and action. This has become an important understanding for me in my work.

If I am feeling particularly moved or upset by a certain conversation, I am now also interested in thinking through, and talking with others:
Why was this conversation or series of conversations particularly significant to me?
Does my upset or distress relate to certain beliefs, values, wishes, hopes that are important to me?
Why are these values significant to me?
How can I find connection with others around these values in my work and the rest of my life?
What further action might I be able to take in relation to my work that would fit with these values?

An opportunity to consider workplace practices
One of the understandings that assists me if I notice that I am struggling in the work, is to consider whether certain stories of my work are being neglected. I am interested in exploring other themes that may have been neglected or overlooked and need to be brought forward. I am particularly interested in ways that this can be done that stand against isolation; I want to consider how conversations about these other neglected stories can be shared and witnessed. A therapist’s distress may therefore be an opportunity to consider generating organisational practices to enable workers to richly describe the commitments, beliefs, hopes and values that influence each person’s work.

It might be an opportunity to consider how there can be a more collective sharing of stories of the work. Questions worth considering might include:
What opportunities are available for workers to talk about the many experiences of the work?
Of the many different stories of work that could be shared, what stories and whose stories are being privileged?
How are the connections people have to what is important and of value to them shared in the workplace?
What opportunities are there for celebrations in relation to the achievements in the work?
Are there opportunities to share moments of sadness, moments of beauty, moments of joy?

An opportunity to reconnect with local knowledge and relationships
Some understandings about therapy locate the therapist’s knowledge and interventions at the centre of change. This understanding can contribute to experiences of despair and burnout. A therapist’s fatigue, or sense of burden, can become an opportunity to reconnect with the significance of local knowledge, skills and histories of experience in addressing the effects of trauma and abuse.
Rather than thinking that we as therapists can independently assist people to deal with the effects of child sexual abuse, notions of de-centred practice enable us to consider how we bring into our conversations the skills and knowledge of those who are consulting us. Questions to consider might include:
How is the work valuing and building on the contributions of the community of people that might support those we are meeting with?
Are we finding ways to document, and create an audience for, the skills and knowledge that the women with whom we meet have demonstrated in responding to the effects of abuse in their lives?

There are many people who find ways to reclaim their lives from the effects of trauma without ever consulting professional help. Keeping an awareness of this assists me to privilege the many aspects of local knowledge and relationships that support people in dealing with these effects. This can include: the care from significant others who have never given up on the person concerned, or whose image and faith in the person has never waned; acts of self-care that have offered sustenance; the role of spirituality; political movements; pets; connection to the earth, rivers, oceans, and so on. I am interested in how we can ensure that the role of the therapist is not valorised over the everyday acts of meaningmaking that support people in surviving trauma and abuse. I am interested in how local knowledge can be valued, especially when we are trying to understand therapists’ experience of their work.

An opportunity to connect with others around the politics of the work
An individual therapist’s distress is also an opportunity to notice, name and connect with others around the politics of the work. Responses to violence against women originated within a collective, political feminist movement and as therapeutic practice has become the primary way in which violence against women is now responded to, various writers have raised concerns about how this individualises and depoliticises the issue. Whenever an individual therapist is distressed at the stories being heard, this can also be an opportunity for re-connecting with wider feminist consciousness and political action. Distress can be an opportunity to not leave these issues in the private, individual realm. Questions to consider might include:
Who else would be most likely to share this sense of distress / outrage?
How could we come together to take some form of action as an outcome of this distress?
How can the ideas and understandings gained in the conversations of therapy inform organisational responses, policy, legislative responses, education of other therapists?
How can what is talked about in the therapeutic conversations connect women with each other around their common experience of life in ways that enable broader social action?
How are the politics of gender, class, race, age and heterosexual dominance being named and responded to within the conversations that are occurring in therapy and by the organization more broadly?

An opportunity to acknowledge that what is sometimes most distressing is not the stories we are hearing
Sometimes what is most distressing in a workplace is not so much to do with the stories being shared in counselling conversations but more to do with other aspects of the work. For example, when I was working as a hospital social worker, one of the most difficult challenges for me and colleagues in our department were the ways in which women were spoken of and treated by those in positions of authority. At different times I experienced this as distressing. Some of my colleagues and I tried different ways of responding to this situation. These included: asking questions about people’s intentions in speaking this way; raising the matter in formal ways at organizational meetings; and trying to demonstrate an alternative way of relating within the wards. I often had a sense that nothing changed in spite of this and was at times feeling considerable despair about this.
A response that made a key difference to me was offered by a therapist who worked in a different setting2. After a discussion together about the political nature of this work and the efforts that we were making to try to influence the hospital culture, this colleague gave me a small plastic figurine of a deep
sea diver. She described that she thought this image of a deep sea diver related to the work we were engaged with. The actions we were taking were frequently quiet, un-noticed and underground (or underwater in the case of the diver!). And yet they were also productive, hard-working, busy and seeing the world from a different perspective. I stuck this deep sea diver figurine to the front of my diary and it accompanied me to ward rounds, allocation meetings, case conferences, and planning meetings. It provided a visual reminder to me of the important preferences that I had for my work as well as a tangible reminder of my connection to others who shared these values and understandings. It wasn’t so much the nature of the conversations I was sharing with hospital patients that was causing me distress but more the actions of disrespect within the hospital culture. This has stayed with me as a reminder that experiences of sadness or distress in my work as a therapist might not be due to the stories I am hearing.

Questions that may be relevant to consider include:
Does the distress relate to the stories that are being heard in the counselling sessions or to other interactions in the workplace or home life?
If other areas are the source of the distress, are there ways of seeking support in relation to this?

An opportunity to consider the real effects of different understandings of a therapist’s distress
The ways in which we understand therapist distress or sadness will have differing effects on our work, our lives, and on the lives of those who consult us. Whenever we are engaged in conversations about experiences of our work, how can we keep this in mind? A question that might be relevant to include is:
How can we take care so that the ways in which we understand our experience of therapeutic work honour the multiple contributions that women who consult with us make to our lives and work?

An opportunity to link with others
Whenever I experience distress or sadness in relation to my counselling work with women, I am now determined to ensure that I am not isolated in this experience. Each of the themes listed above has become a source of conversation with friends, family members, colleagues, or within formal supervision. I would be very interested to hear from you about whether these sorts of explorations about your experiences of your work are helpful.

The question: ‘How can you do this work?’ was first asked of me several years ago and I have been thinking about it ever since! The conversations I have had with other women, colleagues and friends have influenced the ways that I think about what sustains me and how I might respond when I experience distress related to this work. In the first section of this paper, I tried to explore the varied meanings that the question:
‘How can you do this work?’ can have for those women who ask it of their therapist. In the second section, I tried to describe what this question means to me and how it invites me to consider the many different experiences that I have in counselling conversations with women who have been subjected to child sexual abuse.
In the final section, I tried to particularly focus on those experiences of distress that sometimes accompany this sort of work. I have tried to provide a range of questions that I now find helpful to think through whenever I may feel overwhelmed. I hope that these reflections and questions will contribute to your own conversations around what makes this work sustainable for you, and your own responses to the question: ‘How can we do this work?’

Thinking about my experience of counselling is a continuing project. What I have been able to write about here is an outcome of the many conversations with women such as Cathy who have consulted with me and who have been a part of this journey of learning with me. It is also an outcome of many conversations with colleagues. I’d like to especially acknowledge my colleagues that I worked with at Uniting Care Wesley, and within my current supportive workplace, RespondSA. I would particularly like to acknowledge the ongoing contribution to my work of Andrew Groome who has been a colleague in this work for several years. Conversations with those at Women’s Health Statewide and at Dulwich Centre have also been very significant to me. In particular, I would like to thank David Denborough for his encouragement, editorial direction and understandings with this writing. The comments on an earlier draft by Jodie Sloan and Alice Morgan were very helpful.

1 Sue Mann works as a therapist in the child sexual abuse team at RespondSA and as a teacher at Dulwich
Centre. Sue can be contacted c/o Dulwich Centre Publications, PO Box 7192 Hutt St, Adelaide, 5000.
2 This therapist was Leela Anderson from whom I was receiving supervision at the time.

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