"If a client states she is 'unsure' she was sexually abused as a child, it is appropriate to move forward as if she was?" asks one of the 150+ midwives at the Q&A after my break-out session at the ACNM Tristate conference in September.
Good question. Have you ever heard uncertainty from a client and proceeded full steam ahead anyway? I have.
When I first started working with abuse survivors in 2005, I was trained to do a safety plan with all clients. Years later, after hundreds of clients, I realized not everyone needs or wants this. Many do but some have other needs. But my training dictated my actions...for years. Maybe yours does too. You aren't trained to deal with ambivalence or uncertainty. You and professionals who share your title are trained to identify, treat and/or educate. So what do you do when a patient expresses a lack of clarity around part of their history?
While I don't assume someone is a sexual abuse survivor unless they tell me, I do assume a trauma history. Because everyone is a trauma survivor.
This is especially true if your clients tend to be Black, Biracial or Indigenous. (These folks are more likely to experience trauma than folks from any other racial group.) When you assume past trauma, you meet someone where they are...instead of where you think they should be. You acknowledge that their past is a way to help you both understand the present. This is the initial mindset shift you make as a way to truly see the client in front of you.
Using the above question then, shelve your training for a moment. Remind yourself that this is temporary but necessary to meet the client where they are. After clearing mental space by putting aside your expertise, respond with a validating statement:
"It can be confusing to not know,"
or
"You don't have to answer that right now,".
Your patient understands it's frustrating to be with someone who is uncertain. They get their lack of knowledge makes your job harder. So by offering validation, you are not only "forgiving" their confusion but also building trust.
The next thing you can do is ask a reassuring question,
"What would you like to happen from here?"
or
Hhow do you think I could help?".
It's reassuring to clients to hear that you bring knowledge, support and help...on their terms. This question reminds the client that they are your focus. With a reassuring question you are also inviting them to tell you how best to support them. The final thing you can do is to remind the client that they are the expert of themselves. What?! I know, I know. But stay with me.
Client as self-expert is based on a coaching principle (1) I learned almost twenty years ago. I've used it in every job and with every client I have since. Reminding the patient that they know themselves best is not comfortable when they are the ones seeking you out. What are you there for then anyway, right? But, you are still an expert even if you remind clients that they are too. And the benefits while perhaps not immediate, can be significant.
Naming the client as expert yields benefits for you too.
It can be unnerving to hear a disclosure in an otherwise routine interaction. Sexual abuse can feel like a rabbit hole; get too close and you may not be able to scramble out! But declaring client to be self-expert is a kind, smooth way - to both of you - to wrap up a call or appointment...and prevent both of you from fumbling around in an unproductive, possibly traumatizing way. Of course, that neat finish is only successful when you have followed the first two steps. Otherwise, it could feel insensitive and dismissive.
The decision to assume past trauma and move to meeting someone where they are is a game changer. It can be so transformative for clients because it returns power to them. Someone who feels powerful is someone who takes agency in their own life. And that helps you do your good work, better. So yes, move forward! Not as if the client were potentially damaged but as if they went through something hard. Because at some point they certainly have.
~
(1) From The Coaches Training Institute Co-Active Model: "People are naturally creative, resourceful and whole. They are not broken, don't need fixing and have their own innate wisdom about how to live their lives."