Working with survivors of abuse who are navigating the criminal justice process can feel challenging. Standing at the intersection of the criminal justice and mental health systems creates a push and pull experience, as we try to offer the best for traumatised clients.

Therapists work with a client’s subjective experience, following their lead, and respectfully believing their account of what happened as it is disclosed. The criminal justice system values objective facts based in evidence and moves at its own pace. Furthermore, a victim is only believed if there is enough evidence for a ‘guilty’ verdict.

The result for survivors is often re-traumatisation, silencing, and disempowerment:

‘The process wasn’t what I expected at all. I wasn’t properly informed of what was happening nor why… The disadvantages of reporting are that it takes a lot of time and a lot of energy when there’s a lot more going on in your life besides the assault. I also had to [make] excuses as to why I had to be off work. Once I had to make something up for a family member about why I was appearing in court.’ Sam

Should a therapist be working with a client who has been the victim of a crime, whilst they are undertaking the criminal justice process, they are considered by the Crown Prosecution Service to be accessing therapy ‘pre-trial’.

What is Pre-Trial Therapy?

For readers who are unaware: ‘pre-trial therapy’ refers to legal guidance on how therapy notes can be requested, court ordered, and possibly used as evidence in criminal proceedings.

Requests and court orders can happen at any time during or after a survivor accesses therapy. There are many implications for clinical practice given that responding to either of these means sharing a client’s personal data that can be viewed by any number of legal professionals, and possibly the perpetrator(s) who have harmed them.

The idea of a private, safe therapeutic space for survivors is out of our collective control as soon as a survivor begins the criminal justice process. Managing a clients’ emotional and stress responses, alongside our own, becomes a task in and of itself.

Offering talking therapy pre-trial involves upholding the client’s right to their own story, and being allied against the silence that enables abuse to happen:

‘In the past I felt “I can’t verbalise this” and some things were literally unspeakable for me. I have never been able to verbalise it until I was in therapy. That was in a safe place. I couldn’t imagine doing it in a police station or in court.’ M

The area of pre-trial therapy has a long history of restricting access to therapeutic support for victims of crimes – mostly survivors of sexual and domestic abuse. For therapists there is no standardised nor mandatory training on this topic, leading to a lot of stress and confusion on how to support clients at a vulnerable time.

My own experience reflects having to find one’s own way within a nuanced arena. Two years post-qualification in 2016 I found myself being confronted with the CPS guidelines, having never even heard of them before, whilst leading a specialist therapy service within the Rape Crisis network. Since then I have been raising awareness, lobbying to change the guidelines for the better, and developing training and resources.

Different areas of the United Kingdom have different legal systems, with varying versions of pre-trial therapy guidelines. In this article I can speak to working with survivors of sexual abuse reporting in England and Wales, within pre-trial therapy guidelines issued by the Crown Prosecution Service (CPS).

Common Concerns & Myths

But first, I’m going to address some common worries therapists can have when working pre-trial. It is a myth that these legal guidelines only apply to survivors of sexual and domestic abuse; they apply to any victim of any crime.

I believe this myth has partly been perpetuated because the CPS guidelines only refer to victims of abuse. There are many ongoing efforts to improve the system for survivors, but change is slow and inconsistently felt by those brave enough to tell someone what happened.

Attempts to change the guidelines (including my own) have therefore come from politicians, organisations, and services concerned about survivors’ rights to access confidential therapeutic support following abuse.

Between 2001 and 2022 there was a clause in the CPS guidelines stating a victim of a crime couldn’t speak to anyone about their experiences, including in a confidential therapy setting. The reason for this was due to concerns in the legal system that the victim’s oral account of what happened could somehow be changed, thus weakening their primary evidence.

The result was profound, and still echoes to this day. Some services felt that therapy could not be offered if a survivor could not speak freely, turning them away until their engagement with the criminal justice system ended. Survivors were forced to choose between reporting and being supported, which is impossible and unjust.

Other services offered time-limited, structured work to try and help in some way without risking ‘contaminating’ evidence. Survivors empowered to report to the police part-way through therapy (possibly even as a result of therapy) may have been told they couldn’t speak further about their lived experiences – reinforcing the silence surrounding their trauma.

This clause was lifted in May 2022, when an updated version of the guidelines was issued by the CPS. Therapists and support organisations should update their practices accordingly, stepping towards their clients who have been brave enough to navigate an often re-traumatising system.

Minimising Third Party Intrusions

In my years of clinical practice, supervision, and training in this area I feel strongly that the phrase ‘pre-trial therapy’ is very unhelpful. It sounds as though therapists need to offer a special type of therapy to victims of crimes, that we are specifically preparing clients for court, and that therapists work closely with the police as a matter of course.

It is important to assure clients that they can access therapy as they would at any other time, and that we work independently from the legal system and police. The CPS guidelines themselves make this point clearly, along with the following:

‘It is for victims to make decisions about therapy with their therapist. Criminal justice practitioners should play no role in the decision-making process beyond alerting victims to the availability of therapy’.

Supporting Marginalised Clients

Doing so is especially important when working with survivors of marginalised communities such as: LGBT+ people, sex workers, Black clients, and people of colour. If clients from these communities already mistrust or fear the police, their notes being requested or court ordered as evidence can exacerbate pre-existing feelings of anger, oppression, and/or discrimination towards the legal system:

‘If there’s anything out there about sexual violence I can tell you that none of the victims look like me, a black man. That includes all these high-profile cases coming out. Racism sets up the idea that we can only be perpetrators, so how can we be affected by abuse? The same goes for my gender. It’s even more difficult when you think about race and gender together.’ Rob

It should be noted that some clients have positive contact with the legal system, even if the final result isn’t as they’d hoped. For some survivors reporting feels incredibly important for their own sense of justice, or to stop the abuser(s). Within therapy, it is common for survivors to share mixed feelings:

‘Once I reported straight away as I was attacked by a stranger. Then two men found me and they took me to a police station. I found talking to the police okay then. They were really kind and supportive. But there’s also lots of things I didn’t report from my childhood because I felt ashamed and I didn’t think they would believe me. I had no evidence so it felt pointless.’ M

‘I was able to accept that it happened and knowing more about the stranger who assaulted me was helpful in making sense of it.’ Sam

Many survivors’ experiences of the legal system is that it is happening to them, not with them. Unfortunately, this is the perfect breeding ground for re-traumatisation. We must make efforts to minimise this disempowering dynamic when working therapeutically pre-trial, clearing the way for survivors to access the support they deserve.

How to Increase Clinical Confidence & Competence

My clinical experience has taught me to be well-informed about the CPS guidelines, legal procedure, and the reality of going to court. Doing so enables me to communicate clearly what happens if a clients’ notes are requested / court ordered, liaise with legal professionals confidently, and signpost to external support for reporting and going to court.

Survivors need to be made aware as often as possible that they have the right to access therapy and pursue justice simultaneously, and can speak freely with me. I can also offer choices when requests for therapy notes are made, based on informed consent, at the clients’ pace.

Being a solid presence at the intersection of the criminal justice and mental health systems means repeatedly offering survivors transparency, emotional validation, and collaboration when they may need it most.

All quotes are from survivors interviewed for: Hadjiioannou, E. (2021) Psychotherapy with Survivors of Sexual Violence: Inside and Outside the Room. Routledge: London. Click here to buy your copy.

For upcoming training on pre-trial therapy visit: www.pretrialtherapy.co.uk

On the topic of pre-trial therapy: therapists are ethically required to be aware of any guidance or legislation that is relevant to our clients.

What are pre trial therapy guidelines?

There are different versions of pre trial therapy guidelines throughout the UK, issued by the corresponding legal bodies in those areas (England & Wales, Scotland, northern Ireland).

You can read the Crown Prosecution Service guidelines on pre-trial therapy here:

https://www.cps.gov.uk/prosecution-guidance/pre-trial-therapy

There is a dedicated chapter in my book on pre-trial therapy in England & Wales, including quotes from survivors of abuse who have navigated the criminal justice process:

https://www.routledge.com/Psychotherapy-with-Survivors-of-Sexual-Violence-Inside-and-Outside-the-Room/Hadjiioannou/p/book/9780367429515

What do the pre trial therapy guidelines say?

The pre trial therapy guidelines apply to any client who is a victim of any crime – not just survivors of abuse. Historically these guidelines have been disproportionately applied to people affected by sexual and domestic violence.

The result has been restrictions in survivors’ rights to speak freely in a confidential setting, and to access therapeutic support when requested. Furthermore, the use of therapy notes as evidence in criminal proceedings has been experienced by many survivors as intrusive and re-traumatising.

When the Crown Prosecution Service guidelines changed in 2022, the clause that the victim of a crime can’t talk about details of said crime in therapy was finally lifted. Clients can now speak freely when pre-trial. Equally, therapists can offer their services to survivors of abuse / victims of crimes as they would at any other time.

How can therapists help clients pre trial?

Therapists have an opportunity to provide a supportive and helpful experience for the relatively brief amount of time we work with a survivor.

It shouldn’t be down to luck as to whether a client gets what they need within a largely inaccessible mental heath system. If they have navigated the system to meet you, as well as managing their mental health to get to an appointment, we should step up accordingly.

Take action if you recognise the system doesn’t work for survivors. Write to your MP, write to your regulatory body, demand that your training course supports you to work pre-trial, and contact organisations who challenges the restrictive guidelines to make change collectively.

More than this: listen to survivors, make space for the reality of their lived experiences, and use your professional power to advocate for and with survivors to make change.

If you are a survivor of abuse navigating the criminal justice system, I can offer psychotherapy pre-trial.

If you are a therapist or organisation seeking training on pre-trial therapy, I can help.

Contact me at enquire@therapy-leeds.co.uk.

For some people this is true, but for others the impact of trauma can push to the front of your daily life at unexpected times, in unexpected ways.

How does trauma affect people?

The impact of trauma is very powerful as it forces our lives and sense of self to be re-configured. When the past enters the present via re-living traumatic experiences, your life might not feel like it belongs to you anymore. Feeling out of control might also become your new normal.

However trauma re-surfaces, it isn’t a personal failure. It doesn’t mean you aren’t handling it well enough, you’re not strong enough, or that you’re letting other people down by not being okay.

Lots of people worry about suddenly being affected by something traumatic that happened a long time ago, especially when they have been coping with it well for a long time.

For some people certain life stages can bring past events to the foreground. This might be:

• The anniversary of the traumatic event
• A perpetrator of violence dying
• One’s child reaching the age that they were at the time abuse happened

How far does the impact of trauma reach?

Trauma is not only interwoven into the lives of those who survive it but within families, communities, institutions, and societal systems. It is normal to feel affected by a world that comes with the risk of being hurt, especially if your traumatic experiences included being hurt by other people.

When trauma re-surfaces it’s helpful to think of it in the context of your own chronology to understand why now, as well as what you want to do about it right now. The “why” might not be clear, but the truth is that you have survived and lived with trauma so far, so you’re not starting from scratch in continuing to cope.

If you need help to manage the impact of sexual abuse and trauma, contact me at enquire@therapy-leeds.co.uk.

From trying to access support, finding the right service/person to suit you, and to actually doing the work, there are many questions that come up. Here are some common ones:

Therapy is…

Psychotherapy and counselling are types of talking therapy which can help you to understand and manage your mental health more effectively. This does not include diagnosis nor prescribing medication, so is different from a psychiatrist or other kind of medical doctor.

There are many different kinds of therapy which you can access for free/low cost via the NHS and third sector, or privately if you are able to pay yourself.

What kind of therapy should I have?

It’s best to look for a service or therapist that explicitly offers support for the things that you’re struggling with.

In addition to this, consider what might suit you:

• Would you like short-term or open-ended therapy?
• Would it help to be heard and supported by others who have had similar experiences in a group, or speak to a therapist individually?
• How structured do you need appointments to be?
• Is your priority managing symptoms so you can improve daily life?
• Do you need space to explore past events?

Visit the Mind website for explainers on different types of therapy:

What happens in a session?

In order to support you, your therapist needs to learn about you and what you need.

They may ask you questions to understand what you’re struggling with now, any coping strategies, your support network and relationships, and significant experiences in the past which you feel affect you currently.

You have a space to speak freely and ask questions, to make progress together.

I ask that we identify a goal or focus at the beginning of our work, so that we both know and agree on what’s important to change through psychotherapy.

I believe therapy is a two-way process. This means I am pro-active and share my thoughts with you. In this way we can think, explore, and try new things together at your pace.

Isn’t it all just about me finding the answers?

Whilst the focus is on you as the client, you are not the only person in the room. This means therapy is a two-way conversation and a collaborative process, rather than you being expected to find answers and coping mechanisms yourself.

Ready to start therapy? Contact me at enquire@therapy-leeds.co.uk.