Trust the survivor: Why it mattered that my counsellor was a woman

On learning that I was about to begin attending counselling and therapy, a friend (who had had her own experience of therapy) contacted me late one night telling me that I should not be afraid to change counsellor if I felt that the relationship was not right. It seemed an odd thing to say when I’d not even been through the door for an assessment at that point. But it stuck with me.

I understand now what she meant. And the reports from the employment tribunal between Roz Adams and Edinburgh Rape Crisis Centre have given added salience to her late-night message.

Therapy and counselling is about trust. It is always about trust. Attending a service can be in the aftermath of an incident or can be months, or in other cases years later. Choosing the service involves trust. And the process of counselling itself does not immediately involve attending a session and revealing everything that happened. Early meetings involve finding out about the counsellor as much as they are finding out about you.

Over the course of months in counselling and therapy I spoke about things I’d never spoken about to anyone, not friends, not partners, not family. And through the vulnerability, the transparency, the honesty that comes to frame the sessions the relationship of trust is absolute.

But it was not there from the first day. I did not immediately begin talking about the darkest things that had happened, the guilt, the shame. Even after the initial meetings where the counsellor and I both knew why I was there I talked around it. I talked about other things. I talked about talking. I would mumble about “the incident” or – reaching for my inner Mitchell and Webb – would refer to “the event”. Despite my counsellor knowing why I was there in general terms, it took me a number of sessions to tell her directly what happened, why I needed help. Building the required trust took time.

So, how is that rapport built?

The initial allocation of counsellor or therapist was one over which the survivor – when attending as I had through the third sector and the NHS – has little control. But there was one thing over which I had control: the sex of the counsellor. That was stressed in the introductory contact. The services I used knew that it made a difference.

To some this might seem odd. But it mattered. When asked whether I wanted a male or female therapist I asked for the latter. I was insistent. I explained that I would be deeply uncomfortable with a male therapist. In both charity and NHS this was not questioned.

But why was it so important to me?

At the age of ten I was assaulted in my house, in my bedroom, in my bed. The boyfriend of our babysitter came into my bedroom. He abused me while his girlfriend was downstairs.

Since crying myself to sleep that night I have been and remain uncomfortable in solely male company. I tense, physically and emotionally. My shoulders tighten. My breathing shallows. I look for escape routes. I have physical manifestations of psychological distress. I find discomfort in the men who sit too close, the men who invade space, the men who look at others for too long, the men who ease proprietorial hands onto shoulders or backs. The men who know you know. The men who get a kick from knowing you know, the men who subtly bully, the men who smile at you, teeth bared without the smile reaching their eyes.

As a survivor you are hypervigilant. Aware of your own triggers, the looks, the smells, the presence that impact on when you feel safe, when you can be open, transparent, vulnerable; when you can trust.

Before I attended counselling I had sat and told three women what had happened in general terms – a close friend, lovers. I told no man. Not for decades. Not until I felt I had to tell my male GP that I had experienced childhood abuse in order to access treatment. I was uncomfortable, ashamed, guilty. From PE changing rooms at school, through all male meetings at work. I felt eyes watching me. I felt vulnerable. I felt under threat. I could not trust men.

So when I attended a charity supporting adult survivors of childhood abuse seeking counselling and was asked whether I wanted to speak with a male or female counsellor I asked to meet with a woman. And they agreed. They told me most of those attending, male and female, asked to meet a woman because most perpetrators of sexual violence are male

I met with her for months. And the counsellor was the first person I told about the detail of what happened.

When asked whether I wanted a male or female therapist I asked for the latter. I was insistent. I explained that I would be deeply uncomfortable with a male therapist. In both charity and NHS this was not questioned.

To help and support the patient it is necessary that he or she feels from the beginning that there is the possibility for the growth of a relationship of trust. And if, given the nature of the circumstances that led the patient to seek treatment, to seek support, he or she would like to see someone from a particular sex that matters. I don’t know that I would have been able to discuss the detail of my assault with a male counsellor, or someone who I knew was male whatever way they identified. Denying my experience, my trauma, what I knew of who was in front of me that would have mattered for the relationship of trust. How can the relationship build when there appears no honesty, when what could be the most important relationship of your recovery, be based on suppressing what you see and feel, be based on what heart and head is telling you is a lie.  

My sex, the denial of my sex, was pivotal to the assault, pivotal to understanding what happened, pivotal to any prospect of recovery. To discuss this, to address this in any meaningful way, I needed to have absolute trust.

Prior to the Adams case, when women (typically) have raised concerns regarding people working as counsellors for charities, in rape crisis centres, women’s refuges, shelters for domestic violence, or with survivors of childhood abuse about those natal males who self-identify as women working in these environment these concerns were presented by certain politicians, commentators, and some academics as being unreasonable, belittled as wee women’s concerns, anti-progressive, reactionary. That inclusivity trumps trauma.

Some wave their flags decrying those concerned as being on the wrong side of history. Having read the piece by Joan McAlpine on the meeting of survivors at ERCC I see that some said that the women were on the wrong side of the law (an unsustainable view given the public guidance on the Equality Act and its comments on single sex services such as support services for those who had been raped). The Adams case appears to show that what should be at the centre of counselling for survivors has been ignored in some places.

Therapy or counselling should be patient-centred. The survivor sits at its heart. What is notionally inclusive for some is exclusive for others. That survivor needs to trust the process, to trust the therapist. The reasons a patient (be they male or female) does not want counsellors of a particular sex or to attend are rational and dependent on his or her experiences, often the very experiences that lead them to take the enormous step of seeking help and support, and should be respected. Not doing so will lead to self-exclusion. If the success of treatment depends on trust, in those services supporting victims of sexual or domestic violence we should trust the survivor.

The author's name has been withheld to protect their anonymity.