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This is an account of my involvement in the case of two sisters, Janet (5) and Emma (3), who were referred in an atmosphere of crisis to the child guidance clinic where I work. Janet had been raped by a 16-year-old boy and both their parents had also been arrested in separate charges of child sexual abuse (CSA). There were urgent and repeated requests from the social worker involved for psychiatric help for the children. Known normally for being relatively sensible and contained in her work, she was telephoning the clinic with increasing urgency demanding immediate intervention.
The experiences of the following four months were extremely instructive ones, and in this paper I wish to share them and to reflect on the pressures to take into psychotherapy children whose primary needs for the time being lie elsewhere, especially in cases of CSA. Psychotherapists all over the country must be, as I am, frequently receiving requests to offer treatment to the wave of CSA referrals' emerging from recent publicity, and it seems highly important to give some thought as to both whether and when psychotherapy is the response these children need in the aftermath of disclosure.
I also hope to show how indirect consultative help can be of greater use at a time of crisis and upheaval, and in the process, to isolate some of the emotional factors particular to such children and their caretakers. I will not be discussing the assessment itself in detail, as this would raise other issues beyond the scope of this paper that need serious consideration in their own right.
It should be stressed that much of the following material only emerged piecemeal, much only becoming clear at a very late stage of the consultation. Such was the pressure on the social worker and foster mother that one of the first casualties was the capacity to convey clear and coherent information to us.
As is so often the case with CSA, Janet and Emma's story combined a long-term background of emotional difficu