Angela Voulgari - Mental health support is as vital as having food and shelter
We spoke to Angela Voulgari, the Lead Officer for the Equally Safe Edinburgh Committee (ESEC) which is Edinburgh’s Violence Against Women Partnership. Angela is a trained psychotherapist with over 20 years of experience in the violence against women sector.
In this interview we discuss mental health as a right for women, a counselling service for women who sell or exchange sex that Angela helped to pilot in Scotland during the pandemic, and we reflect on the role that all services have in supporting the mental wellbeing of women.
Angela, you have a vast experience in this sector and came from a mental health route. Can you tell us more about your background and your experience working with women who sell or exchange sex?
I came into my current role as Equally Safe Edinburgh Committee Lead Officer in 2021. Before that I held various roles in violence against women projects and services, including SACRO. My actual training was in psychology, counselling and psychotherapy. I’ve worked with women affected by a range of types of violence against women (VAW), including survivors of childhood sexual abuse, domestic abuse, women who have been trafficked, who have experienced FGM, forced marriage, so quite a range of issues. I was at SACRO for about 6 years and I started as a team leader for a project called Bright Choices which supported people, but primarily women and girls, affected by so-called ‘honour’ based abuse.
My experience has always been quite mixed when I work with women because, when you are working as a psychotherapist at a women’s service, there’s no telling what is going to come up. We also know that women almost never experience just one kind of abuse or one kind of violence. And there are always additional factors, challenges, issues, different types of abuse all linking into one. After Bright Choices concluded in 2019, I applied for the role of GBV services manager and one of my first projects was CLiCK, a national pilot.
What exactly was CLiCK and how did it support women selling or exchanging sex?
The original idea behind CLiCK was that, we know the profile of the sex trade is changing and it’s becoming more invisible. It’s no longer street prostitution, where you see which areas are being frequented, which women are going to those areas. A lot of it is now organised online via website, WhatsApp groups, etc. CLiCK was a partnership of organisations who were members of the Encompass Network and who worked to support women in the sex industry, adopting the Equally Safe Strategy’s definition of commercial sexual exploitation as a form of VAW. Members included the Women’s Support Project, Aberdeen Cyrenians, Alcohol and Drugs Action, Dundee Vice Versa and Glasgow Rape Crisis. We wanted to use CLiCK as a way to better identify the needs of women in this changing landscape and to pilot different interventions for what might work best for this new and emerging group of women.
However, 6 months later, there was a pandemic, we were in lockdown and everything was blown out of the water. We all know that during the last 2 or 3 years, women have carried the worst brunt of the implications of COVID and the lockdowns. But no one has suffered more than women in the sex trade. And unfortunately, we’ve also seen a huge rise in the number of women who have had to start participating in the sex industry because they have no other choices.
During the pandemic, as you managed CLiCK, you came up with the idea of piloting a unique counselling service for women selling or exchanging sex. Where did this idea come from?
I think, above all, mental health is a human right. No more, no less important than your physical health, having food on your table and having a roof over your head. Although, we tend to neglect it because I think we tend to prioritise our physical needs over our wellbeing needs, not necessarily realising how connected the two are. I see that in particular with women who are selling or exchanging sex in whatever shape or form or platform.
About 6 months into the pandemic, the Scottish Government allocated some funding to the Encompass Network that was meant to cover women’s crisis needs: food, childcare, rent, gas, electricity, things that women would urgently need for their survival. As I said, I think mental health is as important as any of those needs, so I got in touch with the Women’s Support Project – who coordinate Encompass – and said I could probably source some time-limited crisis counselling for women. We knew the sex industry was shut down: you were not allowed to meet others face-to-face, you were not allowed to advertise. The saunas, the clubs, all of them were closed, women were not going to have an income because they were not eligible for furlough or other kinds of financial compensation, they were going to be left destitute and that was going to have an impact on their mental health as well.
We were able to fund up to 10 sessions of counselling per woman and we shared information about this intervention through the Encompass Network services, including CLiCK. Because everything was happening online, so was the counselling. It’s not ideal in counselling terms because you really want to have the person in front of you, but actually it meant that anyone in any part of the country could have access to therapy, which was ground-breaking! Not many services could actually provide this at the time.
What was the response to this counselling pilot?
First, I think it’s important to put this pilot into context because at the time a big part of CLiCK was the direct engagement with women and for them to tell us what they needed. The CLiCK team at the Women’s Support Project did a couple of surveys at different points asking the women “what are your needs right now?”. It was interesting to see that at the beginning the physical needs were the highest (paying rent, food, etc). Mental health was probably item 4 or 5 on the list. A few months later, it had actually risen with women’s own assessment of their needs. And to be honest, there is no argument stronger than the women telling you “I’m not doing very well.”
The Encompass services were supportive of the pilot because mental health needs are not going to go away. COVID did not cause women in the sex industry to have mental health needs. Their needs have always been there and COVID exacerbated them. It just so happened that with the pandemic, women were still having to sell sex to survive, and because of lockdown, because of covid, punters were taking chances. They were becoming more violent, they would refuse to use contraception, they would force women to do things they didn’t strictly consent to but women felt they had to because the competition was so fierce. We knew all of these things were going to have impacts beyond the surface level.
What was the process to recruit the right therapists for the pilot?
It was an interesting process because, a lot of the work involved understanding where counsellors sit in terms of their views around the sex industry and how those are likely to play out when they are actually supporting someone who is just becoming involved, someone who might have been involved for the last 20 years, or someone who might be resorting to selling sex because of the current circumstances. I actually had to sit down with all the counsellors who were eventually recruited for the pilot and have that detailed conversation with them about this because, at the end of the day it’s also a personality thing. You want someone who is going to come across as friendly and non-judgmental. You don’t want a professional who is going to tell women that ‘this is bad for you, you really should stop doing that.’
We needed to make sure that it was the right person with the right approach, the right attitude and of course the right understanding. We had a bank of four female counsellors in total. Two of them were internal – that is, counsellors who were already working for SACRO doing counselling work for women affected by different forms of violence, women involved in the justice system or involved in the wider service. We also recruited two external counsellors with considerable experience and a sound understanding of VAW to provide support.
What was the approach used to support the women in the pilot?
What was interesting is that it wasn’t just purely traditional counselling in the sense that the counsellor gets paid to have a 1 hour session every week with no strings attached. Instead it was a structured intervention – the discussion I had with all the counsellors was that this is a very specific group with very specific needs, and to be mindful that they were part of a wider service, that counsellors were not operating in isolation.
If a woman wanted to use 3 out of 10 sessions and didn’t want to use more, that’s fine – the other 7 could go to another woman. Similarly, if after a session there were concerns about a woman, because she needed money or food or because she might be at risk of suicide, I asked them not to keep these things to themselves and explained there are women’s workers available to help, there are emergency services available to help. There was really good communication which helped this project to work. And if I hadn’t heard from one of the counsellors for a couple of weeks I would probably give them a ring, just for a wee update and to check in with them.
One thing that is crucial to mention is that I put together a wee leaflet just to explain what counselling is, because women have different experiences of counselling – some have none. What was really important is that this information stated that what is discussed between your counsellor and yourself stays there. It’s not going to come back to me, it’s not going to come back to your worker. Women could use this time in whatever way it worked for them.
We really made sure that there was a clear understanding that the counselling sessions were not going to be recorded and passed around. That the sessions were between the woman and her counsellor and that they were strictly confidential. So any information that came back to me was strictly anonymous, unless confidentiality had to be broken, and it was always with the woman’s permission.
Women have talked about mental health professionals overfocusing on their experience of selling or exchanging sex instead of seeing them as a whole person. Was there any discussion with the counsellors about this before starting the pilot?
It was almost like a term and condition of the service, because when I approached the counsellors I very clearly said that this pilot was going to be part of a wider piece of work, but that it wasn’t exclusively about the selling of sex. I used to work for a service for ethnic minority women who were migrants and had experienced ‘honour’ based abuse, and that’s not their whole life story. They don’t want to talk about FGM all the time for example. They might want to talk about their current challenges, they might want to bring something positive to the session. And I think that’s the understanding that all practitioners have in psychotherapy, that it’s not just about the one thing.
Sometimes we do have a duty to follow up on a disclosure that’s made. When someone talks about something like this in a session, usually they do it for a reason. If a person disclosed an experienced like that to me after three weeks of counselling, I would have to say “right, is that something you want to discuss? Is that important to you? Are you raising this because it puts context into some of your experience or are you just letting me know? Either is fine.”
I think like any other kind of mental health work, sometimes you can get side-tracked. I think counsellors should be checking in, they have a responsibility to check in as to how important the topic is for the woman. However, counsellors shouldn’t be dictating where they go from that point forward-that’s for the woman to dictate.
How did you measure the impact of this service and what was the women’s feedback?
We tried a few different things for that. The first thing was a standardised measure called the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), which we shared with the woman as an online form. It was optional to do and we didn’t put any pressure onto women to fill it out. We had some results with the first few women who accessed counselling.
Interestingly enough, I could track the progress over time in a graph, and you could see an expected trend actually: mental health dips when you start counselling, because you open a can of worms that you didn’t even think was there. So you’re opening this up, but by doing so with the support of a trained professional, you start to reframe your experience, to rebuild foundations. Over time you could see that that initial dip went up and women would start to report feeling better, more resourceful, less anxious or less stressed, less suicidal. This also needs to be seen in the context of the stress of being told one week that lockdown is over and before you know it, we’d be back into lockdown. You cannot ignore the context which was very, very difficult.
We had women who didn’t complete the questionnaire, partly because they didn’t have the time or the energy, partly because they didn’t have the literacy skills, and that needs to be recognised as well. When we talk about women with complex needs, we could also be talking about women whose reading and writing is not at the level where it should be. For those women, I linked in with the counsellors and asked for anonymous feedback, positive or negative, because both are important. Similarly, I reached out to the women’s workers, so for the women that we knew were accessing counselling and one-to-one support, we’d ask their support workers if the women fed anything back about the counselling, again, completely anonymously.
And I have to say, it was overwhelmingly positive. One of the interesting pieces of feedback we got was “I didn’t know that’s how counselling worked. I wasn’t being diagnosed, I was just allowed to talk about what mattered to me” or “it was good not to feel judged” or “it was good to get things off my chest that I didn’t feel I could tell anyone else.”
What are some of your key learnings from this pilot and how do you think they could be used in the future?
I think there’s lessons to be learnt all around. In terms of counselling training, I think there’s a wider need for understanding gender and gender-based violence in the mental health context. You can’t take a principle or a school of thought such as psychotherapy and counselling and not see it in the patriarchal context in which it came to be. For about a hundred years it’s been men ‘curing’ women. You just need to look at Freud’s or Jung’s ‘case studies’, they were all, in their words, “hysterical women.” What did that mean at the time? We don’t have a diagnosis for hysteria anymore and that is because we understand the patriarchy and VAW in a different context now.
In terms of future service-provision, one thing that will likely have implications is the fact that it was online. Women could choose if they wanted to have their camera on or not, if they rather speak on the phone or Zoom. In some ways, that was almost like a protective barrier – they could use the name that they wanted, they could be visible or not if they chose to, and that felt safer for a lot of them.
I also can’t stress enough how important it is to have mental health support. The fact that we live in a patriarchal world, I think women are raised in trauma, regardless of whether they actually have traumatic experiences. We are raised to believe there’s rape around the corner, that we are responsible for our safety and the safety of our children when we live with a domestic abuse perpetrator. We are raised in ‘shame’- and this is going to have an impact. The fact that we have to be in a state of vigilance all the time, that is traumatic in itself – it’s bad for the nervous system, we have science that proves that. And now imagine you are a woman that has to survive, who has to go out and have sex for money or sexually entertain for money or whatever, you are immediately faced with society’s every single judgment around this, such as “you haven’t been raped because you were asking for it,” “you went there to have sex, what were you expecting?” This plays into the mental health of women who are in the sex industry and they then feel that shame and trauma ten times more because they know the eyes of the world are on them.
As activists, as workers, as service managers our position is not to pity women or feel sorry for them, it’s to see their experience for what it is in the context in which it is lived. The reason women come to counselling is because they need that alternative perspective. When you are sitting with a client, as a counsellor you are that mirror, you are that wall on which women can bounce ideas from. And I have read this time and time again from women who have exited the industry: “it never once dawn upon me that I was actually going against what my body wants, against what I’m supposed to be doing to look after myself.” It's only through that process of reflection, self-understanding that women come to those conclusions.
We need mental health support. We need it for women in the sex industry, we need it for everyone. It must be prioritised as much as food and shelter. Because, if you have food and shelter, but really poor mental health, how long is your food and shelter going to last? How will you be able to sustain it? These are interconnected issues.
For services which are not specifically focused on mental health, what do you think is their role in supporting the mental wellbeing of women?
Each service has a role to play. Although there’s a reason why we have specialisms – I can’t do what a midwife does, or what a teacher or a social worker does – you don’t need a specialist training to understand when someone is unhappy or distressed, you just need basic empathy skills.
Gender-based violence and the gendered context in which we live needs to be part of any training for any professional. Because you cannot be a midwife or a nurse or a teacher and not know how gender relates to your work. Where we’re missing the mark is where we have those little opportunities to dig deeper, and we don’t pick them up because we feel it’s not our job.
It’s about opening up that thinking: if you’re a health visitor and you have a woman with a child and the woman is giving you indicators that she might be involved in selling sex, ask the question: “what are your appointments about? Why do you seem a bit worked up today, what’s happening?” you don’t need to provide therapy, you just need to know it and say “thank you for sharing this with me. Would you like some support with this? I can link you with a service.” It’s that simple.
Some services fear that, if a woman presents with complex needs, digging a bit deeper might open a “can of worms” that the service won’t be able to deal with. What would you say to that?
The question is: are you doing your job if you are not doing your job for everyone? Yes, you might open a can of worms or you might not, there’s only one way to find out. We need to be really mindful that, no matter what job we’re doing, we have a duty of care. Our job is to do our due diligence and make sure that people have what they need to live healthy and fulfilling lives, regardless of whether you are a teacher, a counsellor, a social worker, a midwife, a nurse, that is your duty of care. All you have to do is ask the question and then you can say “I don’t know how to deal with this. Thank you for telling me, I’ll get you support elsewhere if that’s what you want.” You have done your job, you’ve checked in, you’ve stated that you are not the best person to help with this. You don’t have to solve every problem that everyone brings you. All you can do is help the person guide themselves to where they will find the support.
And I think this is really important because, in ten sessions of counselling even, you’re going to open a million cans of worms. Are you going to solve all the problems in ten weeks? Of course not. But you’ve already given someone some perspective, you’ve given them options and showed them there’s support available that is up to the individual to decide when they wish to access it, and you’ve let them know that there are people out there ready to help.
Women just need to have that trusting relationship. If you can build trust with someone, it doesn’t matter what your role is, you should be honoured that they chose to disclose an experience to you. It would have been very difficult to disclose to anyone and they chose you – think of it from that perspective. Even if you can’t help that person, acknowledging your shortcomings is not only admirable and brave, it makes the person trust you more.
In this interview we discuss mental health as a right for women, a counselling service for women who sell or exchange sex that Angela helped to pilot in Scotland during the pandemic, and we reflect on the role that all services have in supporting the mental wellbeing of women.
Angela, you have a vast experience in this sector and came from a mental health route. Can you tell us more about your background and your experience working with women who sell or exchange sex?
I came into my current role as Equally Safe Edinburgh Committee Lead Officer in 2021. Before that I held various roles in violence against women projects and services, including SACRO. My actual training was in psychology, counselling and psychotherapy. I’ve worked with women affected by a range of types of violence against women (VAW), including survivors of childhood sexual abuse, domestic abuse, women who have been trafficked, who have experienced FGM, forced marriage, so quite a range of issues. I was at SACRO for about 6 years and I started as a team leader for a project called Bright Choices which supported people, but primarily women and girls, affected by so-called ‘honour’ based abuse.
My experience has always been quite mixed when I work with women because, when you are working as a psychotherapist at a women’s service, there’s no telling what is going to come up. We also know that women almost never experience just one kind of abuse or one kind of violence. And there are always additional factors, challenges, issues, different types of abuse all linking into one. After Bright Choices concluded in 2019, I applied for the role of GBV services manager and one of my first projects was CLiCK, a national pilot.
What exactly was CLiCK and how did it support women selling or exchanging sex?
The original idea behind CLiCK was that, we know the profile of the sex trade is changing and it’s becoming more invisible. It’s no longer street prostitution, where you see which areas are being frequented, which women are going to those areas. A lot of it is now organised online via website, WhatsApp groups, etc. CLiCK was a partnership of organisations who were members of the Encompass Network and who worked to support women in the sex industry, adopting the Equally Safe Strategy’s definition of commercial sexual exploitation as a form of VAW. Members included the Women’s Support Project, Aberdeen Cyrenians, Alcohol and Drugs Action, Dundee Vice Versa and Glasgow Rape Crisis. We wanted to use CLiCK as a way to better identify the needs of women in this changing landscape and to pilot different interventions for what might work best for this new and emerging group of women.
However, 6 months later, there was a pandemic, we were in lockdown and everything was blown out of the water. We all know that during the last 2 or 3 years, women have carried the worst brunt of the implications of COVID and the lockdowns. But no one has suffered more than women in the sex trade. And unfortunately, we’ve also seen a huge rise in the number of women who have had to start participating in the sex industry because they have no other choices.
During the pandemic, as you managed CLiCK, you came up with the idea of piloting a unique counselling service for women selling or exchanging sex. Where did this idea come from?
I think, above all, mental health is a human right. No more, no less important than your physical health, having food on your table and having a roof over your head. Although, we tend to neglect it because I think we tend to prioritise our physical needs over our wellbeing needs, not necessarily realising how connected the two are. I see that in particular with women who are selling or exchanging sex in whatever shape or form or platform.
About 6 months into the pandemic, the Scottish Government allocated some funding to the Encompass Network that was meant to cover women’s crisis needs: food, childcare, rent, gas, electricity, things that women would urgently need for their survival. As I said, I think mental health is as important as any of those needs, so I got in touch with the Women’s Support Project – who coordinate Encompass – and said I could probably source some time-limited crisis counselling for women. We knew the sex industry was shut down: you were not allowed to meet others face-to-face, you were not allowed to advertise. The saunas, the clubs, all of them were closed, women were not going to have an income because they were not eligible for furlough or other kinds of financial compensation, they were going to be left destitute and that was going to have an impact on their mental health as well.
We were able to fund up to 10 sessions of counselling per woman and we shared information about this intervention through the Encompass Network services, including CLiCK. Because everything was happening online, so was the counselling. It’s not ideal in counselling terms because you really want to have the person in front of you, but actually it meant that anyone in any part of the country could have access to therapy, which was ground-breaking! Not many services could actually provide this at the time.
What was the response to this counselling pilot?
First, I think it’s important to put this pilot into context because at the time a big part of CLiCK was the direct engagement with women and for them to tell us what they needed. The CLiCK team at the Women’s Support Project did a couple of surveys at different points asking the women “what are your needs right now?”. It was interesting to see that at the beginning the physical needs were the highest (paying rent, food, etc). Mental health was probably item 4 or 5 on the list. A few months later, it had actually risen with women’s own assessment of their needs. And to be honest, there is no argument stronger than the women telling you “I’m not doing very well.”
The Encompass services were supportive of the pilot because mental health needs are not going to go away. COVID did not cause women in the sex industry to have mental health needs. Their needs have always been there and COVID exacerbated them. It just so happened that with the pandemic, women were still having to sell sex to survive, and because of lockdown, because of covid, punters were taking chances. They were becoming more violent, they would refuse to use contraception, they would force women to do things they didn’t strictly consent to but women felt they had to because the competition was so fierce. We knew all of these things were going to have impacts beyond the surface level.
What was the process to recruit the right therapists for the pilot?
It was an interesting process because, a lot of the work involved understanding where counsellors sit in terms of their views around the sex industry and how those are likely to play out when they are actually supporting someone who is just becoming involved, someone who might have been involved for the last 20 years, or someone who might be resorting to selling sex because of the current circumstances. I actually had to sit down with all the counsellors who were eventually recruited for the pilot and have that detailed conversation with them about this because, at the end of the day it’s also a personality thing. You want someone who is going to come across as friendly and non-judgmental. You don’t want a professional who is going to tell women that ‘this is bad for you, you really should stop doing that.’
We needed to make sure that it was the right person with the right approach, the right attitude and of course the right understanding. We had a bank of four female counsellors in total. Two of them were internal – that is, counsellors who were already working for SACRO doing counselling work for women affected by different forms of violence, women involved in the justice system or involved in the wider service. We also recruited two external counsellors with considerable experience and a sound understanding of VAW to provide support.
What was the approach used to support the women in the pilot?
What was interesting is that it wasn’t just purely traditional counselling in the sense that the counsellor gets paid to have a 1 hour session every week with no strings attached. Instead it was a structured intervention – the discussion I had with all the counsellors was that this is a very specific group with very specific needs, and to be mindful that they were part of a wider service, that counsellors were not operating in isolation.
If a woman wanted to use 3 out of 10 sessions and didn’t want to use more, that’s fine – the other 7 could go to another woman. Similarly, if after a session there were concerns about a woman, because she needed money or food or because she might be at risk of suicide, I asked them not to keep these things to themselves and explained there are women’s workers available to help, there are emergency services available to help. There was really good communication which helped this project to work. And if I hadn’t heard from one of the counsellors for a couple of weeks I would probably give them a ring, just for a wee update and to check in with them.
One thing that is crucial to mention is that I put together a wee leaflet just to explain what counselling is, because women have different experiences of counselling – some have none. What was really important is that this information stated that what is discussed between your counsellor and yourself stays there. It’s not going to come back to me, it’s not going to come back to your worker. Women could use this time in whatever way it worked for them.
We really made sure that there was a clear understanding that the counselling sessions were not going to be recorded and passed around. That the sessions were between the woman and her counsellor and that they were strictly confidential. So any information that came back to me was strictly anonymous, unless confidentiality had to be broken, and it was always with the woman’s permission.
Women have talked about mental health professionals overfocusing on their experience of selling or exchanging sex instead of seeing them as a whole person. Was there any discussion with the counsellors about this before starting the pilot?
It was almost like a term and condition of the service, because when I approached the counsellors I very clearly said that this pilot was going to be part of a wider piece of work, but that it wasn’t exclusively about the selling of sex. I used to work for a service for ethnic minority women who were migrants and had experienced ‘honour’ based abuse, and that’s not their whole life story. They don’t want to talk about FGM all the time for example. They might want to talk about their current challenges, they might want to bring something positive to the session. And I think that’s the understanding that all practitioners have in psychotherapy, that it’s not just about the one thing.
Sometimes we do have a duty to follow up on a disclosure that’s made. When someone talks about something like this in a session, usually they do it for a reason. If a person disclosed an experienced like that to me after three weeks of counselling, I would have to say “right, is that something you want to discuss? Is that important to you? Are you raising this because it puts context into some of your experience or are you just letting me know? Either is fine.”
I think like any other kind of mental health work, sometimes you can get side-tracked. I think counsellors should be checking in, they have a responsibility to check in as to how important the topic is for the woman. However, counsellors shouldn’t be dictating where they go from that point forward-that’s for the woman to dictate.
How did you measure the impact of this service and what was the women’s feedback?
We tried a few different things for that. The first thing was a standardised measure called the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), which we shared with the woman as an online form. It was optional to do and we didn’t put any pressure onto women to fill it out. We had some results with the first few women who accessed counselling.
Interestingly enough, I could track the progress over time in a graph, and you could see an expected trend actually: mental health dips when you start counselling, because you open a can of worms that you didn’t even think was there. So you’re opening this up, but by doing so with the support of a trained professional, you start to reframe your experience, to rebuild foundations. Over time you could see that that initial dip went up and women would start to report feeling better, more resourceful, less anxious or less stressed, less suicidal. This also needs to be seen in the context of the stress of being told one week that lockdown is over and before you know it, we’d be back into lockdown. You cannot ignore the context which was very, very difficult.
We had women who didn’t complete the questionnaire, partly because they didn’t have the time or the energy, partly because they didn’t have the literacy skills, and that needs to be recognised as well. When we talk about women with complex needs, we could also be talking about women whose reading and writing is not at the level where it should be. For those women, I linked in with the counsellors and asked for anonymous feedback, positive or negative, because both are important. Similarly, I reached out to the women’s workers, so for the women that we knew were accessing counselling and one-to-one support, we’d ask their support workers if the women fed anything back about the counselling, again, completely anonymously.
And I have to say, it was overwhelmingly positive. One of the interesting pieces of feedback we got was “I didn’t know that’s how counselling worked. I wasn’t being diagnosed, I was just allowed to talk about what mattered to me” or “it was good not to feel judged” or “it was good to get things off my chest that I didn’t feel I could tell anyone else.”
What are some of your key learnings from this pilot and how do you think they could be used in the future?
I think there’s lessons to be learnt all around. In terms of counselling training, I think there’s a wider need for understanding gender and gender-based violence in the mental health context. You can’t take a principle or a school of thought such as psychotherapy and counselling and not see it in the patriarchal context in which it came to be. For about a hundred years it’s been men ‘curing’ women. You just need to look at Freud’s or Jung’s ‘case studies’, they were all, in their words, “hysterical women.” What did that mean at the time? We don’t have a diagnosis for hysteria anymore and that is because we understand the patriarchy and VAW in a different context now.
In terms of future service-provision, one thing that will likely have implications is the fact that it was online. Women could choose if they wanted to have their camera on or not, if they rather speak on the phone or Zoom. In some ways, that was almost like a protective barrier – they could use the name that they wanted, they could be visible or not if they chose to, and that felt safer for a lot of them.
I also can’t stress enough how important it is to have mental health support. The fact that we live in a patriarchal world, I think women are raised in trauma, regardless of whether they actually have traumatic experiences. We are raised to believe there’s rape around the corner, that we are responsible for our safety and the safety of our children when we live with a domestic abuse perpetrator. We are raised in ‘shame’- and this is going to have an impact. The fact that we have to be in a state of vigilance all the time, that is traumatic in itself – it’s bad for the nervous system, we have science that proves that. And now imagine you are a woman that has to survive, who has to go out and have sex for money or sexually entertain for money or whatever, you are immediately faced with society’s every single judgment around this, such as “you haven’t been raped because you were asking for it,” “you went there to have sex, what were you expecting?” This plays into the mental health of women who are in the sex industry and they then feel that shame and trauma ten times more because they know the eyes of the world are on them.
As activists, as workers, as service managers our position is not to pity women or feel sorry for them, it’s to see their experience for what it is in the context in which it is lived. The reason women come to counselling is because they need that alternative perspective. When you are sitting with a client, as a counsellor you are that mirror, you are that wall on which women can bounce ideas from. And I have read this time and time again from women who have exited the industry: “it never once dawn upon me that I was actually going against what my body wants, against what I’m supposed to be doing to look after myself.” It's only through that process of reflection, self-understanding that women come to those conclusions.
We need mental health support. We need it for women in the sex industry, we need it for everyone. It must be prioritised as much as food and shelter. Because, if you have food and shelter, but really poor mental health, how long is your food and shelter going to last? How will you be able to sustain it? These are interconnected issues.
For services which are not specifically focused on mental health, what do you think is their role in supporting the mental wellbeing of women?
Each service has a role to play. Although there’s a reason why we have specialisms – I can’t do what a midwife does, or what a teacher or a social worker does – you don’t need a specialist training to understand when someone is unhappy or distressed, you just need basic empathy skills.
Gender-based violence and the gendered context in which we live needs to be part of any training for any professional. Because you cannot be a midwife or a nurse or a teacher and not know how gender relates to your work. Where we’re missing the mark is where we have those little opportunities to dig deeper, and we don’t pick them up because we feel it’s not our job.
It’s about opening up that thinking: if you’re a health visitor and you have a woman with a child and the woman is giving you indicators that she might be involved in selling sex, ask the question: “what are your appointments about? Why do you seem a bit worked up today, what’s happening?” you don’t need to provide therapy, you just need to know it and say “thank you for sharing this with me. Would you like some support with this? I can link you with a service.” It’s that simple.
Some services fear that, if a woman presents with complex needs, digging a bit deeper might open a “can of worms” that the service won’t be able to deal with. What would you say to that?
The question is: are you doing your job if you are not doing your job for everyone? Yes, you might open a can of worms or you might not, there’s only one way to find out. We need to be really mindful that, no matter what job we’re doing, we have a duty of care. Our job is to do our due diligence and make sure that people have what they need to live healthy and fulfilling lives, regardless of whether you are a teacher, a counsellor, a social worker, a midwife, a nurse, that is your duty of care. All you have to do is ask the question and then you can say “I don’t know how to deal with this. Thank you for telling me, I’ll get you support elsewhere if that’s what you want.” You have done your job, you’ve checked in, you’ve stated that you are not the best person to help with this. You don’t have to solve every problem that everyone brings you. All you can do is help the person guide themselves to where they will find the support.
And I think this is really important because, in ten sessions of counselling even, you’re going to open a million cans of worms. Are you going to solve all the problems in ten weeks? Of course not. But you’ve already given someone some perspective, you’ve given them options and showed them there’s support available that is up to the individual to decide when they wish to access it, and you’ve let them know that there are people out there ready to help.
Women just need to have that trusting relationship. If you can build trust with someone, it doesn’t matter what your role is, you should be honoured that they chose to disclose an experience to you. It would have been very difficult to disclose to anyone and they chose you – think of it from that perspective. Even if you can’t help that person, acknowledging your shortcomings is not only admirable and brave, it makes the person trust you more.
