Questioning people about the abuse and trauma they may have suffered is a difficult and extremely sensitive aspect of mental health care. Any enquiries about specific episodes of abuse should take place within the context of a general psychosocial history and should never be asked ‘out of the blue’.
Establish a relationship first
Wherever possible, a clinician should establish a relationship with a person before broaching issues about their trauma history. They should also ensure that they have sufficient time to provide appropriate support immediately after disclosure if it is required.
General questions to encourage disclosures about abuse
When taking a psychosocial history, questions about trauma can be introduced with a general question such as: Would you tell me a bit about your childhood? or Can you tell me what your childhood was like?
This might be followed with slightly more specific questions such as: What was the best/worst thing about your childhood? or What was the worst thing that happened to you as a child?
It is always crucial to acknowledge and validate how an individual is feeling and to respond appropriately.
Seeking specific information about abuse
If the general questions do not elicit information about abuse, it may be necessary to ask a specific question such as:
- Did a parent or another adult ever hurt or punish you in a way that left a bruise, cut, scratches, or made you bleed? This question evaluates for possible childhood physical abuse.
- Did anyone ever do something sexual with you or to you that made you feel uncomfortable as a child? This evaluates for possible childhood sexual abuse. The reason for including ‘uncomfortable’ is that some people who were sexually abused as children may have felt confused at the time about whether or not they wanted the event to happen but might nevertheless have felt uncomfortable.
- Did anyone older than you ever do anything sexual to you that was against your will?
- Has anyone ever done something sexual to you against your will, or that you didn’t feel comfortable about? This evaluates for possible adult sexual assault.
- Have you ever been beaten or hit or battered in a sexual or marital relationship? This checks for possible spousal or partner abuse.
- Have you ever been physically attacked or assaulted by someone who wasn’t a sexual partner or spouse? This evaluates for possible non-domestic assault.
- Have you ever been in a situation where you thought you were going to die?
It is advisable not to ask ‘Were you sexually, emotionally or physically abused?’ because many people who were abused will not have used this term to describe their experience. If the client responds with ‘No I haven’t been abused’, the clinician may like to respond in a way that lets the client know that support is available in the future if they wish to revisit this topic at a later date.