Are We Doing Institutional Abuse Treatment Wrong?

My nonprofit org provides a lot of intensive trauma-focused therapy, which enables most of our clients to recover even from significant trauma within a couple of days to a couple of weeks. Because this is a unique service, we get referrals from a lot of sources. When a given client’s treatment is funded by a Victims Compensation agency, auto insurance company, or similar, it is normal for the funder to oversee the treatment. They want to know about the diagnosis, treatment plan, and course of treatment, to ensure that the appropriate treatment is being provided to address the relevant harm that had been done. So far, so good.

Lately we’ve fielded a wave of treatment requests from survivors of institutional abuse (e.g., by clergy, coaches, etc.). Their treatment is paid for by a special fund administered by the institution in question – which is where it gets dicey. Like other administrators of victim-related treatment funding, they want to oversee the treatment. But unlike other such administrators, the institutions are themselves – at least, in an important sense – also the perpetrators of the harm to be treated. This disqualifies them from overseeing the treatment.

Has anyone else noticed this? So far, when we’ve pointed this out, the institutions in question seemed surprised to learn of the concern. Here is the letter we send out:

Dear Treatment Fund Administrator,

In trying to get the paperwork completed to get this treatment authorized, we’ve identified an obstacle, that is systemic and not specific to this case. I recognize that the Institution is trying to help people who may have been harmed via their association with the Institution. Presumably the Institution is also trying thereby to repair its relationship with the community. Addressing this issue will enable the Institution to be more successful in both of these goals.

Please don’t take this personally as I know you’re only trying to help. I also understand that no admission of guilt is involved. I’m addressing the client’s experience and perspective. Here is the issue: In the case of abuse in an institutional context, from the victim’s perspective both the person and the institution are perpetrators. It is appropriate for the perpetrator to pay for the victim’s treatment. But it is not appropriate for the perpetrator to oversee that treatment, to the extent that such oversight may involve access to personal information, as well as possible control over the treatment. That would put the victim at the further mercy of their perpetrator, which is in conflict with the goal of the victim becoming empowered and achieving healing.

Therefore we cannot ask a prospective client to authorize us to discuss their treatment with the Institution, other than in the most superficial way. I can suggest either of two solutions:

1. You adopt a relatively hands-off approach, so that the treatment provider would only give you the most basic level of information, such as whether treatment is called for due to the alleged victimization, what duration of treatment is anticipated, and (later) how much treatment was completed and should be paid for.

2. Alternately, if you prefer to have a greater level of oversight including access to the diagnosis, treatment plan, etc., this oversight could be outsourced to a trusted third party that would administer the program as per your criteria, while not sharing with the Institution the personal details of participants.

I recognize that it might take some time to sort this out. Meanwhile, how shall we proceed with the current case?

So far we have only met with positive responses. So far, the institutions we’ve been working with really do want to help. I guess this is just a new enough thing that it hasn’t been fully thought out yet.

I look forward to the day when we don’t have to send these letters anymore, because they’re already doing it right.