By Jean-Marc Beausoleil
Jo-Anne Couillard has worked at the Adolescent Clinic at Sainte-Justine Hospital for over twenty years, and she intends to stay there for the rest of her career. Nearly 50% of the young people she sees are victims of sexual assault, which is about 80 girls aged 12 to 18 each year. Occasionally, she also sees one or two boys.
“I love my job. I’m empathetic. When they come to see me, they’ve reported a sexual assault. I find that beautiful, and I’m happy to support them; I’m proud of them. I’m able to focus on the positive. My practice is based on healing.”
If they haven’t gone directly through the hospital emergency room, the girls are referred to her by social services, such as the Youth Protection Services (DPJ), schools, youth centers, and CLSCs (local community health centers). When a sexual assault occurred five days or less beforehand, the adolescent is automatically referred to the emergency room to complete their forensic medical file, the contents of which may eventually become evidence in court.
All Francophone minors who are victims of sexual assault in the city of Montreal are referred by the police to Sainte-Justine Hospital. Anglophone victims are seen at the Montreal Children’s Hospital.
The Protocol
In this type of tragedy, when the adolescent is referred by the emergency room, the protocol requires that Ms. Couillard meet with the victim two weeks after the assault and then again three months later: “If I see them the day after the assault, they will all be absent from school and crying. They won’t have slept well. These are normal and predictable reactions.”
After two weeks, the first meeting aims to determine if the adolescent has resumed functioning in a way that approaches a certain degree of normalcy. For example, a return to school, even if difficult, even if concentration in class isn’t optimal, should be interpreted as a good sign. Their appetite returns, at least a little. Also, she hopes that the nightmares of the first few nights give way to sleep that, while disturbed, is nonetheless restorative. “We look to see if there’s progress, an evolution. Is she safe? Does she have support?”
If walls had ears, we shudder to imagine what the walls in this nurse’s office must have heard: “This is a vulnerable population; they often have emotional problems, deficiencies. They tend to gravitate towards someone who will offer them love, tenderness, affection, and a listening ear. If a girl I see two weeks after the assault hasn’t returned to school and is still having nightmares, I’ll see her again before three months have passed. She’ll worry me.” Such cases demand more intervention.
The second meeting, which usually takes place after three months, aims to determine if there is a true post-traumatic stress disorder. In this case, treatment may require psychotherapeutic resources.
Listening Effectively
The first meeting, including an appointment with the doctor, lasts approximately two hours. Fifteen minutes of the first hour are devoted to the interview that Ms. Couillard conducts with the teenager. In her twenty years of practice, she has developed unique skills and listening abilities. She talks about adapting her language to that of her patient. The nurse examines several aspects: the events, their emotional impact, the situation at school and at home, physical and mental health, and the support they receive or don’t receive. Who are the significant people in their lives? If the girl doesn’t mention her parents, a red flag is raised.
When the victim groans when simply asked if she has any allergies, “I know I have to tread very carefully if I want to gain her trust.” The topic of contraception sometimes helps build rapport.
While working with them, Ms. Couillard invites the parents to wait in the waiting room: “Just so she has a space of her own and I can meet with her alone. So she sees that she’s my priority. Sometimes you don’t need to perform miracles. Just have faith. When I meet with them, they’ve spoken to the investigators who are doing their job: they have to ask questions. Often, they give the victim the impression that she isn’t believed, whereas I build a connection. They’re relieved by the difference in attitude from the healthcare professional. I always have a bowl of candy on my desk.”
Of course, Ms. Couillard is bound by professional confidentiality.
The Questions
Ms. Couillard seeks to demystify the process. “Without eliminating the protective reflex, alleviating their guilt accounts for at least 80% of the interviews I conduct.” To achieve this, the clinical nurse asks numerous questions. How is the young girl? How is her sleep? Is she sad? Does she have suicidal thoughts? Is she stressed? Is she afraid? Is she scared of running into her attacker? Is she scared of retaliation? Of getting sick?”
Thanks to this insistence, the girls eventually open up, at least a little. “In the end, they’re glad they were encouraged to talk, even though they sometimes came into my office reluctantly. They’re afraid of being judged.”
Also, at the end of the interview, the teenager is asked to rate her overall well-being on a scale of 100, allowing her to compare her score to her level before the assault and to the next visit, if applicable. It’s also worth remembering that a sexual assault doesn’t have to be insurmountable: “When they have the support of their parents and friends, when they are well supported by a good network, have no serious history of trauma, and have regained a healthy functioning, they often don’t need a psychologist. That’s enough.”
Runaways
The most difficult cases are those of young people who accumulate three or four forensic reports in a short period of time. Reports to the Youth Protection Services (DPJ) are numerous. Runaways recruited by street gangs or lured by pedophiles through social media do exist. Boyfriends, ex-boyfriends, parties…
These are populations already living clandestinely, and whose activities were not particularly affected by the lockdown. While unable to provide official figures, it seems to Ms. Couillard that the last few months of lockdown have led to an increase in the number of assaults.
A sad reality: “Repeatedly abused, these young women run away. They get caught by a guy. They go back to the center. A year later, they run away again.” Alcohol and drug abuse leads to situations of vulnerability: “They wake up naked in bed…” Some victims also suffer from mental disabilities.
Domestic abuse accounts for about 20% of cases: “Chronic abuse by the father, stepfather, brother… I have more trouble with those on an emotional level.”
Expressing Her Emotions
Ms. Couillard vents her emotions to her colleagues. A simple door separates her from the office of her main collaborator: “Sometimes, I go through and tell her, ‘Marie, I need to talk to you, I’m at my wit’s end! I’m in a painful situation.’” Ms. Couillard feels well supported and adequately assisted by her institution: “I absolutely wanted to work at Sainte-Justine.”
At home, she admits to having been a pain in the neck with her daughters, now adults, who used to tell their friends, as an explanation when they were refused permission to do something or go somewhere: ‘We all know, my mother works in sexual assault…’
Addiction
When she isn’t working with victims of sexual assault, Jo-Anne Couillard helps other teenagers, such as those struggling with addiction, whether drug or internet addiction, who are referred to her by the Montreal Addiction Rehabilitation Centres (CRDM). She assesses their physical and mental health. She also helps young people facing questions about contraception or sexually transmitted infections.
She laments the lack of psychiatric resources: “We don’t have psychologists. We’re forced to refer them to community services where there are endless waiting lists.” Even at the Marie-Vincent Centre, a sexual abuse expertise centre, there’s a waiting list of over a year to see a psychologist. Ms. Couillard doesn’t have one. “It’s frustrating.”
Letting Go
“Theoretically, after a young person turns eighteen, I’m no longer allowed to see them. I had one who called me until she was 21. I tried to guide her, to help her find another resource. But she kept calling me back. It’s hard. Sometimes we extend the relationship. Sometimes it’s just me. I’m not able to let go.”
Photo, top: Patty Brito on Unsplash
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