Fatima Le Griguer is a psychologist, founder and coordinator of the "USAP" (the specialized psychotrauma support unit). This unit is dedicated to the care and reconstruction of people exposed to domestic violence, sexual violence, intra-family violence...
To mark 25 of november, the International Day for the Elimination of Violence against Women, she spoke to Fondation RAJA-Danièle Marcovici.
The unit was set up as a functional unit in a hospital attached to adult psychiatry in 2007. I was in charge of receiving victims of violence in emergency departments from 2002 to 2014, where I was confronted with the reception of victims. I felt it was important to develop tools to screen for domestic violence in order to support victims, organise debriefings and offer specific therapies. I had to train in therapies and work with a wide multidisciplinary network, which was an absolute necessity.
This led to the idea of setting up a functional unit at the hospital, which was later extended to the hospital group. Today, we operate in three hospitals: Aulnay, Montreuil and Montfermeil. We work with victims of violence who have suffered psychological trauma, 89% of whom are women, although 11% are men. We mainly see victims of domestic violence, intra-family violence and sexual violence. We also deal with traumatic bereavement, suffering at work, assaults, road accidents and mass disasters.
In 2016, we set up this unit with a psychologist and a secretary. We wanted to expand it and applied for the call for projects on the development of regional psycho-trauma centres. We were approved as a Paris Nord regional psycho-trauma centre alongside Avicenne. We cover the 95, 77 and 93 départements and the whole region in terms of violence against women.
Since April 2020, we have set up a legal hotline and then a police hotline with trained police officers who take complaints from victims at USAP.
In terms of treatment, we have a two-pronged approach. One is immediate or pt immediate as a liaison unit, interacting with the other services. Each psychologist has an emergency slot scheduled during the week. Hospital departments contact us to receive a victim for initial treatment, assessing the person’s situation. Our approach is to protect and raise awareness of violence against women, and we consider hospitalisation if necessary, particularly for women with children.
Our second area of treatment, which is more focused on long-standing traumas, involves organising therapies centred on emotional regulation, for example using emdr (Eye Movement Desentization Reprocessing), hypnosis or CBT. The aim is to link traumatic images to specific emotions and bodily sensations. These therapies are individual and recommended by the WHO.
We have also developed various discussion groups within the unit: two on domestic violence, one focusing on intra-family violence, another on sexual violence, as well as groups on bereavement and suffering at work.
We offer a variety of workshops, such as psychosensory workshops that combine group hypnosis with artistic media, such as painting and clay, to explore specific emotions. Clay is used to work on the sense of touch by associating emotions with sculptural creations, while painting uses colours to represent emotions, for example, black and red for anger. These mixed workshops encourage socialisation and the development of social skills, helping women who have suffered violence to gain confidence and self-esteem.
Some of our colleagues run workshops jointly with outside speakers, such as sophrology or psycho-corporal approaches. We also offer a socio-aesthetics workshop run by a beautician and a psychologist to work on body image and self-esteem through treatments, massages, make-up and hairstyling. In the near future, we plan to open an image coaching workshop to address posture and clothing style, particularly for job interviews.
In addition, we offer a boxing therapy workshop to help patients express emotions that are difficult to verbalise and to reinforce their self-control. The aim of all these workshops is to equip patients with tools they can use independently in their daily lives and in their professional integration.
Our care generally begins at the age of 16 or 17, particularly for young girls involved in underage prostitution, who frequently take part in discussion groups on sexual violence. The length of the treatment varies depending on the problem. Simple traumas, such as street assaults, generally require one or two sessions for rapid recovery. However, in the case of domestic violence, spousal abuse or repeated sexual abuse, the trauma is more deeply rooted, requiring individual and group therapy to deal with all aspects of the trauma.
In some cases, anti-depressive co-morbidities complicate treatment, requiring stabilisation before therapy can begin. We adapt our approach according to the situation, offering different therapeutic techniques such as emd-r. Our aim is to tailor treatment to each individual.
Although we usually talk mainly about domestic violence, intra-family violence also concerns children and the violence that mothers can suffer at the hands of their children. We are seeing more and more situations where women are experiencing violence at the hands of their children, or where they are experiencing violence at an advanced age. After experiencing violence from their husbands, they also experience violence from their children.
As far as sexual violence is concerned, we can see that since #Metoo, there has been more freedom of speech, but it is difficult to provide support for victims, and there are not enough care structures, both for sexual and domestic violence and for violence within the family.
Most health professionals are not sufficiently trained, both in psycho-trauma and in the mechanisms involved in domestic and intra-family violence. What’s more, to work on these issues you need to mobilise a network, which is not currently the case. Many people work in isolation and don’t necessarily interact with other professionals.
What’s more, these players don’t get enough financial support. For example, I’ve set up an association, of which I’m President, which will help us to have an operating budget for group activities and to bring in outside people. Recently, we organised a therapeutic trip that was made possible thanks to the association. We don’t have enough funding to create new posts or to give money to organise treatment.
I also think that prevention is not effective enough, and professionals are not sufficiently trained. So there’s a lot to be done.
It is crucial to prepare victims for the possibility of a case being dropped, as this can have a traumatic impact on victims, depriving them of recognition and undermining their confidence in the justice system. To counter this, we are looking at alternative methods, such as discussion groups, which allow victims to feel less alone by meeting other women who have been through similar experiences.
Closing cases of sexual violence is emotionally trying. It requires preparation for a possible trial or judicial decision. Some women consider giving up, but we encourage them to take a break and attend reconstruction sessions before deciding to continue.
Nevertheless, there have been improvements in the procedures for lodging complaints, thanks in particular to the development of meeting places in hospitals, which facilitate communication between the police and victims.
However, when it comes to dealing with situations of violence, there is still an asymmetry, where the victim’s word is compared with that of the aggressor. The aggressors often have more resources to defend themselves, while the victims, often in financial difficulty, find it hard to access adequate defence. To remedy this, we are working on the creation of a list of lawyers specialised in supporting victims, thus facilitating their access to justice.
Training for judicial staff is an absolute necessity. It is essential to understand the impact of coercive control on the physical and mental health of victims. Ignoring signals from victims, such as health symptoms or cognitive impairment, can be damaging. Victims may feel overwhelmed and distressed, while perpetrators retain control. A deeper understanding of trauma is crucial to fair justice.
In particular, I was part of the justice working group at the Grenelle summit, with Isabelle Rome’s group, which did a lot of work on the issue of control. I’m also a member of the CNVIF, the national committee on domestic violence, which is also looking at ways of dealing with violence. As part of this, I organise days to raise awareness among professionals. Among others, we have invited legal professionals to this day, which will take place on 16 November. The aim is to conduct a multi-disciplinary discussion on these issues to advance the way we deal with them.