“What combination of social responses, community services, and therapies are most effective to create a healing environment for rape victims?”
Introduction
“My clothes were confiscated and I stood naked while the nurses held a ruler to various abrasions on my body and photographed them. The three of us worked to comb the pine needles out of my hair, six hands to fill one paper bag. To calm me down, they said it’s just the flora and fauna, flora and fauna. I had multiple swabs inserted into my vagina and anus, needles for shots, pills, had a nikon pointed right into my spread legs. I had long, pointed beaks inside me and had my vagina smeared with cold, blue paint to check for abrasions. I didn’t talk, I didn’t eat, I didn’t sleep, I didn’t interact with anyone, and I became isolated from the ones I loved most. The only symbol that proved that it hadn’t just been a bad dream, was the sweatshirt from the hospital in my drawer. You took away my worth, my privacy, my energy, my time, my intimacy, my confidence, and even own voice, until today.”
Above is the open letter testimony from a resilient survivor of a high profile rape case. Her detailed experience of sexual trauma serves as a reminder to society of the nightmare that becomes rape victims’ lives. Perhaps you understand this pain, or a friend, parent, spouse, child you care deeply for has been a victim of sexual assault. It is estimated in the US that 1 in 4 women and 1 in 33 men are raped (Rainn Statistics). And as a result, 1 in 4 women and 1 in 33 men are extremely prone to the the psychological effects that can follow sexual assault including PTSD, anxiety, contemplations of suicide, increased risk of drug and alcohol abuse, depression, somatic memories trauma stored in the body that becomes activated through environmental and situational triggers, detachment, lack of intimacy, and a shattered sense of self. Though the circumstances of sexual assault cases vary for each victim, psychological, physiological, emotional, and physical effects effects are universal amongst victims.
Because sexual assault affects 28% of the United States population alone, and inflicts an array of emotional, psychological, and physical damages, it is essential that support providers work to alter social responses, disembody victim shaming and secondary victimization, and strengthen services in order to create a healing community in which all survivors can heal.
Historical Context
The normalization of rape and sexual assault can be seen ingrained into culture and history.. The earliest record of rape and rape culture can be seen in Greek Mythology. One particular story was the rape of Leda by the Greek God Zeus. Zeus had emulated a symbol of godliness to people living in Greece through stories of justice, control, and power. Thus, Leda’s rape was justified because of her perpetrators god-like status. This along with other stories featuring powerful male figures created a stigmatizing culture condoning sexual assault based on the perpetrators status. Other biblical texts praised as law and justice in their time also normalized rape, sex slaves, child marriages, dehumanization of women and men, a lack of punishment for rapists, and a lack of justice for victims. One prominent text states. “If a man is caught in the act of raping a young woman who is not engaged, he must pay fifty pieces of silver to her father. Then he must marry the young woman because he violated her, and he will never be allowed to divorce her.” The unjustified normalization of rape, abduction, and sexual assault continued to flow into medieval times, amongst many others. Rape and sexual assault is also very common in wars throughout history. After WWll had ended, the largest mass rapes occurred against an estimated 1.4 million German women, young boys, and girls by Soviet servicemen. The servicemen saw these acts as moral and justified based on the crimes that the Nazi’s had committed. The events that have trickled through time resulted in an unfathomably large rape culture that still affects our society today. Though our current society is removed from these time periods, and has progressed in numerous ways, we are still held back by deep rooted rape and sexual assault myths, and justifications.
These deep rooted beliefs affected rape laws in first world countries such as the US until a massive legislation reform took place. For example, until the late 1970’s the US defined rape as, “unlawful carnal knowledge of a woman by force and against her will.” This legislation as a whole set a strict list of requirements for a rape victim to be valid. For example, the victim had to first be female, meaning until the late 1970’s men, boys, women married to or friends with their perpetrators could not be acknowledged as rape or sexual assault victims. Amongst many other stereotypes and requirements, this law created a cookie cutter image of rape victims and as a result invalidated countless victims.
Because of the clear lack of legal action to eradicate sexual assault, a rippling tide of feminist movements worked to alter the standing rape legislation in the 1960’s and 1970’s. According to researchers Julie Horney & Cassia Spohn, “The reforms were intended to reflect women's autonomy in American society and to encourage respect for their diverse roles and behavior.. to increase the reporting of rape and enhancing prosecution and conviction in rape cases and treatment of victims in justice systems... prohibit a wider range of coercive sexual conduct... and expand the range of persons protected by law" (Futter, 1). This movement sought to increase public awareness and education of the prevalence of rape and its harmful effects to victims. Specifically, this movement succeeded in redefining rape to acknowledge all victims, and all levels of sexual assault and penetration.
Many states even took the initiative to change the word rape to sexual assault in their state legislations. Many victims define their experience as sexual assault and not rape based on the circumstances and their perceived severity of the assault; as a result, this word substitution acknowledged and validated these victims experiences. Furthermore, the legislation change illegalized using a victim’s background, relationship to the assailant, or sexual history as evidence against the validity of their assault. This resulted in focusing the shift of blame on the perpetrator of the assault instead of the victim.
Rape was also divided into varying offenses and punishments based on the circumstance of the assault, just like all other crimes. This was not meant to discredit or place value on specific experiences, but provide the opportunity for all victims to press fitting charges. When determining the severity of the punishment, courts now had to take into account the various factors of the assault. Just like the unique and very personal circumstance of a sexual assault, these new reforms began to bend the alter and personalize the charge based on the assaults severity.
Prior to these legislation changes, researchers had been studying the mental, emotional and physical effects of rape and sexual assault as early as the 1870’s. 6 scholarly articles were published between 1870 and 1959, a 79 year time frame. The nature of these articles only focused on the effects of forced, stranger rape on women. However, in the midst of the 1960’s and 1970’s rape legislative reforms, publishing rates skyrocketed. The nature of the papers were also extremely altered. In contrast, the 40 year time span between 1960’s and 2003 produced 1,173 articles on rape and sexual assault. The studies content and breadth of research also increased dramatically as compared to the 1870’s. The legislative movement sparked the social awareness necessary for research to begin investigating the effects of date, acquaintance, marital rape, behavioral self-blame theory, treatment of anxiety and depression in rape victims, male rape, rape in the military, rape reform, reduction strategies, avoidance, different therapy models, rape empathy, and emotional processing for victims. The introduction of these new concepts and studies created a platform to expand societies, researchers, and victims understanding of sexual assault, rape, and it’s effects.
Various events, cultures, and beliefs in human history created an environment for rape and sexual assault to flourish and be justified. However, the current legal and social awareness provides hope for those seeking to disembody rape and sexual assault in society. Protests, movements, studies, political action, researchers and overall acknowledgement of sexual assault has begun to create the strong and necessary foundation to begin to resolve rape and sexual assault in society. There is still years of work needed from all members of society in order to create a truly safe, healing environment for rape victims and ensure that this assault is never justified or promoted again.
Research and Analysis
Mental and physical effects
It is estimated that in the United States, every 98 seconds, someone is sexually assaulted and 600 people are raped every single day. (source) It is also estimated by the National Crime Statistics Survey that 1 in 5 women, (20%) and 1 in 33 men (3%) are victims of sexual assault. That accounts for about 31,400,000 women and 4,710,000 men all carrying the complex burden of sexual assault in the United States alone. However, these are extremely low estimates, based solely on the number of reports filed to police and other figures of authority. Thus, other sources have concluded that the total of reported and unreported sexual assaults are as high as 1 in 2 women and 1 in 5 men. (Rape Response Survey)
Countless studies have proved that sexual assault results in significant mental and psychological trauma, most commonly causing symptoms of PTSD, depression, stress, insomnia and anxiety. According to a study by Paul Resnick, within 72 hours after the assault, women reported an average subjective units of distress rating 78 out of 100, and at three months, women reported an average 50 out of 100. PTSD is a severe, long term diagnosis where the victim re-experiences trauma, has social withdrawals, extreme avoidance behaviors, increased hyperarousal, negative change in beliefs, and many other destructive symptoms. A study conducted by Rothbaum, Foa, Murdock, and Walsh concluded that 94% of victims experienced PTSD at two weeks post assault, 64% at three months, and 33% at six months. This mirrors a study by the National Center for Victims of Crime & Crime Research and Treatment Center, which states one third of all rape victims develop rape-related PTSD that lasts longer than 3 months and 11% of victims continue to suffer with major symptoms for a large portion of their lives. PTSD can be intertwined with other diagnoses and entails an array of its own side effects, for example, “80% of men and women with PTSD also meet criteria for comorbid diagnosis (referring to more than one disorder alongside the primary diagnosis), anxiety, or substance abuse disorders” (National Comorbidity Survey, Rape Treatment Outcome Research). Furthermore, rape victims are also three times more likely to experience a major depressive episode in their lives and are 4.1 times more likely to have contemplated suicide and 13 more times likely to have attempted or completed suicide (Kilpatrick). Sexual assault victims also report self blame and lowered self-esteem, panic episodes and nightmares, health problems and somatic memories and experiences, sexual problems, and difficulty with work and social functioning” (Rape Treatment Outcome Research, 2). Overall, these psychological effects burden a large number of the sexual assault victim population and are extremely harmful.
J. Douglas Beamer also sought out the negative effects of trauma, but instead found correlations to the brains psychology. His 2010 study showcased that 2010 symptoms of PTSD including intrusive thoughts, hyperarousal, flashbacks, nightmares, and anxiety represent the behavioral manifestation of stress-induced changes in brain structure and function. Thus, mental afflictions such as PTSD, depression, and anxiety are a result of the acute and chronic brain alterations and reconstructions from sexual assault and trauma. His study stated, “brain areas implicated in the stress response include the amygdala, hippocampus, and prefrontal cortex. Traumatic stress can be associated with lasting changes in these brain areas. Traumatic stress is associated with increased cortisol and norepinephrine responses to subsequent stressors” (P 2). Cortisol and norepinephrine are neurochemical hormones critical to stress response, often provoking humans flight or fight response. Cortisol is the primary stress hormone, acting to resolve fear-related behaviors, trigger other chemicals responses during stress including the brain stem, and assist to increase altering and vigilance behaviors to respond to acute threats. During trauma, the brain is flooded with cortisol; and as a result, victims are often paralyzed with fear and unable to decipher between a flight or fight response. When trauma alters the productivity or functioning of fundamental stress chemicals in the brain, an array of negative effects follow. As a result, victims can become flooded with hormones including dopamine, cortisol, norepinephrine, and adrenaline. This can permanently alter individuals levels of hormones, ability to respond to stress, create health problems such as heart rate and high blood pressure, and create the conditions for mental illnesses. According to the author extreme stress can also affect PTSD victims memories, “studies have shown alterations in memory function following traumatic stress, as well as changes in a circuit of brain areas, including hippocampus, amygdala, and medial prefrontal cortex, that mediate alterations in memory. The hippocampus, a brain area involved in verbal declarative memory, is very sensitive to the effects of stress” (P 3). Though these are only a few examples of how trauma can affect the neurological health of victims, it is absolutely clear that results can be devastating.
In addition to the mental health and psychological impacts, sexual assault victims also experience many physical effects from their trauma. The immediate physical effects that can follow a rape victim include bruising, numbness, bleeding, soreness, broken bones, internal infections, severe head injuries, STD’s, and approximately 5% of cases result in pregnancy. However, long term physical effects are common for rape survivors. Given that rape is not only a violation of an individual's willpower, mind, and sense of self but also an invasion of their intimate body, it can result in trauma being stored in sensitive parts of the body; victims often experience ‘somatic memories.’ Somatic memories or experiences can be defined as “particular emotions, images, sensations, and muscular reactions related to the trauma that become deeply imprinted on people’s minds and these traumatic imprints seem to be re-experiences without appreciable transformation, months, years, or even decades after the actual event occurred” (Kolk 1). These imprinted memories can be activated through a variety of social, environmental, or physical settings that mirror the original trauma, causing the victim to relive parts of their sexual assault. According to researchers Arnsten and Rauch in 1999 and 1996, this reexperience is caused by “the initial high levels of arousal interference (trauma) with frontal lobe function which causes individuals to relive a traumatic experience interferes with adequate Broca’s area functioning (the brain region necessary to put one’s feelings into words) and executive functioning in the brain” (Kolk, 4). This side effect can be viewed as sexual assault victims having their trauma engraved into different parts of their bodies, waiting to be triggered at any passing moment. Researcher Minsky eloquently captured somatics experiences absolute importance in the following quote from his 1980 study, “We shall view memories as entities that predispose the mind to deal with new situations in old, remembered ways - specifically, as entities that reset the states of parts of the nervous system” (Kolk, 1) Thus, rape must also be acknowledged as both a mental and physical trauma.
The effects that can unfold on victims after an assault are widespread, unique, and traumatic. Sexual assault can affect victims on a mental, physical, emotional, and even spiritual level. Based on the detrimental effects of this trauma and how it affects such a large amount of our population, it is pivotal that social responses and resources are positive and available for victims in order to begin healing.
Negative social responses
Social environments play a huge role in the healing process for rape victims. Negative social responses, actions, mindsets, and communities cultivate a negative environment which actually exacerbates the growth and healing of sexual assault victims. Stigmatizing responses, delivery of support, and type of support can create secondary victimization, victim guilt and shame, and increase the victim's levels of PTSD, anxiety, depression, and other effects on mental health.
Social responses characterized as cold, unsupportive, controlling, and blaming are seen correlated in various studies to be extremely detrimental on sexual assault victims recovery and healing process. In one study, “all of the survivors described being blamed for the assault. They also received insensitive reactions, including having a support provider question, doubt, or minimize their experience. There was also ineffective disclosures where victims received a lack of help and support and inappropriate support” (Ahrens 269). Negative social responses such as these have been proven to have detrimental effects on individuals mental, emotional, and physical health as highlighted in a study by Rebecca Campbell. It showcased that, “negative social responses included telling victims to get on with their life, calling them irresponsible, patronizing them, wanting revenge, not believing the story or listening, and trying to control their actions” (Campbell, 297). These findings are similar that to of University of Illinois’ leading criminal justice researcher, Sarah Ullman. Her findings were confirmed in various studies that, “negative social responses are strongly related to increased psychological symptomatology, delayed recovery, and poorer perceived physical health” (1996c). Other researchers, including Davis (2013), Brickman (2015) have also found that a lack of acknowledgement, sympathy, and care creates the conditions for further mental, emotional, and physical trauma. These studies highlight the failure of support providers and society to acknowledge sexual assault as both physical and psychological trauma exacerbates negative effects and cultivates a culture of judgement and hate. This results in victims feeling unable to speak out in a society stripped of safety and acceptance to hear their story.
Secondary victimization is one of the most common responses rape victims feel from formal support providers specifically, (legal, medical, and mental health professionals) where they re-experience trauma based on the negative reactions of support providers. Sexual assault victims are initially victimized and dehumanized by their perpetrator, and can re-experience this victimization from support providers. Researcher Rebecca Campbell defines secondary victimization’s response as, “behaviors and attitudes of social service providers that are victim-blaming and insensitive, and which traumatize victims of violence who are being served by these agencies. Institutional practices and values that place the needs of the organization above the needs of clients or patients are implicated in the problem. The disregard of victims' needs by providers can so closely mimic victims' experiences at the hands of their assailants that secondary victimization is sometimes called ‘the second rape or assault’” (P 4). This secondary trauma can be witnessed through a wide array of actions including victim blaming behavior, a firm belief in rape stereotypes, defending the assault or perpetrator, not providing necessary tests for HIV, STD’s, Aids, or pregnancy, not listening or believing the victims assault, or any other actions that leave the victim feeling further traumatized.
These stigmatizing actions are particularly harmful from those who are supposed to support the pillars of societal justice and protection. This includes law enforcement, lawyers, and mental health providers whose role in society is to reinforce justice while emulating safety and trust. Thus, a lack of validation from these providers have exponentially negative effects on victims’ recoveries. If societal support providers such as these do not believe the victim's story, belittle it, minimize its impact, or blame the victim, it is a lack of validation from those who represent society's morals. This can translate to the fact that the pillars of societal justice are justifying the victims assault, pain and perpetrator.
It is showcased in the number of sexual assault cases taken to court in itself invalidates victims how uncomfortable victims of sexual assault are of reporting or disclosing to formal care providers. Despite the fact that sexual assault is a crime that attacks victims on a mental, physical, sexual, and psychological level, it has the lowest rates of cases that result in trials. Out of 1000 robberies, 20 will result in incarcerations. On the contrary, out of 1000 rapes only 6 rapists will be sent to prison. This is also despite the fact that, “approximately 70% of rape or sexual assault victims experience moderate to severe distress, a larger percentage than for any other violent crime” (The Department of Justice’s 2014 Socio-Emotional Impact of Violent Crime Survey). Rape and sexual assault has the highest ratings of PTSD, stress, and severe anxiety, but the lowest levels of punishment for criminals. Though robberies are an invasion of a home, and rape is the invasion of a human beings body; it has a three times higher incarceration rate. This translates that the assault of a home is more important and wrong than the assault of a body, mind, and spirit. This lack of acknowledgement tells victims that their assault is not important or worthy enough, and as a result of this, victims rarely reach out to the police. According to the US Bureau of Justice Statistics, only 15.8% to 35% of sexual assaults are reported to the police, which clearly showcases the lack of trust and safety victims of sexual assault feel with law professionals.
The last negative reaction is when care providers only accept a specific response from victims. Humans tend to categorize fear into a fight or flight mode. However, trauma holds another response which is immobility or mental and physical paralyzation during and after the assault. As a result, an immobile or non aggressive response to sexual assault makes care providers believe that the victim enjoyed or wanted the act. This simple misconception is deeply harmful to many victims who experienced immobility and shock during their assault. One of the most common responses during trauma according to researcher Vickerman is to freeze. This means that lips are sewn shut so there is no way to scream, bodies nailed in place so they cannot fight and push back, feet sunk to the floor so there is no way to run. Something as traumatic and shocking as sexual assault often immobilizes victims, and can last for months or even years after. Immobilize them from socializing, being in intimate relationships, or treating themselves with love. Not acknowledging this response which many victims experience results in a stigmatizing rape culture that discredits certain assaults as invalid. Other circumstances that can influence how a care provider treats the victim includes the victim's education level, severity of sexual assault victimization, and race depicted social responses and levels of support they received, particularly from formal care providers. (Ullman and Filipas, 10). None of these circumstances change the fact that their bodies and minds were violated, or that they were minds would forever be shaken from the event. More importantly, none of these circumstances make the assault or rape okay. Creating a cookie cutter mold of a victim enables secondary victimization, ignoring their assault just as the perpetrator ignored their rights as a human being. It exacerbates trauma. It is saying that their assault wasn’t “bad enough” or that because they didn’t fight back they liked it. It is the most invalidating thing any support provider could do, it is victim blaming at its very core.
Positive social responses
When society and support providers respond to sexual assault victims trauma in a supportive, empathetic, and caring manner, victim's recovery flourishes. Positive responses provide the support necessary to accelerate growth. It has been proven in various studies conducted by Rime 1995, and Pennebaker, Zech, & Rime, 2001 that the disclosure of traumatic events is related to improved psychological and physical health because processing this trauma both cognitively and emotionally leads to assimilation and decreased stress. Disclosure in itself is perhaps one of the most important steps for the healing process. A study conducted by Sarah E. Ullman in 1996 showed that avoidance coping and lack of in depth disclosure mediated negative effects of negative social reactions and psychological symptoms. Another study states that, “results showed that a greater extent of victim disclosure (e.g., discussing the assault experience at greater length and in greater depth with others) and telling more persons about the assault were each related to receiving more positive reactions from others and decreased negative symptoms” (Ullman and Filipas, 8). As a result, when compared to those who did not have access to a support provider, “victims who had someone in their social network to talk to about the assault exhibited lower PTS scores, depression scores, and fewer health systems” (Campbell & Self, P 4). Thus it can be concluded that simply having someone to speak to about the assault is beneficial for sexual assault victims.
Based on this evidence, the response to a sexual assault victims disclosure is one of the most crucial responses to assist their recovery. The two most supportive responses are providing space for the assault to be spoken about (96% positivity rate,) and of course believing the victim (90% positivity rate.) This creates the pillars of the healing process in which victims can feel safe, protected, and believed for perhaps the first time disclosing their trauma. (Campbell, 296). These responses were closely intertwined with significantly lower PTSD, depression, and health symptom scores. There are countless other social responses which can benefit rape victims. Mobilizing support or providing victims with the tangible resources necessary to work through their trauma was also considered a positive response. This can include taking the survivor to the police, helping them find medical care, and coping info was scored as 90% positive (Campbell, Sefl). Exposing victims to more formal and professional care providers can translate to the fact that the support provider is taking their trauma and assault seriously, and wants to provide them with the services necessary to heal. Those responding to a rape victims disclosure, especially informal support providers, must continue to treat their friend, daughter, or partner as the same person that they were before. This creates a positive environment which does not reinforce the victims idea that the assault had deeply changed them into another person. “Being treated differently or stigmatized by other after rape may cause victims to feel as though the incident somehow permanently transformed this. If rape victims internalize the idea they are different or less worthy persons because of their assault, they may develop greater PTSD symptoms” (Ullman and Filipas, 10). It can be concluded that a degree of normal interactions during the time after an assault with a victim is extremely beneficial to maintain their previous sense of self and image.
The delivery of support is also extremely important. Countless social response studies including Campbell & Sefl (2004) and Ahrens & Campbell (2007) stated that survivors interpreted social responses very differently. They concluded that even though many of the responses were inherently positive, such as, telling the victim they believed them, allowing them to talk, or telling them it was not their fault, were actually perceived as negative by victims because of how the information was delivered. (Campbell & Sefl, 298). Thus, all responses and support must be delivered and accompanied by a mindful, compassionate, and genuine response that is understanding of the trauma. Given that sexual assault is such a personal issue, “the study noted several cases in which the support provider reacted in a cold/detached manner. This suggests that the manner in which help is provided is equally as important as the type of assistance rendered” (Ahrens, 46). It is also noted in this study that support providers can respond with an egocentric reaction, where their emotional needs are put over the victims or they are triggered somehow. This response can affect the delivery of information and support as well which is why it is pivotal for the service provider to focus on the victim's trauma instead of making it about themselves.
It is also important to acknowledge the assault’s mental effects. Many rape victims carry and internalize the aftermath of their trauma on the inside, given that PTSD, anxiety, phobias, depression, avoidance behaviors, and self hatred is not always visible. Society often prefers tangible, visible wounds whose effects can be clearly seen and traced back to its source. This is not the case for many sexual assault victims but should not alter the support they receive. For victims of sexual assaults, it is absolutely essential that support providers acknowledge their internal trauma as being just as painful as an external trauma. Failure to do this is discrediting to the victims, their assault, trauma, and that it occurred. Validating the sexul assault or rape means validating their internalized mental effects as well.
Victims most often reach out to “informal” care providers, which can include family, friends, and partners according to a study, Deciding Whom to Tell conducted by Courtney Ahrens and Rebecca Campbell. Over 75% of the participants interviewed chose to disclose to informal support providers, and these victims received more positive responses than those who reached out to formal support providers. For example, through a log linear analysis, their study proved that survivors who actively sought help from informal support providers as compared to those who did not seek help from formal support providers were more likely to receive positive social reactions, and decreased symptomatology.
For “formal” care providers, mental health services provided the most supportive responses and least amount of secondary victimization, (Campbell & Sefl). This could be for many reasons, as jobs in the mental health field center around training sensitivity, awareness to trauma, and acknowledgement of their clients pain while those working in the legal and medical fields do not always have exposure to these briefs and trainings in such depth. Thus, they are more likely to provide less supportive, victim blaming responses. Victims who had received high mental health support had significantly lower PTSD scores than those who did not. An important aspect of this support system is the relationship that is established. between the victim and therapist, as most treatments last between 4 and 8 months. This time is used to build trust, safety, and create a connection in the relationship where victims feel comfortable disclosing. Thus, long term formal support providers are more impactful and supportive than short term formal support providers and can assist with more information, support, and growth. Many of the survivors in the study explained how the validation and support they received from counselors about the rape, and validating their negative experiences following it was extremely important and helpful to their recovery.
Therapeutic treatments
Therapies are oftentimes a necessary part of sexual assault victim’s healing process. Beyond social responses and support from care providers, therapy provides victims with an array of information and services that providers sometimes cannot. Victims receive fundamental information, statistic and facts not only about their assault, but also the psychological effects they experience after it. This step is normally the introduction of any therapy, reminding victims that they are not alone and that their symptoms and diagnosis are alone. The therapist client relationship also plays an important role in any therapy. Here, the victim is exposed to a formal, educated care provider that will provide resources without bias’ and maintain a healthy relationship with them throughout their healing process. The next aspect of therapies include acknowledgement and coping. Here, the assault is talked about on varying degrees depending on the therapy so that the client may recognize the trauma that was inflicted on them instead of burying it with avoidance behaviors and actions. Because the victims have to talk about their assault and victimization and bring their pain into the open, they are then taught how to deal and cope with it. Here, coping skills and strategies come into place to teach clients how to solve their trauma and how to respond to situations or triggers that invite it back. Though therapies have varying levels of exposure and methods, all can be used to support victims on their road to recovery through different techniques applicable to different victims.
Emotion processing therapy is designed to provide a structured format for victims of sexual assault to process and understand their trauma. This therapy tackles avoidance behaviors often associated with trauma such as escape behavior, avoidance, or dissociation. Sexual assault is a traumatic and oftentimes life altering event, thus a processing therapy is key for those who cannot grasp their trauma occurred and use avoidance behaviors to deny any cognitive processing of the event. This therapeutic treatment is excellent for victims who have yet to acknowledge their trauma as significant, real, and life altering, but does not focus as much on coping with their pain.
Stress inoculation training is quite the opposite; a cognitive, psychotherapy that is best designed to address the the burdens of stress, anxiety, depression, fear, and anger through coping skills. It is broken into three fundamental components. It is focuses on assisting the client in analyzing their current positive and negative coping methods, and also assisting them in finding and applying new skills. These skills are taught, practiced, and applied so that clients may use them during everyday triggers. However, because this therapy focuses on coping with the trauma instead of dealing with phobias, it does not successfully combat rape related phobias. (Vickerman, 4). Thus, this therapy is excellent for individuals who need to analyze and strengthen how they are responding to their assault.
Cognitive processing therapy is a goal oriented, short term treatment. It is designed to change destructive patterns of thinking or behavior by shifting the way an individual thoughts, beliefs, actions, stuck points, behaviors, images, and patterns are held, one’s cognitive process. The treatment lasts between 5-10 months, following weekly sessions of roughly 50 minutes. It combines methods of psychoeducation exposure, and cognitive techniques. Exposure is done through written assignments where the victim describes her rape and its meaning. (Vickerman, 5). The victim addresses both their assault and its meaning, and the victim's beliefs about their trauma. CPT also has positive effects on altering victims PTSD, depression and guilt scores (Resick 2002 & Resick & Schnicke, 1993). This combination therapy is ideal for victims who are struggling with guilt related trauma, phobias, and high depression; and want to alter their cognitive process about their assault and how it impacted their life.
Rapid eye movement therapy is a psychotherapy treatment that was designed to alleviate stress grown from the seeds of traumatic memories. It is one of the most effective therapeutic treatments for trauma. The client begins by focusing on their emotionally disturbing material while being visually stimulated by the psychotherapist as they move their finger back and forth or a different visual/auditory stimulus. It is an eight phase treatment but is considered very short for a therapeutic treatment for intense trauma. REM is also one of the only therapies that also addresses clients physical sensations. “It asks PTSD subjects to focus intensely on the emotions, sensations, and meaning of the traumatic experience, while asking to follow the hand of a clinician who induces slow saccadic eye movements” (Bessel, 3). This therapy is extremely focused on the trauma, and thus does not effectively cover coping skills.
Somatic experience therapy is an alternative therapy which is focused on trauma stored in different parts of the body instead of the mental effects.The therapist works with the client to remove negative energies and disassociate trauma from the body, thus healing the body from the imprint of trauma. Somatic experience promotes awareness of the bodies emotional imprinting capabilities while releasing the physical tension stored from trauma. “Particular emotions, images, sensations, and muscular reactions related to the trauma may become deeply imprinted on people’s minds and these traumatic imprints seem to be re experienced without appreciable transformations” (Bessel, 1). The main goals of somatic experience therapies is to organize and create coherent memories, emotions, visual perceptions, and sensations of the assault that formulate to a fully organized recognition of the assault.
Exposure therapy is a behavioral therapy which gradually exposes patients to their fear without any danger so that they can function in their everyday lives. It is extremely focused on exposing victims to their assault, story, and fears. “If the problem with PTSD or other mental affiliations is dissociation, treatment should consist of association.. If PTSD consists of a frozen sensory world, the therapeutic challenge is to open the patient's mind to new possibilities so that they can encounter new experience, rather than interpreting the present with the past” (Bessel, 2). This is an excellent tool for victims who harbor their fears and assault and let it paralyze their life.
Another important aspect of therapeutic treatments can be found through rituals or group therapies. Both of these methods differ from more conventional therapies because it is done in a group setting. Here, clients can feel more connected. Add more. Given that sexual assault is such an intimate trauma, it is understandable that group therapy does not work for everyone. However, for many, working in a group environment is extremely healing in creating a community of survivors.
Despite what therapeutic treatment an individual chooses to use, it is pivotal to acknowledged that “survivors who received high mental health support had lower PTS scores than those who did not have as much contact with the mental health system” (Campbell, 853). What is so important about any type of therapeutic program a sexual assault victim chooses to pursue is the aspect of self care. Here, the victim is acknowledging that their trauma is real and worth getting help, they have recognized that they need support from care providers and cannot get through this trauma on their own. Here, they have acknowledged the seriousness of the assault that was forced on them, and that they can heal from it.
Communities
When working simultaneously and positively, social responses, therapies, and services work together to create a community in which survivors of seual assault may heal. However, the word “community” can vary from individual to individual. This can include therapeutic group therapies, inner friends and family, and broader societal systems. Community psychologists define communities as both a physical and emotional space. Leading researchers McMillan and Chavis explained, “a community can create the space that members have belonging, and that they matter to one another and the group. This means there is a safe space for disclosures and support.” Thus, this means that the sense of community can be fulfilled for survivors in varying support systems and degrees, as long as it fills the needs of a safe, supportive space. This can be seen through positive social reactions that compose how communities view specific trauma, thus creating a space in which survivors feel respected, validated, and understood. It can be achieved through group therapies, private therapies, or rituals. Community services that embody society's support such as legal, medical, and mental health systems play a paramount role in creating a safe space for survivors. The sense of community can be created between a survivor and their family in their home. There is no set combination or correct equation to fulfill the needs of sexual assault victims.
Conclusion
The healing process of sexual assault is not a clear equation that can be categorized, organized and universally placed on every single victim. Society must acknowledge that though sexual assault and rape is absolutely a universal problem, it hold a unique, and subjective story for victims. Every single sexual assault victim holds different pain and trauma, while responding and healing in different ways. The various factors that compose an assault or rape including the victim’s experience, relationship to the perpetrator, age, previous experiences, the way support is delivered, and an array of other factors determine the degree type of support a victim needs. Thus, healing processes can include any combination of traditional and nontraditional therapeutic treatments, support groups, formal care providers, and social responses for a sexual assault victim. The most important thing to acknowledge is that because the trauma of rape and sexual assault is so subjective, the healing process is as well. This does not mean that one treatment method holds superiority over another, rather that some are more applicable in different stages of the healing process. For example, initially after an assault victims often experience mental paralyzation, immobility, and a lack of acknowledgement. Thus, a therapy that focuses on addressing and acknowledging the assault. On the other hand, victims could be experiencing phobias, anger, and self blame, and thus a different therapy could be used to address these effects. This also means that some victims of sexual assault might have to work through certain parts of their trauma before disclosing to formal care providers, while others may immediately want to file a report. It may take victims 6 months to disclose to a family member while it could take others 6 hours. What is most important is that victims of sexual assault are healing positively, the individual road they take does not matter as long as it supports them. A care provider, no matter how close they are to the victim, does not completely know their assault. Thus, it is not the place of any care provider to completely create a healing plan for victims of sexual assault.
Because of this, society and support providers must shift from the current culture of victim shaming to victim empowerment. All assaults must be recognized as traumatic, severe, wrong, and impactful to the individual. Simply listening to the stories of assault without prejudice and responding without doubt creates a culture that supports victims instead of neglects and blames them. This can be implemented through positive responses, helping the victim find support, and responding in a caring, empathetic manner. Given that many support providers, both formal and informal, do not understand how impactful their responses are on victim recovery, it is essential that a massive wave of education take place.
In order to alter the way sexual assault victims are treated by members of society, organizations, and formal care providers; a massive step of sensitivity education must take place to alter the collective response and understanding of sexual assault. This will allow care providers to move away from cold, detached responses especially when they come from a place of good intentions but are unaware of how to react to a situation that is so painful and grave. An insightful study done by researcher Campbell about responses from community systems to rape victims concluded, “The results of this study highlight the importance of continued education efforts with community system personnel who work with rape survivors. It is entirely possible that police, prosecutors, doctors, nurses, and mental health professionals may be unaware of how their behavior impacts rape survivors- both positively and negatively. Their procedures and practices for rape victims indeed have a psychological impact. These postrape interactions can be experienced as the continuation of rape, not as helpful or to alleviate the trauma of the assault. Rather than only limiting our focus to treating secondary victimization once it occurred, the prevention of it must be a long-term goal” (Campbell, 856). Because those in legal, medical, and mental health fields often work so closely with sexual assault victims, it is imperative that they receive in depth sensitivity training in order to assure their services do not come off as stigmatizing or cultivate a secondary-victimization culture.
This wave of education throughout formal care fields will not only create a much more suitable, sensitive environment in which sexual assault victims can encounter the services they need, but also create collective change in society's sensitivity to sexual assault. Much like the legislative movements in the 1960’s and 1970’s, the most important thing these education and sensitivity trainings will result in is awareness to providers and society as a whole. The massive movement I propose will bring to light education of sexual assault and the proper way to respond to it.
Sexual assault is real, it is painful and gruesome and traumatic. These are not just statistics printed on paper but are representing real traumas and assault occurring every single day. The traumas inflicted on survivors cannot be simplified to times new roman ink. The internal wound of rape affects millions of individuals walking with it pinned to their memories every single day. But countless research articles has illustrated that victims of this trauma can heal, and despite their unique and personalized formula for doing so. It is up to lawyers, police officers, therapists, government members, nurses and doctors, community members, parents, teachers, friends, siblings, you, and me to create a culture that is healing, empowering, and safe for every single victim of sexual assault and rape. It is up to us, to collectively emulate a society that is safe for victims to heal from this trauma.
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