Rape and Sexual Assault: Crisis Intervention
Presented by Trina Young, Psy.D.; Licensed Clinical Psychologist
Presentation Description:
Immediate intervention is crucial after a person experiences the trauma of a sexual assault or rape. How can Crisis Responders best help a victim of sexual assault? What are the immediate needs of the person? What factors help a person recover? This presentation will help guide the Crisis Responder to effectively intervene and plan for successful ongoing recovery of the sexual assault victim.
Session Objectives:
At the end of this session, you will:
- Develop an understanding of the immediate needs of victims of rape and sexual trauma.
- Understand the psychological effects of rape and sexual assault.
- Understand what factors help a person recover and what is not helpful for recovery.
- Know how to facilitate moving the victim from crisis intervention to planning for ongoing recovery.
Introduction
Rape and sexual assault are incredibly traumatic and soul-distorting. We know that it is imperative that crisis intervention take place as early as possible for such acts of interpersonal violence. But after such a horrific crime as sexual assault, it is important for the Crisis Responder to know how best to approach the victim and intervene. Research reveals how the Crisis Responder can be best equipped to minister to victims of rape and sexual trauma.
Definitions
- Trauma: an event outside normal human experience (as described in AACC’s Stress and Trauma Care training program)
- Since the event is considered abnormal and outside human experience, powerlessness is a key characteristic experienced by the victim.
- After experiencing trauma, a person’s sense of safety and attachment to others is “scrambled;” there is a loss of a sense of safety and of connection to others and God
- PTSD:
- a normal reaction to an abnormal situation
- characterized by:
- ongoing re-experiencing of the trauma and increased arousal
- numbing of responsiveness
- Sexual Assault: Unwanted sexual contact that stops short of rape or attempted rape. This includes sexual touching and fondling (some states use this term interchangeably with rape).
- Rape: Non-consensual sexual penetration obtained by
physical force,
threat of bodily harm,
or at a time when the victim is incapable of giving consent due to
mental illness, mental retardation, or intoxication.
Helpful Research
Statistics:
- 1 in 3 women and 1 in 5 men are sexually abused prior to age 18 by someone they are supposed to trust; and many of these abuses are chronic.
- 1 in 4 women in America experience rape in their lifetime.
- Two thirds of rape victims had a prior relationship with their offender.
- In a college sample, only 4% of rape victims actually reported to a rape crisis center.
- 50% of sexual assault victims will eventually seek counseling.
- Interpersonal violence survivors are 10 times more likely to develop PTSD (Borja, et. al., 2006)
Immediate intervention:
Immediate needs
After a rape, survivors may be openly upset, even hysterical, or they may be numb and seemingly calm. You can help victims by meeting immediate needs:
- Obtain medical assistance.
- Physical wounds must be addressed.
- Be prepared to gently inform the victim of the importance of a PERK (Physical Evidence Recovery Kit) exam, also called “Rape Kit.”
- A PERK exam can be completed, whether or not the victim decides to prosecute the perpetrator.
- PERK exams are crucial to prosecuting the perpetrator.
- During immediate intervention, inform the victim not to shower, gargle, or change clothes. This is important for a PERK exam to be successfully completed.
- It is important to respect the victim’s decision of whether or not he or she will choose to have a PERK exam.
- Feeling safe. Rape is a traumatic violation of a person. Especially in the beginning, it is often difficult for victims to be alone.
- Make sure your crisis intervention with the victim is held in a safe place.
- Make sure the victim will be returning to a safe place.
- Work with the victim to schedule safe others to be with the victim in the coming hours and days. It is preferable to have around-the-clock social support.
- Being believed. With date rape especially, victims need to be believed that what occurred was, in fact, a rape.
- Knowing it was not their fault.
- A common response for rape victims is guilt and self-blame; feeling that the attack was somehow their fault.
- Sadly, this feeling is often reinforced by others, even those closest to them.
- The Crisis Responder will need to anticipate this, and gently reassure the victim that the assault was not their fault.
- Regain control of their life. When a person is raped, they may feel completely out of control of what is happening to them. A significant step on the road to recovery is to regain a sense of control in little, as well as big things.
*One researcher who interviewed 33 rape victims regarding their needs writes:
QUOTE: “While clinicians and researchers are busy trying to determine the most effective approaches and techniques, survivors are concerned about support, validation, kindness, and most of all, empowerment.” (Drauker, 1999).
Assessing the victim and situation
- Wholistic Assessment is important.
- Assess the victim’s support systems:
- Individual:
- Assess for Self-blame and Shame: Sexual assault as a crime is unique in that the victim often carries more shame than the victimizer.
- Emotional debriefing may be helpful: ask questions regarding common emotional reactions of fear, helplessness, anger, guilt, anxiety, depression
- Relationships:
- Is there a “safe” significant other?
- Are there immediate friends and family who can be trusted to provide “around the clock” care?
- Community:
- Assess the safety (emotional, physical) of the victim’s immediate community.
- Will the victim have interaction with the victimizer?
- Societal:
- Assess the victim’s society mores and values.
- How respectful of women is the victim’s culture?
- Will the victim perceive or experience judgment vs. acceptance?
Stages of the Healing Process:
- Shock (also referred to as “Disarray”):
- presentation may vary from “numb and stunned” to mutism to being hyperverbal/hyperactive; person is generally very distracted (may appear to have ADHD), unfocused, and may go off on tangential thoughts; speech may not make sense
- This stage can last anywhere from hours to weeks or months
- Typical reactions might include saying "I can't feel anything" or "I can't think clearly." Disorientation and high levels of anxiety are common.
- Denial
- Some deny the event altogether, and others may state it didn't "bother" him/her
- stages of shock and denial can be long-term, and can take severe mental and emotional tolls on victims
- Blaming
- Most blaming is typically directed at the self. Victims may focus on thoughts such as: "If only I didn't...", or "I should have...", or "I shouldn't have..."
- Making matters worse, this self blame is easily exacerbated by supporters like friends, family or investigators
- Pain (also referred to as “Anguish”):
- Anguish may be focused on the gut-wrenching loss, particularly if the victim knew the perpetrator—connected to memory and “what was”
- Pain usually covers two issues:
- Avoiding: acting out or self-medicating with alcohol or other "numbing" medications or drugs
- Feeling pain: sadness, fearfulness and confusion come to the forefront.
- Anger:
- At some point, pain demands a reaction. For victims of sexual assault, this reaction is usually anger.
- The anger might be directed at self – seen when the victim is intensely focused on their own behaviors (self injury and substance abuse are common), or might be focused on others – either the attacker, in particular, or directed at anyone/anything that can become the focus of the feelings, even innocent bystanders like spouses, family members or friends.
- Integration/Acceptance:
- learning to recognize and adapt to a life that is forever changed, a life that can change in many different ways
- The time, effort, and method of reaching this stage differ with each individual. There's no "schedule" for when a person "should recover”
- The unfortunate fact is that many victims don't reach this stage - and certainly those who don't seek assistance have even smaller chances for leading healthy, fruitful lives after sexual assault
- Posttraumatic Growth:
- Recent research points to a mixture of both positive and negative outcomes following interpersonal trauma. Thus giving REDEMPTIVE HOPE for the victim. (see Borja, et.al., 2006; Chopka and Schwartz, 2009)
- Research indicates that Posttraumatic Growth may involve the following:
- improved relationships
- positive changes
- a greater appreciation for life
- a greater sense of spiritual development
(Tedeschi and Calhoun, 2004)
Planning for ongoing recovery
- Assess the victim’s experience of social support, as this has been pointed to as the most helpful resource for decreasing lasting psychological distress (Borja, et.al., 1996)
- Prepare the victim to look for bodily symptoms associated with trauma and grief: fatigue, sleep problems, pain, stomach problems, heart palpitations, chest pressure, backaches, panic attacks
- Sexual trauma “re-wires” the brain’s natural arousal pattern circuitry: best dealt with in regular on-going outpatient therapy
- Prepare the victim to assess for symptoms of PTSD in the coming months.
- Common symptoms that may occur in the future for adults…
- Intrusive thoughts
- Distress
- Detachment from others
- Anhedonia
- Sleep Disturbance
- Irritability
- Shame
- Increase Startle Response
- For Children …
- Generalized fears
- Avoidance
- Sleep disturbance
- Preoccupation with certain symbols
- Posttraumatic play
- Loss of a developmental skill
Conclusion:
Crisis responders are called to be the healing bridge from unspeakable pain to hope. The victim of sexual trauma has been forced to look evil in the eye, and the Crisis Responder will represent the first glimpse back to sanity in human form. Be sensitive to listen, hear the pain, and point out the way to hope for the future. To represent Christ, we must choose and be prepared to be a sanctuary for the hurting.
Soul Care:
Isaiah 53:4-6
Psalm 91:1, 4
Mark 4:35-41
Mark 13:2-11
John 16:33
I John 5:19-20
Isaiah 45:2-3
Reading List:
Allender, Dan (1995). The Wounded Heart: Hope for Adult Victims of Childhood Sexual Abuse. Colorado Springs, CO: NavPress.
Drauker, C. B. (1999). The Psychotherapeutic Needs of Women Who Have Been Sexually Assaulted. Perspectives in Psychiatric Care, 35:1, 18-28.
Langberg, Diane (2003). Counseling Survivors of Sexual Abuse. Longwood, FL: Xulon Press.
Langberg, Diane (1999). On the Threshold of Hope. Carol Stream, IL: Tyndale House Publishers.
Rape, Abuse and Incest National Network. (2009). Get Info. Retrieved January 20, 2011, from http://www.rainn.org/get-information
References:
AACC’s Stress and Trauma Care training program. (2009). Forest, VA: American Association of Christian Counselors.
Allender, Dan (1995). The Wounded Heart: Hope for Adult Victims of Childhood Sexual Abuse. Colorado Springs, CO: NavPress.
Borja, S. E., Callahan, J. L., Long, P. J. (2006). Positive and negative adjustment and social support for sexual assault survivors. Journal of Traumatic Stress, 19:6, 905-914.
Chopko, B. A. and Schwartz, R. C. (2009). The relation between mindfulness and posttraumatic growth: A study of first responders to trauma-inducing incidents. Journal of Mental Health Counseling, 31: 4, 363-376.
Drauker, C. B. (1999). The Psychotherapeutic Needs of Women Who Have Been Sexually Assaulted. Perspectives in Psychiatric Care, 35:1, 18-28.
Foa, E. B., Keane, T. M. and Friedman (2000). Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies. New York, NY: Guilford Press.
Helping Victims of Sexual Assault. Retrieved January 20, 2011, from http://www.aardvarc.org/rape/about/howhelp.shtml
Hensley (2002). Treatment for rape trauma. Journal of Mental Health Counseling, 331-344.
Koss, Mary P. (1993). Rape: Scope, Impact, Interventions, and Public Policy Responses. American Psychologist, 48: 1062 – 1069.
Langberg, Diane (2003). Counseling Survivors of Sexual Abuse. Longwood, FL: Xulon Press.
Langberg, Diane (1999). On the Threshold of Hope. Carol Stream, IL: Tyndale House Publishers.
Rape, Abuse and Incest National Network. (2009). Get Info. Retrieved January 20, 2011, from http://www.rainn.org/get-information
Tedeschi, R. G., Calhoun, L. G. (2004). Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry, 15, 1-18.
Virginia Sexual and Domestic Violence Action Alliance. (2005). Action Alliance Newsletters. Retrieved from http://www.vsdvalliance.org/secPublications/newsletters.html
