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Summary Sheet 6

 

Impacts of sexual assault

Research has documented a range of physical and psychological impacts of sexual assault, ranging from immediate to long term. Being better informed about the psychological effects of sexual violence would greatly assist family and friends of survivors to feel more confident in providing support and understanding.

Barriers to accessing services

The process of silencing women about sexual violence occurs from the macro level of social discourses and representations, through to the micro level of interpersonal interactions. Barriers to reporting and disclosure are also barriers to victim/survivors accessing the specialist services they might require. These barriers may complicate and compound the psychosocial burden already carried by survivors.

Disclosure and Support

Survivors have fewer physical and emotional health problems when they have someone:

• who will believe their account of what happened;
• who allows them to talk about the assault; and
• whose reactions the survivor considers to be healing.

Other people’s confirmation that a serious crime has occurred coupled with an offer of support is instrumental in persuading many survivors to report to police. However survivors often report negative experiences of reporting sexual assault to police.

Needs specifically related to the time when the sexual assault occurred include medical help and practical help such as getting to the police or accessing advice on available options.

Common threads in the narratives of victim/survivors around their needs at the time of disclosure include:

• the need for safety and protection;
• emotional or medical help in crisis (whether months or years after the assault);
• emotional support and being believed by someone who is sympathetic;
• not being blamed;
• making sense of what happened; and
• having their experiences validated.

Australian services

The National Association of Services Against Sexual Violence (NASASV) identified some 118 sexual violence services in 2000. These services continue to be informed by feminist notions of practice and situate the crime of sexual violence as an abuse of rights, particularly the rights of women and children. Statistical information was collected on service users over a 3-week period in 2000, from 37 Australian services (see main paper for more detail).

Interventions

Stages of the healing process:

1. The establishment of safety
2. Remembrance and mourning
3. Reconnection with ordinary life.

The main focus of mental health interventions for victim/survivors of sexual violence include issues of guilt, shame, anxiety, depression, hypervigilance, anger, mood swings, and social discomfort.

Naming sexual assault is seen by researchers and therapists as essential to recovery, however many women (for a range of reasons) do not name their experience as sexual assault even though it meets legal definitions of rape. Sexual assault services can provide an antidote to the culture of censorship and silence that victims can experience in the wider society. The literature identifies two main psychotherapeutic approaches in relation to the treatment of victims of sexual assault: cognitive therapies and feminist (or group) therapy.

Cognitive therapies
The goal of cognitive therapy is to change psychological distress by challenging and changing distorted cognitions (thoughts). Types of therapy include:

• Cognitive Behavioural Therapy (CBT);
• Prolonged exposure therapy;
• Cognitive restructuring therapy;
• Other therapeutic services that address PTSD;
• Interventions that address victim blaming and feelings of guilt;
• Interventions that address sleep difficulties; and
• Eye Movement Desensitisation and Reprocessing (EMDR).

Feminist therapies

• Stress the importance of considering the social and cultural context, including gender-based oppression, in understanding the causes and nature of women’s psychological difficulties.
• The goal of feminist therapy to help the victim/survivor understand that such violence is a societal problem, not just an individual problem.
• Sexual violence is reinforced by gender-based differences in privilege and power that play out within interpersonal relationships.
• Often involves group work with other women victim/survivors, which can include (alongside more formal group therapy) activities such as:
• art therapy, yoga, self-defence, and anger management;
• information on relaxation, tips on how to sleep, relationships and abuse; and
• practical assistance such as help with letters about compensation.
• Focus on survivors’ difficulties with guilt and self-blame in the long term, not merely the alleviation of psychological symptoms in the short term.

Further research is needed to identify the precise mental health outcomes associated with the feminist, rights based approach to counselling used by these services.

Primary Health care

Health care workers must strive to be as unlike the perpetrator as possible in all their interactions with victim/survivors. A non-directive, woman-centred therapeutic approach is indicated. This is in contrast to the more directive approach commonly used in health care settings (where the worker gives directions to the client who is expected to follow these directions).

Important questions for primary health care- physical examinations and gynecological care:

*Is there any way this procedure or the manner in which I am carrying it out might be humiliating or traumatic to victims of sexual violence?

*How can I engage women in shared decision making around this kind of clinical care to maximise them feeling safe, informed and in control of what happens?

To provide psychological support, both the words and actions of the health care provider must demonstrate to the victimised girl or woman (who has taken the risk of trusting that provider with her disclosure of violence) that the provider:

• believes what she says about her experience of violence;
• acknowledges her feelings and validates that her emotional reactions to the sexual assault/abuse are normal;

• will work with her and support her to make her own decisions on what is best for her;
• will provide her with information and contacts to other services that could help her;
• says that ‘no one deserves violence’ and no one can deal with the trauma it causes alone;
• informs her that sexual assault is a crime and a violation of her human rights;
• takes a careful history of sexual victimisation including the type or types of violence experienced, when the violence started and how long it continued and an assessment of its severity;
• undertakes an evaluation of each woman’s current psychological needs, symptoms and concerns and whether and in what way these have changed over time (signs of depression, anxiety and traumatic stress including sleeping difficulties are particularly important indicators of gender based violence); and
• keeps up-to-date information in a convenient form to provide survivors information and referral to sexual assault, legal and other human services within the community.

 

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