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When a person is violently and forcibly subjected to another person's will, he or she experiences a severe sense of loss. There is loss of control over body and environment, loss of a feeling of safety or predictability, of self -esteem and possibly life or health. When the violent subjugation is in the form of sexual assault or rape, the sense of shame, guilt and fear compound the losses actually experienced.
The survivor of sexual assault is most likely a mentally healthy individual and, with appropriate support and interventions, can return to a state of normalcy following the crisis. This is what most survivors want and you are there to help them begin the journey to recovery. The survivor of sexual assault will never forget what happened. However, healing is possible.
THE NATURE OF CRISIS
During a crisis, a person's normal coping mechanisms are not effective. Coping mechanisms are the usual way a person handles stress. They may be adaptive or maladaptive. A crisis is characterized by increased emotional energy and confusion, disturbance in thinking (especially problem solving ability), and perceptual disturbance (i.e., seeing things in a distorted way such as believing that things will never get better).
However, crisis is time-limited. There is a natural push toward some kind of resolution. A crisis generally does not last more than 4-6 weeks. This is why you may see clients missing appointments after this time. The initial crisis has passed and most survivors will try to get back to their life before the assault. This does not mean they are resistant to treatment - they are following a normal coping pattern.
As healthy people, we possess a pattern of physical, mental, emotional, and social responses that allow us to cope with crisis and grief. If those around us understand what we are experiencing, we are free to go through the process that will lead us to stability. One of the most important things an advocate can do is help survivors understand that their feelings are normal and perhaps prepare them for other possible reactions. Also it is important to be able to educate family and friends of survivors so they can know how to respond as well.
SOME COMMON REACTIONS
Knowing some of the common reactions to rape trauma is vital to the process of normalization. Naming reactions and understanding why they are happening can reduce the survivor's perception that he/she is "going crazy."
Physiological: When we are threatened with imminent danger or loss, a very primitive mechanism goes into effect. Hormones are secreted, breathing and pulse rates change, the body automatically prepares itself for a fight for survival. This reaction can last anywhere from a few minutes to a few hours but usually doesn't subside until the individual has had a period of time in a safe, non-threatening environment.
How this appears: Hypervigilance, exaggerated startle response, insomnia, fatigue, anxiety
Mental: When in crisis, our minds are unable to focus on a single subject. We are unable to process alternatives, and we are incapable of making decisions. The total thought process is focused on avoiding the danger that is threatening us.
How this appears: Flashback, amnesia, nightmares, difficulty concentrating, racing thoughts, spacing out, repeating thoughts, self-blame, and confusion
Emotional: At the point of crisis, the main affective responses are fight, fright, and flight. Since this person is simultaneously searching for an escape from the danger, he or she may rapidly fluctuate between anger, fear, and denial.
How this appears: Depression, guilt, shame, anger, sadness, grief, fear, mood-swings, feeling out of control, numb, empty
Social: People in crisis, because they have lost control of their situation, may not be sure which people to trust. They tend to trust a predictable role figure (a doctor, police officer) rather than the actual person with whom they are dealing at the moment.
How this appears: Isolating, avoiding thoughts and feelings, avoiding places and people, sexual dysfunction, loss of interests
As the fear of immediate harm subsides most survivors can also expect to move through various stages along the healing process. All of these stages are normal and vary in length of time.
INITIAL ASSESSMENT
It is important to determine how, and to what extent, life has been disrupted by sexual assault. By such assessment you may be better able to help survivors, and enable them to see the progress they are making in resuming their "normal" lifestyle. The following questions may help the survivor talk about his/her experience(s), but care should be taken to avoid "interrogating" the survivor:
Have you told anyone?
What impact has the rape had on your family? Work? Friends? Support system?
What changes have you noticed in yourself since the rape?
What have you done thus far to help yourself?
What would you like to do but haven't yet?
How have you dealt with crisis in the past?
What has happened recently that has been the most/least helpful?
How do you feel about the assailant?
Have you thought about counseling?
Survivors display incredible coping mechanisms during the assault, even though they do not always realize it. You can reinforce their confidence in their coping mechanisms. As you listen to their experience identify where/when they succeeded: possibly by submitting or resisting, by escaping, or by calling the rape crisis program. Whatever they did to survive was the right thing to do. Helping survivors realize that they are survivors and regain confidence in their own resources is a very important aspect of healing.
RESPONDING TO FEELINGS AND BEHAVIORS
People cope with extraordinary circumstances to the best of their ability. No matter what anyone says or does, this experience will not simply go away. However, survivors can recover from the trauma and live productive lives. Survivors are able to use information about post-traumatic stress responses to help understand their experiences and reduce the impact of the traumatic event. The goal is management of psychological reactions, not elimination of reactions. The most appropriate way to respond to most feelings and behaviors is to actively listen and normalize their experience. All survivors of trauma have existing strengths and resources that are windows to recovery and healing. It is often not the lack of coping mechanisms which create crisis, but rather, the lack of confidence in those coping mechanisms.
The following are additional responses you might find helpful. For all reactions, suggest finding a physical release for energy. Encourage exercise, regular sleep, and nutritional eating. Do not underestimate the value of overall good health. Also, let survivors know of the rape crisis center or another counseling center in their area for individual or group counseling when reactions are effecting their safety or interfering with daily living activities.
| If a client experiences: | then: |
| HYPERVIGILANCE | Let them know the feeling is normal.
Help find ways to make surroundings feel safer (e.g. change the locks, phone by the bed, propping something against doors/windows that will make a noise if opened).
Help become aware of surroundings (the dangers that could present themselves and how to avoid them).
Suggest they consider taking a self-defense class. |
| WORRY (about what others will think) | Allow the person to talk about it.
Suggest the survivor write down or draw thoughts and feelings.
Talk about society's reaction vs. their own reactions.
Talk about myths associated with sexual assault and the actual facts to dispel those myths. Help survivors identify their own beliefs/myths. |
| DEPRESSION | Talk about anger, sadness, shame, guilt since these feelings are associated with depression.
Create plan to contact someone when there is a need to talk.
Do something different (not a usual routine).
Brainstorm list of things/activities which make the person feel good. Suggest he/she picks one activity daily. |
| TROUBLE SLEEPING | Get out of bed and do something else. v Write down thoughts.
Create bedtime routine to provide comfort & security.
Inquire about sleep disturbances in the past. What worked or helped before?
Help the survivor identify how they can feel safer in their own home? (see hypervigilance)
Encourage the survivor to talk about assault during the day |
| CONCERN ABOUT LOVED ONES | Find out if they can or would be willing to talk to their family or friends. Offer to role-play with them about talking with loved ones.
Inform person that friends/family can also utilize rape crisis program services.
Validate fear.
Put that fear in proper perspective (i.e. mother may tend to overprotect her kids). Help regain self-confidence through encouraging decision making. |
| FEAR(of strangers /places, feeling out of control) | Encourage the survivor to go at their own pace.
Offer assistance and explain how you can help.
Find out what he/she needs from you/others.
Provide physical contact only if requested and you are comfortable with it.
Avoid close-ended questions.
Focus on feelings rather than facts.
Affirm that they are in control. |
Children & Adolescents are More likely To Have Behavioral Responses. All of these behaviors express important needs and feelings. It is important to correct the behavior while finding other ways to address the needs.
| AGGRESSIVE BEHAVIOR | Provide clear support for emotions.
Ensure that the survivor is safe.
Help the survivor name emotions.
Show empathy. For example, " I know you're in pain; let's find a better way to deal with the pain. Maybe you can hit a pillow or draw a picture of how you feel."
Teach the survivor to express anger directly in words.
Model healthy ways to express anger. |
| SELF MUTILATION | Develop plan that the survivor will tell you or another trusted adult when he or she feels like hurting himself or herself.
Watch the survivor's body language, listen to tone of voice and then identify the survivor's likely emotions in words he or she can understand.
Encourage activities to develop friendships.
Ensure knives, scissors and other harmful items are not available. |
| COMPULSIVE MASTURBATION | Provide clear support, such as talking about how natural it is to want to feel good.
Note how often the sexual behavior occurs.
Remove sexual stimuli that may increase sexual feelings or confusion.
Teach the survivor that masturbation is done in private, such as the bedroom behind closed doors. |
| SEXUALLY ACTING OUT | Set limits gently, but clearly. For example, "It's not O.K. for you to touch the private parts of my body, and I won't touch yours." or " I can see you want to get my attention, there are other ways to do that."
Provide clear support. Acknowledge the emotions, even if you must help change behaviors.
Encourage the survivor to talk to you or another trusted adult if he or she needs to act out sexually.
Encourage the survivor to engage in physical activities that expend energy.
Do not ignore or minimize the behavior. Talk explicitly about how the behavior can be unsafe and what behaviors would more likely meet the emotional need to feel close. |
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