As an educator of mental health professionals, I have a unique insight into their abilities. The purpose of this article is to highlight some of the areas where I see the greatest gaps in the training of mental health professionals. This information should inform decision makers to invest in training for these specific skills. This is by no means a complete discussion of the subject. Rather, it is intended to shed light on a few key issues.
In a world where even funding for emergency food aid is being cut, funding for care for psychological trauma is usually inadequate. This makes it all the more important that emotional care providers are trained in effective skills that will lead to the best possible outcomes for those they serve.
Stabilize First and Stabilize Well
As with all emotional/psychological trauma, work begins with emotional stabilization techniques. This principle prohibits questioning and talking about the incident unless it is necessary to ensure the immediate safety of the survivor or to inform the authorities that an incident has occurred. Further questioning for the purpose of "talking about it" must be avoided.
If you are unsure about the severity of an event, you can ask: "On a scale of 1 to 10, how bad was it? If circumstances or information from third parties lead to the conclusion that rape has occurred, the assumption is always a 10 without question.
Techniques for emotional containment, such as the "Vault/Safe" technique, can be considered stabilization techniques and are used when flashbacks, intrusive memories, and/or recurrent nightmares occur.
The primary goal is to prevent and reduce symptoms of acute or chronic post-traumatic stress, such as flashbacks, intrusive memories, nightmares, panic attacks, self-harm, and more. Often, emotional stabilization is all that is needed.
Testimony is Primarily for the Benefit of Society
Circumstances may require the survivor to testify to the police or in court. Such situations require appropriate emotional stabilization before, during, and after the testimony. The duration of the experience needs to be as short as possible. Encounters with the perpetrator(s) must be avoided.
Having accompanied survivors before, during, and after police interviews and court appearances, I can say that while justice is crucial and testimony is necessary, the details of how testimony is obtained matter a great deal. Survivors regularly take a huge second hit for society to help the system deliver justice.
Processing Experiences of Rape
Several factors influence the decision to recommend that a survivor process the traumatic experience.
Some factors are on the side of the provider (of emotional care): First, the provider must have the skills and techniques necessary to safely and effectively process major trauma. These include state-of-the-art EMDR protocols, distancing techniques, containment techniques, and more. The provider must not be triggered by detailed narratives of sexual violence, as this would prevent the survivor from processing thoroughly. If the provider lacks any of these characteristics, a referral should be made to someone who does.
When to Process?
Processing the traumatic experience should be recommended if any of these apply:
- The traumatic experience was recent (within the last few months to a few years) and there was no stable life happening between the experience and the present moment;
- Symptoms that are likely caused by the traumatic experience are present and are perceived to be interfering with quality of life.
The reason is as follows: If the survivor could establish a functioning and emotionally quite stable life, then the decision to process should take into account that processing requires resources, effort, time, money, energy. Processing may make things worse before they get better again. The survivor needs to know that and have sufficient emotional and material resources to get through that.
The presence of debilitating symptoms tips the needle in the other direction, favoring processing.
A typical scenario is when someone seeks therapeutic help for relationship problems and it turns out that these problems are likely caused by some trauma, often some form of sexual violence, including rape.
On the other hand, it may be recommended to postpone processing the traumatic experience if any of these apply:
- If the traumatic experience occurred a long time ago and the survivor has established an emotionally and otherwise stable life.
- The survivor is not currently experiencing symptoms that are likely related to the traumatic experience.
Whether or not to process is ultimately the survivor's decision, after appropriate counseling by a trained mental health professional.
Partners and Family
Sexual violence has a severe impact on a survivor's partner, family, and entire social network.
Ideally, others are empowered to be resources for the survivor and to support the work of the provider. In reality, this will be difficult to achieve. Those around the survivor also suffer, especially partners and close family members. It is advisable that these people receive appropriate care for the indirect trauma they have experienced.
The same applies to the survivor's intimate partner, even if the relationship began after the rape.
Outlook
The burden of all forms of sexual violence on survivors, their families and communities, and society as a whole is enormous. We strive to train emotional support providers in effective techniques to mitigate the effects of sexual violence.
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