Facebook Like


Monday, September 25, 2006

First steps to treating rape-and a therapy story

I wrote this one to show you how badly I can blow a case, and to make suggestions to increase the odds it won't happen to you.


You people know me as therapydoc, but I do research and have a faculty appointment, too. One day I took a call, expecting it to be a client, but it was the dean asking me if I would please take on a funded project. There is this small problem, she tells me, of acquaintance rape.

Ultimately a new agency to treat college rape survivors off campus gets off the ground because of the project, and I get a paper out of it, present it to the annual meeting for the Council on Social Work Education.  It's about how social workers should be treating rape.

But the following story happened years before, when all I had to go on was my fairly extensive knowledge of cognitive behavioral and exposure therapies for anxiety and post traumatic stress.  I had used these tools for all kinds of abuse and assault, even for rapes that had happened in the past.

So I'm thinking I'm good talking to a rape victim, someone freshly violated .  Dispassionately, quietly, she tells me, "I was raped over the weekend."
Tell me everything.
"It was right outside your office, across the street at the park on Saturday night. I had parked my car on the street and left a party around mid-night. I saw a man in the car parked behind mine. Before I got into my car and knew what was going on, he grabbed me and pulled me into the park and . . ."

How awful. Did you report it?

"No. I was very embarrassed and I guess, shocked. I was a virgin. I just wanted my mother. I went home. We wanted to keep this private so we came to you for help. The insurance company said you could help me. You know this."

Uh, huh. I know a little. Do you mind telling me the story again? Try to remember everything.

She tells the story again. I am treating this like other trauma or crisis, going over the story, not because I care about the grisly details, but for the healing and warmth, the retelling in a safe place.  I think she'll suffer, this will haunt her, she will have nightmares, and want to warn her of this, begin the exposure therapy immediately, rather than get to know her as a person.  So I objectify her, too, treat her from the book.  I haven't even heard of Rape Trauma Syndrome, something unique, needing something different.  It's not in the DSM.

Assuming that there is meaning in the madness, the mandatory telling and retelling of the narrative, there is theory behind exposure therapy.  Flood the brain with details and it will tire of them.  People who haven't been raped retell silly stories to their friends about things that upset them, then tell them again to others, then retell them to friends-- and the stories are infinitely less traumatic. Somehow there's mastery in the retelling. We feel more control over the situation

I not only tell people to retell stories, but if they are traumatic, we'll do the retelling under very controlled circumstances, bit by bit, over many sessions, for cognitive exposure.  The cognitive in this type of intervention is a way of saying imagined, or visualized, in the brain. That's how therapy is, sometimes, very purposeful, behavioral.  And this helps quite a bit, structured technique.  Add a little EMDR, and you're golden.

Like I said, I'd done all kinds of cognitive behavioral therapy for trauma victims, and there's more than retelling.  We might do a rewrite of a trauma, for example, then repeat the rewrite over and over again in sessions. Sometimes the victim of an assault will bring in a friend or trusted relative and we'll talk about revisiting the scene of the crime, repeatedly, to allow the brain to integrate the idea that in fact, the perpetrator is no longer hanging around.  This type of therapy is useful for any type of assault.  It's useful for kids, too, who have been beat up, bullied.

But rape.  Treating rape.

Wrapping your head around so much stuff, you can't rush it, and sometimes all of that work does nothing to counter the idea that the perpetrator will come around again, eventually.


Rape can be devastating. It can affect a person's emotional and physical health (and will). Reproductive problems or pregnancy, sexually transmitted disease, broken arms, bruises, tears, concussions, even death happen. Emotional symptoms include depression, anxiety, sleeplessness, intense fear, flashbacks, nightmares, suspicion, hyper-vigilance, isolation, irritability, lack of concentration. Socially things can go crazy—victims hide from everyone, stop going to school, lose jobs. 

All of the above and more are consequences of rape.

This is not a short-term therapy.

I have to admit, when this young woman came to see me, I didn't know enough because I knew nothing about Rape Victim Advocacy.

If I had referred this young woman to a victim advocate program or had worked closely with one at the time, she might have continued her treatment, perhaps joined a support group, worked to become a survivor, to help other victims become survivors. 

Who knew?

Rape victim advocate agencies are state funded (in Illinois, relatively well funded at this first writing in 2006) and employ individuals who have often experienced rape themselves, who may have had therapy, surely had support and advocacy, and are now able to work with victims to empower and transform them into survivors.

Advocates call their clients frequently after the first contact, worry about them when they don't show up for appointments, ensure legal advocacy and medical intervention. In other words, they go the extra, extra mile.

Sure rape victims can use therapy and will need to recover from the physical-emotional onslaught they experienced. But I have to say, seriously, based upon my own knowledge and my experience treating that young woman four years ago, that this trauma calls for more than therapy. My client didn't return after the second visit.

Rape victim advocates are the best first step. All kinds of docs need to know this, not only therapists and psychiatrists, but primary care physicians, Ob-gynes, everyone. Get the word out.

therapydoc

45 comments:

a new acquaintance said...

you know the statistic, I'm sure, that one in four women is raped or has been sexually assaulted or harassed in some form or another, right?

Therapy Doc said...

pretty amazing, isn't it?

Stats are even higher ages 16-24.

NINETY PLUS OF ALL RAPES ARE ACQUAINTANCE RAPES.

College campus programmers have done a nice job teaching young people about informed consent, alcohol, rape myths, and group think. (read the bullies bedtime story).

In my studies it's looking like too little too late. We need to educate in elementary, middle, and high schools.

I'll get to what that education actually means, eventually.

danr61 said...
This comment has been removed by a blog administrator.
theohzone said...
This comment has been removed by a blog administrator.
Therapy Doc said...

Come back soon!

Anonymous said...

What's even scarier is that if you've been victimized once then you are 7x more likely to be raped again.

I'm not sure if it's because I am in Canada or because I live in a small town but the victim's advocacy groups here are virtully non-existent.

After being raped a year ago by a co-worker I did press charges. It was more brutal then the assault was but I don't regret the decision. I stood up for myself and fought back.

Lin said...

I know this is an old post -- just found it bouncing around your site.

Am getting ready to go back myself to where I was hurt when I was a kid (just over thirty but seems like a gazillion years ago).

Thank you for advocating it to others...feel less like a freak about wanting to do it now.

And thank you for your sensitivity to the ways rape can be different from other challenges. It is hard to find the words that adequately articulate it, which might help explain the value of advocates who have experienced it themselves: Knowledge is not the same as knowing.

TherapyDoc said...

Lin, that's a great comment. Thanks so much.

brokenhearts said...

i have been dateing a rape victume for about a month and we realy hit it off bolth of us care alot about each other but she is afraid that if she lets me get to close she will get hurt again and i understand this she has been raped by 6 men most of witch were close family we broke up cuz of these problems how can i help the one i care about

therapydoc said...

You really can't do much if a person doesn't want help. But if someone is asking for help, then the answer is in the post. Find her an advocate or a therapist, both preferably. And good luck.

Anonymous said...

I just came across this post on your site and it really impressed me. Your attention to how rape affects so many things and can take so long to heal from is thoughtful and appreciated.
Any mental health professional who tries to push someone to deal with something like this too quickly or forcefully has missed what it's really about.
Sometimes, so much can be solved with time and patience and willingness on the part of professionals to let people heal over time and return to what's difficult when they're ready.

therapydoc said...

Thanks, Anon.

DanR61 said...

Hi,
I think you're doing important work. Someone who has been raped by an aquaintence is feeling so traumatised and betrayed that a blog such as yours that helps figure out what to do and helps them feel more impowered is crucial.

TheOhZone said...

I'm new here. Thank you so much for doing all of this. It's incredibly vindicating, refreshing, interesting, and amazing. Thank you.

Miss Raine Trifles said...
This comment has been removed by a blog administrator.
Anonymous said...

Dear Doc,

I dont know it i was a victim of a date rape or not.. Or it is just a sexual assault or not.. I am really confused.. My ex- said what he did was an act of love, but i dont believe him.. I am still a virgin and i explained that to him thousands of times that i want to keep my virginity till marriage. I still do but he did force me to do stuff i do not want to do..

Since that day and I am completely out of my mind which led me to drop my studies and go back home. I have been diagnosed with sever depression and I went back home, all i do is eat and sleep.. I feel sorry about my degree but I couldnt bear staying at the country i was in any longer! everything reminds me of that day, the cars, the streets the sea everything... I am now hopeless and aimless.. Please tell me what to do..

I am really confused!


Thanks

therapydoc said...
This comment has been removed by the author.
therapydoc said...
This comment has been removed by the author.
therapydoc said...
This comment has been removed by the author.
therapydoc said...

Not to answer personally, but people do have normal suicidal desires and fears, and they mean absolutely nothing, meaning, these are people who would never kill themselves. This is such an important topic that I'm going to post a whole blog on it, maybe real soon. So be on the look-out. Thanks for writing. That said, yeah, a person who feels that way has to get some therapy. Reading about it on a post won't cut it.

Anonymous said...

Dear Doc,

Didn't get a sufficient answer from you??

Wonderingsoul said...

No idea hw I just got to this post from your most recent... Think I must have hit something somewhere.. but wanted to say that I agree with what you wrote that victims need more than just therapy, they probably need retribution and special care.

I have no idea whether I was raped or not.
I don't even think I want to know, bu I do know some of the trauma that the very idea of such a thing can cause.

My incident happened about twelve years ago on a campsite in France.
I have had plenty of time to get used to the whatifs and feel like I hve come to terms with the fact I probably won't ever really know.

It's a horrific thing to happen to anyone. My heart goes out to those who have suffered it.

Thanks for your post, TD.

WS

Anonymous said...

I was raped when I was a kid. Now that I am older I finally broke down and told my parents what happened. They told me that they are going to get me in threapy. But only after the family vacation. I don't think that I can hold on until then. I am broken lost and I need help. Please help me. Give me strenght that I am going to need until I can go to counsling.Please.

therapydoc said...

I know it will help. Show them this post and say, The time is now. And set up the appointment. It might have to wait, anyway, to get to see that doc. But it will help knowing you started the process. If, however, you're self-destructive, there's no waiting. Get evaluated at an ER ASAP. And good luck.

Marie said...

Can I just say it's very validating that you would acknowledge that maybe you didn't handle this well?

I saw a counselor for a few months after being raped on my college campus.

That was 18 years ago now.

(gulp)

the counseling was horrible and it didn't help. I finally bailed out, and the counselor kept calling me. I felt stalked.

i finally went back to therapy about two years ago because I was clinically depressed.

Therapy has helped a lot. My therapist knows I was raped, but we don't talk about it. We talk about everything else. I'm on medication. One of the reasons I stayed in therapy is because the counselor said, "We don't have to talk about this if you don't want to." That gave me the courage to stay and work through other stuff.

I'm considering bringing up the rape in therapy...but not sure. I kind of freak out when I just say the word...like, it didn't really happen to me.

therapydoc said...

I tell people wait til the trust is there, and if the doc's response isn't perfect, to talk that out. At some point, however, it's like late pregnancy. Better out than in.

Nurse and Hospital Stories said...

"Somehow there's mastery in the retelling. We feel more control over the situation"

Definitely agree with this, though I don't have any experience on meeting a patient who is a raped victim. But I have a distant cousin who became a rape victim of her own neighbor. It was a sensational story in our town since that man seems to be a good man. My distant cousin was in trauma after it happened, but as time passed by she survived. Now, she has a baby and a husband and living happily. I guess, the support from the family is a very important factor of healing and seeing the culprit suffer in prison also helps to feel justice and security.

Thanks for sharing, eh
Peny@Barco scrubs

Anonymous said...

What a gift to stumble upon this blog today. I am a survivor of CSA and rape as an adult. I have been in recovery for 20 years. Hard, hard work, but not impossible. And for me, so worth all the pain: I'm 49 years old now, almost finished with my Master's in counseling, and finally(!) in a position to advocate for rape victims. I just started working at a community agency that provides free forensic exams, advocacy and counseling in the immediate aftermath of sexual assault. I saw my first client yesterday. The thoughts you shared about the treatment of recent rape victims has really helped me clarify my purpose in this new role as advocate. Human being first, advocate second, and therapist last. Thanks for your honesty and wisdom...

therapydoc said...

Thank you anon. Your recovery is inspiring. Go from strength to strength.

Anonymous said...

I was abused as a child by my grandfather and brother. Assaulted at 15 by my mothers partner (I cannot even type the r word!) and assaulted again 10 years later by my best friend.
I am married and love my husband but cannot speak to him about these things at all. Two good friends know everything! A year ago my so called friend committed suicide and to be honest ive not really accepted that as wen I think of it I feel guilt.
I've recently changed therapist and the lady I see wants to try EMDR? Would you recommend this?

therapydoc said...

How well do you know the therapist? Do you think she's capable? Have you had any exposure therapies yet? Which ones? EMDR is an exposure therapy. You focus on one snapshot of an event until your brain isn't upset by it anymore. But in my opinion, if you can't even say the r-word, there's a lot to talk about first. I do EMDR but only when I'm pretty sure it's going to work. Is she sure? How many people has she done this with? How's her success rate? It's a great technique, but I don't recommend things without first knowing a lot more about the situation. Ask her, too, what other CBT exercises she uses, She should have a basket full of them. Then you can choose what would feel good to you.Good luck anon. Heartfelt.

Anonymous said...

Ah yes. Sometimes rape happens within the context of abusive, dysfunctional family situations. Mine was forty+ years ago; there was a struggle and a gun went off... couple that with my mom's insistence that I made it all up (and much worse) in the aftermath... sigh. So yes; I did the therapy later in life and have sorted so much out now. Accepting what I can/can't change about me is simply an ongoing life process. What helped me so much while I was dealing with the rape issues themselves was a survivor's website - "After Silence". These are people who know and are self-healing by helping others who've been through the same things. The board is moderated, as well. It's above all a SAFE place. If someone can't get into therapy immediately - it HELPS.

therapydoc said...

Thanks Anon.

Anonymous said...

Hello, I am rape survivor as well as being molested as a child around 6 yrs old and was drugged and raped by my boss on a business trip in KS while he and I reside in NC. After this happened I immediately flew back to NC...my "flight & fight" response kicked in full force on Sept. 8th, 2008 pretty quick. I pursued a civil suit due to this incident no formal criminal charges were filed because I would have had to flown back to KS to file them and I had drained my bank account to simply just get home. I was terrified and was with 8 men that I worked with and being the only female just plain scared to death. I have been in and out of therapy and am currently back in school after loosing my job and not leaving the house much for almost a year except for doctors appoitments. I have been through a lot just as many have. When I went to the hospital the advocate that was sent by my town distrcit attorney was told that I never should up to the hospital and I was told while asking for her numerous times that an advocate did not exsist. I felt even more violated by the health care I did not receive. I had to literally ask the nurse to examine me while she did not even offer me a gown. I have written letter after letter to people in administration and so forth but nothing was ever accomplished. I have a question.....I currently am in or just finished a social psych. class as my professor is a practicing psychologist gave me a rather low grade on a paper and wrote really nasty comments in the margin on my paper. I wrote about the rape. I described things in detail she expressed over and over how she wanted us to write about a personal experience and how it has related to us socially. So she got a personal story. In the margins comments: in regards to criminal charges not being filed because of jurisdiction issues...she circled and wrote "really ?", and asked me due to myself having a hard time finding a therapist...if rape was special vs other tramatic events or if I just simply thought this way? ect....Do you not think that these types of comments were inapropriate or am I just being sensitive. She is very arrogant and has had 8 others from my same class contact the Dean in regards to her actions. I prefer to get my final grade back and am pondering on whether or not she is worth confronting over this or not.

therapydoc said...

I can't give advice, not knowing enough, and not wanting to, but isn't that just perfect? It seems everywhere you go you are punished for being assaulted.

I'm so sorry. This is why some people just don't talk about it. Complaining to administrators can sometimes feel good, but again you risk being hurt again. And yet, if you don't make noise it is certain nobody will do anything.

I think the assignment, by the way, was a terrible idea. Any number of students with post-traumatic stress disorder are likely to suffer the "second rape" in that situation, if not by poor grades, than sheer neglect, failing to take the student seriously. Sound familiar?

Anonymous said...

Dear doc when I was 4 my sisters best friends 15 year old brother locked me in a closet and sexually assaulted me tried to rape me but I was to small.. I'm still unable to handle it

therapydoc said...

You know, there's this saying that time heals everything, but it isn't true for some memories. They need a lot of work. Anon, you gotta' talk about it to somebody, if not confront the idiot,maybe. Thanks for telling me, at least.

Anonymous said...

My wife was rape when she has fifteen by her boyfriend who lie about his age and he was 23yrs old, and she didn´t tell anyone. I feel so bad and i tried to convince her to get therapy but she refuse. She has 33 years old now and I’m worried for her health and probably consequences. I feel bad and it’s hard to talk to her about my feelings, we have 14yrs of married. Obviously the time doesn’t help to heal the pain in this case. What can i do to relief this? Is hard to talk with her because she thinks that i blame her for the rape, and is not. I feel very angry with this idiot (criminal) who do this and can’t let go this situation in the past.

therapydoc said...

Sorry for the slow response. I don't get to the blog every day and comments won't be posted until I read them and approve. Yours of course is a great comment.

I can't give therapy advice here, but can tell you that constant reassurance (I DON'T BLAME YOU FOR THIS! I LOVE YOU!)often pays off. Still, she needs therapy, and you do, too. I think it is great that you have a committed relationship, and hopefully she'll see herself as worthy of the actual joy of emotional and physical intimacy. It can be a slow go, but if a couple is committed to one another, they have time. Best of luck.

Anonymous said...

TherapyDoc,

I'm a sexual assault/rape therapist (also a LCSW) who's run into an issue I haven't experienced before.
A client of mine with a prior childhood/teen history of molestation/assault is acting out sexually by going out to parties like raves and so forth, and attempting to get men to rape her. She's admitted this recently and told two times when it was "successful."

I've worked with clients who have rape fantasy or have "re-lived" their trauma in a safe environment with safewords, but nothing this extreme. I've looked through my bookshelf and researched online and found little about this, outside of anecdotal stories online from women who have done similar things.

Do you have any literature or resources to point to that can help me support my client through this? I've done harm reduction work with her to mitigate some of the more severe consequences but she states that this is very exciting for her and she doesn't want to stop now.

I've done this work for nearly 20 years and haven't dealt with exactly this before.

Any thoughts you have would be appreciated.

In the interests of my clients anonymity, I'll remain Dr. Estelle.


therapydoc said...

Dr Estelle, this is really risky behavior. She needs some kind of intervention, no idea how you'd do that.
My experience in the dom-subdom experience is that it is usually safe, controlled. Her behavior is neither so this is a tough call. If she were my patient I'd call a parent or a next of kin. Someone.Even recommend a hospital stay, certainly an evaluation. At least some education on subdom role in relationships, how to be that in a safe way. Could be she's really sick, high, in an episode and needs that evaluation at the ER.

Anonymous said...

I am wondering if you think the sex of the therapist matters?as a female rape victim I am nervous about going to a male therapist yet that is all that is available where I live. Do you think it matters? I would have to drive 75 miles to see a female.

Anonymous said...

Hello, I am a nineteen year old rape victim. I was raped when I was fourteen years old. I have decided to seek professional help, but I'm not sure what to expect, especially because its been a few years since the incident. What would therapy entail?

therapydoc said...

Thanks for writing. The answer depends upon the therapist, of course. Many will just let you talk, always a good thing, before they "do" anything. The therapies are sometimes called "exposure" therapies because whenever you go over and over and over the same thing, like the details of a rape, your brain tires of them and you are able to file them away in some little file cabinet in the brain. EMDR is one technique some use. Try the search feature on the sidebar and you'll see more on EMDR. Search the words "rape" and "trauma" and "sexual assault" and "cbt". Good luck!

Anonymous said...

I am a male victim. I have many symptoms as a result of this. I havent spoken to anyone or tried therapy. I think its best to talk to a serviver. They understand. I do read alot of coments of people who suffer. I wish for the ones who have been in these situations the best.