PTSD and Healing After Sexual Trauma

This post is a part of the Feministe series on Sexual Assault Awareness Month.

Before I really get started, this is a piece about how you, a rape survivor, can regain a sense of wellness after the fact. This is neither a professionally nor universally designed plan of action to combat PTSD or heal one’s spiritual self after rape, though I have tried to gather as many ways and means as possible that you can have agency in your recovery regardless of whether you have access to Western clinical treatment practices. I also want to emphasize that these methods should in no way be used to pressure someone to “get over” the trauma of having one’s trust betrayed, one’s body violated, and one’s worth shamed by a culture set up to discredit victims. “Getting over it” is subjective, it’s a process, and it’s closure well-earned, and it’s not up to anyone other than the survivor to lead the way to emotional healing, if indeed “over it” is a benchmark that can ever truly be achieved. This is not a piece about how to end sexual violence. If I’m glib, this piece is how to get on with your life as best you can after you’ve experienced sexual violence.

That said, these methods are also heavily informed by my experience as a het, cis, able, white, Western woman who has straddled the middle and lower class divide for the last decade. My healing process has been largely attempted as an adult, with short periods of access to clinical treatment and long periods without, and as such, I have provided suggestions for people who can get access to formal clinical therapy and suggestions for those who cannot. There is overlap in both groups, for sure. Unfortunately I have no expertise on methods to obtain healing services in the rest of the world, so if you come across or create resources, please share an we will link prominently. To help me close any gaps in my suggestions here, please, please, please share links and suggestions in the comments as others will certainly reference this post in a very real time of need.

If you need help immediately, please locate a rape crisis center that can help you in your area: 1.800.656.HOPE.

PTSD

Post-Traumatic Stress Disorder is a clinical term for a group of symptoms experienced by people who have undergone trauma.  PTSD usually occurs within three months of a traumatic experience, but in some instances can present years after the fact. If you attempt to look up PTSD online, many of the websites you will find will detail treatment perspectives for combat veterans, including many resources from the Department of Veteran Affairs, because veterans have long been the largest organized advocacy group calling attention to the long-term effects of PTSD while calling for insurance companies and government agencies to treat PTSD like the illness it is. Women are four times more likely to experience PTSD than men, and most experts “believe this is because women are at increased risk of experiencing the kinds of interpersonal violence… most likely to lead to PTSD” such as molestation, rape, physical attack, intimate partner violence, and childhood physical abuse. This is further troublesome when gender is layered with intersecting oppressions. As the other contributors for this series have illustrated (time and time again — is everyone paying attention this round?), the more oppressed your social group the more likely you are to be targeted for sexual and other physical abuse. Your age, your gender presentation, your color, your ethnicity, your social class, your immigration status, your adherence to patriarchal culture, your physical ability, your emotional and intellectual ability — if any of these things are apart from the accepted social norm, the more likely you will be targeted for sexual abuse.  If you are institutionalized, you are ripe for sexual abuse, whether the institution is a nursing home, a hospital, or a prison.  Rape is a systematic assault, rapists are systematic abusers, and they target the victims of their abuse based on their perception of whether you have the agency to fight back, legally and physically and emotionally.

Some years ago I met a young woman who told me she was a graduate student in Trauma Studies, a whole method of study meant to examine how groups of people cope with trauma after a catastrophic event, and how to make them better.  That there even was such a thing!  I wondered then what it would look like if someone tried to heal women who’d been victimized, or sexual assault survivors, from this death by a thousand cuts.  I wondered what our “community” would look like. 

Regardless, all sexual assault survivors do not have PTSD.  Some people will have PTSD after a traumatic experience, and some will not experience anything at all.  Clinicians have posed some reasons why PTSD is present in some but not others, supposing that the way the body processes chemicals and hormones related to stress may be a factor, or perhaps a predisposition to major depression and anxiety, and/or the degree and frequency of trauma that a person experiences over the course of a lifetime.  It is likely that if you are genetically vulnerable to inherited emotional disorders, you are more likely to develop clinical PTSD than someone who is not.  PTSD frequently coexists with depression and anxiety disorders, with many of the symptoms diagnosed by clumsy clinicians as major depression and generalized anxiety disorders alone.

Symptoms of PTSD are lumped together as 1) unwanted, intrusive memories; 2) avoidance and emotional numbness; and 3) anxiety and increased emotional arousal.  These three groups can be expanded into a more detailed list. Some people have repeated scary dreams that relate to the assault, or have daytime flashbacks where they relive the trauma while awake.  Some people report that they have difficulty maintaining close relationships, or that they feel generally emotionally numb when presented even with unrelated emotional problems.  Others report feeling an overwhelming sense of shame, or guilt, or responsibility for their rape, and may engage in self-destructive behavior like drug and alcohol abuse in order to cope.  The symptoms can come and go, and are rarely felt at their worst at all hours of the day every day, but most resources will inform you to see a doctor if your symptoms are severe, or if you’ve experienced symptoms to a degree where you feel as though you are unable to get your life under control, or if you’ve experienced these symptoms with severity for over one month.

Triggers

We’ve had some controversy over triggers in the blogosphere recently on whether or not trigger warnings are patronizing or whether they are a reasonable effort to make in a community where we can basically be certain that we have more than our fair share of assault survivors in the audience who appreciate fair warning.  I’ll put myself out on a limb and say that I haven’t yet met a fellow rape survivor who doesn’t have triggers that she is better off trying to control.

A trigger is “an experience that triggers a traumatic memory in someone who has experienced trauma.”  Even though a trigger is upsetting to the person triggered, may not be an intrinsically violent or upsetting experience to an outsider, but it will exacerbate PTSD symptoms in the assault survivor.  Many folks will use language like “safe space” to indicate that triggers are acknowledged and that sexual assault survivors can participate in said space with a reasonable expectation that she will not be triggered.  Triggers can be represented by any number of things, but to give an example, my triggers are rape in visual media, violence against children and animals, and fast, violent movements near my face and head.  I have also discovered with reference to the Kobe Bryant and Roman Polanski cases that long-term media frenzies around celebrity rape trials are extremely triggering for me personally.  It is so, so important to be able to identify what triggers you so that you can use whatever favorite tool you have in your toolbox to cope once you have been triggered.  Initially, it will likely be best if you attempt to avoid your triggers altogether if they tend to trigger debilitating emotions, but you will find that they will not trigger as dramatically as you pursue treatment.

If you have identified your triggers, it is okay to ask your friends and confidantes to help you maintain boundaries that keep you emotionally safe.  People who ignore you aren’t looking out for your best interest anyway, so why keep them around so they can continue to trigger you?  It is okay to ask, for example, that you and your friends avoid watching the movie with the graphic rape scene.  It is okay to request that triggering language is posted below a jump-cut on your favorite blog.  It is okay to protest if someone avoids your request, and it is also, in many cases, if you feel safe, okay to explain why. 

I’ve been long-winded up to this point in part because I feel that it is important to lay out some of the basics of what people are dealing with when it comes to the aftermath of sexual assault.  Whether you have access to formal treatment or not, one of the biggest obstacles many rape survivors face is the rationalization for seeking treatment at all.  We minimize our need, we minimize the pain we feel and blame ourselves to being too weak to just deal with it.  There are other things to spend our time and money on, we think.  We decide that the physical aches and pains that resulted afterward aren’t related to the anxiety and depression we feel inside.  So it’s important to realize that you aren’t alone, that you’re not a freak for feeling as bad as you do, and for the inability to get it out from under your skin.  AND you’re not a bad person for feeling you can’t get past it. This is trauma.  The insidious power of rape is the ability for a rapist to create and maintain an underclass through the act of rape.  You were targeted.  It was unfair.  Hell yes, it fucking hurts.  It is no wonder at all that you feel the way you do. 

If You Have Access to Clinical Treatment

The first step is finding a clinician you trust.  If you have the luxury of clinical treatment, do yourself a favor a shop around until you find a progressive clinician that you trust.  This person may be a psychologist, a psychiatrist, a social worker, a licensed therapist, or grad student studying any of these things.  I have had exceptional luck finding good therapists, and I live in a small college town in the middle of Indiana.  My method probably won’t fit everyone’s criteria, but I invite you to glean what is useful and shed what isn’t and share your differences in the comments.

I am more comfortable with women therapists, so I start there in the phone book.  Look for unusual advertisements in print and online, where therapists use particular language to cue what kind of therapy they specialize in, and for this type of therapy you’ll be looking for therapists that use language specifying experience with trauma, women’s issues (and many therapists will use this exact phrase), and sexuality.  They will also often specify that they welcome and work with queer communities.  These people, in my experience, are the ones you want to work with because they tend to lack prescriptive Men are from Mars, Women are from Venus kinds of gender roles and POVs that can be actively harmful to someone dealing with sexual trauma.  At this point I start making phone calls to find out their office hours and payment criteria.  More on this in a minute.

Without getting too deep into my personal experience, I have seen some therapists whose personal interests and treatment models did not at all jive with mine, meaning that prayer at the end of the session was unwelcome and uncomfortable, or that when the subject of rape came up it was brushed under the table because the therapist did not have the tools to work with me.  Ethical therapists will suggest in similar situations that you switch therapists, and will probably suggest an alternative person — but not always, in which case you need to do so for your own sake.  If your therapist doesn’t seem equipped to help or understand you, don’t waste your time and emotional energy.

Once you’ve found a therapist you like, there are a few different models for talk therapy your therapist might use, including Cognitive-Behavioral Therapy (CBT), Psychodynamic Therapy, and EMDR, among others.  Many therapists will use a mixture of methods specified to what works best for you as the patient. 

CBT helps you make sense of experiences that lead to negative symptoms, i.e. figuring out what triggers you, how and why.  CBT can help you break negatively biased narratives about yourself — that you, for example, are worthless or helpless or beyond help — and realign your thinking toward more affirmational narratives of self.  For people who experience traumatic symptoms after sexual assault, this can help you break the line of thinking that you somehow deserved the trauma or could have done something to change or prevent it or that you’re never going to get better so why try.  These negative feedback loops are thought to lengthen and worsen bouts of depression and anxiety, and having the tools to intervene can be immensely helpful to those with trauma.

Where CBT focuses on what is present, psychodynamic therapy focuses on the unconscious mind, “where upsetting feelings, urges and thoughts that are too painful for us to directly look at are housed.”  Before you dismiss this as so much Freudian woo-woo, this is a way of saying that the therapist identifies your defense mechanisms and helps you to identify, redefine, and let go of whatever fear or trauma is leading you to employ said defense mechanisms.  Psychodynamic therapy isn’t as widely used to treat PTSD symptoms in particular, but it can be helpful to work through some of the side effects of assault trauma, such as an inability to bond and attach with partners and children, or inappropriately defensive and hostile reactions to daily stimuli, all of which can be problematic for rape victims after the fact.

EMDR, or Eye Movement Desensitization and Reprocessing, intends to change the way you react to triggers.  Incidentally it’s one of the treatments that did me best while undergoing formal treatment, and it’s one that is gaining credibility in the Veteran PTSD treatment community.  It also makes absolutely no sense to me whatsoever.  Before I describe the process, I will note that it is procedurally very complicated and that although there is agreement that it is very successful for PTSD treatment, there is a lot of controversy about how and why it works.  I encourage anyone interested to do your research and be sure you do it with a therapist you truly trust.

The way my therapist explained it to me was that it was a way of changing a variety of assault experiences from “THE thing that happened to me” to “A thing that happened to me,” and this is exactly how it feels now.  She used a rotating LED light that went back and forth at a speed I could follow with my eyes, and while I followed the light, she led me through a series of Q&A sessions where I recounted my assault experiences in as much detail as I could handle.  At the end of each short session, she would stop and ask me whether I had any particular physical or emotional pain resulting from my recollections, and if I did the next short session would focus on that.  We did this over the course of several hour-long sessions, during which I recalled all kinds of details about the assault that I wouldn’t have normally recalled in my then-usual anxiety.  I was then able to process and redetermine the efficacy of some of the values and negative feedback loops I had attached to the events.  After this course of treatment was completed to our satisfaction, regular therapeutic treatment for anxiety and depression symptoms (i.e. stocking the toolbox with coping tools I could self-administer) was so effective that we reached a stopping point in our relationship.

If You Do Not Have Access to Clinical Treatment

Double-check to see if you do indeed have access to clinical treatment.  Many people, including myself, stop looking for a therapist before you start, either because you don’t have insurance or because your have really crappy insurance.  For those of us in the United States and in other similarly shitty countries that don’t care about their citizens’ well-being, finding mental health care can be really frustrating.  A lot of insurance companies will cover some mental health care, but it will be of the type that is court-mandated for incorrigible teenagers and habitual drunk drivers.  These facilities will accept you as a patient but they often aren’t equipped with the kind of tools and training necessary to help long-term, voluntary patients that are seeking help with the legacy of sexual trauma.  The good news is that there are some ways around this that are still applicable to low-income and uninsured people. 

Upthread I mentioned that you should talk to your potential therapist about payment methods when you meet with them.  A lot, A LOT, of smaller offices operate on sliding scale fees, fees that are adjusted based on what you can afford with your income and expenses.  Some therapists even ask you to NAME what you can afford and pay that each session.  Fees will vary wildly depending on the education level, demand, and philosophy of the therapist you choose, but I personally have paid between $0 and $90 a session with a professional, licensed therapist.

Part of the key for finding a cheap but engaged and qualified therapist when you don’t have that benefit built into your health coverage is that shitty, unacknowledged work that the poor have to do to get shit done.  Part of that is the ability to, again, find a therapist whose philosophy matches yours, which is even more important if you don’t have the luxury of leisurely shopping around.  Try to find people who have background in community activist healing services that are meant exactly for people like you.  Look for people who may be politically aligned with activist communities, i.e. feminist therapists, queer therapists, therapists of color, people whose therapeutic philosophy includes the value of mental wellness for all and not only for the very wealthy and connected.  They are out there everywhere, and they are signaling you in their ads and other communications with potential clients.

If you can’t find or afford a therapist in the long-term, there are alternative treatments that will also help you in the healing process.

One of the biggest, most difficult steps in treatment for many sexual assault survivors is how to get reacquainted with your body.  Many suggest learning any type of progressive or deep relaxation therapy method, ways of relaxing major muscle groups to help aid concentration and break anxiety patterns.  Relaxation tapes, or meditation tapes, are commonly used by therapists to teach people with anxiety how to calm and self-soothe, and these are the same kinds of tapes people who aren’t in therapy use for personal meditation.  You can download tons of different types of podcasts for free that will play on a handheld or desktop mp3 player, or check out any number of these tapes and CDs from your library.  If your library doesn’t have any, check to see if your library is part of an inter-library loan system, in which case they will get your requested tape from a sister library and call you when it comes in.  It’s suggested that you listen to the tapes in a calm, relaxing place, while laying down or seated, and follow the instructions that lead you through the tensing and relaxation of major muscle groups, usually in a pattern from toe to head.

Another way to get reacquainted with your body after it’s been violated is to manipulate it.  Move it in a way that is free and happy for you, that is a reminder of how beautiful, functional, and strong your body is, and how resilient you are.  Take advantage of community health collectives that provide services like acupuncture, yoga, and massage, all of which can be enormously helpful with residual pain and the release of stress that occurs in assault survivors when they receive touch from another person, and all of which can be adjusted to help a range of different types and abilities of bodies.  I personally benefited from physical training and self-defense, all for free at the YWCA, not because I thought it would protect me from future assault, but because it helped to re-frame my body as a source of power instead of a place for another person’s abuse and desire.

Group Therapy is beneficial to rape victims for a lot of reasons:  it’s group-led, encourages support among peers, and often includes an educational phase that can be helpful in re-framing your circumstances and feelings around the rape.  Additionally it helps people who are isolated, or who fear isolation, create intimacy with others in an emotionally safe and structured way.  Many rape crisis centers use group therapy as a main mode of therapeutic activity because of its efficacy, and if you are able to find a group affiliated with a crisis center near you, it is almost always free. 

When BFP blogged here earlier this month with her excellent piece on the role of citizenship in sexual assault cases, she pointed to the role of testimonios as an organizing tool to both bring the issue to light and bring a sense of justice to the survivor.  And as BFP noted, all cultures do this to some degree, if perhaps without the documentary, because it’s important to most people to tell their stories, shape their own narratives, and feel as though their experiences are heard.  Therapy, if anything, is a guided telling of your story, a way for someone who is trained in the art of healing to bring perspective to the parts of the story you don’t understand, or pull you back when you’re unfair to yourself.  For most rape victims, justice is elusive.  Most rape cases go unreported, even fewer are investigated, and even fewer are prosecuted.  Many of us, if we dare to tell our stories, aren’t believed at all.  Part of healing, I believe, is refusing to be boxed in by the stigma and telling our stories regardless of our fear, and to make society accountable to us BECAUSE WE ALL MATTER. 

I don’t have any easy answers or poetic conclusions to end this piece with, other than to say that it does get better for you as an individual.  It may never be gone, but you will find peace sooner if you pursue it.  And again, please help me fill in the gaps or modify what I’ve written here by leaving suggestions in the comments.


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16 comments for “PTSD and Healing After Sexual Trauma

  1. Sunset
    April 29, 2010 at 8:46 am

    Very nice how you acknowledged there were things to without therapy. That’s something I’ve been missing for a long time. As a non-financially-independent young adult I do not have access to proper therapy. I am also in the very real place of having to hold it together or lose my education (because of limits on time off from school). Most sites I’ve seen seek to make you feel guilty for not getting into therapy, without the acknowledgment that it’s not possible for everyone.

  2. April 29, 2010 at 9:21 am

    Lauren, in your more than ten years of writing about your experiences, you have touched so many people — probably more than you know. Stay strong.

  3. Jen
    April 29, 2010 at 9:25 am

    Great article! As a survivor of incest and rape I also found EMDR to be extremely helpful. My clinician used hand held sensors instead of the light band which was less distracting for me. EMDR took away the overwhelming wave of emotions I felt whenever I spoke of the events or experienced a trigger. Once that was gone I could begin to process each of the events. After 6 months of therapy I feel like a new person. Most of my triggers have been resolved. I am much happier and every area of my like has benefited.

    I also benefited from method called TAT http://www.tatlife.com/ which allowed me to release most of the stress surrounding those past events. While I do recommend working with a clinician there is a free booklet that describes the process http://www.tatlife.com/index.php?option=com_content&view=article&id=55

  4. A
    April 29, 2010 at 9:35 am

    I’ve been reading this blog for a long time, but I’ve never commented before. I just wanted to say that this post feels fated for me. I’ve been trying to find a therapist for a long time to work through sexual assault trauma and through the trauma of watching a loved one die. I’m going in tomorrow to a new one who wants to perform EMDR, and I’ve been skeptical of it. This makes me feel safe, or like I made a good decision. Who knows if it will work, but just the fact that it’s listed here makes me feel better. Thanks for posting this.

  5. PrettyAmiable
    April 29, 2010 at 9:53 am

    This was an amazing post, Lauren.

    As an aside, should anyone be looking for a psychologist, one place you may want to start is at a local university’s psychiatric services. It varies, of course, but most progressive universities will have someone on staff well-versed in sexual trauma and will typically have references for other therapists in the area if you are unable to use the university’s resources. I’ve done this twice and it worked well for me.

    I adored this post, again.

  6. RD
    April 29, 2010 at 10:04 am

    I know some good tricks to try for if you feel yourself start to dissociate and don’t want to. None of these will help if you’re already too far gone tho. The easiest one you can do anywhere is to put your hands on a surface close to you and concentrate hard on the feeling of your hands on that surface. You can chant or sort of sing to yourself and concentrate on the words. Or, and this is a trick I learned from the amazing Young Women’s Empowerment Project – get a spray bottle with some lavender oil, spray a little, and smell it. It really helps! They handed these out at a presentation they did in NY.

  7. Dom
    April 29, 2010 at 12:05 pm

    I’ve been assaulted several times throughout my life but when I was in a study the clinician seemed to feel my experiences of harassment were the most traumatic. I think it’s because they’ve affected my ability to make a living and, therefore, take care of myself and survive. Right now I’m unemployed – again – and I get triggered by things that would normally be innocuous. Last time it was just that a man approached me to offer a job, and called me something that can sound either familiar or like flirtation. I was badly triggered, even though I am 90 per cent sure he didn’t mean it in the flirtatious way (it’s the equivalent of “dear” or “honey”). We socialized habitually so it couldn’t be said that he was much too familiar. Others – all women – would use the same word and it wouldn’t bother me. What happens when I get triggered is that the last harassment situation I was in comes back to me over and over again and I feel the same very high level of anger and I can’t function anymore. I’ve been in therapy for years and nothing seems to work.

  8. April 29, 2010 at 12:35 pm

    I recently have found a therapist who felt comfortable enough to go in depth in confronting and talking about the abuse. Prior therapists were, as the post discussed, not comfortable doing so and the issue kept getting pushed off.

    It’s not always comforting to go there, but I know I need to, and I have goals to reach that I have set for myself.

  9. April 29, 2010 at 2:11 pm

    Something I found out (the hard way) is to ask any therapist you may go to how they handle patients cancelling appointments. I went to one appointment with this man who made up his mind about me about 10 minutes in and ignored pertinent things I was telling him. I shut down about halfway through the session and since I couldn’t bring myself to confront him and tell him I wouldn’t be back (and then have to answer questions why), I went ahead and let him schedule my next appointment and then got the hell out of there.
    I called back the next day and instead of just letting me cancel the appointment (this was a week in advance, not just the day before) they told me I had to actually talk to the person who told me I didn’t have it bad and only had minor depression after I told him I thought of killing myself and was having hallucinations. Luckily I got his voicemail and not him and was not there when he returned my call, but I had to call in 3 seperate times before they finally cancelled the appointment.

  10. RD
    April 29, 2010 at 2:23 pm

    I have a really wonderful therapist (for free, tho I have medicaid) through the Sex Workers Project at the Urban Justice Center. Really I don’t think I could have a more wonderful therapist (but EMDR sounds like something I should try to get).

  11. Sunset
    April 29, 2010 at 5:19 pm

    @ PrettyAmiable

    I would be careful with university services as a student. It depends on how open the school is to sexual assault. My personal experience was with the head of the center, who is a very old-fashioned white male. The encounters I have had with him left me with a clear impression that I am, to him, a troublemaker, and that I was the problem for not being strong enough.

    I would be very careful in going to university services. I’ve seen too many cases on my end that resulted in students being “encouraged” to leave.

  12. William
    May 1, 2010 at 3:04 am

    First and foremost, I’d just like to say that this was an excellent, excellent post Lauren.

    As someone in the field right now who has quite a bit of experience with trauma survivors I have a couple of suggestions myself but first I’ve got a comment.

    Ethical therapists will suggest in similar situations that you switch therapists, and will probably suggest an alternative person — but not always, in which case you need to do so for your own sake.

    An ethical clinician should always refer you out if its a bad fit and in such a case they should actually refer you. Terminating is not enough, they must also direct you to more appropriate care. No referral, no ethical practice, it really is that simple.

    Anyway, I have some advice on finding a good therapist in addition to Lauren’s good ideas.
    1) Ask them what their theoretical orientation is and why. You don’t have to be an expert in the field and you don’t even necessarily have to understand their answer when they give it. Just listen, write down what sound like important words or phrases, and google them when you get home to see if it sounds like a good fit for you. You’ll probably want to avoid anything that advertises itself as “manualized” (because you’re a person, not a car). You’ll also likely want to avoid anyone who describes themselves as “eclectic” or “integrative” because, in my experience, people who do not have a strong theoretical identification tend to be less well-read and lack the passion for the work that comes with having a strong professional identity. One thing you want in therapy is consistency.

    2) Ask if they have experience with trauma survivors and, if so, how much and to what extent. Working with trauma survivors is hard work and it isn’t something every therapist is good that. Thats OK, their feelings won’t be hurt and therapy is about your needs.

    3) Trust your instincts. Its an unfortunate reality that there are a lot of poor clinicians working today. Rationality is overrated. If something feels wrong, if the fit feels bad, if you’ve got a nagging suspicion that theres something you’re not being told, if you just feel kinda squicked out but can’t explain why, even if you just don’t like the person for some reason, do what you have to in order to cope with the hour and don’t come back. A pretty significant percentage of therapy is about the relationship and the fit between therapist and client. You’re thinking about investing a lot of time and probably money that you could use for something else, there is absolutely nothing wrong with being picky.

    4) [full disclosure: I identify as an analyst] Don’t be afraid of the analysts. Trauma is where analysis has it’s roots and it is how the theory was initially developed. A lot has changed since the 60s (not to mention since Freud) and the specialty has become increasingly female and GLB (though, sadly, not always TQ). I was at the major American psychoanalytic conference just last week and had the chance to sit in on some excellent constructionist and postmodern panels and the field is increasingly moving towards a more expressive view of gender, sexuality, and identity. It certainly isn’t right for everyone and is deals better with historic, insidious, or complex/prolonged trauma, but it can do wonders for the right person.

  13. Zanne
    May 1, 2010 at 12:34 pm

    Great post, Lauren — thank you for sharing all your wisdom and encouragement.

    I’d like to offer a counterpoint to William’s recommendation to avoid manualized therapies (full disclosure – I’m a graduate student in clinical psychology and identify as a behaviorally oriented therapist… and I frequently use treatment manuals).

    A “manualized therapy” is one that follows a written set of guidelines or suggestions. Many of these therapies have been tested and found to be effective in clinical trials (e.g., EMDR, prolonged exposure therapy, cognitive processing therapy, seeking safety for combined PTSD and substance abuse). In using a manualized therapy, it’s up to the therapist and client to decide how strictly to adhere to the manual’s guidelines. Research suggests that most therapists using manuals do not adhere to them rigidly, but rather use them to guide therapy in a general sense based on what the client wants/needs.

    I agree with William that it’s most important to find a therapist whom you trust and with whom you have a good “fit.” Whether a manual is used or not is not going to be the sole determinant of whether you benefit from treatment. However, I would not rule out manualized therapies out of hand.

  14. Bethany
    May 1, 2010 at 3:30 pm

    This is wonderful advice for those who have experienced sexual assault. It seems that many times women who are victims are blamed for “crying wolf” or exaggerating the extent of the assault. This information needs to be widely available to women everywhere. Thank you.

  15. William
    May 1, 2010 at 7:49 pm

    Zanne, I agree completely that finding a therapist which you trust and with whom you have a good fit is the most important factor. My major problem with manualized treatment is that it has more to do with marketing and professional propaganda than with client care. Manualized treatments make research easy but, as you pointed out, most behavioral clinicians don’t adhere nearly as strongly to the manual as studies do. This isn’t really the place for a professional skirmish, so I’ll just say that the reason I warned people away from manualized treatments is that (in my experience) they often they imply less seasoned and confident clinicians and the rigidity with which some early clinician use manuals can be especially dangerous for survivors of sexual trauma. There is also the concern that out of all of the dominant theoretical orientations cognitive therapies (which are essentially the only therapies with manuals) offer the least emphasis on client autonomy both theoretically and in practice.

  16. B Mama
    May 22, 2010 at 11:23 am

    I found this to be helpful. Fortunately, it was years ago that I suffered from sexual assault. Like most victims I was shocked and horrified that it had the audacity to happen to me when I’ve never been and am still not “the kind of woman or person something like that happens to”….[not underlying implication that rape only happens to certain kinds of people – would anyone say that about burglary or car accidents?! I don’t think so. So, it isn’t a reasonable ‘explanation’ for why someone – male or female, would be a sexual assault victim. One of the most helpful comments came from an adult male police officer. “Well it wasn’t your fault. Don’t beat yourself up over it.”

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