Resources for Counsellors

This page offers a variety of resources that are intended to equip counsellors with relevant information to work with specific needs of sexual assault survivors.

This page has been organized by five pertinent categories in serving sexual violence clients. However, there are many other topics not covered here that are also important in serving survivors of sexual violence. Under each topic there are articles listed which were chosen based on a desk review of the literature. A summary is provided for each article along with links where the original article can be accessed to read more on each topic. You can also access links to additional resources.

This page provides information to help you decide:

• 1. Child Sexual Abuse
• 2. Trauma Informed Counselling
• 3. LGBT Sexual Assault
• 4. The Impact of Sexual Assault on Survivors
• 5. The Intersection of Mental Illness and Sexual Assault
• Additional Links

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1. Child Sexual Abuse

 

This article has pertinent information for counsellors survivors of child sexual abuse as it works to characterize childhood sexual abuse and the impact it can have on the life of a survivor. It also describes the long term effects childhood abuse can have on survivors and the implications this places on the way in which survivors are treated in counseling. These long lasting effects potentially include “higher levels of depression, guilt, shame, self-blame, eating disorders, somatic concerns, anxiety, dissociative patterns, repression, denial, sexual problems, and relationship problems,” with depression being the most common trait.

While there is no single agreed upon form of treatment that is considered best for treating childhood abuse survivors, it has been found important to “assess the client presenting problems, the effects the abuse has on their current functioning, and how the client currently copes”. After evaluating these characteristics, the therapist should ensure they are working to increase “[the client’s] ability to accurately attribute responsibility,” as survivors tend to have difficulties externalizing the abuse. Allowing the client time to develop a relationship with the counsellor and to maintain control over their therapeutic treatment, are important steps in treating survivors. This can be accomplished through “techniques such as using encouragement, validation, self-disclosure, boundary setting and client empowerment”.

In terms of the pace of the treatment “therapists are recommended to address the more general psychosocial problems before treating the sexual problems of survivors”. In relation to this, an important goal during therapy for survivors should include “gaining skills that will help them find and develop supportive relationships”.

This article works to describe child sexual abuse (including the characteristics of those most likely to be victimized), its effects on survivors and the strategies counsellors should follow during treatment. Overall researchers agree “that the prevalence of child sexual abuse varies by age, sex, and family economic status”. However, some populations are more likely to be victimized than others. For instance girls, those belonging to the LGBTQ community and lower income children are also more likely to be victimized. Sexual abuse occurs in many forms including: “incest/familial abuse (by a blood relative), extrafamilial abuse (by someone outside the child’s family), pressured sex (use of persuasion or enticement), or forced sex (use of force or threat of harm)”. However one thing that is found among “95% of child victims, [is that they] know their perpetrators”.

The symptoms of child abuse vary among victims but usually involve some “physical, emotional, behavioral and sexual aspects”. When evaluating a survivor the “effects of child sexual abuse can be categorized as psychological, interpersonal, and behavioral”. There is a wide range of psychological effects including “lower levels of self-esteem (Elliot, 2001), higher rates of depression, anxiety, eating disorders, substance abuse disorders, post-traumatic stress disorder (PTSD), self-mutilation, and suicide”. Victims of child sexual abuse tend to lack interpersonal skills “that affect the victim’s ability to form effective and meaningful relationships”. In terms of behavior, child sexual abuse can “emerge as violations of social mores or laws”.

When treating survivors, challenges counsellors may face include “anger, trust issues, social withdrawal, self-blame, emotional dysregulation, dissociation, eating disorders, self-injury, and Post-Traumatic Stress Disorder”. In terms of treatment strategies, according to the article Cognitive-behavioral approaches have been reported to “be more effective than supportive therapy in promoting improvements in children’s knowledge about body safety skills” and reduce the overall impact of sexual abuse.

 

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2. Trauma Induced Counselling

This article features the lessons learned by clinicians as they apply and teach others how to carry out trauma-focused exposure therapy. The expectations and preconceived notions clinicians may have of practicing this form of therapy is discussed. Such as, “exposure therapy requires a new set of clinical skills, therapists themselves will experience a high level of distress hearing about traumatic events, and clients will become overly distressed”. The authors describe the typical obstacles faced by clinicians during this form of therapy and provide case examples. Those challenges mentioned in the article include “finding the appropriate level of therapist involvement in session, handling client distress during treatment, targeting in-session covert avoidance, and helping the client shift from being trauma-focused to being more present and future oriented”.

This article features ten principles that characterize trauma informed service. The intention of the article is to provide information in order that the term “trauma informed” would not just be a philosophy but also be put into practice throughout a survivor’s treatment. These principles make evident the feasibility of incorporating trauma informed services in all facets of a survivor’s treatment.

• Principle 1. Trauma-Informed Services Recognize the Impact of Violence and Victimization on Development and Coping Strategies
• Principle 2. Trauma-Informed Services Identify Recovery From Trauma as a Primary Goal
• Principle 3. Trauma-Informed Services Employ an Empowerment Model
• Principle 4. Trauma-Informed Services Strive to Maximize a Woman’s Choices and Control Over Her Recovery
• Principle 5. Trauma-Informed Services Are Based in a Relational Collaboration
• Principle 6. Trauma-Informed Services Create an Atmosphere That Is Respectful of Survivors’ Need for Safety, Respect, and Acceptance
• Principle 7. Trauma-Informed Services Emphasize Women’s Strengths, Highlighting Adaptations Over Symptoms and Resilience Over Pathology
• Principle 8. The Goal of Trauma-Informed Services Is to Minimize the Possibilities of Retraumatization
• Principle 9. Trauma-Informed Services Strive to Be Culturally Competent and to Understand Each Woman in the Context of Her Life Experiences and Cultural Background
• Principle 10. Trauma-Informed Agencies Solicit Consumer Input and Involve Consumers in Designing and Evaluating Services

 

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3. LGBT Sexual Assault

This article describes several studies completed among the LGBTQ community and explores “sexual violence — in the form of hate or bias-motivated crimes, intimate partner violence, childhood sexual abuse, and adult sexual assault — against victims who identify as lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ)”.

The effects of sexual violence in the LGBTQ community is compounded by the already occurring systematic oppression of this population. Therefore “specific correlations between sexual assault victimization and high-risk sexual behaviors, mood disorders (i.e., depression), and suicide attempts” are especially prevalent among individuals who identify as LGBTQ. This prejudice against the LGBTQ community allows for an absence of accessible LGBTQ affirming services, and creates “barriers to post-assault services due to homophobia and transphobia”. Sexual harassment of LGBTQ individuals is especially prevalent in academic settings with research suggesting “a correlation between sexual harassment victimization and increased rates of suicide attempts and missed school time”. Rates of childhood sexual abuse have been reported at higher rates within the LGBTQ community which “has been correlated with psychopathologies (i.e., psychological distress, mood disorders), substance abuse, and high-risk sexual behaviors”. Intersectionality causes the LGBTQ community to experience discrimination and higher rates of sexual assault than heterosexuals in many different contexts including during incarceration, seeking shelter during periods of homelessness, when undocumented, when seeking police assistance, in schools, etc.

With the many compounded aspects of being an LGBTQ sexual assault survivor, rates of attempted suicide are high with a “total of 64% of respondents reported attempting suicide”. Providing services to survivors of sexual assault who identify as LGBTQ is especially challenging, the article recommends utilizing LGBTQ-affirming practice models, providing professional development opportunities, and information dissemination.

 

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4. The Impact of Sexual Assault on Survivors

The purpose of this article is to highlight the research that has been completed on sexual assault services in order to emphasize how “high quality services can minimise the harm experienced by the victim/survivor”.

Common mental health problems among survivors includes “major depression, generalised anxiety, panic, phobias, symptoms of traumatic stress and suicidal thoughts and actions”. Often times survivors experience co-occurring symptoms including “reduced self-esteem and a damaged sense of gender identity”. Survivors relationships may also suffer due to their trauma, this can be helped by better informing family and friends “about the psychological effects of sexual violence”.
In addition to these more general mental health issues, “women who have experienced sexual violence constitute the single largest group of people suffering from PTSD”. However, some feminist researchers argue that the psychiatric diagnosis of PTSD does not paint a complete picture of the distress and trauma experienced by sexual assault survivors.

The authors argue that:

the concentration on a set of decontextualised and medicalised set of problematic symptoms inherent in the diagnosis of PTSD shifts attention from survivors’ psychological concerns including the impact of sexual violence on their sense of themselves, their lives, their relationships, their sense of safety in the world and their overall health and wellbeing.

Co-occuring with PSDT, many survivors experience symptoms such as daily intrusive thoughts and reoccurring nightmares. Sexual assault survivors also experience “forms of psychological distress that do not meet criteria for the diagnosis of psychological disorders such as intense feelings of shame, existential insecurity and self blame”.

In treating survivors, research suggests two main forms of therapeutic treatment: cognitive behavioural therapy and feminist (or group) therapy. Cognitive behavioral therapy works to relieve psychological distress “by challenging and changing the distorted cognitions which give rise to it”. This form of therapy teaches clients to “recognize, observe, and monitor their own thoughts and assumptions, especially their negative automatic thoughts”. Other recommended therapies that fall under this category include: Prolonged exposure therapy and Cognitive restructuring therapy. Eye Movement Desensitisation and Reprocessing (EMDR). Group therapy, in contrast to traditional therapies, emphasizes the need to recognize the social and cultural influences that may cause or shape a survivor’s physiological distress rather than “attribute problematic behaviours and emotions to intrapsychic causes”. This form of therapy works to develop understanding that sexual assault is not simply an individual problem but rather a systemic issue. However, during therapy there is also an emphasis on individuals developing meaning in one’s life, a sense of self, and their interpersonal relationships, despite trauma. According to research on this form of therapy, “those women who improved immediately after the treatment were likely to retain this improvement at a follow up” four and a half years later. Older women were less likely to retain their psychological improvement however, younger women who began with fewer symptoms had greater success in maintaining improvements.

 

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5. The Intersection of Mental Illness and Sexual Assault

This article discusses and confirms the impacts that rape has on a survivor’s short and long term mental health. Comparisons between victim and non victim’s mental health status were made in order to determine whether rape victims were more likely to experience mental health problems such as PTSD.

The study determined that “almost one-third (31%) of all rape victims developed PTSD sometime during their lifetime”. It is evident that survivors of sexual assault face greater difficulties in terms of their mental health as “rape victims were 6.2 times more likely to develop PTSD than women who had never been victims of crime (31% vs 5%)”. The mental illness that victims do face can be persistent considering, “rape victims were 5.5 times more likely to have current PTSD than those who had never been victims of crime (11% Vs 2%)”. According to the research, “3.8 million adult American women have had rape-related PTSD (RR-PTSD)”.

In addition to PTSD, survivors experience many other symptoms related to mental health. For instance, “30% of rape victims had experienced at least one major depressive episode in their lifetimes” compared to only ten percent of those who never experienced sexual assault. These mental health issues are deep rooted and affect their life at a deep level, considering “Rape victims were 13 times more likely than non-crime victims to have attempted suicide (13% Vs 1%)”. Survivors of sexual assault also have higher rates of alcohol and drug abuse, with survivors being “26 times more likely to have two or more major serious drug abuse problems (7.8% Vs 0.3%)”. Survivors of sexual assault also experience distress over the stigma they face and fears they have including fear that their relatives will find out, fear outsiders will blame them, fear of their identity being revealed in media, fear of becoming pregnant, or contracting an STI or HIV/AIDS. These fears must be considered when treating a survivor of sexual assault.

 

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Additional Links

Counseling Victims of Sexual Harassment
Salisbury, Jan; Ginorio, Angela B.; Remick, Helen; Stringer, Donna M.
Psychotherapy: Theory, Research, Practice, Training, Vol 23(2), 1986, 316-324.
http://dx.doi.org/10.1037/h0085616

Rape Trauma Syndrome
Ann Wolbert , Burgess lynda, Lytle Holmstrom
http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.131.9.981

Recovered memories of abuse: Assessment, therapy, forensics.
Pope, Kenneth S.; Brown, Laura S.
Washington, DC, US: American Psychological Association Recovered memories of abuse: Assessment, therapy, forensics. (1996). ix 315 pp.
http://dx.doi.org/10.1037/10214-000

Imagery Rehearsal Therapy for Chronic Nightmares in Sexual Assault Survivors With Posttraumatic Stress Disorder
http://jama.jamanetwork.com/article.aspx?articleid=194063&resultclick=1
Krakow B, Hollifield M, Johnston L, et al. JAMA.2001;286(5):537-545. doi:10.1001/jama.286.5.537.