In this article, treatment issues in counseling survivors of rape are reviewed, including sociocultural influences on a woman's response to rape, a survivor's history of victimization, the specific nature of the assault, and a survivor's experiences with victim-blame. A multimodal treatment approach for women who experience chronic symptoms of posttraumatic stress disorder in the aftermath of rape is also presented. To assist mental health counselors in delivering quality services based upon current standards of care, the model incorporates four empirically supported techniques based upon expert consensus guidelines for treating survivors of trauma.
Violence against women is a significant social problem, as there is a high probability that any woman will experience some type of violence in her lifetime. According to the National Violence Against Women survey, more than half of all women report an experience of attempted or completed rape and/or physical assault (Tjaden & Thoennes, 1998). While both men and women are victims of rape, women are disproportionately affected by this crime; 1 in 6 women compared with 1 in 33 men report having experienced an attempted or completed rape in their lifetimes. For the purposes of this paper, therefore, the focus will be upon women's experiences and treatment needs following sexual assault and rape.
A significant proportion of women who are sexually assaulted or raped experience symptoms of posttraumatic stress disorder (PTSD) within 2 weeks following the assault (Resnick, Acierno, Holmes, Kilpatrick, & Jager, 1999). The Diagnostic and Statistical Manual of Mental Disorders--Text Revision (DSM-IV-TR; American Psychiatric Association, 2000) groups PTSD symptoms into three clusters:
* Intrusion (re-experiencing of the trauma, including nightmares, flashbacks, recurrent thoughts)
* Avoidance (avoiding trauma-related stimuli, social withdrawal, emotional numbing)
* Hyperarousal (increased emotional arousal, exaggerated startle response, irritability)
While most women experience these symptoms in the immediate aftermath of rape, PTSD continues to persist in survivors at lifetime rates between 30% and 50% (Foa, Hearst-Ikeda, & Perry, 1995; Meadows & Foa, 1998; Resnick et al., 1999).
When symptoms persist for 3 months or longer and meet DSM-IV-TR diagnostic criteria for chronic PTSD, there is a likelihood that survivors will also experience comorbid disorders including anxiety, depression, and substance abuse (Foa, Davidson, & Frances, 1999; Koss & Kilpatrick, 2001; Resnick, Acierno, Holmes, Dammeyer, & Kilpatrick, 2000). Further, they are likely to experience greater physical distress (e.g., chronic pain, sexual dysfunction, headaches, upset stomach, back pains, acne, indigestion) in the year following rape and utilize medical services at higher rates than do women who have not been raped (Clum, Nishith, & Resick, 2001). Women who are particularly at risk for chronic PTSD include those who were injured during the attack, were threatened by the perpetrator that they may be hurt or killed, have a history of prior assault, or have experienced negative interactions with family, peers, or law enforcement systems (Regehr, Cadell, & Jansen, 1999).
Survivors do not typically seek formal mental health services in the year following rape (Kimerling & Calhoun, 1994). Despite their initial hesitancy, survivors may seek counseling eventually when their symptoms become intensified or chronic (Draucker, 1999). Mental health counselors therefore need expertise in providing treatment for survivors whose symptoms are both persistent and severe. Mental health professionals can serve as a primary source of support in a survivor's recovery, yet many practitioners report a lack of training in this area during their programs of study (Campbell, Raja, & Grining, 1999). …