WORKING WITH

1. WORKING WITH SEXUAL ASSAULT SURVIVORS ADVANCED TRAINING

2. Experiencing sexual violence transforms people and changes their lives forever. Once victimized, one can never again feel quite as invulnerable. Rape represents the most serious of all crimes against a person, short of homicide. Prevalence • 1 in 6 women has been the victim of a completed or attempted rape at some time in their life. Centers for Disease Control, 2000 • In Florida, it is estimated that 1 in 9 women are raped at some time in their life. Centers for Disease Control, 2003 Characteristics • 60% of sexual assaults occurred in the victim’s home, the home of a friend, relative, or neighbor. Bureau of Justice Statistics, “Sex Offenses and Offenders” 1997 • 43% of rapes occur between 6pm and midnight; 24% between midnight and 6am; 33% occur between 6am and 6 pm. Bureau of Justice Statistics, “Sex Offenses and Offenders” 1997 • 70% of female victims and 74% of male victims knew their assailant. National Crime Victimization Survey, 2003

3. Childhood Sexual Abuse • 44% of rape victims are under age 18; 15% are under age 12. Bureau of Justice Statistics, “Sex Offenses and Offenders” 1997 • 93% of child sexual assault victims knew their perpetrator; 34% were family members, 59% were acquaintances. Only 7% of the perpetrators were strangers. Bureau of Justice Statistics, “Sexual Assault of Young Children as Reported to Law Enforcement” 2000 Teens and Young Adults • In one study 50% of high school boys and 42% of high school girls believe that there are times when it is “acceptable for a male to hold a female down and physically force her to engage in intercourse.” Hopper, Sexual Abuse of Males; Prevalence and Lasting Effects and Resources,” 1997 • Girls aged 16-19 are 4 times more likely than the general population to be victims of rape, attempted rape, or sexual assault. Bureau of Justice Statistics, National Crime Victimization Survey 2000

4. VICTIM PERSPECTIVES While more stringent laws have been enacted to protect survivors of rape, our society’s perception of survivors has changed little. AS A SOCIETY…. • We EXPECT victims to behave in a socially acceptable way….acting out their frustrations and anger is unacceptable. • We EXPECT victims to be SO grateful for the help we are giving them. • We EXPECT the victim to do what we think is best for them, and to make the correctchoices for themselves. • We EXPECT victims to disclose everything so that we can better help them. • We EXPECT victims to follow our rules and the rules of society. • We see them as weak and unable to manage their lives.

5. FOR SURVIVORS OF SEXUAL ABUSE/ ASSAULT ANY REACTION IS NORMAL

6. Uniqueness of Sexual Assault as a Criminal ViolationWhen Compared to Other Crimes The violation of “self” that causes trauma in crime victims is a subjective injury, unique to eachindividual. In the case of sexual assault, the violation amounts to the gravest psychological injury criminals inflicted on their victims short of murder. Reasons: • The majority of victims are in fear for their life, even if they know the assailant. • The crime is often intended to be as degrading and dehumanizing as possible, and that has a lasting negative effect. • Due to the nature of the trauma, most survivors will remember more about the attack next week, next month….etc. This leads to the judicial system, law enforcement and friends and family sharing the belief that they are “making up” additional details, when in fact they are remembering them for the first time. • As a society we don’t ask the same questions of any other crime: “What were you wearing, were you drinking, were you leading the person on, do you have sex with many people, etc.”

7. Society’s “Second Assault” After the Rape • The forensic rape exam is often felt to be like a second rape. • The sexual assault victim is sometimes treated like “the criminal” by law enforcement, the judicial system, friends and family…depending on their level of education about survivor behavior and whether survivor has had prior contact with law enforcement, has substance abuse issues, etc. • Sexual Assault victims are often not believed.The less physically violent the assault, and the closer the relationship between the assailant and the victim, the more likely the victims will be blamed or thought to be lying. • Sexual assault is a perversion of the most intimate physical act.The victim may be angry that what had been thought of as an act of love is now thought of as an act of violence. • It is the only crime in which consent and degree of resistance are issues. • Because rarely does someone “witness” the attack, it often become a “he said, she said”.

8. Reaction of family and friends, and society. • Loved ones may blame the victim, or be traumatized along with the victim. • Loved ones may be out of touch with the victim’s reactions and unable to understand their own reactions. • Sexual assault is often sensationalized in the media, especially when it is “stranger rape”. • The general public may react by stigmatizing a victim because of the assault. • Survivors may have problems at work due to time away for counseling, attendance at trial, or simply because of the stigma associated with sexual assault. • Survivors of sexual assault suffer physical, emotional, and financial burden.

9. OUR SOCIETY HAS DONE A FANTASTIC JOB OF BLAMING THE VICTIM FOR SOMEONE ELSE’S VIOLENCE

10. BLAMING AND JUDGING • WHY DO WE BLAME AND/OR JUDGE OTHERS? • … to feel safe for ourselves and the people we love. • Society has taught us to blame the victim.

11. Survivors often blame themselvesbecause it gives them a sense of control • The survivor feels if they are to blame, then they can do something to prevent future attacks. • In recognizing that they are not to blame, then they have to cope with the reality that you can never be 100% safe from sexual assault. • For a survivor to truly understand that the rape/ abuse/ assault was NOT their fault the issues that “the world is notfair/just” and “bad things happen to good people” become distorted and their core belief system is “wrong”. This makes it a very “scary” world to live in.

12. THE VICTIM’S ONLY GOAL IS TO SURVIVE. SOMETIMES COOPERATION IS REQUIRED FOR SURVIVAL. CONSENT VS. COOPERATION • There is a HUGE difference between Consent and Cooperation. Victims cooperate with one goal in mind…..to become survivors. • Consent: Equal power, both people agree to be there, either can leave and do as they choose. • Cooperation:Doing as you are told to avoid consequences. Victim believes her life/physical well-being is in grave danger. This belief may/may not come from spoken threats, but the implied threat of what may come next. Often if a woman cooperates it is not viewed as rape, i.e., use of condom, telling him what he wants to hear, etc. Many times, cooperation = survival

13. TWO COMMON REACTIONS • What do you think would be a common reaction of a survivor would be right after the rape? • Expressed • Hysterical, crying, anger, aggression • Inappropriate laughter or smiling • Controlled • Calm, reserved, no emotion • Movements may be robotic-like

14. SUBSTANCE ABUSINGSURVIVORS • AUTOMATICALLY DISTRUSTFUL OF LAW ENFORCEMENT BECAUSE OF THEIR DRUG/ALCOHOL USE. • MORE LIKELY TO LIE ABOUT DRUG USE • SUBSTANCE ABUSERS ARE MORE LIKELY TO END UP IN SITUATIONS “OUT OF THEIR CONTROL” • STRANGE PEOPLE • STRANGE PLACE • UNSUBSTANTIATED TRUST IN INDIVIDUALS MANY PEOPLE, PARTICULARLY THOSE USING SUBSTANCES, MAKE POOR SAFETY CHOICES. REGARDLESS OF THE SITUATION AND THE SUBSTANCE USE, NO ONE DESERVES TO BE RAPED.

15. WHAT IS COMMON BEHAVIOR FOR SURVIVORS??? EVERYTHING! Most behaviors = regaining control in their lives. NORMALIZE THESE BEHAVIORS….IT CAN GIVE THE SURVIVOR RELIEF AND AFFECT THEIR BELIEFS ABOUT THEIR “CORE SELF”

16. While 80% of rapes are committed by someone the survivor knows:When someone rapes you, they become a stranger • If the survivor knows the perpetrator, he/she may still have feelings for the perpetrator. • No name calling, or judgmental statements etc. because only the survivor has THAT right…Talk about the bad behavior not the “bad” person. • Survivor behavior and attitudes can change from appointment to appointment or minute to minute. • Focus and concentration are usually extremely difficult for survivors • Be careful with tone of voice and how we speak to them…the tougher they are….the kinder we need to be.

17. Since many adult survivors are also survivors of childhood abuse. Many survivors get “stuck” at the emotional age they were raped/ molested/assaulted. • They may have poor impulse control • They may have lack of volume control • They may have temper tantrums/rages • They may get angry or cry when they don’t get their way

18. TIPS FOR WORKING WITH SURVIVORS You cannot alter emotions… • You cannot convince a survivor “not to” be scared, sad, guilty, feel shame, responsibility, etc. • You can alter thoughts…this alters emotions

19. TALKING TO SURVIVORS DON’T SAY THINGS LIKE: • I understand • It sounds like • I’m glad you can share those feelings • You’re lucky that….. • It’ll take some time, but you’ll get over it • I can imagine how you feel • Don’t worry it’s going to be all right • Try to be strong for your children • Calm down and try to relax

20. DO SAY THINGS LIKE: • You are safe now (if true) • I’m glad you’re talking with me now • I’m so sorry that happened • It wasn’t your fault It must have been really upsetting to see (touch, feel, smell, hear) that • I can’t imagine how terrible you are feeling • Things may never be the same, but they can get better • You are not going crazy • THESE ARE NORMAL REACTIONS TO THE KIND OF TRAUMA YOU’VE BEEN THROUGH.

21. THINGS COUNSELORS CAN SAY TO EASE GUILT FEELINGS AND PLACE THE BLAME WHERE IT BELONGS….ON THE PERPETRATOR! • “Rape is NEVER the survivor’s fault”. • “You did EXACTLY the RIGHT thing….and the reason I know that is because you are sitting here”. • No one ever has the right to make you do something you don’t want to. • No one ever has the right to hurt you. • “It’s not your fault… • Would you have accepted a date if you knew you were going to be raped? • Would you have got into his car if you knew you were going to be raped? • Would you have gone to his house if you knew you were going to be raped? • Have you had other dates and not been raped?

22. ALWAYS EXPLAIN WHY YOU ARE ASKING CERTAIN QUESTIONS. Try to ask them in a way that can give survivor a feeling of control in their recovery. • ALWAYS EXPLAIN WHY CERTAIN PROCEDURES, ETC. ARE IMPORTANT • LET SURVIVOR KNOW SHE/HE HAS CHOICES

23. Validating statements that they did nothing wrong may give the survivor some relief. Another validating statement is: “What you’ve told me so far doesn’t tell me much about you…… but it tells me A LOT ABOUT HIM……

24. Use the same words client uses to describe her/his victimization. “incident” “rape” “event” etc. Never hand the client a tissue (unless asked) If you hand a client a tissue, they will stop crying; keep a box close by and let client take when they need them.

25. Developing Trust with Client • Explain Process • “It’s your journey….I just have the map” • “You don’t have to talk about anything you don’t want to” • “Let me know if anything makes you uncomfortable” • “Anything you say it confidential” • “You DO NOT have to forgive the person who hurt you to recover”…it’s your choice

26. Survivor Reactions Each victim of sexual assault will have his or her own life experiences and personality that will influence how he or she react to the assault • Setting Limits/Boundaries Because their personal boundaries were invaded when they were young by someone they trusted and depended on, they may have trouble understanding that they have the right to control what happens to them. Someone who has had a recent rape may still experience trouble setting boundaries because their own boundaries were so violated. They can also go the opposite direction and build walls instead of boundaries.

27. General soreness all over the body • The body stores pain • Body pain may last for years without proof of problem through medical testing • Some survivors develop fibromyalgia • Nightmares/Night Terrors • Nightmares are common for survivors • Very often nightmares will change over a period of time where the victim gains control over the perpetrator, even to the point of killing perpetrator. (They can feel guilt over this as they feel it makes them “bad people”) • Some may not be able to sleep at night or have to sleep with lights on • May feel vulnerable when sleeping • Some survivors may wake up with panic attacks • Have trouble breathing • Accelerated heart rate • Extreme fear / rush of adrenaline • Disoriented / feel they are reliving attack/abuse • Tense muscles

28. Difficulty Concentrating • This is common for survivors. Many survivors feel like “they are going crazy” because they can’t remember things • Impaired memory • As with any kind of trauma impaired memory is normal. If crisis is recent, survivors may remember more next week, next month, next year, etc. For survivors of childhood sexual abuse, they may have repressed the memories. These may start to come back later in life in the form of flashbacks which they can’t explain. Many feel like they are “going crazy” because they aren’t sure if it is real or not. • Flashbacks • Flashbacks can come in the form of pictures or intrusive thoughts that interrupt normal activities. Sometimes the survivor may feel they are “in the moment” again and respond with varied reactions: hysteria, fighting back at unseen attacker, freezing, crying, etc.

29. Substance Abuse • Many survivors will use substances to push down memories • Substance abuse (opposed to use to experience feeling “out of control”) for some survivors it represents “control” as it is a reprieve from stressful feelings and memories • Eating Disorders • Bulemia, anorexia, and overeating represent control. Once they realize it can be “out of their control” whether they are ever raped again, there is little they feel they can control. What they put into their body is one absolute they have control over. • Feeling loss of childhood/ Innocence /Grieving/Mourning • Being abused as a child means the loss of many things- childhood experiences, trust, innocence, normal relationship with family members (especially if the abuser was a family member). There may be trauma bonding where the survivor still has contact and conflicting feelings for perpetrator. • The survivor must be allowed to name those losses, grieve them, and then bury them.

30. Guilt, Shame, and Blame • The survivor may carry a lot of guilt because you may have experienced pleasure or because you did not try to stop the abuse. • There may have been silence surrounding the abuse that led to feelings of shame. • It is important for the survivor to understand that it was the adult who abused his/her position of authority and should be held accountable, not the survivor. • Anger • This is often the most difficult emotion for an adult survivor of childhood sexual abuse to get in touch with. • As a child their anger was powerless and had little to no effect on the actions of the abuser. For this reason they may not feel confident that their anger will be useful or helpful. • Anger (either at self or others) – distancing means safety

31. Hyper-vigilance • always being “on your guard” • Looking over your shoulder • Rapid eye movement (being on alert) • Not wanting to sit with back exposed or have people behind them • Exaggerated “startle response” • “jumpy”/ startled by loud noises • Panic Attacks • Accelerated breathing • Racing heart • Muscles tense • Frozen or shaky • Heightened adrenaline

32. Depression • Depression is a common symptom of survivors. Many have lived with it so long they may not even recognize they are depressed. • Social Withdrawal • Many survivors live a lonely existence. They may feel the only way to be safe is to disconnect from society for safety reasons. • Numbing/Apathy / Flat affect • Detachment, loss of caring • May not be able to express emotion; recount events in monotone or without feeling

33. Rigid “rules” for life • To feel control survivors may have very rigid “rules” for themselves and others. May not be open to any new ideas. • Unrealistic expectations of self and others • Survivor may engage in “perfectionism”, people pleasing, etc. and has limited tolerance for others who don’t reciprocate. • Cutting • For survivors, cutting can represent many things; most deal either with control or to validate that they can feel. • They can control how much, when, where, how deep, location on body, location of action • Cutting can also be used as a distraction from the painful emotions that the survivor is feeling.

34. Put themselves in risky situations • Many people are just stunned to hear of survivors going to dangerous places/situations after a rape. • This is about control. “I can do ___ and I will make it out safe.” • Engage in sexual activity very soon after the rape • To regain control • To turn a devastating experience back into a positive one. • Don’t want sex, uncomfortable with sex, sexual dysfunction • even with someone they trust, they may be unable to have sex as it triggers fearful and painful emotions. • Orgasm during rape • May feel guilt • Confusion, did they “like it” • If same sex can be confused about sexual identity

35. Fantasies about the assault/rape • Common for survivors • Usually fantasy is to remove fear about experience • Fantasy may change over period of time where survivor is in charge and not raped, hurt, demeaned, etc. • Sexual acting out / promiscuity • If survivor of childhood abuse they learned that “providing sex” is their value as human being, so • Why not use your value to get what you want • May feel they have no other worth • “If I say YES to everyone, I can never be raped again” • Must have “kinky sex” to prove sexual prowess and value (control)

36. Suicidal ideation • Many survivors may speak about thoughts of suicide currently or in the past. A thorough assessment should be done. • Unrealistic expectations of recovery • Some survivors are expecting the counselor to “fix them” attempting to place responsibility on counselor • They want the process to be a quick one with no pain • They want to be “well” without disclosing everything • Rose colored glasses (after recovery, the world will be fair, right and I won’t ever feel anger or pain again) • Dissociation • Many victims retreat into dissociative states (including out-of-body experiences during the assaults), and even though these states help the victim survive, their emotional costs are very high (particularly in cases of incest, survivors may develop Multiple Personality Disorder).

37. Triggers • A trigger is a sight, sound, smell, phrase or movement that causes the victim to “flashback to an incident”, or creates the same feelings and emotions that occurred during an incident. The emotion could be anxiety, fear, sadness, guilt, shame or a variety of other emotions. Many times when we are speaking with a victim, without knowing it, we may hit a trigger. The victim may not even realize it’s a trigger. When you are talking with a victim, what could be a clue that you have hit a trigger???? • Sudden shifts in mood; • Change in tone of voice; • Acting fearful; • Acting aggressive; • Avoidance of subject (even if the subject is not about a past incident, etc.)

38. Triggers can move • Many times a survivor will feel like they are “going crazy” because they feel fear about things they feel are not connected to the abuse/assault. • When they have panic attacks, or otherwise get triggered, other stimuli around at the time of the current event can attach itself to the original trauma and become additional triggers.

39. Trust • 80% of survivors knew their assailant and very likely trusted them. • This enormous violation by someone they trusted has changed their core views: • of love, • relationships, • their identity and role in the world, • their value/worth as a human being • world view of fairness, right and wrong Loss of security, trust in others and the world • Learning to trust again may be very difficult for survivors. • You may find that you they from one extreme to the other, not trusting at all to trusting too much.

40. Fear • Generally a fear of what other people think. Paralyzed into inaction or indecision for fear of going against what is socially accepted. • Due to their victimization, survivors may not know what is socially acceptable. This can be one of their biggest challenges. Can have fears of: • Death (depending on whether their victimization was terrifying or not) • People they don’t know • Crowds / being alone • Someone taking advantage of them (this is why it is so important for them to set boundaries) • People finding out / feeling “damaged” FEAR OF CHANGING (HEALING) BECAUSE THEY CAN’T IMAGINE WHAT THAT LOOKS LIKE

41. Something to Say “YOU SURVIVED THE ‘EVENT’, ‘INCIDENT’, ETC. YOU WILL SURVIVE THE MEMORIES OF IT.’ I’LL BE HERE WITH YOU.”

42. Denial • They may refuse to acknowledge the truth, because it is too hard or too painful. They may want to recover, but that path seems so difficult. • Denial that it has affected them negatively • Assault not scary • Got something from assault • Feel they initiated • Liked attention/gifts, etc. • Saving other siblings • Denial that they can recover • Denial that Things you can ask/say • Oh, how normal of you • Can you tell me why you decided to come here? • Time to deal with it • Can’t stay sober • Friends/family wanted me to come

43. Insecurity / Lack of confidence The survivor may feel the following: • What do you know? Why would anyone trust your opinion or your course of action? Despite the fact that the survivor has life experiences and a unique mind and personality, they may devalue their own voice to the point that not only do they feel that others shouldn't listen to them, but begin to lose all faith in themselves. Because many survivors learned early not to trust their own feelings and perceptions, they don’t feel others will trust them, so they may rarely make decisions, have healthy boundaries, etc. The opposite behavior can happen as well. They are in such need for control in their lives, and may not have good social skills so they use anger, aggression to protect themselves.

44. The good news is they are still there, but only they can go within to fan the flame of their spirit and help it to burn brighter. Again, it all goes back to their willingness to change. And that in itself can cause great feelings of fear. What they have done to this point has worked and they may be very resistant to change. ASK THE CLIENT WHAT THEY WOULD LIKE TO CHANGE.

45. So how do you learn to trust yourself? Now, developing your self and trusting in it are two different things. You can have a sense of who you are and what you think, and yet still be unable to trust in it. This has no easy answer, but here are some ideas for where to start. • Stop worrying what others will think. What is the worst that can happen, honestly? What, someone will laugh at you? Hate you? Think you are stupid? Well, let me ask you this: Have you ever laughed at someone? Thought they were stupid? Hated them? Guess what--you have no control over what other people think of you, and thinking you do is nothing but a delusion. No matter how hard you try, there will always be people who you will not get along with or who won't care for you--but it's nothing personal, and in fact, the harder you try to get everyone to like you, the more likely you'll lose respect--theirs and your own. • Find out who you are. This is not an overnight solution. This could be your life's journey, but so long as you're taking it, you're doing all you can to get into harmony with your truest self. They began by asking for help. When you do this, you reawaken parts of your self that have been dormant, but that when revived, will strengthen you in so many ways.

46. Learn to listen to yourself. I don't care how long you've been ignoring that voice inside you, so long as you're alive, it's still there. It may be tiny--only a croak--but if you get very quiet, you can hear it. • Begin first by simply acknowledging its existence, and then, when you're aware it's there, begin by listening to it. Hear your thoughts and desires and ideas and opinions, and just let them be. Don't dismiss them. Just listen. At some point, you'll realize that you have something unique to contribute, and you will begin to allow that voice to actually reach your throat and be spoken. It may take awhile. Be patient. So if you haven't already, find your self. Say hi. Take it out for a drive or a walk. Get to know it. And then, when you know each other for a while, make a commitment. Bring it home. Sleep next to it. Eat breakfast with it. Soon, you and your self will be joined at the hip, and you'll be ready for anything.Trusting your self is one of the most important steps on your journey toward recovery.

47. Sexuality Because entering into an intimate relationship involves trust, respect, love, and the ability to share, the survivor may flee from intimacy or hold on too tightly for fear of losing the relationship. If abused in childhood: • You likely have to deal with the fact that your first initiation into sex came as a result of sexual abuse. • They may experience the return of body memories while engaging in a sexual activity with another person. Such memories may interfere in their ability to engage in sexual relationships which may leave them feeling frightened, frustrated, or ashamed.

48. Distorted Thinking Patterns • All-Or-Nothing Thinking- You see things in black-and-white categories. If your performance falls short of perfect, you see yourself as a total failure. • Overgeneralization - You see a single negative event as a never-ending pattern of defeat. • Mental Filter - You pick out a single negative defeat and dwell on it exclusively so that your vision of reality becomes darkened, like the drop of ink that colors the entire glass of water. • Disqualifying the positive - You dismiss positive experiences by insisting they "don't count" for some reason or other. In this way you can maintain a negative belief that is contradicted by your everyday experiences.

49. Jumping to conclusions - You make a negative interpretation even though there are no definite facts that convincingly support your conclusion. A. Mind reading. You arbitrarily conclude that someone is reacting negatively to you, and you didn't bother to check this out. B. The fortune teller error. You anticipate that things will turn out badly, and you feel convinced that your prediction is an already-established fact. • Magnification (Catastrophizing) or Minimization- You exaggerate the importance of things (such as your goof-up or someone else's achievement), or you inappropriately shrink things until they appear tiny (your own desirable qualities or the other fellow's imperfections). This is also called the "binocular trick."

50. Emotional Reasoning - You assume that your negative emotions necessarily reflect the way things really are: "I feel it, therefore it must be true. • Should Statements- You try to motivate yourself with shoulds and shouldn'ts. "Musts" and "oughts" are also offenders. The emotional consequence is guilt. When you direct should statements toward others, you feel anger, frustration, and resentment.