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After an assault

Margaret Edwards & Charlotte Chapman April 1, 2013

collegeToday’s college students face more than exams, adjustment issues and a tough job market. They also deal with a complex sexual and social landscape that is full of choices and pitfalls, often without the safety net provided by their families at home.

A 2007 Campus Sexual Assault Study conducted with a Department of Justice grant by Christopher Krebs and colleagues found that 28.5 percent of undergraduate women surveyed had experienced an attempted or completed sexual assault either before or since entering college. According to Emily Douglas and David Finkelhor of the Crimes Against Children Research Center, between 9 and 32 percent of girls and 5 to 10 percent of boys come to school with a history of sexual abuse.

Although the statistics vary depending on what is counted, it seems clear that many students on college campuses have experienced trauma and the associated negative psychological effects. Trauma is known, for example, to increase a person’s risk of abusing alcohol and other substances, as well as increasing the risk of further trauma. Thus, sexual trauma recovery and related problems are a very common issue for college counselors. Effective intervention soon after a trauma can prevent mental health and substance abuse problems, the interruption of social development and the derailment of academic dreams. But how should a college counselor engage the traumatized student?

The first session after an assault is particularly challenging, and a lot rides on that session because it often determines whether a student will follow through with getting help in a timely manner. If a client in this situation feels judged, is pressed too fast for details or is offered unsolicited advice, she or he may not return for the second appointment. It is important to slow down and to support these clients as they try to make sense not only of what has happened but also their resulting reactions.

The approach of motivational interviewing, as developed by William Miller and Stephen Rollnick, is especially helpful in establishing a safe, trusting psychological environment in which to work through a trauma. Motivational interviewing is based on autonomy, collaboration and evocation. For example, asking for permission before providing information or advice and reflecting feelings rather than asking questions about what happened allows the counselor to join with the client without also joining her in the trauma. In addition, allowing the client to set the pace and goals of counseling helps her to re-establish a sense of agency in her own healing, which is important in likewise re-establishing her sense of psychological safety.

Client scenario

Anna is a college junior just getting ready to take her final exams. She walked into the counseling center today in tears and said she wanted to talk about a bad date she had two weeks ago. Anna explains that she attended a date function with Chris, the roommate of her friend Josh. At first, she says, things went pretty normally — drinks, dinner, dancing and barhopping afterward. Anna’s first indication that she might be in trouble was Chris’ insistence on pushing more drinks on her. The second occurred when Chris took her home after the function and followed her in, even after she said no. Chris repeatedly suggested they have sex and ignored Anna’s response.

Since the date function, Anna says, she has been unable to sleep without the lights on, and she can’t remember what she just read, no matter how many times she reads it. She says she is afraid this will wreck her semester and end up costing her admission to medical school. Anna also says she is terrified she will run into Chris; she finds herself looking out for him constantly. She is afraid people will take sides against her or judge her if she reports the incident. Anna says she blames herself because she was unable to stop Chris and because she was drinking before the incident happened.

Listening to Anna’s story as a counselor, it would be easy to fall into the trap of asking her too many questions, labeling what happened, jumping to a diagnosis or even reflecting back in such a way that causes Anna to feel judged. Understandably, it can feel especially urgent as a counselor to give the client advice about reporting this kind of incident or seeking immediate medical help. Doing so, however, increases the risk of making the client feel judged, unheard and more anxious, which can result in the client refusing to continue with counseling.

First-session do’s and don’ts

Do:

  • Build rapport through eye contact that meets the client’s, mirroring her own.
  • Relax your body posture, and breathe to help the client breathe.
  • Listen, and ask as few questions as possible, making them as open-ended as possible. 
  • Affirm the client’s desire to be in control of her reaction, her right to make a choice about how she responds or reports, and her desire to be autonomous. This is especially important if she is unused to asking for help.
  • Use the client’s language as closely as possible, especially in terms of how she refers to the incident (even if she refers to it as “bad sex” and you think it was rape).
  • Summarize frequently.
  • Ask about safety issues (see sidebar above for more details).
  • If the client needs help managing her anxiety as she is telling the story, ask for permission to teach her to ground herself through a breath or by focusing on a physical sensation (such as two fingers touching).
  • If the client asks about why she is having certain symptoms or expresses a concern that she is “feeling crazy,” ask for permission to explain the physiological and psychological responses to trauma. Avoid jargon. For example, the counselor can explain that many people have reactions to a loss of physical or psychological safety that last for a while beyond the incident. Symptoms that some people experience include jumpiness, difficulty sleeping (or sleeping too much), changes in appetite, difficulty focusing or paying attention in class, a feeling of numbness or, alternatively, feeling tearful. If the client wants to know more, she might find it helpful to read Peter Levine’s excellent explanation of how trauma affects the brain, Waking the Tiger: Healing Trauma: The Innate Capacity to Transform Overwhelming Experiences.

Don’t:

  • Call the incident rape or assault unless the client does. Do not otherwise label her experience because she may be experiencing ambivalence about what to call it herself. If you label, she may feel you are judging or pushing her too fast.
  • Refer to the perpetrator in language stronger than the client uses, especially if the perpetrator is someone she knows. If you do use stronger language, the client may feel an impulse to defend the perpetrator.
  • Be overly expressive in terms of sympathy. Many clients need to see whether it is safe to tell you their story. If your reaction to what they are saying is stronger than their reaction, clients can become flooded or feel a need to hold back in order not to upset you.
  • Ask for more details than the client wants to provide (including how much she had to drink, what she was wearing or whether she kept any evidence). Beyond what is necessary to assess for the client’s current physical safety (such as whether the perpetrator lives nearby or has access to the client’s contact information), you do not need the full story to start the counseling work. 
  • Insist that the client report the incident right away. If there is a reporting procedure at your school or an advocate who helps students through the reporting process, you can ask if the client would like information about those resources.

Focus on safety

As experts such as Judith Herman and Lisa M. Najavits have observed, unwanted sexual contact of any kind results in loss of one’s core sense of safety. Many authors, including Babette Rothschild and Peter Levine, have described how reactions to this loss vary depending on a person’s prior experiences, sense of autonomy, culture and neurobiological factors. Even very decisive, assertive people can freeze and/or be unable to defend themselves when faced with an unexpected sexual assault, regardless of whether they know the perpetrator. As a result, many blame themselves, numb themselves to avoid feelings and, thus, lose some of their ability to sense danger.

One of the core purposes of counseling a college student who has been raped is to re-establish that student’s sense of safety and control. Even in the initial session, it can be helpful to ask the student to identify elements of a safety plan that includes practical physical and psychological elements as a first step toward this treatment goal.

There are three key areas of safety questions to ask a client:

  • What makes you feel physically safe when you are alone? What are some things you can do to feel physically safe in your room? 
  • Who helps you feel safe? Why do they feel safe? What do they need to know about you and about what has happened to help you feel safe?
  • How can you establish some boundaries so that [the perpetrator’s name] cannot make contact with you without your permission?

Conclusion

As counselors, we sometimes struggle with the reality that we cannot change what has happened to our clients. Similarly, we cannot protect them from the unfolding series of reactions that are common to people who have experienced trauma. They do the work, not us.

As our clients make their way through a cycle of reactions — among them anger, guilt, shame and grief — we can:

  •  Listen as they make sense of their story
  • Reflect compassionately as they learn ways to cope with their responses
  • Offer practical help, as they ask for it, so they can re-establish their ability to sense and respond effectively to danger, manage their emotions and regain their feeling of control over their lives 

The first and most important step, however, is to help clients establish a feeling of safety in the counseling relationship.

Types of safety

Safety is more than physical, and it remains an issue for anyone who is experiencing a trauma reaction. The following kinds of safety must be re-established for a person to heal after an assault.

  • Physical: Your body is not in danger. If a threat presents itself, you are appropriately reactive to any warning signals to ensure that your body is protected. You either remove yourself from the situation or defend yourself (flight or fight).
  • Emotional: You can identify your feelings in a situation, recognize what your intuition tells you and act on these feelings appropriately.
  • Mental: You are able to access belief systems and patterns of thinking and awareness to accomplish what you want or need on a consistent basis.
  • Spiritual: You can identify and trust in your beliefs about a higher power and your connection to the universe, and you can use those beliefs to lead you to healthy decisions.

— Margaret Edwards & Charlotte Chapman

Margaret Edwards, a licensed professional counselor, is a trauma counselor at the University of Virginia Women’s Center. Contact her at me8n@virginia.edu.

Charlotte Chapman, an LPC and national certified counselor, is director of counseling services at the University of Virginia Women’s Center. She is also a member of the Motivational Interviewing Network of Trainers. Contact her at cmc5nq@virginia.edu.

Letters to the editor: ct@counseling.org

 

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