Counseling Today, Member Insights

Counseling survivors of sexual violence

By Amy E. Duffy November 4, 2019

After spending more than 14 years in the mental health field working with a variety of populations, including gang-affiliated youth, adults with chronic and persistent mental illnesses, combat veterans, and survivors of human trafficking, I am struck with an inescapable theme: Sexual violence plagues every facet of society. Sexual violence does not discriminate, regardless of demographics.

As a counselor, I entered this field to become a helper and to become a part of something bigger than myself. Fred Rogers could not have said it any better: “Look for the helpers. You will always find people who are helping.” This sentiment still rings true in my heart, but one thing the mental health field has shown me is that helping sometimes requires us to combat the systemic and institutionalized injustices that are prevalent in our society.

I recently found myself in a counseling session with a college-age cisgender female who was displaying feelings of hopelessness, crying profusely, and asking me “Why?” She was directly asking me why — after her sexual assault and after exercising every legal right available to her — the system was failing her. I was apologetic for her experience, but I found myself at a loss for words. She was correct; the system was failing her. Our society and our legal system have justice gaps that are expansive. I couldn’t think of an answer I could provide in that moment that would address her feelings of hopelessness.

In subsequent months, as I became aware of similar scenarios playing out with other clients, I began to feel both compassion fatigue and burnout begin to take root. As I’ve mentioned, my intention as a counselor is to help, and I felt that I was not helping enough. I know trauma and its associated treatment modalities like the back of my hand, but that didn’t mean I was doing my part to address the gaps in justice or systemic and institutionalized inequalities that were drastically affecting my clients and their shared experience with sexual violence.

Professional counselors cannot ignore the reality that 1 in 3 women and 1 in 6 men report some form of sexual violence over the course of their lifetimes (according to the National Intimate Partner and Sexual Violence Survey 2010-2012 state report). The Thomson Reuters Foundation conducted a survey in 2018 that concluded that the United States was the 10th most dangerous country for women among the 193 member states of the United Nations; it tied for third among nations where women were most at risk for sexual violence. The foundation defined sexual violence as “rape as a weapon of war; domestic rape; rape by a stranger; the lack of access to justice in rape cases; sexual harassment; and coercion into sex as a form of corruption.” Unfortunately, I have personally borne witness to each of these definitions of sexual violence while working in the mental health and counseling fields.

Given the epidemic of sexual violence, both domestically and globally, it is impossible for counselors to avoid contact with individuals who have survived such violence. To date, counselor education programs do not have a reputation for providing an adequate and thorough understanding of practices for working with this population in their curricula. In addition, progress in the field of sexual violence has been negligible, partially due to the significant gaps in research necessary to better inform prevention, policy and advocacy efforts. These absences of vital counseling resources triggered my desire to explore the Multicultural and Social Justice Counseling Competencies (MSJCC) in search of a plausible answer to this dilemma.

The MSJCC

The MSJCC, developed by Manivong Ratts, Anneliese Singh, Sylvia Nassar-McMillan, S. Kent Butler, and Julian Rafferty McCullough, recognize that individuals are part of a larger ecosystem in which privilege and marginalization coexist. The MSJCC provide a framework to best support survivors of sexual violence not simply on the intrapersonal level, as addressed within treatment models and counseling strategies, but on all socio-ecological levels, through advocacy and action. The MSJCC emphasize the importance of understanding individuals in the context of their social environment while advocating for social justice within that social environment.

In addition, the MSJCC framework acknowledges the need for understanding the complexities of diversity and multiculturalism within the counseling relationship, as well as recognizing the negative influence of oppression on mental health and overall well-being. This framework reinforces the need for counselors to recognize and uphold the reality of intersectionality, in which the various social constructs of race, ethnicity, gender, sexual orientation, economic status, religion, spirituality and disability contribute to a client’s unique worldview, experience and existence as a human being.

When counselors partner with survivors of sexual violence, both the counselor and the client need to recognize the roles that privilege and marginalization play in sexual violence and within the counseling relationship. Effective treatment and long-term healing cannot exist without this mutual understanding. The reality is that victim-blaming, rape myths and gender inequality are persistent elements in American culture and globally; these cultural characteristics constitute what is known as rape culture. Victim-blaming is the extent to which society holds victims of sexual violence responsible for their own victimization, whereas rape myths are stereotyped false beliefs regarding rape, survivors and perpetrators.

Within rape culture, the survivor is marginalized while the perpetrator is privileged, most commonly due to gender. The privilege of gender is then further extended and embedded into society within systems and institutions that protect the perpetrator. These systems and institutions are built upon the foundations of victim-blaming, rape myths, and gender inequality. For example, states such as North Carolina still have laws that blame the victim and support rape myths. These laws include the inability of a person to withdraw their consent to engage in sexual intercourse once consent has been provided. In addition, a person who voluntarily consumes alcohol and then is sexually assaulted is not protected under North Carolina criminal law because of the fact that they voluntarily incapacitated themselves.

Sexual violence is a gender-based violent act. Approximately 91% of sexual violence survivors are women, whereas roughly 9% are men (according to U.S. Department of Justice statistics on rape and sexual assault for 1992-2000). Each of these individuals has been violated in a perpetrator’s effort to oppress and exert power over the survivor. Within the counseling relationship, the counselor and client need to explore the perceived and actual characteristics of their respective marginalized and privileged statuses relative to the issue of sexual violence and in the full context of the intersectionalities described earlier.

Although toxic masculinity may be a newer term in our culture, the constructs associated with it have historically been interwoven into American culture and should be taken into account when applying the MSJCC framework with survivors of sexual violence. Toxic masculinity describes the rigid characteristics and attitudes that are often (falsely) associated with what it means to “be a man.” These characteristics include strength, violence, sex, power, and an absence of emotion and vulnerability. Toxic masculinity perpetuates sexual violence directed not only toward women but also toward men. Understanding the gender-based nature of sexual violence and social constructs such as toxic masculinity, it is vital for counselors to fully embrace the MSJCC framework and the ways in which it relates to survivors of sexual violence.

In my clinical opinion, a counselor should not enter the counseling relationship without fully understanding and accepting the reality that in American culture, 25% to 35% of people endorse rape myth acceptance and therefore engage in victim-blaming and the perpetuation of gender inequality. Counselors should also understand and accept that toxic masculinity is, in fact, a deficit for all genders. This understanding and acceptance is a component of counselor self-awareness within the MSJCC framework. Counselors must become aware of their own attitudes, beliefs and biases pertaining to sexual violence prior to engaging in a counseling relationship with survivors of sexual violence.

The MSJCC require ongoing self-awareness and personal reflection regarding the beliefs, values and biases possessed by the counselor. This is particularly important when working with survivors of sexual violence because of the socialized cultural beliefs to which all counselors have been exposed. If counselors have not adequately addressed their potential beliefs, values and biases, it can result in bolstering shame among survivors of sexual violence.

Expanding the role of the counselor

A primary concept of the MSJCC is the expansion of the counselor’s role. This expanded role is essential when working with survivors of sexual violence. Traditionally, the counseling process has occurred within the confines of an office setting and on the proverbial therapy couch. That scenario has never been adequate when addressing the needs of those who have experienced sexual violence and thus is long overdue for modification. With the inception of the MSJCC, counselors have a framework for expanding on their traditional role to provide best practices in the presence of a profound gap in justice for their clients. 

Social justice advocacy conducted within the MSJCC framework allows counselors to work at the intrapersonal, interpersonal, institutional, community, public policy, and international/global levels to address the systemic obstacles affecting survivors of sexual violence. In the remainder of this article, I will provide a hypothetical case conceptualization (representing a composite of numerous actual cases) to illustrate this multilayered application of the MSJCC framework by a counselor working with a survivor of sexual violence.

Counselor self-awareness: Beliefs, values, biases

The counselor identifies as Christian, is supportive of homosexuality and same-sex marriage, and opposes marital rape, recognizing that nonconsensual sex within a marriage is, in fact, rape. The counselor recognizes the value in people waiting until marriage to engage in sexual intercourse but believes that imposing this standard on others can inadvertently create significant pressure and shame, particularly if someone is then exposed to sexual violence. The counselor believes sexual intercourse should be between consenting persons who provide affirmative consent (with affirmative consent being defined as the presence of yes means yes rather than simply no means no).

The counselor also believes there is no place for aggression or violence within sexual intercourse. The counselor attributes this aggressive mindset in part to the prevalence of pornography, in which close to 90% of sexual acts include aggression against women (according to the 2010 article “Aggression and Sexual Behavior in Best-Selling Pornography Videos: A Content Analysis Update,” published in the journal Violence Against Women). The counselor believes that sexual violence is about power, control and dominance rather than a perpetrator’s elevated drive for sex or inability to control temptation, and that the latter beliefs reinforce rape myths and victim-blaming. The counselor also recognizes and opposes gender inequality in all spheres of life, including the sexual double standard that exists between men and women. The counselor has had consenting partners throughout her life span and has survived sexual violence twice.

The counselor has explored the antecedents to rape culture to identify her own experiences with these antecedents as well as with associated beliefs, values and biases. The counselor is opposed to traditional gender roles and finds them to be oppressive for all genders. The counselor believes that gender and gender roles should be fluid and not rigid and attributes this belief to being raised in a home where traditional gender roles were not always strictly enforced.

Regarding adversarial sexual beliefs and hostility toward women, the counselor recognizes her personal history of strained relationships with prominent female figures as a child, as well as significant “girl drama” during pre-adolescent and adolescent development. Historically, the counselor has interacted better with males and has had periods of doubting women. Regarding the acceptance of interpersonal violence, the counselor believes in standing up for one’s self, even if that means taking physical action. The counselor supports the Second Amendment but believes gun control is not adequate at this time. The counselor has historically enjoyed action movies but has recently begun exploring violence in the media.

To further understand how the counselor’s beliefs, values and biases could affect the counseling relationship when working with survivors of sexual violence, the counselor completed the Illinois Rape Myth Acceptance Scale (IRMA) and scored a 108 out of 110, indicating greater rejection of rape myths. The counselor also recognizes that this score is not reflective of the counselor’s lifelong involvement with rape myth acceptance and is aware of historically faulty thinking as an adolescent and young adult. The counselor acknowledges that self-reflection and development have contributed to her current IRMA score.

Privilege, marginalization and intersectionality

The counselor also examines the ways in which privilege and marginalization interact within the counseling relationship. The counselor is privileged due to being white, middle class, heterosexual and Christian, and having had the opportunity to obtain a higher level of education, whereas the counselor is marginalized for being a woman.

The client in this case conceptualization is privileged due to being heterosexual and Christian, whereas the client is marginalized for being a black woman of lower socioeconomic means who has not been afforded the opportunity to complete her education to date.

The counselor identifies the MSJCC quadrant of privileged counselor-marginalized client as the most appropriate to describe the counseling relationship. The counselor is also aware, however, that this is the counselor’s own perception of privilege and marginalization within the counseling relationship and that the client may have a different perception.

The socio-ecological model

The counselor begins at the intrapersonal level by sharing her worldview (as previously described) and bearing witness to the client’s worldview. The beliefs, values and biases of both parties are explored. Intersectionality is a main component within the intrapersonal level, with the social constructs of race, ethnicity, gender, sexual orientation, economic status, religion, spirituality and disability being explored by both the counselor and the client.

The counselor and the client also have an open discussion about privilege and marginalization, including the ways that they may enrich or create obstacles within the counseling relationship. For instance, both the counselor and the client have a shared experience and openly process their experiences of gender inequality and being discriminated against for being women. At the same time, the counselor openly recognizes the existence of white privilege and verbally acknowledges that her race has not made her life more difficult. The counselor also honors the specific incidences of racism that the client has experienced and is openly willing to share with the counselor.

At the intrapersonal level, the counselor and the client also discuss and process the client’s experiences with self-blame, victim-blaming, and rape myth acceptance. The client shares self-blaming beliefs such as, “I should not have gone out that night” and “I never should have had those drinks.” The client also shares victim-blaming attitudes that others have projected onto her, including how the client’s clothing was too revealing and how she could have been more assertive in her denial to engage in sexual intercourse.

Following the exploration at the intrapersonal level, the counselor begins to support the client at the interpersonal, institutional, community, public policy and international/global levels. At the interpersonal level, the counselor assists the client in exploring her various relationships and identifying a healthy social support network consisting of family, friends, neighbors and co-workers. During this time, the counselor also assists the client in implementing appropriate boundaries within those relationships that have been identified as being unhealthy or unsupportive. The client determines that several familial relationships are unsupportive due to significant victim-blaming attitudes and the demonstration of rape myth acceptance. The client then gives the counselor permission to provide psychoeducation regarding victim-blaming and rape myth acceptance to these family members and to challenge their beliefs that are further victimizing the client.

The family members resist the psychoeducation and continue to engage in victim-blaming and rape myth acceptance. Therefore, the client decides to implement boundaries to appropriately distance herself from these relationships. The client then makes an intentional effort to widen her social network by connecting with other friends and family members. After visiting a shared interest group with the counselor, the client decides to join the group in hopes of also making new friends.

At the institutional level, the counselor and the client begin to explore the social institutions with which the client is associated. During a session, the client shares that she has observed sexual harassment in her workplace and expresses concern that she will continue to be exposed to these interactions. With the client’s permission, the counselor reaches out to the employer and offers to provide an organizational training to the entire staff on sexual harassment and gender inequality in the workplace.

The client also shares that she has been a member of her church for more than a decade. She is finding it increasingly difficult to attend regularly, however, because of the feelings of shame associated with the church’s message regarding purity. The client also shares her perception that the church displays rape myth acceptance frequently during its teachings. With the client’s permission, the counselor reaches out to explore the possibility of meeting with church leaders about their own rape myth acceptance tendencies and to develop a plan with church leaders to provide a more supportive environment for survivors of sexual violence. Furthermore, the counselor uses this experience to develop a program to help all community churches create safe places for survivors of sexual violence.

The counselor’s work does not stop here. As an active member of the community, the counselor has various opportunities to address norms at the community level. For instance, when processing at the intrapersonal level, the client shared her experience with racism, disclosing that she often felt unheard during her school years and was frequently passed over when her hand was raised to contribute to class discussions. Instead, she received discipline referrals for speaking out of turn and being disruptive. The counselor validates the client’s experience with microaggressions and acknowledges this display of racism. The counselor then assists the client in connecting with a community volunteer opportunity in which the client will be tutoring school-age minority females. This gives the client an opportunity to empower not only herself but minority female youth as well.

The counselor also notices that the community has limited events to raise awareness about sexual violence, suggesting that the topic is unimportant, taboo, or not considered to be an issue within the community. With that in mind, the counselor decides to organize a committee of other counselors to coordinate an annual Take Back the Night event. The hope is to engage the community more on the topic and to create a new community norm of open discussion regarding sexual violence.

The public policy level is most closely associated with the gap in justice witnessed by survivors of sexual violence. For that reason, the counselor is intentional about making action at this level a priority. The counselor becomes knowledgeable about state and federal laws that affect survivors of sexual violence and openly shares this information with the client. The counselor attends public forums on the topic and provides expert testimony regarding the need for improved laws that protect survivors. The counselor also meets with state legislators to discuss how laws that reinforce victim-blaming and rape myth acceptance affect survivors of sexual violence and the communities in which they live.

At times, the counselor challenges the language used in sexual violence legal cases, including questions such as “What actions did you take to prevent the alleged sexual assault?” and statements such as “The victim chose to stay.” The counselor does this by reframing these retraumatizing questions and statements to be trauma-informed. In these instances, the counselor reinforces the truth that survivors cannot prevent their sexual assault from happening, nor does one’s decision to be in a specific environment suggest that survivors are responsible for being assaulted.

Similar to the public policy level, the international/global level requires the counselor to take action outside of the office and, at times, behind the scenes. The counselor educates herself on gender inequality on a global level, including human trafficking, farming disparities between men and women, unequal labor wages, lack of education for females, immigration, and child marriage. The counselor joins organizations that address these various topics, which have both direct and indirect associations with sexual violence. The counselor then disperses information on these topics on a blog linked to her website. Finally, the counselor participates in specialized training to complete immigration assessments for those seeking asylum in the United States and those hoping to gain access to their afforded protections under the Violence Against Women Act.

Conclusion

Sexual violence is epidemic in contemporary society. This epidemic is largely fostered by the prevailing rape culture in the United States and worldwide. Thus, it is highly likely that counselors will encounter survivors throughout their careers across a wide range of clientele. This article provides relevant background information on sexual violence and victimization, along with an application of the MSJCC, to promote a deeper understanding of sexual violence and to detail a promising framework for counseling and advocating for these survivors.

 

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Amy E. Duffy is a licensed professional counselor supervisor specializing in trauma and working in private practice in Raleigh, North Carolina. She is currently pursuing her doctoral degree at North Carolina State University, where she is studying gender inequality and sexual violence in her dissertation research. Contact her at amyeduffylpc@gmail.com or HarborBehavioralHealth.com.

Letters to the editor:  ct@counseling.org

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, go to ct.counseling.org/feedback.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

1 Comment

  1. Julie

    The date of this statistic tells me all I need to know about how much attention sexual violence does NOT get: Approximately 91% of sexual violence survivors are women, whereas roughly 9% are men (according to U.S. Department of Justice statistics on rape and sexual assault for 1992-2000).
    It is discouraging to see such outdated statistics as the ‘most recent’. Rape culture indeed.
    Thank you for this article and continuing to create awareness.

    Reply

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