Sexual Violence and the Recovery Process

2015

Findings and Recommendations

 

Sexual Violence and the Recovery Process: An Exploration of Rape Crisis Centre Counselling in Ireland
Sexual violence has been recognised as one of the most frequent forms of trauma worldwide. The overarching aim of this research was to investigate the nature and effectiveness of Irish Rape Crisis Centre (RCC) counselling in order to develop in-depth understandings of the factors that influence recovery from sexual violence and the responses required. This is the first comprehensive study of RCCs nationally and, indeed, internationally. As a unique and deeply personal process, counselling has an ethereal quality that is not easy to capture. However, the findings provide salient insights into the complex nature of recovery in the context of Irish RCC counselling.
The following are the main findings of this research and the associated recommendations:
RCC Counselling Approach The RCC approach is humanistic, holistic and underpinned by a specialist understanding of trauma Sexual violence is viewed as a violent act that is manifested sexually Empowerment is the guiding principle and goal of RCC therapeutic work RCC counselling is underpinned by an integrated framework that addresses all aspects of trauma The therapeutic relationship is conceptualised as the focal point of the healing process The RCC approach is non-diagnostic, non goal-oriented and not time-limited RCCs foster an inclusive concept of victimisation, yet ‘survivor’ is equated with woman in the 2006 training manual for counsellors
The Recovery Process It is evident that recovery is a process and an outcome, a personal journey involving struggle and growth It also appears that recovery is never-ending The value of working through the consequences of sexual violence with the help of RCC counselling is evident 2015 Findings & Recommendations
Outcomes of RCC Counselling Strength, knowledge and self-awareness Being believed, understanding that the sexual violence experienced is not one’s fault Developing adaptive coping strategies and self-caring routines Forgiveness, acceptance and compassion Reconnecting with others
RCC Counselling Process
The following are the main themes that emerged: RCC counselling as a safe space to explore the consequences of sexual violence The significance of counsellors facilitating survivors to find their own answers The centrality and complexities of the therapeutic relationship Supervision and peer support as crucial in terms of counselling practice and counsellor well-being The salience and complexities of the RCC empowerment approach The likelihood that survivors do not necessarily need to recount the full details of their traumatic experience(s) in order to heal The importance of working with trauma held in the body The significance of RCC specialist training Psychiatric conditions and high levels of medication as inhibitors of deep therapeutic work
Factors Influencing the Recovery Process Survivors’ readiness Traditional norms of femininity and masculinity Gender in the therapeutic relationship Support from family and friends
Ways in which RCC Counselling may be Improved
The vast majority of survivors who completed a questionnaire (87.5%) would strongly recommend RCC counselling. The following suggestions were made by survivors and counsellors for service enhancement: Improved funding Improved inter-agency work Group work, including mixed gender support groups The availability of complementary therapies in RCCs
Recommendations:
The findings have important implications for RCC practice and national policy. In light of these findings, the following recommendations are suggested:
RCCs RCCs to revise their training for counsellors in order to address the challenges and gaps identified in the research, particularly in relation to male survivors and female perpetrators RCCs to explore ways of hiring more male counsellors RCCs to consider the provision of complementary therapies, including mixed gender group work RCCs to develop their inter-agency approach with GPs and psychiatrists RCCs to receive ongoing adequate funding from TUSLA ( Child & Family Agency) to ensure continued service provision that eradicates waiting lists, in addition to ongoing training for counsellors, particularly in relation to working with trauma held in the body and with survivors who have autism or Asperger’s syndrome RCCs to be formally recognised as the specialist service for survivors of sexual violence
COSC (The National Office for the Prevention of Domestic, Sexual and Gender-based Violence) Cosc, in conjunction with RCCs, to consider new ways of promoting RCC services to survivors, particularly men Cosc to fund further research in the area of sexual violence – updated national prevalence study; studies investigating and exploring: the outcomes of other RCC support services, the influence of alternative gender identities and ethnic background on the recovery process and the challenges posed by working with survivors who have autism or Asperger’s syndrome; a study exploring RCC links with services that assist survivors with eating disorders and addictions Cosc to revisit their strategy on gender-based violence in terms of enhancing their understanding of the role that gender plays in the perpetration and experience of sexual violence and its aftermath.
Background and Objectives
Sexual violence is a serious and widespread problem internationally and in the Irish contextii. Given their predominance as survivors, women and girls who come to terms with its profound consequences have been the almost exclusive focus of research and support to date. The broadening of the discourse around sexual violence to account for the experiences of men and boys is a relatively recent development, and this increased awareness is reflected in the growing number of men accessing Irish RCC counsellingiii. Though RCCs have been at the forefront of the Irish response since 1979, a systematic assessment of their services had been lacking.
In this research, I therefore examined the conceptual framework underpinning the RCC response to sexual violence, assessed the outcomes of the counselling services provided and sought to understand the role of RCC counselling in the recovery process. A particular focus was placed on identifying ways in which RCC counselling may be improved and understanding how factors such as gender facilitate or impede recovery. The research was conducted within a feminist framework, whereby rape, sexual assault and sexual abuse are recognised as acts of violence, involving abuse of power and control. Six RCCs within Rape Crisis Network Ireland (RCNI) participated in the studyiv. Located in the west, east and south of Ireland, these centres range from small to large in size.
Research Methodology
As the central research aim was multi-faceted, I chose a mixed-strategy design in order to combine the best of quantitative and qualitative approaches, thereby capturing the different layers of data required to answer the research objectives. I first analysed the 2003 and 2006 RCNI training manuals for counsellors. I also conducted 3 interviews with RCC/RCNI coordinators in order to explore a number of questions that emerged. Next, I employed a pre-tested self-completion questionnaire with a quota samplev of women and men who have experienced rape and/or sexual assault as adults, children or both. These survivors were accessing RCC counselling at the time of study participation and had been attending this service for at least 3 months. Out of a target sample of 155, I received 43 completed questionnaires (39 from women, 4 from men) across the 6 participating RCCs. The participants who completed a questionnaire represent a cross-section of survivors who access RCCs across the following variables: age, geographical location, type of sexual violence experienced, when the sexual violence occurred and length of time participating in counselling. While awaiting the return of the questionnaires, I conducted semi-structured, in-depth interviews with 12 counsellors, 9 women and 3 men from the 6 participating centres who provide a range of counselling approaches between them. This was followed by 14 interviews with survivors of sexual violence in childhood and/or adulthood, 10 women and 4 men who had completed a questionnaire.
The quantitative aspect of this study draws on the field of evaluation research, in particular, outcome evaluation. As recovery is not a linear process, measuring a change in survivors’ behavioural and psychological symptoms through pre- and post-testing may distort an understanding of the outcomes of the services providedvi. As the overall goal of RCC services is understood as supporting survivors in their healing process, outcome evaluation not only incorporates an assessment of the degree to which services are operating as intended, but also of whether survivors have received the help they felt they needed and the difference this has made to their lives. The following are the main findings.
RCC Counselling Approach
It’s literally, to me it’s like a flower that just kind of opens up slowly with the right help and support and love, unconditional love, cause that’s ultimately what we give our clients in a very non-touch kind of way, is that unconditional love, where we don’t shame or embarrass or judge like the original abuser, the family, the people that refused to hear, listen, see (Cathy, counsellor in a large RCC).
What makes RCC counselling unique in the Irish context? Both humanistic and holistic, Irish RCC counselling offers an important alternative to traditional clinical models. Moreover, it is underpinned by a specialist understanding of trauma. As RCCs draw upon feminist analyses of sexual violence as an abuse of power and control, empowerment is the guiding principle and goal of their therapeutic work. The survivor is thus viewed as an active agent in their own recovery. RCCs conceptualise sexual violence as a violent act that is manifested sexually, thus enabling counsellors to address its implications for an individual’s sexuality. Indeed, RCC counselling is underpinned by an integrated framework that recognises the deep psychological, emotional and physiological impact of sexual violence, in addition to the social context within which recovery takes place. Although RCCs recognise Post-Traumatic Stress Disorder (PTSD) as a common consequence of sexual violence, their approach is non-diagnostic. RCC counselling places an emphasis on survivors’ coping strategies and the therapeutic relationship is conceptualised as the focal point of the healing process in which trust, boundaries and self-worth can be re-learned. Aiming to foster well-being and growth, the RCC approach is not goal-oriented or time-limited. While RCCs foster an inclusive concept of victmisation, I believe the engrained equation of ‘survivor’ with woman evident throughout the updated 2006 training manualvii to be problematic, nonetheless. I also view the under-exploration of female perpetrators as a gap that needs to be addressed. Next, I discuss the findings in relation to the recovery process.
The Recovery Process
It can be really hard and really tough, em, and there’s times when I really did hit rock bottom and even through the counselling process I found it. You know, where, where I was in my life. And then you’ll get these lovely times and it’ll pick you up and, and em, it makes everything worthwhile. So there’s times when it’s very tough and it’s very challenging, em, but it’s always so worth it. You come out the other side of something and the bright sunny day is there and you know you’ve let go of something else that you were carrying and you’re lighter and brighter (Rachel, survivor of sexual violence in childhood and adulthood, aged 44).
It appears that individuals who participate in counselling embark upon a personal journey, a process involving both struggle and growthviii. It also seems that the journey is never-ending. A myriad of conflicting emotions may be experienced at the outset, ranging from fear to hopefulness. It appears that the difficulties individuals encounter become intensified as they begin to really face the emotional and physical impact of the traumatic event(s) for the first time. Indeed, the profound impact of sexual violence can often prove too much to bear, particularly in the case of child sexual abuse. The decision to participate in counselling is not one that is easily made and it seems that survivors must do it for themselves and must really want to do it. Although the process can be overwhelming and survivors may feel, at times, that they are making no progress, the value of working through the consequences of sexual violence with the help of RCC counselling is evident. Each of the survivors in the study conveyed positivity in
relation to the transformations that have taken place with the help of counselling. Indeed, some of these individuals advised that they have hope for the future in relation to continued growth. Several counsellors discussed this aspect of the journey in terms of integrating the trauma into one’s present life and self in order to ‘move on’.
RCC Counselling Outcomes
I have a new partner and it’s the first time I’ve ever experienced a loving relationship but I’ve known what it is now to have one but only because I’ve had things examined for myself through the process here so it’s. I can’t talk highly enough about what’s happened here because it’s changed my life and effectively everyone around me has benefited from what’s happened, you know, and my children are getting the benefit of it big time now (Mark, survivor of sexual violence in childhood and adulthood, aged 44).
The findings thus provide support for the efficacy of RCC counselling services in terms of assisting survivors in their healing process in line with their humanistic ethos. Survivors reported numerous positive outcomes, such as strength, knowledge and self-awareness. Many survivors who participated in an interview discussed their identity in terms of how counselling has helped them to discover their true selves. Others spoke of a recreation of the self or learning to simply be. Although RCCs employ the term survivor in order to honour an individual’s resilience and strength, acknowledging one’s victimhood emerged as an important first step in the recovery process. Indeed, individuals may eventually move past their survivor identity, which itself seems to represent problematic terminology, given its connotations of mountain rescues. Many survivors also noted the importance of being believed, coming to an understanding that the sexual violence they experienced was not their fault and developing self-caring routines. However, it is evident that counsellors should not assume that self-blame is an ever present consequence of sexual violence. Although almost a quarter (23%) of the survivors who completed a questionnaire reported continuing isolation, despite counselling, this does not appear to be a flaw of the RCC approach. It seems that reconnecting with others is a particularly difficult aspect of recovery. Moreover, the personal meaning that isolation has for different individuals varies, as, although counselling may be the only support that one has, it can be all that a survivor needs. However, it seems likely that the trust that is built in the therapeutic relationship helps survivors to build trust in themselves and their own lives. For survivors of child sexual abuse, the importance of forgiveness, acceptance and compassion also emerged. Given the complexity of the healing journey, it seems that, while survivors generally learn how to cope with the consequences of sexual violence, they may encounter times when they revert to old, maladaptive coping mechanisms. As it appears that the slowly evolving nature of the recovery process is never-ending, issues may continue to arise at different times in a survivor’s life after they have completed counselling. While it seems they can, generally, employ the coping strategies they have learned with the help of counselling, some individuals need to return, as these issues serve as a signal that they are ready to go deeper. However, Thomas, a survivor, and Cathy, a counsellor in a large RCC, challenged the idea that recovery can be delineated into stages. Perhaps the term ‘cycle’ would better reflect our understanding of the recovery process as non-linear. The complexities evident in these findings provide an insight into the nature of the counselling process.
The RCC Counselling Process
I am allowed to express my feelings, thoughts and experiences and know that they will not be minimised, as well-meaning friends have a habit of doing. It is a time for me, where I can be myself and not be afraid the reaction will be disgust (Teresa, survivor of child sexual abuse, aged 56).
According to the survivors who participated in the research, RCC counselling predominantly involves a trusting relationship that creates a safe, non-judgemental space; a place where they could be themselves, share their pain and be honest about their feelings. The significance of counsellors accompanying survivors on their healing journey by facilitating them to find their own answers emerged as an important theme. Given the particular significance of the therapeutic relationship, it seems that once survivors begin to trust their counsellor and realise that they will be there for them throughout their journey of recovery, they begin to relax into the counselling process. A number of counsellors discussed how they establish trust by ‘learning the survivor’s language’, namely their way of being in the world and in the counselling session. However, the therapeutic relationship is not without its difficulties. Some survivors who participated in an interview discussed the negative emotions they have sometimes felt towards their counsellor as a result of difficulties they have faced. However, it appears that counsellors truly embody the humanistic principles by ensuring open communication, while establishing appropriate boundaries. As self-awareness around their practice was identified as a key component, supervision and peer support were characterised as crucial in terms of both counselling practice and counsellor well-being. The importance of the RCC empowerment approach has also emerged very clearly in the research. However, it is evident that even when counsellors facilitate the recovery process to take place at the survivor’s pace, this does not necessarily equate to individuals feeling in control. Highlighting the complexities involved, it appears that counsellors need to gently challenge survivors if they think that they are avoiding difficult issues. Indeed, Siobhan, who works in a large RCC, raised the question of whether counsellors are challenging enough when it comes to behaviour that is destructive to one’s self or one’s family and friends. Furthermore, the findings indicate that a crucial aspect of the counsellor’s role involves employing their specialist knowledge in order to help survivors to connect to their emotions in a safe way. While the vast majority of survivors confirmed the importance of being allowed the time and space necessary to heal and grow, it is evident that it can be difficult to decide what path to take and to find the answers oneself, particularly for survivors of child sexual abuse. From the counsellor’s perspective, the difficulty may involve watching a survivor struggle, yet the importance of letting something deeper emerge cannot be underestimated.
As healing takes place in the present, it seems likely that survivors do not necessarily need to recount the full details of their traumatic experience(s) in order to heal. It seems that although these details may never be told verbally, the story is always told psychologically, via the emotions that arise. The process of working with trauma that is held in the body, therefore, emerged as an integral aspect of the recovery process within the context of counselling, whereby counsellors ‘hold the space’. Counsellors described this process in terms of helping survivors to slow things down and encouraging them to become attuned to their feelings, while guiding them through body awareness. Counsellors’ assistance in naming somatic sensations and making sense of the associated emotions in order to release or let them go also emerged as a salient theme. Siobhan discussed how this way of working represents a shift for RCCs. As it appears that dissociationix has often become their default coping mechanism, this process can take longer
for individuals who have experienced child sexual abuse. It seems likely that the trust that is built in the therapeutic relationship is central to survivors feeling comfortable to express their vulnerability and emotions. Each of the survivors who participated in an interview discussed the progress they have made in relation to understanding and expressing their feelings and letting go of their shame, anger, hurt and pain. As RCC specialist training provides an understanding of the dynamics involved in sexual violence, it appears to help counsellors to be non-judgemental and to facilitate survivors to process their emotions in their own time. According to many counsellors, psychiatric conditions and high levels of medication negatively affect a survivor’s ability to engage in this type of deep therapeutic work. Several counsellors thus advised that, if they thought that a survivor needed medication for a psychiatric condition or was suffering from depression, they would adjust their approach and advise the individual that it would be helpful to talk to their GP. Megan, a survivor who is high functioning autistic, also questioned the suitability of the emotional work involved in counselling survivors for individuals with autism or Asperger’s syndrome. This raises the question of whether counsellors need to learn more about these conditions. Indeed, it is evident that a number of factors influence the recovery process.
Factors Influencing the Recovery Process
What I have seen with them [men], and I don’t know if they’re aware of it themselves, is a vulnerability that’s actually quite touching. It’s quite tender…It was quite freeing, you know, because all of their perpetrators were male and, eh, they were no less angry or upset or frustrated or in pain or dealing with addictions than the rest of us. It was just, we were all one (Mairead, female survivor of sexual violence in adulthood, aged 40, discussing her experience of a mixed gender RCC support group).
The majority of counsellors stated that they ‘meet the survivor where they are’. Indeed, survivors’ readiness emerged as an integral factor in their decision to access counselling and it also seems to influence the manifestation of issues when the time is right. It is evident that gender is also an important factor influencing the recovery process. The conceptual framework underpinning the RCC approach to counselling survivors is predominantly informed by their work with women, in addition to feminist analyses of sexual violence. In order to account for men as survivors and women as perpetrators, RCCs recognise that gender is not the sole source of power, nevertheless. Moreover, counsellors are made aware of the possible gendered consequences for men, in addition to the ways in which norms of masculinity influence responses to victimisation. As such, RCCs recognise the importance of helping men to access the emotions that lie beneath the male self-protective masks that may be employed to hide their pain. However, it would appear that gendered norms influence the recovery process in a number of complex ways. Several counsellors maintained that women, generally, internalise their suffering, whereas men tend to act out of their pain. It also seems that men tend to question their masculinity and/or sexuality. Moreover, the guilt that survivors can harbour as a result of physically responding to the sexual acts enforced upon them appears to be a particular struggle for men or, at least, one that they are either more comfortable sharing or are more fearful of in terms of what they think this says about their sexual orientation. It seems likely that reassurance and an understanding of the dynamics involved are central to helping survivors overcome these feelings of guilt and confusion. Although it appears to be more commonplace for male survivors to fear that they will become a perpetrator of sexual violence, the only survivor in this study who shared this concern was Megan, who was abused by her adoptive mother. It is thus evident that being
the same gender as the perpetrator may be an important factor. Indeed, she reported experiencing disbelieving attitudes in relation to the abuse. Mark likewise advised that he encountered a number of negative responses to the adult rape he disclosed.
It is also evident that it may be more difficult for men to acknowledge that they are victims and that they need help. They may also struggle more than women with talking about what happened to them and with knowing how they feel. However, there was disagreement among the counsellors regarding the exploration and expression of emotions. While several counsellors maintained that men, generally, find it more difficult to get in touch with all of their emotions, several others reported that survivors tend to find it easier to get in touch with the emotions that are deemed acceptable for their gender. Anger emerged as a frightening and complex, yet dynamic, emotion in the research. Although some female and male survivors discussed the difficulties they have experienced with connecting to this emotion, the importance of expressing it in a safe way is evident. It is also clear that while women may find it difficult to connect to this emotion in a session, they may take it out on someone less powerful, such as children. Several counsellors stated that they help survivors who are experiencing difficulties to become aware of the emotions that arise in order to find a way to connect to them, if this is what they want and are ready to do. As gender norms, familial upbringing and personality were identified as possible inhibiting factors, they also reported helping survivors to explore their beliefs. Catriona, a counsellor in a medium-sized RCC, maintained that being told that you deal with whatever you want to deal with can be more frightening for men. Although some counsellors have found men to, generally, be more practical and task-oriented than women, there was unanimous agreement that men do deal with their emotions.
Although the majority of counsellors interviewed advised that they have not found it more difficult to build the psychotherapeutic relationship with men than with women, it is evident that the dynamic may be different. Indeed, gender emerged as a factor influencing this relationship in a number of ways. It is evident that, while some survivors do not have a preference for a woman or a man as their counsellor, for others, this is a consideration. A number of salient factors were identified in this respect, among them the gender of the perpetrator. The potential value of survivors working through their trust issues with a counsellor of the same gender as the perpetrator was thus highlighted. However, the problematic nature of being overly concerned that such problems will transpire is also apparent. It is evident that the gender of the counsellor may influence a survivor’s comfort with expressing particular types of emotions in different ways. However, this is not necessarily a prohibiting factor, as survivors may learn to access both their anger and their ‘softer’ emotions, regardless of the counsellor’s gender. It also seems likely that there is a potential effect of gender conditioning on how a counsellor views working with women and men. Indeed, such conditioning may influence the counsellor’s approach and the survivor’s perception of the process. While I validate the necessity of paying close attention to the gendered issues that may arise, I, nevertheless, caution against the prospect of being overly concerned that such problems will transpire. However, it is likely that the RCC person-centred approach will go a long way towards transcending any gender-related issues that may arise. Support from family and friends was also identified as a factor influencing the recovery process. As it can be difficult to be in a relationship with a survivor, RCCs provide support for partners. However, problems may arise in relation to unsupportive partners or friends who are unhappy with the positive changes occurring in the survivor’s self-esteem.
Suggestions for Service Enhancement
As we can see, the survivors who participated in the research, generally, framed their experiences of RCC counselling in positive terms. Indeed, all of the survivors who completed a questionnaire would either strongly recommend or suggest RCC counselling, the vast majority (87.5%) opting for strongly recommend. The fact that RCC counsellors are sexual violence trauma specialists was an important factor in this regard. Improved funding emerged as the most common suggestion among survivors and counsellors to improve RCC counselling, with waiting lists and reduced training highlighted as repercussions of recent budget cuts. Moreover, Siobhan, a counsellor in a large RCC, asserted that centres may have to reconsider their non goal-oriented approach if they continue to struggle economically. It is imperative that RCCs receive adequate funding in order to ensure that survivors are allowed the time and space to acknowledge and understand the impact of the trauma and to address the issues that arise at their own pace. Although some challenges were identified, among them the divide between the clinical and non-clinical models, the need for improved inter-agency work is also evident. Finally, group work and complementary therapies, such as Reiki, were recommended by some survivors. Indeed, interesting intersections emerged between gender and group work. It is evident that mixed gender support groups may be beneficial for both women and men in terms of challenging gendered norms, in addition to finding a balance between practical and emotional approaches to the recovery process. It seems likely that the availability of complementary therapies in RCCs would ensure that survivors have access to additional support in a way that is safe.
About the Research
Funded by the Irish Research Council, this study was conducted from 2010-2014 by Caroline Forde, PhD, and supervised by Nata Duvvury, PhD, Centre for Global Women’s Studies at the National University of Ireland, Galway. I would like to thank the survivors and counsellors for sharing their perspectives, experiences and stories. I also wish to thank the participating RCCs and the RCNI, in particular Susan Miner, PhD, for endorsing the research and for assisting me in its realisation. In this report, pseudonyms are used when referring to individual participants.
For further information, please contact the author, Caroline Forde: cforde@tcd.ie.
i This was a study of RCCs within Rape Crisis Network Ireland (see footnote iv). RCCs employ the term ‘counselling’ (rather than psychotherapy), which comprises short-term crisis support and longer-term deep therapeutic work.
ii McGee, H., Garavan, R., De Barra, M., Byrne, J. & Conroy, R. (2002). The SAVI report. Sexual abuse and violence in Ireland. A national study of Irish experiences, beliefs and attitudes concerning sexual violence. Dublin: Liffey Press – 42% of women and 28% of men reported some form of sexual abuse or assault in their lifetime.
iii RCCs began providing services to men in the 1990s. Although the number of men accessing RCCs has increased since this time, in 2014, only 15% of clients were men. Also, it is estimated that only a minority of survivors (20%) seek support from specialist services – RCNI (2015). 2014 National rape crisis statistics. Galway: Rape Crisis Network Ireland.
iv Up until May 2015, RCNI was the national representative body of the majority of Irish RCCs. However, the number of affiliated centres has undergone a process of change. RCNI is currently in a state of flux, their funding revoked by the Irish government. However, RCCs continue to provide support services as their funding is guaranteed by TUSLA, the Child and Family Agency. An RCC Managers’ Forum has also been established.
v Participants who seem to represent a cross-section of RCC clients.
vi Sullivan, C. & Coats, S. (2000). Outcome evaluation strategies for sexual assault service programs: a practical guide. Michigan, US: Michigan Coalition Against Domestic and Sexual Violence.
vii A chapter entitled Male Survivors was added to the updated RCNI Basic Training Manual for counsellors, which was published in 2006.
viii This is in keeping with the Irish Mental Health Commission’s commitment to placing service users at the centre of mental health care and promoting an ethos of recovery as a personal process within Irish mental health services – MHC (2013). Strategic Plan 2013-2015. Dublin: Mental Health Commission.
ix Dissociation involves partial or total separation of aspects of the traumatic experience and enables survivors to distance themselves from the powerful emotions of fear, shame, or anger.