The aftermath of rape: A counsellor's advice

Here, Mumbai-based clinical psychologist Sadia Raval sheds light on the emotional trauma of rape victims and imparts therapeutic advice to them and their families.

Victims of date rape, or any other form of sexual assault, for that matter, experience a host of negative emotional effects. These can range from an immediate presentation of fear and anxiety to deeper rooted feelings of insecurity and loss of self-esteem. Hence, it is vital for many to undergo therapy and restore a sense of normalcy to their lives. And for therapy to be effective, a mental health practitioner needs to simultaneously address several areas where difficulties exist.

When the incident of sexual assault such as a rape is recent, there may be more urgent demands on therapy. The therapist needs to become a part of the victim's immediate support system. Addressing current distress is the chief concern.

The individuals may display feelings of fear and insecurity -- a sense of feeling unprotected and uncared for. Enlisting the support of the immediate family and friends at this time may be of crucial importance. Often the family is distraught, unable to make sense of the crime and vicariously experiences intense distress.

In their attempts to fit the experience in some sort of a framework of comprehension, the family members may search for reasons and blame-objects, resulting in holding themselves or the survivor responsible. Facing questions and pressures from people around them may be a struggle for both, the victims as well as their families. Easing out this distress by helping the individuals and family to avoid blame and to avoid assuming responsibility for the assault is essential.

Also, immediately after the crime, the survivors may need to repeat and report the incident several times to family or concerned authorities. Helping them to answer questions about it assertively and working with their sense of shame and embarrassment in speaking about it may be a pressing focus of therapy.

In some cases, denial may also be an important part of the immediate presentation. The individual may try to underplay the intensity of the emotions by denying the true nature of the event. When it is short-term and immediately follows the crisis, denial can be a positive coping mechanism. A therapist needs to be extremely sensitive to the victim's level of comfort in acknowledging the impact of the situation. When circumstances are such, therapy may be limited to providing support and addressing current practical difficulties. However when denial continues over a longer period of time it may need to be gradually addressed. As American writer James Baldwin once said, 'Not everything that is faced can be changed, but nothing can be changed until it is faced.'

Long-term work with a victim will focus on more deep-seated reactions to the assault. The nature of the assault may decide which issues seem to surface with greater intensity. In case of date-rape, the perpetrator being someone known may lead to greater anger and more self doubt. Here there is more scope for self blame, extreme anger, questioning one's trust of people and doubting one's ability to understand people.

For the most part, people usually perceive themselves as invulnerable although they are confronted with frequent reports of crime through media and other sources. This illusion is important, as it is self-assuring and lets us go about our day-to-day activities without a constant fear of the future. In case of sexual assault, this illusion is broken and shakes the fundamental assumptions of one's invulnerability and safety.

Mistrust of the world at large, a chronic fear of being harmed and a pervading sense of hopelessness can become chronic difficulties that need to be addressed while working with victims.

Therapeutically, a large number of approaches have been used in working with sexual assault. In situations of trauma, thoughts and internal interpretation of events can become extremely negative and self-damaging. Hence cognitive approaches can be used that help the client identify their thoughts, their self-talk (what they are actually telling themselves about the situation) and can work on helping people cognitively re-interpret the events. These approaches work best when combined with behavioural techniques, ie techniques that deal with overtly reducing distress through altering certain behaviours. These include teaching relaxation, anxiety-reduction techniques and focusing on what next the victim needs to 'do'.

Group therapy may also be very helpful in alleviating a sense of isolation and may provide a platform for venting distress in front of others who can truly identify with it. It may also help in building new meaningful relationships and getting other victims' perspectives.

Although several techniques are known to be useful in handling the array of distressing symptoms in the aftermath of rape, it is important to understand that individual differences in reaction to such an incident may be greatly varied. A highly empathetic approach, aimed at understanding the unique meaning of the incident for a particular individual and guarding against general presumptions of how the incident 'should' or 'must' affect one, are most effective.