Abrams, K. M., & Robinson, G. E. (1998). Stalking: Part II: Victims' problems with the legal system and therapeutic considerations. Canadian Journal of Psychiatry, 43, 477-481.

This paper presents the results from the second of a two-part review on stalking. It focuses the therapeutic tasks for victims and therapists and on victim difficulty with the legal system. Results of an extensive literature search suggest that victims experience a number of emotional consequences from being stalked. Additional stressors result from the legal system's lack of response. The authors state that treatment of victims must be handled in a comprehensive manner, with attention to education and psychotherapy.

Topics: Effects; legal responses; stalking; treatment

Azikiwe, N., Wright, J., Cheng, T., & D’Angelo, L. J. (2005). Management of rape victims (regarding STD treatment and pregnancy prevention): Do academic emergency departments practice what they preach? Journal of Adolescent Health, 36, 446-448.

This study examined the difference between institutional policy and practice concerning the role of emergency contraception (EC) and STD-screening for sexual assault cases in 85 emergency departments. Results showed that 60% of emergency departments screen for STDs. Additionally, 85.9% provide EC counseling, 87.7% administer the first dose in the emergency department, and 64.7% offer HIV postexposure prophylaxis (PEP). Interestingly, only 67.9% of emergency departments have an EC policy and only 55.3% have a nonoccupational HIV PEP policy. As such, the majority of academic emergency departments are apparently offering EC counseling, EC treatment, and HIV PEP to victims of sexual assault, despite the absence of institutional policies.

Topics: Medical response; treatment; victim services

Barber, M., Jenkins, R., & Jones, C. (2000). A survivor's group for women who have a learning disability. British Journal of Developmental Disabilities, 46, 31-41.

The authors describe a women's group that was conducted for 6 women (aged 20–33 years) with learning disabilities and a history of sexual abuse/assault. The authors then review the format of the group sessions, the therapeutic process, as well as information learned from the evaluation of the impact of the group on variables including the women's self-esteem, psychological well-being, assertiveness, and overall satisfaction with the intervention. The initial outcome was mostly favorable; however, this effect was not maintained for each measure at a 3-month follow-up. The authors discuss possible reasons for the findings and make recommendations for future group work with this population.

Topics: Disabled; survivors; treatment

David, W., Simpson, T. & Cotton, A. (2006). Taking charge: A pilot curriculum of self-defense and personal safety training for female veterans with PTSD because of military sexual trauma. Journal of Interpersonal Violence, 21, 555-565. [Posted October 2006.]

Key Points: Participation in a self-defense/personal safety intervention reduced symptoms of PTSD and depression among female veterans who had experienced sexual assault and sexual trauma in the military.

Abstract: A group of twelve female veterans (average age 48.3 years) in treatment for PTSD at a VA hospital participated in this 12-week, 36-hour pilot treatment program. Each three-hour group session included one hour of psychoeducation and role-play; one hour of physical self-defense training with a male and a female instructor, and one hour of debriefing. Three female psychologists were present throughout each session. Data was collected from ten women: twice before the intervention, immediately after completion, and at three and six months after. Significant changes lasting over time included: being able to better identify risky vs. safe situations; less avoidance of social situations to avoid triggering memories; less hyperarousal; less depression; and increased self-efficacy. A strong bond developed among participants which may have helped all twelve complete the program.

This study was limited by a small sample size of self-selected participants who were carefully screened for psychological and physical stability. Further studies should be done to determine if equally positive results are found in other groups.

Topics: Military; survivors; treatment

Frazier, P., Tashiro, T., Berman, M., Steger, M., & Long, J. (2004). Correlates of levels and patterns of positive life changes following sexual assault. Journal of Consulting and Clinical Psychology, 72, 19-30.

Research suggests that factors such as personal resources, environmental resources, coping strategies, and event appraisals affect the development of positive live changes following a traumatic event. Building on previous work, this study considered features associated with early reporting of positive life change and differential self-report patterns of positive life change over time. The study measured prior victimization and survivor ethnicity (aspects of personal resources); social support (an aspect of environmental resources); approach, avoidant, and religious coping (aspects of coping strategies); and behavioral self-blame, control over the recovery process, and taking precautions to prevent future assaults (aspects of event appraisals). The authors hypothesized that social support, approach coping, perceived control over the recovery process, taking precautions, and being African American would be associated with a greater degree of early positive life change. It was hypothesized that these same variables would also predict a more rapid increase in positive life change over time. Participants (N = 171) were recruited from female sexual assault survivors assisted at one of seven emergency rooms in the Minneapolis/St. Paul area. Respondents completed questionnaires postassault at 2 weeks, 2 months, 6 months, and 12 months. Results provided partial support for the authors’ hypotheses. Participants who reported higher initial levels of social support, approach coping, religious coping, and perceived control over the recovery process also reported higher initial levels of positive life change. Participants who reported increases over time in social support, approach coping, religious coping, perceived control over the recovery process, and taking precautions also reported increases in positive life changes over time. Limitations include a limited list of positive change variables as well as a lack of generalizability to male survivors and non-ER service consumers. Further research is needed to examine the contribution of ethnic differences, religious coping, and various control appraisals.

Topics: Effects; survivors; treatment

Hensley, L. G. (2002). Treatment for survivors of rape: Issues and interventions. Journal of Mental Health Counseling, 24, 331-347.

This article is a review of various issues and interventions related to counseling survivors of rape. It summarizes relevant statistics, discusses four important issues, and details four treatment modalities. The four issues discussed all relate to the experience of the rape survivor, including: 1) how sociocultural factors will influence the survivor's reaction to the rape, 2) the survivor's history of prior victimization, 3) the specific details of the assault against the survivor, and 4) how victim-blaming may affect the survivor's recovery. The treatment modalities detailed are drawn from best practices for the treatment of post-traumatic stress disorder (PTSD). The first modality detailed is psychoeducation, where the counselor provides an education about commonly experienced PTSD symptoms. The second is exposure therapy, where the counselor guides the survivor through multiple re-tellings of the assault. The third modality is Resick and Schnicke's Cognitive Processing Therapy, where the survivor's maladaptive beliefs about the assault are identified and challenged. The final modality described is actually a summary of various anxiety management techniques.

Topics: Effects; risk; treatment

Mahoney, P. (1999). High rape chronicity and low rates of help-seeking among wife rape survivors in a nonclinical sample: Implications for research and practice. Violence Against Women, 5, 993-1016.

The authors analyzed sexual assault chronicity and help-seeking behaviors among 201 survivors (aged 18+ years) of marital (N = 37), acquaintance (N = 109), and stranger sexual assault (N = 55) by utilizing National Crime Victimization Survey data. They found that marital sexual assault survivors were significantly more likely than acquaintance and stranger survivors to experience multiple assaults, with many marital survivors experiencing more than 10 assaults in a 6-month period. The marital group was also less likely to seek medical, police, or agency help. The authors conclude by discussing the implications for research and practice generated by these data.

Topics: Marital rape; survivors; treatment

Marques, J. K. (1999). How to answer the question "Does sexual offender treatment work?" Journal of Interpersonal Violence, 14, 437-451.

This study asserts that although sex offender treatment is an established clinical specialty, evidence regarding its effectiveness has been slow to accumulate. One ongoing treatment outcome study, California's Sex Offender Treatment and Evaluation Project, is used to highlight several problems that are inherent in this type of research, and to illustrate that even well-designed studies make only a limited contribution to the empirical database on treatment effectiveness. The findings from this study are also used to show that the broad question, "Does sex offender treatment work?" needs to be broken down into a number of more specific and useful questions. Given the diversity of clients and programs in this field, outcome data are from a wide range of treatment programs that vary in approach, setting, intensity, and types of offenders treated. Program managers and clinicians are urged to evaluate the impact of their services in order to contribute to our knowledge base on treatment effectiveness.

Topics: Treatment

Marx, B. P., Miranda, R., Jr., & Meyerson, L. A. (1999). Cognitive-behavioral treatment for rapists: Can we do better? Clinical Psychology Review, 19, 875-894.

This article provides an overview of current cognitive-behavioral treatment strategies being used with sexual offenders and addresses the specific reasons why such treatments present limited success. Current strategies emphasize control of deviant sexual arousal, modification of cognitive distortions, skills training, biological treatments, and relapse prevention. Adult rapists differ from other sexual offenders (i.e., child sex offenders) on various dimensions. For example, the behavior of rapists can range from unsolicited verbal behavior to brutal sexual assaults. Other sex offenders usually do not display such variety in behavior. Consequently, the heterogeneity among them needs to be addressed in treatment strategies as well. Physiological, emotional, and cognitive states contribute toward sexually deviant behavior in a complex response pattern and not necessarily as individual causative factors. That kind of approach is too simplistic. Furthermore, the functional differences in the behavior of rapists is rarely examined and should provide a focus for treatment as well. The authors conclude by proposing an idiographic approach to treatment that implements a functional analysis to inform treatment protocol, promotes psychological acceptance, and addresses characterological and interpersonal issues during treatment.

Topics: Perpetration; treatment

Ullman, S.E. (1996). Social reactions, coping strategies, and self-blame attributions in adjustment to sexual assault. Psychology of Women Quarterly, 20, 505-526.

In this paper, the author presents how social reaction to rape disclosure affects sexual assault victims. A mail survey was completed by a convenience sample of adult sexual assault victims (N=155). Information was obtained on sexual assaults and postassault experiences. As expected, all negative social reactions were strongly associated with increased psychological symptoms, while most positive social reactions were unrelated to adjustment. The only social reactions related to better adjustment were being believed and being listened to by others. Victims experiencing negative social reactions reported poorer adjustment even after controlling for other variables known to affect psychological recovery. Avoidance coping mediated the association of negative social reactions with adjustment. The article concludes with a discussion of the implications of these findings for research and treatment of sexual assault survivors.

Topics: Disclosure; treatment

Updated 08/01/07