The first goal of counselling must focus on the establishment of safety. The alliance between counsellor and survivor is formed initially around the common goal of ensuring a reasonable degree of safety and no other work should be attempted until this has been achieved. However, in this area there is much to be done and no shortage of tasks for both counsellor and survivor to perform. Safety needs to be achieved around a list of different areas in the person’s life as follows:

• Physical safety from further harm by the perpetrator
• Regular healthy patterns of eating, sleeping and exercise
• Freedom from self destructive behaviours
• Freedom from the symptoms of Rape Trauma Syndrome
• A safe home to live in
• Adequate work and money
• Self protection within the community

For survivors of long-term abuse and childhood sexual abuse this phase may take a long time because self-care and being able to comfort themselves are not patterns ever fully established in the development of abused children. Developmental problems take years of time and professional intervention to resolve, hence Rape Crisis does not take on clients such as these. We do however facilitate our clients’ access to the resources they do need that can help them and a counsellor would see a client until referral is successful, thus fulfilling the goal of the initial stage in part before handing it over to a more appropriate person. The concept of a facilitated referral is more useful than simply passing the client on to another service and leaving it at that.

Survivors from poverty stricken and oppressed communities will also need much time and support to work through this phase as their survival needs will not be easy to encompass and they may be forced to live in violent homes and communities. Rape Crisis has made a concerted effort to link itself with organisations and resources aimed at poverty alleviation and community development but counsellors are also called upon to be creative and innovative in supporting clients towards safety. A client cannot attempt to recover from rape until she can be sure of food on the table and a sheltered place to sleep.

There are as many strategies for support as there are areas needing safety and these must all be mobilised where needed. Some examples are as follows:

• Information and literature on rape and on trauma and its symptoms
• Information on how to recover from trauma
• Psychiatric medication for regulating sleep, depression and anxiety
• Hard exercise to manage stress
• Daily logs to chart reactions and emotions
• Homework tasks to help manage these
• Concrete safety plans
• Gradually forming reliable relationships for support
• Visualisation, breathing exercises and meditation
• Self help programs
• Social agencies
• Admission to various kinds of hospital programs (day treatment, in patient, emergency psychiatric services)

Details of all these strategies will be available for counsellors in the counselling offices and the office teams and supervision groups are available to discuss other ideas and for problem solving. For instance a really fragile client who may experience her toughest times when she can’t sleep in the early hours of the morning could be given numbers for the 24 hour counselling services available and be encouraged to use them.

Stage Two: Remembrance and Mourning

Once safety on all levels has been accomplished the focus of the work shifts to an active, in-depth exploration of the traumatic experiences. This work is vital to the recovery process and failure to address it a common error in the treatment of survivors but at the same time addressing it in a premature or over zealous way could be equally seen as a failure. A careful review with the client should precede the decision to begin active uncovering work and she should give her full permission before moving on. It should not proceed unless the tasks of establishing safety have been thoroughly covered. Her timing and her pace are the deciding factors that counsellors should follow and support and by this time the alliance between counsellor and survivor should be strong enough to go ahead with. She must be ready to tell the story of her trauma and to tell it completely, in depth and in detail.

The basic principles of empowerment continue to apply throughout this process. The choice to confront the horrors of the past rests with the survivor. The counsellor plays the role of witness and companion. Both must be brave and feel secure in their differing roles in order to be able to do this. Freud describes this kind of uncovering well:

“The patient must find the courage to direct [her] attention to the phenomena of her illness. Her illness must no longer seem to her contemptible but must become an enemy worthy of her mettle, a piece of her personality, which has solid ground for its existence, and out of which things of value for her future life have to be derived. The way is thus paved…for a reconciliation with the repressed material which is coming to expression in her symptoms, while at the same time place is found for a certain tolerance for the state of being ill.”

Reference:
Sigmund Freud, Remembering, Repeating and Working Through, 1914 in Standard Edition, Vol. 12, trans J. Strachey, Hogarth Press, London, 1958.

In this respect the illness he is speaking of can quite simply be seen as the symptoms of Rape Trauma Syndrome (bearing in mind that Feminist theory does not regard this as an illness as such but rather as an injury.) A rape survivor can come to see the symptoms of RTS as being the expression of the trauma she suffered while at the same time, having gone through the process of establishing safety, is able to tolerate them to some degree.

The purpose of this part of the process is not a sudden catharsis, or sudden release of emotion by association with the trauma that is its cause but rather a slow and careful exploration of memories, thoughts and feelings as the client is able to cope with them. Thus she integrates the trauma into herself and is therefore free to reconnect with herself and others. She remembers what happened, what she thought about at the time and how she felt but is not called upon to relive them all at once; this is a mastery experience rather than a re-enactment or debriefing. The counsellor may even be called upon to slow a client down if she becomes flooded with memories and emotions.

Before the telling of the story the survivor should be encouraged to tell the counsellor something of her life before the rape so that she can own the person she was before it happened and begin to restore the flow of her life. She should be encouraged to talk about her important relationships, her dreams and ideals and her previous struggles and conflicts. Then she is asked to put the story into words, initially simply as a statement of the facts in detail and in the order in which they occurred. If she skips forward she needs to brought back, if she goes off on a tangent or rambles she needs to be refocused and bit by bit taken through the event right through to completion. At each point the counsellor needs to also ask the client what she was thinking at the time and what was going through her mind and what emotions she felt, what physical sensations she had and really to give as much detail to the description of her inner experiences as to that of the outer events.

If her symptoms worsen dramatically then that is taken as a signal to slow down or backtrack. She must however know that the process could be painful and that she’ll feel vulnerable at this time and might not be at her best at work, at home and in relationships. She needs to be able to draw on the support created in the initial phases of safety and learn to tolerate some increase in the intensity of her symptoms. She should also be sustained by the hope of new meaning in her life through integrating the trauma, or bringing all the parts of herself, both the traumatised and “healthy” aspects of who she is, into a whole.

In recounting the thus far unspeakable story she may come up against unanswerable questions like why this happened or why it had to happen to her. Both client and counsellor must be prepared for the uncertainty of knowing there may not be answers. Evil is meaningless and empty and completely arbitrary in who it finds; no human explanation is possible and no victim deserving. Both have to face the possibility of these bleak conclusions and in doing so have their faith and beliefs challenged. To accept this is to allow for the trauma to be transformed. If not the survivor might push for a premature closure of the story based on the facts alone in an attempt to avoid the emotional aspects that lead to feelings of conflict and uncertainty; and in so doing leave out what is essential to the healing.

What happens is that the abnormal processing of the trauma is changed as it is processed or worked through in this gentle but deep and systematic way. The telling of it in the right order and with all the rich detail of feelings and sensations brings relief. But this is still not the end. Now she has to feel the grief at her losses and mourn them. Ironically this, the most relieving part of the process, is the one most survivors dread the most, fearing they will not cope with the overwhelming emotions. Some also feel mourning is a sign of defeat, showing that the perpetrator has won in some way. For these reasons it is important for counsellors to reframe grieving as an act of release and courage rather than of being overwhelmed and humiliated. Only by grieving can she reconnect with the part of her that is indestructible.

But many clients resist this part because it is so difficult and this can lead to stagnation, the most common problem with this phase of treatment. Resistance also wears many disguises: most frequently it appears as a fantasy of magical resolution through revenge, forgiveness or compensation. Counsellors must make sure they don’t collude with their clients’ fantasies or they will remain stagnating and frustrated by the lack of therapeutic progress. The counsellor must be aware of the potential for resistance and be able to work through this.

In revenge the roles of victim and perpetrator are reversed and the survivor imagines this will rid her of the feelings of shame and helplessness – feelings all exacerbated by the remembering process – and immediately restore her sense of power. But images of revenge can be just as traumatic as those of the event itself and can also be frustrating since revenge can never change what happened. In grieving she can vent her feelings of helpless fury and transform them into the healthier and more satisfying ones of righteous indignation.

The fantasy of forgiveness is also a search for empowerment and an attempt to exorcise the trauma but through love rather than hate. Such forgiveness is out of reach for most ordinary humans – most spiritual traditions agree that forgiveness and retribution are both divine. And even divine forgiveness requires the perpetrator seek it and offer confession, repentance and atonement. For human beings healing is not about exorcism it is about adaptation and integration and the rediscovering of restorative love in her own life before ever she can consider extending it to the perpetrator. She will find this through grieving not through forgiveness.

The fantasy of compensation is one of the most difficult of the resistances to mourning to overcome because the legitimacy of the survivors desire for it in the face of the injustice she endured is completely understandable. She feels entitled to compensation and her quest to achieve it can be an important part of the full healing journey. However by tying her fate to that of the perpetrator she does not liberate herself from his influence but holds her recovery hostage to the miracle of his acknowledging what he did and offering public apology or humiliating punishment. She might wait years for this wish to come true but by grieving she liberates herself to seek justice through the more formal social channels and gives herself a greater chance of enduring its rigours.

Risks for the survivor in grieving are that in facing despair she will succumb to depression and confront thoughts of suicide. She feels it impossible to live in a world where such cruelty exists. She wants to escape from her misery and has lost all faith in love. It’s important here to keep her in touch with her capacity to love no matter how small and insignificant it may seem. Visualisation and soothing imagery are also useful here and usually the suicidal feelings and depression pass – they are part of a necessary transition. For many survivors the time passes slowly and seems endless and they ask how long it must go on. It cannot be hurried nor can it be by-passed and there is no strait answer to the question but this.

Stage Three: Reconnecting

The third stage of recovery involves the active pursuit of social reconnection. In the process of establishing mutual, non-exploitive peer relationships the survivor will often reassess and renegotiate long-standing relationships with friends, lovers and family. Issues of boundaries may be explicitly addressed for the first time. She may wish to disclose the rape for the first time to people close to her who didn’t know it happened. A new level of transformation of the trauma takes place and new meaning is created. Having come to terms with the past the survivor now needs to create a new future.

If there is one thing that exemplifies this part of the process it is the survivor’s learning to know and rely upon herself. She no longer feels possessed by the trauma; she possesses it as a part of herself. She can now look at, decide and become the person that she wants to be. She discovers the parts of herself that she most values, from the time before the trauma, from the trauma itself and from the process of her recovery. She can take up old and new hopes and dreams. It takes courage; she may fear failure and disappointment, she must move beyond the limited stance of “victim” and learn to thrive. She must dare to define her ideal self and take up its challenge.

At the same time as embarking on this adventure her life becomes more ordinary as she lets go of her symptoms. She sleeps and eats well, can function at home and in her job, she feels calmer within herself and gets on with others in the daily rhythms of her existence. The peaceful, even boring, norms of daily living may be scary at first and even a little strange as she waits for something to come along and disrupt it all again. Helping her believe in the wonder of ordinariness is part of the counsellor’s role at this time. She may need affirmation from her counsellor or have herself discovered positive aspects that the trauma showed her about herself but respect for her strengths is a very crucial thing for her counsellor to offer at this time. Help her to celebrate her survival and more, her ability to move on.

Learning to fight is another aspect of this phase, where clients learn to take back their power. Sometimes this is a conscious choice to face danger that could express itself in doing something like a self-defence course or taking up martial arts training. It could also be a renewed determination to bring the perpetrator to justice and to take up the challenge of seeing the pathway through the Criminal Justice System to a close. Some survivors may look at characteristic ways of handling situations and question their own submissiveness or passivity. As a result of this they might look for more assertive ways of handling situations and actively learn how to be more assertive. Some may challenge women’s traditional roles in society and change their more stereotypically feminine attitudes. Provided she fully realises the perpetrator’s responsibility for the crime committed against her then she should be free to explore aspects of being that render her more vulnerable to exploitation but not until she can locate the blame for what happened to her with the rapist.

She has also regained her capacity to trust in others and in the safety of her life. She can once again take initiative in friendships and other relationships. She can maintain her own point of view and boundaries, she does not drown in the emotions of other people or feel overwhelmed by her own; she can even risk deepening relationships. She can also focus on issues of identity and intimacy even though she might feel awkward and self-conscious. She can become ready to explore sexual intimacy and the process of arousal and orgasm without being bombarded by associations with the rape. However reclaiming ones own capacity for sexual pleasure is a deeply complex process and will have to have its own built in safety mechanisms to help the survivor feel completely in control at first before she allows herself to abandon control in favour of pleasure and connectedness. Some clients will need help with this and to be given access to resources other than those the counsellor can offer such as self help sex manuals and guidelines for exploring sexual intimacy in a safe way with a partner.

Most importantly, if the survivor does not take up these challenges it is not for the counsellor to take responsibility for her life. The old saying “You can take a horse to water but you cannot make it drink” holds true here. No matter how thirsty you might think a survivor is to renew her connections to her life and a hopeful future if she is not going to do it for herself then no one is and counsellors just exhaust themselves in trying. Both counsellors and clients also have to realise that resolution of the trauma is never final; recovery is never complete. The impact of the rape continues to echo through the years, especially when there are other stresses and life crises to face. Marriage, divorce, birth and death will all hold the potential to reawaken traumatic symptoms. They must be reassured that the door to counselling remains open for them to re-enter as needs arise. Provided she can return her attention to the tasks of ordinary life rather than of survival and recovery. She has told her story and can move on.

Recovery Criteria

So how do we know that the survivor has recovered? Mary Harvey at Cambridge Hospital’s Victims of Violence program has developed seven domains through which to determine recovery as follows:

Memory

The survivor can choose to recall or not to recall the trauma. There are no gaps in memory and the survivor has a clear and coherent story or picture of what happened that can be integrated into their life story as a whole.

Affect range and tolerance

Feelings and emotions are not experienced only in extremes but can be felt, named and endured in a broad range of types and intensities.

Memory and affect are linked

Memories are recalled together with appropriate feelings and at an appropriate level. The survivor can have feelings in the present about what happened in the past and can remember what she felt at the time of the trauma without reliving the emotion itself.

Symptom mastery

Symptoms of Rape Trauma Syndrome have receded or become manageable.

Self-esteem

Feelings of self hate, blame, badness and shame are replaced by more realistic views of the self. Responsibility for the abuse is placed firmly with the perpetrator, the survivor can accept what they did to survive and is able to care for herself again.

Attachment

Feelings of isolation are replaced by a capacity to feel connected to others and distorted perceptions of others become more realistic.

Meaning

The survivor is able to create realistic meaning to the trauma, to acknowledge complex and contradictory views about reality and is able to feel a realistic sense of hope and optimism about the future.

During each of the three stages of recovery in counselling each of the seven dimensions or domains must be considered in a kind of matrix. In this way the question how far along the road to recovery is this client can be answered and appropriate counselling offered. So someone who, for example, experiences important gaps in memory but instead experiences a lot of nightmares, bodily states or intense emotions unrelated to current events and who cannot understand the relationship between the gaps and the symptoms would be in Stage One of recovery. The person who begins to see the relationship and to deliberately fill in the gaps while the symptoms consequently decrease would be in Stage Two while the person who fully understands the relationship and has filled in all the gaps and now seeks to remember who she was before the trauma and to knit the memories together in their proper places is in stage three. This step by step meticulous process takes time and energy and both counsellors and clients need a great deal of support during it.

This model has value in matching a particular client to a particular focus in counselling and is therefore a valuable screening tool. It also provides a foundation from which to develop different types of interventions finely tuned to the recovering survivor’s changing needs.

The Victims of Violence program is currently taking up the challenge of filling in the blocks and systematically describing the difference in each dimension for each stage. It’s quite good for us that they haven’t done so because it gives us the freedom to explore and do so in a way that is meaningful to us in our own context. This is a process that perhaps not many counsellors will embrace but those that do will find it fascinating and useful to their clients.