Secondary Trauma

The Extended Psychological Event

Rape survivors may turn to a variety of services in their community for assistance such as the police, medical facilities, mental health organisations, courts and religious institutions. The responses of these services can deeply affect the rape survivor’s well-being and influence her ability to recover from the trauma. If they are negative they can increase the level of trauma she experiences and make her recovery even more difficult. Rape survivors are often denied help by their community services and sometimes the help they do receive leaves them feeling doubted, blamed and retraumatised. These negative experiences are called the second rape or secondary trauma or secondary victimisation. In other words, victim’s well-being may be affected not only by the rape but also by the help seeking interactions after the assault. The trauma of rape extends far beyond the actual assault and any helping intervention strategy must address the particular difficulties faced by rape survivors and prevent secondary trauma.

When rape victim’s needs are not met by the very people they turn to for help the effects can be quite devastating. Because traumatic incidents invariably cause damage to relationships, people in the survivor’s world have the power to influence the eventual outcome of the trauma. In the aftermath of rape survivor’s are extremely vulnerable. Their sense of self has been shattered and their faith in the world as a safe place has been destroyed. Rebuilding some form of trust, even if it is minimal, is the primary task of anyone wanting to help a rape survivor.

Secondary victimisation has been defined as “the victim-blaming attitudes, behaviours and practices engaged in by community service providers, which further the rape event resulting in additional trauma for the rape survivors”. But it is not the only cause of extending the trauma for survivors. Secondary trauma stems from three main causes:

  • An acceptance of certain myths and stereotypes about rape leads to personnel treating victims in an insensitive manner
  • Personnel refuse to provide any assistance at all or refuse some form of assistance
  • Even if assistance is offered and even if it is offered in a sensitive manner the procedures themselves are traumatic

If service providers ascribe to myths about rape, such as believing that women often provoke rape by the way they dress or are prone to lie about having been raped as a form of revenge, they may tell the survivors that she is not a credible witness, that her story is not believable or even just give her a sense of being doubted. A rape survivor may have her case dismissed, not taken seriously, might not be referred for a forensic examination or medical treatment, may not be fully informed of the health risks associated with rape and even if they want these services they are denied. And finally when women are offered services the services themselves cause distress: the police statement and counselling services because it causes her to relive the rape experience by retelling it, the forensic examination because it probes and exposes her body in the same way as the rape did even if the motivation is completely different and the court case because it introduces the survivor to an adversarial situation – the battle ground of the court room.

When women go public with stories of rape, they place a great deal of trust in our social systems and in doing so risk disbelief, scorn, shame, humiliation and refusals of help. For men reporting rape the risks are the same and in some instances even greater as men are expected to be able to defend themselves from harm and may even be ridiculed for having been raped. The implications for recovery are very clear – a negative experience leads to a much poorer outcome. Therefore preventing secondary victimisation and trauma must be a key focus in any intervention with rape survivors. Men, women from poorer communities and those raped by someone known to them are at greater risk for secondary victimisation.

Preventing secondary trauma involves the conscious use of the “principles of empowerment”: safety, restored control, respect and ongoing support. If service providers are able to encompass these principles in their work then they go some way towards fulfilling the primary task of rebuilding the trust. An awareness of the damage caused by secondary victimisation lead to the development of a set of minimum standards for service delivery by the Department of Social Development. Rape Crisis has taken these standards and grouped them under the headings of the four principles of empowerment as follows:

Safety:

  • Physical, emotional and mental
  • Reassurance of physical safety from further harm
  • Reassurance about confidentiality
  • Making the victim feel comfortable
  • Explaining upcoming procedures in detail
  • Offering to call a family member or other trusted person

Restoring control:

  • Give information to the victim
  • Receive information from the victim
  • Involve the victim in all decisions that affect him or her
  • Ensure that interventions happen with victim’s informed consent
  • Inform victim of his or her legal rights

Respect:

  • Treat the person with respect for their dignity
  • Affirm their strengths
  • Speak in their own language where possible
  • Listen attentively
  • Adhere to their wishes as far as possible
  • Respect diversity of language, culture, religion, race, sexual orientation and gender

Ongoing support:

  • Treat the person in a caring manner
  • Offer access to available resources
  • Offer emotional support to victims
  • Offer practical support to victims
  • Involve family members or other trusted person in supporting the victim
  • Refer victims to other relevant services for further assistance
  • Accompany victim in stressful situations

Using these principles and applying them consciously involves service providers in becoming aware of their own biases and moral judgements. One of the simplest and most direct ways of doing this is to consider how far from the “ideal” most rape cases are from a legal perspective. The following is a description of “the perfect case” for the system, one that allows everyone’s job to be a lot easier than it may otherwise be:

“… the perfect case would be one in which all the information checks out, there are police witnesses to the crime, the victim can provide a good description of the assailant, there is supporting medical evidence including sperm and injuries, the story remains completely consistent and unchanging, the victim was forced to accompany the assailant, was previously minding her own business, a virgin, sober, stable emotionally, upset by the rape, did not know the assailant who has a prison record and a long list of current charges against him.”

Of course there are few, if any, survivors that meet these requirements completely and so each survivor represents hard work for the team. And if the team is tired or overworked or operating under stress they may not be as sensitive to the survivor’s needs as they would wish. And of course they are all subject to believing the myths about rape at some point or other even though we know they are not true. It takes a lot of thought and care and self-awareness to be completely unbiased and sensitive to every survivor, so it is important for service providers to know how they would like to be and to work out why they are not like that sometimes. Then they can work at it and help others around them to do so.

When it comes to the medical examination in particular, the intervention itself is traumatic anyway and so it is doubly important for service providers to be acutely aware of the potential for further harm to the survivor. The following quote by an emergency-room physician describes the essentials:

“The most important thing in medically examining someone who has been sexually assaulted is not to re-rape the victim. A cardinal rule of medicine is: Above all do no harm…and rape victims often experience an intense feeling of helplessness and loss of control. If you just look schematically at what a doctor does to the victim very shortly after the assault with a minimal degree of very passive consent: A stranger makes a very quick intimate contact and inserts an instrument into the vagina with very little control, or decision-making on the part of the victim; that is a symbolic set up of a psychological re-rape.”

“So when I do an examination I spend a lot of time preparing the victim; every step along the way I try to give back control to the victim. I might say, ‘We would like to do this and how we do it is your decision,’ and provide a large amount of information, much of which I am sure is never processed; but it still comes across as concern on our part. I try to make the victim an active participant to the fullest extent possible.”

Based on research findings, three further prevention approaches are recommended:

  • Increased involvement of rape crisis centres
  • Specialised training for all service providers
  • Development of multidisciplinary teams in systems offering integrated care to survivors

and Rape Crisis Cape Town would add two more:

  • Increased use of specially trained community based volunteers in victim support
  • Increased supervision and support to service providers

Rape crisis centres services are under utilised by survivors even though they are consistently effective in assisting victims to negotiate their pathway through the Criminal Justice System, in offering crisis intervention and advocacy services. Many rape survivors don’t know about these services and how they help survivors. Service providers need to refer rape survivors and inform them about local rape crisis centres. State service providers don’t usually get thorough and comprehensive training in issues of violence against women and victim support in their academic education and so must ensure that they are exposed to this at a later stage in order to gain an understanding of the issues and to learn the appropriate skills. Also rape care centres that bring together police, doctors, nurses, victim support volunteers, social workers and prosecutors to work as an integrated team assisting rape survivors are some of the most helpful services to rape survivors and avoid the stress associated with traveling from one service to the next and facing a different environment and attitude towards care every time they do so.

Community based victim support volunteers are also an important component of service provision for rape survivors. This model, where community members form a community-based organisation that organise the volunteers through recruitment, training, support and rosters, is exceptionally attractive. It seems to offer a solution to the challenge of preventing secondary trauma by offering support to victims as a parallel process alongside direct service provision by members of the Criminal Justice System. Volunteers offering practical and emotional support based at police stations, schools and hospitals also strengthen the community with tools, capacity and support that empowers the community against the tide of violence. They are perfectly positioned to restore some of the trust that has been damaged through violence. In the South African context community members do not always easily access professionals when they are needed most. They usually work during office hours, weekdays only and only counsel from their offices, which might be far from where the victim is. Within this context community volunteers are wonderful because they are able to bridge this gap. If correctly managed and well supported, they take a lot of the burden off service providers too, allowing personnel to perform their jobs knowing that the rape survivors is getting maximum support.

One last thing that makes service providers reluctant to engage with victims on an emotional level (which is often required if secondary trauma is to be prevented) is that they themselves do not get adequate support and supervision within their settings and therefore fall prey to vicarious trauma – in other words because they are not supported they begin to take on and experience some of the feelings experienced by the victims they treat. Small wonder that they attempt to distance themselves from victims and adopt the victim-blaming attitudes that allow them to remain removed.

Of course secondary trauma cannot always be prevented. It is for this reason that counsellors and others service providers helping a survivor some time after the rape must treat the process of going through the CJS as part of the trauma and not leave it out of the healing process.

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