Obviously no one can tell you how to express yourself and how to reassure a particular survivor. There are certain things to think about and issues to explore for yourself each time you see a rape survivor that can guide you, along with the suggested guidelines as outlined in the particular protocol for the setting in which you are working. It is your personal understanding of these things and your sensitivity in handling each case that prevents secondary trauma.

• Safety – it is vital that the survivor feels safe from further harm. Stating this clearly for a person in shock is vital.
• Restoring control – this extends to her situation, her body and her surroundings or environment.
• Ongoing support – she will recover more quickly if she has good support on a journey that is only just beginning. Don’t let her leave without some idea of the support she will have to start off with.
• Respect – every step in an emergency counselling protocol has been suggested based on respect for the survivor.
• These four things should get you through almost anything a survivor presents you with. But be honest and genuine…

There are a host of common responses to survivors that have been documented that DON”T help even when delivered with the best intentions and it is perhaps wise to know what these are.

• Over solicitous – this means being too eager or anxious to show your concern
• Cold – only interested in the clinical tasks and not the human relationship
• Paternal or maternal – limiting her freedom or responsibility by fatherly or motherly concern or attitude
• Patronising – supporting or encouraging her in a condescending way
• Impersonal – being primarily interested in the case and not the person
• Angry or vengeful towards the perpetrator – expressing feelings that you think the survivor should shareComplimentary – making some kind of judgement about the person

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 setup 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.”

[Reference: Kernberg, O in Judith Herman, Trauma and Recovery (New York: Basic Books, 1992), 160-161.]

Interestingly enough this goes for the counsellor as well. Probing too much emotionally can also be a violation and she is going to have to tell her story to many other people such as the nurse, the doctor and the police. You don’t have to hear it unless she wants to tell you about it.

Another thing to consider in terms of the biases that survivors face in seeking justice and medical care after a rape is how far they differ from the ideal. 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.”

[Reference: Burgess, Ann and Holstrom, Lynda. The Victim of Rape: Institutional Reactions. John Wiley and Sons, New York, 1978.]

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 we would wish. And of course we 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 to know how you would like to be and to work out why you are not like that sometimes. Then you can work at it and help others around you to do so.

Kathleen Dey

Rape Crisis Cape Town

June 2001