After a sexual assault, most survivors are psychologically affected. Larraine Lynch, Clinical Manager for The King County Sexual Assault Resource Center (KCSARC), explained common reactions to trauma include reliving the assault, avoiding thoughts, feelings and situations that remind the survivor of the assault, and hypervigilance. “Each survivor’s reaction to their assault is unique and may include some or all of the symptoms with varying severity,” said Lynch.
KCSARC offers a wide range of services and resources to fulfill their purpose of “[alleviating], as much as possible, the trauma of sexual assault for victims and their families.” In 2017 KCSARC served 197 Auburn residents.
Common Reactions Following Trauma
Most commonly survivors experience the intrusion of being unable to escape thoughts and memories of the assault. This invasion of the survivor’s thoughts often continues in the form of dreams and nightmares. Some survivors may experience emotionally distressing flashbacks to their assault. These flashbacks commonly are accompanied by physiological symptoms such as stomach pain, headaches, muscle tension, rapid heart rate, chest pain, and nausea.
Often a survivor may feel negative beliefs about themselves. Self-blame is extremely common, with survivors thinking there is something wrong with them and that they did something to bring on their assault. Believing the world is not safe, survivors frequently develop a lack of trust in others and themselves, and have difficulty opening up to another person.
Smells, songs, places and even people can hold new meaning and have negative associations to a survivor after the violation of being sexually assaulted. Often survivors participate in avoidant behavior to escape these intrusive reminders. It is also common that a survivor will not want to talk about their sexual assault. This avoidance can lead to isolation and a worsening of psychological symptoms.
A survivor’s avoidance can also manifest in the way of disassociation. Dissociation is the mental mechanism by which one withdraws attention from the outside world and focuses on the inner world. Dissociation is not always a flight or fight response to threat or trauma. It is often a common coping mechanism used for excessive boredom or another purpose. For example, meditation, daydreaming, and highway hypnosis are all mild forms of
94% of women who are raped experience symptoms of PTSD during the two weeks following the rape
It is common for a survivor of sexual assault to become hypervigilant and on-edge after their assault. Survivors frequently have a compulsive need to familiarize themselves with their surroundings to ensure their safety, continually waiting for – or fearful of – the next assault. This state of hyperarousal prevents the survivor from being able to relax, fall asleep or stay asleep. With less sleep and energy diverted to scanning for danger, individuals can experience heightened irritability and angry outbursts. This hypervigilant state also makes it difficult to concentrate.
Physiologically speaking, psychological trauma responses present in a variety of ways. Headaches, nausea, insomnia, rapid heartbeat, labored breathing and fatigue are typical. Failure to engage in healthy eating, exercise, and proper hygiene are also commonly seen in survivors. The stress of trauma can also exacerbate on-going medical issues. Some survivors turn to smoking, alcohol, and drugs – at times in excess – for solace.
Receiving Relief Through Therapy
Many of the survivors who utilize KCSARC’s services begin by contacting its 24-hour Resource Line. Specially trained counselors staff the resource line. This resource line is not just for survivors, but according to the KCSARC website is a “vital resource for victims, their families, and friends, or anyone who is concerned about sexual assault or child abuse and safety in their community.”
KCSARC offers therapy for children, teens, and adults. Therapy services begin with a comprehensive trauma assessment, which includes a “best-practice model for assessing trauma.” This format allows the therapist to determine the unique treatment needs of the survivor. A survivor may have individual requests, such a preference of the gender of their therapist. These needs are respected and met to ensure the most successful outcome of treatment for the survivor.
Lynch shared that in the comprehensive assessment the therapist spends quite a bit of time hearing the survivor’s story. The clinician also reviews the survivor’s trauma history and symptoms. If the survivor is a child, the clinician will first meet with the parent/guardian and will meet with the child second.
At the end of the assessment, the therapist reviews the results with the survivor. The therapist makes treatment recommendations which the therapist and survivor use to determine a treatment tailored to the survivor’s treatment needs. Time is taken to discuss post-trauma symptoms and to normalize how the survivor is reacting to their assault. Many survivors express feeling crazy as they continue to struggle after their assault.
Lynch explained that KCSARC utilizes evidence-based models of therapeutic treatment when working with survivors. For children and adolescents, Trauma-Focused Cognitive Behavioral Therapy and Prolonged Exposure Therapy for Adolescents are the most common models used. There are several best practice treatment options for adult sexual assault survivors, including Prolonged Exposure Therapy and Cognitive Processing Therapy.
According to KCSARC’s website, “because treatment is a focused and structured intervention, most clients complete therapy in an average of 16-20 sessions. Some individuals participate in fewer sessions; some may participate in more. Treatment is flexible and individualized based on client’s needs.”
When working with a survivor trauma intervention is very focused. Lynch explained that allowing for avoidance prolongs trauma symptoms. Weekly focus on the survivor’s trauma works to reduce these symptoms in a very gradual way. This method enables the survivor to face memories, feelings, and fears they have been trying to avoid.
Throughout therapy, the therapist works with the survivor in diminishing their self-blame. The therapist will walk through the pre-conditions to offending, helping the survivor to understand that the offender had to be motivated to commit the assault. The therapist works with the survivor to realize that the offender had to think that what they did was ok and that they had or created an opportunity to assault (i.e., driving home from the bar, being isolated at a party, babysitting, etc.). With both the motivation and the means, the offender then makes the abuse happen – through bribing with candy, threatening or drugging.
13.3% of college women indicate that they have been forced to have sex in a dating situation
“New learning occurs as survivors approach trauma-related fears, shifting unhelpful and inaccurate beliefs that have contributed to self-blame, mistrust in others or feeling unsafe in the world. Discussing offender behavior, including preconditions to offending, can help to shift self-blame. As survivors begin to understand that an offender had to have the motivation to offend, had to distort their thinking to justify their offending behavior, had to create opportunities to be alone with the victim and then work to manipulate, groom and/or coerce the victim to make the abuse happen, self-blame begins to unravel as survivors continue their therapy,” said Lynch.
Secondary Victims of Sexual Assault
Sexual assault may dramatically impact the survivor’s loved ones, creating secondary victims. Just as a survivor, they too can’t stop thinking about the assault, replaying the fact that their loved one was assaulted. Loved ones may experience avoidance or get upset when the assault is disclosed or discussed. They may be reeling and in shock, not knowing how to support their loved one. Though not the fault of the survivor, these reactions and symptoms can weigh heavily on them; causing further psychological symptoms to work through.
Loved ones must also learn to adjust to the needs and new behaviors of a survivor. A survivor may experience sexual anorexia or trauma responses during healthy sexual relations. This can be difficult for current and future partners. The survivor may be the primary bread-winner and may no longer be able to work or work as much. Parents of abused children may experience a separation within the family, causing both a financial and housing crisis.
To help alleviate some of the emotional chaos loved ones feel after a survivor’s assault, KCSARC has a Family Services Department. According to KCSARC’s website this department, “offers a variety of educational programs for non-offending parents, family members, and caregivers. These programs are provided in a one-on-one format, rather than a classroom setting, so that [KCSARC] can provide information that is relative to the particular family’s situation.”
Parent support specialists in KCSARC’s Family Services Department talk with parents and partners about common reactions to trauma and how to support their loved one after abuse. Parents and caregivers are an integral part of child’s healing, and they learn skills to help coach their children and teens during times of stress.
Breaking Through to the Other Side of Trauma
As survivors begin to approach the world and live the life they want to, they begin to experience opportunities to trust in others and the world again. When a survivor and therapist agree the work in therapy is complete, a continuing care plan is created. This collaborative plan is developed by reflecting on the tremendous work the survivor accomplished and documenting the insights and strategies they found helpful. “We want clients to leave with the plan, what they’ve learned in therapy and knowing that they can put it into place,” said Lynch.
Therapy ends with individual graduation for the survivor. This ceremony honors and acknowledges the challenging work they have done in therapy. Some survivors invite friends and family, celebrating with cupcakes and coffee. Lynch shared that “for a lot of them they are feeling better than they have in a really long time.”
According to Lynch, often when a survivor finishes working with KCSARC, they leave wanting to take a break from therapy and are encouraged to do things they have wanted to but had been unable. Lynch described working with survivors as “very hopeful work. You get to see survivors doing and feeling better. Symptoms fade and free up more energy. Survivors show up in ways they’ve wanted to. They begin doing more with friends, or sign-up for school, or go out for jobs they’ve wanted.”
If a survivor experiences the return of trauma symptoms, they can always return to KCSARC. Booster sessions are available for survivors who have completed therapy work. Returning for additional sessions does not mean that the therapy did not work. A life stressor may have occurred that agitated some anxiety or depression. The return of symptoms may also suggest that the meaning of the trauma has changed for the survivor. For example, a child survivor may return when they are a teenager. It is vital that a survivor never thinks that they failed at therapy because stress has activated some symptoms. Instead, it’s important to remember that they have been able to reduce their symptoms effectively in the past.
One in four victims of sexual assault under the age of twelve is a boy
When asked if sexual assault reporting has increased recently, Lynch expressed that she felt it was likely that awareness was raised rather than reporting. Male survivor reporting, however, has risen in her time with KCSARC, with more males seeking KCSARC services in the last three to five years. According to Lynch, “we often see more male clients after it is talked about in the media or sports – so after [Jerry Sandusky], or after our fundraising breakfast.”
Avoiding Secondary Trauma
A crucial part of working with survivors is avoiding secondary trauma. KCSARC staff has one-hour meetings scheduled with their supervisors each week to help prevent this. An open-door policy is also maintained to allow team members to debrief as needed. KCSARC also works with outside consultants, having staff meet with outside counselors each month. Lynch shared that “KCSARC is very committed to training. When you feel competent in what you are doing, it helps you.” She went on to say that “KCSARC’s staff all share the common mission to serve survivors and that common goal brings us together.”
Healthy boundaries with survivors are also essential, explained Lynch. “Without healthy professional boundaries, you won’t be able to be in the profession long. However, as helping professionals, we all have soft spots. Certain stories may sit with us differently – that’s when we will talk with supervisors. We want to help but know it is outside of the scope of our work. I put on my social worker hat and build a team around the survivor as I cannot be that support.”
Survivors of sexual assault struggling with psychological symptoms shouldn’t consider their trauma a life sentence. Lynch explained that while psychological symptoms “may show up more as anxiety, depression or PTSD; the good news is that there are treatments that are proven to be effective in treating each of these. Individuals who participate in trauma treatment commonly no longer experience trauma specific symptoms.”
KCSARC’s trained advocates are available to provide crisis intervention, information, and referrals, and on-going support 24 hours a day, seven days a week through their 24-Hour Resource Line at 888-99-VOICE (888-998-6423). Calling the resource line is confidential.
KCSARC first opened in 1976 as King County Rape Relief, serving only adult survivors of sexual assault. KCRR dissolved in 1999, and KCSARC took over providing invaluable resources to survivors in the Puget Sound region. Over its 42-year history, KCSARC has had a profound impact on the advocacy and increased awareness of sexual assault. Read more about KCSARC’s history on their website.
Larraine Lynch received a Bachelor of Arts in Sociology from the University of British Columbia, a Bachelor of Social Work from the University of Victoria and a Master of Social Work from the University of Washington. She is a Licensed Independent Clinical Social Worker and Certified Sex Offender Treatment Provider in the State of Washington. She is also a Child Mental Health Specialist. Larraine is a professional member of the American Professional Society on the Abuse of Children, the National Association of Social Workers, the International Society for Traumatic Stress Studies and the Association for the Treatment of Sexual Abusers. Lynch joined KCSARC in 2007 and serves as KCSARC’s Clinical Manager, providing oversight and clinical supervision for KCSARC’s team of trauma-specific therapists.