Final Thoughts on Best Practices

Throughout the book, the authors have argued that it is important to use a contextual model to consider all of the factors that influence how survivors conceptualize what happened to them, whether or not they disclose the incident to others, and how others respond to their disclosures. It is also imperative that professionals understand how these factors may serve as barriers to survivors seeking and receiving high-quality and affirming services. In light of this, in this chapter, the authors offer more general recommendations for ways formal sources of support can improve their service delivery when working with sexual assault survivors. Overall, there have been recent gains and improvements within the disciplines that serve sexual assault survivors, as well as within society as a whole. Despite this progress, there is still more work to do.

Psychotherapy with Sexual Assault Survivors

Sexual assault is associated with an increased risk of a wide range of mental health problems; therefore, treatment should be targeted to address the client’s primary presenting concerns. In this chapter, specific recommendations are provided for using psychotherapy to treat survivors of sexual assault. In particular, suggestions are given for using exposure-based treatments and cognitive-based treatments with these clients. These recommendations focus on how to increase disclosure of details of the assault and to address negative reactions that clients may have received from other disclosure recipients. Furthermore, suggestions are offered related to the terminology and language used during these discussions in treatment.

Case Example 1

Addressing disclosures of sexual assault in an empathic manner while being efficient with time is a crucial assessment skill for clinicians to develop. This chapter provides a case example of an intake evaluation with a survivor of sexual assault. The authors provide recommendations for handling discrepancies in reporting across measures, limiting the level of detail obtained during an assessment, using the client’s language to describe the experience, discussing social reactions to disclosures, and presenting case conceptualizations that link the client’s sexual assault to their current mental health symptoms. The importance of these recommendations is discussed along with the case example.

Scope of the Issue

The worldwide frequency of sexual assault and the associated psychosocial difficulties have led to sexual violence being deemed a serious public health issue. There is a growing understanding in the field that survivors’ outcomes following sexual assault follow unique trajectories and professionals need to conduct thorough, unbiased assessment to adequately capture survivors’ presenting problems and their person-specific contributing factors. Although survivors are increasingly disclosing their victimization, they still experience obstacles to reporting victimization and receiving services. For example, many survivors report that formal sources of support are unhelpful or even potentially harmful. With the goal of increasing access to affirming and supportive services, the remaining chapters of this book highlight many of the common issues that emerge when working with sexual assault survivors and cover best practices for receiving disclosures of sexual assault.

Special Considerations for Various Populations

While the recommendations provided throughout the book are meant to help clinicians work with survivors of sexual assault of various ages and backgrounds, working with some populations requires additional considerations. This chapter provides additional recommendations for working with survivors of sexual assault from various specific populations. In particular, recommendations are given for working with child and adolescent survivors; adult survivors of childhood sexual abuse; male survivors; survivors who identify as gender and sexual minorities; survivors who are Black, indigenous, and people of color; and survivors who are serving or have served in the military. Suggestions are also provided for clinicians who work in educational settings and those who provide group therapy.

Case Example 3

Exposure therapy is one of the treatment strategies identified as being effective in treating posttraumatic stress disorder. However, conducting exposure therapy with a survivor of sexual assault requires clinicians to be skilled in how to conduct imaginal exposure to ensure that the survivor includes sufficient detail for the exposure to be effective. This chapter contains a case example in which a clinician works with a client to begin imaginal exposure therapy for posttraumatic stress disorder secondary to a sexual assault. This chapter provides recommendations to help clinicians elicit more details about the sexual assault and encourage the client to use sexual terminology while recounting their memory of the traumatic event.

Assessing Sexual Assault and Reacting to Client Disclosures During Assessment

In mental health settings, not all survivors of sexual assault will present due to concerns related to their sexual assault, and even among those who do, some may not disclose this history without prompting. Given the prevalence of sexual abuse and sexual assault, all clients should be screened for a history of exposure to these experiences. A wide range of self-report and interview measures are available for this purpose; a brief overview of measures available for both child and adult populations is provided. In this chapter, considerations for choosing assessment measures are discussed to help providers select appropriate measures to use in their clinical practice. In particular, this chapter provides information about how language in assessment measures may affect disclosure from clients. Finally, this chapter provides recommendations for reacting to client disclosures during an assessment.

Labels and Language Related to Sexual Assault

Professionals need to critically consider the language they use when working with survivors of sexual assault because it can convey they are empathic helpers or, conversely, may inadvertently alienate survivors. This chapter discusses the inconsistencies in definitions within the literature, the importance of clarifying how others use terms, the significance of particular words (e.g., survivor vs. victim), the role of the survivor’s conceptualization of the incident(s), and the influence of sociocultural factors on our understanding of sexual violence. Professionals need to recognize that people’s knowledge and use of particular words and definitions will vary widely and that beliefs engrained in our society (e.g., gender roles, masculinity) create barriers to care for many survivors. Ultimately, intentional work focused on the language that professionals use is fundamental to providing survivor-centered support because it serves as an indicator of nonjudgmental and affirming services.

The Role of Reactions to Disclosure in Mental Health Among Survivors of Sexual Assault

Although services and support have the potential to be helpful, a survivor’s trajectory toward recovery is contingent on the social reactions they receive. Given that fear of negative social reactions is the primary reason that sexual assault survivors delay disclosing or fail to disclose their victimization to others, we review numerous correlates of when and why survivors disclose their assault, typical social reactions survivors receive, the psychosocial impact of social reactions on survivors, and recommendations for ways providers can provide services that are more survivor-centered. Because nondisclosure limits the resources, services, and support available to survivors, it is important to understand what contributes to survivors’ decisions regarding if and when they tell others about their victimization. Furthermore, given the link between negative reactions and psychosocial difficulties, it is important to minimize the potential for a survivor to receive a harmful response from a provider.

Case Example 2

While some disclosures of sexual assault are expected, such as when a client is presenting for services to address problems resulting from sexual assault, other disclosures are not expected. Therefore, clinicians must be prepared for when these disclosures do occur. In this chapter, two case examples are presented—one in which an unanticipated disclosure occurs during an intake evaluation and one in which an unanticipated disclosure occurs during the course of therapy. The authors provide recommendations on how to handle these disclosures, including how to assess whether further discussion of the sexual assault is necessary and how to handle possible disruptions to the therapy plan when disclosures occur.