Counselling

Counselling involves an assessment process, safety and resource building (ie. coping strategies and support), trauma processing and closure. This follows empirically based practice (Schwarz, Courtois, Van der Kolk, Herman).
Many therapists specialize in the treatment and care of sexual assault survivors and/or victims of intimate partner abuse. However, there are many who do not and it is through developing a therapeutic relationship with a client they discover that this person has some type of abuse in their history. Since the therapeutic alliance is already strong, it could be countertherapeutic to refer at this stage in therapy. In reference to the cited statistics on sexual assault and partner abuse, it is highly likely that these most therapists will encounter these issues in their practice. Therefore, developing some expertise in this area would prove to be helpful.

General Guidelines:

Provide a supportive environment

• Be aware that a client may be coming to you in a crisis stage. This does not necessarily mean soon after the assault. Should the person decide to talk about the assault 10 years after it happened, she/he could still be in a crisis stage. Therefore, your interventions must focus on the present symptoms, which can include flashbacks, intrusive memories, panic, fear, insomnia, and trembling.
• In a crisis stage it is normal to forget appointments, to arrive late etc. Therefore, it is necessary to repeat important information, hand out appointment cards at every session, and with the consent of your client, give reminder calls before appointments.
• Normalize the client's responses. Therapists may have a guideline of possible impacts, but not everyone will have those impacts. Clients will cope in different ways; therapists can work to support them in their knowledge of what could work for them in terms of coping.
• Support client's decisions with respect to reporting to police.
• Discuss with clients what their expectations are with respect to the counselling sessions. Discuss the therapy process and realistic expectations and outcomes of treatment.

Believe your client

• Therapists are not the police or judges. You are here to help a person move through a difficult period. Even if someone is not honest about why they are presenting for therapy, this is an indicator of another problem.
• Do not use expressions that imply judgment, for example, "Why did you go to his house?"

Respect the rhythm of the client

• Understand that telling the story takes time. The client is in control of the amount of information they wish to disclose and when they choose to do so, if at all. A client's apparent resistance is a normal phase, it does not mean the person is uncooperative.
• At times clients may need to take a break; this is normal considering the great effort it takes to confront sexual assault and/or partner abuse and the associated symptomatology.
• As with any relationship, there are ebbs and flows. There will be periods where the client will reach a plateau and other periods where important work and movement are occurring.

Provide a safe environment

• Is your office far from public transportation?
• How safe is the path from the nearest bus or subway to your office?
• If you provide evening appointments, how safe is the area at that time?
• What does the layout/decor of your office say about the type of therapy you provide?
• Is your environment consistent with your therapeutic values?
• If you work in an institution and have little control over the decor can you find some creative ways to express a caring environment?
• Be clear from the beginning about professional boundaries and the limitations of confidentiality.
• When can the client call you and how often?
• What happens when sessions are missed?
• What are the rules with respect to touching?
• Discuss how the relationship will be terminated.

There are a number of factors that will decide the appropriate time for therapy to end. The end of therapy does not mean that this person will never have problems again, but it will be apparent that the assault/abuse no longer controls the person. Adams & Fay in their book "Free of the Shadows", include a list of the gains undergone by the client prior to leaving therapy. Below is an adaptation of this list;

• A strong sense that she/he is not alone.
• An understanding of the phenomenon of sexual and intimate partner violence in our culture and the impact it has had on their life.
• A sense of control over one's life and further development of coping skills.
• A sense of physical well-being and knowledge that one can take care of self and body.
• Being at peace with their decision about reporting to the police and taking legal action.
• Being able to express their sexuality in a positive way. Not burying or expressing it indiscriminately or in a self-destructive way.
• Freedom from alcohol or drug dependence.
• Increased self-esteem, by having been heard and seen as a person with skills and resiliency.
• Freedom from the desire to get revenge on the offender.
• The ability to choose or not to choose to talk about the assault.
• An ability to trust when the survivor chooses to trust.
• Freedom from guilt or self-blame.
• Memories of the assault/abuse that no longer threaten to overwhelm.
• Progress from victim to survivor and maybe to warrior.
• A new picture of the world and her/his place in it [1989: p.91-92]

Recommended Reading:

The following books are recommended readings to assist therapists in doing trauma work.

Adams, C. & Fay, J. (1987). Free of the Shadows Oakland: New Harbinger Publications.

Dolan, Y.M. (2000). One Small Step, Moving Beyond Trauma and Therapy to a Life of Joy. New York: Authors Choice Press.

Dolan, Y.M. (1991). Resolving Sexual Abuse. New York: W.W. Norton & Company Inc.

Herman, J.L. (1992).Trauma and Recovery. New York: Basic Books.

Meichenbaum, D. (1994). A Clinical Handbook/Practical Therapist Manual for Assessing and Treating Adults with Post-Traumatic Stress Disorder (PTSD).Waterloo: Institute Press.

Resick, P. & Schnicke, M. (1993). Cognitive Processing Therapy for Rape Victims A Treatment Manual. London: SAGE Publications Inc.

Schwarz, R. (2002). Tools For Transforming Trauma. New York: Brunner-Routledge.

Van der Kolk, B. A., McFarlane, A. C. & Weisaeth, L., Editors. (1996). Traumatic Stress: The Effects of Overwhelming Experience on Mind, Body, and Society. New York: The Guilford Press.