Counselling Rape Survivors

According to the Home Office findings, Rape is defined as ‘forced to have sexual intercourse (Vaginal or anal penetration)’. The legal definition stipulates it to be ‘penile’. In general terms, rape is an act of aggression and violence against another; it is not an act of sex but is one of specifically dominance and power.

Key points of the findings of the Research, Development andStatistics directorate of the Home Office published in 2002 are listedbelow. 0.4% of women aged 16 to 59 in England and Wales said they hadbeen raped in the year preceding the 2000 BCS, an estimated 61,000victims. 0.9% of women said they had been subject to some form ofsexual victimization (including rape) in this period. Around 1 in 20women (4.9%) said they had been raped since age 16, an estimated 754,000 victims. About 1 in 10 women (9.7%) said they had experiencedsome form of sexual victimisation (including rape) since age 16.

Age is the biggest risk factor for experiencing sexual victimisation; women aged 16 to 24 were more likely to say they had been sexually victimised in the last year than older women. Women are most likely tobe sexually attacked by men they know in some way, most often partners(32%) or acquaintances (22%). Current partners (at the time of theattack) were responsible for 45% of rapes reported to the survey.Strangers were responsible for only 8% of rapes reported to the survey.
18% of incidents of sexual victimisation reported to the survey came to the attention of the police; the police came to know about 20% of rapes. 32% of women who reported rape were ‘very satisfied’ with theway the police handled the matter, 22% were very dissatisfied. Lessthan two-thirds (60%) of female rape victims were prepared toself-classify their experience as ‘rape’ and less than three-quarters(70%) of women who self-classified themselves as having been victims of ‘attempted rape’.

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Amnesty international reported that there were 14,000 recorded rapesin 2003 and 11,441 recorded rapes in 2002, representing a 8% increase.According to the Home Office, in the year ending March 2003, the totalnumber of sexual offences recorded by police in England & Wales was 48,654, a 17% rise over the previous year.

A victim of rape feels the “fight or flight” response that humans have built-in; which means that when the incident is over, one is leftwith a feeling of devastation, exhaustion, confusion, sadness, etc. The lingering psychological disorder is called Post Traumatic Stress Disorder (PTSD). The most effective therapeutic approach for long-term,severe PSTD appears to be talking treatment sessions with a clinicalpsychologist, in which the person is encouraged to talk through theirexperiences in detail. This may involve behavioural or cognitivetherapeutic approaches. Antidepressants may also be prescribed torelieve concurrent depression, a common feature in survivors, andenable the person to get the most out of any psychological treatment.Counselling may be helpful too in the early stages of recovery,particularly from counsellors experienced in the treatment of PTSD.

Before we go into detail on counselling for rape survivors, it is essential to take into account the effectiveness of counselling in general. According to the Department of Health (2001), Counselling hasbeen defined as “ a systematic process which gives individuals anopportunity to explore, discover and clarify ways of living moreresourcefully, with a greater sense of well-being ”. The use ofcounselling as a means of responding to people in distress and turmoilhas been increasing rapidly in recent years. This has generated adebate on the effectiveness of counselling process itself. The methodsof evaluation of effectiveness is also highly controversial. Theconcerns in the qualitative and quantitative evaluation is discussed indetail later.

Bondi summarises from her reports on controlled trials conducted inhealth care settings. They seem to indicate that counselling is aneffective intervention, clinically and economically. Its costs andbenefits are broadly comparable to those of antidepressant medication. Moreover, it seems to be a popular choice with many patients. Cautionis sometimes attached to the results of these trials. This may be dueto the fact that it only involves a small trial when compared to thelarge trial group of medication. Studies of counselling in othersettings indicate a high level of satisfaction among clients. Bondialso writes that there is good evidence to suggest that counselling hasa capacity to reduce demand on psychiatric services. This is becausecounselling prevents less serious problems from becoming more seriousand helps people to maintain reasonably good levels of mental health.

Choice of treatment of survivors of rape has been one of increasing significance within health care and also highlights the need toconsider factors other than clinical and cost-effectiveness.Counselling is not the only form of talking treatment available. Otherforms of talking treatment include psychotherapy, cognitive behaviourtherapy, self-help groups and support groups.

Counselling attaches a great significance to the autonomy of the victim and therefore it cannot be administered to the unwilling. The success of counselling, therefore, depends on active participation. For counsellingof rape victims, feelings caused by abuse may be quite overwhelming and difficult to deal with. The Department of Health (2001) has recommended counselling as one of the types of psychological therapy for depression, anxiety, panic disorder, social anxiety and phobias andpost traumatic disorders. These problems can be mainly related tosurvivors of rape.

The National Center for Victims of Crime (2004) recommends that counselling can help cope with the physical and emotional reactions to the sexual assault or rape, as well as provide necessary information about medical and criminal justice system procedures.

According to the reports by the Brunel University (2005) on sexual abuse and rape, sharing experiences in a safe, understanding and confidential setting may help to manage their feelings by being heard and taken seriously.  Counselling enables to make sense of the present, in relation to the past.  Some survivors of sexual abuse maybe plagued by memories in the form of distressing flashbacks, mental images or nightmares.  Talking about the images and memories while being heard and supported will often ease the problem.  It may beeasier to share incidents and feelings with a professional counsellorconfidential, rather than a friend. Some people prefer to talk to ahelpline so they do not have to face the person they are disclosing to.  

According to Bondi’s summary of her studies on the effectiveness ofcounselling that sceptics often voice doubts of counselling because itappears to involve nothing other than one (or two people) “chatting” toa counsellor. However, in spite of these doubts, communication takesplace when counselling is effected, whereby a special kind ofrelationship is developed between the counsellor and the victim. Bondiattributes this to the fact that human beings are social creaturescapable of connecting with others. It is worth to note that allapproaches to counselling share a commitment to apply insights andunderstandings about the importance of these connections to offertherapeutically effective relationships.

Impacts of counselling on rape survivors often depends on the development of a helpful working relationship between the counsellor and survivor.  According to the STAR findings, some women feel nervous and unenthusiastic about seeing a counsellor. Therefore, it is essential that they feel relaxed and comfortable to be able to talk freely. Setting up of a pace comfortable for the victim is important as it recognises the interlinked nature of people’s lives (Skinner andTaylor,  Home Office report 51/04). 

According to Bernes (2005), effective counselling leading to a good counsellor-victim relationship follows the following dynamics. They are an emotionally charged, confiding relationship between the patient and therapist; warmth, support and attention from the therapist in a healing setting; a positive therapeutic alliance between patient and therapist; a new rationale or conceptual scheme offered with confidence by the therapist; the passage of time; installation of hope and expectancy and finally techniques consistent with patient expectation and efficacy.

Common process strategies in counselling include gathering sufficient information, listening well and with understanding, helping the individual reflect and gain insight, helping in decision-making and goal setting, and providing options and ideas for client consideration (Korhonen). According to the Home Office reports on the STAR scheme, the data collected from the survey did not give any indications that anyone counselling technique works better than another.  Methods likedrawing or making lists of feelings, events, concerns and workingthrough them were found to be effective by some rape survivors. Some found making plans for the future, for example, symbolic moves such aschanging the décor of the room seemed to indicate a new phase in their lives. 

Others indicated that a flexible integrated approach with respect, a respectful politeness, support and even the smiling face of the counsellors seemedto have helped them. The need for administering couna respectful, supportive and caring environment is also essential. Also, them cope development of a programme of work that enabled them to look at themselves in a logical, positive and respective manner athem cope with their emotions and move forward at their own pace is essential.

The university of Dundee has introduced a computer counsellingtechnique called ‘ENHANCE’ for rape victims. Often, women who have been raped find it hard to talk about their feelings and research evidence shows that in sensitive and potentially embarrassing areas of human functioning, some people may find it easier to talk openly to acomputer. ENHANCE,  a computer based facility which includes a diaryfacility for free writing, a visualisation tool to describe feelingsand graphic manipulation and exploration, an information base to accessa range of supportive information, leaflets and contacts and the optionof what to destroy or save it for later reference. Further work is being done to develop ENHANCE and the researchers feel that their workcan be transferred to other agencies in future. Furthermore, it is inan early stage to be assessed for effectiveness. Computer counselling is, therefore, new and brings to attention to the fact there is very few online support available for rape survivors. This can be a good sourceof data for qualitative research as it reduces some of its ethical risks which are discussed in detail later.
   

It is very difficult to assess the effectiveness of counselling forrape survivors as due to the dilemmas in relation to the ethicalpractises of counselling, training and qualifications of counsellors and the evaluation of counselling and little published information.Counselling services are offered in a wide range of settings, which influences the kind of outcomes (Bondi). Bondi, in her review ofdifferent counselling orientations writes that similar effects may beusually reported. This is consistent with the argument that it is thequality of the therapeutic relationships offered by the counsellorswhich determine the effectiveness of counselling. 

Effectiveness of rape counselling can be studied by either qualitativeor quantitative research. McLeod (2000) reports from his paperpresented at the 8th Annual International Counselling, University of Durham that counselling in Britain at the beginning of the twenty-first century does not have a clear vision of the role of research. It is worth mentioning that very few studies have focussed on research methods to measure effectiveness of counselling for rape victims. McLeod also reports that, in general, published studies of counsellingand therapy in dominated by quantitative research like up to 95%. Ingeneral, cultural assumptions are concerned with the development ofmethods that are valid and reliable.  Quantitative research reduceshuman experience and action to variables. Hypothesis are framed interms of the relationships between these variables, which can often beinterpreted a rational voice allowing no expression of feeling orpersonal experience (McLoad, 2000).  There has been no reports relating to quantitative research on counselling for rape.

Qualitative research has been used lately in the health care settingsand voluntary organisation for rape survivors. Qualitative research refers to research conducted in an interpretive or critical tradition. Research conducted in this tradition generally includes ethnographies, naturalistic observation or intensive interviewing studies, and usessome type of content analysis of words or texts to generate themes, which summarize the results of the study. The goals of qualitative research are not usually to generalize from the findings to some largertruth, but rather to explore or generate truths for the particular sample of individuals studied or to generate new theories. There is often an emphasis in qualitative research on perception or livedexperience.
 There  are quite a few ethical concerns in qualitative research of assessing the effectiveness of counselling of rape victims.  Knapik (2002)in his paper summarises the ethical concerns of qualitative researchwhich mainly revolve around an assessment of benefit versus harm,confidentiality, duality of roles, and informed consent  It is oftenassumed that qualitative data does not involve physical manipulation orintrusive procedures on victims. But it can pose certain risks to the victims. 

Moleski and Kiselica (2005) highlight the dangers of a dual or multiplerelationships between the counsellor and victim. During research involving in-depth interviews or focus group discussions on such asensitive as rape, the researcher (generally a counsellor, but called aresearcher in this context as the data collected is for the purposes of qualitative research) develops a relationship of trust with the victim. The relationship may be misinterpreted by the participant as atherapist-client relationship. The data may be interpreted in waysunflattering or damaging to participants. It is therefore important toassess the harms and benefits in dealing with real clients.
Secondly, risks to individuals participating in qualitative researchmay often not be anticipated. This is because the method and researchquestions are always evolving and changing from the various organisation’s approach to the case. These risks should be made clearto the participants from the beginning and also during the course ofthe experiment.

Thirdly and most importantly, qualitative research  always generatesquestions on the ability to protect confidential information. Usually, names and personal data are excluded from published results, but quotations, cues from the publications can always identify theparticipant to those familiar with the research. Reasons for this maybe because of the nature of sensitivity of the rape abuse problem, trial groups always being small and trials being conducted in smallcommunity structures.

Reports were published by the Home Office on the ‘STAR young person project’ on assessing the counselling services offered to rape survivors. Young women primarily had a positive counselling experiencebut a small number reported some level of dissatisfaction.  One of the reasons were the short sessions of counselling, as they could not continue working with their counsellors on a long term basis. This indicated the issue of assess to a restricted number of sessions. Another issue was the pace at which information is disclosed to thecounsellor, as a small percentage of the women disliked gettingstraight to the information or having to answer questions pertaining tothe incidents within a shorter period of contact between the victim andthe counsellor. This may be because a certain time span is needed toestablish a counsellor-victim relationship which varies from case tocase and depends on the severity of the case.    

Another small percentage of the STAR participants felt that the counsellor was not equipped to work with areas of the case and thatthey were given unhelpful advise or irrelevant information or help in away which was not the one suited for the particular case. This throwslight on the training issues of counsellors, whether they are properly equipped for the job. Another percentage of the women, said that thecounsellor disapproved of them being late or related issues whichindicate an over-protective or over-controlling issue which can causenegative impacts on the counselling experience. The findings indicatethe need for a more flexible approach during counselling experiences, longer-term counselling and support by the counsellor, proper trainingfor counsellors and more research into counselling methods and theirevaluation. 

According to the findings of the British Crime Survey (2002), it isdifficult to assess the level of support for victims of rape due to the small number of victims in year 2001. Also, the British Crime Survey(2002) reports that support services are under-funded, relative tosupport services dedicated to victims of domestic violence. In UK, therapy services for rape survivors are available from charity andlistening services, health services provided by the universities forstudents, NHS and  few religious movements.  In the NHS, there areusually long waiting lists sometimes up to a year for patients toaccess counsellor services. In voluntary and charity services there maynot always be round-the clock assistance for rape survivors. Telephone access is restricted to certain times of the day. 

Findings of research on women rape victims are available in a varietyof forms and from a variety of places. Professional journals such as Violence Against Women, the Journal of Interpersonal Violence, Aggression & Violence Behavior, Violence & Victims, and the Journal of Family Violence include research conducted by psychologists, social workers, sociologists, advocates, and others. In addition to professional journals, findings of research are presented at domesticviolence conferences, described in the popular press, found on websites devoted to ending violence against women, and are available aspublications from government agencies like the Home Office, UK orprivate research organizations (various voluntary organisation’swebsites).

Research reports published in scientific journals are subject to peer-review.  Research published in scientific journals thus gives thereader some confidence in the scientific credibility of the researchfindings. Scientific credibility, however, does not necessarily meanthat the findings represent “the truth”. Research released directlyfrom an organization sponsoring the research does not usually gothrough the peer review process. So there is a real need for independent qualitative research into the counselling services for rape victims in the UK. The UK Home Office should actively engage inindependent evaluation of counselling services for rape victims.

The STAR project recommendations the following for future research. There is need for piloting and evaluating peer support systems. New research projects into contexts and circumstances of rape is requiredto throw new light on the academic and practitioner’s knowledge. More research is needed into the needs of victims from internet supportservices while reviewing the current internet support service toprovide guidelines for practise. More creative approaches in regards toservices for survivors were also required.

It is also recommended that counsellors be given appropriate training to improve the services to rape survivors. According to Bernes (2005), there are five critical components forbecoming an effective counsellor. The counsellor should have aprofound, genuine and early draw to the field, a profound and genuinefascination to try to understand human nature, cognitive ability, arigorous and quality academic program and major field exposure.

There is therefore a genuine need for efforts to be focussed in creating effective counsellors to deal with rape victims. More funding to develop therapy services is required. There is a need to establish infrastructure towards organisations involved in treatmentand care of victims. Further research into the effective processes ofvarious approaches of counselling is recommended. Detailed research isneeded into the qualitative analysis of effectiveness of thecounselling processes. Also, independent qualitative analysis in victimsupport is needed to verify the results. In general, in the UK, counselling for rape survivors have still a long way to go.