Mental health articles

Recommended intervention strategies incorporate feminist and trauma
therapy as applied to sexual victimization (e.g., Brown, 2003; Herman, 1992;
Walker, 1994). Feminist models externalize the trauma, viewing sexual victimization
within the context of sexism and other forms of oppression, and
emphasize shared power in the therapy relationship. Herman (1992) characterizes
psychological trauma as disempowerment and disconnection from others,
and views the recovery process as occurring in a healing relationship that
empowers the survivor and creates new connections. Th e goals of “survivor
therapy” (Walker, 1994) are to ensure safety; restore a sense of control; move
toward interdependence on others; acknowledge sociopolitical, cultural, and
economic contexts; provide respect and empathy for the victim; and develop
new coping strategies. For Koss and Harvey (1991), recovery is a “victim to
survivor process” in which traumatic symptoms are reduced, eff ect is no longer
overwhelming, reconnection with others occurs, meaning is assigned, and
self-blame is replaced by self-esteem. Sue and Sue (2003) espouse integration
of multicultural factors to address signifi cant contextual variables. Reviewing
all these models, there is considerable overlap and consistency with clear
implications for counseling.
Bearing witness to victims’ stories of abuse can be diffi cult for counselors,
who should strive to empathize with the pain and helplessness without getting
trapped in it. Counselors need to balance clients’ emotional processing and
disclosure with containment and control, so that clients are not overwhelmed.

Working together with the client helps determine the optimal pace and depth
of exploration. Specifi c techniques found to be helpful with sexual victimization,
such as eye movement desensitization reprocessing (Shapiro, 2001), narrative
therapy, and art therapy, may be integrated into the counseling process
but require specialized training. Attention to the somatic aspects of trauma
(Brown, 2003) may include recommendations for exercise and relaxation
techniques, consideration of antidepressant or anti-anxiety medications, and
testing for pregnancy and sexually transmitted diseases, including HIV/AIDS.
Bibliotherapy may be useful to provide information on the process of recovery
and coping skills, such as the cognitively based self-help guide, Th e Rape
Recovery Handbook (Matsakis, 2003).
Group counseling can be eff ective as a primary intervention or an adjunct
to individual therapy. Typically, specifi c groups are recommended, although
mixed-abuse groups can be successful (Walker, 1994). Various group theoretical
orientations can be used, including insight-oriented, relational, feminist,
and cognitive-behavioral approaches. Benefi ts of group treatment include
reduced isolation, explicit support, validation, confi rmation of experience,
reduced self-blame and enhanced self-esteem, egalitarian mode of care, opportunities
for safe attachment, shared grief, and assignment of meaning (Koss
& Harvey, 1991). Group participation can facilitate social skill redevelopment,
educate regarding victimization, and allow for exploration of the traumatic
event’s impact. Selection criteria, assessment of client readiness, treatment
goals, format, process, duration, and structure are other important considerations.
Guidelines include clearly delineating expectations, creating group
norms, sharing time and focus as equally as possible among participants, and
facilitating a sense of safety, respect, and trust. Participants oft en report that
they are able to extend compassion and kindness to other members that they
are not yet able to bestow on themselves.