Case studiesA multiple case study of rape victim advocates self-care routines: theinfluence of organizational contextDate: 2002Author: Sharon M. Wasco, Rebecca Campbell, Marcia R. ClarkPublication: American Journal of Community Psychology. Volume: 30. Issue: 5INTRODUCTIONThe rape victimology literature has documented many of rapes direct effects onvictims.Over 30 years of solid empirical evidence suggests that up to one in five Americanwomen will be raped in her lifetime (see Koss, 1993), that after the assault she islikely to suffer psychological distress (Hanson, 1990; Neville & Heppner, 1999) andphysical health problems (Golding, 1996; Koss & Heslet, 1992), and that she mayemploy several types of coping to deal with these experiences (see Burt & Katz,1988). Additionally, research indicates that although a sizable number of rape victimsare likely to stay silent about their experiences, other victims may turn to family,friends, or service providers for help and support (George, Winfield, & Blazer, 1992;Kimmerling & Calhoun, 1994; Ullman, 1996). As victims share their experiences ofsexual assault, the number of individuals exposed to, and impacted by, negativeeffects of rape increases exponentially.A fairly recent trend in the victimology literature explores the vicarious effects ofsexual assault on family members or therapists of rape victims (see McCann &Pearlman, 1990). Empirical research suggests that those who are in close contact withrape survivors can experience quite a bit of distress, with female significant othersusually being more affected than males (e.g., Davis, Taylor, & Bench, 1995). Despitepotential negative outcomes, some women do choose careers that involve dailyexposure to rape. The current work explores the assumption that rape crisis workrequires employees to engage in various types of self-care (Stamm, 1995) in order toperform their job duties effectively and responsibly. Trauma researchers offer thenotion of self-care to distinguish strategies and routines employed by those who workwith trauma victims from more traditional models of coping. A key tenet of self-caretheory is that organizations can be instrumental in facilitating workers use of suchstrategies (see Rosen bloom, Pratt, & Pearlman, 1995). To gain a better understandingof the strategies women use to deal with a heightened awareness of rape, as well asthe ways organizational context influences such processes, this exploratory studyemployed qualitative and quantitative methodologies to describe the subjectiveexperiences of a small number of rape victim advocates working in diverse settings.The Ripple Effect of RapeEmpirical studies have shown that secondary traumatization, or secondary traumaticstress, is prevalent among family members and significant others of violent crimevictims in general (Amick-McMullan, Kilpatrick, & Veronen, 1989; Riggs &Kilpatrick, 1990), and rape survivors in particular (Barkus, 1997; Davis et al., 1995;Holmstrom & Burgess,1979; Remer & Ferguson, 1995). "Secondary traumatization"refers most frequently to indirect effects of trauma, such as experiencing recurring
disturbing images, on victims family members and significant others. Relatedly,"vicarious traumatization" (McCann &Pearlman, 1990) and "compassion fatigue" (Figley, 1995) are theories predicting that,over time, service providers who assist victims may experience indirect psychologicaleffects of trauma, which can significantly alter the way victim-helpers perceive theworld and have lasting impacts on their feelings, relationships, and lives (McCann &Pearlman, 1990; Saakvitne & Pearlman, 1996). Astin (1990) reported that her work with rape victims resulted in nightmares, extremetension, and feelings of irritability, lending support to models of indirecttraumatization. Empirical studies have also documented similar experiences amongmental health service providers. Female counselors who work with sexual assaultsurvivors experience symptoms of distress (e.g., intrusive thoughts or memories,increased arousal, numbness) similar to those experienced by victims themselves(Pearlman & MacIan, 1995; Schauben & Frazier, 1995). Trauma counselors alsoexperience shattering of their basic beliefs about safety, trust in oneself, and trust inthe goodness of others by the traumatic nature of the stories they hear from clientseveryday (Johnson & Hunter, 1997; Pearlman & MacIan, 1995). Victim advocateswho do outreach work with rape survivors seeking help from community systemsreport feeling anger and fear in response to helping victims access medical and legalservices (Wasco, 1999; Wasco & Campbell, 2002). This line of research suggests thatas survivors turn to service providers for help, the repeated exposure to thedevastation of rape impacts providers lives.Coping With Exposure to RapeIn response to vicarious, secondary, or even direct stress, service providers who workwith rape victims are likely to employ various coping methods. Schauben and Frazier(1995) were among the first to explore the coping strategies utilized by rape victimcounselors. These researchers surveyed 148 counselors who worked with rapevictims, at least some of the time, about the strategies used to cope with job-relatedstresses. Four common types of common strategies emerged from the open-endedresponses. Over 35% of the sample reported engaging in (1) activities that promotedphysical health, (2) spiritually oriented activities, (3) leisure activities, and (4) seekingboth emotional and instrumental support. Other strategies included changing workconditions, cognitive restructuring, and engaging in political action (Schauben &Frazier, 1995). In a later study of 73 counselors, Johnson and Hunter (1997) foundthat sexual assault counsellors were more likely than other types of counselors to useescape/avoidance st rategies of coping.Recently, Iliffe and Steed (2000) interviewed 13 female and 5 male counselors whoworked with domestic violence victims and/or perpetrators. Although participants inthis study were aware of the negative effects that domestic violence counseling had ontheir lives (e.g., burnout, changes in views about the world), they were able to utilize awide range of strategies to deal with these issues. Debriefing and peer support wereidentified by all the participants in this study as the most important resources fordealing with the difficult nature of their work (Iliffe & Steed, 2000). Also, socializingand physical activity, such as exercise or gardening, reading, and participating inrecreational activities, were commonly cited as strategies to reduce negative effects ofcounselling sessions. Counselors also reported thinking about positive things, such as
identifying clients resilience and strength, and discussed channeling their anger,feelings of xpowerlessness, and other energy into sociopolitical activism as helpfulcoping strategies (Iliffe & Steed, 2000).Case Study 2The Mental Health Impact of RapeDean G. Kilpatrick, Ph.D.National Violence Against Women Prevention Research CenterMedical University of South CarolinaThe National Womens Study produced dramatic confirmation of the mental healthimpact of rape. The study determined comparative rates of several mental healthproblems among rape victims and non-victims. The study ascertained whether rapevictims were more likely than non-victims to experience these devastating mentalhealth problems. Posttraumatic Stress Disorder.The first mental health problem examined was posttraumatic stress disorder (PTSD),an extremely debilitating disorder occurring after a highly disturbing traumatic event,such as military combat or violent crime. Almost one-third (31%) of all rape victimsdeveloped PTSD sometime during theirlifetime; and more than one in ten rape victims(11%) still has PTSD today. Rape victims were 6.2 times more likely todevelop PTSD than women who had neverbeen victims of crime (31% vs 5%). Rape victims were 5.5 times more likely tohave current PTSD than those who had neverbeen victims of crime (11% Vs 2%).The U.S. Census Bureau estimates that thereare approximately 96.3 million adult women inthe United States age 18 or older. If 13% ofAmerican women have been raped and 31% ofrape victims have developed PTSD, then 3.8million adult American women have had rape-related PTSD (RR-PTSD): If 11% of all rape victims have PTSD, then an estimated 1.3 million American women have RR-PTSD. I f 683,000 women are raped each year, approximately 211,000 will develop RR-PTSD annuallyOther Mental Health ProblemsMajor depression is a problem affecting many women, not just rape victims.
However, 30% of rape victims had experienced at least one major depressive episodein their lifetimes, and 21% of all rape victims were experiencing a major depressiveepisode at the time of assessment: By contrast, only 10% of women never victimized by violent crime had ever had a major depressive episode; and only 6% had a major depressive episode when assessed. Rape victims were three times more likely than non-victims of crime to have ever had a major depressive episode (30% Vs 10%). Also, they were 3.5 times more likely to be currently experiencing a major depressive episode (21% Vs 6%).Some mental heath problems are lifethreatening. When asked if they ever thoughtseriously about committing suicide: One-third (33%) of the rape victims and 8% of the non-victims of crime said yes. Rape victims were 4.1 times more likely than non-crime victims to have contemplated suicide. Rape victims were 13 times more likely than non-crime victims to have attempted suicide (13% Vs 1%).Substance AbuseThere was substantial evidence that rape victims had higher rates than non-victims ofdrug and alcohol consumption and a greater likelihood of having drug and alcohol-related problems. Compared to women who had never been crime victims, rapevictims with RR-PTSD were: 13.4 times more likely to have two or more major alcohol problems (20.1% Vs 1.5%). 26 times more likely to have two or more major serious drug abuse problems (7.8% Vs 0.3%). The National Womens Study findings provide compelling evidence about the extent to which rape poses a danger to American womens mental health -- and even their continued survival -- because of increased suicide risk. Thus, rape is a problem for Americas mental and public health systems as well as the criminal justice system. Key Concerns of Rape Victims To effectively respond to rape victims, service providers and criminal justice officials need to understand the major concerns of rape victims. Without accurate information, it is difficult to
develop policies and programs to meet victims’ needs.The National Women’s Study identified several critical concerns. To determinewhether victims’ concerns have changed over time, the study divided these concernsinto two categories: all rape victims vs. victims that had been raped within theprevious five years (1987-91). The changes in concerns included: The victim’s relatives knowing about the assault: Relatively little change over time. Seventy-one percent of all victims and 66% of victims within past five years are concerned about relatives finding out about the rape. People blaming the victim: Rape victims are concerned about being blamed for the rape, and this has not changed over time. In fact, 69% of all victims and 66% of recent rape victims say they worry about being blamed. People outside her family knowing she had been sexually assaulted: No significant difference. Sixty-eight percent of all victims and 61% of rape victims within the past five years are concerned about this. The victim’s identity being revealed in the news media: Women raped within the last five years are more likely to be concerned about the possibility of their names being published than all rape victims (60% vs. 50%). Becoming pregnant: Sixty-one percent of recent rape victims, as opposed to 34% of all rape victims, are concerned about getting pregnant. Contracting a sexually transmitted disease (not including HIV/AIDS): Recent rape victims were more than twice as concerned as all rape victims about contracting sexually transmitted diseases. (43% Vs 19%). Contracting HIV/AIDS: Recent rape victims were four times more likely than all victims to be concerned about getting HIV/AIDS as a result of the rape - regardless of the recency of the rape (40% Vs 10%). The stigma of rape persists. Victims are greatly concerned about others discovering they were raped. Service providers and criminal justice officials should endeavor to maintain the confidentiality and respect the privacy needs of victimsFrom this case study I have gathered that post dramatic stress disorder is a high riskfor the mental state of those suffered from a rape attack.