SStt.. CCaatthheerriinnee UUnniivveerrssiittyy SSOOPPHHIIAA Master of Social Work Clinical Research Papers School of Social Work 5-2016 SSeexxuuaall AAssssaauulltt CCeenntteerr AAddvvooccaatteess aanndd PPssyycchhootthheerraappiissttss:: AAnn EExxpplloorraattoorryy SSttuuddyy ooff IInntteerrvveennttiioonnss Renae Lockerby St. Catherine University, [email protected] Follow this and additional works at: https://sophia.stkate.edu/msw_papers Part of the Social Work Commons RReeccoommmmeennddeedd CCiittaattiioonn Lockerby, Renae. (2016). Sexual Assault Center Advocates and Psychotherapists: An Exploratory Study of Interventions. Retrieved from Sophia, the St. Catherine University repository website: https://sophia.stkate.edu/msw_papers/625 This Clinical research paper is brought to you for free and open access by the School of Social Work at SOPHIA. It has been accepted for inclusion in Master of Social Work Clinical Research Papers by an authorized administrator of SOPHIA. For more information, please contact [email protected]. Sexual Assault Center Advocates and Psychotherapists: An Exploratory Study of Interventions by Renae E. Lockerby, B.A. MSW Clinical Research Paper Presented to the Faculty of the School of Social Work St. Catherine University and the University of St. Thomas St. Paul, Minnesota in Partial fulfillment of the Requirements for the Degree of Master of Social Work Committee Members Lance Peterson, Ph.D., LICSW (Chair) Lisa Powers, MSW, LICSW Peggy LaDue, BSW, LSW The Clinical Research Project is a graduation requirement for MSW students at St. Catherine University/University of St. Thomas School of Social Work in St. Paul, Minnesota and is conducted within a nine-month time frame to demonstrate facility with basic social research methods. Students must independently conceptualize a research problem, formulate a research design that is approved by a research committee and the university Institutional Review Board, implement the project, and publicly present the findings of the study. This project is neither a Master’s thesis nor a dissertation. SEXUAL ASSAULT CENTER ADVOCACY AND PSYCHOTHERAPY 2 Abstract In the following qualitative study, the researcher attempted to identify and compare the self- identified approaches taken by Sexual Assault Center (SAC) advocates (n = 4) and outpatient psychotherapists (n = 4) in working with adult survivors of sexual violence. Using grounded theory methodology, data from semi-structured interviews were coded using an open coding process. From this, six themes emerged from the interviews with SAC advocates and ten themes emerged from the interviews with psychotherapists, suggesting approaches used when providing crisis intervention and counseling to adult survivors of sexual violence. These themes and their corresponding subthemes are discussed in this report. The study demonstrated that when providing crisis intervention and counseling to adult survivors of sexual violence, SAC advocates and psychotherapists take many of the same approaches, but that the work of SAC advocates is structured to be more short-term and to meet the immediate needs of survivors of sexual violence, whereas the work of psychotherapists tends to be more long-term and with the use of specific therapeutic treatment interventions and assessment tools. Several implications can be drawn from this study. This study informs direct practice of and referrals made by social workers, service choices made by survivors, policy surrounding the funding of SACs, and future research related to crisis intervention and counseling approaches used with survivors of sexual violence. Keywords: Sexual Assault Centers, Rape Crisis Centers, Psychotherapy, Advocacy, Sexual Trauma, Sexual Violence, Sexual Assault, Rape SEXUAL ASSAULT CENTER ADVOCACY AND PSYCHOTHERAPY 3 Acknowledgements I would like to thank my committee chair, Lance Peterson, for his guidance, encouragement, and genuine compassion for his students. The time and effort he put into reading the numerous pages of this research report and answering all of my questions is greatly appreciated. He truly models the values and ethics of a good social worker through the way he treats his students. I would also like to thank my committee members, Lisa Powers and Peggy LaDue, for helping me to think critically about all aspects of this research project, for their time, and for their relentless support throughout this entire graduate program. I would like to thank my parents for always encouraging me to be my best and for their unwavering support for everything I do. Finally, I would like to thank my husband, Aaron, for his love, patience, encouragement, and his ability to help me put things into perspective. SEXUAL ASSAULT CENTER ADVOCACY AND PSYCHOTHERAPY 4 Table of Contents Section Page I. List of Tables 5 II. Introduction 6 III. Literature Review 13 IV. Conceptual Framework 26 V. Methods 29 VI. Findings 36 VII. Discussion 57 VIII. References 70 IX. Appendices A. Agency Request for Participant Recruitment Letter 78 B. Agency Permission Letter Template 81 C. Script for Sexual Assault Center Advocate Participant Recruitment 82 D. Script for Psychotherapist Participant Recruitment 84 E. Consent Form 86 F. Interview Guide 89 SEXUAL ASSAULT CENTER ADVOCACY AND PSYCHOTHERAPY 5 List of Tables Tables Page Table 1. Psychological First Aid Core Actions and Goals 21 Table 2. Similarities and Differences of Themes and Subthemes between SAC Advocates and Psychotherapists 55 Table 3. Themes and Subthemes of SAC Advocates and Psychotherapists Presented Within the Ecosystems Paradigm 56 SEXUAL ASSAULT CENTER ADVOCACY AND PSYCHOTHERAPY 6 Sexual Assault Center Advocates and Psychotherapists: An Exploratory Study of Interventions According to the 2011 National Intimate Partner and Sexual Violence Survey, approximately “19.3% of women and 1.7% of men have been raped [forced penetration] during their lifetimes” (Breiding et al., 2014, p. 1). Moreover, approximately 43.9% of women and 23.4% of men have experienced other forms of sexual violence, such as unwanted or coerced sexual touch (Breiding et al., 2014). Breaking these rates down further, 64.1% of multiracial women, 55% of American Indian/Alaskan Native women, 46.9% of non-Hispanic white women, 38.2% of non-Hispanic black women, 35.6% of Hispanic women, and 31.9% of Asian or Pacific Islander women have experienced some form of sexual violence in their lifetimes (Breiding et al., 2014). Furthermore, rates of sexual violence victimization are higher among lesbian, gay, and bisexual people than among heterosexual people (Walters, Chen, & Breiding, 2013). Although there are no national studies estimating sexual violence committed against transgendered people (Testa et al., 2012), the rates still appear to be high (Clements-Nolle, Marx, & Katz, 2006). Additionally, Casteel, Martin, Smith, Gurka, and Kupper (2008) found that “women with severe disability impairments were four times more likely to be sexually assaulted than women with no reported disabilities” (p. 87). In a study that looked at homeless individuals within five U.S. states, 49% said they have experienced a violent attack while homeless and 15% said that this violent attack took the form of a sexual assault or rape (Meinbresse et al., 2014). Clearly, rates of sexual violence victimization are high among the entire U.S. population, but are even higher in minority groups, specifically. Sexual violence is not about love or attraction (National Sexual Violence Resource Center [NSVRC], 2010); rather, it is a tool of oppression, used to control others (Rape Abuse Incest National Network, 2009). It is maintained by this oppression and by SEXUAL ASSAULT CENTER ADVOCACY AND PSYCHOTHERAPY 7 the acceptance of misinformation about sexual violence, such as the myth that the victim asked for it so it’s the victim’s fault (Campbell, Dworkin, & Cabral, 2009). A large reason for the differences between minority and majority populations in terms of their experiences with sexual violence, is that those who belong to minority groups, such as women; non-whites; people who identify as lesbian, gay, bisexual, and transgender (LGBT); people with low socioeconomic status (SES); people who have disabilities; etc. often experience high rates of oppression just by the nature of their identities. Because people belonging to oppressed groups typically lack power and are often vulnerable because of their lower social statuses, they are an easier “target” for sexual offenders (Pennsylvania Coalition Against Rape, 2007, p. 7). Therefore, sexual violence is a social problem, maintained by oppressive institutions and harmful social norms. Each state defines terms such as sexual violence, rape, and sexual assault differently (Rape Abuse Incest National Network, 2009). The following definitions will be used in this report unless specified otherwise. According to Centers for Disease Control and Prevention (CDC)/National Center for Injury Prevention and Control’s publication, Sexual Violence Surveillance: Uniform Definitions and Recommended Data Elements, sexual violence is defined as a sexual act that is committed or attempted by another person without freely given consent of the victim or against someone who is unable to consent or refuse. It includes: forced or alcohol/ drug facilitated penetration of a victim; forced or alcohol/drug facilitated incidents in which the victim was made to penetrate a perpetrator or someone else; nonphysically pressured unwanted penetration; intentional sexual touching; or non- contact acts of a sexual nature. Sexual violence can also occur when a perpetrator forces SEXUAL ASSAULT CENTER ADVOCACY AND PSYCHOTHERAPY 8 or coerces a victim to engage in sexual acts with a third party. (Basile, Smith, Breiding, Black, & Mahendra, 2014) The Division of Violence Prevention, National Center for Injury Prevention and Control, and the CDC’s definition of rape will also be used in this report and is stated as “completed or attempted forced penetration or alcohol- or drug-facilitated penetration” (Breiding et al., 2014). The following definition of sexual assault, provided by the U.S. Department of Justice, Office of Violence Against Women (2015), will be used: “any type of sexual contact or behavior that occurs without the explicit consent of the recipient. Falling under the definition of sexual assault are sexual activities such as forced sexual intercourse, forcible sodomy, child molestation, incest, fondling, and attempted rape” (What is Sexual Assault? section, para. 1). The term sexual assault is differentiated from rape in that it includes any form of sexual contact, including rape. Sexual violence is a term that includes rape and sexual assault, as well as other forms of non- contact, non-consensual sexual experiences such as being forced to watch others engage in sexual activities. Childhood sexual abuse will refer to any act of sexual violence against a child. Essentially, sexual violence refers to any form of unwanted sexual activity and, therefore, will be used most frequently in this report. It should also be noted that the terms “victim” and “survivor” will be used interchangeably throughout this report. Not only does sexual violence impact so many people, it can also cause serious emotional, psychological, and behavioral issues for survivors and their friends and families. Possible reactions to sexual violence can include, but are not limited to flashbacks; hypervigilance; anxiety; feelings of helplessness, shock, numbness, fear, anger, guilt, shame, and self-blame; denial; sleeping and eating difficulties; and self-esteem issues (NSVRC, 2010). Often, these reactions are exacerbated by a victim’s encounter with medical or criminal justice SEXUAL ASSAULT CENTER ADVOCACY AND PSYCHOTHERAPY 9 personnel. When seeking medical or law enforcement services after an assault, victims are often met with blame and are faced with the re-traumatizing task of having to defend themselves in front of powerful professionals such as police, doctors, and prosecutors (Campbell, 2008; Campbell et al., 2009; Murphy, Banyard, Maynard, & Dufresne, 2011). These difficult experiences may be even worse for marginalized populations, such as those with low SES, those who identify as LGBT, and racial minorities, because those who belong to these groups are often discriminated based on their identities alone (Campbell, 2008). Similar unsupportive reactions by friends and family; a victim-blaming, oppressive society; and the effects of multiple and/or historical trauma can also impact a victim’s reaction to sexual violence, specifically by perpetuating self-blame (Campbell et al., 2009). Clearly, sexual violence and social and systemic responses to victims can seriously impact a survivor’s reaction to this type of trauma. Support from psychotherapists and other community providers can often alleviate some of these negative responses and help the victim cope adaptively after a crisis like sexual assault. Campbell (2008) noted that community mental health clinics, community-based support services such as rape crisis centers, and treatment studies are avenues in which sexual assault survivors can access mental health care. However, the focus of this report will be on workers within mental health clinics and rape crisis centers. As noted previously, sexual violence encompasses more than the traditional definition of rape, or non-consensual penetration by a body part or object; therefore, the term rape crisis center may not accurately represent all forms of sexual violence seen by these community-based agencies. In order to be more inclusive of all forms of sexual violence, the term sexual assault center (SAC) will be used throughout this report, even though the term rape crisis center was seen most frequently throughout the literature. The term “advocate” will be used to refer to a person who carries out the work of a SAC, whether on a