The psychotherapeutic needs of women who have been sexually assaulted.

PROBLEM. Despite the significant emotional repercussions of sexual assault, women survivors often avoid formal mental health treatment. Little is known about why survivors are reluctant to use professional services to facilitate recovery. METHODS. A descriptive study used content analysis to describe the therapy experiences and self-perceived psychotherapeutic needs of 33 women who survived sexual assault by male intimates. FINDINGS. With regard to professional services, the participants were most concerned about the quality of the therapeutic relationship and advised clinicians to appreciate the strengths and resources women bring to their own recovery. The participants' specific psychotherapeutic needs were influenced by the pervasiveness of the violence in their lives. CONCLUSIONS. Clinicians should not focus exclusively on the amelioration of symptoms but should provide support, validation, and empowerment for sexual assault survivors who seek treatment. Key words: Psychotherapy, qualitative studies, rape, sexual abuse, trauma Many women who seek psychotherapy have been sexually assaulted at some point in their adult lives. Sexual assault may include a wide variety of experiences ranging from unwanted petting to rape. Women who are sexually assaulted frequently experience a number of psychological effects, including posttraumatic stress symptoms in the immediate aftermath of an assault and long-term symptoms such as anxiety, depression, and substance abuse (Browne, 1992; Hanson, 1990; Koss, 1993; National Victim's Center, 1992; Resick, 1993). Although the prevalence of sexual assault is difficult to estimate because survivors often do not report the experience to authorities, Koss found that in seven representative samples of adult women, between 20% and 28% of participants acknowledged having been raped at some point in their lives. Sexual violence against women is most frequently perpetrated by men close to them, most often a male partner (Council on Scientific Affairs, AMA, 1992). Despite the emotional sequelae of sexual assault, relatively few survivors either seek formal mental health services soon after the assault, return after an initial visit to a mental health professional, or complete brief postrape treatment programs (Koss & Harvey, 1991). For example, Koss (1988) reported that in a survey of college student rape survivors, only 4% had used rape crisis centers. Women who have been sexually assaulted by someone they know are especially reluctant to enlist professional help (Allison & Wrightsman, 1993; Koss & Harvey). Research indicates, however, that almost half the women who are sexually assaulted will seek counseling eventually (Koss & Harvey). Although survivors may be reluctant to commit to formal mental health treatment owing to a natural resistance to discuss the assault and assume a patient identity, or because of pragmatic constraints such as relocation, they may shun professional services because they believe clinicians are unable to meet their unique treatment needs. Little systematic outcome research on clinical interventions for sexual abuse survivors has been conducted (Foa, Rothbaum, & Stekette, 1993; Koss et al., 1994), although researchers have demonstrated the efficacy of some cognitive-behavioral approaches, including systematic desensitization (Frank et al., 1988), cognitive therapy (Foa, Rothbaum, Riggs, & Murdock, 1991; Frank et al.), exposure therapy (Foa, 1997), stress inoculation training (Foa), composite therapy combining multiple interventions (Echeburua, de Corral, Sarasua, & Zubizarreta, 1996), and eye movement desensitization and reprocessing (Rothbaum, 1997). Positive outcomes also have been demonstrated for some group treatments (Resick, Jordan, Girelli, Hutter, & Marhoefer-Dvorak, 1989; Resick & Schnicke, 1992). Most outcome studies have evaluated brief therapy that is designed primarily for women raped by strangers and conducted soon after the assault. …