Content warning: sexual violence
As a psychotherapist with almost a decade’s worth of experience, I’m used to the logistics of appointments within my private practice. Usually, I receive an email asking to book an initial meeting. Once we agree on a suitable time, I send information on my location, and check for any accessibility requirements. Simple? Not so.
I work with a lot of different mental health concerns and hold specialist skills in the impact of sexual violence. In addition to seeing adult clients one-to-one, I have set up and managed services within women’s organizations. This means I have witnessed many people’s accounts of their lives, and what has happened to them.
One thing you don’t learn in training is all the barriers people have to navigate to get the support they need within the mental health system. Before this comes the societal barriers of our world. Using your voice to say you’ve been sexually violated is one thing, raising your hand to seek help is another. Reporting to the police is often re-traumatizing.
In my experience, the further one moves away from being white, middle class, able-bodied, educated, cisgender, and heterosexual, the harder it is to navigate this system—and it’s hard enough as it is. Regardless, for any survivor of sexual violence, there are repeated experiences of disbelief, disempowerment, silencing, and a loss of control during the process of seeking support.
One way to gain insight into someone’s journey through the mental health system is from managing waiting lists. I see someone’s referral, add their name to a list, have them or their referrer contact me to ask when they’ll be offered an appointment (usually several times, as there can be over a years’ wait for specialist help), finally arrange an appointment, and then perhaps they don’t attend. Maybe after a while, they’ll get in touch again, ask to go back on the list because they now feel ready to talk, and the whole process starts again.
Survivors who do get through the door of a therapeutic service bring internalizations of these barriers with them, which usually manifest as negative thoughts as they try to make sense of their experiences. Talking about the #MeToo movement, other survivors they know, and the latest high-profile man to have dozens of allegations raised against him shows me how blame, shame, and guilt repeatedly arise as challenges to recovering from sexual violence.
Survivors react differently toward the news cycles we’ve sadly become accustomed to. Some are sympathetic, some are re-traumatized, and some are defensive. When you’ve recovered from the latest way of being confronted with the matter, you’re left with a mind and body that feels disrupted. What happens then?
Misconceptions About Trauma
Sometimes what happens is more silence, more disempowerment. People think that being full of emotion is the default reaction, but it’s also common to feel nothing at all. This is partly down to misconceptions that we’ve all internalized. For example, Why didn’t you fight back/stop it/push them away? or, Why aren’t I angry/sad/over it yet?.
When sexual violence happens, the layers of the brain associated with survival are activated to override everything else. The most common response is to freeze, although fight and flight can happen too. The experience of processes that are usually unconscious, and implicit forcing themselves to the forefront of our experience can make us feel out of control of our minds and bodies.
This can be wariness around someone you feel safe with (scanning for potential danger) or struggling to be fully present in your body (dissociation). The disconnect between the layers of our brain is mirrored in the disconnect that happens because our sense of self, others, and the world have been forcibly re-configured. Survivors experience this as a sense of unintegration, disconnection, or a shattered self.
What happens to our brains and bodies when we’ve been through something traumatic, such as sexual violence, is a component of healing that survivors must address. Integration and communication between the different layers of our brain allow the body and mind to be better integrated, and the same follows for the different aspects of ourselves and lives as a result.
Living in the World as a Survivor
Facilitating the ways people navigate this re-configured world is a huge part of my role as a psychotherapist and, of course, the real work is learning how to fully exist again as a person you recognize. This is especially true as the world changes in ways survivors can’t verbalize, but it’s felt in all layers of who they are. Often, this can be physical symptoms where the past comes alive in the present such as flashbacks, nightmares, nausea, and muscle tension.
These are normal symptoms and point to the difficulty that human bodies and brains have in processing traumatic experiences. Added to this is the fact that humans need safety, trust, and connectedness to exist in the world, and with other people. Sexual violence, as an act occurring between person to person, defies these principles. Therefore, an explicit focus on my working relationship with a survivor is part of the reparative experience.
Psychotherapy can, and should, be a safe space for survivors but it’s a very particular bubble within a world that enables sexual violence to happen. Navigating the mental health system to find a professional that appropriately responds feels impossible especially if your internal dialogue makes blame, shame, and guilt your only companion. Often I’m told, ‘Someone else deserves this appointment more than me.’ That is never true.
Offering a different experience than what society, and our internal dialogue, provides is key in addressing each domain affected by sexual violence. Psychotherapeutically responding to manifestations of these is vital in challenging the complex impact of trauma. When a positive internal shift happens, a survivor can position themselves in the world with more strength, power, and assurance.