On the last track, we discussed four important concepts in the treatment of a cases of crisis precipitated by a sudden status change. These four concepts are understanding social roles, assessment, intervention techniques, and anticipatory planning.
On this track, we will discuss four concepts regarding crisis counseling following rape. These four concepts are McDonald’s phases of reaction, guilt, an intervention technique for rape victims in crisis and their partners, and an overnight care technique.
Crisis Counseling Following Rape - 3 Concepts
#1 - McDonald’s Three Phases of Reaction
I find an initial step regarding crisis counseling following rape is McDonald’s three phases of reaction.
Phase One: "acute reaction," is characterized by a victim in either a disorganized, emotionally active state, or an emotionally contained state with only occasional signs of emotional pressure, such as increased motor activity or inappropriate smiling.
Phase Two: "outward adjustment" is described as a period in which the rape victim goes through a denial of the emotional impact of the rape. He or she may restore their social life, reject attempts at assistance, and attempt to carry on as if nothing has happened.
Phase Three: "long term process – reorganization," is characterized by emotional confrontation with the experience, changes in life space because of the trauma, nightmares, and deterioration of sexual relationships. As you can see from McDonald’s stages, crisis counseling is an ideal approach to use with many rape victims. Crisis intervention allows the rape victim an opportunity for emotional catharsis, reality testing for self-blame, active short term support, and assistance in identifying situational supports available.
#2 - Guilt
In addition to McDonalds phases of reaction and types of rape, a second reaction regarding crisis counseling following rape is guilt. I have found that many women cannot accept themselves as a victim unless others in their lives acknowledge that something extremely disruptive has occurred in the victim’s life. The victim’s claim to having been victimized often needs confirmation from others. Additionally, I have found that many clients experience guilt because they feel that they ‘submitted’ to the rapist’s demands. This guilt may occur even in victims who were physically beaten, or whose lives were threatened with a weapon.
I feel that one cause for this guilt is the popular medical misconception that penetration, and thus rape, cannot fully occur if a victim, especially a woman, is unwilling. I often find that this clearly false belief needs to be addressed during crisis counseling for a rape victim. Do you agree?
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#3 - Intervention Technique for a Rape Victim in Crisis
Third let’s look at an intervention technique for a rape victim in crisis. Angela, 26, was a legal secretary who was brought to the crisis center by her employer. That morning on her way to work, Angela had been raped by a stranger. Angela had returned home, showered, changed clothes, and calmly gone to work, where she matter-of-factly announced to her employer what had happened. Her employer encouraged her to go to the hospital, but Angela stated she was fine. However, by midafternoon Angela was acting disoriented and confused, and her employer drove her to the crisis center.
After hearing Angela’s story, my first step in the crisis intervention was to make sure that Angela was seen by a doctor for the minor injuries she had sustained, and so that a rape kit could be collected. Angela was understandably upset at the thought of the procedure. I explained to Angela that a female from the rape crisis team would be with her during the entire procedure, and that I would call ahead to ensure that Angela was seen by a female physician and questioned by a female police officer. When Angela returned, she was pale and trembling, but in control, and stated that while the procedure had been highly unpleasant, it was not as negative an experience as she anticipated.
Since Angela was still very frightened, I asked her if she had a friend or family member that she would like to contact and possibly have spend the night with her. Angela became very distressed and stated, "Oh my God, Ryan!!" When I asked who Ryan was, Angela hesitantly admitted Ryan was her fiancée. Angela became distraught, and stated, "I am so ashamed… Ryan will probably hate me… he will probably never want to touch me again! What have I done?!" I stated clearly to Angela, "You have done nothing wrong." Angela continued to cry and berate herself. Once she had calmed down, Angela asked me if I would call Ryan and explain to him what had happened.
I of course believe in client empowerment, but due to Angela’s crisis situation, I placed a call to Ryan, who reacted with concern and anger, and asked if he could see Angela. I explained that he could come to the center and ask for me by name. Due to Angela’s request, I met with Ryan alone, and explained, with Angela’s permission, the full details of what had occurred. Ryan began to cry and curse, stating, "Oh God… my poor Angela… I’ll find that bastard and kill him!"
When Ryan calmed down, I asked him specifically if his feelings for Angela had changed. Ryan appeared startled, and asserted that he loved Angela. I explained Angela’s concerns that he would reject her. In response Ryan stated clearly, "Of course I still love her! This was in no way Angela’s fault!"
#4 - Overnight Care Technique
Since Ryan expressed a desire to do everything possible to help Angela, I walked Ryan through what to expect from Angela and the Overnight Care technique. I felt working with Ryan was an important part of resolving Angela’s crisis. I explained to Ryan that after being raped, women usually feel guilty, unclean, and fearful of intimacy with another man, even a loved one. I stated, "Angela will need your strength, love, and constant reassurance that nothing has changed between you."
I stated to Ryan, "The overnight care technique works like this: If Angela agrees, spend the night at her apartment.
If Angela gives permission, hold her, touch her, and reaffirm your love for her.
Speak with Angela about your upcoming marriage so she knows your intentions are still the same.
Do not attempt to initiate sexual intercourse unless Angela asks."
After speaking with Ryan, I met alone with Angela to repeat to her what Ryan had said. I found that by intermediating between Angela and Ryan, I was able to reduce some of the tension and anxiety Angela was experiencing regarding asking her most trusted source of situational support for help.
My next several crisis interventions... were joint sessions with Angela and Ryan. The focus was on ventilation of their feelings and helping Angela express anger towards her rapist. Think of your Angela. Does she or he have a supportive partner, like Ryan, who could be a valuable asset to crisis counseling following rape?
On this track, we have discussed three concepts regarding crisis counseling following rape. These four concepts are McDonald’s phases of reaction, guilt, and an intervention technique for rape victims in crisis and their partners.
On the next track, we will discuss four concepts regarding therapeutic crisis intervention in the case of a premature birth. These four concepts are four tasks for the mother of a premature infant, assessing the family, interventions, and anticipatory planning.
Peer-Reviewed Journal Article References:
Armour, C., Shevlin, M., Elklit, A., & Mroczek, D. (2012). A latent growth mixture modeling approach to PTSD symptoms in rape victims. Traumatology, 18(1), 20–28.
Resick, P. A., Williams, L. F., Suvak, M. K., Monson, C. M., & Gradus, J. L. (2012). Long-term outcomes of cognitive–behavioral treatments for posttraumatic stress disorder among female rape survivors. Journal of Consulting and Clinical Psychology, 80(2), 201–210.
Silverman, D. C. (1978). Sharing the crisis of rape: Counseling the mates and families of victims. American Journal of Orthopsychiatry, 48(1), 166–173.
Online Continuing Education QUESTION 10
What are the four steps in the Overnight Care technique for a the partner of a client in rape crisis?
To select and enter your answer go to .