With the rise in sexual violence cases — rape, molestation, child sexual abuse, trafficking and so on — many victims and survivors have come forward with a greater than ever chance of being believed and responded to, therefore they need to be assured that they will get access to the type of therapy that will not re-traumatise or shame them. It is important for counselling practitioners to have a good understanding of the intricate dynamics of complex trauma, sexual violence and child sexual abuse, to be able to provide the appropriate therapeutic intervention.
What is trauma and complex trauma?
The meaning of trauma is often contested among clinicians, researchers, practitioners and the survivors of trauma. The American Psychiatric Association’s Diagnostic and Statistical Manual (DSM V) defines trauma as “exposure to actual or threatened death, serious injury or sexual violation in which intense fear, horror or helplessness predominates.” This can occur either through a single event or repeated traumatic events.
Complex trauma is usually associated with prolonged, repeated traumatic experiences which involve multiple violations such as sexual assaults, physical violence, emotional abuse and neglect and often committed by someone known to the victim. In contrast to a single traumatic event, the repeated betrayal of trust, in which abuse masquerades as protection or affection, gives rise to a range of symptoms such as dissociation, alterations in sense of self, and fear or intimacy in relationships.
Symptoms of trauma and complex trauma
About one third of survivors of trauma and complex trauma develop symptoms of Post Traumatic Stress Disorder (PTSD) and it is more commonly diagnosed in females. This trend can be attributed to the difference in the male-female coping styles. Females tend to seek help for their symptoms whereas males tend to mask their symptoms and often take to self medication and alcohol or drugs. Common symptoms of PTSD include:
Re-experiencing: It is the most typical and commonly occurring symptom, wherein the individual involuntarily and vividly re-lives the trauma in the form of flashbacks, nightmares and physical sensations such as pain, sweat, nausea or trembling.
Avoidance and emotional numbing: In order to suppress or push memories of the traumatic event, individuals avoid certain people or places that remind them of the traumatic event. Some individuals try to deal with their emotions by shutting off and not feeling anything at all, which can lead to isolation and severe depression.
Hyperarousal: Can be simply understood as “feeling on edge”. Individuals with PTSD can be very anxious and their hyperarousal often leads to irritability, angry outbursts and sleep disturbances (insomnia).
Role of specialised practitioners
Mental health clinicians and practitioners have a huge role to play in the rehabilitation of sexual trauma survivors. There is a dearth of specialised counsellors and therapists dealing with sexual trauma in the country. Existing practitioners can undertake specialised trauma training courses, usually available online and affiliated with good institutions. They can also participate in workshops hosted by a number of leading NGOs working with survivors of sexual violence such as those organized by RAHI Foundation. Recently, a project funded by the US Department of Health and Human Services, Administration for Children, Youth and Families’ Children's Bureau has also invited practitioners to attend their training programme — A cultural adaptation of Trauma Focused Cognitive Behavioral Therapy (TF-CBT). Lastly, making use of counselling manuals designed for practitioners with a focus on planning therapeutic interventions with sexual trauma patients can also be immensely helpful.
The author is a fellow of the Higher Education Academy of UK, and Doctoral Researcher at Anglia Ruskin University