Should I consider therapy?
It’s totally up to you to decide. Seeking support from a therapist after sexual assault, sexual harassment or sexual abuse is your decision and should never be forced on you. Many people find therapy to be important in their healing process. Others never see a therapist and find their own ways of healing. Many survivors have said that peer support - connecting with a peer who can provide support and has similar lived experiences - has been critical to their healing.
You may have some questions you want answered before you decide; below are some frequently asked questions.
What is therapy?[See: RAINN]
Therapy is an opportunity to unpack and understand your experience in a non-judgmental environment so that you can develop new coping skills, ways to deal with your feelings, and strategies for managing stress. You can also explore thoughts and feelings that you may not feel comfortable expressing to a friend or family member.
Healing is a process – it takes time.
For some, the healing process for an emotional wound is similar to a physical wound. Some wounds will heal themselves, others require intervention. You can make sure the wound doesn’t get infected by taking care of it as soon as possible. Once the wound is addressed, it will begin to heal and a scab will form. The scab will eventually fall off, and a scar may be left (or not). The scar is not life threatening, but it is a reminder of the injury. Not dealing with the serious wound at the time of the injury can lead to long term impacts. This is also true of psychological wound. Some people heal on their own; others need and want intervention. There is no ‘right’ way to heal – everyone has to find the way that works best for them. Trust your gut about what you need.
Contact your local sexual assault centre to talk about what is available in your community. There are often free sessions available and also fee-for-service therapists and counsellors. There may be a waiting list for the free sessions and they will be time-limited.
What should I consider if I’m looking for a therapist?
Experience with your issue
If you survived a trauma like sexual assault, abuse or harassment, it can be helpful to know that your therapist has experience working with your specific challenges. Ask about their experience working with survivors of sexual violence and how they’ve helped them overcome issues specific to this kind of trauma.
Feels like a fit - Personality Success in therapy depends on creating an open, honest dialogue with your therapist. It’s often easier to open up when you “click” with your therapist’s personality and style. It’s okay to interview a few prospective therapists on the phone or have a couple of sessions before finding the right fit. If the therapist doesn’t feel like a fit for you – find someone who does.
Type of therapy
There are different approaches, or theories, of psychotherapy that will influence how your sessions play out. Some forms of therapy involve more talking, while others involve more “homework” or exercises to practice after your session. Some, like EMDR, use a specialized technique and protocol that the therapist will explain before beginning. Some therapists subscribe to a particular theory, while others may blend elements from multiple approaches.
Who are therapists?
The term psychotherapist, or “therapist,” is an umbrella term for a mental health professional who is trained to help people who are dealing with challenges in their lives, including recovering from traumatic experiences. Therapists come from different educational backgrounds, including psychology, psychiatry, social work, or counseling, and are registered with professional associations. There are differences in what they believe about trauma and healing. Ask them.
A safe, confidential space
Generally, what you say to your therapist will remain private. Therapists know that in order to be comfortable sharing very personal information, you need the trust that anything you share will stay between the two of you. There are a few exceptions to this rule to keep you and others safe. For instance, if you tell the therapist you are thinking about hurting yourself or another, the therapist may notify a family member or law enforcement in order to keep everyone safe. Also, if a therapist has ‘reasonable and probable grounds to suspect a child under the age of 16 is in need of protection’ they are obligated to report that to the local child protection agency. Your therapist should let you know about the limits of confidentiality early in your relationship.
Talk about timelines
While there is no timeline for recovering from sexual assault or abuse, you may be able to work with a therapist for a defined amount of time to help you find ways to heal from the experience. Therapeutic treatments are designed to give you to tools to structure your life and interact with your environment in a healthy way that works for you. Some people are ready to leave therapy after a few months. Others find a therapeutic relationship to be beneficial and want to continue counseling for a longer period of time.
You can, and should, talk about timelines with your therapist. A flexible timeline can help you set goals for recovery and make it easier to track your progress. When you’re ready to leave therapy, remember that the door doesn’t have to remain closed. You can always schedule a check-in appointment at a later time or resume therapy if you need it.
You may decide at a certain point that your relationship with your therapist isn’t working out. Maybe you aren’t seeing the progress you had hoped, or maybe you feel that you just don’t “click.” For the sake of your own health and progress, don’t abruptly stop attending sessions. Consider the following tips to help you through process of transitioning to new support.
- First, write out your concerns. Then set them aside for a little while. Review this list later when you’ve had some time to think about it. It can be helpful to bring this list into a session with your current therapist to guide a conversation about your concerns.
- Communicate with your therapist. Ask to reserve time at the end of the appointment to discuss your concerns. It can seem intimidating to tell a therapist you wish to leave. Remember that they are professionals. Most therapists will be able to give you a referral for another professional that might be better suited for your particular situation.
- Get a second opinion. If you’re not sure that this current treatment is working out for you, you can seek the opinion of another professional. They may confirm your concerns or they could reaffirm that you are on the right track.
- Be prepared to retell your story. A new therapist won’t know your personal history. You may have to retell parts of your life that you haven’t addressed explicitly in a while. You are entitled to ask for a copy of your records to share with your new therapist, but it’s likely that they will want to do their own assessment.
Different kinds of therapies
Therapies that can be helpful:[Adapted from National Institute of Justice]
For the most part, therapy models that focus on helping victims recover from trauma can be categorized into three frameworks:
- Cognitive-behavioral model- treatment is aimed at changing a person’s behaviors within their environment. The model weaves together cognitive (thinking), behavioral (behaving), and social learning theory components. Examples of specific cognitive-behavioral approaches include exposure therapy or prolonged exposure, stress inoculation training, eye movement desensitization reprocessing, cognitive processing therapy, and assertiveness training.
- Psychodynamic psychotherapy- focuses on several areas such as:
- the expression of emotions,
- the exploration of avoidance of distressing emotions,
- the examining of past experiences,
- the identification of defense mechanisms, and working through interpersonal relationships.
An important part of psychodynamic psychotherapy is bringing the person’s conflict and inner tensions from the unconscious into the conscious so that they can better manage and experience healthier functioning.
- Supportive psychotherapy or supportive counseling may be provided in individual or group settings, and allows an individual to share traumatic experiences and the symptoms that resulted from the event. Supportive approaches aim to normalize experience, instill hope, increase interpersonal learning, and decrease an individual’s sense of isolation.
I have heard about EMDR for trauma – What is it?
The mind can often heal itself naturally, in the same way as the body does. Much of this natural coping mechanism occurs during sleep, particularly during rapid eye movement (REM) sleep. Francine Shapiro developed Eye Movement Desensitisation and Reprocessing (EMDR) in 1987, utilizing this natural process in order to successfully treat Post-traumatic Stress Disorder (PTSD). Since then, EMDR has been used to effectively treat a wide range of mental health problems.
What is a session like?
EMDR uses the natural healing ability of your body. After a thorough assessment, you are asked specific questions about a particular disturbing memory. Eye movements, similar to those during REM sleep, are recreated by asking you to watch the therapist's finger moving backwards and forwards across your visual field. Sometimes, a bar of moving lights or headphones is used instead. The eye movements last for a short while and then stop. You are asked to report back on the experiences you have had during each of these sets of eye movements. Experiences during a session may include changes in thoughts, images and feelings. With repeated sets of eye movements, the memory tends to change in such a way that it loses its painful intensity and simply becomes a neutral memory of an event in the past. Other associated memories may also heal at the same time. This linking of related memories can lead to a dramatic and rapid improvement in many aspects of your life.
- National Institute of Justice
- Public Health Agency of Canada
- The National Center for Biotechnology; McGill Journal of Medicine
- What is EMDR?
See also: Finding and Evaluating Therapists on 1in6 resources for boys / men who have experienced sexual violence