Considerations when Targeting Rape with EMDR
In my work, first as a rape crisis responder and now an EMDR therapist, I have witnessed the power of the relationship in helping women recover their lives after sexual trauma.
Women are statistically the most common victim of sexual assault. Men have sexual trauma as well, but working with them is another article. When working with a client who has survived rape one thing I am always mindful of is the relationship. The counseling relationship in many ways mirrors all relationships, and we need to know someone for a while and trust them before we can talk about our most difficult life moments. A benefit of EMDR is that we can help survivors have relief through desensitization from symptoms often in a short amount of time compared with other trauma therapies. Reprocessing tends to be more effective with rape survivors once we have established a strong therapeutic alliance. The very nature of rape violates the survivor in the most personal way, as the rapist attempts to gain control of the survivor's mind and body. Because of this, it can take time with some survivors to establish rapport.
During preparation psychoeducation is key for rape survivors. One of the primary challenges facing rape survivors is that we live in a ‘rape culture’. Our culture has many norms, beliefs regarding sexual objectification of women and girls, victim blaming, denial of rape, minimization of the offender's responsibly, and behavior. In his latest book, Dr. Bessel van der Kolk discusses the importance of language and relationship, "finding words where words were absent before and, as a result being able to share your deepest pain and deepest feelings with another human being….especially if other people in our lives have ignore of silenced us. Communicating fully is the opposite of being traumatized" (van der Kolk, p. 239, 2014). When we provide survivors with psychoeducation regarding rape, we also create a shared language with the client. One that is counter-culture with a healing capacity. There are several significant things it is important to clarify with survivors of rape…
During the preparation phase of EMDR, it is necessary to provide the survivor with an understanding of the dynamics of rape in order to increase her adaptive information on the issue. It is not a surprise that the majority of rape survivors hold a negative belief (negative cognition) in the responsibility category. This NB is difficult to challenge because it is literally embedded in our culture. Common socio-cultural beliefs that set the stage for responsibility themed negative beliefs include victim blaming, lack of understanding regarding legal definitions of rape (i.e., in the state of Iowa a woman cannot consent to sex if she is intoxicated, and husbands can and do rape their wives) as well as some religious beliefs.
We identify both adaptive and dysfunctional neuro-networks in EMDR therapy, the adaptive neuro-network may hold the belief, "I did the best I could at the time" while the maladaptive or ‘stuck in trauma time’ neuro-network believes, "I should have done something different".
A way I begin this conversation with clients is to simply state, one of the weirdest and most devastating things our culture does in response to rape is blame the survivor. Sometimes, I will ask clients if they have any thoughts about why people say stupid things like, "were you drinking, what were you wearing or maybe, did you have consensual sex and then get scared?" Survivors have some wonderfully insightful understandings about this issue. Typically, I will share, "I think it is about fear. If people can believe that someone did something wrong that lead to rape, then they can believe that if they or their loved ones do everything right they will never be raped."
Survivors may share that same thinking with their Negative Belief of responsibility They may feel if they believe they are responsible in some way, they have some control of the future. As long as they never do THAT thing again, they can be safe in the future. Of course, not every rape survivor has a negative belief of responsibility and we must be careful not suggest we think they do.
Survivors may have been drinking at the time of a sexual assault and if so, inevitably this becomes part of the narrative of responsibility and shame. It is an opportunity to discuss how drinking does not equate to rape. When we choose to drink, we know there are some natural consequences. For example, if I drink I might feel tipsy or drunk, if I drink too much I might feel sick or have a hangover, etc. These are all natural consequences of drinking alcohol. However, rape is not a natural consequence of drinking. Yes, some perpetrators use alcohol as a weapon but rape is not a natural consequence of drinking.
The irrational notion that women should somehow fight off the perpetrator also needs to be challenged. This belief again illustrates a cultural message regarding rape. We rarely hear similar statements regarding any other type of violent crime. Have you ever heard someone ask a victim of robbery "Did you fight them off, or scream ‘no’?"
We frequently hear about the ‘fight or flight’ survival response but actually freeze or submit is the most common response for women and children who are being assaulted. And, those with a freeze response are also at increased risk for PTSD. The freeze or submit response occurs because the survival brain is designed to quickly (and often without conscious awareness) decide how to best survive. Historically, the threat for women and children is an adult male, difficult for most women and nearly all children to outrun or outfight, so the brain’s best option is to freeze or submit. Explaining this to survivors is very empowering for those who responded to the rape with a freeze or ultimately a submit response. Psycho -educational information such as this in the preparation phase will increase the adaptive information needed to help survivors of rape achieve more rapid healing.
History Taking/ Target Sequence Planning
History taking as in all EMDR is fundamental, as many adult survivors of rape were also childhood survivors of sexual abuse or some other type of abuse. Once the history is complete, the decision is whether to begin at the touchstone (childhood abuse) or with the most recent adult rape. Both have pros and cons and you will use your best clinical judgment to determine a starting point. When working with a client that has survived pervasive childhood sexual abuse from a caregiver, it is helpful to have a good understanding of developmental trauma and attachment. This type of trauma requires a different approach and there are wonderful EMDR resources on this topic. Laura Parnell and Sandra Paulson both have written extensively on this topic.
Other considerations when creating the targeting sequence plan includes identifying if there is an active investigation or potential trial. Clients who are likely to be a witness in the courtroom need to be given informed consent regarding the impact of EMDR on testimony. Shapiro asserts that clients and attorneys need to be made aware that a witness who receives EMDR may be less emotive in the courtroom. While I agree this is a something that clients and attorneys need to be aware of, I also include that there are some potential benefits for witnesses who complete EMDR. Survivors who have not received EMDR may experience a flood of emotion causing them to use a coping strategy of compartmentalizing, numbing or dissociating, all of which can lead to a client appearing robotic or like an aloof witness. Client's who have not had EMDR may also flood with emotion during testimony. While this may benefit the prosecution in some ways, it also makes it difficult to give a complete testimony of events. Clients who have completed EMDR may not flood with emotion but still may experience appropriate sadness or grief when retelling their story. An important result of EMDR therapy can be a more coherent witness compared to the survivor who floods with emotion when testifying.
As part of the targeting plan, clients can benefit greatly from starting with the fear of being in the courtroom with the offender or a future template of rehearsing how they would like to manage the courtroom experience. With the processing continuum (EMD/EMDr/EMDR) there are many options for titrating the desensitization process. I have frequently used future processing or restricted (EMD) with clients over the specific image of seeing the offender in the courtroom or providing testimony.
During processing attunement remains critical to assist the survivor in staying within the window of tolerance. The clinician needs to watch for any sign of dissociation and respond appropriately with grounding if needed. During all phases of EMDR with a rape survivor, using strengths based empowerment language is also incredibly helpful. Remembering that the nature of rape is to take away all of a victims choices, empowering interweaves such as, "You survived" "You're taking back your life" can be helpful for moving processing along.
Having knowledge of the processing continuum from Kiessling (2014) gives us several options. A-TIP for crisis management can be helpful in bringing down acute stress from the incident. Restricted (EMD) processing is an effective option for specific disturbing aspects of the assault such as something hurtful or shaming said by a loved one or an official. If concerned about stability, restricted processing can be very helpful for reducing acute distress. While the processing continuum allows for multiple options, the ideal processing for the actual rape is unrestricted (EMDR standard protocol) processing. Few moments are as powerful in therapy room as when the survivor reports feeling so distant from her negative belief that she can barely relate to it anymore. EMDR is wonderful tool for helping women reclaim their lives after rape.
Author note: I have intentionally used the word rape in this article as sexual assault is broad term and I am writing here about the specific crime of rape. I believe using the word rape can be helpful for the client as sexual assault can feel like a minimization of their rape.
– Amy Terrell LMHC
Certified EMDR Therapist
EMDR Approved Consultant