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Balancing the Power Dynamic in the Therapeutic Relationship

Section 14
Disclosure of Sexual Assault

Question 14 | Test | Table of Contents

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Most survivors eventually disclose the abuse to people that they trust including relatives, close friends, family, physicians, and therapists. "Breaking the Silence" refers to broader disclosure, encompassing complaints to professional bodies, lawsuits, and public statements, as mentioned earlier -- anything that alerts the professions and the public to the common occurrence and tragic consequences of abuse by health professionals.

Breaking the silence
is not for everyone, and it can be personally disastrous or counter-therapeutic. The old adage, "The best revenge is a good life" depending on the client's needs, may be the best strategy here.

As mentioned earlier, breaking the silence is made difficult by a number of factors, including survivors' feelings, community attitudes and lack of support, the self-protective stance of the health professions, and the idiosyncrasies of the legal system.

♦ Dealing with Emotions that Obstruct the Desire to Break the Silence
Emotions that obstruct survivors' desire to break the silence include shame, self-doubt, and fear. The problems created by the sexual abuse, including pervasive self-doubt about their own judgment, perceptions, and motives, combine with shame and self-blame to make a complaint or public disclosure seem impossible. Who wants to confess publicly that she was duped and used?

Quite rightly, survivors fear the consequences of disclosure. They hear tales of husbands divorcing patient-wives, of children being taken away, and of their humiliating sexual secrets being made public. Most survivors are angry with the health professions and reluctant to trust boards of inquiry and committees that consist of other professionals who work in the same field. Still struggling with guilt about their own complicity and lingering positive feelings towards the professional, some survivors hesitate to take the step that may cause the offending health professional pain or even damage his career.

♦ 4 Patterns of "Victim Thinking"
Michaels believes that "victim thinking" can be traced to one of the following four common patterns of thinking that emerge during the actual trauma, during secondary wounding experiences. Ask yourself if you have observed these four patterns in your abuse survivors:
1. The person cannot tolerate mistakes in him or herself or others.
2. Personal
difficulties are denied.
3. Black-and-white
thinking prevails.
4. Survival
tactics are continued.

Because of the severe damage often sustained by people who are sexually abused by mental health professionals, the frequency of secondary wounding experiences is high. Immersed in a desire for revenge or compensation, lacking community and family support, unable or unwilling to get therapeutic help, still struggling with PTSD symptoms, they may be unable to transcend the victim identity and unable to get on with their lives.

♦ Helping Mary through Breaking the Silence
Here is an example of what I stated to Mary as she was in this "Breaking the Silence" stage. "There is no such thing as "resolving" your trauma issues and being "done" with your past. For the truly traumatized, there is no "forgetting" and no amount of therapy or mind-control can protect you from traumatic memories, feelings, and conflicts coming back into your life. However, if you have never really attended to the trauma, if your trauma-processing work has been half-hearted or incomplete, then your present-day life is saddled with a major burden: the issues from your traumatic past with which you have not dealt.

"If you haven't spent adequate time dealing with the trauma and are trying to suppress or minimize what happened to you, then you are spending your energy fighting yourself. If this is the case, it is no wonder that you are exhausted and have little energy for other people. Most of your energy goes to keeping the trauma in denial or repression and managing your symptoms, so they don't get out of control and cause an economic or emotional disaster. Essentially, you are spending your time and strength trying to pretend the trauma never happened, or trying to convince yourself that it wasn't that important and, of course, you can handle it (and the emotions and issues that it raised) all by yourself."

♦ Allow a Perpetrator to Resume Practice?
Regarding breaking the silence, Kenneth Pope states there is a tendency of licensing boards and bodies to assume that perpetrators can be rehabilitated. Pope suggests that this "may support a deep and chronic sense of special entitlement among therapists." In other professions, Pope maintains, sexual offenders would not be allowed to return to their job in contact with the population that they had abused. Allowing a perpetrator to resume a limited therapy practice, he points out, such as seeing only male patients, ignores the more fundamental issue of abusing a position of the balance of power and trust.

Pope draws attention to a case where a psychiatrist was prohibited from treating females, and stresses that such interventions "do little to address the underlying failures of self management that characterize patient-clinician sexual contact." He feels there is a failure to focus on the development of a therapeutic alliance essential for treatment to proceed... Pope states a concern that a clinician who cannot be considered competent to treat women should be considered competent to treat men.

Pope feels licensing boards need a great deal of education to make them aware that sexual abuse of clients, like other varieties of sexual assault, is not just about sex. Other dimensions such as the balance of power differential between mental health professional and client; the mystique and special entitlement accorded to health professionals; the breach of trust and fiduciary duty; the lack of caring, empathy, and concern; as well as other personality and situational factors, are all involved. I feel if mental health professionals who sexually abuse clients are allowed to return to practice, they should have a lengthy period of monitoring and supervision as there is little evidence that rehabilitation plans are effective, and literature indicates the recidivism rate is high.
Reviewed 2023

Peer-Reviewed Journal Article References:
Campbell, R., Javorka, M., Gregory, K., & Vollinger, L. (2021). Supporting sexual assault survivors with disabilities: Tracing disclosure and referral pathways to postassault health care services. American Journal of Orthopsychiatry. Advance online publication.

DeCou, C. R., Cole, T. T., Lynch, S. M., Wong, M. M., & Matthews, K. C. (2017). Assault-related shame mediates the association between negative social reactions to disclosure of sexual assault and psychological distress. Psychological Trauma: Theory, Research, Practice, and Policy, 9(2), 166–172. 

Gueta, K., Eytan, S., & Yakimov, P. (2020). Between healing and revictimization: The experience of public self-disclosure of sexual assault and its perceived effect on recovery. Psychology of Violence, 10(6), 626–637.

Hakimi, D., Bryant-Davis, T., Ullman, S. E., & Gobin, R. L. (2018). Relationship between negative social reactions to sexual assault disclosure and mental health outcomes of Black and White female survivors. Psychological Trauma: Theory, Research, Practice, and Policy, 10(3), 270–275.

What are some feelings an abuse survivor experiences to detour him or her from informing others? To select and enter your answer go to Test.

Section 15
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