Doctoral Interns’ Perceptions of Preparedness to Work with Victims and Survivors of Sexual Assault at University Counseling Centers

ABSTRACT

Counselors at university counseling centers (UCCs) should be prepared to provide services to sexual assault victims and survivors, as an estimated 23% of females and 5% of males are assaulted during college, with rates being higher for sexual and gender minority students. We surveyed doctoral interns (N = 49) at UCCs regarding interns’ training and educational experiences during their graduate programs, practicum, and internship placements, as well as the services that the interns and UCCs provide to recent victims. Among our findings, 96% of the sample had expected to work with a recent victim, 82% had already done so, and only 22% perceived themselves as fully prepared to provide such services. In addition, the majority of UCC interns had focused on sexual assault cases during case conferences, didactic trainings, and supervision. These results have implications for graduate programs and internship sites.     

Responding to Sexual Assault Victims: Considerations for College Counselors

College counselors need to be informed of effective interventions when counseling students who have been sexually assaulted. This article applies research and theory from the general literature on counseling sexual assault victims to college counselors' work with this population. An overview of the effects of sexual assault is followed by specific implications for counseling students who have been sexually assaulted.     

Drug‐Facilitated Sexual Assault on Campus: Challenges and Interventions

The use of gamma‐hydroxybutyric acid (GHB) to facilitate sexual assault is increasing on campuses nationwide. This article provides college counselors with an overview of the use of GHB in campus sexual assault, outlines suggestions for crisis intervention, and discusses the challenges of counseling survivors of drug‐facilitated sexual assault.     

Pathways from childhood abuse to prospective revictimization: Depression,sex to reduce negative affect,and forecasted sexual behavior

Research suggests that adverse events in childhood, such as childhood physical, sexual, and emotional abuse, confer risk for later sexual assault. Psychological distress, coping strategies, and sexual behavior may help explain the path from childhood abuse to revictimization. The present study explored how the use of sex to regulate negative affect (SRNA) operates independently, and in combination with other psychosocial factors to increase college women's (N = 541) risk of experiencing prospective adult sexual assault (ASA). Sequential multiple mediator models in Mplus were used to assess the effect of three different forms of childhood abuse on prospective ASA, both independently and while controlling for other forms of childhood abuse. The indirect effect of adolescent sexual assault (AdolSA), depressive symptoms, SRNA, and participants’ response to a sex-related vignette was tested using bias-corrected bootstrapping. In the full path model, childhood emotional abuse and AdolSA predicted ASA, while childhood physical and sexual abuse were directly associated with AdolSA, but not ASA. Additionally, depressive symptoms and participants’ estimate of their likely behavior in a sex-related vignette directly predicted prospective ASA. Results using bootstrapping revealed that a history of childhood abuse predicted prospective ASA via diverse direct and indirect paths, as well as through a similar multiple mediator path. Overall, findings suggest that a combination of affective, coping, and sexual expectancy factors contribute to risk for revictimization in adult survivors of childhood abuse. Future research directions and targets for risk-reduction programming are discussed.     

Quality Improvement in University Counseling Centers

University Counseling Centers (UCCs) experience high clinical demands and severe client presentations leaving counselors with limited time and resources to evaluate delivery of services. In this article, we present clinician-friendly quality improvement (QI) strategies used at a large Midwestern university and provide recommendations for implementing QI programs at other UCCs even as their resources may vary. With counselor-led efforts examining and evaluating services, UCCs can use QI programs to inform and improve counseling practices as well as advise university administrators about the positive outcomes of the center’s work.     

The International Platform of Sexuality & Relationship Education

This study was an investigation of the additional risk conferred by the experience of psychogenic amnesia for memories of childhood sexual abuse (CSA) on the likelihood of becoming a victim of sexual assault in later life. A total of 210 community respondents completed a retrospective web-based trauma survey. The majority of respondents were female (74.3%) and their ages ranged from 16 to 65 years, with a mean age of 33 years. Chi-squared analysis revealed that survivors of CSA demonstrated significantly greater risk (58%, χ^2 = 44.461, p = 0.0005) of experiencing sexual assault in adolescence in comparison with their non-abused counterparts (13%). Furthermore, survivors who reported having been amnesic for their abuse-related memories demonstrated a higher rate of adolescent revictimisation (86%) than survivors who had retained continuous memories of their victimisation (48%, χ^2 = 8.626, p = 0.003). Overall, once-amnesic survivors of CSA demonstrated 6.6 times the risk of sexual assault and an eight-fold risk for rape during adolescence in comparison with their non-abused counterparts. It is proposed that the elevated risk conferred by amnesia for CSA might be mediated by two distinct pathways, both of which are associated with the use of dissociation as a defence mechanism.     

The impact of child sexual abuse and stigma on methods of coping with sexual assault among undergraduate women.

OBJECTIVE: The aim of the current study was to determine whether a prior history of child sexual abuse increased the likelihood of using disengagement methods of coping with a sexual assault that had occurred within the past year. Once this was established, a mediational model was tested in which it was hypothesized that specific traumagenic dynamics and changed world views would mediate the association between child and/or adolescent sexual abuse and increased use of disengagement coping methods in response to a recent sexual assault. METHOD: One thousand and fifty women undergraduates from a New England state university completed a survey for research credit. Respondents were asked detailed questions regarding experiences of sexual assault within the past year, histories of child and/or adolescent sexual abuse, traumagenic dynamics, and world assumptions. Analyses were based on 106 participants who had experienced a sexual assault within the past year. RESULTS: Sexually assaulted young women with a history of child sexual abuse used more disengagement methods of coping to deal with the adult sexual assault than women without this history. In addition, the relationship between prior sexual abuse and the use of disengagement coping strategies was mediated by feelings of stigma, but not by feelings of betrayal and powerlessness or beliefs in the meaningfulness and benevolence of the world. CONCLUSIONS: This is the first study to find that sexually revictimized young women may be particularly at-risk of relying on disengagement methods of coping with sexual assault. Furthermore, this association is mediated by feelings of shame or stigma. Directions for further research and clinical implications are discussed.     

Group treatments for women sexually abused as children: a review of the literature and recommendations for future outcome research

OBJECTIVE: Adults with a history of sexual abuse often suffer many long-term consequences. It is important that therapists be able to provide effective treatment to address the host of issues that are presented in therapy by adult survivors of childhood sexual abuse (CSA). In order to provide the best possible treatment, therapists should know which treatments are most effective. METHOD: This paper provides a critique of the outcome research of 13 studies (six uncontrolled and seven controlled) on the treatment of adults who suffered childhood sexual abuse and discusses specific methodological strategies that can enhance the quality of such research in the future. RESULTS: Although many of the studies contain methodological limitations, the results generally indicate that group treatment helps reduce symptomatology in the short-term and at follow-up. CONCLUSION: Although outcome research has not been published on specific individual or conjoint treatment approaches for adult survivors of CSA, several outcome studies have found group treatment to be effective in the recovery of female CSA survivors.     

Sexual Assault Is Just the Tip of the Iceberg: Relationship and Sexual Violence Prevalence in College Students

With the advent of the “Dear Colleague” letter in 2011, higher education institutions have become focused on sexual assault and related policies, procedures regarding offenses, and prevention education. Institutions should consider using this spotlight on interpersonal dynamics to increase awareness about other types of relationship violence that may be more common. This secondary data analysis of 72,067 U.S. college students indicates stalking, emotional abuse, and physical abuse are very common. Along with relationship difficulties in general, these forms of relational violence occur more frequently than sexual assault. Implications for counseling and mental health services are provided.     

The Utility of an Efficient Outcomes Assessment System at University Counseling Centers

Due to increased demands placed on university counseling centers (UCCs) in recent years, there is a need for these centers to enhance the efficiency and effectiveness of their psychological services. Regularly monitoring client progress is one approach to increase the likelihood of positive clinical outcomes. This article describes the use of the Behavioral Health Measure–20 (BHM-20; Kopta & Lowry, 2002) in monitoring the progress of 13,803 clients at 23 UCCs across the United States from 2006–2011. Results show that the BHM-20, via the CelestHealth System–MH (CHS-MH), is an effective instrument for the electronic administration, scoring, and tracking of client progress. Overall, clients improved over the course of treatment and the benefit from treatment peaked between 7 to 10 sessions. Three case vignettes using the CHS-MH in patient care are presented. Implications for continuing the use of monitoring individual client change at UCCs are discussed.     

Supporting youth involved in domestic minor sex trafficking: Divergent perspectives on youth agency

Domestic-minor sex trafficking (DMST) continues to affect youth in the United States; however, lack of empirical evidence for interventions and the complex sociopolitical discourses surrounding sex trafficking and the commercial sexual exploitation of children (CSEC) hamper delivery of effective services to this population. To explore perspectives on best practices with these young people, 20 in-depth interviews were conducted with key stakeholders whose work provides them with a unique vantage point on the needs and experiences of survivors of DMST in New Jersey. Notes from interviews were coded and analyzed for emergent themes. While key stakeholders generally agreed on best practices, there were several important areas of dispute that emerged regarding how best to serve youth involved in DMST, specifically with regard to youth running away from services, models of service provision, and the use of technology by these youth. Findings suggest that professionals from diverse backgrounds may disagree about the extent to which youth involved in DMST possess agency in their decision-making capacities as adolescents. This study explores these areas of dispute, and discusses the implications for the many different professionals and systems that must work together in providing services to this population.     

Recent Sexual Assault and Suicidal Behaviors in College Students: The Moderating Role of Anger

Sexual assault and suicide are 2 of many issues facing college students. Recent research calls for an examination of anger in suicidal behavior. Through a series of moderated logistic regression models, the authors examined the moderating effects of anger on the association of recent sexual assault and suicidal behaviors. Results support the moderating role of anger in the association of sexual assault with suicidal thinking, but not with self‐injury or suicide attempts. The authors discuss practitioner implications.     

Characteristics of effective interventions in improving young people's sexual health: a review of reviews

The purpose of this paper is to conduct a review of reviews to identify characteristics of effective sex and relationship education (SRE) interventions and/or programmes in young people to improve sexual health and identify barriers and facilitators for implementation. Six bibliographic databases were searched from 1986 to 2006 for systematic reviews that assessed SRE interventions or programmes in participants between 10 and 18 years old and their partners. All outcomes of improvement in sexual health were assessed and 30 systematic reviews were included. Effective interventions and/or programmes tended to be those targeting younger age groups before they become sexually active, focused interventions tailored to the physical and biological development stages, theory based, and abstinence education programmes that incorporate values of relationships and provide skills training and links to contraceptive services. Adequate training of personnel delivering the interventions and culturally sensitive programmes were identified as important facilitators of effectiveness. Future research should explore the appropriate age for initiating sex education and investigate targeting specific behaviour compared with multiple-outcome targeting. Research exploring the reasons for interventions focusing on specific populations (i.e. African and Hispanic origins), even if they were conducted in countries dominated by Caucasians, is warranted.     

“Jagged Edges”: Victim Blaming,Student Care,and Legally Defensible Sexual Assault Investigations

Victims and survivors of sexual violence are sometimes blamed for the assault because of irrelevant factors such as how much they had to drink or what they wore. Research has indicated that conservative religious beliefs increase the prevalence of victim blaming. In order to see if this pattern extended to college administrators, we used a hermeneutic phenomenological approach and interviewed eight sexual assault investigators at a faith-based institution to understand their lived and shared experiences. Four significant themes emerged from our study: the tension between student care and a legally defensible process, hope amid a never-ending saga, forbidden knowledge, and victim blaming. We conclude with a call to focus more carefully on language used, recommendations for decreasing the prevalence of victim blaming, and on preventing investigators from compassion fatigue, vicarious traumatization, and burnout.     

Therapeutic interventions with child survivors of sibling sexual abuse: The professionals’ perspective

BackgroundSibling sexual abuse (SSA) is a continuum of childhood sexual behaviors that do not fit age-appropriate curiosity. SSA may be the most prevalent, longest lasting form of intrafamilial sexual abuse – and the least reported, studied and treated.ObjectiveThis exploratory qualitative study examined the experience of intervention with SSA survivors from the perspective of mental health professionals, and explored their major therapeutic challenges.Participants and settingThe sample consisted of 20 Jewish Israeli mental health professionals working in private clinics or public social welfare services who had experience with SSA.MethodsSemi-structured interviews focusing on the characteristics of SSA events, perceptions about the effects of abuse, intervention priorities and therapeutic challenges compared to other types of child abuse.ResultsProfessionals working with SSA survivors are preoccupied with the need to provide them with physical and emotional protection, as well as to help them process the abuse narrative. They also find themselves dealing with survivors who do not experience themselves as victims despite external evidence of abuse, or with the need to reconcile their perception of the sexual relationship as mutual, as opposed to the formal requirement to differentiate between “offender” and “victim”. In either case, the reality of these survivors can be just as painful as in other SSA cases.ConclusionsThe complexity of SSA calls for unique intervention skills, including working with survivor narratives that do not fit the victim/offender dichotomy on one hand and that do not minimize the potentially harsh consequences of SSA on the other.     

Familial financial stress and child internalizing behaviors: The roles of caregivers’ maltreating behaviors and social services

Based on the family stress model and the stress-buffering model, the present study examines the relationship between caregivers’ financial stress and child internalizing problem behaviors, the mediating role of caregiver maltreating behaviors, and whether social services for caregivers buffer this relationship. The current study is based on data from wave two of the National Survey of Child and Adolescent Well-Being dataset (N = 2670). Results indicated increased high familial financial stress was associated with child internalizing problems. Caregivers’ psychological aggression, physical assault, child neglect, and sexual maltreatment emerged as mechanisms mediating this relationship. Tangible service and social network service were found to mitigate the deleterious effect of financial stress on child internalizing behaviors, but primarily for those whom financial stress was high. These findings highlight the role perceived financial stress has on potential maltreatment and child outcomes, rather than relying on objective measures of economic status. Implications for social services focused interventions for children and caregivers coping with high levels of perceived financial stress are discussed.     

The social marketing approach: a way to increase reporting and treatment of sexual assault

OBJECTIVE: Too often communities remain silent in response to cases of sexual assault of children. Members of the community are afraid to report such incidents and victims are reluctant to seek and accept treatment. The purpose of the paper is to examine whether application of a social marketing approach may serve as an effective means for motivating communities to report and victims to seek professional treatment. METHODS: The paper is based on a case study of an ultra-orthodox Jewish community in Israel, where an informal campaign of silence developed. Using content analysis of documents and in-depth interviews, the research examines the implementation of a social marketing approach by a multidisciplinary team of professionals in the community. It focuses on developments in the community's attitude to sexual abuse, especially with regard to reporting assault and seeking and accepting treatment. RESULTS: The findings show a considerable reduction in the fear that victims and other members of the community felt with regard to exposing the issue; a change among the community leaders, some of whom initially objected to reporting and treatment; introduction of an alternative community dialogue that advocated reporting and treatment; and a rise in the number of reports and of people in treatment. CONCLUSION: The paper recommends the integration of principles of social marketing in community programs aimed at dealing with sexual assault. In particular, it suggests the identification of competing groups in the community, construction of specific programs for different segments, addressing the no-monetary prices that the change may incur on the different groups, location of appropriate places for distribution of messages, and use of effective personal, as well as public means of communication and promotion.     

Building a Culture of Respect Across Genders: Eliminating Sexual Misconduct

Clinical staff members at virtually all college counseling centers provide therapy for victims of sexual misconduct experiences such as sexual assault, sexual harassment, relationship violence, and stalking. A number of college counseling center counselors are also involved in primary, secondary, and tertiary sexual assault prevention efforts. This article develops a model of prevention based on the twin principles of affirmative consent and bystander intervention. We begin with a review of research on sexual assault prevention on campus. We then illustrate this model as it was developed and implemented at a particular institution over the past two decades. We provide effectiveness data in the form of event participation rates, satisfaction measures, and learning outcomes to demonstrate the results of this comprehensive approach. Finally, we end with recommendations for further development of prevention efforts.