An individual who experiences sexual violence will often encounter challenges when working through the feelings and emotions surrounding their trauma. It is not uncommon for a survivor of sexual violence to experience nightmares, flashbacks of the event, difficulty concentrating or sleeping, or avoiding anything that might be a reminder of the trauma.
This avoidance behavior is a normal reaction to the trauma of sexual violence, and may be present as the survivor struggles to re-gain control of their environment with the goal of preventing future traumatic experiences. It is an example of a protective response and is a normal coping response to a traumatic experience.
This protective response can become problematic, as a survivor of sexual violence continues to avoid people, places, or things associated with the trauma. By avoiding the thoughts, feelings and memories surrounding the sexual violence, the survivor is unable to process the trauma and runs the risk of prolonging the challenges surrounding the event. The purpose of exposure therapy is to process their feelings surrounding the sexual violence while working towards eliminating and reducing an individual’s PTSD symptoms, thus allowing the individual to move forward with their life.
Prior to beginning exposure therapy, it is important to ensure that the survivor has been instructed in utilizing coping techniques, such as controlled breathing, relaxation techniques, and imagery exercises. Failure to review this with a survivor can cause a re-traumatization of the survivor.
During the course of treatment of exposure therapy the clinician will work with a survivor to recall aspects of the sexual violence that are disturbing to the survivor. These might include people, places, or things associated with the trauma. As unpleasant emotions and feelings surface, the clinician addresses these feelings within the context and safety of the therapeutic relationship, with the goal of reducing stress, recognizing strengths, and increasing coping skills, thus leading to a reduction, and eventual elimination of the PTSD symptoms.
There are three main types of exposure therapy:
In Vivo Exposure Therapy
This type of therapy involves direct exposure to the people, places, or things associated with the sexual violence. For example, a man who was sexually assaulted may travel with his therapist to the parking lot where the assault occurred, thus allowing him to re-experience the emotions and feelings connected with that location.
Interoceptive Exposure Therapy
Focuses on addressing the physical sensations associated with the act of sexual violence. For example, a survivor may associate hyperventilation with the sexual assault. A trained clinician would work with the survivor, and induce hyperventilation, perhaps by encouraging the survivor to inhale and exhale quickly, in the hopes that the survivor would begin to disconnect the bodily reaction from the strong association with the sexual assault.
Imaginal Exposure Therapy
It is can be impractical or unsafe for a survivor to return to the location of a sexual assault. Working with a trained clinician, the survivor accesses memories of the assault through an on-going dialogue that recalls the events and feelings of the trauma. The clinician will ask the survivor to re-tell their experience several times in the hopes that this will allow the survivor to gradually decrease the trauma related symptoms. The clinician may ask permission to record the re-telling of the event, so that the survivor may listen to their story outside of their sessions, increasing their exposure to the event, and allowing the survivor. Re-telling the trauma helps a survivor of sexual violence make sense of what happened which can lead to fewer negative thoughts about the trauma.
It is important to recognize that not all survivors of sexual violence may benefit from exposure therapy. Some may have difficulty with the level and intensity of the exposure to their trauma, or have difficulty imagining, visualizing, or verbalizing their experience with sexual violence. It is important that he survivor works with an experienced clinician to determine which method is best suited for the client and their trauma.
Dr. Stephen J Oreski, LCSW
Sexual Violence and Abuse
An Encyclopedia of Prevention, Impacts, and Recovery