Enrichment > Spring 2009 > Greatest Challenges of Pastoral Care


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Healing From the Pain of Sexual Assult

As a Christian counselor, I recognize the progress the church has made in dealing with emotional pain and struggles in Christians. Many churches have support groups and lay counseling ministries. Some have professional counseling centers. Many churches have groups for divorce recovery, grief, addictions, depression, or even sexual abuse. Pastors often preach on issues related to marital conflict and divorce, depression, anxiety, and abuse. But there is one issue I rarely hear addressed in the church. Few Christian books address this topic. I have worked with the American Association of Christian Counselors for nearly 10 years and can count on one hand the number of workshops that have addressed this critically important issue.

Rape is a devastating and traumatic event, so why is our society and the church so reluctant to address it? A significant reason we give so little attention to rape is the shame and stigma surrounding sexual assault. This sense of shame keeps most rape victims from reporting the crime or seeking help for their physical, emotional, and spiritual wounds.

Perhaps the Christian community does not address rape because we mistakenly believe it is not a pervasive problem. Not only is rape a significant issue facing the church and society, but the pain and devastation of rape go back to the beginning of recorded history.

The most well-known biblical case is the rape of Tamar, the sister of Absalom and daughter of David. Read the story of her assault in 2 Samuel 13. This gives clear insights into the pain and problem of rape. We also have misconceptions about rape. All of these contribute to a failure of the church to meet the needs of sexual assault victims and their families.

Let me address a few of these misconceptions.

1. We believe rape is not a widespread problem and/or we do not personally know anyone who has been raped. Statistics from the Rape, Abuse, and Incest National Network1 show:

  • 1 in 6 women* is sexually assaulted in her lifetime.
  • Someone in the United States is sexually assaulted every 2 minutes.
  • 7.7 million American women have been raped.

If these statistics are accurate (I believe they are conservative.), you probably know a woman who has been raped. You may know this woman well — perhaps she is even your wife, sister, best friend, or daughter. There is also a good chance she has never told you about this painful event. Sixty percent of sexual assault victims do not report their assault to the police. A large percentage of victims never tell anyone except a therapist or close friend about the assault.

2. We imagine that rape involves a stranger breaking into a home or jumping out of the bushes and attacking a woman with a gun or knife. While this is true in some instances, the largest percentage of women who are sexually assaulted happen from date or acquaintance rape. In 73 percent of cases (some estimates are as high as 90 percent), rape victims know their assailants. Only 11 percent of rapes involve the use of a weapon. In 84 percent of cases, the rapist only used physical force in the attack. All of these details were true of the rape of Tamar. When her brother, Amnon, raped her, he did not use a weapon, only physical force.

3. We often believe if the attacker did not physically harm or seriously injure her during the attack, she will not experience any long-term consequences. This is a serious and damaging misconception. Let me offer the truth:

Victims of sexual assault are:

  • 3 times more likely to suffer from depression
  • 6 times more likely to suffer from post-traumatic stress disorder
  • 13 times more likely to abuse alcohol
  • 26 times more likely to abuse drugs
  • 4 times more likely to contemplate suicide

Scripture describes Tamar’s pain following her attack by saying she “put ashes on her head and tore the ornamented robe she was wearing. She put her hand on her head and went away, weeping aloud as she went” (2 Samuel 13:19). Scripture also describes her long-term consequences: she “lived in her brother Absalom’s house, a desolate woman” (verse 20).

Many of the women who come to your office with addictions, depression, panic attacks, or marital problems may have been sexually assaulted in their past — perhaps many years ago. This event is contributing to their present problems. Most of these women do not consciously connect the problems they are currently experiencing to the rape in their past until a caring and knowledgeable counselor or pastor helps them connect the dots.

Here is how you can help victims of sexual assault.

Ask the Right Questions

Woman who come to you for help dealing with a rape will often present another problem. I have helped clients who have been raped work through those painful issues. Not one of these women, however, came to her first session stating that she had been raped. The problems they mention first are depression, panic attacks, addictions, eating disorders, and most frequently, relationship issues with their husband or boyfriend. Only after I build trust and ask key questions do I uncover the deep, painful secret they are living with. I also discover that many women, especially if the assault happened when they were young, have never called the experience rape. Asking, “Have you ever had any unwanted sexual experiences?” seems to be easier for women to answer.

I ask them to tell me about their first unwanted sexual experience. Many times, their first sexual experience was an assault.

It is often easier for women to speak to other women about these issues. While there are many male counselors and pastors who have training to deal with these issues, women are more comfortable discussing sexual assault with another woman or with another woman present.

Do Not Ask the Wrong Questions

Most of the shame carried by rape victims comes from society, courts, and even well-meaning individuals. They will imply that the victim is responsible for what happened to her. In the account of Tamar, her brother, Amnon, hated her after he assaulted her and sent her away like a worthless piece of trash. Rape victims often feel rejection and secondary wounding following their assault. In 2 Samuel 13:16, Tamar told Amnon, “Sending me away would be a greater wrong than what you have already done to me.” We often heap more pain and shame on rape victims by the way we interact with them about their experience.

Be careful in the questions you ask and the responses you give to a victim of sexual assault. Never ask questions that imply the victim asked for or encouraged the assault. Questions about her clothing, past sexual behavior, or why she made the choices she made at the time of the assault (“Why were you there alone at that time of night?”) are not helpful. She has already run through every If only I had… in her mind. The majority of rape victims blame themselves, in whole or in part, for what happened to them.

No matter what a woman chooses to wear, no matter what poor choices she has made about relationships or sexuality in the past, or bad judgment in regard to safety or alcohol consumption — justifies someone sexually assaulting her. We must never imply — directly or indirectly — that a woman is to blame for being raped. We want to educate girls and women about personal safety and choices they can make to prevent sexual assault. But the time for this education is not when you are trying to help a victim heal.

Give them a safe place to tell their story to the degree they are comfortable

Rape victims need to tell their story. When to tell, whom to tell, and how much to tell should be left up to them.

Rape victims find it incredibly difficult to talk about such a terrifying and painful experience. A woman needs a safe place to talk. A counselor should not pressure her to tell her story or reveal details of the assault before she is ready to do so.

Listen to her story with understanding and compassion. Two things are helpful: First, tell the victim you are sorry about what happened. Second, assure her it was not her fault. These are critically important to the healing process.

Direct sexual assault victims to people who can help them heal physically

The first person I refer a victim of sexual assault to is her gynecologist. I keep a list of female gynecologists I trust in my office. While many male gynecologists are qualified and comfortable assisting rape victims, women are more comfortable with a female physician.

If she has not shared information about the rape with her physician, she needs to do so immediately. While it may be difficult for her to face the reality, rape victims need to have a thorough exam and necessary tests, even if they are not reporting the assault. Any woman who has had an unwanted sexual experience needs to be fully tested for all sexually transmitted diseases, including HIV. Women are terrified at this thought and are reluctant to face the possibility they may carry lasting physical effects from the assault. But it is always better to know for sure.

For many women, these tests bring a peace of mind when they learn they are disease free. Knowing this will speed the emotional healing process. Women who do contract a disease can get treatment immediately and avoid potential long-term effects such as infertility or cervical cancer. It is also critical that they know they have a disease they can pass on to their spouse (or future spouse). I often do extensive education because the majority of people are ignorant about STDs. They are generally unaware that many STDs have few or no side effects, and they can have one of these diseases for years without knowing it.

Direct them to people who can help them heal emotionally and spiritually

While not every rape victim will need professional therapy to heal, many will. Many women will only seek counseling after the emotional fallout has caused their life to become unmanageable. This can occur years after the rape, but the consequences can be devastating.

I suggest that all rape victims see a professional counselor for at least a few sessions. This allows the therapist to assess for complications and possibly prevent the more serious disorders that can be a long-term result of rape. It also provides a safe relationship for a woman to turn to if issues crop up later.

When they are available, I find that rape support groups provide one of the greatest opportunities for healing. They not only provide a safe place for the victim to discuss her experience and pain, but she can share with others who have had the same experience. This is one of the most powerful weapons against the shame and pain of rape. When possible, I recommend a Christian counselor or support group. If none are available, there are many well-qualified clinicians who can help in the emotional healing from rape.

Spiritual healing, however, will require someone who can address faith issues. Rape victims struggle with two primary spiritual issues. The first is a crisis of faith that most believers experience when something terrible happens in their life. They struggle with why a loving God let something so terrible happen to them. The other major spiritual issue is that of forgiveness. Most secular counselors do not address this issue or understand the importance of forgiveness as part of the overall healing process. While it may take time — sometimes years — for rape victims to get to the point where they can consider forgiving their rapist, it is critical. Even more important is that they can forgive themselves.

A Spouse Must Be Included in the Healing and Recovery

The one exception in allowing the victim to keep the assault private has to do with her spouse or future spouse. In marriage, husband and wife become one flesh. This spiritual, emotional, and physical union requires openness and honesty. Withholding significant information such as a sexual assault from a spouse will undermine the foundation of the marital union and cause misunderstanding and confusion.

In almost every case, a victim of sexual assault needs significant time and help to heal sexually. Even if a rape happened years before a marriage, it can dramatically affect marital and sexual intimacy. Many women thought they had healed from a sexual assault in their past, until their wedding night.

Victims of all traumas, including rape, can have symptoms of post-traumatic stress disorder (See sidebar The Trauma of Rape) when faced with a situation that triggers memories of the rape. For a rape victim, this can occur even during a desired sexual encounter with her husband — the man she loves and trusts. A rape victim can become overwhelmed with fear, anger, disgust, and shame during sexual intimacy with her husband. These feelings can come on suddenly and unexpectedly. And often, the victim does not understand what triggered the feelings and is powerless to control them. This can be confusing and frustrating for couples who do not understand what is happening or why.

The issues surrounding sexual healing for rape victims are complex. I suggest that couples work with a trained counselor to assist them in this journey. Both husband and wife need to understand that sexual recovery from rape is a process, and both partners must be committed to the healing process with compassion and patience.

The spouse of a rape victim needs to understand that the reactions she experiences during sex have nothing to do with her feelings about or desire for him. While not true of all rape victims, many struggle to enjoy sex and/or to feel safe and comfortable with their body and their sexuality. This is a result of the violation they experienced. I make it clear to the rape victim and her spouse that healing is in sexual intimacy with her husband. But that can be a long road for some women, and it requires patience and understanding from her spouse.

Statutory Rape

There is no such thing as consensual sex between an adult and a child. While the legal age varies from state to state, most states mandate that any adult engaging in a sexual act with a person under the age of 16 is committing rape. Check the guidelines of your state for the statutory age of consent. If someone reports sexual contact between an adult and someone under the statutory age of consent, I suggest you report this under the same guidelines as mandatory reporting standards for child sexual abuse.

I am passionate about helping survivors of rape heal, recover, and reclaim the life, relationships, and sexuality God intends them to have. I feel this way not just because I have clients who have been raped, but because I am a survivor of rape. For many years I did not share this traumatic experience with anyone. I suffered the same consequences I mention in this article. But when I finally did get help from a compassionate Christian counselor and from loving and understanding friends, God brought grace and healing to my life. I pray that as a pastor, you offer that same assistance to a woman who is hurting.

If you or someone you love has been sexually assaulted, you may contact the National Sexual Assault Hotline at 1-800-656-HOPE.

*Men can also be victims of rape. However, the majority of rape and sexual assault victims are female. In this article, I have referred to victims as female.

Note

1. Rape, Abuse, & Incest National Network (RAINN) www.rainn.org

The Trauma of Rape

States have no reporting requirements or limits to confidentiality for sexual assault. Reporting is at the discretion of the victim. If she does, however, report it to police she has no control over how they will handle the case. The only requirement for reporting is in the case of statutory rape, when the victim is under the age of 16. In that case, it is also child abuse and mandatory reporting is required.

Acute Stress Disorder & Post-Traumatic Stress Disorder

A number of symptoms are normal in the wake of crisis and trauma. A person who experiences an event that threatens her life, safety, or well-being, or witnesses an event where another person is injured or killed, will likely experience physical, cognitive, behavioral, and spiritual symptoms. These symptoms, when experienced in the immediate aftermath of a crisis, are not pathological and need to be normalized. Explaining and normalizing these symptoms is a significant aspect of crisis intervention. The severity and duration of these symptoms, however, indicate the presence of an anxiety disorder such as ASD or PTSD.

Acute Stress Disorder

ASD is a psychiatric diagnosis that psychologists give individuals in the first month following a traumatic event. The symptoms that define ASD overlap with those for PTSD, although there are a greater number of dissociative symptoms for ASD, such as not knowing where you are or feeling as if you are outside of your body. Because ASD is a relatively new diagnosis, research on the disorder is in the early stages. Diagnosis rates range from 6 percent to 33 percent depending on the type of trauma. Individuals must have three or more of the following dissociative symptoms to be diagnosed with ASD:

  1. Subjective sense of numbing, detachment, or absence of emotional responsiveness
  2. A reduction in awareness of one’s surroundings
  3. Derealization
  4. Depersonalization
  5. Dissociative amnesia

ASD is also characterized by persistent re-experiencing the event, avoidance of stimuli that bring back memories of the trauma, and marked symptoms of anxiety such as sleeplessness, irritability, and hypervigilance. ASD can only be diagnosed within the first 30 days following the event. A diagnosis of ASD appears to be a strong predictor of subsequent PTSD. In one study, more than three quarters of the individuals who were in motor vehicle accidents and met criteria for ASD went on to develop PTSD.1 This finding is consistent with other studies that found that over 80 percent of people with ASD develop PTSD by the time they are assessed 6 months later.2, 3

Post-Traumatic Stress Disorder

If post-traumatic stress disorder symptoms persist for longer than 30 days, psychologists often diagnosis the patient as having PTSD. Although there is considerable variation among factors, the estimates are that 5 to 11 percent of trauma victims will develop PTSD4. Symptoms include:

1. Re-experiencing the event through intrusive thoughts or dreams and intense distress upon exposure to any stimuli or cue that causes the individual to recall the event.

2. Avoidance of stimuli associated with the trauma and numbing of general responsiveness through efforts to avoid thoughts, feelings, or conversations associated with the trauma and avoidance of anything that triggers recollection of the trauma. Individuals may also experience an inability to recall certain aspects of the event, diminished interest in significant activities, feelings of detachment from other people, a restricted range of affect, and a sense of a foreshortened future.

3. Individuals may also experience symptoms such as sleep disturbances, irritability or anger, difficulty concentrating, hypervigilance, and exaggerated startle response.

If the symptoms persist between 30 days and 3 months, the PTSD is Acute. If duration of the symptoms is 3 months or more, the PTSD is considered Chronic.

MARK CAMPER, editor, Christian Counseling Today

Notes

1. Bryant, R.A., & Harvey, A.G. (2000). Acute Stress Disorder: A Handbook of Theory, Assessment, and Treatment. Washington, D.C.: American Psychological Association.

2. Creamer, M., & Manning, C. (1998). Acute Stress Disorder following an industrial accident. Australian Psychologist, 33, 125-129.

3. Bryant, R.A., Guthrie, R.M., & Moulds, M.L. (2001). Hypnotizability in Acute Stress Disorder. American Journal of Psychiatry, 158, 600-604.

4. Breslau, N. (2001). The Epidemiology of Posttraumatic Stress Disorder: What Is the Extent of the Problem? Journal of Clinical Psychiatry 62 ( Supplement 17): 16-22.

Resources for Rape/Sexual Assault*

  • Rape, Abuse, & Incest National Network (RAINN) www.rainn.org
  • National Sexual Assault Hotline – 800-656-HOPE
    Provides 24/7 free, confidential advice.
  • National Sexual Violence Resource Center www.nsvrg.org
  • Sex Laws.org www.sexlaws.org
    Provides information on statutory rape charges, age of consent by state, and sexual assault laws.
  • Joyful Heart Foundation www.joyfulheartfoundation.org
    Provides information and resources for victims of sexual assault.
  • *The above sites are not faith-based, but provide excellent information and assistance. For referral to a Christian counselor, contact the following:
  • American Association of Christian Counselors: www.aacc.net – Go to “Find a counselor.”
  • www.e-counseling.com – site for online Christian counseling
  • The Assemblies of God Ministerial Enrichment counseling referral service is an up-to-date nationwide referral list of certified, professional Christian counselors. For a referral in your area call 417-862-2781, ext. 3014.