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Nashville Medical News

Nashville Medical News
6/1/2009
By: CINDY SANDERS
The Healing Starts Here

Sexual Assault Center Helps Victims Find Victory

National statistics show that one in four people will be sexually abused in their lifetime. Sexual assault knows no boundaries. It crosses racial, ethnic and socioeconomic lines. Often, a friend, relative or acquaintance is the one crossing that line... and the resulting devastation takes both a physical and psychological toll.



Therapeutic Modalities

The Sexual Assault Center has many tools in their kit to individualize therapy to best suit their clients' needs. Rachel Freeman, LCSW, vice president of clinical services for SAC, said the organization has invested in advanced training to better serve their clients so that a full spectrum of therapeutic options is available. Below are some of the most common evidence-based and evidence-informed practices for trauma survivors.

Trauma Focused Cognitive Behavior Therapy (TFCBT): Freeman called this the "gold standard" modality that is rooted in talk therapy and cognitive behavioral therapy but pulls from other options such as art therapy, journaling or putting together a scrap book to create a trauma narrative while also focusing on positive coping skills, relaxation skills and psychoeducation.

Eye Movement Desensitization & Reprocessing (EMDR): This therapy uses a form of bilateral stimulation such as eye movement or knee taps while talking to help patients access the root of their trauma. "It's a treatment modality that can be used when someone's feeling stuck... like they have hit a wall," explained Freeman. "When your brain is engaged in bilateral stimulation while talking, it lets you pull up the memory. What we know about trauma is that it is stored deep in our brain, and it stays there until we help people get it out."

Play Therapy: This is a particularly effective way to access trauma in children (although it can also be used with adults... particularly those abused as children). "Play is the language of children so it's a less intimidating way for children to deal with their trauma than talk therapy," Freeman noted.

Art Therapy: This modality allows for creative self-expression utilizing a variety of media in a safe, less intimidating manner. One example is The Clothesline Project, which was started nationally by the Rape Crisis Centers in the 1990s. Women came forward to express their anger, fear and hope as survivors of domestic and sexual violence. By illustrating t-shirts, these women found a creative way to "air their dirty laundry" and take an important step towards healing.

Hypnotherapy: SAC has two advanced certified hypnotherapists on staff who use a number of relaxation methods to access memories of past traumas.


"There is a myth that sexual assault happens by a stranger in a dark alley," said Rachel C. Freeman, LCSW, vice president of clinical services for the Sexual Assault Center. "It does happen, but it's not nearly as prevalent as we presume. Eighty percent of all sexual assault incidences happen by someone known to the victim, and the majority are planned."

Each year, the SAC (formerly the Rape and Sexual Abuse Center) works with approximately 700 clients who are trying to put their lives back together after an assault. Freeman said about half of the clients are children under age 18 split pretty equally between boys and girls. The remaining 350 are predominantly female adult victims who are survivors of childhood sexual abuse, rape survivors or non-offending parents of children who have been sexually abused.

"We know sexual abuse affects the whole family –– not just the individual –– so we want to offer comprehensive care," Freeman said.

Although not nearly as many adult men are seen at the center, Freeman said those that do come for help typically fall into the same categories as the women. "It's like a double whammy with men. It's still so taboo to talk about sexual assault in general and it's typically believed that sexual assault only happens to women," she said, adding that men who have been victimized need to know help is available for them, as well.

Freeman oversees 14 in the clinical department, including 10 therapists. All SAC therapists have a minimum of a master's degree in their field and all are licensed or working toward licensure. As with physical medicine, Freeman explained therapists often have specialty areas of expertise in addition to their general clinical knowledge.

"Each of our therapists specialize in a different treatment modality so we have a variety of tools to choose from," she explained. "A client is placed with a therapist who best meets their unique, individual needs."

There are a number of options ranging from play therapy and art therapy to eye movement desensitization and reprocessing (see box). "There's not just one standardized way to treat trauma so we pride ourselves on being able to offer all of these," she noted.

Unfortunately, none of the evidence-based tools have an opportunity to work if a victim doesn't seek out help. Freeman said it is well known within the therapy community that many people never disclose sexual assault. One barrier that is a non-issue in Middle Tennessee is the cost of care. SAC works with many insurers, including TennCare, but Freeman stressed that no one is ever turned away regardless of their ability to pay. Additionally, she said the quality of care is exactly the same whether or not SAC is reimbursed for services.

Overcoming the social stigma of disclosure, however, is a much bigger hurdle... but it's a vital step for an individual's long-term mental and physical health.

Possible red flags of sexual assault include:

* Depression and anxiety,
* Behavior changes at work or school,
* Becoming socially withdrawn,
* Changes in eating habits,
* Sleep problems including nightmares or difficulty falling and staying asleep,
* Exaggerated startle response,
* Fear, anger, guilt and shame,
* Self blame and/or low self esteem,
* Dissociation,
* Psychosomatic complaints such as unexplained headaches and stomachaches or physical complaints such as irritable bowel syndrome or other gastrointestinal issues as emotional pain begins to manifest itself in a physical form, and
* Sexual reactivity (sexually inappropriate towards others or sexually promiscuous) in response to their own victimization.

 

She added these tangible signs of sexual assault are the tip of the iceberg. Left untreated, sexual assault victims often suffer dire long-term outcomes including suicidal ideations, self-mutilation, eating disorders, substance abuse and sexual dysfunction.

Luckily, a victim's life script doesn't have to end this way.

"We know that people who disclose sexual assault and are supported and believed have a much higher prognosis of healing," she said of evidence-based data.

Freeman added the physical health community could become stronger partners by asking more questions. "It's OK for physicians and nurses to ask if their patients have ever experienced sexual assault. I think many people are hesitant to ask that question, but it's appropriate as long as we can respond in a supportive, caring manner," she said.

If the answer is "yes," then the next step is to reassure the survivor that it isn't their fault; they didn't "deserve" the assault; they have done the right thing by disclosing the assault; and that there is help. Providers might also need to assess a patient's safety and take steps to get the victim to a safe place if they are still in harm's way.

For healthcare providers and individuals, starting the healing process is as simple as picking up the phone and calling the SAC Crisis Line at 1-800-879-1999 (manned 24 hours/day, seven days a week), or during office hours dialing the SAC Intake Line at 615-259-9055, ext. 335.

"We've been doing this for 31 years... since 1978... and we cover all of Middle Tennessee," Freeman said. She added that with the agency's move to MetroCenter last June, therapists now have more room and resources available to help patients.

"We know the hardest step is often walking into this building so if we can provide a comforting, nurturing environment, people will be more likely to seek help. This facility is much more conducive to the healing environment we want to offer our clients," she said. At 16,000 square feet, the new location is twice the size of SAC's former site near the Howard School Building downtown. It also features a dedicated art therapy room, anger room, library, larger playground and a serenity garden.
SAC Receives AmeriChoice Grant for Davidson County Education Program
AmeriChoice by UnitedHealthcare of Tennessee announced last month that it has given the Sexual Assault Center (SAC) a $10,000 grant so the agency can continue to bring required sexual assault prevention education to students of Davidson County schools.

SAC has created and delivers a comprehensive sexual assault prevention program to students of all ages across Tennessee and also trains the school-based counselors who deliver the actual education to the students. The AmeriChoice grant will fund the creation of more than 7,000 activity books required to deliver and support the school-based training in many of Davidson County's Title I schools.

"The gift AmeriChoice has made to the Nashville Community by providing the funds for the Safe@Last Curriculum will not only help children who are in abusive situations, but will actually prevent other children from being abused," said Mary Grissim, vice president of education services for SAC.

The sheer prevalence of sexual assault makes it imperative that both mental and physical healthcare providers be attuned to the signs and outcomes of this violent crime to bring victims out of the shadows and into the light where they can receive the help and medical attention they need.

"The more we talk about it, the more likely people will be to disclose it and the less likely people will suffer these long-term effects," Freeman said. "The sooner we respond, the better the chance of healing. Talking about it is really a form of primary prevention... and that's our ultimate goal... to end sexual violence."



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