COUNSELLING
THINGS THAT COUNSELLORS SHOULD NOT DO

Jacqui was working late when she was raped in her office by a security guard. At first she spoke about it until friends accused her of "flaunting the rape", she was told her openness would "embarrass her husband," even though he said it did not. And so instead of doing what she needed to, she clammed up and steadily became more and more dysfunctional. She stopped working because she feared returning to the premises, she cared for her home and child less, she no longer cared what she looked like, she drank more and then some months later she was in a serious car accident in which a friend died.

She had a nervous breakdown and was admitted to Tara, where in its quiet and beautiful surroundings, and with the assistance of a gentle, skilled male therapist, over three months she began talking about the rape and learning how to rebuild her life. The gender of the therapist is important because traditional rape theory says that only women should deal with those raped. Ask any rape survivor; that is a fallacy, some women are appalling in their manner toward rape survivors. It is not gender that is important in healing - but attitude.

Jacqui might never have had to be admitted to Tara - if everyone around her had treated her with love, compassion and an understanding of post rape trauma syndrome; a severe version of post traumatic stress syndrome that many survivors of wars and violence (including violent crime) experience.

One in two South African women will be raped in her lifetime - one in four children in our schools have been sexually molested, and yet the broad medical community including psychologists and psychiatrists, is woefully ignorant about how to treat these survivors of the most violent of all trauma. A psychologist on the ethics committee of the SA Medical Association says, "let us have no doubt in our mind, rape is torture." At South African medical schools there is only an optional 50 minutes worth of training (in seven years of medical education) on how to assist rape survivors - even medical schools admit that it is not enough and the University of the Witwatersrand is re-examining its syllabus. In May of last year the South African Medical Association admitted the inadequacies of doctors in private practice and said it would remedy that shortfall - it has yet to do anything. The psychiatric and psychological community have remained mum about getting their act together.

The very first counsellor I went to after I was raped noted, "he (the rapist) was wearing an earring ... do you think he was homosexual?" I was stupefied. She later commented, "was it worse for you getting raped by a black man?" No, it wasn't, getting raped was the worst thing. Classically, rape survivors will go to three to six counsellors before settling on one - or will choose none. Miranda and Patrick were woken in the early hours of one morning by four intruders in their bedroom brandishing guns. The men not only looted the house, but bound Patrick next to his wife and repeatedly raped her. Despite the fact that this sort of incident is relatively common in South Africa, particularly in Gauteng, the first psychologist (a man) that the couple went to burst into tears when Patrick recounted what happened. Patrick got up and walked out. Neither has gone for counselling since.

The first general practitioner (not my own) that I went to the day after my rape commented, "you're the first person I've ever met who has been raped" - I doubt it somehow. She then rambled on for an hour and a half about how time would heal (the most stupid thing anyone can say to someone who has recently survived violent trauma) and displayed her astonishing lack of knowledge about HIV. I sat there silent, angry and resentful - but not as much as when I got her bill for a counselling session I did not ask for and that she had no competency to give.

My previous home GP came to the house five days later when I was going through acute Post Traumatic Stress Syndrome: the rapist had called the house four times, the police had revealed they had lost the file with evidence collected on the night of the rape. I was crying, and screamed if anyone suddenly came into my line of vision. On four occasions I was speaking normally to people, when my face would freeze, my voice disappear and I would collapse and remain in that state for five to 10 minutes. My doctor did not know how to revive me, or what to do apart from prescribing Valium (wrong solution) and sleeping pills. I never got the pills but instead went home with a friend who put me in a hot bubble bath with gentle music, gave me a bowl of soup and performed reiki on me. It was the most important therapy I had after the rape, the reiki removed the intense feeling of something bad in my stomach and helped settle me.

Canada's British Columbia Women's Hospital and Health Centre notes: "Survivors of sexual assault who come to the emergency room are in a state of crisis. They usually feel extremely confused and vulnerable, and often have difficulty making even small decisions. In recognizing this difficulty, we offer the patients a five day starter kit of medications with access to a follow up program at a community clinic. We believe that follow up counselling and medical care are crucial components and must be implemented in any service offering HIV prophylaxis to survivors of sexual assault." Unless a rape survivor goes to a Netcare rape clinic in this country she is unlikely to get such caring treatment.

Research in Toronto, Canada showed that 83% of female psychiatric inpatients reported a history of physical or sexual abuse; mental institutions report lower figures here for two reasons: SAs are more resistant to seeking psychiatric help and many who do conceal their rape. An Alexandra AIDS activist I know has been diagnosed with borderline personality disorder - because the psychiatrist who 'treated' her failed to ascertain that she had been gangraped some years previously. The psychiatric diagnosis is completely erroneous because the symptoms the woman displays are those of classic post rape trauma syndrome, but because the psychiatrist was arrogant and ignorant, a lethal combination, the woman was treated for the wrong disorder.

In Canada rape crisis centres offer a pamphlet from an organisation called Justice for Women that gives sound advice on where to go for help, including: "Don't Like the Treatment by your Doctor, Psychiatrist?" or "Discriminatory (Sexism, Racism) Statements by a Judge?" or "Got a Complaint about a Lawyer? Who Hasn't?" Having access to organs to complain about bad treatment are critical in helping a women regain her sense of control over the things that are happening to her. There is very limited access to similar material in South Africa, and much of it is copied from US or British sources and is not always relevant to SA - for example, it is often quoted in South Africa that most women are raped by someone they know. Untrue. That is true for North America, in South Africa around 80% of women will be raped by strangers, and 60% will be raped in their own home at knifepoint or gunpoint - and 75% of South African women will be gang raped. And yet among all the discussion about rape in the past year in this country, psychotherapists - the ones who have the most to learn from rape survivors, to enable them to counsel better ... have been the most silent, the least curious.

Anna, who was gangraped in July last year and went to a rape counselling organisation in Cape Town recalls: "when I first went my counsellor did not speak directly about the rape, I felt she should have tackled the issue head on and not beat about the bush. I wanted to get it over and done with." Indeed, every rape survivor talks of the desperate desire to "normalise" after a rape. Anna then went into group therapy with other rape survivors. "At first I did not feel I connected with anyone, I felt intimidated in the group when others talked about their encounters, I felt intimidated that mine was the most recent. Sometimes I felt emotional, and it was a problem for me to tell people I was having a bad day. I wanted people to see my positive attitude, and not me crying and being down. I would go through days where I felt totally, totally shit. Over Christmas I pretended a lot that I was cool, everyone else was jovial but I didn't really feel it. I felt alone." Anna says psychotherapists "must feel that they can touch you, they are very aloof. They sit across from you in a chair, there is this vacuum between you. Everything is so far away. My counsellor sometimes could only see me after 5pm or 6pm, by those times in winter it is dark and I rely on public transport." Rape survivors recommend that medical practitioners must as soon as possible after the rape touch them and ask direct questions, if they do not survivors will very quickly begin resisting touch and talking about the incident, with dire consequences for her emotional healing. And indeed poor handling by police or medical personnel soon after the rape can cause serious secondary trauma.

Dr Lyn Kelly of Tara Hospital's psychotherapy unit in Johannesburg sees the patients who wait months or years before talking. She says that typically those patients that are admitted are showing "a lot of anxiety, depression, intrusive memories of the rape, they often try to avoid things that remind them of the trauma, or the type of person the perpetrator was, or places that remind them of rape, they even avoid certain types of shows on television. "They are often in a state of hyperarousal - agitated, anxious, cannot sleep, have exaggerated startle responses and will jump at the slightest noise, and have an inability to concentrate. In the early stages many cannot remember aspects of the rape, or find it difficult to piece together - they sometimes recall things, but sometimes they never do."

Dr Kelly says that some of the things that can exacerbate post traumatic stress or rape trauma syndrome include "poor support from family and friends, a previous history of trauma... This may have something to do with the fact that they had no control over their body during the rape, they had no say over what happened to them and when they get people who say, or imply, it was their fault or they could have prevented it they begin blaming themselves and breaking down. "Survivors of sexual violence need to be treated with respect, compassion and empathy.

"The best thing for a person who has survived rape or trauma is for people to be there, and to listen to what they say in the calmest way possible - but that is easier said than done, if it is a family member they may feel very emotional too." However, nothing is going to shut up a rape survivor faster than seeing her mother constantly crying at mention of the rape, or her partner going into a rage and threatening to kill the rapist or friends that ask her why she did not do this or do that to prevent the rape.

Rape is the only crime where a person is likely to be disbelieved. No-one suggests to a person who claims they were hijacked that the fact that they voluntary gave the keys to their car, and did not fight for the gun means they actually freely gave the car away. No-one says - why did you drive down that road/stop at that light/return home at the same time each day? And yet a woman raped endures those sort of outrageous, stupid questions. And while the average hijacking lasts around three minutes, the average rape - including threats, beatings, being tied up, harangued and sexually violated - takes three to four hours or much more.

Dr Kelly says it is important that people around a rape survivor do not negate her experience, "don't say, 'you'll get over it'; 'don't worry about it'; 'put it behind you.' All they want to do is get over it, but it takes time, it is not a quick or easy process. Accept the person's feelings. Show empathy and gentleness. And if they don't want to speak, don't force them, leave the door of communication open, just be there." She suggests too that in group therapy it is often useful to allow the group, at it's onset to set it's own ground rules, "they may be as menial as not allowing smoking or as crucial as allowing a person to keep quiet if that is what they want to do."

Dr Kelly says the type of drug regime a rape survivor is put on is very important. She says that benzodizepines such as Valium, Rohypnol and Loramet can lead to dependency. She includes Xanor and Ativan as no-no's, although she says they can be effective in the very short term - the danger however, is that they give oblivion and encourage the rape survivor's desire to escape and pretend this never happened to her. To help patients sleep she recommends Stilnox and Imovane, but is opposed to Ativan or Dormicum. She says anti-depressants such as Prozac and Arapax are good, however, these require a minimum six month course. Cipramil is also favoured among some doctors.

However, in the views of this rape survivor, and of many others - stay away from the drugs unless absolutely necessary. Take them in brief spells to help sleep or calm you down after severe stress, but don't wake up and open your mouth for the drug of the day. Learn coping skills - and you are most likely to do this by deliberately going out and meeting rape survivors either through rape crisis groups, friends, rape clinics or medical staff. Try and find someone who has been raped in a similar way to you and share your thoughts and experiences. And remember this: don't let anyone tell you what to say, don't let anyone tell you what to think. If people say they understand, even if they have been raped - say, 'no you don't' - because they don't, each rape is unique, because each rape survivor and each rapist is unique. Discard friends and even relatives who are unsupportive. Do one thing a week to make yourself feel good - it may be a long bath, it may be buying yourself flowers or a new nail varnish. Go for a haircut, a facial and definitely reflexology or a massage to relearn the healing power of touch - and to relearn how to love yourself. Never let anyone call you a victim - we are only victims if we are dead. You are a survivor of one of the most appalling acts of torture that can happen to anyone - celebrate the first act of survival, the fact that you are alive, and use it as a building block to a better, happier, more creative, more fulfilling life. You not only can do it. You deserve it.

Charlene Smith ©

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