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Herman & Wallace Blog

Working with Survivors of Sexual Assault

Lauren Mansell, DPT, CLT, PRPC is the author and instructor of Trauma Awareness for the Pelvic Therapist, a course now available remotely. Lauren's next offering of her course is coming up this May 1-2, 2021

Working with survivors of sexual violence has been the most challenging and rewarding aspect of my pelvic rehabilitative work. I am fortunate to have been trained as a legal and medical advocate for sexual assault survivors and worked within mental health prior to becoming a physical therapist. I hope to give everything I know about being a patient centered trauma aware practitioner. Can we talk about how common sexual violence is within our society and within our work? I can spout the statistics: 1 in 3 females and 1 in 7 males report unwanted sexual attention; 1 in 6 females and 1 in 33 males experience sexual assault.* But in our rooms, sexual violence is pandemic.

Please feel empowered to provide appropriate, trauma-informed support to these patients. It starts with our wellness and self-care. We cannot empower others if we have not empowered ourselves. We don’t have to be perfect. Practice self-forgiveness. Know your triggers. Commit to impeccable self-care. Be well. Keep ourselves safe by practicing empowered choice. If you have empowered choice, you can provide and teach empowered choice to your patients. What is empowered choice? Empowered choice is saying: we don’t do anything you don’t want to do or I don’t do anything I don’t want to do. Ever. Give your patient the power of directing their healing while providing extensive physiology and anatomy education with trauma-focused, patient-centered care. With information, patients choose what they want treated when. And with empowered choice, they tend to choose higher level treatment quicker. Additionally, they may show up to more appointments and, from my experience, they get better faster. I know we all do this with informed consent, but I have found success with being immensely purposeful in repeatedly telling the patient that they are in control of the treatment. Patients are completely in control of the treatment, not to be confused with being in control of me.

After empowered choice, normalizing their experience is valuable for our treatment relationship. This is possibly the saddest part of this work- how normal it is for my patients to have sexually violent experiences. I say over and over how typical it is for patients to have experienced sexual violence and how it negatively affects pelvic function. I also say they don’t need to tell me anything about their trauma and that I don’t require they go to counselling to participate in pelvic rehab. I do however let them know if they want to disclose their traumas or be connected to resources, I will gladly assist in their support. I do let them know that there are times I have to report (I live in a mandated reporting state) and tell them exactly what my rules are. Being clear and informative while being supportive and trauma-informed helps reduce the SHAME patients who experienced sexual violence carry. These patients typically feel embarrassed and ashamed by the abuse perpetrated against them in addition to the physical somatization from the trauma. And that their response during treatment is a normal response to an abnormal situation.

Take care of you. Empowered choice for all involved. Normalize the survivors’ response. Disempower Shame. And join me for Trauma Awareness for the Pelvic Therapist if you want more science and skills for patient care!


* Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, National Crime Victimization Survey, 2018 (2019).

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Department of Education's Changes to Title IX

Last week- on May 6 amid a pandemic- the Department of Education released changes to Title IX. Title IX is a 1972 Civil Rights Act that bans sexual discrimination within the educational system. Sadly, the new provisions within the 2,033 page document include the following changes:

  • Narrows the definition of sexual harassment
  • Reduces options to survivors of sexual assault, dating violence and stalking
  • Reduces liability of colleges and universities
  • Reduces mandated reporting of sexual violence
  • Deregulates federal guidelines to protect sexual violence survivors
  • Changes the ‘standard of proof’ from ‘preponderance’ to ‘clear and convincing’
  • Bolsters protections for perpetrators
  • Allows for live hearings and cross examinations of the assault survivor
  • Only investigates if assault reported to ‘certain people’

23% of undergraduates and 11% of graduate students report having experienced sexual violence, AND we know survivors under-report assaults. We talk extensively about medical and legal considerations for sexual violence survivors in my "Empowering the Sexual Assault Survivor" course. Participants who took my course will need to know those protections we discussed just a few days ago are slated to be rolled back. Today, in my remote course "Trauma Informed Care", we lay the physiological and neurobiological framework for empowering the sexual assault survivor. Following that, in addition to how to continue empowering for survivors, we elaborated on the legal changes listed above.

Outrageously, these Title IX deregulating provisions are to go into effect August 14, 2020 while schools are struggling to keep students safe amid coronavirus pandemic.  Again, let us look at these percentages (23% of undergraduates, and 11% of graduate students) and think about who needs safety and protection.

Schools do have choice in whether they roll back their protections to survivors of sexual violence. If you're looking for ways to help, you may want to reach out to your alma mater and ask what changes they are planning to make in the context of this new deregulation and disempowerment of Title IX protections. Maybe contact your local sexual assault coalition and see how you can become involved.  You could also contact your legislature and/or leave comment on www.regulations.gov (search title IX and education).Empower yourself so that you can empower others! As a physical therapist specialized in pelvic rehabilitation, empowering survivors of sexual violence happens every day in my practice. I hope you feel empowered, supported and successful in doing this challenging work too!

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Upcoming Continuing Education Courses

Pelvic Floor Level 2B - Satellite Lab Course

Apr 10, 2021 - Apr 11, 2021

Nutrition Perspectives for the Pelvic Rehab Therapist - Remote Course

Apr 10, 2021 - Apr 11, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2B - Mequon, WI Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Health In Balance Physical Therapy

Pelvic Floor Level 1 - Satellite Lab Course

Apr 10, 2021 - Apr 11, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2B - Bozeman, MT Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Great Northern Physical Therapy

Pelvic Floor Level 1 - Self-Hosted

Apr 10, 2021 - Apr 11, 2021
Location: Self-Hosted Course

Pelvic Floor Level 2B - Annapolis, MD Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Encompass PT

Pelvic Floor Level 2B - Marietta, GA Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Southern Pelvic Health

Pelvic Floor Level 2B - Torrance, CA Satellite Course

Apr 10, 2021 - Apr 11, 2021
Location: Women's Advantage Inc

Lumbar Nerve Manual Assessment and Treatment - Remote Course

Apr 10, 2021 - Apr 11, 2021
Location: Replacement Remote Course

Pelvic Floor Level 2B - Fort Smith, AR Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Arkansas Colleges of Heatlh Education

Pelvic Floor Level 1 - Missoula, MT Satellite Location (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Florence therapy and wellness

Pelvic Floor Level 2B - Doylestown, PA Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Central Bucks Physical Therapy LLC

Pelvic Floor Level 2B - Ann Arbor, MI Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Probility Physical Therapy

Pelvic Floor Level 2B - New Orleans, LA Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Ochsner Therapy and Wellness/Ochsner Health System

Pelvic Floor Level 2B - Worcester, MA Satellite Course (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Central Mass PT & Wellness

Pelvic Floor Level 2B - Buffalo, NY Satellite Course

Apr 10, 2021 - Apr 11, 2021
Location: CorrEra Physical Therapy

Pelvic Floor Level 2B - Self-Hosted

Apr 10, 2021 - Apr 11, 2021
Location: Self-Hosted Course

Pelvic Floor Level 1 - Greenville, SC Satellite Location (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: His Therapy

Pelvic Floor Level 1 - Fultondale, AL Satellite Location (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: TherapySouth Fultondale

Osteoporosis Management - Remote Course

Apr 10, 2021 - Apr 11, 2021
Location: Replacement Remote Course

Pelvic Floor Level 1 - Derby, CT Satellite Location (SOLD OUT)

Apr 10, 2021 - Apr 11, 2021
Location: Griffin Hospital

Pediatric Incontinence and Pelvic Floor Dysfunction- Remote Course (SOLD OUT)

Apr 16, 2021 - Apr 18, 2021
Location: Replacement Remote Course

Pediatric Incontinence - Grand Rapids, MI (Rescheduled)

Apr 17, 2021 - Apr 18, 2021
Location: Mary Free Bed Rehabilitation Hospital

Pregnancy Rehabilitation - Remote Course

Apr 17, 2021 - Apr 18, 2021
Location: Replacement Remote Course

Manual Therapy for the Abdominal Wall - Remote Course

Apr 17, 2021
Location: Short Form Remote Course

Pudendal Neuralgia and Nerve Entrapment - Remote Course

Apr 17, 2021 - Apr 18, 2021
Location: Replacement Remote Course

From Challenged and Concerned to Centered and Empowered

Apr 18, 2021
Location: Short Form Remote Course

Pelvic Floor Level 2B - Houston, TX

Apr 24, 2021 - Apr 25, 2021
Location: Texas Children’s Hospital

Pelvic Floor Level 2B - Garden City, NY Satellite Course (SOLD OUT)

Apr 24, 2021 - Apr 25, 2021
Location: Metro Physical & Aquatic Therapy