Working with Survivors of Sexual Assault

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 in mental health before 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 our work? I can spout the statistics: 1 in 4 women and about 1 in 26 men have experienced completed or attempted rape. About 1 in 9 men were made to penetrate someone during his lifetime. Additionally, 1 in 3 women and about 1 in 9 men experienced sexual harassment in a public place.¹ 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 to direct their healing while providing extensive physiology and anatomy education with trauma-focused, patient-centered care. With information, patients choose what they want to be treated and 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 them to go to counseling 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. Join me for Trauma Awareness for the Pelvic Therapist if you want more science and skills for patient care the next course is scheduled for May 11-12th.

Reference:

Fast Facts: Preventing Sexual Violence | Violence Prevention | Injury Center | CDC. (n.d.). https://www.cdc.gov/violenceprevention/sexualviolence/fastfact.html#:~:text=One%20in%204%20women%20and,Sexual%20violence%20starts%20early.

AUTHOR BIO:

Lauren Mansell DPT, CLT, PRPC

Lauren received her Doctor of Physical Therapy degree from Governors State University and a Bachelor's Degree in Psychology and Sociology from Northwestern University. Before becoming a physical therapist, Lauren counseled suicidal and homicidal SES at-risk youth who had survived sexual violence. Lauren was certified as a medical and legal advocate for sexual assault survivors in 1999 and has advocated for over 130 sexual assault survivors of all ages in the ED. Lauren's physical therapy specialty certifications include Certified Lymphedema Therapist (CLT), Pelvic Rehabilitation Professional Certificate (PRPC), and Certified Yoga Therapist (CYT). She is a board member of the Chicagoland Pelvic Floor Research Consortium, American Physical Therapy Association Section of Women's Health and Section of Oncology, and is a 2017 Fellow of the Chicago Trauma Collective. Her goal as a trauma-sensitive practitioner is to empower patients to create meaningful, healthful lifestyle changes to improve their physiology and wellness.