How does a victim cope with rape? What tools do psychologists employ to help a rape victim lead a normal life after the trauma she has suffered? Women Talk Online Blogger Debarati Mukherjee speaks to New Delhi-based psychotherapist, Dr. Saima Nafis Khan.

 When a victim of rape comes to you for help, how do you start the conversation?

Women who decide and make a commitment to come for counselling are making a very powerful and life-affirming choice. Rape is a traumatic experience and it’s very hard for them to talk about what happened to them. So I never force my client to talk about something which she is not comfortable with.

I start the conversation by saying that in counselling, it is healthy to have feelings and express them because the person is in a safe environment where the information shared is kept confidential. I also inform them that at different stages in counselling they will go through different stages of emotions. At times they may feel like running away and forgetting all about it, because this is a normal part of the counselling process. It is important to keep reassuring them that as a counsellor, you are there as a support to them through all these stages and will help them bring a satisfying change in their lives.

What do you do to protect the victim’s identity?

It is very important to inform the victim that there are clear laws on protecting the identity of the rape victim. The victim’s identity cannot be disclosed. We avoid registering their entry in the visitors’ log book at our clinic. We also don’t share the information of the counselling sessions to their significant others unless and until the victim consents to do so.

How do you help the victim live her life normally?

First, it is important to normalize the woman’s response to the rape. We work on her emotional symptoms which include depression, anxiety, sleeplessness, intense fear, flashbacks, nightmares, suspicion, hyper-vigilance, isolation, irritability and lack of concentration. Secondly, we help in preventing maladaptive coping behaviours and the emergence of long-term psychopathological illnesses. Third, family members need to be counselled to deal with rape victims. They must know what not to discuss in front of her, not to leave her alone and learn to control their emotions. Fourth, we help and encourage them to restore a healthy social network.

Do you help her to fight for justice? How do you instil courage in her?

Dr. Saima Nafis Khan

I encourage but do not create pressure on my client to report the attack. If the client does not want to report the rape, I respect her decision. I facilitate contact with community groups like victim support centres, crisis centres and legal centres.

To instil courage in the victim, it is important to identify and prioritize her fears, dangers and needs and help her work on it. If she is fighting for justice, we teach her how to communicate effectively with the official system because severe trauma and real fears frequently lead to a communication style that is frantic, incoherent, and fragmented. We also identify and deal with families and associates who have turned hostile towards the victim because of her decision to go to the courts. Lastly, we reassure them at every stage that we are there as a support throughout.

What psychological approach do you use to treat victims?

Treatment includes psychotherapy in combination with hypnosis and timeline techniques and Neuro- Linguistic Programming (NLP) techniques. The combinations of cognitive and behavioural therapies have been used with victims of rape with PTSD (Post Traumatic Stress Disorder) and have had great success.  Most cognitive-behavioural therapies consist of Stress Inoculation training, Prolonged Exposure, and Cognitive Processing Therapy.  These components are taught and administered to patients in order to stop avoidance, change maladaptive cognitions and teach coping skills that will extinguish the symptoms and return the victim to healthy living.

Hypnosis and time line techniques help the client to relive the trauma under suggestions which allows the patient to discuss the rape verbally and discharge the emotions that cannot be released during the normal state of consciousness. They also help in changing the recollections of terror, anxiety, and helplessness that are associated with the specific symptoms. While under hypnotic suggestion, the therapist can instead associate the symptoms with safer thoughts such as relaxation, confidence, and control.  This allows the patient to recall the memory during normal consciousness and enables the victim to deal with the memory and not avoid it, thus allowing them to express the emotions, discuss the event and conquer the trauma.

NLP teaches the client how to identify their maladaptive thoughts by focusing on their internal dialogue.  Once identified, the client learns how to substitute more adaptive and positive linguistics. Relaxation techniques and breathing exercise are also taught to deal with physical symptoms like palpitation, aches and pain and sleep.
How long does it take for a victim to return to normal life?

There is no set time for recovery; it may take several months and sometimes several years. It is important to give a victim the right support because she does recover and moves on with her life.

Patterns of readjustment vary greatly and it is important to state again that there is no one way for a rape victim to readjust. Encouraging them to sleep, eat, and exercise as regularly as possible will help them regain some normalcy in life. One can help them participate in activities when they are ready. Encourage them to join support group provide an avenue for her to sort out her feelings with others who have similar experiences. This helps in rebuilding the confidence.

We inform the loved ones to take out time for victims and keep reassuring them by saying positive affirmations like “I believe you,” “I’m here if u want to talk,” “You are not alone.” As a family member, one shouldn’t criticize or judge them. Help them make their choices. Being raped is the ultimate loss of control over a victim’s environment. Allow your loved one to make her decisions as a way to begin on the road to empowerment. Finally, it’s important to tell victims that it is okay to feel angry, scared or sad and these are all normal emotions that everyone experiences.

It is said that a rape is like a scar that never gets healed completely. Do you agree?

Yes, if it is not assisted and managed properly.

Do you also deal with patients who were raped in their domestic front? How do you deal with them?

Yes, I do. Most of the women who come for counselling hide the fact from their family that they are seeking professional help because the choices women confront are not risk- free. So I basically try to encourage them to report to the domestic violence cells or to the police. I also provide them with medical assistance if required.

If it is marital rape then I help them re-evaluate their expectations from a relationship or their marriage which helps them in taking a decision to stand against violence. I help them prioritise their needs and reorganise the available resources. I ask them to take up self defence courses to protect themselves from violent attacks. I identify and help them build up social support.

It is believed if you are raped, lodging complaints and meeting psychologists add to pressure from society. Do you agree?

Yes, I agree because most victims are afraid of humiliation or defaming their family’s image. Furthermore, they are heckled by law enforcers and cornered by society. Many do not get any family support if they meet a psychologist or go ahead and lodge a complaint.

Lastly, counselling is not very well accepted in the Indian society. People believe that those who meet counsellors are “mad.” Indian society is male-dominated, where consciously or unconsciously, women are taught to suppress their feelings, desires and needs.

Interview: Debarati Mukherjee

Editor: Manasi Gopalakrishnan