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The Rape Crisis Intervention Handbook
A GUIDE FOR VICTIM CARE
The Rape Crisis Intervention Handbook
A GUIDE FOR VICTIM CARE
Edited by
SHARON L. MCCOMBIE Director, Rape Crisis Intervention Program
Beth Israel Hospital Boston, Massachusetts
PLENUM PRESS • NEW YORK AND LONDON
First Printing-May 1980 Second Printing-May 1983 Third Printing-August 1986
ISBN-13: 978-1-4684-3691-4 e-ISBN-13: 978-1-4684-3689-1 DOl: 10.1007/978-1-4684-3689-1
© 1980 Plenum Press, New York Softcover reprint of the hardcover 1st edition 1980
A Division of Plenum Publishing Corporation 233 Spring Street, New York, N.Y. 10013
To my father Ernest F. McCombie
Contributors
Judith H. Arons, M.S. W., A.C.S. W .• Staff Social Worker, Obstetrics and Gynecology Service, Ambulatory Care Unit, Beth Israel Hospital; Clinical Instructor, Simmons College School of Social Work, Boston, Massachusetts
Ellen L. Bassuk, M. D . • Assistant Professor of Psychiatry, Harvard Medical School; Director of Psychiatric Emergency Services, Beth Israel Hospital, Boston, Massachusetts
H. Jean Birnbaum, B.A . • Consultant, Massachusetts Criminal Justice Training Council, Boston, Massachusetts
Renee S. Tankenoff Brant, M.D . • Instructor in Psychiatry, Harvard Medical School; Director, Sexual Abuse Treatment Team, Children's Hospital Medical Center, Boston, Massachusetts
Ann Wolbert Burgess, R.N., D.N.Sc . • Director of Nursing Research, School of Nursing, Boston University, Boston, Massachusetts; Chairperson, Rape Prevention and Control Advisory Committee, U.S. Department of Health, Education and Welfare
Janet Weeks Evans, R.N . • Nursing Coordinator, Rape Crisis Intervention Program, Beth Israel Hospital, Boston, Massachusetts
Lynda Lytle Holmstrom, Ph. D. • Professor and Chairperson, Department of Sociology, Boston College, Boston, Massachusetts
A. Nicholas Groth, Ph.D . • Director, Sex Offender Program, State of Connecticut, Department of Corrections, Somers, Connecticut
Barbara Schuler Gilmore, R.N., M.S.N . • Coordinator, Rape Service, Newton-Wellesley Hospital, Newton Lower Falls, Massachusetts
vii
viii CONTRIBUTORS
Henry Klapholz, M.D . • Assistant Professor of Obstetrics and Gynecology, Harvard Medical School; Coordinator of Medical Education, Department of Obstetrics and Gynecology, Beth Israel Hospital, Boston, Massachusetts
Sharon L. McCombie, M.S. W., A.CS. W .• Founder and Director, Rape Crisis Intervention Program, Beth Israel Hospital; Clinical Instructor, Simmons College School of Social Work, Boston, Massachusetts
Catherine H. Morrison, M.S. W., A.CS. W .• Supervisor, Department of Social Service, Beth Israel Hospital; Clinical Instructor, Simmons College School of Social Work, Boston, Massachusetts
Peter]. Murphy, III • Detective, Brookline Police Department, Brookline, Massachusetts
Carol C Nadelson, M. D .• Professor of Psychiatry, Tufts University School of Medicine; Associate-in-Chief and Director of Training and Education, Department of Psychiatry, Tufts New England Medical Center, Boston, Massachusetts
Malkah T. Notman, M.D . • Associate Professor of Psychiatry, Harvard Medical School; Liaison Psychiatrist with Obstetrics and Gynecology, Department of Psychiatry, Beth Israel Hospital, Boston, Massachusetts
Alice E. Richmond, Esq . • Former Assistant District Attorney, Suffolk District; former Assistant Professor, New England School of Law, Boston, Massachusetts
Daniel Silverman, M. D. • Instructor in Psychiatry, Harvard Medical School; Director of Medical Education, Department of Psychiatry, Beth Israel Hospital, Boston, Massachusetts
Preface
This handbook is intended to be a comprehensive resource for those involved in providing crisis intervention to rape victims. The medical, legal, and counseling needs of the rape victim are presented to prepare helping professionals to offer sensitive and skillful assistance to women who have suffered sexual assault. The interdisciplinary thrust of the book reflects our conviction that health professionals, police, and prosecuting attorneys must share their expertise and coordinate their efforts in order to successfully meet the multiple needs of rape victims and their families. While an extensive literature on rape has developed in the past decade, to the best of our knowledge there is no single source for the practical treatment-oriented information sought by those who work directly with victims. The primary objective of this book is to offer just such a guide to service providers.
The book is organized into sections that deal with a specific area of the treatment of victims. Detailed guidelines are provided for the nursing, medical, counseling, police, and legal services involved in comprehensive crisis intervention. Interdisciplinary teaming and the emotional impact of rape on service providers are discussed by authors actively involved in rape crisis work. Rape laws are explained and court preparation for victim-witnesses is carefully outlined. Of particular relevance to counselors is an overview of crisis theory and a psychodynamic perspective on rape trauma. Treatment guidelines for counseling victims and their families are discussed and illustrated with case examples. We lead off with chapters that examine the cultural factors that perpetuate violence toward women and that explore common misconceptions about victims, offenders, and assaults. Although the focus of the book is on the adult woman victim, we have included a chapter on children victimized by sexual abuse. The special problems facing men who work with rape victims are addressed in the final chapter written from the point of view of the male counselor.
There are several references in the text to the appendixes of the handbook. These contain some of the educational materials we developed for the Rape Crisis Intervention Program at Beth Israel Hospital in Boston. The
ix
x PREFACE
inclusion is not meant to indicate that these items are definitive or ideal; rather they are submitted as examples of working guidelines and fact sheets. In addition to nursing and medical protocols, we have included an example of a hospital permission form to release evidence to the police and a sample of a third-party report form for the anonymous sharing of information with the police for victims who will not report the crime to the authorities. We have included a copy of the information sheet the hospital gives to victims treated in our emergency room. There are also examples of three public education sheets that are frequently requested. The first is a questionnaire concerning myths and facts about rape that is used to encourage discussion. Another outlines the basic facts about what to do if raped, and the third lists safety precautions useful in increasing awareness about potentially risky situations.
The idea for this handbook came from our experience in training health professionals, police, and lawyers to work more effectively with rape victims. Requests for teaching and consultation evolved from the medical and counseling services we were offering to victims through the Rape Crisis Intervention Program.
Back in 1973, a small group of women mental health professionals at the Beth Israel Hospital began to organize a pilot project to provide comprehensive emergency medical and psychological assistance to women who had been raped. At that time, there was a conspicuous lack of information in the professional literature about the treatment of the adult rape victim. We found that we were largely dependent on our own resources to educate ourselves about the special needs and problems of these women. Our original interest was stimulated by the shocking frequency with which we discovered a history of a rape in the backgrounds of the women we saw in our practices. At the time of the rape, the vast majority of them had remained silent about their experience, and those who had sought assistance had usually been met with suspicions of complicity or wrongdoing. It was apparent that the original trauma of the rape was compounded by the lack of social support and services.
In the years since then, there has been an expansion in this country of services for rape victims and literature addressing the sociopolitical, epidemiological, medical, legal, and psychological issues of sexual assault. Our pilot project grew into an established Rape Crisis Intervention Program, which offers immediate and follow-up medical and counseling services to victims and their families. We have treated over 600 victims in our emergency room. The program also supplies consultation and training, provides public education to the community, and conducts ongoing clinical research on the acute and long-term impact of rape on life adjustment.
This handbook is an attempt to share the understanding we have developed from our clinical experience. There are several omissions in the book.
PREFACE xi
We do not deal with the effects of rape on homosexual women because we do not have enough direct knowledge of these victims. Also we have not addressed the needs of the male victim. While we recognize that adult males are also victims of sexual assault, the majority of those seeking services today are female. Our experience with male victims is limited, but from what we have seen, the men present the same kind of concerns and symptoms as the women we have met. They have, however, the added burden of the humiliation and fear associated with the homosexual nature of the assaults. The conspiracy of silence that kept women rape victims from our attention a decade ago still persists today for men.
Some readers may take exception to our stereotypical use of pronouns in the text. Doctors, police, and lawyers are usually referred to as "he," while nurses and counselors are designated as "she." We have followed this pattern for the sake of simplicity and readability. We do, however, fully recognize that all of these professions have both men and women among their ranks. Unfortunately, these professions still remain predominantly filled with one sex or the other. We strongly believe that men as well as women must become involved in directly helping victims as well as in changing the forces that perpetuate rape in our society. Rape and the fear and anguish it exerts will continue as long as we fail to see it as a problem that affects all of us.
This book came to be through the collective work of many people who gave generously of their energy and expertise. In addition to the work of the contributing authors, I am particularly grateful to Catherine H. Morrison for her invaluable editorial assistance and for the encouragement she provided throughout the process of developing this book. A special thanks is extended to Professor Morton D. Paley of the English Department, University of California at Berkeley, who brought his considerable editing skills and a fresh perspective to the material. The editorial contributions of Amy Schafer, Karen Shultz, Judith Arons, Andrew Gill, Donald Kalick, Maria Karagianis, and Claude Bernard were also vital to the completion of this project. I wish to thank Kate McShane for her support and secretarial assistance, and I am very grateful to Hilary Evans of Plenum for her patience and counsel throughout the preparation of the manuscript.
I am deeply appreciative of the women who used the rape crisis intervention services at the Beth Israel Hospital. It is their pain that has made this book necessary, their courage that has made it possible. I hope that what we have learned from them will contribute to helping other victims of rape.
Sharon L. McCombie Boston
Contents
Part I • Myths and Realities
Chapter 1. A Cultural Perspective on Rape
CATHERINE H. MORRISON
Chapter 2. The Rapist: Motivations for Sexual Violence
A. NICHOLAS GROTH AND H. JEAN BIRNBAUM
Chapter 3. Rape Typology and the Coping Behavior of Rape Victims
ANN WOLBERT BURGESS AND
LYNDA LYTLE HOLMSTROM
Part II • The Hospital Emergency Room
Chapter 4. The Nursing Care of Rape Victims
BARBARA SCHULER GILMORE AND
JANET WEEKS EVANS
Chapter 5. The Medical Examination: Treatment and Evidence Collection
HENRY KLAPHOLZ ,I
Part III • The Legal System
Chapter 6. The Police Investigation
PETERJ. MURPHY III
3
17
27
43
59
69
xiii
xiv
Chapter 7. Rape Law and the Judicial Process
ALICE E. RICHMOND
Chapter 8. The Experience of the Rape Victim in the Courtroom
ALICE E. RICHMOND
CONTENTS
79
97
Part IV • Psychological Overview of Rape Trauma
Chapter 9. A Crisis Theory Perspective on Rape
ELLEN L. BASSUK
Chapter 10 • Psychodynamic and Life-Stage Considerations
121
in the Response to Rape 131
MALKAH T. NOTMAN AND CAROL C. NADELSON
Part V • Psychological Intervention
Chapter 11 • Counseling Rape Victims
SHARON L. MCCOMBIE AND JUDITH H. ARONS
Chapter 12 • Counseling the Mates and Families of Rape Victims
DANIEL SILVERMAN AND SHARON L. MCCOMBIE
Part VI • Special Considerations
Chapter 13 • The Child Victim
RENEE S. TANKENOFF BRANT
145
173
185
Chapter 14 • The Male Counselor and the Female Rape Victim 193
DANIEL SILVERMAN
CONTENTS xv
Part VII • Appendixes
Appendix 1 • Guidelines for the Nursing Care of Rape Victims in the Emergency Unit 201
Appendix 2 • Guidelines for the Medical Care of Rape Victims 207
Appendix 3 • Permission for Release of Material Evidence to the Police 215
Appendix 4 • Third-Party Rape Report 217
Appendix 5 • Information for Patients Coping with Sexual Assault 219
Appendix 6 • Rape Questionnaire 223
Appendix 7. Practical Facts and Suggestions about What to Do if Raped 225
Appendix 8 • Safety Precautions to Avoid Assault 227
Index 231