Psychotherapy as activism
How effective is a therapeutic intervention that only asks survivors to change in the aftermath of sexual violence?
Being a psychotherapist is a contradiction in itself. We have jobs we can’t talk about. We are intimately involved in many people’s lives but are compartmentalised by appointment times. There are a huge number of us in closed-off spaces, accessed only by waiting lists or the exchange of money. We are somehow there but not there in society at large.
As a psychotherapist specialising in the impact of sexual violence, this contradiction takes on particular significance. Sadly, sexual violence is everywhere, with 35% of women and girls worldwide being survivors, alongside 5% of the adult male population in the UK, for example. Such violence is a prolific societal phenomenon, yet truths about it are inconsistently voiced in support services such as psychotherapy - a reflection of the world at large. Survivors exist, but risk being an invisible population.
The scale of sexual abuse is due in part to the powerful effectiveness of myths which both minimise the issue and pathologise our responses to it. One classic example is the idea that you are most likely to be attacked at random by a stranger in the street, closely followed by the myth that such attacks should result in you actively defending yourself. If you have an image of a creepy man in a trench coat then you’re touching on the ability of myths to limit our understanding.
These myths teach us to be wary of strangers, worry about random violence, and only be concerned about attacks outside the home and in the street. We are taught that we’re able to spot a perpetrator because we know what ‘he’ looks like, and therefore we can avoid being sexually violated if we walk away from people like this when we see them. We learn that the right way to react to, and perhaps even to stop sexual violence from happening, is to fight back.
But in 90% of cases in the UK the perpetrator is known to the survivor before sexual violence occurs. We only need to look at the skyrocketing rates of domestic violence under the global coronavirus lockdown to reinforce this point, with perpetrators now having 24/7 access to survivors in their own homes.
Additionally, the most common response to sexual violence is for survivors to freeze, though ‘fight or flight’ also happen. In any case, our responses aren’t usually under our own control because they’re the result of autonomic physiological processes designed to keep us alive when we’re under threat. Both perpetrators and survivors can be of any gender, age, ethnicity, sexual orientation, class, ability or disability.
The power of myths to challenge recovery is no small thing, especially as these myths tend to be internalised before sexual violence occurs. I’ve often heard a client say, ‘I know it wasn’t my fault...but I shouldn’t have gone home with them’ in the same breath. The continual looping back to blaming oneself for what happened shows how myths perpetuate the notion that it is somehow always the victim who mis-managed the situation and caused sexual violence to play out.
My profession is bound by privacy, rooted in being silent about what we are told. That’s often what makes it so effective, as anyone who has felt assured by the confidentiality of an appointment will tell you. Psychotherapists should absolutely hold fast to this principle since it is part of establishing the trust that’s essential to moving the work forward, and for treatment to be effective.
After a certain point however, silence stops being so helpful – when the truths of sexual violence and its impact are held only in the spaces where they are spoken. We also ask survivors to ‘present’ to therapy services (as the formal terminology puts it), but rarely ‘present’ ourselves outside of this context. Psychotherapy remains a privilege for the few rather than an essential part of managing mental health for everyone. That doesn’t sound like accessibility or equality to me.
For all these reasons I’ve come to the conclusion that working only in private fuels a general passivity in response to sexual violence, which is highly problematic. My resolution is to expand my role, not only into being more active in appointments but also as an activist outside of them.
How effective is a therapeutic intervention that only asks survivors to change in the aftermath of sexual violence? How useful is the advice I give when I know that a client is going home to someone that abuses them? Psychotherapy loses so much of its value if our work in service to survivors only happens in appointments.
As an activist, the internal pull to respond to the destruction that’s caused by sexual violence leads me into the wider world which I share with every other person, even if our experiences are different. Living in a shared world means that our existences are contextualised by inequalities, some of which feed into the perpetration of sexual abuse.
These inequalities lead to disempowerment of speech, autonomy and movement once sexual violence has taken place. Simply put, survivors aren’t always able to say what has happened, nor ask for professional help. Societal myths teach everyone to think about sexual violence in limited parameters. Post-traumatic stress symptoms repeatedly force a person’s physical repertoire into fight, flight or freeze mode so that moving freely in society becomes less of an option. Survivors can’t engage in regular life in all the ways they used to.
Being sexually violated is an abuse of human rights, so how is it possible not to become an activist when repeatedly faced by such abuses? To fully hear and respond to what clients tell me I have to do much more than simply teach them how to cope with what they’ve been subjected to.
For survivors to access formal psychotherapy services more easily, psychotherapists need to step outside the consulting room and into the wider world. This includes being visible in community spaces where people already feel comfortable in engaging with others. My work has included running free support groups for female-identifying survivors of sexual violence in beauty salons, and being a participant and speaker at community wellbeing groups.
Demystifying the process of seeking support, passing on truths about sexual violence in order to push back against the myths, and challenging oppressive systems that further disempower our clients are all important. These actions enhance what we can offer to individuals by changing the world for and with them, rather than simply asking that they continually adapt to a world where sexual violence is rife.
Doing this activist work is especially important given that many survivors are already worn out by the demands of survival and everyday living, which can be such a drain on the mind and body. When they are ready, and when they wish to engage in activism too, then we can create change collectively both inside psychotherapy and in the wider world.
Psychotherapists can model what it means to be empowered in speech, autonomy and movement by utilising these freedoms in their practice and their activism. Hope is instilled in survivors when we do so, especially if the work starts from a place of believing someone when they say that they have been sexually abused.
Even the act of writing or speaking is a visible form of activism, providing a narrative that normalises the impact of traumatic experiences from the truth of survivors’ lived experiences. Part of my own work includes challenging the restrictions on ‘talking therapy’ that have been put in place by the UK Crown Prosecution Service, as well as speaking at my local ‘Reclaim the Night’ rally in 2019.
Stepping outside of the formal services we offer as psychotherapists while maintaining strict client confidentiality means that the work of recovery starts far earlier than otherwise, and also that it becomes much more effective as a result. Offering spaces to talk via psychotherapy is activism in itself in the face of a society that wishes survivors to stay silent. However, we have much more power available to us - if we choose to use it.
Note on language: ‘sexual violence’ and ‘sexual abuse’ are used interchangeably to denote the wide range of non-consensual sexual acts a person can experience. The word ‘survivor’ is used to refer to a person affected by sexual abuse in the spirit of empowerment. It is understood that ‘victim’ is a term preferred by some.
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