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Communicating with rape victims




Communicating with rape victims as a service provider (medical, law enforcement or other) can be a very frustrating experience. It helps to understand why it is difficult for rape survivors to relay information and how to best encourage them to tell their stories.


For one thing "Clients often feel words are too immediate and too explicit to describe the experience and the resulting emotional response generated by sexual abuse. Created within the context of what psychiatrist Winnicott (1971) described as the "good enough" therapeutic relationship, artwork may be viewed as more concrete and symbolic, or less immediately explicit and therefore safer than verbal communications." (Clukey, 2003). Art work can also be used as a 'first step' or introduction to telling their story in narrative (words). Sometimes it's easier to get used to telling the story in image form before writing, and then saying the words. (Lev-Wiesel, 1998)

Some therapists who work with trauma patients are working on "integrating both verbal and nonverbal therapy with a client with severe anxiety and depression." (McNamee, 2004) The reason for this is the way the brain works. The right brain works with images and the left brain works with logic and words. PTSD victims temporarily loose communication (essentially) with the left side of the brain. The creative, image oriented side has to take over those functions. That makes logic and words more difficult. This is due to the passage between the two sides (corpus callosum) being damaged by PTSD. (Villarreal, G. et.al., 2004) , (Seritan, 2005). There is also new evidence that PTSD patients actually store traumatic memories in image form in a different part of the brain than normal memories. (Turner, 2004)

An example of what this means is:

What if your computer could only show graphics or pictures because it had a virus? There would be no text accessible. You could only see the parts of webpages that contained images. That is sort of what it's like to not have functioning on the left side of the brain (language, math and logic). Because of this it may be better to use visual aids when explaining things to victims with PTSD who are using their right brain (images and creativity).

More information on this is available here.

Many rape victims also have a temporary disfunction called psychomotor retardation.

For service providers "careful communication with the patient is vital. As with any severe emotional trauma, patients who have been raped may not be able to hear or understand information and/or instructions. All information should be presented often and in many different ways so that the patient can absorb it. The patient should be informed of what is to happen at each phase of the examination and, whenever possible, should be allowed choices about her examination and treatment. This begins to restore some sense of control. If the protocol involves plucking hair or scraping nails, the patient should be allowed to collect these samples herself rather than having medical providers reenact her assault. Psychomotor retardation is very common in women who have been sexually assaulted and can be maddening to busy providers, but the patient must be allowed to move at her own pace." (emedicine)

Psychomotor retardation is described as "(slowed thinking, speech, body movements) or agitation (inability to sit still, hand-wringing, pulling at clothing, skin, or other objects) that is apparent to others." (minddisorders) It is also one of the five criteria for major depressive episode according to the Diagnostic and Statistical Manual of Mental Disorders. In addition it is a part of combat stress and eating disordered behavior. For GHB date rape drug victims psychomotor retardation may be effected or compounded by this drug. (NIH)





Online resources


Telling your story- a tutorial



A directory of resources for people having trauma and mental issues



Attainment Company


This company makes systems which help communicate with a combination of sounds and images.


Flash cards for communication via images


These cards are for children with autism but the idea is that communication via images is better for those with trauma issues. The Flash! Pro2 CD-ROM has a huge collection of over 10,000 color photographic images in 65 categories (click above on "Samples") that you can preview and print to teach speech, language and communication to children of all ages.


The Sidran Institute - Catalog by Subject



Medline directory



Journal articles

Communication and rape victims

McNamee, Carole M. (2004). Using both sides of the brain: Experiences that integrate art and talk therapy through scribble drawings. Art Therapy. 21(3), 2004. pp. 136-142. link

Neuroscience researchers identify a cerebral cortex with two functioning hemispheres: a left hemisphere associated with language and speech and a right hemisphere associated with visual-motor activities. Additionally, neuroscientists argue that contemporary lifestyles favor the verbal, logical left brain and often ignore the truths that present in the right brain. Psychotherapy techniques range in their use of left-brain verbal discourse and right-brain nonverbal discourse. In a case study, the author describes experiences integrating both verbal and nonverbal therapy with a client with severe anxiety and depression. Nonverbal therapy involved annotated scribble drawings. Images in the drawings became the stimuli for verbal discourse with the client. Other client responses to the annotated scribble drawings are described.




Lev-Wiesel, Rachel (1998). Use of drawing technique to encourage verbalization in adult survivor of sexual abuse. ; Arts in Psychotherapy. 25(4), 1998. pp. 257-262. link

Demonstrates the effectiveness of drawings (art therapy) in encouraging an adult survivor of childhood sexual abuse to speak about the past traumatic experiences. This ability to speak up not only breaks the conspiracy of family members to keep the secret, but also enables the victim to deal with negative feelings toward himself/herself and his/her parents. The drawing technique is illustrated in 4 therapeutic sessions (out of 24) with an adult female who was sexually abused by her father in childhood.


Holistic Assessment of rape victims. By: Mayer, Rick A.; Ottens, Allen J.. Guidance & Counseling, Mar94, Vol. 9 Issue 4, p24, 4p

This article describes a method for the holistic assessment of rape victims. This method consists of assessing the effect the rape has on the victims'affective, cognitive and behavioural functioning. By assessing the severity of the trauma in these areas counsellors are able to develop appropriate treatment strategies.
"The TAF permits counsellors to assess clients' level of impairment with respect to affective, cognitive and behavioural reactions to a crisis. Space is provided on the TAF for counsellors to make notation of any significant clinical findings. Affective categories are: (a) anger/hostility (may be present as agitation or a desire for possible retaliation); (b) fear/anxiety (may be present as sense of disorientation or jittery tension); and (c) sadness/melancholy (may be present as emotional and/or physical exhaustion accompanied by a sense of hopelessness). Counsellors are asked to identify clients' affective reaction to the crisis event using these categories and also assess the level of impairment. Should more than one affect be present, counsellors must judge which affect is primary, secondary and tertiary."




Art speaks in healing survivors of war: The use of art therapy in treating trauma survivors. Baker, Barbara Ann; Journal of Aggression, Maltreatment & Trauma, Vol 12(1-2), 2006. pp. 183-198.

Mental health clinics can use creative art therapies as a means of reaching out to war refugees in their communities who may not respond to traditional talk therapy. In this case, the use of quilting and other artwork was utilized by the staff at Chicago Health Outreach to assist displaced Bosnians to cope with their war-related trauma and integration into their new environment in the United States. It can be difficult to reach refugee populations within a community whose culture and language are different from the majority, but finding other means of communicating can make a real difference for these individuals as they find safety and understanding by working on and sharing special creative projects.






Burmark, Lynell (2004). Visual Presentations That Prompt, Flash &Transform. Media & Methods, 40 (6), p4-4.



This article suggests ways to conduct classroom sessions using projectors. Flashcards remain a stable way to help students retain information. Instead of spending hours laminating paper flash cards, create a digital template. A projector is used to show the flash slides for specific areas of study. Teach students word processing commands like cut, paste and move in a fun way by projecting scrambled jokes. Use the move command in the word processor to show students how the word processor tools work. By projecting this process, a large class can see how simple the transfer of information can be. This kind of text sequencing can be used to reorder not just jokes, but also event timelines, size of numbers or objects, and other selections. Have a full-screen photographic image projected in your classroom when students walk into class. Then have them write their interpretations of the projected image. By using these readily you can create compelling curriculum and reach those learners who have failed to learn from text-only media. Images are more than illustration. They are the heart of comprehension and the fastest route to academic success.





The healing art: The integration of art therapy into the modern psychoanalytic approach. Sharon, Ruth Velikorsky; Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 65(7-B), 2005. pp. 3724.

In this study I want to illustrate how the production of drawings and written associations of a patient in the psychoanalytic framework can be a springboard for progressive verbalization and communication. It is helpful because it can facilitate the expression of pre-verbal and non-verbal material. Experiences of the patient, before the age of language acquisition, fall into this category. I will do this using a case study approach, by presenting the case of Rachel, a preoedipal patient whom I treated through the use of art in the psychoanalytic framework. Her case will be presented, and the repetitive material which signalled the presence of the resistance and the unconscious material in her art work and written associations to it will be summarized and explored. I will discuss the presence of the transference, countertransference, and resistance in our therapeutic relationship-as present in her work, her actions, and her behavior as treatment progressed. My purpose in doing that is to explore the ways in which the use of art effected those elements. I also hope to open this field for more research in this area.





A descriptive study: Selection and use of art mediums by sexually abused adults: Implications in counseling and art psychotherapy. Clukey, Frances Harlow; Dissertation Abstracts International: Section B: The Sciences and Engineering, Vol 64(4-B), 2003. pp. 1679.

This research was designed to explore what happens in the process of therapy when clients, having persisting symptoms of sexual abuse and having disclosed that abuse, have access to a wide variety of art materials to select and use in treatment. A blend of qualitative and quantitative research in design, the study is an initial step towards a greater understanding of the potentially transformative experience of art making and the role of art mediums in the practice of therapy. Treatment for abuse is a long, complex and arduous process. Persistent aspects of abusive experience remain deeply buried within the body and cause periodic, cyclical, somatic and psychological problems in an individual's life. Clients often feel words are too immediate and too explicit to describe the experience and the resulting emotional response generated by sexual abuse. Created within the context of what psychiatrist Winnicott (1971) described as the "good enough" therapeutic relationship, artwork may be viewed as more concrete and symbolic, or less immediately explicit and therefore safer than verbal communications. Sensory-based therapies such as art therapy are, therefore, particularly useful in accessing traumatic memories and transforming the experience to a less damaging state. For this study, the author set up private practice to work as therapist with eight individuals for eight fifty-five minute sessions in a traditional art therapy studio. Each session was documented on videotape. Artwork was photographed. Videotapes, artwork, intake histories and the researcher/therapist's notes were analyzed. Brief case studies were developed. Data were considered by frequencies and ordinal comparisons for immerging patterns. The data described art mediums as accessing cognitive, symbolic, emotional, perceptual, kinesthetic and sensory levels of understanding. A spiral model facilitated understanding the process. The potential to pace the process of therapy by direction and selection of more or less mediated, fluid and controllable art mediums was shown to exist. Through the spatial and kinesthetic processes of art making in art therapy, the individual controls recollection, comprehension, integration and resolution of trauma. Art mediums are central in art therapy as they safely provide the means of expression and reflection to transform trauma in the bodymind.



Three art assessments: The Silver Drawing Test of cognition and emotion; draw a story: Screening for depression; and stimulus drawings and techniques. Silver, Rawley; New York, NY, US: Brunner-Routledge, 2002. xxiv, 315 pp.

(from the jacket) Art can be an invaluable means of communication. It can bypass language and hearing impairment and become a means of communicating thoughts or feelings too difficult to express with words. This book uses three original art assessments that use stimulus drawings to elicit response drawings that provide access to a patient's emotions and attitudes toward themselves and others while testing for the ability to solve problems and convey ideas. Each assessment includes studies of reliability, validity, and normative data, drawing on international research in the field and on the author's own body of work spanning more than forty years. Stimulus drawings are provided as well as drawing from imagination tasks, and rating scales to assess emotional and cognitive content.



Arts as language: Access to thoughts and feelings through stimulus drawings. Silver, Rawley; New York, NY, US: Brunner-Routledge, 2001. xix, 187 pp.

from the cover) Discusses the use of the visual medium as a linguistic parallel to verbal or written communication. While recognizing that language expands and facilitates thought, the author illustrates the existence of high-level thinking in its absence and demonstrates the usefulness of drawing as an expressional tool for patients who are unable, or unwilling, to express themselves through the conventional use of language. Covering areas such as cognition, creativity, and emotion, this book provides the reader with an introduction to and explanation of stimulus drawing assessment. In this approach, drawings serve as the principal channel for the exchange of ideas. Stimulus drawings are provided to the patient to evoke a response drawing. These response drawings allow patients to sketch their fantasies, thus allowing some sort of gratification. The drawings may also serve as a means of acceptably expressing feelings the patient deems inappropriate, such as fear or anger. Reviews of qualitative and quantitative studies follow the introduction. By reviewing studies of children, adolescents, and adults suffering form various impairments and injuries, the author shows the broad applicability of stimulus drawing assessments.



Mandala artwork by clients with DID: Clinical observations based on two theoretical models. Cox, Carol Thayer; Cohen, Barry M.; Art Therapy, Vol 17(3), 2000. pp. 195-201.

The authors have explored the compositional patterns and thematic imagery in mandala drawings by a large group of patients diagnosed with multiple personality/dissociative identity disorder (MPD/DID). In approaching this work, they used both the Ten Category Model (G. M. Cohen & C. T. Cox, 1995) and the Great Round of Mandala theory (J. Kellogg, 1978, 1997) looking for parallels between the two systems of analysis to help therapists better understand the nonverbal communications of their clients. Although not a formal research study, the observations based on the synthesis of these two unrelated models are nonetheless consistent with the assessment and treatment literature on DID.


Art psychotherapy groups: Between pictures and words. Skaife, Sally; Huet, Val; Florence, KY, US: Taylor & Frances/Routledge, 1998. x, 209 pp.

(from the cover) Presenting an account of the challenges encountered in art psychotherapy practice, this book explores new theoretical material arising from the merging of art and group psychotherapy. The contributors present in-depth discussion of case studies with client groups such as children, forensic patients, patients on acute psychiatric wards, the cognitively impaired elderly, institutionalized patients moving into the community, and drug and alcohol abusers. A common theme which emerges from the book is that the physical use of art materials and the space of the art room offer a possibility for communication of feelings which is not possible in purely verbal groups. This allows clients with severe mental health problems, and groups who would not normally be considered for purely verbal group therapy, to benefit from a psychodynamic group process.
The book is intended to be a resource for practising and trainee art therapists, and all professionals working psychodynamically with clients who have severe mental health problems.


Therapeutic presence: Bridging expression and form. Robbins, Arthur; Philadelphia, PA, US: Jessica Kingsley Publishers, Ltd., 1998. 280 pp.

(from the cover) In the therapeutic workplace, the interaction between patient and therapist is built upon cognitive, affective and expressive experiences. The contributors to this book explore this interaction, examining the concept of therapeutic presence, and the therapist's ability to maintain it. The theory integrates a creative framework that synthesizes traditional and non-traditional approaches to treatment, and will be of use to all mental health professionals.
The author suggests that, since therapeutic presence calls for an openness and awareness of the intersubjective space between therapist and patient, therapists who become receptive to the subtle cues of sensory perceptual communication, as well as to the playful mirroring and meditative interaction, will achieve more successful and meaningful interactions with patients. Therapeutic presence requires a sensitivity to the temporal characteristics of the therapeutic frame, and an experience of energy that may open, shut down, or disrupt the field of therapeutic contact.
This stance can be applied to therapeutic modalities ranging from psychoanalysis to creative arts therapy, in work with both short term and long term populations. The author suggests that the full use of the therapist's creative energies may provide the only solution to overwhelming therapeutic situations.



Seritan, A., (2005) Hysteria and the Mind-Brain Connection. Psychiatric Times, 52 (13), 41-42.

Abstract: The article focuses on the development of theories on conversion disorder. The drawback of the theory that nonverbal memory content could be processed into a verbal form is that it relates consciousness to the left brain function. The derealization and depersonalization in posttraumatic stress disorder is caused by the failure of left hemisphere to function during states of extreme arousal. According to Pierre Janet, hysteria is a deficit of selective attention or undoubling of personality.



Lee Park, Hye-Suk (2005). Multiple exemplar instruction and transformation of stimulus function from auditory-visual matching to visual-visual matching. ; Dissertation Abstracts International Section A: Humanities and Social Sciences, Vol 66(5-A). pp. 1715.

The present study examined (1) whether MEI was needed for children with developmental disabilities to acquire bidirectionality across listener responses and speaker responses as naming; (2) whether naming was prerequisite for reading comprehension; and (3) whether there was an effect of MEI on rudimentary reading comprehension. Four children with developmental disabilities with a range of 2 to 4 years in age participated in Experiment I, and four four-year old children with developmental disabilities participated in Experiment II. A multiple baseline design across participants with multiple probes within participants was implemented in a time lagged fashion. Three sets of four items were presented as stimuli in flash cards. The participants received instruction either on listener responses or speaker responses with a set of stimuli, and received probes for untaught speaker responses or listener responses as emergent naming, and for untaught reading comprehension in form of matching symbols to the corresponding written words. Responses (listener or speaker) the participants received instruction on during the pre-intervention phases were counterbalanced across the participants in Experiment I and Experiment II. Sets of stimuli were counterbalanced in Experiment II. The participants who received speaker instruction showed untaught listener responses as naming but did not emit untaught reading comprehension with the presence of naming in their repertoires in Experiment I and Experiment II. The participants who received listener instruction did not show clear emergence of untaught speaker responses, and received remedial naming instruction followed by probes for reading comprehension in Experiment I and Experiment II. These participants also did not show untaught reading comprehension during the post-naming probes. MEI on naming and reading comprehension was delivered with another set. All the participants emitted untaught reading comprehension during probes that were conducted after MEI with the original set of the stimuli. Instruction either on listener or speaker responses was delivered with a new set of stimuli counterbalanced in responses they received instruction on within the participants in order to test whether they emitted untaught naming and reading comprehension with the new set of stimuli. All of the participants showed untaught naming and reading comprehension with the new set of stimuli. The results were discussed in terms of equivalence class, naming, and relational frame theory. (PsycINFO Database Record (c) 2006 APA, all rights reserved)



Cherney LR. Aphasia, alexia, and oral reading. [Review] [79 refs] [Journal Article. Review] Topics in Stroke Rehabilitation. 11(1):22-36, 2004.

Alexia is an acquired disturbance in reading. Alexias that occur after left hemisphere damage typically result from linguistic deficits and may occur as isolated symptoms or as part of an aphasia syndrome. This article presents an overview of the classification of the alexias, including both the traditional neuroanatomical perspective and the more recent psycholinguistic approach. Then, assessment procedures are reviewed, followed by a summary of treatment approaches for alexia. Finally, two case studies illustrate how oral reading of connected language (sentences and paragraphs rather than single words) has been used as a technique for treating alexia in patients with aphasia. [References: 79]




American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.



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Search terms: *Art Therapy; *Drawing; *Oral Communication; *Psychotherapeutic Techniques, *Art Therapy; *Explicit Memory; *Life Experiences; *Psychotherapy; *Sexual Abuse; Art; Counseling; Emotional Responses; Symptoms, *Art; *Art Therapy; *Drawing; *Measurement; *Psychological Assessment; Attitudes; Cognitive Processes; Communication; Emotions; Problem Solving; Projective Personality Measures; Projective Techniques; Screening Tests

Related links: PTSD and communication, Victim blame


American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.

Clukey, Frances Harlow. (2003). A descriptive study: Selection and use of art mediums by sexually abused adults: Implications in counseling and art psychotherapy. ; Dissertation Abstracts International: Section B: The Sciences and Engineering, 64(4-B), 2003. pp. 1679.

Villarreal, G. et.al., (2004). Reduced area of the corpus callosum in posttraumatic stress disorder. Psychiatry Research: Neuroimaging Section, 131(3), 227-235. Link


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