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