From attraction to action to assault, sexual behavior takes many forms. At least for humans, this most basic of activities is anything but basic. As the pioneering sex researcher Alfred Kinsey put it, the only universal in human sexuality is variability itself.
While sex remains as a means of establishing intimate bond for some, it may also serve as a symbol of expressing power, punishment, and control for others. This often tends to challenge the very assumption of sexual aggression as “only power and not sex”. However, a knitting theory laid down by Beverly McPhail combining several feminist theories of rape into a new comprehensive model acknowledges that “rape occurs due to multiple motives rather than the single motivation of power/control. The multiple motivations include, but are not limited to, sexual gratification, revenge, recreation, power/control, and attempts to achieve or perform masculinity. Power/control remains an important component of rape but maybe the motivation, the means, and/or the result.”
This takes us back to our question, how is sexual aggression about both POWER and SEX?
To understand this, we must first explore the concepts of CONTENT and PROCESS in relationships in the context of psychology. The content involves the “what” in the relationship exchange. Money, doing the dishes and going to the movies are all examples of content. It is what people are engaged in the exchange. The process involves the “how” of the self-exchange; namely, how the self-other exchanges are structured. Dependency, autonomy, shared/opposing interests, and power/status differential.
Thus, when we speak of sexual aggression, we see it involves both “content” (which is the sex part) and “process” (the power/status/dominance part). In cases of sexual aggression, one uses some aspect of their resources (job, money, physical strength, stealth) to try to dominate another person into some form of sexual behaviour.
Recognizing the process/content distinction allows us to see why saying “it is not about the sex, but only about the power” is off the mark.
THE MECHANICS OF SEXUAL AGGRESSION
Various psychologists, gender activists, social workers, and researches have constantly tried to explore motivations and intentions directed towards sexual assault. Some studies show that these perpetrators have a unique taste for non-consensual sex, rather than for non-consensual violence per se. While a few others focus on the fact these ideologies are stemmed from a sense of sexual entitlement, and often directed towards punishments and gaining dominance over the person. The use of alcohol and other substance abuse has been reported as a part of this context.
These studies and researchers have constantly tried to manifest sexual aggression as a means of achieving power, control, dominance, and sexual gratification. All components are interdependent and inter-related. So, why does it matter?
The mechanics of sexual aggression play a vital role in understanding and shaping the narrative of the perpetrator. Moreover, it guides in understanding red flags or possible patterns to look out for in relationships and equip clients in a better way to avoid relapsing/identifying trauma and encourage trauma recovery.
When we think of Sexual and Physical Violence and Abuse, one should remember that these are not mutually exclusive components but rather parts of a continuum. One such excellent model to recognize abusive behaviors and facilitate intervention is THE DULUTH MODEL. This model makes use of the “Power and Control Wheel” as a tool to understand patterns of abusive behavior and how the perpetrator uses these 8 items of the inner ring as means of “PROCESS” in relationships.
To elaborate, the outer ring of physical and/or sexual violence and abuse is used as a tool along with one or more of the inner ring items, usually called as tactics [intimidation; emotional abuse; isolation; economic abuse; male privilege; coercion and threats; using children; and minimizing, denying, and blaming] to achieve the innermost circle of power and control.
The whole point of explaining the mechanics is to gain some insight over the effects of this process which is more than just physical coercion and silence. It is about our reaction to the situation being an outsider, and failing to understand the narrative and emotion of the survivor.
Many survivors have a silent reluctance to these assaults. Since these unwanted experiences typically involved repeated emotional coercion, they are often afraid to speak out due to fear of being disbelieved or assaulted again. Secondly, incest/molestation ranging from early childhood to adolescence or longer often describe feelings of shame, guilt, anxiety and body perceptual issues. Another shared aspect amongst survivors is a sense of regret. Some blame substance use, while others invoke culture and religion for feeling this way. At all times, all of these thoughts, feelings, and emotions keep driving the consciousness car of the brain, affecting the survivor to carry out their daily lives and sometimes stick to the cycle of complex trauma because this is what looks comfortable or “meaningful” to them. There’s a sense of lost purpose, identity, emotions, and body image. In short, their relational world experiences itself are wounded that the thought of exploring other opportunities seems like a vulnerable situation to their autonomic nervous system.
TRAUMA INFORMED CARE AND ROLE OF OCCUPATIONAL THERAPISTS
Trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual’s functioning and physical, social, emotional, or spiritual well-being (SAMHSA, 2012, p. 2). It generally overwhelms an individual’s or community’s resources to cope, and it often ignites the “fight, flight, or freeze” reaction, an autonomic nervous system dysregulation at the time of the event(s). This frequently produces a sense of fear, vulnerability, and helplessness. Childhood neglect or abuse along the years betrays an individual’s trust in others and impairs their ability to form healthy relationships as adults.
As occupational therapy practitioners, we can begin by refining and highlighting areas of our practice that closely align with Trauma Informed Approaches. These include:
taking a non-pathological view of the people we serve through respecting the person
seeing their humanity
empathizing with their experiences with pain, and
taking time and care in obtaining the occupational profile
Occupational profile is the highlight of our professional identity and one that allows us to deeply connect, but it also aligns with the principles of TIAs, as occupational profiles allow us to build trust, collaborate with and empower our clients, and get to personal issues that are unique to each person we work with.
Potential areas impacted due to trauma include: ADLs, social participation, education, sleep/rest, play/leisure, body structures and functions, values, beliefs and spirituality.
ADVICE FOR THERAPISTS: STRATEGIES TO MANAGE TRAUMATIC MEMORIES
Strategy #1: Do not assume that your role is to investigate, corroborate, or substantiate allegations or memories of abuse (American Psychiatric Association [APA], 2000b).
Strategy #2: Therapists should maintain an emphatic, non-judgmental, neutral stance toward reported memories of sexual abuse or other trauma. Avoid prejudging the cause of the client’s difficulties or the veracity of the client’s reports. A therapist’s prior belief that physical or sexual abuse, or other factors, are or are not the cause of the client’s problems can interfere with appropriate assessment and treatment (APA, 2000b).
Strategy #3: Focus on assisting clients in coming to their own conclusions about the accuracy of their memories or in adapting to uncertainty regarding what actually occurred. The therapeutic goal is to help clients understand the impact of the memories or abuse experiences on their lives and to reduce their detrimental consequences in the present and future (APA, 2000b).
Strategy #4: Some clients have concerns about whether or not a certain traumatic event did or did not happen. In such circumstances, educate clients about traumatic memories, including the fact that memories aren’t always exact representations of past events; subsequent events and emotions can have the effect of altering the original memory. Inform clients that it is not always possible to determine whether an event occurred but that treatment can still be effective in alleviating distress.
Strategy #5: There is evidence that suggestibility can be enhanced and pseudo memories can develop in some individuals when hypnosis is used as a memory enhancement or retrieval strategy. Guided imagery techniques can enhance relaxation and teach self-soothing strategies with some clients; however, use of these techniques is not recommended in the active exploration of memories of abuse (Academy of Traumatology, 2007).
Strategy #6: When clients are highly distressed by intrusive flashbacks of delayed memories, help them move through the distress. Teach coping strategies and techniques on how to tolerate strong affect and distress (e.g., mindfulness practices).
TRAUMA INTERVENTION PROTOCOL (TIP) MODELS
1] Social-Ecological Model
Trauma cannot be viewed narrowly; instead, it needs to be seen through a broader lens—a contextual lens integrating biopsychosocial, interpersonal, community, and societal (the degree of individualistic or collective cultural values) characteristics that are evident preceding and during the trauma. Here are the three main beliefs of a social-ecological approach (Stokols, 1996):
One: Environmental factors greatly influence emotional, physical, and social well-being.
Two: A fundamental determinant of health versus illness is the degree of fit between individuals’ biological, behavioral, and socio-cultural needs and the resources available to them.
Three: Prevention, intervention, and treatment approaches integrate a combination of strategies targeting individual, interpersonal, and community systems.
2] Ecology of Human Performance Model
The Ecology of Human Performance (EHP) is a model based on the relationships between a person, their context, the task, and the person’s performance (Dunn, 2017). EHP is a person-centered framework where the person brings their own unique set of variables including past experiences, interests, and sensorimotor, cognitive, and psychosocial skills. Terminology used in EHP differs from other models by using terms such as “task” instead of occupation, which makes this model useful for interdisciplinary teams to support collaboration. The main elements of this model include:
Improving Performance Range: The performance range has been defined as the number and types of tasks that are available to a person based on the interaction between the person’s factors and context variables. These factors include their skills, abilities, and motivations as well as considering context variables that support or inhibit the performance. To increase the performance range, the person, context, and tasks features must be considered equally. EHP model encourages using an interdisciplinary approach. The EHP model can be understood by many professions and provide a non-discipline specific language so that many disciplines can work together towards a common goal.
Context and Performance: A person’s context must be understood in order to understand the person. The context is going to influence how a person is going to be able to perform tasks. The person-context relationship is dynamic in which, the person is influenced by and influences their context. When an occupational therapist utilizes a simulated environment versus a natural environment, there may be different performance outcomes. The four contexts that are identified in the EHP model include physical, social, cultural, and temporal context.
Intervention Approaches: The five types of intervention approach according to the EHP model include:
a. Establish/Restore: focuses on a person’s factors and aims to improve the person’s skills in order to increase their performance range in multiple tasks.
b. Alter: focuses on the context in which a person is performing a task. The context could be changed in order to find the best match between the person’s current abilities and the context that is available.
c. Adapt/Modify: The context or tasks are adjusted to support the person’s current skills and abilities.
d. Prevent: Influences the course of events by changing the person, context, or task variable to prevent negative outcomes.
e. Create: focuses on creating interventions that support optimal performance for any person and many populations.
3] Narrative Therapy
This approach views psychotherapy not as a scientific practice, but as a natural extension of healing practices that have been present throughout human history. Stories of trauma, feeling and emotions associated are told and retold, expressing the traumatic experience, putting the trauma in the context of the survivor’s life, and defining the options he or she has for change. Narrative structure helps clients connect events in their lives, reveals strings of events, explores alternative expressions of trauma, evokes explanations for clients’ behaviours, and identifies their knowledge and skills. The use of stories in therapy, with the client as the storyteller, generally helps lessen suffering.
This can be a great tool while assessing occupational profile and exploring topics of autonomy, consent, body image, and intimacy.
It is anticipated that the use of this short-guide will provide occupational therapists with trauma-informed and evidence-based intervention resources to increase awareness and insight towards trauma-informed care. Additionally, it can improve occupational performance and engagement for people who have experienced trauma with healthcare workers.
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