Restoring Soul – Part 3

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Contents

6 What works? Effective interventions for adult survivors of sexual violence 
6.1 Introduction
6.2 Understanding recovery 
6.3 How formal support systems helped recovery
6.4 How informal support systems helped recovery 
6.5 The criminal justice system and recovery 

7 Conclusion 
7.1 Introduction 
7.2 Repeat sexual victimisation 
7.3 Implications for the criminal justice system 
7.4 Implications for the formal support system 
7.5 Informal support systems
7.6 Implications of a systems approach 
7.7 Achievements of the project and suggestions for the future
7.8 Final word 

Appendices 

Appendix A: Background to the project
Appendix B: Definitions of key terms
Appendix C: Socio-demographic characteristics of participants in pathways study
Appendix D: Number and service type of participants in the environmental scan
Appendix E: Factors that increase the risk of sexual violence 
Appendix F: Nature and dynamics of sexual violence
References 

List of Tables

Table 8: Survivors’ ratings of systems that helped recovery
Table 9: Socio-demographic characteristics of participants in pathways study 
Table 10: Number and service type of participants in the environmental scan 
Table 11: Factors that increase the risk of sexual violence
Table 12: Nature and dynamics of sexual violence 

List of Boxes

Box 3: Good practice principles of service delivery

6 What works? Effective interventions for adult survivors of sexual violence

6.1 Introduction

The overarching objective of this project was to generate an empirical evidence base about ‘what works’ to promote the safety and well-being of adult survivors of sexual violence. This chapter brings together information from the pathways study, environmental scan and literature review to address this issue. It does not explore the clinical effectiveness of different types of interventions.

One of the major aims of the pathways study was to gain an understanding of the key points at which different types of intervention and support are most effective, and of factors that promote healing and recovery. The chapter begins by looking at survivors’ understanding of recovery and their assessments of the importance of formal, informal and criminal justice system responses to recovery.

Community service providers who took part in the environmental scan were also asked to identify interventions or other aspects of service provision that promote recovery. The chapter then summarises their views on ‘what works’.

The chapter considers survivors’ and service providers’ views on formal services within the context of findings from the literature review. The literature review provided an overview and critique of ‘good practice’ in relation to:

•  types of services or therapeutic modalities that have been identified as assisting recovery
•  principles of service delivery that are critical in achieving successful outcomes and can be utilised in different types of services.
  

The review primarily focused on literature specific to sexual violence.

This is followed by an assessment of survivors’ views on the importance of informal systems and the criminal justice system to recovery.

6.2 Understanding recovery

Recovery, as defined for this project, relates to a restoration of well-being across the physical, mental, emotional, spiritual and interpersonal spheres. From a Western viewpoint, recovery is seen as an individualistic process. For Māori, it encompasses a restoration of mana for survivors and their whānau. Similarly, for survivors from Pacific and other collectivist cultures, the task of recovery involves significant social networks. While the pathways study tended to focus on individual recovery, there were nevertheless strong indications that recovery is socially mediated.

Participants in the pathways study described recovery as a process, rather than an end-point, that can occur over a long period of time. Most survivors did not consider their recovery to be complete and identified a variety of processes that still needed to happen: dealing with the hurt and anger, and ‘get[ting] the nightmares and flashbacks under control’ (Kingi and Jordan., 2009: 151). Some wondered whether their healing would ever be complete.
The most serious emotional effects of sexual violence include feelings of powerlessness and a profound impact on a survivor’s sense of self and identity.

I’m still struggling with believing that I am nothing more than an object ... a filthy piece of human flesh ... That’s why I’m working on it. (Kingi and Jordan, 2009: 151)

Re-establishing a new identity and regaining a sense of autonomy to counter the ‘personality disintegrating’ effects of the trauma is a major task of recovery (Brison, 2002).

The following quotation illustrates the importance to recovery of rejecting a victim based sense of identity. It also points to the importance of rejecting self-blame, which might be easier for survivors who recognise that they are not alone in their experience.

Don’t think of yourself as a victim. It is just a crap thing that happened to me, and it happens to women all over the world. I was not going to be a victim! You just have to get through it and find the help that you need. (Kingi and Jordan, 2009: 177)

Key intervention points
Data from the literature review, survivors and service providers shows that key points of intervention for survivors of sexual violence and/or their whānau are both early and as needed over the longer term.

Tell someone straight away. That is really important – the longer you hold it in, the more damage it does. It causes physical illnesses too. Get into counselling and deal with it straight away. (Kingi and Jordan, 2009: 154)

Specialist sexual violence services endorse the importance of informed and appropriate early intervention, with the proviso that some interventions can cause further harm, hence the need for specialist knowledge (TOAH-NNEST – TC, 2009).

Some survivors sought help soon after the violence occurred. Others were unable to name what happened to them for months or decades later. While naming and disclosing sexual violence can be a positive and empowering experience, it can also trigger a crisis and a need for intervention at that point.

Recovery is not a linear process and survivors’ needs are likely to change over time. This means crises can be triggered at different points, resulting in the need for ‘primary crisis responses’ and ‘periodic crisis responses’ for survivors and their whānau (Hamilton-Katene, 2009). A widespread range of interventions could be required at any point.

6.3 How formal support systems helped recovery

The findings from the pathways study show that recovery is socially mediated. Research participants were asked to rate, on a scale from 1 (not at all important) to 5 (very important), the role played by key people or agencies in their recovery. Table 8 shows the number and proportion of participants who rated particular types of support as important or very important. The majority placed most importance on counselling and specialist sexual violence services, followed by informal support systems. The criminal justice system tended to play a less important role in recovery.

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Table 8: Survivors’ ratings of systems that helped recovery

Notes
• The numbers of respondents answering each question varied according to individual situations. Percentages are based on the numbers responding to each question.
• Five responses did not relate to formal systems per se, so are not included in this table.

Source: Kingi and Jordan. (2009).

How counsellors and specialist services contributed to recovery
Survivors highlighted the importance of psychological support from skilled professionals such as specialist sexual violence services and counsellors or other therapists. Some survivors highlighted the importance of engaging with multiple agencies, as they needed help with more pressing issues, such as food parcels or alcohol and other drug issues, before dealing with the impact of sexual violence.

It is important to note that the researchers were unable to ask detailed questions about the full spectrum of factors that might have contributed to recovery. For example, there was no information in the pathways study about the extent or usefulness of anti-depressants or other drugs commonly prescribed for depression, anxiety and so on. It is reasonable to assume that they were prescribed for at least some survivors who had counselling.

Survivors were asked what these formal agencies did that made a difference and how the services contributed to their well-being. The most frequent factors were as follows.

•  Emotional support. This was provided through individual counselling or in a group context and was crucial when survivors needed help to move on or were suicidal.
•  Listening and letting survivors talk. Survivors valued the opportunity to talk freely, without having to worry about the listener’s reactions.
•  Validation and belief. This was often associated with empathic and non-judgemental listening and addressing survivors’ anxiety about whether what they were feeling and doing was ‘normal’.
•  Teaching coping skills and strategies. It was not always enough to be listened to. Survivors needed practical advice on how to cope with flashbacks and fear, and how to manage intimate relationships.
• Providing information and explanations. Survivors had a wide range of information needs, for example, about other services that might provide support, medical and health issues, and criminal justice processes.
•  Availability and reliability. Sexual violence was often followed by a dramatic upheaval in survivors’ lives. Reliable and regular support provided a sense of containment and safety. Access to 24-hour crisis lines was important, because ‘the lowest and darkest times of the day seldom fall between 9am and 5pm’ (Kingi and Jordan, 2009: 114).
  
• Safety and trust. The loss of safety and trust that follows sexual violence underlines the importance of support being offered in an environment of trust and safety and by counsellors or agency staff who survivors perceive as safe and trustworthy. This confidence in the support person might need to be built up over time.
•  Advocacy. The disempowerment that ensues from sexual violence means that some victim/survivors rely on others to argue their case and protect their rights, particularly around legal processes.

It was also important for survivors to find the ‘right’ counsellor. This involved feeling a connection with the person, and being comfortable with their style and the techniques used. This did not always happen with the first counsellor, and there was a danger that survivors could then decide that counselling was not for them.

Counselling is really good as long as you get the right person. One counsellor was unhelpful – New Age strategies getting me to hold my arm up to fix my adrenal glands with movements. I was already going nuts – I didn’t need that! (Kingi and Jordan, 2009: 118)

The researchers pointed out that ‘reasonably high levels of confidence and self-esteem are needed to embark on a ”shopping trip” to find the right person, characteristics typically lacking in those who may have just been raped’ (Kingi and Jordan, 2009: 116).

Māori survivors
Support from kaupapa Māori services was highly valued by the small number of survivors who accessed these services (n=4). These counsellors provided cultural support and took the time needed to establish whanaungatanga (that is, relationships, kinship or whakapapa connections) and build a strong relationship. Some Māori survivors also benefited from Western therapeutic modalities.

Māori survivors encouraged other survivors to break the silence around sexual assault and to get help.

Find someone you trust; [a] friend or counsellor who won’t judge you. Go through the process of telling the police – speak up (even if you feel ashamed). Speak up and be heard. (Kingi and Jordan, 2009: 166)

‘Good practice’ in counselling and specialist sexual violence services
The literature review distinguished between two distinct applications of the term ‘good practice’. They were the:

•  type of service delivery – this refers to particular types of services, programmes or therapeutic modalities that have been identified as effective
• principles of delivery – these principles are critical to achieving successful outcomes, but can apply to a variety of services.

Survivors’ views on what helped recovery showed that they valued services that adhered to good principles of service delivery.

Service providers who responded to the environmental scan said that good quality services are central to ensuring that survivors’ emotional needs are met. They identified seven aspects of services that were working well in their community to promote survivors’ recovery and well-being. The aspects were:

•  effective counselling
•  effective crisis support
•  follow-up support
•  effective services for specific groups (Māori, Pacific people and young people)
•  inter-agency collaboration
•  police services, particularly specialised services
•  education.

To a large extent, this information is also more relevant to the principles of service delivery than to service effectiveness.

It was beyond the scope of the pathways study and the environmental scan to collect information on specific types of therapies available in New Zealand or evaluate their effectiveness. The literature review addressed the issue of good practice in service delivery and highlighted gaps in knowledge, both in New Zealand and internationally.

The literature review indicated that there was a reasonable evidence base on good practice principles of service delivery internationally. However:

• relatively few New Zealand guidelines were identified
•  aside from the Accident Compensation Corporation guidelines (ACC, 2008), no guidelines were specific to sexual violence
•  no national guidelines were located for specialist sexual violence services, although there may have been in-house guidelines that were not available for the review
•  no Māori or other ethnic-specific guidelines relating to sexual violence were located, although some generic mental health guidelines were available.

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Effectiveness of mental health interventions
One of the main findings from the literature review was that counselling is beneficial at all stages of recovery, but crisis intervention in the stages immediately after the sexual assault is crucial to health and well-being. This finding supports the views of survivors and providers. However, particular types of interventions might be more effective than others. The main findings in relation to effective service delivery for mental health care are discussed next.

Post-crisis mental health care
There is evidence that around a quarter to a third of women who have been raped experience negative effects for several years. These effects include major depression, generalised anxiety, panic attacks, phobias and suicidal ideation. Post-traumatic stress disorder (PTSD) is common and is often co morbid with depression and anxiety. Some co-morbid conditions might improve with the treatment of PTSD, but some might require specific treatment, as they can impede effective treatment of PTSD.

PTSD sufferers might first access help through primary or secondary health care services (that is, general practitioners and specialist medical services respectively). Survivors might also have a range of short- and long-term medical needs, such as eating disorders, that have mental health dimensions. As a result, continuity of care among primary, secondary and mental health services could be needed to ensure survivors’ physical, psychological and social needs are met.

Different types of mental health interventions
There is a gap in knowledge about what types of counselling modalities are used in New Zealand and by whom. The review of overseas literature also located few evaluations of the effectiveness of different types of mental health interventions for sexual violence specifically. Evidence on the effectiveness of major therapeutic approaches tended to be inconsistent, and not all forms of therapy have been evaluated.

Trauma-focused cognitive behavioural therapies, which aim to manage the memory of the trauma, were found to reduce sequelae such as anxiety, depression and PTSD at different post-rape stages.

Relational therapy, which integrates survivors’ immediate social network into the treatment, has also been found to decrease symptoms of depression better than individual treatment does. However, there were similar decreases in PTSD and no significant differences in family functioning for survivors receiving relational therapy and those receiving individual treatment.

Indications are that feminist approaches, which integrate elements of cognitive behavioural therapies with group therapy to reduce fear, anxiety, self-blame, shame and guilt might be effective. There does not seem to have been any research into the effectiveness of integrative therapies.

Effectiveness of specialist sexual violence services
The literature review did not locate any evaluations of New Zealand specialist sexual violence services. Overseas researchers have noted that few studies have examined if and how specialist sexual violence services benefit victim/survivors, although evidence is consistent that victim/survivors rate the help received from these agencies more highly than that provided by other formal support systems.

The literature reviewed cited a study from the United States, which found significant differences between victim/survivors who were treated at a hospital where advocates from specialist sexual violence services worked, and those treated at a hospital where advocates did not work. The major findings were that the victim/survivors:

• were significantly more likely to have police reports taken
• were less likely to be treated negatively by police
•  reported less distress after their contact with the legal system
•  received more medical services
•  reported significantly fewer negative interpersonal interactions with medical system personnel
• reported less distress from their medical contact experiences.

Some authors argue that a lack of research evidence on the effectiveness of specialist sexual violence services is not necessarily problematic, because a ‘what works’ approach tends to value the views of experts over those of service providers or the knowledge-based practice of service providers. Rape Crisis Network Europe, for example, has defined ‘good practice’ for specialist sexual violence services as any action that proved successful or achieved positive outcomes for users of their services (Rape Crisis Network Europe, 2003).

In the absence of national standards, or even an overview of services that are responding to adult victim/survivors of sexual violence across New Zealand, survivors’ comments are our best source of evidence that these agencies are providing much-needed and valued services.

6.4 How informal support systems helped recovery

Overcoming the disempowerment of sexual violence is a key task of recovery. The survivors in this research seemed to have found multiple ways of doing this, as suggested by their endorsement of self-help strategies as an important part of recovery. Many survivors read self-help books or looked for material on the internet. Some self-help strategies, such as meditation, reading the Bible or exercising, played a role in restoring a sense of peace or strength.

However, it is clear that not all self-help strategies are adaptive or healthy. Self medicating through alcohol or other drug use could result in further vulnerabilities and problems. Specialist services provide information on self-help options. Self-healing might be best promoted with support from both formal and informal networks.

In some respects, self-help strategies seem distinct from external support offered by formal and informal systems. However, strategies such as reading self-help books are ways of seeking social information that can help survivors understand what happened to them, decide how to respond, or think about what choices are available to help their recovery. Responses from informal support systems can fulfil similar functions. Responses fell into two main categories: emotional and practical support.

Important elements of emotional support included belief, acceptance and validation. This could take the form of reassuring survivors that they were good people and had a right to feel angry about what had happened, or helping them to make sense of the violence. Survivors valued support people who were prepared to listen in a non-judgemental way, allowing them to talk and ‘offload’ as needed. Given that some friends and family members withdrew from survivors, simply ‘being there’ for the survivor could be a powerful statement.

Practical support encompassed things such as others doing the supermarket shopping, offering the survivor a place to live, and an employer offering time off work.

Māori survivors
The pathways study highlighted the importance of connection to others as a central element of recovery for Māori survivors. Support from friends was the most helpful factor in their recovery, followed by counselling or psychological support.

My friends are my closest family. They were worried. They saw the change in me (withdrawn, insecure, detached and not willing to get involved with anyone). They were there for me. (Kingi and Jordan, 2009: 164)

Because offenders were often partners or whānau members, proximity to the perpetrator could also play a major role. Living near whānau and friends was important for healing, whereas living near the offender hindered recovery. Survivors who lived in rural communities thought it was easier to access local hauora (health) services, because counsellors are often known to the community and often provide home visits.

6.5 The criminal justice system and recovery

Survivors’ responses about the importance of the criminal justice system for recovery are somewhat ambiguous, particularly when set against some of the qualitative analyses of their experiences with police and of going to court.

Views on the court process
Over half of those whose cases went to court rated the trial as important to their healing and recovery. Yet, when asked about the helpful and unhelpful aspects of the court process, survivors were more likely to say nothing stood out as particularly helpful, or to refer to preparation and support, rather than factors relating to court processes per se.

In terms of what was helpful about the court process, one survivor referred to giving evidence from behind a screen. Only one other referred to the outcome of the trial, which resulted in the offender’s imprisonment, even though 11 of the 17 cases that went to trial resulted in a conviction. These two people seemed better able to articulate what was unhelpful, particularly in terms of their treatment by defence lawyers, giving evidence and having to see the offender.

The literature review identified various practices and procedural reforms that are seen as good practice, because they enable victim/survivors to give their best evidence in court while protecting their dignity and integrity and limiting secondary victimisation. However, there did not appear to be consensus around these practices, nor evaluations of their effectiveness. Some of the procedural reforms mirrored survivors’ comments above. They related to:

• introducing screens in court so that victim/survivors did not have to see the attacker while they were giving evidence
• ensuring victims’ right to have a support person present while giving evidence
•  enabling victim/survivors to be cross-examined from outside the court room through the use of video or other equipment.

Views on police responses
There were similar ambiguities around survivors’ views on the police. Survivors rated their engagement with the police as the least important factor contributing to healing and recovery. However, when they were asked if there was anything the police had done at any stage that was helpful, 24 out of 33 participants said ‘yes’ and 25 said they were satisfied or very satisfied with how they had been treated.

Survivors who had undergone a formal police interview identified a variety of helpful police responses. They said the police:

• were supportive, both at the time of reporting and throughout the criminal justice process
•  believed them
• provided information
•  listened non-judgementally
•  were considerate
•  were understanding and warm
•  were kind and appropriate in the way they asked questions.

These factors are consistent with the principles of good service delivery noted earlier in this chapter. They are also consistent with the Adult Sexual Assault Investigation Policy, published by New Zealand Police (1998). The policy was under review at the time of this research. The policy acknowledged the destructive consequences of sexual violence and prioritised the safety of the victim. It was aimed at:

• ensuring early intervention and maximum protection
• aiding the victim’s long-term recovery
•  ensuring the victim’s co-operation with the investigation through to completion.

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The ‘good practice’ literature review that was commissioned for this project and the environmental scan identified other elements of good practice that the New Zealand Police is implementing, including appropriate environments for interviews, specialist police units, training in investigative interviewing; and training on sexual violence for officers from recruits to specialist investigators. It was beyond the scope of this project to evaluate the quality of training, the extent to which it is put into practice, or whether good practice principles are being applied consistently across the 12 police districts.

Perceptions of ‘justice’
One way of interpreting these ambiguous findings is to think about survivors’ motivations, expectations and personal circumstances when they report sexual violence to police, and how these might change over the time it takes for a case to go to trial. Questions about recovery in the context of the criminal justice system could be wide of the mark unless we understand what survivors hoped to achieve in the first place.

In the pathways study, none of the survivors said that they reported to police as a way of helping with recovery. Their main reasons for reporting were to ensure that the offender was held accountable and to protect others and themselves from the offender. At the point of reporting – often within hours or days of the assault – many were feeling ashamed, scared, dissociated and angry. Restoring a sense of personal safety was likely to be an immediate need. The thought of recovery, and what it might entail, might have taken some time to surface. More survivors said they would advise others to report to police than not. The important thing was to ‘surround yourself with people and have support and ask more questions’ (Kingi and Jordan, 2009: 155).

As victim/survivors move through successive stages of the criminal justice process – with a concomitant investment of time, emotions and other resources – their motivations for going to court might become more entwined with the recovery process. In cases where offenders were found guilty, survivors who read out their victim impact statements in court said it was a healing and ‘deeply empowering’ experience that brought closure and ‘a shift of the power balance’ (Kingi and Jordan, 2009: 99).

The findings raise questions about whether and how victims’ understandings of ‘justice’ intersect with the objectives of the criminal justice system. There have been moves in recent years towards a more victim-centred criminal justice system, but fundamentally the system is not intended to serve a therapeutic function. While the criminal justice system can be experienced as highly validating by some survivors, in its current form it might not be the best forum for those who hope it will contribute to healing.

Some of the reasons survivors in the pathways study gave for reporting to police are consistent with the deterrent and punitive functions of the criminal justice system. However, reporting an offence to ensure police know about an offender does not necessarily indicate a need to ‘have one’s day in court’. Such reasons for reporting are cause to question the notion that ‘justice’ for rape victims equates to a conviction at trial.

Little research has investigated sexual violence survivors’ understandings of justice, or how their motivations and needs change over time. Research on domestic violence has suggested that at least some survivors are more interested in procedural justice than in substantive justice (Holder and Mayo, 2003). In other words, some victims will feel that justice has been done if they feel they have been treated fairly and that the trial was fair, regardless of whether the offender was convicted and punished.

Summary
When we looked across the informal, formal and criminal justice systems, it was clear that there were a small number of underlying factors that survivors valued and felt contributed to their recovery. These included responses such as emotional support, empathy and belief.

Participants in the pathways study indicated that ultimately, individuals have to determine what is best for them. One of the most important things that people in informal and formal support systems can do is to help survivors define and prioritise their own needs and work out their best pathways to recovery.

In the context of formal response systems and the criminal justice system, the factors that emerged from the pathways study are consistent with good practice principles of service delivery that were identified in the literature review (Mossman et al., 2009a: 122-123). These principles are outlined in Box 3.

Box 3: Good practice principles of service delivery

These principles raise particular issues around inter-agency collaboration. The criminal justice system and other formal agencies are underpinned by different ideologies and serve different functions. As noted, historically, criminal justice practices have not been victim-focused, nor are they intended to be therapeutic. It can seem that survivors’ needs and objectives conflict with the needs of the criminal justice system and other formal agencies. The objectives of all parties are best served when victim/survivors are informed about what is happening and why. Attitudes and behaviours that help survivors feel they have control over decisions (for example, about what services to access) are likely to help rather than hinder the roles of all agencies concerned. Survivors who are taken seriously, kept informed, and treated respectfully and fairly are likely to perceive that they have received procedural justice. In the long term, this might be as important to recovery as any legal outcome.

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7 Conclusion

7.1 Introduction

This report has summarised information from four research reports on factors related to:

• the key points at which and reasons why cases involving sexual violations against adults enter the criminal justice system
•  for cases that are recorded by the police but do not proceed through the criminal justice system, the key points at which and reasons why they do not proceed
• the basis for survivors’ decisions to access counselling and other support services, and their pathways to healing and recovery
•  key intervention points and ‘what works’ to promote recovery and well-being.

Findings on each of these issues are summarised in the relevant chapters of this report. Rather than recapping those findings, this chapter draws out some of the key messages that emerged throughout this report and considers their implications for the sexual violence response system. It looks at some areas where there continue to be knowledge gaps, and concludes with a brief appraisal of the project’s achievements and suggestions for the future.

7.2 Repeat sexual victimisation

The prevalence of repeat sexual victimisation emerged as an issue of critical importance in this research. The pathways study showed how a history of repeat sexual victimisation, often beginning at a young age, was frequently associated with other forms of violent victimisation, and with the presence of other factors that heightened the risk of sexual violence. Many of these survivors had prior social or intimate relationships with their attackers.

A variety of factors, which can exist singly or in combination, can increase survivors’ risk of sexual victimisation. Some of these factors, such as disability, mental illness or alcohol misuse, may exist before the sexual violence and are risk factors in themselves. They can also be consequences of sexual victimisation, but it is not always possible to determine which came first.

We do not have statistics on how many survivors might be victims of repeat sexual victimisation, but there would be value in determining this. Crime victimisation surveys have found that at least 19 percent of women and 5 percent of men in New Zealand have been victims of sexual violence in their lifetime (Morris et al., 2003). They also show that at least a quarter of those experience more than one incident of sexual violence. Women are significantly more likely to experience more incidents than men (Mayhew and Reilly, 2007). These surveys are known to underestimate the prevalence and incidence of sexual violence for various reasons, not least because victims might be reluctant to disclose sexual offences to interviewers, but also because survey methods often fail to capture populations at heightened risk of sexual violation.

Given the health burden likely to be borne by these victims, there is a case for giving them support for their diverse needs quickly and effectively, to restore them to health. The impacts of sexual violence are likely to span all domains of these survivors’ lives: their emotional and physical well-being, their ability to contribute to the economy and society, and their capacity to form and maintain healthy and trusting relationships. If we assumed 25 percent as the minimum estimate of survivors who have experienced repeat sexual victimisation, providing comprehensive, accessible and appropriate support to that group alone is likely to result in a reduction in ongoing costs associated with poor, or no, intervention.

As identified in this research project, secondary traumatisation is also an issue that needs to be considered. The effects of sexual violence ripple out to affect those closest to survivors, their wider networks and, ultimately, all of us. This is reflected in women’s fears for their personal safety and the effect of sexual violence on health and economic issues at the national level. Secondary traumatisation is an issue that has received little attention internationally.

7.3 Implications for the criminal justice system

Cases involving the most vulnerable victims, if reported to the police, are least likely to proceed through the criminal justice system and result in conviction. There are several reasons for this. Some reasons are related to the legal difficulties of proving non-consent or that an offence occurred when memories are impaired by alcohol or other drugs. Other reasons are related to non-legal factors that permeate the beliefs and attitudes of the variety of actors involved in the criminal justice process. This can include scepticism and victim-blaming, misunderstandings of the nature and dynamics of sexual violence, and biased assessments of victim credibility.

The research provides clear evidence that many victims who report sexual violence to police are more vulnerable, or less psychologically robust, than the population in general. This sits alongside the understanding that vulnerable victims who are sexually violated by intimate partners are also likely to be subject to intimidation or other pressure from the assailant, their family or other social networks, as reflected in rates of attrition, and particularly ‘victim withdrawal’.

It is likely that some suspects in cases that do not proceed, or defendants who are found not guilty, are in fact guilty of the charges. As a result, some victims are likely to return to domestic or social situations where there is a possibility of repeat sexual victimisation, other forms of retaliation, or even an escalation in offending, including the possibility of domestic homicide.

In respect of ‘victim withdrawal’ it is understandable that survivors – who are directly affected by the publicity and outcomes of a trial as well as the impacts of sexual violence – will have strong views on whether a case proceeds or not. Forcing a reluctant victim to give evidence could be counter-productive: it has the potential to revictimise the survivor, and a reluctant witness could undermine the case. At the same time, survivors’ wishes not to proceed must be weighed against the public interest of proceeding with a trial, particularly in more serious cases and where there is a risk of repeat or escalated offending. Decisions not to proceed can result in public criticism of the effectiveness of the criminal justice system, especially given the perception that perpetrators who were guilty of the charges are free to offend again.

This research has shown that victims who are having doubts about continuing can be encouraged and supported to continue with the criminal justice process. There is room for more explicit discussion, training on and formalising of practices that could help overcome victims’ reluctance to proceed. Together with this, consideration needs to be given to ways in which victims’ safety and well-being can be supported if they choose not to proceed, or if they return to potentially risky situations. One way of addressing both issues could be through collaboration between services that victims are likely to contact, or are already in contact with. This would also require consideration of what this means for resourcing those services.

Despite high attrition and low conviction rates, the criminal justice system remains an important avenue of redress for some victims. Ongoing efforts to improve practices and processes across the various arms of the criminal justice system are crucial, both because it is in the public interest and because survivors’ awareness of the potential for disbelief and secondary victimisation can be a powerful deterrent to reporting.

While the current degree of under-reporting is cause for concern and the conviction rate is dismaying, it is not realistic to aim for 100 percent on either measure. There is room for a dialogue on what our goals might be in respect of reporting and conviction rates. This question might best be considered in relation to survivors’ motivations for reporting sexual violence to police. It is clear that that reporting sexual violence to police is not the primary concern of most survivors. There is still a need for fuller information on what motivates or enables victim/survivors to report to police (particularly compared with those who do not) and what they hope to achieve from the criminal justice system. Related to that is the need to understand survivors’ understandings of ‘justice’ and how they can be helped to achieve it. A better understanding of these issues might help us to consider what other ways could be open to survivors to help them achieve their ‘justice’-related goals.

Most survivors who had contact with the police were satisfied with the way they were treated. In all, the evidence indicates that the New Zealand Police has made moves towards implementing good practice through initiatives such as policies for and training on responding to victim/survivors of sexual violence. What we could not assess was the quality of the training, the take up of the messages, and the consistency with which policy has been implemented across the 12 police districts. Ongoing monitoring and evaluation would help the New Zealand Police to maintain high standards across the country.

The attrition study has provided baseline data for New Zealand, as well as a methodology that can be replicated. Repeating the study at systematic intervals could be used to monitor changes in the numbers and types of cases recorded by police and systematic differences in cases that proceed or do not proceed through the criminal justice process, and gauge trends in conviction rates. This information, combined with qualitative analyses of police cases, could also help gauge the effectiveness of training and implementation of police policy.

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7.4 Implications for the formal support system

The research results were unequivocal on the value of expert professional interventions in promoting recovery. Survivors identified counselling and specialist sexual violence services as central to their recovery. They also valued culturally appropriate and accessible services. However, the findings overall raised questions about the current context of service provision. In particular, it seems that specialist sexual violence services across the board are experiencing difficulties in delivering consistent and skilled support to survivors and their family and whānau.

The findings showed that survivors rate early and ongoing intervention, particularly from specialist sexual violence services and counsellors, as a key factor in restoring well-being and promoting recovery. In relation to good practice, the literature review showed that there is more information on principles of good service delivery than there is on good types of services, programmes or interventions. It appears that specialist sexual violence services and counsellors are generally adhering to principles of good service delivery, although there have been few evaluations internationally and none locally. Survivors will not be well served within a systemic context marked by poor accessibility, a lack of cohesiveness, and no guidelines on the effectiveness of therapeutic interventions.

Early intervention could prevent repeat sexual victimisation, but internationally, little attention has been given to designing and testing interventions to prevent repeat sexual victimisation. We do not have any evidence as to whether current interventions have an explicit focus on, or even the unintended benefit of, preventing repeat sexual victimisation. Research is needed to develop and evaluate evidence-based programmes aimed at reducing repeat sexual victimisation.

In terms of clinical interventions, overseas literature indicates that trauma-focused cognitive behavioural therapy helps reduce psychological impacts such as post-traumatic stress disorder. To the best of our knowledge, there have been no evaluations of non-Western therapeutic modalities (Mossman et al., 2009a), nor do we know what types of therapies are being offered in New Zealand. This is an avenue for research that could help develop and implement appropriate and effective services for New Zealand.

The responses of a wide range of formal systems are crucial to ensuring the well being of victim/survivors with histories of repeat sexual victimisation, multiple forms of victimisation, and associated health conditions. Many will be more likely to access the medical and mental health system, social services and other community services, than specialist sexual violence services. They will be seeking help for matters as diverse as financial support, gambling, drug addiction, or their children’s truancy. Any of these settings could be critical points for intervening and responding to sexual violence, and potentially preventing repeat sexual victimisation.

For example, there is ample evidence that survivors of sexual violence are likely to use a disproportionate share of health care services (Fanslow and Robinson, 2004). However, there is little information on whether survivors actually disclose the cause of their symptoms to health providers, or whether health professionals discuss the possibility of sexual violation with them. These services could provide crucial information to survivors and referrals to other agencies that could help meet their various needs.

Most of the participants in the pathways study had contacted a formal service of some type and all had disclosed to someone. Internationally, there has been little research on survivors who do not access formal support systems. It is not clear how these survivors’ pathways to recovery and their outcomes compare with those of survivors’ who seek and find help. The major unanswered question is how to put these survivors in touch with formal agencies that could help them. These people are important from a recovery perspective and a burden-of-disease perspective, because of the feedback they provide about failures in service provision and community liability following on from unmet service needs.

7.5 Informal support systems

The research evidence suggests that more attention needs to be paid to informal support systems, both in terms of their responses to sexual violence and because of secondary traumatisation. Informal social networks are often the first point of disclosure and, therefore, the first potential point for ensuring early and appropriate interventions through formal support systems and, when warranted, the criminal justice system.

Survivors who find the courage to disclose to a friend, family or whānau member, or someone else they know cannot be guaranteed a supportive response. Rape myths and victim-blaming often underpin negative responses. People who want to help might not know how to respond. All too often they do not have the awareness and knowledge to be able to refer survivors to appropriate service providers. Impacts such as secondary traumatisation of loved ones or division among social networks can add to survivors’ suffering.

In the case of rape myths and victim-blaming, we are dealing with widespread and entrenched attitudes that are not easily amenable to change. Increased reporting to police of sexual violence perpetrated by partners and other known offenders, as well as the number of participants in the pathways study who spoke out about partner rape, indicate that heightened awareness of the nature and prevalence of sexual violence is having an effect. Overall though, statistics from a range of studies show that the level of sexual violence remains high in New Zealand.

Sexual violence often occurs in social situations where victims are using alcohol or other drugs. Impaired memory as a result of alcohol or other drug use substantially reduces the likelihood that a sexual offence reported to police will progress to trial or result in a conviction. Beyond this, it raises the issue of safety. In many situations potential victims become intoxicated in the company of friends, family or others. In such situations, friends looking out for friends (or even people they do not know) could help to prevent sexual violence.

Efforts to promote awareness of and reduce tolerance for sexual violence might be more effective if they go hand in hand with initiatives to inform the wider community about what to do and where to go, to equip them to help the survivor (and themselves if they are experiencing secondary traumatisation) through referrals to specialist services. Programmes are also being trialled in New Zealand to look at ways that bystanders can help ensure safety by intervening in potentially risky situations. Promoting the knowledge gained through these programmes could prevent sexual violence.

Other countries are increasingly adopting a public health approach to sexual violence, from primary prevention through to intervention. Public health-type messages might have the biggest impact when it comes to promoting community awareness of sexual violence and specialist response services. Given the prevalence of sexual violence, widespread awareness is important because any one of us could find ourselves in the situation of having to respond to a disclosure.

There are particular gaps in knowledge about outcomes for survivors who try, but are unable, to find appropriate help. We know that some survivors experience pressure from informal networks to keep silent or put up with a partner’s sexual violence. What we do not know is how big a burden these survivors are carrying or the flow-on effects to their families, whānau and the wider society.

7.6 Implications of a systems approach

This report has shown that formal and informal support systems and the criminal justice system have a critical function in responding to victim/survivors of sexual violence. It has also shown that victims’ ability to draw on and develop internal strengths, particularly through engagement with external supports, plays a crucial role in their survival and recovery.

A systems approach suggests that the overall system bears the responsibility for ensuring that the needs of victim/survivors are met. By helping survivors regain control and establish new connections, the system can contribute to recovery. Victims are not well served when the components of the system do not work together as well as they could. For example, this can result in survivors not having equitable access to services, as a result of shortfalls in workforce capacity. Findings from the pathways study, environmental scan and literature review indicate that the responsiveness and effectiveness of formal and informal support systems and the criminal justice system can be enhanced through collaboration and linkages within and across systems.

 
7.7 Achievements of the project and suggestions for the future

This project has engaged with a wide range of individuals and agencies from across New Zealand. It has delivered new, comprehensive and robust evidence to inform policy and operational responses for improving the safety and well being of adult victim/survivors of sexual violence.

The project began as a partnership between the Ministry of Women’s Affairs, Ministry of Justice and New Zealand Police, and has had input and support from other government and non-government agencies. Accordingly, it began with a strong focus on the criminal justice system, but also gathered information on other formal and informal support systems that respond to adult survivors of sexual violence.

The findings from the four research streams have provided clarity on some matters and have brought other questions and issues into the spotlight, particularly concerning informal and formal support systems. In some respects, the project has only scratched the surface of the knowledge gaps, partly because sexual violence has been under-researched in New Zealand for some time. This chapter has referred to areas where there continue to be information gaps. There are more.

One of the clear gaps is the lack of ethnic-specific and culturally specific research. We were fortunate to have some Māori input to the project (from both research participants and advisors to the project). Still, we are aware that a kaupapa Māori approach would yield rich and nuanced information that would promote understanding of the specific ways in which sexual violence affects Māori women and their whānau, as well as ways to address sexual violation among Māori.

Similarly, our meetings with women from Pacific communities heightened our awareness of how difficult it can be for them to speak about sexual violence amongst themselves, let alone to researchers and officials. We understand that speaking up runs the risk that their communities are misrepresented or ‘pathologised’, when, in fact, sexual violence crosses all cultural, ethnic and class boundaries.

The research has gathered some information on other groups of survivors, but it is largely silent about the experiences of migrants and refugees, people with disabilities, men, sex-workers, gays, lesbians, bisexuals, transgender people and intersex people. As much as anything else, the information we have collected highlights what we do not know – but need to know – to build a sexual violence response system that could work for some of the most vulnerable people in our society.

In their own way, these silences speak loudly about the pressing need for, but also the sensitivity and complexity of, this type of research. It requires researchers with skill, insight and dedication to building relationships and trust with services and survivors. We hope that funding and time-frames for future sexual violence research make allowance for ethnic-specific and culturally specific work streams.

7.8 Final word

We are profoundly grateful to the female and male survivors of sexual violence who took part in this project. They have shown us that victim/survivors are resilient and courageous. While the effects of sexual violence are devastating, they are amenable to the right combination of formal interventions and support from informal social networks. With the right help, survivors can move along a path of restoring what was lost through sexual violence: their sense of safety and well-being, and the core part of themselves, their identity, their soul.

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Appendices

Appendix A: Background to the project

In 2006, the Ministry of Women’s Affairs identified major gaps in the New Zealand evidence base on the impact of and responses to sexual violence. These gaps centred broadly on victim/survivor decision-making and help seeking, key intervention points for ensuring the safety and well-being of victim/survivors, and the provision of effective response services.

In the same year, the Ministry of Women’s Affairs submitted a proposal to the Cross-Departmental Research Pool for a two-year research project: Strong and Safe Communities – Effective Interventions for Adult Victim/survivors of Sexual Violence. The proposal was developed in partnership with the Ministry of Justice and New Zealand Police. The Cross-Departmental Research Pool announced funding for the project in February 2007 and the project began in July 2007. Researchers from the Crime and Justice Research Centre, Victoria University of Wellington, were contracted to conduct the work. International experts reviewed the four research reports.

The Ministry of Women’s Affairs led the project, and the Ministry of Justice and New Zealand Police provided support, advice, financial and in-kind contributions, including assistance with data collection. The Accident Compensation Corporation and Ministry of Health provided additional financial contributions.

Project governance was provided by an inter-agency steering group, comprising officials from the Ministry of Women’s Affairs, the Ministry of Justice, the New Zealand Police, the Accident Compensation Corporation, the Ministry of Health, Te Puni Kōkiri, the Ministry of Social Development and the Ministry of Pacific Island Affairs.

An inter-sectoral advisory group promoted a cross-agency approach to the project, provided expert technical advice on the research approach, advised on how the victim services sector operates, and facilitated engagement between researchers and the victim services sector. It comprised officials from the Ministry of Justice, the New Zealand Police, the Accident Compensation Corporation, Te Puni Kōkiri, the Ministry of Social Development and the Ministry of Pacific Island Affairs. Non-governmental organisation members included one tauiwi and one Māori representative from each of Te Ohaakii a Hine – National Network Ending Sexual Violence Together and the National Collective of Rape Crisis Centres.

The Taskforce for Action on Sexual Violence was also established in July 2007. The taskforce provided a way for government, non-governmental organisations, and the judiciary to work together to address the social, health, and economic impacts of sexual violence; improve outcomes for adult victims; and hold offenders accountable. Planning for the Ministry of Women’s Affairs research project pre-dated the Taskforce’s establishment, but the project had critical links with the taskforce’s work programme. The Ministry’s Chief Executive was the deputy chair of the Taskforce, and ministry officials supported the Taskforce Secretariat and led or contributed to several streams of the work programme.

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Appendix B: Definitions of key terms

An adult was defined as a person aged 16 years or older at the time of the assault. Some victim/survivors of adult sexual violence are also survivors of childhood sexual abuse, but this group was beyond the project’s scope.

Sexual violence (or sexual assault) is a broad term that covers a continuum of behaviours. The project focused on sexual offences at the more serious end of the continuum. It adopted the definition of sexual violation in section 128 of the Crimes Act 1961, which covers rape and unlawful sexual connection.

Safety refers to freedom from the risk of further sexual victimisation, physical or psychological injury, or secondary victimisation. Potential sources of further risk include other people, risky or self-harming behaviours, or engagement with justice, health, or other services.

Well-being refers to physical, psychological, and emotional welfare. Well-being can be promoted in many ways, including through the belief and support of others; knowledge of and access to therapeutic interventions that promote recovery; knowledge of and access to legal redress; the perception that justice has been done; knowledge about rights and choices; having one’s needs met; and regaining a sense of control over one’s body and life.

Safety and well-being are on a continuum. After an incident of sexual violence, the first priority is safety, or removing the victim from the risk of further harm. This is followed by the longer process of recovery or restoring well-being.

Recovery relates to a restoration of well-being across a range of domains, including the physical, mental, emotional, spiritual, and interpersonal spheres. Different sectors have different models of recovery. Recovery is a process, not an end, and people recover in different ways.

The term victim/survivor is used interchangeably with the terms ‘victim’ and ‘survivor’. This terminology reflects that:

experiencing sexual violence is an act of victimisation and has to be acknowledged as such. However, being victimised does not mean those raped should have to assume the ‘victim’ label with all its negative connotations; conversely, survival is neither assured nor necessarily immediately apparent: some women may always deem it a ‘work in progress’. (Mossman et al., 2009b: 4)

In most of this report, we use the term ‘perpetrator’ to refer to an individual who commits sexual violence. When discussing findings for cases that entered the criminal justice system, we refer to ‘the accused’, ‘suspect’ or ‘defendant’.

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Appendix C: Socio-demographic characteristics of participants in pathways study

Table 9: Socio-demographic characteristics of participants in pathways study

Source: Kingi and Jordan (2009)

Appendix D: Number and service type of participants in the environmental scan

Table 10: Number and service type of participants in the environmental scan
Criminal justice agencies Community agencies

Source: Mossman et al. (2009b).Appendix E: Factors that increase the risk of sexual violence

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Appendix E: Factors that increase the risk of sexual violence

Table 11: Factors that increase the risk of sexual violence

Source: Kingi and Jordan (2009); Triggs et al. (2009).

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Appendix F: Nature and dynamics of sexual violence

Table 12: Nature and dynamics of sexual violence

Source: Kingi and Jordan (2009); Triggs et al. (2009).

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Published in October 2009
by the Ministry of Women’s Affairs | Minitatanga Mō Ngā Wāhine
PO Box 10 049, Wellington 6143, New Zealand

Phone: 64 4 915 7112
Fax: 64 4 916 1604
Email: mwa@mwa.govt.nz
Website: www.mwa.govt.nz

ISBN 978-0-478355-00-0 (Digital)
ISBN 978-0-478252-47-7 (Print)