Since the #MeToo movement went viral in 2017, stories about sexual assault and abuse have made regular headlines. Nearly two years later, such traumatic experiences remain ever-present in the media, as new disclosures emerge and dominate our conversations about politics and pop culture.
The first half of this year alone brought Leaving Neverland, an agonizing documentary featuring two adult men who describe how pop star Michael Jackson sexually abused them as children; a memoir by the columnist E. Jean Carroll that included a passage detailing how President Trump assaulted her in a dressing room two decades ago; and, sex-trafficking charges against the financier Jeffrey Epstein.
These accounts forced us to confront, yet again, the pervasiveness of sexual assault and abuse, but there’s something important missing from that public dialogue: what happens to survivors who are deeply affected by details from specific cases, or the ongoing national reckoning, and realize they want or need help with recovery.
Many of survivors may discover, though, that it’s difficult to access not just formal therapy but care that’s a good match for their needs, backgrounds, and life experiences. Therapy is often unaffordable for those without health insurance, and even those with coverage find it difficult to access for various reasons. Some survivors, particularly women of color and black women, avoid seeking therapy altogether because of past negative experiences with mental health professionals.
Meanwhile, trauma hasn’t been a subject covered extensively in graduate-level education for psychology, which means providers may have a college degree but little or no training in how to treat the effects of sexual abuse and assault.
So while #MeToo has radically changed our collective awareness about sexual trauma, along with our willingness to believe survivors, we still have not come to terms with the barriers to recovery and healing.
“I think that survivors hearing about #MeToo has helped spur them to reach out for help that they’ve deserved for so long,” says Kristin Mills-Trowbridge, a longtime counseling coordinator at Kansas City’s Metropolitan Organization to Counter Sexual Assault (MOCSA).
“They will say, ‘I feel like I’m in a good place with this,’ and then they’re still reminded of [sexual assault] on social media and in the general media, what feels like nearly daily. Clients say that is re-triggering for them.”
Between the end of 2016 and 2018, the nonprofit organization received 35 percent more calls to its crisis line. This mirrors what happens at national hotlines when media reports of sexual violence rise. After Carroll’s book excerpt was published by New York, for example, RAINN’s National Sexual Assault Hotline saw a 53 percent increase in calls compared to the prior week. Though RAINN provides guidance on how to pursue professional mental health help, it does not track how many callers its hotline workers refer to therapy.
In 2018, MOCSA provided counseling to more than 1,400 clients, and its waiting list is currently five weeks long. Counselors are trained in techniques like trauma-focused cognitive behavioral therapy, which helps adolescent and teen clients process their experiences and emotions, and Eye Movement Desensitization and Reprocessing (EMDR), a therapy shown to reduce the intensity of trauma memories. MOCSA also offers nine support groups.
“In combination between all the clients who are calling us, regarding accessing services, there is some general feedback that they have been in counseling before but the sexual assault or abuse wasn’t addressed in a full way,” says Mills-Trowbridge. “I would imagine [it’s] because the therapist doesn’t have specialized training.” Survivors, she adds, don’t have to work quite as hard as they have with past therapists to help MOCSA counselors understand what they’ve been through.
“Survivors don’t have to work quite as hard to help us understand what they’ve been through.”
MOCSA, which is funded by federal and private grants, businesses, and individuals, provides its services free of charge, as do other rape crisis centers. But research has shown that at least a quarter of the 1,300 country’s centers have waiting lists for core services like counseling.
Mills-Trowbridge says there simply aren’t enough resources to meet the nationwide demand for high-quality mental health help. When MOCSA clients want to see a private therapist, staff will refer them to a handful of skilled, local providers or help them look online.
But no matter your location, web searches can often lead to dead ends, filled with therapists who aren’t taking new clients or won’t accept insurance. Recent research even suggests that lists of in-network psychologists and psychiatrists compiled by health insurance companies are frequently out of date and may be purposely inaccurate to discourage people from accessing expensive mental health benefits.
One alternative is seeking therapy via video or messaging through a service like Talkspace. In 2017, in the wake of #MeToo going viral, the company offered 500 free months of therapy to survivors of domestic and sexual violence. Neil Leibowitz, chief medical officer of Talkspace, said in an email that the company offers its therapists support from trauma experts. Additionally, only therapists with previous experience can treat Talkspace clients with trauma-related issues.
In general, it’s unclear how many of the estimated 95,000 active, doctoral-level licensed psychologists in the U.S. have received training to treat clients who’ve experienced sexual trauma. When the American Psychological Association last surveyed mental health professionals in 2015, it found that more than half of the 4,600 respondents frequently or very frequently served clients with trauma or stressor-related disorders, but the scientific and professional organization did not track how many had participated in training to learn effective methods for treating trauma.
For some survivors, however, receiving a specific type of therapy may be less of a concern, particularly if they’ve previously had negative experiences with mental health providers.
Jameta Nicole Barlow, a community health psychologist and assistant professor of writing at George Washington University, says women of color and black women may seek alternatives to formal therapy in part because licensed psychologists or psychiatrists — including those with expertise in treating trauma — often lack the cultural competency to understand how their racial and ethnic identity intersects with their trauma experiences.
“People are finding different ways to address healing for themselves and their communities that are non-traditional because they may not have a counselor that can address their unique issues,” Barlow says.
“People are finding different ways to address healing for themselves and their communities that are non-traditional.”
In Barlow’s experience, these approaches include group-focused activities like dancing, walking, or yoga. Barlow personally facilitates Emotional Emancipation Circles, an intervention designed to address trauma related to anti-black racism. She also leads healing retreats that incorporate writing, journaling, and personal narrative. Sexual trauma often eventually emerges as a topic of conversation in both settings. Barlow says the culturally relevant environment she creates at retreats, along with social support participants receive from each other, can be critical to survivors’ recovery.
Lillian Comas-Diaz, a clinical professor of psychiatry and behavioral sciences at the George Washington University School of Medicine, says that expanding survivors’ access to various types of treatment must become part of a political agenda, perhaps championed by a progressive politician or the so-called “squad” comprising Alexandria Ocasio-Cortez of New York, Ilhan Omar of Minnesota, Rashida Tlaib of Michigan, and Ayanna Pressley of Massachusetts, all Congressional Democrats.
Comas-Diaz believes more therapists need training in how to treat trauma, but also says we need to seriously consider holistic methods that target the mind-body connection and go beyond talk therapy. That could include EMDR as well as practices like acupuncture, trauma-sensitive yoga, and testimonio, which Comas-Diaz describes as a “healing and empowering method where the person narrates her or his experience with trauma and oppression.”
Ultimately, Comas-Diaz envisions a wide-scale effort to reach survivors with the right services and interventions.
“We need a public health perspective on this, backed by a government initiative,” she says. “We’re talking about remediation.”
If you have experienced sexual assault, you can call the free, confidential National Sexual Assault hotline at 1-800-656-HOPE (4673), or access 24-7 help online by visiting hotline.rainn.org.