As sexual violence cases surge in India, focus on counselling of victims

SUPRIYA RAMESH

When was the last time your male friends looked at their watch before stepping out of their house? Well, mine say that it was in school when they had to return before the curfew. For women, however, not much has changed. Be it a school-going girl, a college student, or a working woman, they are expected to be back home before it's too dark.

While we are aware of the increasing crime rate - rape, sexual assault, molestation, cruelty by intimate, etc - against women, victims hardly come forward to seek therapy for it. It is high time that we also start talking about therapy and how it can help victims mentally.

According to recent data released by National Crime Records Bureau (NCRB), Delhi had the highest rate of crime against women in 2021 at 147.6 per cent among Union Territories. It was recorded that there is an increase over the past three years from 13,395 in 2019 to 14,277 in 2021.

Among cities with a population of two million or more, the NCRB data places Jaipur at the top with a crime rate of 194 per cent, followed by Delhi at 147.6 per cent.

In terms of the actual number of cases among the 19 large cities, Delhi topped the list at 13,982 cases, followed by Mumbai, Bengaluru, and Hyderabad. Delhi also marked the highest number of actual cases in the past three years amongst these cities, with 12,902 in 2019 and 9,782 in 2020, the data shows.

Even in this day and age, people dread taking therapy as they think it would not be very "bold" of them. Society might label them as "weak", "mentally unstable", "sensitive", etc, which is what many fear. According to the World Health Organisation (WHO), approximately one in three women experience physical or sexual violence, often perpetrated by an intimate partner.

"In my half-a-decade-plus professional trajectory as a psychologist, I can count the 'reported' cases of rape, molestation, sexual history or cruelty that were brought for consultation 'directly' to me, literally on my fingers. Even though a lesser number of 'direct' cases of sexual or rape history prefer taking therapy, it's interesting if I reflect in retrospect now, that more than half of the cases I've ever consulted for psychosis-based conditions such as schizophrenia or even mood-based disorders such as bipolar or schizoaffective disorders have had some or the other history of 'sexual abuse' associated with it," said Mahima Sahi, Chief Psychologist at heyy (a mental healthcare app).

A WHO report says that individuals, who have experienced sexual violence are more likely to experience depression, anxiety, post-traumatic stress disorder (PTSD), and other mental health conditions. Howbeit, the cases for consultation remain low, primarily due to the social "stigma" associated with seeking help and feeling judged for it.

Sahi says that the most common types of cases that are reported for therapy are the ones with a history of cruelty by an inmate, mostly the partner, or that of physical abuse by a family member such as the father in the case of females and a family relative in case of males. It is followed by experiences of being inappropriately touched or sexually perpetrated by peers or college mates in the case of young adults.

However, victims who have faced childhood abuse or those that were gruesome or sadistic in nature, are the ones that require the most care. "Extra care and sensitivity in handling cases as intense as these are essential for the simple reason that an early or intensely traumatic experience has the potential to have "lasting impacts'' on one's psyche that may or may not be reversible in the lifetime of the victim," Sahi explained.

Experiencing sexual assault or rape can have a significant impact on a person's mental health, and it is common for victims to experience changes in their personality, behaviour, and capabilities as a result of the abuse.

Sahi said: "Physical and emotional effects of the abuse, as well as the psychological impact of the trauma, affect a person's mood, thoughts, and behaviours, and may cause them to feel anxious, depressed, or isolated. They may also have difficulty sleeping, concentrating, or participating in activities they previously enjoyed. It is also common for victims to experience changes in their cognitive abilities, such as difficulties with memory, concentration, or decision-making."

According to Sahi, some of the potential effects of sexual assault or abuse on victims include:

* Psychological effects: May experience a range of mental health issues, including depression, anxiety, PTSD, and other conditions. They may also experience low self-esteem, feelings of worthlessness, and difficulty trusting others.

* Cognitive effects: May affect the victim's cognitive abilities, such as their memory, concentration, and decision-making. Victims may have difficulty remembering details of the abuse, may struggle with concentration or may have difficulty making decisions.

* Emotional effects: May experience a range of emotions, including fear, shame, guilt, and anger. They may also feel isolated, overwhelmed, or numb.

* Behavioral effects: May exhibit changes in their behaviour, such as becoming more withdrawn or isolated, exhibiting changes in eating or sleeping patterns, or engaging in self-destructive behaviours.

"Another commonality in the mental state of victims in my experience has been the feeling a range of emotions, including fear, shame, guilt, and anger when they enter therapy. They feel overwhelmed, isolated, or numb at times and many still feel uncertain about seeking therapy, as they are worried about the stigma, shame, or judgment associated with it," Sahi said.

Rape, sexual assault, and molestation are common experiences across all age brackets and gender groups. However, in Sahi's experience, young adults in the age group of 19-25 years or teenagers in the age group of 10-18 were the most common ones seeking consultation.

Post the abuse, the process of healing varies from person to person. It is influenced by a variety of factors, including the severity of the abuse, the individual's coping mechanisms, and the support they receive from family and friends. Therapy can be an important part of the healing process for victims of sexual assault and can help them work through the trauma they have experienced and develop coping skills to manage their feelings and emotions.

"The process of healing can be long and difficult, and it is not uncommon for victims to struggle with the psychological effects of the abuse for an extended period of time. Moreover, it is not uncommon for victims to experience setbacks or periods of difficulty, even after they have received therapy. It is important for victims to be patient with themselves and understand that healing from sexual assault is a process that can take time," Sahi said, adding that it is also important for them to seek support from a mental health professional and have a supportive network of friends and family members who can provide emotional support as they navigate the healing process.

Depending on the individual circumstances and experiences of the victim, the number of therapy sessions necessary to heal and move on from the trauma of the abuse varies tremendously. While some people just need a few sessions to learn how to deal with their moods and emotions, others need more intensive therapy.

Sahi said: "However difficult it may be, it is important for victims of sexual assault or abuse to understand that seeking therapy is a 'brave' and 'proactive' step towards healing and that they do not have to face the challenges of recovery alone."

There are a number of strategies that women can use to cope with the trauma like seeking support and having a supportive network of friends, family members, or other trusted individuals who can provide emotional support and help them navigate the healing process.

Taking care of one's physical and emotional well-being is an important part of the healing process. They may find it helpful to engage in self-care activities such as getting enough sleep, eating a healthy diet, exercising, and engaging in activities they enjoy.

"Developing coping skills to help them manage their emotions and thoughts, such as relaxation techniques, mindfulness, or stress management techniques. Working through the trauma of sexual assault or rape can be an important part of the healing process. It might be helpful to engage in therapy or other types of trauma-focused treatment, such as cognitive-behavioural therapy or exposure therapy," Sahi asserted.

Pursuing justice through the legal system or other means is a crucial step in their recovery. Taking the aid of a representative or legal counsel to assist them in navigating the procedure and defending their rights could possibly help.

"It is also important for women to be patient with themselves and understand that healing from sexual assault or rape is a process that can take time," she added.

How does the therapy work? Sahi answered: The process of therapy for a sexual assault, rape, or molestation victim typically begins with an initial assessment, during which we gather information about the individual's history, experiences, and current mental health status to understand the individual's needs and develop a treatment plan that is tailored to their specific circumstances and goals.

During therapy sessions, we work with the individual to identify and address the psychological and emotional effects of the sexual assault or abuse like exploring the individual's thoughts, feelings, and behaviours related to the abuse, and working through any trauma or other mental health issues that may have arisen as a result of the abuse.

Depending on the case, we may also use a range of techniques and strategies to help the individual cope with their emotions and thoughts, such as cognitive-behavioural therapy, exposure therapy, or relaxation techniques. In other instances, provide guidance and support to help the individual develop healthy coping skills, such as effective communication skills, emotional regulation, or stress management techniques.

As the individual progresses through therapy, the focus of treatment may shift towards addressing any ongoing challenges or issues that may arise, and help the individual build resilience and move forward in their recovery. The process may also involve working with the individual to develop a plan for ongoing support and self-care after therapy has ended.