Sexual Trauma in the Military

"Do not assume how anyone feels about their service in the military." AUS student and veteran

Military Culture

• Normalization of violence
• Family of choice
• Very specific hierarchy/Chain of command
• 18-25 years old

The US Dept of Veteran's Affairs defines Military Sexual Trauma (MST) as sexual harassment that is threatening or physical assault that is sexual in nature. These traumas occur when the person is in the military. The location, the genders of the people involved, and their relationship does not matter (OARS, 2016). *Compliance does not equal consent.*

Statistics (Protect Our Defenders, 2015)

• 1,027,810 - number of veterans that visited the VA for MST
• 2014 20k/1.3 million active duty members were sexually assaulted or raped 47,000 times
• 13% of men report vs 40% of women

Statistics (cont.)

• 53% of MST survivors are male
• 86% do not report assault and if they, do they wait until separation
• 62% who do report, suffer retaliation

2014 MST Reports (POD, 2015)

Barriers to seeking help or reporting

• Perpetrator is often a peer or unit superior
• Fear of retaliation - often retaliation is worse than initial traumatic experience
• Victim blaming
• Choosing to report may end career

Reporting - Unrestricted vs Restricted

• Unrestricted allows survivor to press charges, but chain of command is notified. Expedited relocation.
• Restricted means the survivor has access to care, but cannot press charges.
• If chain of command is immediately notified, then automatically considered unrestricted. Relocation questionable

Perpetrators

• Control
• Outrank
• Serial predators
• Think Catholic Church scandal...

Survivors

• Experience is similar to childhood sexual abuse.
• Violated by "family member".
• Betrayal of loyalty to service.
• Often held responsible for attack.
• Question own ability to continue to serve.
• May have "dishonorable discharge" and no access to VA benefits.

Clinical Considerations

Assessment

• Couples? Individual? Family?
• Safety and risk assessment for suicide
• What is presenting issue?
• Often initial diagnosis is an eating disorder, somatic, and dissociative disorder (Swords to Plowshares, 2015)
• *Language is important in building therapeutic alliance, i.e. "survivor" vs "victim"

Prolonged Exposure (Koa, 2011)

• Focus on specific trauma/confront the memory through activation
• Change narrative of survivor's association of negative behavior (self-blame)
• Create new perspectives
• Integrate trauma memory to reduce anxiety

Holographic Reprocessing (Katz, 2014)

• Integrated approach borrowing from psychodynamic, experiential, cognitive behavioral, and narrative therapies. Trauma viewed through an observer's lens rationally and experientially.
• A - Identify patterns; think attachment
• B - Cognitive shifts & holistic reappraisals
• C - Reprocessing using imagery

Resources

• OARS - Local Organization
• VTSC - Local Organization
• VAWatchDog.org
• MentalHealth.VA.gov
• MHN Gov't Services (MFLCs)
• ProtectOurDefenders.org
• The Invisible War - Documentary

References

• Briere, J. N. & Scott, C. (2015). Principles of trauma therapy: A guide to symptoms, evaluations, and treatment. Los Angeles, CA: Sage.
• Dick, K. (Director), & Zeiring, A. (Producer). (2012). The invisible war [DVD]. United States: Chain Camera Pictures.
• Foa, E. B. (2011). Prolonged exposure therapy: Past, present, and future. Depression and Anxiety, 28(12), 1043-1047. doi:10.1002/da.20907
• Hardy, K. (2016, May 2). Understanding military sexual trauma [presentation]. Veterans Training Support Center. Seattle, WA
• Katz, L. S., Douglas, S., Zaleski, K., Williams, J., Huffman, C., & Cojucar, G. (2014). Comparing Holographic Reprocessing and Prolonged Exposure for Women Veterans with Sexual Trauma: A Pilot Randomized Trial. Journal of Contemporary Psychotherapy: On the Cutting Edge of Modern Developments In Psychotherapy, 44(1), 9-19. doi:10.1007/s10879-013-9248-6
• Kelly, U. A., Skelton, K., Patel, M., & Bradley, B. (2011). More than military sexual trauma: Interpersonal violence, PTSD, and mental health in women veterans. Research In Nursing & Health, 34(6), 457-467. doi:10.1002/nur.20453
• Outreach and Resource Services. (n.d.). Retrieved May 24, 2016 from http://oars4vets.org/about-mst/
• POD: Protect Our Defenders. (n.d.). Retrieved May 24, 2016 from http://www.protectourdefenders.com