Providing humanistic psychotherapy for sexual assault survivors in a neoliberal society

A U.S. national survey reported 44 percent of women and 23 percent of men experience some form of sexual violence (Breiding et al., 2014). It is not surprising that survivors of sexual assault have more positive interactions with service providers when they feel believed, validated and heard (Martsolf et al., 2010). Nor is the evidence that survivors who have positive experiences after disclosing their assault have fewer physical and psychological health issues, utilize more adaptive coping skills, have higher self-esteem, and exhibit fewer PTSD symptoms (Campbell, Ahrens, Sefl, Wasco, & Barnes, 2001; Martsolf et al., 2010; Sigurvinsdottir & Ullman, 2015; Ullman & Peter-Hagene, 2014). However, there are unfortunately barriers to providing empathic, effective services to survivors.

“Psychology is wedded to the social, cultural, political and economic conditions of its times” (Sugarman, 2015, p. 115). The ways that clinicians engage with survivors of sexual assault and their plans for treatment are heavily influenced by managed care, a system that prizes short-term counseling with deliverable outcomes. Therefore, managed care can often be a barrier to working with survivors of sexual assault from a humanistic frame. Some survivors may be labeled “problematic” or “chronic” if they need longer-term treatment, while others who decline psychotherapy or medication may be considered “resistant” (Pack, 2008). This dichotomy illustrates the double-edged sword that is working with survivors of sexual assault within managed care: It simultaneously stigmatizes survivors who use “too many” services and blames others who use “too few.” This dilemma can be understood in terms of Rizq's (2014) audit culture that “is undermining our therapeutic relationships with patients” (p. 211). In the same line, Layton (2015) has identified “an untenable conflict between the therapists' ethic of care and a neoliberal ethic of surveillance” (para. 26).

The current managed care system was able to take hold in part because of the rise of a neoliberal agenda in Western society that endorses reduced state responsibility for social well-being, privatizing public assets, and corporatizing human services (Sugarman, 2015, p. 104). In many ways, humanistic therapy, which was founded on the premise that humans inherently hold the capacity and desire for self-actualization, unintentionally promotes neoliberal ideals. Neoliberalism's “glorification of individual self-help and responsibility” (Beres, Crow, & Gotell, 2009, p. 142) has permeated psychology, with psychotherapy's focus often being on intra-individual psychological problems that can be solved through individual means. Productivity, another major value in neoliberalism, is so pervasive in psychological discourse that the brain after trauma has been described as a broken machine (Summerfield, 1999), a metaphor that effectively reduces humans to their output ability. There are certainly many benefits to supporting survivors to feel self-efficacious and productive, a major one being that it helps them be successful members of the neoliberal society in which they exist. However, this emphasis on individualism may also delimit how survivors understand their own experiences and assess their recovery. How do clinicians combat the reductionist approaches that are often encouraged in managed care, and instead develop alternative approaches?

Qualitative studies of sexual assault survivors in therapy have highlighted the importance of clinicians truly listening to survivors and understanding post-assault experiences in the survivor's own words (Harvey et al., 2000; Reissman, 1989; Sorsoli, 2010). These findings are directly in line with humanistic psychology and are especially important when working with survivors of sexual assault because survivor narratives often involve discontinuity that is challenging for any listener, even clinicians, to tolerate (Harvey et al., 2000; Riessman, 1989). Therefore, clinicians must be able to resist the urge to shape survivors' stories into coherent narratives, and instead hold the space for contradiction. Humanistic psychotherapists would also benefit from adopting Slade, Williams, Bird, Leamy, and Le Boutillier's (2012) redefinition of recovery that is based on (a) process rather than clinician driven markers or outcomes, (b) judged on a sense of empowerment and connection rather than merely the absence of symptoms, and (c) not requiring professional treatment, as many survivors will recover without engaging in psychotherapy or pharmacotherapy.

Central to models that resist a reductionist, intra-individual conceptualization of distress and treatment is the sociopolitical context within which survivors of sexual assault experience distress (Lafrance & McKenzie-Mohr, 2013). For example, Burstow (2003) introduced the concept of political empathy (p. 1310) as a skill clinicians need in order to understand the client's social location and experiences of oppression, something that is not required in managed care settings. Ecological models (e.g., culturally inclusive ecological model of sexual assault recovery; Neville & Heppner, 1999) are also valuable as they recognize that “mental health consequences of rape are caused by multiple factors beyond characteristics of the victim or the assault” (p. 238). A major benefit of ecological models is that support can be offered at any level of the model (i.e., not only individual, but at microsystem, macrosystem, etc.; Campbell, Dworkin, & Cabral, 2009). Scholars have also critiqued the intra-individual focus of traditional empowerment and emphasized that connection and community should be valued as much as individual empowerment, leading to the concept of group empowerment (Cosgrove & McHugh, 2000; Fallot & Harris, 2002; Riger, 1993).

Ultimately, many clinicians working with survivors of sexual assault are dependent upon reimbursement from managed care institutions, and therefore, must be able to work within those systems. However, by understanding the influence of neoliberalism on managed care, clinicians can more judiciously utilize or resist the neoliberal values embodied in a managed care system, such as productivity and self-reliance. By being more aware of the pulls of neoliberalism, and borrowing from the approaches outlined above, clinicians can maintain the values of humanistic psychology and respond to survivors of sexual assault in genuine and empathic ways that will enhance their recovery.

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