Trauma-informed strengths-based group intervention guideline for female survivors of adult sexual assault

Abstract

High prevalence rates of sexual assault perpetrated against women are well documented, both nationally and internationally. Although this type of trauma can lead to numerous adverse long-term effects, some survivors overcome it and experience positive changes in themselves and their lives. Although traditional pathogenic or deficit-based models have dominated literature, a paradigmatic shift towards a salutogenic or strengths-based approach is becoming evident in emerging literature. This shift encourages mental health professionals (MHPs) and researchers to focus on positive and adaptive post-trauma outcomes that incorporate potential areas of positive psychological changes, such as emerging growth, and spiritual and existential adaptive outcomes. Thus, a more detailed understanding of the interactions between indicators of distress and psychological well-being (PWB) is required. This intervention research is comprised of three phases and four manuscripts. A rapid review was conducted in Phase One to investigate evidence-based interventions available to female survivors of adult sexual assault (FSASA) (Manuscript 1). In Phase Two, a convergent mixed-method study was conducted to investigate real-life examples through an online survey targeted at South African FSASA residing in the Gauteng Province. The quantitative section of this study measured and correlated several variables, namely posttraumatic stress, PWB, resilience, and PTG in the sample (Manuscript 2). Validated psychometric instruments used included the PCL-5 (DSM-5 clinician checklist for PTSD), the Mental Health Continuum (MHC-SF), the Adult Resilience Measure (ARM) and the Posttraumatic Growth Inventory (PTGI). The qualitative data consisted of participant answers to open- ended questions on their recovery experiences. This data was analysed to compare the themes apparent in the recovery experiences of participants that showed SSR to those who showed FSR (Manuscript 3). In Phase Three, the rapid review and empirical study findings were integrated to develop a trauma-informed strengths-based group intervention guideline for FSASA (Manuscript 4). The main barriers to service delivery were highlighted during stakeholder consultations, namely i) insufficient training opportunities for staff, and ii) financial constraints. These prevented clients from returning for additional sessions, impacting recovery rates. Both quantitative and qualitative findings were discussed for the convergent mixed-methods study. Findings from the quantitative section showed that participants experienced high levels of trauma, with most participants experiencing more than one sexual assault. Participants received both formal and informal support and more than half attended psychotherapy. A total of 68% of the participants scored above the diagnostic threshold for PTSD; however, the participants viewed themselves as doing well mentally. Average levels of resilience were observed with personal resilience scores surpassing relational resilience scores. Correlational analysis indicated that PTSD decreased and PWB increased as time passed after the assault and the duration of therapy was correlated with better mental health. For the qualitative section, barriers to accessing support included apprehension and distrust of self and others, lack of resources and informal support. Informal support included emotional validation and active support. More positive counselling experiences were reported by women in the SSR group than in the FSR group. Experiences and symptoms related to PTSD, resilience and PTG were reported in both groups. A strengths-based trauma-informed group intervention guideline was developed from these findings. MHPs (psychologists, social workers, counsellors) can apply these guidelines in facilitating and enhancing resilience processes, PWB, and PTG-enabling outcomes in FSASA.