INTERNATIONAL JOURNAL OF GROUP PSYCHOTHERAPY, 53(2) 2003

SEXUAL ASSAULT
VANDEUSEN AND CARR
GROUPS

Recovery from Sexual Assault:

An Innovative Two-Stage Group
Therapy Model

KAREN M. VANDEUSEN, PSY.D.

JOETTA L. CARR, PH.D.

ABSTRACT
This article describes an innovative two-stage model of sexual assault therapy
groups for women in a university setting. This model is recommended for use in
various settings and includes a supportive therapy group and two specialized
therapy groups, one for childhood sexual abuse survivors and the other for sexual
assault (acquaintance rape and stranger rape) survivors. Theoretical underpin-
nings of the model are discussed in addition to practical aspects of group develop-
ment such as elements of an effective group, screening of potential members, and
marketing and recruitment techniques.

The college years offer unique developmental opportunities be-

yond education and career preparation. Students begin a journey
toward self-exploration and identity formation as they venture out
beyond their families, support networks, and communities, and
enter a new social environment. While several challenges and
stressors are inherent in these years, many college students face
additional barriers as they attempt to cope with the effects of child
sexual abuse and/or sexual assault in adolescence and young
adulthood, including acquaintance rape and stranger rape.
Childhood sexual abuse and sexual assault have reached epi-
demic proportions in the United States (Morrow & Smith, 1995).

Karen M. VanDeusen is an assistant professor in the School of Social Work, Western

Michigan University, and Joetta L. Carr is an associate professor at the University Coun-
seling and Testing Center.

201
202 VANDEUSEN AND CARR

Sexual assault is measured by both incidence rates, where the

number of separate victimizations are measured within a specific
time period such as an academic year, as well as by prevalence rates
where the number of people whose lives are impacted by rape are
measured over a more broadly defined period of time such as their
entire lifespan. Results from the most recent National College
Health Assessment survey (American College Health Association,
2000) found that the incidence of rape and attempted rape of fe-
male college students within the last school year was 6.5%, with
12% reporting sexual touching against their will. Similarly, the
Sexual Victimization of College Women survey (Fisher, Cullen, &
Turner, 2000) found that 2.8% of the women surveyed reported
experiencing attempted or completed rape within one academic
year. The number of attempted and completed rape incidents (35
per 1,000 college women per academic year) exceeded the num-
ber of victims, since some women experienced multiple victimiza-
tion (Fisher et al., 2000). On the other hand, the lifetime preva-
lence rates for rape of women measured over many studies has
consistently been between 15-25% (Koss, Gidycz, & Wisniewski,
1987; Malamuth, Sockloskie, Koss, & Tanaka, 1991; Shapiro &
Schwarz, 1997), and approximately 20% for childhood sexual
abuse (Finkelhor & Browne, 1986). Koss et al. (1987) reported that
54% of college women experienced some form of sexual aggres-
sion since age 14.

COMMON AND DIFFERENTIAL EFFECTS OF CHILD SEXUAL

ABUSE AND SEXUAL ASSAULT

Childhood sexual abuse and sexual assault often result in common

negative effects that are potentially long-lasting. Survivors of sex-
ual trauma have been reported to experience a greater incidence
of anxiety and depression (Browne & Finkelhor, 1986; Courtois,
1988; Kilpatrick, Best, Saunders, & Veronen, 1988; Koss, Dinero,
Seibel, & Cox, 1988; Shapiro & Schwarz, 1997); sexual dysfunction
(Browne & Finkelhor, 1986; Courtois, 1988; Herman, 1992; Kil-
patrick et al., 1988; Koss et al., 1988; Shapiro & Schwarz, 1997);
 SEXUAL ASSAULT GROUPS 203

and dissociative, avoidant, and intrusive symptomatology

(Shapiro & Schwarz, 1997) compared to women who were not sex-
ually assaulted. Female college students who were raped were
found to engage in more health risk behaviors, including physi-
cally fighting with a partner, using drugs or alcohol during their
last sexual experience, suicidal ideation, drinking and driving,
smoking cigarettes, becoming sexually active before the age of 15
(Brener, McMahon, Warren, & Douglas, 1999), having multiple
sexual partners (Brener et al., 1999; Shapiro & Schwarz, 1997),
and having sex more frequently than women who were not raped
(Shapiro & Schwarz, 1997).
Sexual assault victims also reported more somatic complaints
and visited health care professionals more frequently when com-
pared to non-victims (Kimerling & Calhoun, 1994; Longstreth,
Mason, Schreiber, & Tsao-Wei, 1998). Common somatic com-
plaints reported in women who were sexually abused as children
include chronic pelvic pain, premenstrual syndrome, and irritable
bowel syndrome (Briere & Runtz, 1993, Briere & Zaidi, 1989;
Longstreth et al., 1998).
While the experience of child sexual abuse, acquaintance rape,
and stranger rape share several common features and resulting
damaging effects, there are important differences. Finkelhor
(1981) identified features unique to childhood sexual abuse, in-
cluding offenders who are acquaintances, and family members or
friends who have power and authority over the child and use psy-
chological coercion as a primary tactic. There tends to be more
chronic and repetitive abuse in these cases. If it occurs within the
family, there are many implications for the family system as a
whole, and different social agencies are involved (Finkelhor,
1981).
Finkelhor and Browne (1986) identified four dynamics that re-
sult from child sexual abuse. These include “traumatic sexualiza-
tion” in which a child develops dysfunctional sexual feelings and
attitudes through the experience of sexual abuse; “betrayal” by the
offender and other family members as a result of their response to
the abuse; “powerlessness” due to repeated violations of the
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child’s body; and “stigmatization” as a result of an internalized

sense of badness, shame, and guilt that become internalized in the
self-image of the child (p. 180).
Several authors have reported that chronic and prolonged child
sexual abuse leads to more severe negative effects (Browne &
Finkelhor, 1986; Courtois, 1988, 1997; Herman, 1992). Herman
(1992) suggested that chronic and prolonged child sexual abuse
results in more complex symptoms, including disturbance in iden-
tity and personality development, impaired ability to relate to oth-
ers, damaged sense of self, chronic depressed mood, dissociative
symptoms, persistent suicidal thoughts, self-injurious behavior, al-
ternations between holding anger in and having anger outbursts,
and being inhibited sexually or engaging in compulsive sexual be-
havior. Herman calls this phenomenon complex posttraumatic
stress disorder.
When the sexual assault occurs in late adolescence or adult-
hood, however, the ego is more developed, the personality and
identity are better formed, and the victim often has more psycho-
logical resilience. In addition, she may have better support systems
and better access to treatment. If the perpetrator is not a family
member or authority figure in her life, she may be less inclined to
dissociate the trauma and instead find more ways to integrate it.
Herman (1992) writes about single-blow traumas being less dam-
aging than the repeated victimization that often occurs in child-
hood where children are powerless to leave. Of course, a brutal
rape by a stranger or by an intimate partner or acquaintance can
be devastating to a young woman.
Rape trauma has many of the characteristics of an acute stress
disorder and often turns into posttraumatic stress disorder if the
symptoms persist more than a month. PTSD is characterized by se-
vere anxiety or increased arousal, reexperiencing the rape, avoid-
ance of reminders of the rape, and a variety of dissociative symp-
toms (Herman, 1992). Although these symptoms can continue for
years without proper treatment, they usually begin to abate within
3 to 6 months. If the adult victim was also abused as a child, her re-
 SEXUAL ASSAULT GROUPS 205

covery will most likely be more challenging and require more in-
tensive treatment (Herman, 1992).

GROUP TREATMENT OF SURVIVORS

Yalom (1995) suggested that group treatment offers advantages

over individual treatment based on therapeutic factors or compo-
nents that he has identified as important. Groups can instill hope,
disconfirm the patient’s feelings of being alone in their suffering,
impart information, assist patients to feel needed and useful, de-
velop socializing techniques and interpersonal learning, create
group cohesion, and promote catharsis (Yalom, 1995). Yalom’s
factors are similar to Herman’s (1992) goals of trauma-focused
groups that include reconstruction of the trauma with the group
as witnesses, reconnection with others, collective empowerment,
and imparting compassion and respect among members.
The group treatment literature on female victims of child sexual
abuse and sexual assault is mainly descriptive as opposed to
evaluative. Some of the groups described are closed membership,
time-limited, trauma-focused groups for latency age children
(Zaidi & Gutierrez-Kovner, 1995), adolescents (deYoung &
Corbin, 1994), and adult women incest survivors (Goodman &
Nowak-Scibelli, 1985). Others include an open membership sup-
port group for adolescent victims of repetitive sexual abuse
(Cornman, 1989); process-oriented therapy groups for adult survi-
vors of child sexual abuse (Knight, 1996; Tyson & Goodman,
1996); a therapy group for adult survivors of child sexual abuse uti-
lizing solution focused, Ericksonian, and feminist perspectives
(Chew, 1998); and support groups for rape survivors
(Conyers-Boyd, 1992; Xenarios, 1988; Zaidi & Gutierrez-Kovner,
1995). Several authors provide anecdotal support for the efficacy
of group treatment for survivors of sexual assault (Courtois, 1988,
1997; Goodman & Nowak-Scibelli, 1985; Herman, 1992; Tyson &
Goodman, 1996; Xenarios, 1988; Zaidi & Gutierrez-Kovner,
1995).
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Outcome Studies

There have been few outcome studies that evaluate the effective-
ness of group treatments for child sexual abuse and/or sexual as-
sault survivors. Of those, some rely on posttreatment self report
only to establish the effectiveness of the treatment (Herman &
Schatzow, 1984; May & Housley, 1996; Reeker & Ensing, 1998),
while others use improved methodologies that include the addi-
tion of standardized measures applied before and after to assess
treatment outcome (Longstreth et al., 1998; Roth, Dye, &
Lebowitz, 1988), control groups (Resick, Jordan, Girelli, Hutter, &
Marhoefer-Dvorak, 1988; Resick & Schnicke, 1992; Richter,
Snider, & Gorey, 1997), and randomized assignment of subjects to
treatment and control groups (Alexander, Neimeyer, Follette,
Moore, & Harter, 1989; Zlotnick et al., 1997).
May and Housley (1996) reported that group therapy was more
effective than individual therapy in increasing adolescent sexual
abuse survivors’ self-esteem. Reeker and Ensing (1998) reported
positive outcomes in children aged 5 to 8 who participated in a sex-
ual abuse treatment group, including increased knowledge of sex-
ual information, prevention methods, and increased self-esteem.
Herman and Schatzow (1984) found that adult survivors of incest
who completed a time-limited therapy group reported improve-
ments in their self-esteem and identified having contact with other
survivors as the most helpful aspect of group.
Roth et al. (1988) evaluated the effectiveness of a 1-year treat-
ment group for women sexual assault survivors utilizing
Horowitz’s (1976) theoretical conceptualization of the trauma re-
sponse. Despite an initial worsening of symptoms, participants
showed reductions in intrusive symptoms, depression symptoms,
and fear on standardized measures that were taken at seven inter-
vals during treatment. Longstreth et al. (1998) evaluated the effec-
tiveness of a time-limited group for adult survivors of child sexual
abuse utilizing Yalom’s (1985) method of process-oriented ther-
apy groups. Members showed improvements in self- esteem, cop-
ing strategies, interpersonal relationships, and overall distress on
 SEXUAL ASSAULT GROUPS 207

a standardized measure of global symptoms. These results were

maintained at 1-year follow-up, except for hostility levels.
Resick et al. (1988) compared three methods of short-term
group therapies for female rape survivors including stress inocula-
tion, assertion training, and support with information to a wait-list
control group for female rape survivors. All three treatment
groups were found to be effective and there were no significant
differences between treatments. Resick and Schnicke (1992) com-
pared the effectiveness of a cognitive processing therapy (CPT)
group to a wait-list control group for rape survivors. Results
showed significant post-test improvements in depression and
PTSD symptoms for those who completed the CPT group when
compared to the wait-list controls. These positive gains were main-
tained at 6 month follow-up. Richter et al. (1997) compared the ef-
fectiveness of a process-oriented, problem-solving group to a natu-
rally occurring wait-list control group for female survivors of
childhood sexual abuse. Those who completed the treatment
group showed significant improvements following treatment on
measures of depression and self-esteem when compared to the
wait-list controls and greater gains at 6 month follow-up.
To date, two studies have compared the effectiveness of differ-
ent group treatment methods utilizing random assignment to
groups for female sexual assault survivors (Alexander et al., 1989;
Zlotnick et al., 1997). Alexander et al. compared the effectiveness
of an interpersonal transaction group, a process group, and a
wait-list control group. Both treatment groups showed post-treat-
ment improvement on measures of depression and general dis-
tress and maintained these gains at 6 month follow-up. The pro-
cess group showed more improvement in social adjustment when
compared to the other conditions. Zlotnick et al. compared the ef-
fectiveness of an affect-management group to a control group for
women who had PTSD as a result of childhood sexual abuse.
Women who completed the affect-management group showed sig-
nificant reductions in PTSD and dissociative symptoms when com-
pared to the control condition.
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Predictors of Group Treatment Outcome

Follette, Alexander, and Follette (1991) explored variables that

predicted outcomes for female incest survivors in time-limited
group therapy utilizing an interpersonal transaction group
method and a process group method based on Yalom’s (1975)
model. Women with more positive outcomes had more education,
were not in a relationship, experienced less severe forms of abuse,
and had less pretreatment depressive symptoms and distress.
Hazzard, Rogers, and Angert (1993) also explored predictor vari-
ables for positive group treatment outcomes. They found that
women who presented with greater levels of initial symptoms re-
ported higher levels of pretreatment distress, more trauma symp-
toms, and experienced intercourse as part of their abuse. Women
who made the most progress in group had no history of using sub-
stances, shared similar abuse histories with other group members,
and received some treatment prior to entering group.

OUR MODEL

Our group therapy model was developed from our combined ex-
periences of leading over two dozen groups for sexual assault sur-
vivors over the past 15 years in both agency and university settings.
The second author has additionally utilized this model in her coor-
dination and supervision of sexual assault support and therapy
groups led by other clinicians within the university setting over the
past 5 years.
This article is the first to discuss a two-stage model of group ther-
apy that addresses the specialized needs of both survivors of child
sexual abuse, and teen and adult survivors of sexual assault, taking
into account their trauma type and where the survivor is in their re-
covery process. While child sexual abuse survivors and sexual as-
sault survivors share some common features, there are important
differences in their trauma experience, their response to the
trauma, and the resulting negative effects.
Our model is based on the premise that the experience of child
 SEXUAL ASSAULT GROUPS 209

sexual abuse and sexual assault differ in significant ways

(Finkelhor, 1981; Herman, 1992), and that these qualitative differ-
ences have important implications for treatment. From our clini-
cal experience, we have found that when survivors of childhood
sexual abuse and sexual assault are included in the same therapy
group, there is an increased risk for potential harmful effects.
These effects include a greater risk of some members discounting
or minimizing their victimization experience when comparing
their experience to other members’ experiences that differ based
on trauma type, blaming themselves for their survivor behavior
based on misperceptions of power and control at the time of the
assault(s), and, as a result, limiting the range of experiences and re-
sulting negative impacts that they choose to share in the group.
The potential for negative effects is increased when a small num-
ber of members share a common trauma experience resulting in
an increased sense of feeling different or isolated from other
members. This group dynamic fits with Courtois’s (1988) warning
regarding the negative consequences of including “isolates” in
group.
Although the above risks exist to varying degrees in all sexual as-
sault therapy groups, separating members based on type of sexual
assault within these broad categories increases members’ com-
monality of victimization experience and, as a result, minimizes
these risks and promotes a sense of safety, cohesion, and valida-
tion among members. This is supported by Hazzard et al. (1993),
who found that women who experienced similar types of sexual
trauma made greater progress in group.
It is quite common for participants to have experienced both
childhood sexual abuse and sexual assault. In such instances, the
appropriate choice of group should depend on the participants’
perception of the most traumatic event(s). For example, a survivor
may have worked through issues related to her experience of sex-
ual abuse as a child, but is more distressed due to a recent rape. In
contrast, a survivor may have been date raped, but, may report
feeling most disturbed by her experience of child sexual abuse. In
each of the above examples, the potential group member should
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be assigned to the group that will best meet her treatment needs
while being encouraged to share her total experience of victimiza-
tion within the group.
Most sexually victimized clients start their recovery with some
form of individual treatment, either in the form of crisis interven-
tion counseling or psychotherapy. We argue that group work is the
treatment of choice at key junctures in recovery, such as when the
crisis has passed and the survivor has stabilized, because recovery
from trauma is essentially a social phenomenon involving recon-
necting with community (Herman, 1992).

Theoretical Framework

The theoretical orientation of our model is integrative, combining

cognitive-behavioral, feminist, relational, and psychodynamic the-
ories. The theoretical framework of our psychoeducational sup-
portive therapy group model fits with Foy et al.’s (2000) concept of
“supportive” therapy groups utilizing a “covering” approach with
the focus on helping members work through current issues (p.
156). Our supportive therapy group model corresponds with
Herman’s (1992) stage one of recovery— creating safety, a neces-
sity when the survivor is in the early stage of her recovery and a pre-
requisite to deeper uncovering work.
The theoretical framework of our trauma-focused therapy
group model fits with Foy et al.’s (2000) concept of “trauma focus”
groups in which the primary focus is on members’ in-depth explo-
ration of their trauma experiences (p. 157). Our approach also cor-
responds to Herman’s (1992) stages two (remembrance and
mourning) and three (reconnection). Trauma memories and grief
are accessed through in-depth remembering of the trauma and
grieving through in-depth exploration of the survivor’s story and
associated thoughts, feelings, and meaning attributed to it. Finally,
reconnecting with others is achieved through group process.
The trauma-focused therapy groups are appropriate only when
the survivor has established a sense of personal safety, has the ca-
pacity to manage her symptoms and engage in self-care strategies,
 SEXUAL ASSAULT GROUPS 211

has stability in terms of situational factors, and has a support sys-

tem that she can rely on as she embarks on more in-depth uncover-
ing work (Herman, 1992). Ideally, members participate in the sup-
portive therapy group first and then proceed to one of the two
therapy groups based on their most distressing trauma type. This
two-stage process is not always practical nor is it optimal for some
participants. Some survivor’s needs may be best met by moving di-
rectly into one of the therapy groups based on their readiness and
timing issues such as the availability of a particular group. In the
university setting, we have found that approximately one third to
one half of the supportive therapy group members move on to one
of the therapy groups. These proportions are sometimes due to
graduating or leaving school for alternate reasons.

Common Features of the Supportive Therapy and Trauma-Focused

Therapy Groups

The support and therapy groups share several common features

including voluntary membership, a safe and confidential environ-
ment, and a closed structure in which no new members are added
beyond the second week to facilitate cohesion, trust, and predict-
ability among members and leaders. The groups are typically led
by two female clinicians, and average between five and eight mem-
bers, although seven to ten members is considered optimal. Goals
that are shared across groups include achieving empowerment,
addressing safety needs, increasing self-esteem, validating feelings
and victimization experience, modeling and experiencing healthy
relationships, developing or enhancing healthy coping strategies,
and regaining a sense of control over their lives.

Differential Features of the Supportive Therapy Group Model

Techniques used in the supportive therapy group are educational

and cognitive, providing for an exchange of information including
discussion of common myths, common symptoms patterns, how
members coped, and positive self-care strategies. Primary goals of
the supportive therapy group are to empower the survivor to feel a
212 VANDEUSEN AND CARR

greater sense of control over herself and her environment, reduce

isolation and provide a safe context to interact with others who
share a common experience, gain access to new information, and
manage current symptoms. Although members in the supportive
therapy group share some aspects of their sexual assault with the
group, the goal is to connect with others who share similar experi-
ences in a physically and emotionally safe environment.
The supportive therapy group differs from the trauma-focused
therapy groups in the setting in which it is held, number of sessions,
member and facilitator characteristics, group focus, content, and
member expectations (see Table 1). The supportive therapy group
is held in a non-clinical setting such as a women’s center to provide
easy access for members and remove any stigma that might be asso-
ciated with entering a counseling center. The supportive therapy
group is a closed, time-limited psychoeducational group that is 10 to
12 weeks in duration. Separate supportive therapy groups for survi-
vors of childhood sexual abuse and acquaintance or date rape is op-
timum. We recognize, however, that this may not be practical in re-
ality due to funding constraints or client availability. Separation
based on trauma type is less important with the support group for-
mat due to the psychoeducational focus of the group versus the
more intense trauma focus of the therapy groups.
The supportive therapy group is led by two female professionals
trained in sexual assault issues and group process and may include
supervised graduate students, mental health professionals, or
health care professionals. The role of the leaders is to provide a
structured, safe environment; to empower members to share their
thoughts and experiences in relation to the group topics; and to
provide new information in a didactic manner. Supportive ther-
apy group members may be at different stages in their healing pro-
cess with some women just beginning to acknowledge issues re-
lated to their sexual assault experience and others well into their
healing process. The focus of the supportive therapy group is on
providing safety, connection, education, support, and shared
strategies for coping and self-care; and on rebuilding relation-
ships, intimacy, and sexuality.
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TABLE 1. Model of Supportive Therapy and Trauma-Focused

Therapy Groups

Supportive Trauma-Focused
Therapy Therapy
Focus Education and Sup- Trauma
port
Shared Goals Symptom reduction
Safety
Empowerment
Increased self–esteem
Healthy relationships
Regain control
Coping strategies
Content Topical In–depth exploration
of the trauma utiliz-
ing exposure–type
story telling tech-
nique
Setting Non–clinical Clinical
Facilitators Two trained female Two female psycho-
professionals therapists
Structure Closed (10–12 weeks) Closed (10–12 weeks)

Members contribute to the development of the group’s educa-

tional content by identifying topics they would like to learn more
about. Topics usually include the impact of the assault on their
lives, partner, friends and family reactions, creating safety, regain-
ing intimacy, sexual problems after sexual assault, trust issues, and
assertiveness. Participants have the opportunity to share their sex-
ual assault experiences and related emotions, thoughts, and expe-
riences during group discussion with the guideline that they share
as much or as little as they wish. Group-building exercises such as
drawing a “life map,” writing a letter to oneself as a wise old
woman, sharing an artifact, identifying needs both in and outside
the group, creating survivor poetry or journals, creating video
clips, and discussing rape myths can be helpful in developing
group cohesion. These activities are designed to assist women in
processing their feelings, dealing with self-defeating behaviors,
building healthy coping skills, and improving relationships.
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Differential Features of the Trauma-Focused Therapy Group Model

Techniques used in the trauma-focused therapy groups include

members’ initial setting of goals related to the sexual assault; the
combined efforts of group members and leaders to establish a safe
environment; an exposure method of telling one’s story in as
much detail as possible in the presence of others who have shared
similar experiences; and a structured process by which members
support each other as they tell their stories, ask questions that fos-
ter further sharing, and validate each others feelings, thoughts,
and responses to the trauma. Throughout the process of group,
members become a cohesive unit where self-defeating patterns of
behavior can be examined and challenged. Primary goals of the
therapy groups are to create a safe environment where members
can participate in in-depth exploratory work; express their feel-
ings, thoughts, and coping behaviors; and receive validation and
feedback from others who have shared similar experiences.
The therapy groups are closed, time-limited groups that take
place in a clinical setting such as a counseling center or social ser-
vice agency and run for 10 to 20 weeks, the preferred duration be-
ing 20 weeks. The facilitators are two female psychotherapists with
clinical expertise in the area of sexual abuse and sexual assault.
The treatment approach involves a middle phase focused on
in-depth exploration as members tell their assault stories in as
much detail as possible with associated thoughts, feelings, and sen-
sations. Although the telling of a survivor’s story is not a new con-
cept in the treatment literature (deYoung & Corbin, 1994;
Gold-Steinberg & Buttenheim, 1993; Herman, 1992), our model
includes a unique exposure method in which members choose
one group session to recount their complete assault story while re-
connecting their emotions with the trauma. This process takes on
a ceremonial quality as each member thoughtfully prepares and
tells her story, supplementing it with music, artwork, or other
means of expression. Other members act as active participant-ob-
servers, asking probing questions and providing feedback follow-
ing the storytelling. There is a cumulative healing effect that takes
 SEXUAL ASSAULT GROUPS 215

place during the course of group (deYoung & Corbin, 1994) as

members process each other’s stories, receive validation from oth-
ers, and validate others’ experience while they continue to resolve
feelings related to their own trauma. As a result of the preparation
and experience of sharing their trauma in more detail than ever
before within the context of a supportive environment, survivors
qualitatively report a significant reduction in their symptoms, neg-
ative cognitions, and self-defeating behaviors, and an increased
sense of mastery over their victimization and reconnection with
others.
Case Vignette. Julie’s story illustrates how our therapy group pro-
cesses assisted in her trauma recovery. Julie, who was 18, was doing
homework in her dorm room when two men knocked at her door.
Since she knew one of them, she let them in. The second man, a
friend of the friend, stayed behind and asked if he could hang out
with her. He kissed her and eventually raped her. She filed a police
report, went to the hospital, and got the necessary evidence col-
lected, but the prosecutor refused to take the case. This crushed
her and she reported that she did not trust people; became de-
pressed; lost her self-respect; and developed panic attacks, night-
mares, migraines, and crying spells. Julie also became obsessed
with cleanliness, order, and control in her life. She became de-
tached, bitter, angry, and lost her best friends. She had six individ-
ual sessions of crisis counseling after the assault.
Julie heard about the trauma-focused therapy group from an ar-
ticle in the university newspaper. Joining the therapy group was
courageous, given Julie’s lack of trust in people and her year of
pretending that the rape did not happen. Julie stated at the onset
of the group that she wanted to get her personality back, to laugh,
and to be able to feel things and trust again. The group members
assisted Julie in realizing that the rape was not her fault and that be-
ing hard on herself was her way of trying to control her experi-
ence. The therapist reframed her subsequent and uncharacteristic
casual sex with men as a traumatic reenactment or repetition com-
pulsion. Julie volunteered to tell her story first so that she could
216 VANDEUSEN AND CARR

“get it over with.” Although scared, she prepared carefully, select-

ing her favorite music and compiling photos of herself as a young
girl, with her parents, with her dog, at her graduation, and at her
college orientation. When Julie told her trauma story she began to
cry, grieving her loss of friends, her innocence, and her “old self.”
She also got in touch with her hatred for the rapist. Julie was con-
fronted on her cynicism and bitterness. Other members chal-
lenged Julie’s lack of assertiveness with her roommate and sug-
gested other approaches to resolving social conflicts. Other
members’ stories triggered new memories for Julie and new con-
nections and insights. At the end of the 10-week group, Julie re-
ported feeling genuinely happy and more positive about herself
and that she was no longer experiencing panic attacks, night-
mares, migraines, or crying spells.

Group Therapy Outcome

Members provide a retrospective self-report evaluation following

the completion of the group. Participants qualitatively report be-
havioral, affective, and cognitive benefits of their group experi-
ences. Based on self-report, behavioral improvements include
reduced isolation, expanded social supports, increased knowledge
about common symptoms and their management following the
sexual assault, and increased strategies to avoid future assaults. Af-
fective outcomes include validation of negative feelings such as
guilt, shame, anger, and powerlessness; decreased psychological
numbing and dissociation; ability to grieve losses; and reintegra-
tion of feelings with traumatic events. Cognitive outcomes include
a decrease in intrusive thoughts and images related to the trauma,
decreased self blame, decreased fears of being alone, decreased
fears of revictimization, increased sense of personal safety and
well-being, an increased sense of control over one’s life, and an in-
creased sense of trust in others.
Members routinely comment that the group minimized their
feelings of isolation, provided strong support, and provided a
sense of hope for the future. Overwhelmingly, members identify
 SEXUAL ASSAULT GROUPS 217

that connecting with others who shared a similar experience was

the single most helpful factor. A limitation noted most often by
members was that the group was not long enough in duration.

ELEMENTS OF AN EFFECTIVE GROUP

A great deal of preparation is necessary for an effective group. An

effective group provides a structured setting for the important
work of recovery. Participation should be voluntary after careful
screening. We recommend a thorough individual screening inter-
view in which the structure of the group and member expectations
are discussed. In addition, the therapist must assess level of psy-
chopathology and goodness of fit between the potential member
and the group. Information should be gathered regarding the po-
tential member’s trauma history and resulting effects, current sup-
port systems, and coping methods. The group process and focus
should be discussed in detail in an effort to prepare potential
members for the level of emotional intensity of the group.
Screening interviews also provide a time for the leader(s) and the
member to begin to develop rapport, and for the member to begin
to feel a sense of acceptance and safety. Potential members who
are in a crisis state, lack external supports, are actively suicidal, or
are psychotic should not be considered candidates for the group.
Instead they should be provided with more appropriate treat-
ment. It is not uncommon for members to feel an increased level
of distress in the early stages of group treatment. Therefore, the
authors support the recommendation of others (deYoung and
Corbin, 1994; Tyson & Goodman, 1996) that members participate
in conjoint individual therapy during the course of the therapy
groups. After a potential member is screened, she should be asked
to sign a participant agreement form that formalizes the partici-
pant’s commitment to the group while providing informed con-
sent.
In the early stage of group, participants should develop group
guidelines and generate a list of topics that they would like to ad-
dress during their time in group. Participants also should be in-
218 VANDEUSEN AND CARR

volved in deciding how to manage contact outside of the group set-

ting, and potential consequences of such contact need to be
discussed. In the university setting, participants most often man-
age out-of-group contact well and it sometimes offers additional
support. Perhaps as a result of discussing possible negative out-
comes of such contact, members tend to be cautious and inclusive
when planning out-of-group contact, although we recognize and
have experienced times when such contact has been disruptive.
Consistent attendance is imperative across all groups. We have
found that members recognize the importance of attendance and
hold each other accountable toward this end. A particular prob-
lem may occur when a participant fails to attend group when
someone is telling their story. In this instance, important informa-
tion, opportunities for healing, and an important connection be-
tween members is compromised. At the completion of all of our
groups we provide participants with an evaluation form regarding
the group process, structure, and activities. We ask about partici-
pants’ experience with group leaders, what they found most help-
ful, and recommendations for future improvement of the group.1

Marketing and Recruitment Techniques

Preparation for an effective group includes utilizing successful

promotion of the groups and solicitation of referrals. Intensive
publicity and recruitment efforts are necessary for sufficient mem-
bership. At the university, we made a permanent laminated poster
that features our groups and provides registration information. In
addition, each semester we print a smaller flyer with similar infor-
mation and distribute it to all faculty, staff, and student organiza-
tions. We also post it throughout campus. Our campus newspaper
does a feature article on our groups each year, which includes an
interview with group leaders. We do outreach with the sororities,
and flyers are posted in all health center exam rooms. We also in-

1. The participant agreement, informed consent, list of topics, and evaluation forms are
available from the authors by request. We have not utilized a group treatment manual.
 SEXUAL ASSAULT GROUPS 219

vite other counselors to refer their clients who may be appropriate

for the groups. Notwithstanding all this publicity, we find it a chal-
lenge to formulate a group in some semesters. Survivors are reti-
cent to join others in the group recovery process, especially if they
have used denial as a major coping mechanism or feel stigmatized
by identifying themselves as assault victims. To join a group is to
truly face the full impact of the assault and its ongoing effects. Sur-
vivors need to be at this point in their recovery in order to be ready
for group work.

CONCLUSION

This article describes an innovative two-stage model of sexual as-

sault groups for women in a university setting. Included is a review
of recent group literature and a description of the theoretical un-
derpinnings, focus, techniques, and goals of the supportive and
trauma-focused therapy groups. Important considerations when
developing groups for sexual assault survivors are discussed, includ-
ing screening procedures and marketing and recruitment tech-
niques. Although the group model is applied to a university setting,
the model was developed from the authors’ combined experience
of leading sexual assault groups in both agency and university set-
tings. The model is applicable in various settings. A limitation of this
article is that it is descriptive and only provides qualitative and retro-
spective self-report outcome data to support the model’s efficacy.
Future research is needed to provide empirical support for the effi-
cacy of this model of support and therapy groups.

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Dr. Karen VanDeusen Received: October 18, 2001

Western Michigan University Revision Received: March 11, 2002
2333 East Beltline S.E. Accepted: March 20, 2002
Grand Rapids, Michigan 49546
E-mail: karen.vandeusen@wmich.edu