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April is Sexual Assault Awareness Month (SAAM), a time to recognize the prevalence and impact of sexual assault, raise awareness about how to prevent sexual violence, and talk about the resilience of survivors. Sexual violence is a public health, human rights, and social justice issue. The National Sexual Violence Resource Center provides information for survivors and advocates, including research, tools, and resources to end sexual harassment, assault, and abuse.

We may not want to look at it, but sexual violence is real, and unfortunately, common. Sexual violence, including assault, occurs when there is sexual activity without consent being asked for or freely given. All people of all ages, genders, abilities, racial identities, and sexual orientations can be sexually assaulted, however, minority groups such as LGBTQ, women of color, and transgender populations are affected more statistically than cisgender or straight identifying people. CDC prevalence statistics indicate that 1 in 3 women and 1 in 4 men experience sexual violence involving physical contact during their lifetime, with a first incident often occurring between ages 11 and 17, and commonly by someone known, not a stranger. In addition, the Human Rights Campaign reports that 47 percent of transgender people are assaulted at some point in their lifetime, and report higher statistics for gay, lesbian and bisexual populations than straight populations.

We know that an incident of sexual violence is a trauma, can lead to PTSD, and that EMDR therapy can help resolve symptoms of sexually violent traumatic events. EMDR therapists working with survivors of sexual assault and violence are encouraged to learn more about sexual assault, how best to work with this population, and ways to advocate for sexual violence prevention in schools, workplaces, policies, and society. As the CDC indicates, ways to stop sexual violence include:

Sexual violence can be treated with EMDR therapy effectively and efficiently. Safety and stability are of primary importance when dealing with survivors. The use of EMDR involves a client-centered approach where the clinician follows, listens, and makes adaptations to ensure client safety and comfort. Therapists could use empowering interweaves if they apply such as: “You survived. It is over. You are safe now.” Also, EMD restrictive processing can also be considered to address distressing current situations until the client is ready for a full reprocessing (Shapiro, 2018, p. 295).

Below are some resources that could be helpful for EMDR therapists working with this population. EMDRIA has an online community EMDR and Intimate Partner Violence for EMDRIA members to share questions and best practices. For EMDR trained therapists, there may be applicable upcoming workshops on our Education Calendar.

We reached out to Monica L. Urbaniak, LMFT-S, EMDRIA member and expert on working with survivors of trauma and sexual assault to answer some questions about using EMDR therapy with survivors of sexual assault.

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Interview with Monica Urbaniak, LMFT-S

Tell us a little bit about you, your experience becoming an EMDR therapist, and your experience with survivors of sexual assault?

Howdy! I’m Monica Urbaniak and I’m a clinician, trainer, and consultant specializing in trauma and sexual assault in Dallas, Tex. I’ve been a therapist for more than two decades and have spent most of my career working with persons impacted by sexual assault, domestic violence, and other crime victimization.

During my tenure as the clinical director at a rape crisis center, I knew it was imperative to get myself and my staff trained in EMDR not only to equip us with effective clinical tools for providing the best treatment to survivors, but also to help with vicarious traumatization, compassion fatigue, and burnout. Many of my colleagues in other practice settings were using EMDR. Working in a non-profit oftentimes means very limited training budgets, however, when we were finally able to scrape together enough funds for the courses, we reached out to our EMDRIA trainer and were not only welcomed, but felt that the team went out of their way to ensure that my staff and I had everything we needed to be successful and feel supported.

It was easy to see the immediate and long-term benefits of using EMDR with persons impacted by sexual assault at the rape crisis center. Survivors of recent sexual assault, childhood sexual assault/abuse, and survivors with multiple and poly-victimization histories received EMDR therapy and demonstrated good results. Staff also reported decreased trauma exposure related impacts. We were thrilled that this tool was making a big difference.

Since moving into private practice, I continue to support clients living with the traumatic effects of sexual violence. Receiving training in additional EMDR protocols through conferences and workshops has been so valuable, especially as the landscape of clinical work has evolved in the last few years. I also belong to the best EMDR consultation group and have experienced remarkable connection and support from other EMDR clinicians as I keep learning.

What do you feel is most valuable about utilizing EMDR therapy with clients who have survived rape or sexual assault?

Many survivors I have worked with have been reticent to receiving therapy due to the perception that they will have to relive traumatic experiences or talk about traumatic experiences repeatedly. Oftentimes, survivors have had those experiences in past therapeutic settings. EMDR therapy has provided a way for survivors to process multiple and complex traumas without requiring a survivor to relive each event or to share painful details with a therapist. Additionally, many survivors do not have access to language for their experiences so talk therapy alone can be a challenge. Survivors may experience strong sensory memory and EMDR is an effective tool for processing trauma experienced through the body.

What successes have you seen regarding the use of EMDR therapy with sexual assault survivors?

I’ve had numerous clients engage in therapy specifically seeking EMDR because they haven’t felt like they were able to process the trauma in other clinical settings effectively, or they had some success processing parts of the traumatic experience but are still experiencing difficulties. Sexual assault survivors may develop flashbacks and experience overwhelming sensory memory of the events that occurred. The impact of sexual assault on a survivors functioning may have significant short- and long-term effects, including challenges in work/school/community, lingering physical problems, difficulties developing and sustaining healthy relationships, and mental health issues including PTSD, depression, and anxiety. Survivors may also experience beliefs about their complicity in their own victimization (self-blame) or fears around future victimization and safety. EMDR therapy’s AIP model and three-pronged approach allow for comprehensive processing in neural networks to provide survivors not only symptom resolution, but more adaptive self-belief structures.

What myths would you like to bust about using EMDR therapy with these clients?

I sometimes wonder if people think that EMDR therapy looks like a therapist turning on tappers, getting the lightbar going, or asking someone to follow their fingers, and then the therapist just kicks back. It’s my belief that, especially with victimized and vulnerable populations, developing a working relationship founded on trust and safety is imperative and is a foundational part of EMDR therapy, as are solid clinical skills. When working with any population, it’s important to receive additional training and to have a network of support.

I have heard from clinicians who worry that a sexual assault survivor may not be able to tolerate EMDR therapy. The resource development aspect of EMDR therapy is an integral part of establishing emotional and psychological safety for survivors before, during, and after treatment. As clinicians it is our job to assess and assist clients in having the appropriate internal and external resources and support when we use any therapeutic tool. Survivors have already survived a very painful life experience and maybe living with the effects of that each day…they are already surviving and using some tools to do so. Through the EMDR process we can help survivors better cope with all the negative judgements sexual assault survivors endure, and often internalize. Plenty of data exists supporting the effectiveness of EMDR therapy for treating the impacts of sexual abuse and assault!

Any specific complexities or difficulties that you have experienced and overcome when using EMDR therapy with sexual assault survivors?

Some of my clients have also been presented with the additional challenge of being required to testify in criminal cases against an alleged sexual assailant. I have had colleagues in the criminal justice and civil justice environments express concern that providing EMDR therapy to sexual assault survivors will make the survivor appear less traumatized and may impact perception or credibility of survivors seeking those legal remedies. It’s my belief that we shouldn’t withhold healing or prolong suffering for survivors for those reasons. The clients with whom I have had the honor of supporting report that EMDR therapy has provided them the ability to experience symptom management and relief so that they were able to return to a healthier level of functioning during the protracted criminal justice process. Survivors have also reported they felt they were better able to tolerate the process of providing testimony due to the EMDR work they did.

 

Monica L. Urbaniak, LMFT-S is a Consultant, Trainer, and Clinician specializing in trauma and sexual assault. For nearly two decades, Urbaniak has worked with survivors of trauma, helping them heal through therapy and support. She also provides training and consultation to clinicians, organizations, and community groups towards ensuring that services are client-centered and trauma-informed. Urbaniak holds a Master of Science Degree from New Mexico State University, is a Licensed Marriage and Family Therapist and Board Approved Supervisor, and is EMDRIA Certified in EMDR. She has held numerous leadership positions in the community including an officer for the Dallas County Sexual Assault Coalition, founding board member of the Dallas Area Rape Crisis Center, and as President of the Board of Texas Association Against Sexual Assault.

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Resources

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EMDR and Sexual Violence Resources

Peer-Reviewed Articles/Dissertations:

Allon, M. (2015). EMDR group therapy with women who were sexually assaulted in the Congo. Journal of EMDR Practice and Research, 9(1), 29-34. Open access: http://dx.doi.org/10.1891/1933-3196.9.1.28

Covers, M. L. V., de Jongh, A., Huntjens, R. J. C., de Roos, C., van den Hout, M., & Bicanic, I. A. E. (2019). Early intervention with eye movement desensitization and reprocessing (EMDR) therapy to reduce the severity of posttraumatic stress symptoms in recent rape victims: Study protocol for a randomized controlled trial. European Journal of Psychotraumatology, 10(1), Open access: https://doi.org/10.1080/20008198.2019.1632021

Covers, M. L. V., de Jongh, A., Huntjens, R. J. C., de Roos, C., van den Hout, M., & Bicanic, I. A. E. (2021). Early intervention with eye movement desensitization and reprocessing (EMDR) therapy to reduce the severity of post-traumatic stress symptoms in recent rape victims: A randomized controlled trial. European Journal of Psychotraumatology, 12(1). Open access: https://doi.org/10.1080/20008198.2021.1943188

Cowan, A., Ashai, A., & Gentile, J. P. (2020). Psychotherapy with survivors of sexual abuse and assault. Innovations in Clinical Neuroscience, 17(1-3), 22-26. Open access: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239557/

Cumming, L. (2021). Perceptions of effectiveness of eye movement desensitization and reprocessing treatment intervention from survivors of intimate partner violence [Doctoral Dissertation, Walden University]. Walden University. Open access: https://scholarworks.waldenu.edu/dissertations/9851/

Edmond, T., & Rubin, A. (2004). Assessing the long-term effect of EMDR: Results from an 18-month follow-up study with adult female survivors of CSA. Journal of Child Sexual Abuse, 13(1), 69-86. https://doi.org/10.1300/J070v13n01_04

Edmond, T., Rubin, A., & Wambach, K. G. (1999). The effectiveness of EMDR with adult female survivors of childhood sexual abuse. Social Work Research, 23(2), 103-116. https://doi.org/10.1093/swr/23.2.103

Edmond, T., Sloan, L., & McCarty, D. (2004). Sexual abuse survivors’ perceptions of the effectiveness of EMDR and eclectic therapy. Research on Social Work Practice, 14(4), 259-272. https://doi.org/10.1177/1049731504265830

Edmond, T., Vothe Schrag, R. J., & Bender, A. K. (2019, Mar 15). Opening the black box: Identifying common practice approaches in urban and rural rape crisis centers. Violence Against Women. https://doi.org/10.1177/1077801219832903

Fonseca, T. M., & Smith, C. (2021). The treatment of trauma-induced sexual pain among women: Clinical considerations for the use of adjunctive EMDR. The Canadian Journal of Human Sexuality, 30(1), 114-124. https://doi.org/10.3138/cjhs.2020-0035

Gerardi, M., Rothbaum, B. O., Astin, M. C. & Kelley, M. (2010). Cortisol response following exposure treatment for PTSD in rape victims. Journal of Aggression, Maltreatment & Trauma, 19(4), 349-356. https://doi.org/10.1080/10926771003781297

Harris, H., Urdaneta, V., Triana, V., Vo, C. S., Walden, D., & Myers, D. (2018). A pilot study with Spanish-speaking Latina survivors of domestic violence comparing EMDR & TF-CBT group interventions. Open Journal of Social Sciences, 6, 203-222. Open access: https://doi.org/10.4236/jss.2018.611015

Husain, B. (2022). EMDR with first-generation college students at-risk of facing a forced marriage. Clinical Social Work Journal, https://doi.org/10.1007/s10615-021-00828-6

Jaberghaderi, N., Rezaei, M., Kolivand, M., & Shokoohi, A. (2019). Effectiveness of cognitive behavioral therapy and eye movement desensitization and reprocessing in child victims of domestic violence. Iranian Journal of Psychiatry, 14(1), 67-75. Open access: https://doi.org/10.18502/ijps.v14i1.425

Jimenez, G., Becker, Y., Varela, C., Garcia, P., Nuno, M. A., Perez, M. C., Osorio, A., Jarero, I., & Givaudan, M. (2020). Multicenter randomized controlled trial on the provision of the EMDR-PRECI to female minors victims of sexual and/or physical violence and related PTSD diagnosis. American Journal of Applied Psychology, 9(2), 42-51. DOI: 10.11648/j.ajap.20200902.12. Open access: http://www.sciencepublishinggroup.com/journal/paperinfo?journalid=203&doi=10.11648/j.ajap.20200902.12

MacCulloch, M. (2007). Effects of EMDR on previously abused child molesters: Theoretical reviews and preliminary findings from Ricci, Clayton, and Shapiro. The Journal of Forensic Psychiatry & Psychology, 17(4), 531-537. https://doi.org/10.1080/14789940601075760

Mosquera, D., & Knipe, J. (2017). Idealization and maladaptive positive emotion: EMDR therapy for women who are ambivalent about leaving an abusive partner. Journal of EMDR Practice and Research, 11(1), 54-66. Open access: https://doi.org/10.1891/1933-3196.11.1.54

Nederpel, T. M. H. (2020). The moderating effect of persistent dissociation on the efficacy of early EMDR therapy on post-rape PTSD [Masters Thesis, Utrecht University]. Utrech University Repository. Open access: http://dspace.library.uu.nl/handle/1874/397715

Nijdam, M. J., van der Pol, M. M., Dekens, R. E., Olff, M., & Denys, D. (2013). Treatment of sexual trauma dissolves contamination fear: Case report. European Journal of Psychotraumatology, 4, 19157. Open Access: https://doi.org/10.3402/ejpt.v4i0.19157

Oosterbann, V., Covers, M. L. V., Bicanic, I. A. E., Huntjens, R. J. C., & de Jongh, A. (2019). Do early interventions prevent PTSD? A systematic review and meta-analysis of the safety and efficacy of early interventions after sexual assault. European Journal of Psychotraumatology, 10(1). Open access: https://doi.org/10.1080/20008198.2019.1682932

Ricci, R. J., & Clayton, C. A. (2008). Trauma resolution treatment as an adjunct to standard treatment for child molesters: A qualitative study. Journal of EMDR Practice and Research, 2(1), 41-50. Open access: https://doi.org/10.1891/1933-3196.2.1.41

Ricci, R. J., Clayton, C. A., & Shapiro, F. (2006). Some effects of EMDR on previously abused child molesters: Theoretical reviews and preliminary findings. Journal of Forensic Psychiatry and Psychology, 17(4), 538-562. https://doi.org/10.1080/14789940601070431

Rostaminejad, A., Alishapour, M., Jahanafar, A., Fereidouni, Z., & Behnammoghadam, M. (2022). Eye movement desensitization and reprocessing as a therapy for rape victims: A case series. Clinical Case Reports, 10(3), e05620. Open access: https://doi.org/10.1002/ccr3.5620

Rothbaum, B. O. (1997). A controlled study of eye movement desensitization and reprocessing in the treatment of posttraumatic stress disordered sexual assault victims. Bulletin of the Menninger Clinic, 61(3), 317-334.

Rothbaum, B. O., Astin, M. C., & Marsteller, F. (2005). Prolonged exposure versus eye movement desensitization and reprocessing (EMDR) for PTSD rape victims. Journal of Traumatic Stress, 18(6), 607-616. https://doi.org/10.1002/jts.20069

Scheck, M. M., Schaeffer, J. A., & Gillette, C. (1998). Brief psychological intervention with traumatized young women: The efficacy of eye movement desensitization and reprocessing. Journal of Traumatic Stress, 11(1), 25-44. https://doi.org/10.1023/A:1024400931106

Schwarz, J. D., Baber, D., Barter, A., & Dorfman, K. (2019). A mixed methods evaluation of EMDR for treating female survivors of sexual and domestic violence. Journal of Counseling Outcome Research and Evaluation, 1-15. https://doi.org/10.1080/21501378.2018.1561146

Schwarz, J. D., Baber, D., Giantisco, E., & Isaacson, B. (2021). EMDR for survivors of sexual and intimate partner violence at a nonprofit counseling agency. Journal of EMDR Practice and Research, 15(4), 202-207. http://dx.doi.org/10.1891/EMDR-D-21-00014 Due to broken DOI link, retrieve article here: https://connect.springerpub.com/content/sgremdr/15/4/202

Smyth-Dent, K., Walsh, S. F., & Smith, S. (2020). Field study on the EMDR integrative group treatment protocol for ongoing traumatic stress with female survivors of exploitation, trafficking and early marriage in Dhaka, Bangladesh. Psychology and Behavioral Science International Journal, 15(3), 1-8. Open access: http://dx.doi.org/10.19080/PBSIJ.2020.15.555911  (https://juniperpublishers.com/pbsij/pdf/PBSIJ.MS.ID.555911.pdf)

Swinden, C. (2018). The child-centered EMDR approach: A case study investigating a young girl’s treatment for sexual abuse. Journal of EMDR Practice and Research, 12(4), 282-295. Open access: http://dx.doi.org/10.1891/1933-3196.12.4.282

Tarquinio, C., Brennstuhl, M. J., Reichenbach, S., Rydberg, J. A., & Tarquinio, P. (2012). Early management of rape victims and presentation of an emergency EMDR treatment protocol. Sexologies, 21 (3), 147-156. https://doi.org/10.1016/j.sexol.2011.11.012

Wolpe, J., & Abrams, J. (1991). Post-traumatic stress disorder overcome by eye movement desensitization: A case report. Journal of Behavioral Therapy and Experimental Psychiatry, 22(1), 39-43. https://doi.org/10.1016/0005-7916(91)90032-Z

Wright, L. C., & Warner, A. (2020). EMDR treatment of childhood sexual abuse for a child molester: Self-reported changes in sexual arousal. Journal of EMDR Practice and Research, 14(2), 90-103. Open access: http://dx.doi.org/10.1891/EMDR-D-19-00060

Books/Chapters:

Shapiro, F. (2018). Sexual Abuse Victims in Selected Populations. In F. Shapiro, Eye movement desensitization and reprocessing therapy (3rd Ed), (pp. 293-202). New York, NY: Guilford Press.

Other Articles:

Conway, C. (2019, Dec 3). Pioneers in bringing a promising PTSD treatment to survivors of domestic violence, Jill Schwarz and her grad students hope to spread it statewide. The College of New Jersey News. https://news.tcnj.edu/2019/12/03/jill-schwarz-brings-ptsd-treatment-to-domestic-violence-survivors/

da Fonseca-Wollheim, C. (2019, Nov 21). After trauma, a silenced vocalist sings again. The New York Times. https://www.nytimes.com/2019/11/21/arts/music/lucy-dhegrae-national-sawdust.html

Fuller, K. (2021, April 28). The relationship between sexual assault, self-harm, and trauma. Psychology Today. https://www.psychologytoday.com/ca/blog/happiness-is-state-mind/202104/the-relationship-between-sexual-assault-self-harm-and-trauma

King, D. (2021, September 8). ‘There’s no escape’: Memories of being raped by Catholic priest haunt Columbus man. The Columbus Dispatch. https://www.dispatch.com/in-depth/news/2021/09/08/columbus-man-raped-catholic-priest-child-haunted-memories/7504888002/

Nordic Model Now! (2019, May 21). An EMDR therapist on what she’s learned working with people who’ve experienced prostitution. https://nordicmodelnow.org/2019/05/21/an-emdr-therapist-on-what-shes-learned-working-with-people-whove-experienced-prostitution/

Ramirez, R. (2020, May 20). My healing journey after sexual assault. Marie Claire. https://www.marieclaire.com/health-fitness/a32494850/sexual-assault-therapy/

Swanson, H. (2019, Nov 14). ‘I had to practice saying I was raped. Now I have to practice saying I have PTSD.’ Glamour. https://www.glamour.com/story/i-had-to-practice-saying-i-was-raped-now-i-have-to-practice-saying-i-have-ptsd

Podcast:

Savage, J. & Sundwall, M. EMDR with Sexual Abuse Survivors. Notice That EMDR Podcast. Podcast retrieved from: http://emdr-podcast.com/episode-18-emdr-with-sexual-abuse-survivors/

 

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