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Home > Public Resources > Trauma Blog > 2022 - September > Supporting MST survivors during disclosure: what is a therapist to do?

Supporting MST survivors during disclosure: what is a therapist to do?

Kathryn Carroll, LCSW & Anne Rufa, PhD

September 26, 2022

I still remember the day Maria (not her real name) came into my office and told me she planned to tell her husband about being sexually assaulted. She was looking to me to tell her if it was a good idea or not, and guidance on how to drop this proverbial bomb. I felt a sinking feeling in the pit of my stomach, panicked for a minute, and racked my brain for what to do. This wasn’t covered in my CPT or PE trainings!
 
Inevitably, most clinicians working with survivors of sexual trauma will face a similar situation: either a client will share that they want to disclose their trauma to someone in their life, or they will tell their provider about a time they did disclose and how it impacted them. Studies have shown that most disclosures occur in a survivor’s social network and that the way a disclosee reacts can have a lasting impact, both positive and negative depending on the reaction. 
 
Survivors of military sexual trauma are faced with unique challenges when it comes to disclosure. After the assault they may be isolated from their typical social networks, and for many a disclosure to their military peers can be complicated. (Should I report? Will this ruin my military career? Screw up unit cohesion?) Working with such survivors, we sought to better understand their experiences of disclosure: how they prepared, if at all, what they expected, what kind of reactions they received, and how it all affected them in their recovery process. “You’re going to look at me differently: A qualitative study of disclosure experiences among survivors of military sexual assault” is the result of that inquiry. While exploratory in nature and limited in scope, some key findings point to a number of recommendations for clinicians working with this population.
  1. Include questions about disclosure experiences as a part of standard trauma screening. Knowing details about a client’s previous disclosures, including to whom they disclosed, how much detail was shared, the response/reaction they received, and its overall impact on their recovery process may provide valuable context for case conceptualization and treatment planning. If a client has not disclosed their trauma, it may be helpful to explore what kind of situations may prompt them to disclose so that they can consider how they want to approach a future disclosure.
  2. Encourage clients to utilize therapy to prepare for disclosing their trauma to increase a sense of personal control. Our study found that MST survivors who disclosed their trauma rarely prepared for the disclosure, and often had a mismatch between expectation and actual experience. Given the significance of control (or the lack thereof) for survivors of trauma, clients may benefit from focusing on and exerting control over whatever aspects of the disclosure they actually can control, including simply making the decision whether or not to disclose. In addition to focusing on what is in a client’s control, it is important to be realistic about what is not in the client’s control. While we may not be able to control how someone reacts, we can identify who in their life is a truly safe support person based on history and experience.
  3. Incorporate disclosure experiences into trauma processing. The veterans in our study were at various different points in their trauma recovery journey, which appeared to influence the way they made sense of their disclosure experiences.  Therapists may be able to help clients contextualize and/or make healthy meaning of previous disclosure experiences, even if the client felt that the disclosure was negative. This type of discussion may also lay the foundation for helping trauma survivors to better identify safe versus unsafe support in their social network and rebuild the capacity for appropriate trust.
  4. Education about receiving disclosures can be a powerful intervention. Our study found that support persons on the receiving end of a disclosure respond in many different ways, and sometimes those responses were perceived as harmful by the veterans disclosing their assault.  In addition to basic information about trauma and assault, family members involved in a client’s treatment may benefit from education about how to receive disclosure in a helpful way. Additionally, including education on helpful disclosure responses should be a standard part of trauma-informed care training.
Our findings indicate there is no magic formula that will ensure a disclosure goes well, but the commonalities we did glean shed light on how clinicians can best support their veteran and service member clients who have experienced MST leading up to or after sharing their experience.

Target Article 

Rufa, A. K., Carroll, K. K., Lofgreen, A., Klassen, B., Held, P., & Zalta, A. (2021). "You're going to look at me differently": A qualitative study of disclosure experiences among survivors of military sexual assaultJournal of Traumatic Stress.

Discussion Questions

  1. What kind of disclosure experiences have your clients presented with? How have you supported them? 
  2. What existing interventions or resources do you have that can be applied to processing disclosure? 
  3. How can we prepare disclosure targets to receive disclosures and support those who have experienced sexual assault, as clinicians? As a society? 
  4. As clinicians, what is our role in educating disclosure targets about how to be a good disclosee? 

About the Authors

Kathryn K. Carroll, LCSW is a clinical social worker who has worked with survivors of trauma in various settings, including inpatient medicine, transitional housing, military and veteran services, and community violence intervention.  She currently works at the Institute for Nonviolence Chicago as the Associate Director of Behavioral Health and Wellness, where her focus is on embedding trauma support into organizational policies and practices to promote healing and wellness for frontline violence intervention workers.  She has a strong interest in the intersection between evidence based trauma treatment and public policy.  Kathryn can be contacted at [email protected].  
 
Anne K. Rufa, PhD is a clinical-community psychologist who specializes in the treatment of trauma. In addition to clinical work, she has a passion for community-engaged research. Her work aims to address mental health disparities and to promote health equity for oppressed groups by addressing differential access to mental health services and building capacity in community-based organizations, with long-term goals of enacting policy change and dismantling racist systems. Dr. Rufa can be contacted at [email protected] or @ARufaPhD.