Advocacy and Maslow’s Hierarchy of Needs
“Establishing a safe physical and emotional environment where basic needs are met, safety measures are in place, and provider responses are consistent, predictable, and respectful”
P 5 Washington Coalition of Sexual Assault Programs (2012) Creating Trauma Informed Services
“The evaluation reveals that in the immediate aftermath of rape most victims/survivors want a more flexible and practical form of support, and relatively few are ready at this point to undertake counselling. A combination of support, advocacy and information on case progress were their priority needs. How these needs were met varied across the SARCs. Where there is limited or no specific support work these needs tended to be picked up by counsellors and specialist police officers but in an ad hoc and unco-ordinated way.” Lovett, J., Regan, L. and Kelly, L. (2004) Sexual Assault Referral Centres: Developing Good Practice and Maximising Potentials. Home Office Research Study 285. P 74
Maslow’s hierarchy of needs is very salient to the advocacy role as it closely reflects feedback from victim/survivors. Fundamental issues about physical safety, health and accommodation are most important alongside emotional distress, anger and confusion, especially when reporting recent sexual assault.
Victims of sexual violence commonly report fearing for their lives. Domestic and family violence often co-occurs with sexual violence and reporting can precipitate an escalation in violence. Domestic violence deaths more than doubled in Western Australia from 10 in 2011 to 21 for the 12 months up to November 2012. Most deaths were women and children. Click here for more. The deaths of two for these 21 women were featured in the Four Corners program, A matter of life and death in July 2012.
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Advocates need to be aware of the range of strategies and multi-agency programs to protect women. Click here for the some of these from the Australian Family and Domestic Violence Clearing house.
Safety planning should incorporate some generic checklists and be adapted to the client’s particular circumstances, emotional state and needs. Click here for safety planning information, resources and safety planning checklists from 1800RESPECT.
Following recent sexual violence, victim/survivors may be concerned about pregnancy, sexually transmissible infections (STIs), damage to reproductive or other organs and bones and for young women who have not had penetrative sex before, virginity. While medical treatment should always be offered, consent is required for the examination as well as separate consents for any forensic examination, storage of materials and passing on of any evidence to police. The forensic medical examination will be discussed in the section on legal issues.
Clients require different types of practical supports and different times depending on their particular needs. One way for advocates to prepare for the multiple needs of clients and their families is to create checklists for commonly recurring situations. The Advocate Emergency Room Checklist from the Texas Association Against Sexual Assault (www.taasa.org) is a good example of practical supports and considerations as a ‘first responder’ in the hospital situation.
Holistic assessment of a number of life areas is another way of helping the victim/survivor and their supportive non-offender identify strengths and needs. Typically, advocates work with a range of issues beyond the immediate sexual assault as these are commonly interrelated.
Having separate files (hard copies and computer files) of various areas may help to develop the advocate’s own knowledge base as well as to make information and resources easily available to victim/survivors:
- Accommodation services and options
- Emergency comfort items such as toiletries, bathing facilities, change of clothes (remember to be forensically astute in all these areas)
- Family support
- Financial assistance
- Legal information for different stages
It may be useful to have resources and checklists to ensure advocates remember basics, particularly during highly charged, emotional encounters:
- Transport options
- Medical certificate
- Case tracking and reminders
- Food, drink (hot or cold) – Having drink/food not only shows you care, it engages in a socially relaxing situation and also helps to stimulate the digestive system including the parasympathetic / calming side of the nervous system which opposes the fear/adrenaline side.
- Family and children’s spaces including things for them to do
Clients should be providing with a brief explanation of main service areas along with a brochure outlining these area. This not only allows clients to know what’s available, but may also prompt the victim/survivor to consider important life areas they may have otherwise omitted.
While emotional support is part of therapy and therapeutic in its own right, the advocate’s role does not include the direct provision of therapy. That’s not to say therapists can’t also be advocates. Indeed, therapists are a primary target group for this website. While there is overlap, supportive, client-led counselling is different from therapist-led, therapy.
Trauma effects, privacy fears, strong mixed feelings of anger, fear, shame, numbness and confusion, prior negative experiences or perceptions of the welfare and legal systems and other complicating factors such as intoxication and chaotic lifestyles can be overwhelming for victim/survivors, their family as well as those who provide support.
A trauma informed approach helps advocates deal with the multiplicity of issues and allows the advocate to conceptualise many of the surface behaviours and symptoms arising out of protective, fear responses including the cumulative effect of concurrent and/or earlier trauma histories. Ask the question ‘What has happened to you?’ rather than ‘What is wrong with you?’ ” p1.
These insights allow advocates to better empathise with and attend to distressing symptoms. Using the Principles of Trauma-Informed Care (pp 5-6) is likely to help facilitate emotional safety and feelings of control which are at the heart of emotional support. Some examples of strategies advocates use include:
- relationship (with self and the client)
- non-verbal language
- emotional self-regulation which allows for emotional co-regulation with the client
- mindfulness techniques (i.e. focus on here and now sensations to ground)
- Click here for videos by Dr Regalena Melrose on approaches to trauma related stress with children.
- Click here for a video by Babette Rothschild on Dual Awareness which is one of several techniques emerging to deal with trauma related states.
For first responders, some of the most helpful things that can be said are:
- I’m very sorry it happened to you.
- It’s not your fault
- You’re safe now
Those three simple statements will go a long way.
Mary Koss, Professor of Public Health, University of Arizona in the NSW DVD: Anyone’s Story: Understand and Responding to Adult Sexual Assault.
Victim/survivors have had their trust betrayed and may be struggling to have a sense of control over their lives. Some of the elements which can help to restore or create trust include:
- Empathy, understanding, belief and validation. Together, these help to show your caring and trust for the client
- Presence – being alert, focused on the client and showing attentive and genuine interest
- Proximity – spending time with the client, letting them know how they can reach you as well as providing pro-active follow-up
- Reliable, consistent and useful – listening well enough and having resources to offer and facilitate meaningful and valuable benefits for clients
- Professional and ethical – explaining and maintaining boundaries, walking your talk, professional competence and integrity
- Skilful use of touch and personal space – being attuned to when and how (if appropriate) to use comforting/supportive touch as well as when to be physically close and when to provide space
- Privacy – safe environment and protect confidentiality
- Time – don’t expect trust immediately but be trustworthy. Not trusting may have been an important defence for keeping safe
- Doing that little bit extra – promise less, deliver more
What’s in a name?
For some, the terms ‘counsellor’ and ‘counselling’ means support, guidance and healing. For others, it means confronting painful trauma issues in therapist led sessions where they have little control. To deal with this, some services use different terms and roles such as, Victim Advocate (Rape Crisis Adovcate), ‘Counsellor/Advocate‘, or in the UK Independent Sexual Violence Advisor (ISVA). Of course psychological therapy is important and should be offered to victim/survivors and their non-offender families. However, the advocacy role and therapist role, while having some overlap, are separate.
Advocates should also consider timing and how to raise the issue of therapeutic counselling.
It’s not your fault
Victim/survivors often blame themselves for the assault saying “I shouldn’t have… let him in, drunk so much, allowed things to go this far” or “I should have, caught a cab, not been so trusting, read the signs”, etc etc. Correcting these beliefs through explaining societal myths and placing responsibility directly on the perpetrator assists victim/survivors by:
- validating your belief that a sexual assault has occurred
- reducing some of the shame and guilt associated with the assault
- placing the shame and guilt on the perpetrator –