Numbing after rape, and depth of therapy

Abstract

The author considers the reactions of four women who had been sexually assaulted, with a focus on the rape trauma of two women with the diagnosis of "Complex-PTSD." Both patients also had prolonged episodes of illegal drug dependence. The article investigates a variety of therapeutic responses to ameliorate disabling post-rape psychological symptoms, especially an intense feeling of numbing. Psychodynamic treatment was chosen for investigation rather than Prolonged Exposure (PET), or Cognitive Behavioral Therapy (CBT). Choice of these two treatments is supported by substantial statistical evidence. But many therapists continue to use psychoanalytic based approaches to treat rape victims. Schottenbauer et al, (2008) concluded that PET and CBT approaches had high non-response and dropout rates. Also psychodynamic comprehension may be particularly suitable for "complex PTSD" as defined below in this article. Two vignettes contrast the treatment processes and outcomes of these two women to two other patients who had been sexually assaulted, but whose psychopathology was less severe. The author proposes that full comprehension of severe numbing is essential in the selection of the best intervention strategy because this symptom (or affect) may determine the prognosis of raped patients.