By Olivia Bentley, Ph.D.

June 5, 2023

Given current prevalence rates of sexual assault and sexual harassment, it is likely that you, as a Military Health System provider, are working with patients who have experienced some type of sexual assault.¹  The following strategies are important for clinicians to implement with all patients:

1. Communicate potential effects to the patient so they can choose how, when, and to whom they could disclose sexual assault or harassment from an informed perspective, prior to their disclosure to you
2. Initiate conversations when appropriate and relevant with patients on sexuality, consent, and personal safety to signal you are capable and interested in talking about any sexual experience
3. Become knowledgeable of the mandatory DOD sexual assault and harassment reporting requirements and their potential impact on the person who discloses to you in session, or who chooses to officially report the events through formal channels

Strategies for Responding to Sexual Assault Disclosures

Follow the patient’s lead. Consistent with trauma-informed care principles, it’s best practice for you to empower patients to set the pace for the disclosure and choose how to discuss sexual assault within the therapeutic relationship.² Once a patient discloses sexual assault to you, as a DOD health care provider, you are required to notify the Sexual Assault Response and Prevention Office, as outlined in DODI 6310.09. However, your patient still has a choice of how or even if they want to focus on processing their experience of sexual assault in therapy. Sometimes patients mention experiences with sexual assault as context for presenting issues they do want to address. For example, a patient may identify they want to work on how they handle conflict in their marriage, explaining they feel angrier ever since experiencing a sexual assault. Their provider may recommend treating the direct effects of the assault, but the patient may not be ready or willing to process that experience quite yet, if ever. A simple acknowledgement of the disclosure and transparent check-in regarding how the patient wants to proceed can be helpful if you are unsure.

Use the patient’s own words when discussing their experience. Avoid using legal terms or language that may be perceived as minimizing what did or didn’t happen. The term legality has been used to describe the ways people may scrutinize individuals’ disclosures of sexual assault in everyday life against criminal-legal definitions.³ Sometimes legal terms are used with good intent to collect more information or to support the patient, but patients may experience re-traumatization related to the provider’s word choice.

Validate the patient’s experience. For clinical purposes, it is important to focus on harm rather than intent of the person who harmed or “severity” of the offense. Focusing on the severity of the offense or the legal terminology, such as asking the patient if a rape occurred or not, can minimize the patient’s experience. Legal conceptualizations tend to influence how we view sexual assault, focusing more on offender behavior and intent and less on the harm caused.³

The strategies outlined are consistent with the core principles of trauma-informed care² and DODI 6310.09, which requires that patients receive a trauma-informed response. Consider implementing when responding to a disclosure of sexual assault or harassment in your clinical practice.

Relevant Policies

For more information, please refer to the following policies:

• DODI 6310.09, “Health Care Management for Patients Associated with a Sexual Assault,” May 7, 2019
• DODI 6495.02, “Sexual Assault Prevention and Response (SAPR) Program Procedures,” March 28, 2013
• DODI 6400.01, “Family Advocacy Program,” May 1, 2019

Additional Resources

Sexual Assault Prevention and Response Office

Family Advocacy Program

References

1. Department of Defense. (2022). Department of Defense annual report on sexual assault in the military. https://www.sapr.mil/sites/default/files/public/docs/reports/AR/DOD_Annual_Report_on_Sexual_Assault_in_the_Military_FY2021.pdf
2. Psychological Health Center of Excellence. (2018). Health care provider’s guide to trauma-informed care. U.S. Department of Defense, Defense Health Agency. https://www.qmo.amedd.army.mil/ptsd/PHCoE_TraumaProviderBrochure_v0.9_Final%20508_07MAR2018_.pdf
3. Gash, A., & Harding, R. (2018). # MeToo? Legal discourse and everyday responses to sexual violence. Laws, 7(2), 21.

Dr. Bentley is a licensed professional clinical counselor and contracted subject matter expert at the Psychological Health Center of Excellence.