UNDERSTANDING AND RESPONDING

TO THE TRAUMA

OF

VICTIMIZATION

To experience anguish and anxiety in the face of the perils that threaten us is a healthy reaction. Far from being crazy, the pain is testimony to the unity of life. The deep interconnections that relate us to other beings.

Joanna Macy

Victims of personal crimes are dealt a severe blow to their view of reality:

• They have been deliberately violated by another human being
• The crimes may range from having a pocket picked to murder
• The issues involved with each type of crime are unique
• The personal abilities of victims to deal with the specific type of crime are also unique

• Every 2 seconds a property crime is committed
• Every 15 seconds a woman is battered
• Every 46 seconds someone is robbed
• Every minute 1.5 adult women are raped
• Every minute approximately 6 American children are reported as abused and neglected
• Every 21 minutes someone is murdered
• Every day 55 Americans are killed in alcohol-related traffic crashes

(from National Victim Center 1994 Crime Clock)

Most victims experience a common series of emotional reactions. This parallels the grief process outlined by Elisabeth Kubler-Ross in On Death and Dying, or rape trauma syndrome described by Ann Burgess in Rape and its Victims. It consists of three basic stages:

STAGE ONE: Crisis/Acute Stage

Denial - "This cant' be happening to me, it must be a dream."

"I feel like an observer, watching and reliving someone else's experience."

STAGE TWO: Intermediate Stage (24 hours to 6 weeks):

A series of different emotions intrude and fade with varying intensity: fear, anger, guilt, frustration, embarrassment. They are often accompanied by disruptions in eating/sleeping patterns and a change in lifestyle. Victims can fluctuate between feeling able to cope to feeling out of control. One minute they will blame themselves and the next rage against the individual(s) who harmed them.

STAGE THREE: Reintegration (one week to one year):

Victims resume normal life. The intrusive memories lessen and the victims integrate the crime into their total life experiences. As one victim commented, "I have it in perspective now and don't think of it very often anymore."

While these are the primary stages of crisis, victims react differently. Many victims are amazingly resilient and can cope easily in the aftermath of a crime. In some cases, it takes longer for the bruises to heal than the emotional scars. Much depends on how the crime is perceived by the victim, family and friends, and the community. Victims' reactions do not take place in an isolated environment, but are influenced by other circumstances.

Identifying and Assessing Signs of Crisis*

With the gift of listening comes the gift of healing, because listening to your brothers or sisters until they have said the last words in their hearts is consoling. Someone has said that it is possible "to listen a person's soul into existence." I like that.

-Catherine de Hueck Doherty

Natural caregivers have known for centuries the value of listening with great care and little judgment to a person's sorrow and pain. Though some people have a natural gift for providing that kind of help, most people need some assistance in learning the basics of crisis intervention -- it is, to a degree, "contra-instinctual" -- and everyone can, with study, improve their crisis intervention skills.

In the aftermath of a catastrophe, most victims must deal with the physical and emotional shockwaves of the event but also, in short order, with the sense of helplessness, powerlessness, and a loss of control.

For many victims, the physical and emotional reactions which describe crisis are not severe, and recede after a few hours or days. For others, the crisis is put on hold while they mobilize their survival skills, and only days, even years, later, are they slapped with a sense of the enormity of the event, now vividly remembered. Even victims who do not develop the symptoms of long-term stress reactions face the risk that certain "triggers" will reproduce the old feelings of panic, helplessness, anger, and the like.

"Crisis Intervention" is obviously a humane effort to reduce the severity of a victim's crisis, to help the victim win as much mastery over the crisis experience as possible. To understand the potential benefits of crisis intervention, it is worth emphasizing that these are a battery of skills that victim advocates should possess -- but so should others whose professional work brings them into contact with victims in crisis.

A common response in the shock of the moment is for the victim to retreat into a childlike state, and when the immediate danger is passed, to turn to someone nearby who is perceived as an authority figure for help-- a law enforcement officer, teacher, nurse, a friend, anyone who offers a sense of "parental" comfort. Anyone whose job constantly puts them in that role discovers how "accessible" the victim is at the moment. The helper is now invested with extraordinary influence in the life of the victim in crisis. In these circumstances, the helper is a crisis intervenor -- perhaps a gifted one, perhaps one whose talents have been forged by experience, or far more likely, a conscientious professional with no training or skills in how to interact with people in crisis, to the detriment of both the victim and the professional.

"Crisis" encompasses a number of intense, tumultuous emotions; it can be a continuing condition, or alternatively flare and recede; any stressful, post-crime event, such as going to a battered women's shelter, or to a lineup, or to a trial, may put the victim back into crisis. While there are no predictors about who will experience crisis, or when the onset will be, or how severe it will be in the intensity or duration, a working presumption for most crisis intervenors is that the sooner the service is offered, the better. Indeed, there is a conviction among many practitioners that on-scene intervention, when the victim is in the early stages of distress, may prove to prevent or greatly reduce the crisis symptoms that might otherwise afflict the victim.

A. Safety and Security

1. The first concern of any crisis intervenor should be for the physical safety of the victim. Until it is clear that the victim is not physically in danger or in need of emergency medical aid, other issues should be put aside. This is not always immediately obvious. Victims who are in physical shock may be unaware of the injuries they have already sustained or the dangers they still face.

For the crisis intervenor who is responding to a telephone crisis call, the question should be posed immediately, "Are you safe now?" Intervenors who are doing on-scene or face-to-face intervention should ask victims if they are physically harmed. That question alone may cause the victim to become aware of a previously undiscovered injury.

2. A parallel concern should be whether the victim feels safe. The victim may not feel safe in the following circumstances:

The victim can see and hear the assailant being interviewed by law enforcement officers.

The victim is being interviewed in the same area where the attack took place.

The victim is not given time to replace torn clothes.

The victim is cold and uncomfortable.

The assailant has not been apprehended and he has threatened to return.

Any of these may make the victim feel unsafe even if there are law enforcement officers present. In the aftermath of Edmond, Oklahoma, post office mass murders in 1986, one of the survivors of the attack said that he would not feel safe until the assailant, Patrick Sherrill, whose final killing was of himself, was physically in his grave.

3. A priority for some victims and survivors is the safety of others as well. If a couple has been robbed in a street crime, each may be more worried for the other person than himself or herself. Parents are often more concerned about the safety of their children than their own.

4. Survivors of victims of homicide may not focus on safety but rather seek a sense of security through the provision of privacy and nurturing. Their anguish and grief can be made more painful if there are unfamiliar and unwanted witnesses to their sorrow.

They, too, will suffer feelings of helplessness and powerlessness. The shock of the arbitrary death of a loved one is usually not assimilated immediately and survivors may not understand questions or directives given to them. One mother did not realize that she had said yes when she was asked if she wanted to identify the body of her son. When she was taken to the morgue, she became hysterical and distraught because she was not properly prepared.

5. All victims and survivors need to know that their reactions, their comments, and their pain will be kept confidential. If confidentiality is limited by law or policy, those limits should be clearly explained.

6. Security is also promoted when victims and survivors are given opportunities to regain control of events. They cannot undo the crime or the death of loved ones, but there may be opportunities for them to take charge of things that happen in the immediate aftermath.

7. Hints for Helping.

a. Make sure the victims/survivors feel safe or secure at this point in time.

• Sit down to talk.

Ask the victims/survivors where they would feel safest when you talk to them, and move to that location.

If it is true, reassure them with the words "You are safe now."

Identify yourself and your agency clearly, and explain your standards of confidentiality. You might say, "Our program's standards require me to keep all information that you tell me confidential unless you give your permission to me to release it..."

If possible, keep media away from victims/survivors or help them in responding to media questions. If the case involves a sensational crime and there are media representatives approaching the survivors, try to ensure that the victims/survivors understand that they do not have to answer questions unless they want to, and under circumstances of their own choosing.

• If they have loved ones about whom they are concerned, try to find out as much information as possible about the safety of the loved ones. For instance, a mother who has been a victim on the way home from work might not be as worried about the victimization as the safety of a child who is home alone awaiting her arrival.

If victims are to be interviewed by law enforcement officers, try to ensure that they understand questions by asking them to repeat the question back to the interviewer.

Provide victims with information that may help to assure them of their safety. For instance, if they have been survivors of a massacre, it may help if they are assured that the gunman is dead, or that he has been apprehended.

If they are not safe, keep them informed about the extent of additional threat. For instance, if the gunman is still at large, try to get information about his whereabouts. If possible, find them an alternative location at which to stay for a few hours or a few days. In the aftermath of the serial killings of five co-eds in Gainsville, Florida, the victim/witness program and the community arranged for students to sleep together in dormitory-like conditions in a large auditorium surrounded by guards, all to restore a sense of safety.

Give victim permission to express any reactions and respond non-judgmentally. Say: "You have a right to be upset over this tragedy, so don't be afraid to tell me what you are thinking."

b. Respond to the need for nurturing -- but be wary of becoming a "rescuer" on whom the victim becomes dependent. The "rescuer" who ends up months later making decisions for the victim has subverted the primary goal of crisis intervention; that is, to help the victim restore control over his or her life.

An apt analogy for the role of the crisis intervenor at this stage is as follows: when a person breaks his leg, a doctor sets it and puts it in a cast. While it heals, the patient uses crutches to get around, and when the cast is removed, the leg still needs exercise and care to become strong again. When someone survives a violent crime or the death of a loved one, they survive with a fractured heart. The crisis intervenor becomes like the doctor. The initial intervention helps the survivor by protecting that heart as much as possible against further harm. Later, the crisis intervenor provides support, understanding, and a few crutches while the survivor begins the long process of healing a broken heart.

c. Help survivors to re-establish a sense of control over the small things, then the larger ones, in their lives.

While it is important to assist survivors with practical activities, it is also important to allow them to make decisions for themselves and to take an active role in planning their future.

The crisis intervenor initially can offer survivors a sense of control by asking them simple questions involving choices that are easily made. For instance, "What name would you like me to use in talking with you?" "Where would you like to sit while we talk?" "Would you like a glass of water?"

Often the recovery of a physical object that is important to the survivor helps to re-establish a sense of control. For instance, after an arson burned down much of one family's home, the entire family was strengthened when a law enforcement officer found their cat in the bushes nearby. The family had thought the cat had died in the fire.

B. Ventilation and Validation

1. Ventilation refers to the process of allowing the survivors to "tell their story." While the idea of "telling your story" seems a simple concept, the process is not easy. Victims need to tell their story over and over again. The repetitive process is a way of putting the pieces together and cognitively organizing the event so that it can be integrated into the survivor's life. The first memory of the event is likely to be narrowly focused on, say, a particular sensory perception or a particular activity that occurred during the event. Victims usually see the criminal attack with tunnel vision. They know intuitively that other things are happening around them, but they may focus on an assailant's knife, their struggle to get away, their first impression of a burglarized room.

As time goes by, memory will reveal other parts of the event. These bits of memory will come back in dreams, intrusive thoughts, and simply during the story-telling process. The victimization story will probably change over time as they learn new things and use the new information to reorganize their memories.

For example, a victim who reported a burglary first told the crisis intervenor that he heard a noise and he went downstairs to see what was wrong, finding a burglar in his front room. The burglar grabbed something and struck him in the stomach before running out the front door. There was a crash and then everything went silent.

When the man repeated the story the second time, he said that he remembered that it was just a noise, but it sounded like some whispering and rustling. On a later telling, he remembered that when he came downstairs, he saw a brief flash of light toward the back of the house.

Upon investigation, it was discovered that there had probably been two burglars and one had exited through the kitchen window in the rear of the house.

This process of reconstructing a story results in inconsistent or contradictory stories, which undermine an investigation or a prosecution. However, from a crisis intervention perspective, it is perfectly normal for the process of ventilation to reveal a more complete story over time. Realistically, a victim will tell his story over and over again, with or without a crisis intervenor, in order to reconstruct the event, so that the story will often change anyway. The difference is that the crisis intervenor will provide a sounding board for the victim's distress as the review process unfolds.

For victims, the replaying of the story over again helps them get control of the real story. The "real" story is not only the recitation of the event itself, but usually includes the story of various incidents in the immediate aftermath; the story of ongoing traumatic incidents related to the crime; the story of families' or friends' involvement in the event; and so forth. Each of these stories must be integrated into the victim's final mental recording of the event.

2. A part of the ventilation process is finding words or other ways that will give expression to experiences and reaction. In this aspect, ventilation is often culturally-specific. Some cultures may express their reactions through physical or various artistic forms rather than words. In most of the United States, words are the most comfortable form of expression.

The power found in putting words to feelings and facts is tremendous. There is often a depth of emotion in telling another person that a loved one has died, even in finding the name of the loved one. The power is also illustrated in the release that many victims find when an intervenor responds to their ventilation with a word that expresses what victims feel. For instance, victims may feel intense anger towards an assailant and find the word "anger" insignificant to express their intensity. When an intervenor offers a word like "outrage" or "fury" to describe their feelings, victims often feel a sense of liberation -- a sense of permission to feel such intense emotions.

The exact words to describe events and experiences are often vital. For example, Mothers Against Drunk Driving (MADD) is adamant about the importance of calling the collision of a car driven by someone drunk a drunk-driving "crash," a term often used to describe a mechanical or human error.

3. Validation is a process through which the crisis intervenor makes it clear that most reactions to horrific events are "normal."

a. Validation should be content-specific. Example: rather than saying "I can't imagine how upset you are," it is preferable to say "I can't imagine how upset you are about your son's death in the car crash."

b. Care should be taken in the words that are used to validate. For instance, many survivors do not want to hear their reactions are "normal reactions to an abnormal situation" - a common summation of what crisis and trauma produce - because survivors want to have their experience validated as unique. Telling them that their reactions are "not common" seems to be more effective.

c. Where possible, repetition of the actual phrases that the survivors use to describe experiences is useful. Example, if someone says, "I can't sleep at night, I am so afraid that someone will break in and kill me and my family," an appropriate response would be, "It's not unusual for you to be afraid after such a terrifying experience. If you can't sleep at night, that only shows how afraid you are."

4. The focus of validation should be that most reactions of anger, fear, frustration, guilt, and grief do not mean that the victim is abnormal, immoral, or a bad person. They reflect a pattern of human distress in reaction to a unique criminal attack.

a. While most reactions are normal, there are some people with pre-existing mental health problems who have harmful reactions. There are also some who react to personal disasters in a dangerous way - to themselves or others. In the aftermath of crisis, the intervenor should always be alert to any words or other signs of suicidal thoughts or threatening behavior towards specific individuals. If these arise, seek immediate professional help - a mental health professional, a suicide hotline, even a law enforcement agency if there is an imminent threat to someone else.

b. While most reactions are normal, most people have not experienced such intense feelings, so they think they are "going crazy." Survivors should be reassured that while the crisis has thrown their lives into chaos, they are not, as a consequence, crazy.

5. Hints for Helping. The following introductory questions will help the victim focus on the crime in an objective way. It will help the victim impose an order on the event and begin to take control of the story. It may help to ask the victim to recall that day from the beginning, so that the "normal" parts become part of the crisis story.

a. Ask the victim to describe the event.

b. Ask the victim to describe where he or she was at the time of the crime, who he or she was with, and what he or she saw, heard, touched, said, or did.

c. Ask the victim to describe his or her reactions and responses. As the victim begins the description, remember to validate the reactions and responses. If she says: "I remember turning stone cold when I felt the hand on my back and a tug at my purse," say, "Some people have called that a `frozen fright' reaction."

d. Ask the victim to describe what has happened since the crime, including contact with family members, friends, the criminal justice system, and so on. Responses to this question will help reveal whether the victim has suffered additional indignities as a result of the crime or whether the victim has been treated with dignity and compassion.

e. Ask the victim to describe other reactions he or she has experienced up to now. Again, validate reactions.

f. Let the victim talk for as long as you can. If you are running out of time, give the victim at least a fifteen-minute warning, such as, "Mrs. Jones, I really want to hear more about your experience and reactions, but I have to leave in about fifteen minutes. If we don't finish up this part by then, I want to do that tomorrow, at a time that is good for you. If I don't hear from you, I'll give you a call, if that's okay."

g. Don't assume anything - even the apparent pattern of the crisis reaction is suspect. So, for example, the victim's controlled calm of the moment may yield to tears in a few minutes, or a few weeks. Indeed, if the victim is experiencing crisis, it is safe to bet that his or her reactions will take new form over time.

h. Don't say things like: I understand.

It sounds like...

I'm glad you can share those feelings.

You're lucky that...

It'll take some time but you'll get over it.

I can imagine how you feel.

Don't worry, it's going to be all right.

Try to be strong for your children.

Calm down and try to relax.

Do say things like: You are safe now (if true).

I'm glad you're here with me now.

I'm glad you're talking with me now.

I am sorry it happened.

It wasn't your fault (if there was no attributable blame to the victim).

Your reaction is not an uncommon response to such a terrible thing.

It must have been really upsetting to see [hear, feel, smell, touch] that.

I can't imagine how terrible you are feeling.

You are not going crazy.

Things may never be the same, but they can get better.

To improve communication with the victim, avoid words like:

Feelings - although this chapter is concerned with victims' feelings, in practice it is better to stick with the word "reactions" to describe "feelings." Many people are uncomfortable with being asked to talk about their feelings or emotions.

Share or sharing - ask people to tell you about their experiences. Don't ask them to "share" those experiences or thank them for "sharing." No one can literally share another person's experience, even if they have suffered through the same event. Many people resent the presumption implicit in this term, or the "social work" connotation it carries.

Client or Victim or Survivor - when talking to or about a person for whom you are providing crisis intervention, use the victim's preferred name.

Incident or Event - when referring to the crime or the criminal attack. While such words may be used in other settings, they are inappropriate in talking with the person who has survived such an "event."

Alleged - when referring to a victim. Let the lawyers speak of alleged victims and offenders if they need to. Victim advocates should assume that people who describe themselves that way are what they say - victims of crime.

C. Prediction and Preparation

1. One of the potent needs that most victims have is for information about the crime and what will happen next in their lives. Remember, their lives have typically been thrown into chaos and they feel out of control. A way to regain control is to know what has happened and what will happen - when, where, how.

2. The information that is most important to victims is practical information. The following are examples. Note that some topics may raise scary possibilities that the victim has not even considered; the intervenor may tactfully touch on such issues or defer them. However, never duck any unpleasant surprise if there is reason to believe that the victim will find out about it soon.

a. Will the victim have to relocate? Many burglary victims need to move temporarily because their homes are no longer secure. If relocation is necessary or recommended, what are the victim's options?

b. Does the victim have adequate financial resources to pay for any immediate needs caused by the crime? The robbery victim may not have money to pay for food or rent, even if a compensation program may reimburse a victim at a later date, the need for immediate money is sometimes overwhelming.

c. What legal issues confront the victim? Will the case be processed in the criminal justice system? Will there be an investigation? What are the chances that there will be an arrest - and then prosecution, trial, conviction, and sentencing? Does the victim have civil litigation options? Might it be feasible for the victim to sue the offender or a third party who might be held responsible for factors leading up to the attack? Note that honest answers and estimates are essential; to the victim of a "cold" burglary with no immediate suspects, the bad news is that fewer than one such case in fifty results in an arrest in most jurisdictions - and giving a rosier picture will undermine your future credibility. By the same token, there may be many questions that arise which are beyond the intervenor's expertise; note them, and help the victim to get expert answers.

d. What immediate medical concerns face the victim? An injured victim needs information about the extent of those injuries. A sexual assault victim may need information to make informed decisions on testing for pregnancy or sexually-transmitted diseases, including HIV. The survivor of a victim of homicide or catastrophic injury may need detailed information about the cause of death or extent of injuries.

e. What will be expected of the survivors of a homicide victim in the immediate future? Will they be asked to identify the body? If so, what is the condition of the body? Is there a need to address immediately funeral considerations? (Some religions call for immediate burial.) Do the survivors know their loved one's body will be given an autopsy?

f. What does the victim need to know about the media? As indicated above, if the case is sensational or has a "newsworthy" face to it, it is likely that there will be media coverage. Does the victim know his or her rights? Is the victim prepared for a full media intrusion? Has the victim been warned that what appears in the media may not have any relation to the truth as he or she has experienced it?

3. The second priority is the information on possible or likely emotional reactions that the victims might face over the next day or two, and over the next six months or so - emphasizing that there is no particular timetable when victims can expect to experience crisis reactions, or which of the intense emotions may surface. In many ways, this review will become as important as anything else they learn. In the initial stages of dealing with the crime, practical issues are their priority. Some of the emotional concerns that should be outlined, however, are the following:

a. Immediate physical and mental reactions to crisis. These reactions may include inability to sleep, lack of appetite, anxiety, numbness, estrangement from the world, a sense of isolation, anger, fear, frustration, grief, and an inability to concentrate.

b. Long-term physical and mental reactions. These reactions may include intrusive thoughts, nightmares, terror attacks, continued sense of isolation, inability to communicate with others, sleep disturbances, depression, inability to feel emotion, disturbance of sexual activity, startle reactions, irritability, lack of concentration, and so forth.

c. Reactions of significant others. While some friends or family members serve as the most important source of emotional support for victims, many cause as much harm as good. Three common reactions that may cause victims distress are: over-protectiveness; excessive anger and blame directed toward the victim; and an unwillingness to talk about or listen to stories of the crime.

d. Victims should expect that everyday events may trigger crisis reactions similar to the ones they suffered when the crime occurred. Thus, the birthday of the son who was murdered may trigger overwhelming feelings of grief and anger about the murder. A sunset of a particular shade and color may trigger a panic attack in a victim who was robbed during such a sunset. The smell of alcohol on the breath of a young man may trigger an outburst of rage in a young woman who had been raped by a man who had been drinking.

4. In addition to needing predictable information, victims need assistance in preparing for ways in which they can deal with the practical and emotional future. The following are some hints for helping.

a. Take one day at a time. Suggest that the victim plan each day's activities around needed practical tasks. Help the victim list the tasks that need to be done and set a goal for accomplishing a certain number each day. Victims who have been severely traumatized may want to check in with you after each day to report their progress and to receive positive feedback on any successes.

b. Problem-solving. Show the victim how to use problem-solving techniques to address the overwhelming problems that he might face. Suggest that the victim list the three most important problems confronting him for the next day. After he makes his list, have him analyze whether all three really need to be done in the next twenty-four hours. If he thinks so, ask him to sort the list in priority order. Take the first problem he has listed and ask him to think about all the possible ways he might deal with the problem. After he has discussed such ideas, ask him to choose the option that he thinks is most feasible.

Example: Jim is a robbery victim. The robber stole his wallet and the contents of his pockets, which included all of his cash, his bank card, his driver's license, his car and apartment keys, and a pocket watch. Jim is panicky because it's 9 at night and he doesn't have any money and doesn't know how to get home. Even if he is able to get there, he doesn't have keys to get into his apartment or to drive to work in the morning.

You ask Jim to list his three biggest problems. He says: getting home, getting in his apartment, and getting to work in the morning, in that priority order. You ask him to think of all the possible ways he might be able to get home. After some thought, he decides that he can borrow a quarter from you and call a friend to come get him. He then realizes that his friend would probably let him stay at his house overnight, if needed. He also realizes, as he is thinking, that he might be able to call his landlord from his friend's house and arrange to get into his apartment. As he begins to think calmly and carefully about the problem he remembers he has an extra set of keys to both his apartment and his car at home... and so the problem-solving begins and may continue.

c. Talk and write about the event. Suggest to victims that they use audiotapes or write a journal to tell their unfolding stories. Even if no one else sees or hears these stories, it is a way of expressing oneself and a way of processing thoughts.

d. Plan time for memories and memorials. It can be predicted that certain things will be trigger events for future crisis reactions. Urge victims to try to think through what those trigger events might be and allow themselves time to deal with those reactions. For example, a woman who had been sexually assaulted on October 14 routinely took that day off from work to do something nice for herself and to think about her pain.

e. Encourage victims to identify a friend or family member on whom they can rely for support during times when they must confront practical problems. If they are able to name that person, suggest that they call and explain their need for support and help. If this is done in advance, it makes it easier to request certain help when the time comes.

f. Good nutrition, adequate sleep, and moderate exercise can significantly help victims survive times of crisis. That underestimated triad is, in fact, the basis for virtually all stress reduction programs. Help victims set up their own regular routine of health. At first it may be difficult, but if they keep trying they will readily realize some benefits.

... Charles Dickens said, "No one is useless in this world who lightens the burdens of others."

* Reprinted with permission of National Organization for Victim Assistance

Secondary Victimization*

After the trauma of a crime, many report being victimized by the very systems that were designed to help them. The media, health services and criminal justice system can respond to victims of crime in ways that make them feel traumatized again. A counselor can help to reduce the chances of secondary victimization by helping victims to understand their rights.

While the American criminal justice system is primarily modeled after the English system, there is an important difference in criminal prosecutions. Historically, criminal prosecutions in England were private actions brought by the victim or a representative of the victim. In the American tradition, a crime is deemed to have been committed against the state or against society as a whole. An unfortunate outcome of this is the victim's assignment as a witness. Since the crime is viewed as being committed against the state, it is the state's job and right to prosecute. In criminal cases, it is not the victim who decides if the case will go to court. The victim has little or no control over the process of bringing the offender to justice.

In recent years, America's victims' rights movement has advocated to up-grade the victim's role in the criminal justice process. It has sought to balance the rights of victims and the accused. During the past two decades, all states have passed laws affirming the rights of crime victims. Almost every state has enacted "victims' bills of rights." A quarter of the states have passed constitutional amendments for victims' rights.

Today, victims are frequently categorized - sexual assault victims, domestic violence victims, child abuse or neglect victims, elderly victims of abuse, victims with disabilities, victims of hate-motivated crimes, and even Good Samaritans. Many states have included surviving family members of homicide victims in their definition of "victim." These groups often have rights and remedies that are unique and distinct, such as protection from abuse orders for domestic violence victims, videotaped testimony and testimonial aids for child victims, and protective services for elderly victims.

All states have rights for crime victims, but the scope varies greatly from state to state. Victims' rights can include:

Courts in every state are permitted to consider or even to request a victim impact statement. These statements provide a way for those deciding a case to factor in the human cost of the crime and for victims to participate in the criminal justice process.

Almost all states provide for victim input at sentencing. Impact statements can be mandated by law, or left to the judges' discretion. Most victim impact statements normally written, and become part of the pre-sentence report. They may be drafted by the official preparing the pre-sentence report, the victim, or survivors of the victim, depending on the law. In some states, the parent or guardian of a minor or incompetent victim can prepare the statement. The Child Protection Act of 1990 permits child victims of Federal crimes to submit victim impact statements in ways that are "commensurate with their age and cognitive development," which could include drawings, models, etc.

A state may allow written or oral statements at sentencing. The oral statements may be made by the victim, survivors of a victim, or in some states, a representative of the victim or victim's estate.

Victim impact statements can include the financial, physical, psychological or emotional harm that the victim or victim's family suffered. State law might specify what can be included in the statement, or it may simply permit a "description of the impact of the offense." Victims may be permitted to state what sentence they wish the offender to receive or voice their opinions about the proposed sentences. In more than half of the states, victims can submit impact statements even if the offender was sentenced prior to the passage of an impact statement law. The majority of states also permit victim input at the parole hearing.

In 1990, the California legislature passed a law which permits the use of videotaped victim impact statements at parole release hearings. Acknowledging that many victims are unable to travel to parole release hearings, more states are permitting video impact statements. Some states are permitting the use of audiotaped victim impact statements for the same reasons.

Victim impact statements that are submitted to the court at the time of sentencing should also be included in an offender's file. This assists the paroling authorities in understanding how the crime affected the victim(s) soon after it occurred, rather than its impact at the time(s) of parole release hearings. In over half of the states, the original victim impact statement is kept on file by corrections authorities, and reviewed as part of the parole process. Many states solicit updated impact statements for parole hearings as well.

In its rush to be the first with the news, the media can often inflict a "second victimization" upon crime victims or survivors. Common complaints that victims have include: interviewing survivors at inappropriate times; filming and photographing gruesome scenes; searching for the "dirt" about the victim; seeking interviews with friends or neighbors', interviewing or photographing child victims; printing victims' names, addresses or places of employment; and scrutinizing victims' past. After a crime, victims are frequently physically and mentally numb. They are confused and disoriented.

A recent study shows that television news directors agree in principle that crime victims have privacy rights and the individual's right to privacy is not outweighed by the public's desire to know. However, directors are less likely to adhere to this principle if they know a competitor is going to break the story.

While victims have rights when dealing with the media, many yield to media pressures and answer questions that they would not consider answering under other circumstances. In most cases, there are no legal remedies if his or her rights are violated.

The National Victim Center developed this list of rights for victims:

Twenty-eight percent of rape victims report some degree of physical injury as a result of the rape (Rape in America, 1992).

Every year, domestic violence results in almost 100,000 days of hospitalizations, almost 30,000 emergency department visits, and almost 40,000 visits to physicians (American Medical Association, 1991).

Every year hospitals spend millions of dollars treating victims -- including victims of physical abuse, homicide, terrorism, aggravated assault, rape and domestic violence. Even though hospital staff see many victims of trauma and in many cases are one of the first to respond to victims, hospitals are frequently understaffed and personnel undertrained to deal effectively with the emotional needs of victims.

Individuals whose physical wounds do not appear to be severe may be forced to sit and wait while others are treated. In some cases the victim and the offender may be brought to the same hospital for treatment. The victim may be forced to be in close proximity to the offender while awaiting or receiving medical treatment.

Staff who deal with victims of crime on a daily basis may respond to victims in ways that seem to minimize their pain and emotional trauma. Because treating victims of crime is routine, hospital staff may fail to explain procedures with sensitivity and care and thereby cause secondary victimization.

With the HIV/AIDS epidemic, the trauma of a sexual assault has evolved into a potentially life threatening concern. To date, there have been no documented cases of HIV transmission in adult victims as a result of a sexual assault. This does not mean that transmission is impossible. The physical trauma to the body increases the susceptibility to infection. Child or elderly victims are at increased risk of infection.

Although there is no prescribed way to introduce the topic, a discussion about the rape exam or general health concerns may provide a natural opening to insert the topic. A counselor can also wait for the victim to raise the issue.

A victim's desire to have an offender tested for HIV is understandable, but the results rarely relieve the fear and anxiety. Knowing the results of an offender's present HIV test does not guarantee that the victim is free from exposure to HIV. Current research indicates that a person could be exposed to the virus, yet not test positive for months or years. This individual could transmit it to another even though test results are negative. Additionally, in many cases the offender may never be apprehended. Although a number of states have mandated testing of alleged and/or convicted offenders, not all provide for immediate testing or automatic notification to victims.

Due to the high-risk behaviors of numerous sexual offenders, and the frequency with which some children are assaulted by the same offender, the risk of infection for children, when compared with adults, is higher. While the risk is higher, the incidence of HIV infection in children is so low that testing is not recommended unless a strong belief or evidence exists that the offender engages in high-risk behaviors or the child exhibits symptoms of sexually transmitted diseases. If testing is deemed advisable, the parent(s) or legal guardian(s) must give permission.

Most people consider sexual assault victims as the victim group at highest risk for HIV infection. However, domestic violence victims should also be considered. Women whose partners use drugs are at risk. Victims may be coerced into using intravenous drugs with shared needles, and consequently exposed to the virus. Most battered women are not powerful enough to convince their partners to use a condom. Sexual assault may be part of the battering cycle.

Cross Cultural Issues in Crisis*

I. Understanding Cultural Contexts

A. CULTURE (cul' tur): "the totality of socially transmitted behavior patterns, arts, beliefs, institutions, and all other products of human work and thought characteristic of a community or population." The American Heritage Dictionary of the English Language

1. Issues that help define culture identity include attitudes towards spirituality, birth, dress and other factors.

2. Sources of cultural identity include not only race, ethnicity, nationality and religion but also such attributes as age, gender, language, sexual orientation.

B. Placing yourself in your own cultural context. It is important to know your own values and cultural references before trying to interact with others with different values and references.

II. Issues Of Cultural Perspective

A. Culture and crisis

1. Most literature on trauma and appropriate intervention strategies is based on theoretical and philosophical paradigms drawn from a white, Anglo-Saxon, Judeo-Christian perspective in the United States. Yet it is clear that people with different cultural backgrounds, including those backgrounds that are drawn outside of race, ethnicity, nationality or religion, may perceive trauma and appropriate treatment differently.

"All ethnically focused clinical, sociological, anthropological, and experimental studies converge to one central conclusion regarding ethnic America: Ethnic identification is an irreducible entity, central to how persons organize experience, and to an understanding of the unique 'cultural prism' they use in perception and evaluation of reality. Ethnicity is thus central to how the patient or client seeks assistance (help-seeking behavior), what he or she defines as a 'problem', what he or she understands as the causes of psychological difficulties, and the unique, subjective experience of traumatic stress symptoms.

"Ethnicity also shapes how the client views his or her symptoms, and the degree of hopefulness or pessimism towards recovery. Ethnic identification, additionally, determines the patient's attitudes toward his or her pain, expectations of the treatment, and what the client perceives as the best method of addressing the presenting difficulties." E.R. Parsons, "Ethnicity and Traumatic Stress: The Intersecting Point in Psychotherapy," in Trauma and Its Wake, ed. Charles R. Figley, Brunner/Mazel: New York, 1985.

2. Several different conceptual schemes provide some insight into how different cultures may need different types of intervention or strategies for service delivery.

a. The Axis of Control describes the degree to which individuals feel in personal control of their lives, and the degree to which they may feel personal responsibility for what happens to them, or their community.

b. The Axis of Conflict describes how people tend to react to conflict in their lives and the goals they seek in resolving that conflict.

c. The Axis of Life attempts to illustrate different perspectives on life and death issues and whether individuals seek to resolve their concerns about life and death through communing with nature, God or technology.

3. Each perspective described through these suggests differences in attitudes, philosophies and values when providing outreach and service to different cultural groups.

B. Cultural assessment

1. That analysis can be based on any dominant and uniting characteristic of a population. For instance, if a crisis response effort was being planned for an intervention at Gallaudet University, the only four-year liberal arts university for deaf people in the United States, it would be important to think of the frame of reference of the hearing impaired or deaf populations. It would be critical to think about the integration into the hearing impaired culture, or lack thereof, of any particular group or individual within the college.

2. For purposes of illustration on how an assessment might be made, the following is a "checklist" for helping counselors determine the level of ethnic identification that a victim may have.

a. Determine the extent that the ethnic language is spoken in the home.

b. Determine how well English (or the dominant language or dialect in a country) is spoken.

c. Determine the stresses of migration on the ethnic group as a whole and how long the individual or community has been in the United States.

d. Determine the community of residence and the opportunities the individual has for linking with people of a similar ethnic origin.

e. Determine the educational attainment and socio-economic status of the individual and the community.

f. Determine the degree of religious faith of the individual or the community and whether that faith reflects the religion of the ethnic group.

g. Determine the presence of intermarriage in the community, by the individual, within the individual's family, or within the community as a whole.

C. Understanding Cultural Competence

1. A long-held theory of cross-cultural assistance has been that it is best if members of the same cultural, racial or ethnic group assist each other. That is, an Hispanic/Latino victim theoretically would best be served by an Hispanic/Latino counselor. While this is still a useful goal in some cases, it has not been practical in application since there has often been a shortage of helpers from different cultures in the communities where they are needed most.

2. James Green offers the following definitions of ethnic competence that could be utilized as well to explain a more generic definition of cultural competence. (Source: James Green, Cultural Awareness in the Human Services. Prentice Hall, 1982.)

a. "Ethnic competence as awareness of one's own cultural limitations. One of the implications of the model of help-seeking behavior is that the more similar the cognitive and affective characteristics of the client and the worker, the greater chances for effective communication...cultures are in fact different."

b. "Ethnic competence as openness to cultural differences. The belief that underneath we are all the same and that we all share a basic understanding of what is good and valuable in life might well be added to our list of common American values. These beliefs derive from the melting pot ideology, with its assumption (and hope!) that the cultural differences that separate people are less important than the things that unite them, and that manifestations of differences are best under-emphasized in order to assure tranquillity in social relation... The acceptance of ethnic differences in an open genuine manner, without condescension and without patronizing gestures is critical for the development of an ethnically competent professional style..." (While Mr. Green accurately refers to the traditional belief about a melting pot society -- more and more people currently subscribe to the "tossed salad" description of the mixture of ethnicities.)

c. "Ethnic competence as a client-oriented systematic learning style. All cross-cultural encounters are potential learning experiences. They may result in the discovery of new information or an enhanced understanding of something not fully appreciated before. Systematic learning depends on whether the worker-as-health-provider is willing to adopt the role of worker-as-learner."

d. "Ethnic competence as utilizing cultural resources. To do so, the worker must know the resources available to the client and how they may best be used. "Resources" here mean not only community agencies but also institutions, individuals and customs indigenous to the client's own community."

e. "Ethnic competence as acknowledging cultural integrity. In catch phrases such as "culture of poverty," "cultural deprivation" or "the black problem" the prejudicial view is expressed. Yet all cultural traditions and extant communities are by definition rich, complex and varied."

III. Recommendations For Cross-Cultural Service Delivery

A. Preparation for providing cross-cultural victim assistance

1. Take advantage of as many cross-cultural educational opportunities as possible.

2. Consider the following possibility. Most people who think of themselves as members of a dominant cultural group spend less time learning about minority groups than do minority groups within the same population. Minorities need to learn about dominant cultural values in order to survive or succeed.

3. Be aware of institutional and latent cultural bigotry. Such bigotry includes racism, sexism, ageism, homophobia, and so forth. While it is easy to identify obvious indicators of bigotry, subtle signs of discrimination, ignorance and prejudice may be more difficult to observe.

a. Language often carries inherent messages of prejudice.

b. Stereotypes also often are indicators of bigotry.

c. Educational programs can carry implicit biases in favor of the dominant culture.

d. Symbols, traditions, and behaviors may be implicitly discriminatory.

e. It is wise for crisis responders to spend time thinking about the difference between bigoted words, phrases, or humor, and what constitutes non-bigoted or discriminatory speech.

f. Racism is one of the most important factors in cultural experiences. Some have suggested that the more people of one race are exposed to people of other races the less likely either race will be racist. However, others suggest that if people lack any exposure to a different race they may also be non-racist. People become racist when exposed to negative experiences or stereotypes about other races. When those experiences or stereotypes are reinforced by media, friends and family, language or formal education, racism becomes entrenched.

B. The following action plan for working in a cross-cultural context is based on further work of Erwin Parsons.

1. Prior to doing cross-cultural intervention, find out about a culture's routines, traditions and impact of family relationships. Routines such as regular mealtimes or mode of dress can affect when and how interventions are made. Crisis responders should be prepared to participate in traditions to the extent possible.

2. The orientation: Have an open discussion about difficulties of working with individuals or groups who come from a different cultural context than yours.

a. Express a willingness to learn about the ethnic group involved.

b. Communicate some appreciation and respect for the individual's culture.

c. Acknowledge your differences and your limitations.

3. Address practical problems first.

a. Deal with immediate environmental problems such as financial loss, secure shelter, family conflict and the like that the individual is having difficulty handling by himself.

b. Build trust.

c. Assist the survivors or victims with financial resources or compensation if possible.

d. Help the survivors focus on something tangible that they can accomplish over the next few days.

4. Crisis intervention with cultural focus.

a. Search for the meaning of suffering and pain relevant to the dominant cultural group involved.

b. Search for the meaning of death in the culture.

c. Search for the meaning of life.

d. Make an effort to acknowledge your limitations with language or other communication concerns, and ask the survivors to tell you if you say something wrong or do something offensive.

e. Ask survivors to tell their story and talk to them about the crisis reaction.

f. Ask survivors if their families should be present during discussions or if they would like to have clergy members present.

g. Ask survivors if they would like to go to a place or worship or if there are any ceremonies or rituals that are particularly directed at crisis in the culture.

h. Ask survivors to describe what they would like you to do to be of assistance to them and then tell them truthfully what you can or can't do.

I. Useful cross-cultural intervention includes: reduction of isolation, relaxation techniques, meditation, education about crisis and trauma reactions, neuro-lingual programming, reframing the crisis in culturally relevant terms, helping individuals to develop control, increase self-esteem and self-regulation.

j. Be aware of culturally specific communication techniques such as the use of eye contact, the integration of food and drink in discussion, the pace of conversation, body language and so forth.

IV. Different Ethnic-Cultural Contexts

Crime victimization is often more prevalent within minority populations than between the dominant population group and minorities; therefore, crime victimization is included as a context for understanding cultural environments. While ethnic groups suffer victimization, they often also become victims of the system when accused of crimes.

Victims Who Are Disabled

Individuals with a physical disability are more likely to be unemployed, under-employed and less well educated. Women who are disabled are less likely to be married than men who are disabled. People of color who are disabled are more likely to be negatively impacted both economically and socially. Persons with disabilities are not only misunderstood by society as a whole but often by their families as well. They are frequently discouraged from expressing themselves sexually. When working with an individual who has a disability:

When working with a victim who is blind or sight impaired: