Treatment of rape trauma with EMDR therapy: "I feel that it was some kind of cold water bucket experience, like welcome to the world of adults"

A 30-year-old woman (I'll call her Leena here) came to my reception, and told me that she had had symptoms of depression and anxiety since she was young, but the psychotherapeutic treatment started in her teens had stopped when she became an adult. Leena said that she especially suffers from anxiety in social situations and that she has also had varying degrees of panic attacks in the past couple of years. The panic attacks had almost always occurred in the company of men.

Leena said that she had been raped at the age of 16 by a young man she had already known. It had happened during the continuation of the party, where after everyone had gone to sleep, the man had had sex with Leena against her will. Leena told that she had frozen in the situation and been unable to do or say anything. The man's friend had watched the event from the side. Leena never filed a criminal complaint about the incident.

Leena said that she hoped that the outcome of psychotherapy would be that she would get her life back to normal and not think about the rape issue anymore. She was found to have some symptoms of post-traumatic stress disorder, especially intrusive thoughts and physical anxiety, as assessed by the IES meter. She said that the worst thing about the incident was that she felt guilty about it.

During the first treatment session, I asked Leena to focus on the target memory and I guided her to name the negative thought about herself related to the event in question and the image that represents it. Leena said: "I'm worthless and dirty". As an alternative positive cognition to be attached to the target memory, Leena chose "I am valuable and it was not my fault"". As an alternative positive cognition to be attached to the target memory, Leena chose "I am valuable and it was not my fault". Its veracity was felt before starting desensitization on a scale of one to seven (1 = feels completely wrong and 7 = feels completely right) as one. The target memory evoked feelings of dread and helplessness in Leena at the reception, both mentally and physically. She felt that the intensity of the feeling of disturbance of the image related to the target memory was ten on a scale of 0-10. During the first 45-minute treatment, the disturbance of the mental image decreased from ten to eight.

During the second treatment session, bilateral stimulation with a visual stimulus was started while Leena focused on the target memory. Below is described the processing of Leena's (L) mind step by step as the bilateral stimulation progresses and lasts approximately 20-30 seconds at a time. In order to reduce the length of the text, each phase of bilateral stimulation (BLS) is not marked, but they are repeated after Leena's feedback, always with relatively the same duration. At the beginning of the treatment, the disturbing image related to the target memory was seven on a scale of 0-10.

L1: The image is frozen.


L2: Harder to catch it.

BLS etc.

L3: I remember that I started to get really tired. I felt like I was safe and that's why I stayed there.

L4: I didn't do anything wrong. It seems unfair, I didn't give any tips or permission for anything.

L5: "I'm innocent" is running through my head.

L6: I'm trying to understand that other person, but I can't see it from their point of view.

L7: It hurts me to remember their touch.

L8: I feel like I'm a tool.

L9: I feel that even if someone else thinks I have no value, maybe that's not the whole truth.

L 10: I am angry with myself, but also with the other person.

L11: I don't know if I was trying to get some approval or be a friend or why I was there.

L12: My trust has been broken.

L13: Difficult to stay in the memory, I start analysing it from the outside.

L14: It feels like there are two separate things. Why was I even there and what did it lead to.

The therapist's cognitive intervention: Why were you there?

L15: Those guys were cool and nice.

L16: I strived for approval. That I belong to a group.

The therapist's cognitive intervention: Have you experienced not belonging?

L17: From a very young age.

L18: I have always been very open to meeting new people. I became very careful. I started building a wall.

L19: I feel that my value is determined by what use am I.

L20: It's somehow difficult for me... I feel like it strongly defines my identity in the company of men. There is always a fear in the background that what use do I have.

Therapist: Let's go back to the target memory, what do you notice now?

L21: Difficult to reach.

L22: Was I afraid to say no because I wouldn't be accepted... If the other person had flirted, etc., I wouldn't have stayed there.

L23: I panicked, there was no time to think.

L 24: In a way, I accepted what was happening as a price for being appreciated.

L25: Despair.

L26: Somehow I'm trying to think about how I should see it so that it doesn't determine my worth.

Therapist's cognitive intervention: If a woman is a victim of a sexual crime, does that tell about a woman's worth?

L27: No.

L28: It's not my fault.

L29: How someone might value me does not determine the truth.

L30: I had an internal wow experience that I am pretty valuable.

L31: Nothing more or new.

Therapist: How disturbing does the event feel now?

L32: 2-3, because there’s still that filth.

L33: I blame myself for not having been able to say no.

L34: I feel that it was some kind of cold water bucket experience, like welcome to the world of adults.

L35: I felt that I was not aware of the rules of the game.

L36: Should have somehow been more careful.

L37: Now I feel even sadder than before.

L38: I got stuck in the filth.

Therapist: Where on your body do you feel the dirtiness now?

L39: In the chest and neck area.

Therapist: Would you take your hand and rub it on that area and then put your hand out so I can see it.

L40: I notice that part of the weight is in the hand.

Therapist: Look at your hand, is there dirt on it?

L41: No...that dirtiness is imaginary.

L42: Although that dirtiness is unpleasant, it is part of only one event.

L43: It feels somehow more loose.

L44: I felt that I'm ready to let it go on some level, it doesn't have to define me.

L45: I feel more liberated somehow.

Therapist: How disturbing does the event feel now?

L46: I would like to say one.

Therapist: Let's start instilling positive cognition to that event. Is "I'm valuable and it wasn't my fault" still suitable as a positive cognition?

L 47: Yes.

Therapist: How true does it feel now if 7 is completely true and 1 is completely false?

L48: Six.

Therapist: Good, connect it to the mental images that represent the event.

L49: It's somehow even a gleeful feeling, I won’t let that event define me anymore.

L50: Kind of like overcoming yourself.

L51: Maybe I should appreciate myself even more because of this event.

Processing the target memory into neutral and attaching positive cognition to it took a total of 105 minutes. The time spent and the content of the material produced by Leena represent a very typical script for rape trauma EMDR treatment. The message of this writing, which Leena and I agreed together, is that it is possible to get rid of rape trauma permanently, and it does not require years of continuous talk therapy.

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