Thesis (M.A.)--Rowan University, 2009. / Typescript. Includes bibliographical references.

The study examined rape counselling, with particular emphasis on countertransference reactions experienced by the counsellors of rape survivors. Four subjects participated in semi-focused, open-ended interviews, which were taped and transcribed verbatim. The phenomenon of countertransference was discussed, and countertransference reactions identified and examined. The management of empathic strain, in order to sustain empathic inquiry and therapeutic efficacy, was discussed. The main results of the study included the identification of common victim themes, and the feelings evoked in the counsellor in the therapeutic relationship. These included feelings of anger, hopelessness, helplessness and sadness, particularly in the counselling of children, who may be HIV positive as a result of the attack, and victims of chronic abuse. Challenges of rape counselling included shortcomings in the system, and rape myths which trivialize the crime and blame the victim. The need for education and enlightenment of both the public and magistrates on the deleterious effects of rape was emphasized by all subjects.

This study employed a case-based research design to document the psychological assessment and treatment of Zanele, a 15-year-old black Xhosa speaking female who was raped twice in 2006 by the same perpetrator. The aim of the study was to explore whether, the model for assessment and intervention for posttraumatic stress disorder (PTSD) developed by Ehlers and Clark (2000) was effective and transportable to the South African context. Zanele had a sufficient understanding of English for assessment to proceed without use of an interpreter. She reported a number of PTSD symptoms which were causing her significant distress and had impacted on her social and educational functioning. These included flashbacks of the perpetrator's face when she looked at the faces of black men, nightmares about the traumas she had endured and feeling isolated from others. A number of cognitive techniques were utilised in this study, however the central interventions included working with triggers, imagery rehearsal techniques with a focus on nightmares, and reliving with cognitive restructuring within and outside reliving. Psychoeducation and increasing her social support were also important components of the intervention. Her progress was monitored by means of several self-report measures which were displayed in graphic and tabular form. In addition, a thematically selective narrative of the assessment and first 23 sessions of the intervention was written which documents some of the central processes set in motion by the interventions. These results provide evidence that this model was both effective and transportable to the South African population. In addition, the study demonstrated that it is possible for a white English speaking clinician to work with a black Xhosa speaking individual and make substantial therapeutic gains.

In 2009, South African police statistics revealed that more than 68 332 women were raped in the country. The evidence from independent researchers has shown that SAPS statistics are highly susceptible to under-reporting and the actual figure is more than double this amount. One pervasive feature of the phenomenology of rape is post-traumatic stress disorder (PTSD). PTSD is a highly debilitating condition with severe individual and societal costs. The condition takes a critical toll on occupational functioning, schooling and personal relationships and is associated with depression, suicide risk, self-harming behaviours and alcohol-abuse problems. The Ehlers and Clark (2000) cognitive model represents the most efficacious treatment for PTSD but the approach is severely under-utilised by South African practitioners working with sexual trauma. The reasons for such under-utilisation relate to a lack of exposure and training surrounding the model and concerns about the transportability of the treatment to a multi-cultural context. One method of addressing these barriers to treatment delivery is through systematic case-based research. Systematic case-based research offers a complementary means of refining theory and developing evidence-based practice in the context of a developing country. The method offers an intensive analysis and description of the particular phenomena under study within its real-life context. It allows the researcher to intensively examine and identify the specific aspects of the therapist’s responses and client’s reactions that contributed to significant change. Unlike efficacy studies, generalisability in case-study research is based on replication on a case-by-case basis and the creation of case law. This research study uses a systematic-case study approach to investigate the applicability of the Ehlers and Clark (2000) model in the treatment of rape-related PTSD in South Africa. The study aims to demonstrate the transportability of the model and develop a needed evidence base for service providers in the country. Seven women participated in the project and lent their treatment process to the research. The participants varied in terms of age, race, culture, socio-economic status and the nature of their sexual trauma. Through synoptic thematic analysis of their therapy process specific client-related personal aspects, client-related contextual factors and state-level factors were found to impede treatment delivery and implementation. The implications of these aspects for clinical practice and social policy are comprehensively discussed.

The present study presents three individual cases; all three clients had endured a traumatic event, namely rape, and all three met the criteria for PTSD. Despite the fact that each of the clients was initially assessed as being a suitable candidate for psychological treatment, none of the cases proceeded to the therapy phase of treatment. A number of obstacles, both personal and contextual, were encountered during treatment implementation, preventing or limiting a successful outcome of psychological treatment in each case. An examination of these cases highlights a few of the many obstacles frequently faced when delivering psychological treatment to the South African context. In so doing, this research provides an opportunity to consider the possible reasons for the limited documentation of treatment efficacy within the South African context, as well as to enhance our understanding of and sensitivity towards the cultural and contextual factors playing a role in psychological treatment.