Trauma victims have unique needs that regulators should be aware of. This article is an adaptation of a presentation by Michael Milnor and Nancy Oglesby at the 2019 FSBPT Annual Meeting.
Behaviors of victims of sexual assault are often misunderstood. As Barbara Ziv, the forensic psychiatrist that testified at both the Bill Cosby and Harvey Weinstein trials said, “Sexual assault is one of the most misunderstood crimes…people think they know it. However, most common knowledge about sexual assault is wrong.” It is important that regulators understand and recognize trauma when handling complaints of sexual assault.
Sexual assault is rarely committed by the “stranger hiding in the bushes.” It also rarely involves significant amounts of violence, especially when it occurs between people who know each other. Research tells us that in the far majority of sexual assault cases the parties involved know each other. Both the criminal justice system and medical board regulatory systems are struggling with how to appropriately respond to these cases. Most cases reported do not end in any kind of conviction or accountability.
In your world of physical therapy regulation, it is often more complicated than in the criminal justice system, which is our background. It is complicated by the fact that you are dealing with professionals who have a license to touch. Additionally, perpetrators often seek out victims who have perceived credibility issues, whose statement will not stand up well compared to medical professionals who are usually regarded as having high levels of credibility.
Research tells us that the majority of people will never commit a sexual assault, however, those that do usually offend multiple times and have multiple victims. Therefore, recognizing the serial nature of sexual offenders, and the need for intervention and accountability, it is important to understand a few things about sexual assault.
Trauma response applies to all types of violence, but it is misunderstood more frequently in sexual assault cases because there is usually no obvious external evidence that corroborates what has happened. For example, if police are responding to someone who has been shot and that person is saying crazy things, laughing, unable to recount exactly what happened to them, or exhibiting other “odd” behaviors, the officers don’t say, “Oh wow, you’re acting strange, you haven’t been shot,” because there is clear evidence of what happened.
However, with sexual assault, we usually don’t have the external corroboration that a bullet wound provides. Therefore, it is easy to focus entirely on a victim’s statement and behavior and when it doesn’t make sense to default to what law enforcement has traditionally been taught: a weak narrative and unusual behavior means an unreliable statement or deception. Also, when victims exhibit what we frequently refer to as “counterintuitive behaviors,” like going back to the same medical provider even after they were assaulted, it is easy to point to their choices as proof the assault didn’t happen. In fact, what may be occurring is a natural instinct in all of us, which is when we get hurt, we tend to minimize the severity of a situation and try and normalize what has just happened.
So, what’s going on in the brain when impacted by trauma? Here is a really basic overview.
It is very uncommon for someone to report a sexual assault immediately. A delay in disclosing what happened, especially making an official report, is the norm. Regardless of the timing of the report, there is no typical victim demeanor. Victims can relay what happened to them while appearing upset, flat, frightened—and they might even laugh.
Everyone has heard the phrase “fight or flight” and many people expect a victim to fight back against their attacker or to try and run away. In reality there may instead be a “freeze” response, either from the surprise and shock of what is occurring or from what is scientifically called tonic immobility. In investigations you may hear a victim say something like, “I wanted to run, but I just couldn’t feel my legs.” Or you may hear a victim describe another form of “flight,” which may actually be disassociation, by saying something like, “I felt like I was watching this happen from outside of my body.”
Traditional interview methods focus on the “who, what, where, when, and why” questions. Instinctively, investigators want to take a clear, concise statement that is chronological and detailed. However, if the brain has been impacted by trauma and memories have been encoded differently than normal, this approach will not result in getting the best statement from your victim.
Trauma victims may strongly encode in their memory what they perceive as central to their survival while many other peripheral details may be weakly encoded or not encoded at all. For instance, a victim may be able to describe a clock on the wall that they focused intently on during the assault but not be able to recall what was heard. If a nurse had knocked on the door twice but the victim says no one came to the door, it doesn’t necessarily mean the victim is being dishonest or is not credible. Instead, it could mean those sounds were not ever encoded in their memory.
Since it is a different experience for every victim, there is no way to know what a victim will encode in their memory. Because of this, instead of expecting a chronological, strong narrative, one should expect the possibility of a weak narrative with gaps in the victim’s memory. Realizing this, the best way to start an interview is to ask the victim to share what they are able to remember about their experience. This gives them permission to start at any point and also lets them know you realize they might not remember all of the details.
Other things to consider for a successful trauma-informed interview are included below:
Traditionally, investigators have asked victims “why” questions—questions like “why didn’t you scream out” or “why did you stay in the room?” These questions are heard as judgmental questions by a victim and can quickly shut down trust and communication. Instead, consider questions like these:
Ultimately, we are after the most accurate account possible of what occurred. In addition to the statement, finding ways to corroborate the event is critical. The following questions can lead to information that can ultimately be corroborated:
Trauma will frequently manifest itself into a victim’s life in a way that can be documented. Although not proof of the assault in and of itself, documenting the manifestation of trauma can corroborate what a victim has experienced.
We are training law enforcement to change the script. Inconsistent statements, gaps in memory, a weak narrative, and/or counter-intuitive behaviors are not always a sign of dishonesty or false allegations. Training investigators to understand trauma is necessary to properly conduct sexual assault investigations.
Co-founder, Justice 3D
Mike Milnor has been involved in law enforcement for over thirty-six years and recently retired as Chief of Police for Altavista, Virginia. In addition to being involved in thousands of investigations, Mike has also done an extensive amount of teaching in criminal justice with an emphasis in the areas of sexual assault, child abuse, elder abuse, and domestic violence, as well as being a Professor of Criminal Justice at Liberty University. Mike also contributed to the development of Virginia’s Model Law Enforcement Policy on Sexual Assault Investigation. In 2016, Mike was selected to the core faculty of the National Center for Campus Public Safety, which allowed him the opportunity to instruct at colleges and universities across the country in the areas of sexual assault investigation, Title IX compliance, and campus violence.
In 2016, Mike cofounded Justice 3D, a company that offers training and consulting to allied professionals nationally on issues of child abuse, domestic violence, and sexual assault.
Nancy has been a career prosecutor in the Commonwealth of Virginia for over twenty years. She is currently Virginia’s Domestic and Sexual Violence Resource Prosecutor. Nancy has handled thousands of domestic violence, child abuse, and sexual assault cases. In addition, she has provided training on these issues to many professionals including prosecutors, law enforcement officers, advocates, medical professionals, and forensic interviewers. She has been appointed by four Virginia governors to statewide advisory boards, commissions, and task forces devoted to combatting domestic and sexual violence. Nancy also served a key role in the development of Virginia’s model law enforcement policies related to domestic and sexual violence.
In 2011, Nancy was chosen by the Virginia Association of Commonwealth’s Attorneys to receive the Virginia S. Duvall Distinguished Juvenile and Domestic Court Prosecutor Award. She also was recognized in 2012 as the Outstanding Woman of the Year in the area of Law and Government by the Richmond YWCA. In 2017, she received the Lecturer of Merit Award in recognition of her exceptional leadership and commitment to the training of Virginia Prosecutors. Most recently, in 2019, she was recognized by the National Organization for Victim Assistance for her dedication to empowering victims and survivors of crimes.
Nancy is a co-founder of Justice 3D, a company that offers training and consulting to allied professionals nationally on issues of child abuse, domestic violence, and sexual assualt.