An Overview of Trauma’s Impact on Boundary Violation Investigations

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.

Offender Dynamics

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.

What’s Going on in the Brain

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.

• When the brain is working normally, we store memories in an autobiographical and chronological fashion. When prompted to recall a memory, we can usually recall those memories easily, almost like looking into a filing cabinet. The way we encode memories when our brain is impacted by trauma is different. Central details of the event become strongly encoded and peripheral details are weakly encoded or not encoded at all. What is critical to realize is that what are central details from the victim’s perspective may not be what would be expected.
• Also, the pre-frontal cortex, when working correctly, serves as our logic center. It is the part of the brain that separates us from animals, it is where we conduct our highest cognitive functions and it is where we usually make our decisions. When trauma impacts the brain, our pre-frontal cortex can stop working or “turn-off.” The brain realizes that weighing consequences, thoughtful decision making, and moral choices are not needed to survive. Often some of the counterintuitive decisions we see in victim behavior can result because their logic center is not functioning properly from the impact of trauma.
• Finally, when the brain experiences trauma, chemicals are released to survive the event that effect a person’s behavior. For example, one of the most common chemicals released is catecholamine, which can cause a surge of energy but can also impair memory.

Victim Response

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.”

Trauma-Informed Approach to Interviewing

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:

• Prioritize the victim’s comfort—make sure it is a safe, private place to talk. Across the country law enforcement are using what are known as “soft” interview rooms. These rooms look and feel a lot like living rooms instead of the formal feel of traditional interview or conference rooms.
• Trust and empathy are important. Interviewers should acknowledge that this is a hard experience for the victim. Trauma-informed interviews can take a lot of time and be very difficult. When possible, including an advocate in the process for the victim is the best practice.

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:

• Help me understand your perspective when…?
• What was going through your mind when…?

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:

• How did your life change immediately after the assault?
• Is there anything you do differently now than you did before this happened?
• What stands out the most about your experience?
• Who have you shared your experience with?

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.

Conclusion

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.