#MeToo. Time’s Up. I Believe Survivors. 2017 brought a massive uprising of activism around issues of sexual harassment, assault, and gender-based violence in our communities. However, the challenge is not new to clinical work, and mental health professionals regularly grapple with the best way to support clients navigating an onslaught of sexual violence in their daily lives. Mental health professionals may need to engage problem-solving strategies, emotion-based coping, and structural change advocacy to find the approach that best suits their individual patient’s need.
The Challenge of Sexual Harassment
Before we prescribe a remedy, however, we must diagnose the condition. Sexual harassment is a pattern of unwelcome sexual comments or actions that rely on power dynamics to make a victim uncomfortable. Sexual harassment is startlingly widespread. Even among healthcare providers, 30% to 70% of nurses, 53% of female psychologists, and 22% of dental hygienists report experiencing sexual harassment during their careers.1
Gelfand, Fitzgerald, and Drasgows’ typology for sexual harassment includes 3 distinct modalities: gender harassment, unwanted sexual attention, and sexual coercion. Gender harassment includes hostile or degrading language and behavior, such as catcalling. Unwanted sexual attention centers on inappropriate flirting, touching, grabbing, or sexual propositions. Sexual coercion involves the use of power or position to demand sexual favors, such as a supervisor promising a promotion or raise if their employee goes on a date with them.2
Regardless of whether a harasser is a boss, coworker, patient, schoolmate, or acquaintance, the consequences of prolonged harassment can be dire. Anxiety and depression are common problems for both men and women.3 Many people experience eating disorders, drug and alcohol abuse, job stress or turnover, and burnout.4
A Therapist’s Role
Mental health professionals have a plethora of tools at their disposal for helping sexual harassment victims process their experiences and move forward.
Current research on harassment indicates that problem-based coping strategies are generally more beneficial, because they allow the victim to have perceived control over the harassment.1 Problem-focused coping can include:
- confronting the harasser in a safe and premeditated environment;
- changing online and in-person behavior, such as deleting social media accounts, varying travel patterns, or requesting the harasser be transferred to a different employee’s supervision or care;
- blocking the harasser on social media; and
- seeking support from family members and peers.5
Therapists can offer additional strategies, such as using “I” Statements — “I think, I feel, I want” — when speaking to a harasser, or using the “broken record” approach, wherein a victim repeatedly uses a single direct statement in response to a harasser’s statements of deflection.1 Therapists can also use roleplay and cognitive rehearsal techniques to emotionally prepare their client if they choose to actively confront their harasser.
When a Patient Can’t Escape
Not everyone has the ability to actively confront their harasser. In situations where job security, housing, or other resources are at stake, different strategies are needed for coping with toxic interpersonal relationships.
Lucie Fielding, a counseling intern based in Charlottesville, Virginia, experienced harassment from one of her practicum site supervisors when she came out as transgender. “When I came out to my supervisor, he started asking a lot of inappropriate questions, like whether my wife and I were staying together, how we have sex, and whether I’ve had ‘the surgery.'” Fielding notes that this is a common form of harassment experienced by transgender people and that it made her uncomfortable. “I didn’t say anything, though. I found ways to reduce contact with him. I relied on my other supervisor more and reduced hours at that practicum site.”
Similar passive coping strategies are a common response to harassment. These strategies include wishful thinking, mental distraction, avoidance, and acquiescence.5
When a victim uses more passive strategies, they are at higher risk for revictimization by the same harasser. Mental health professionals can offer reframing techniques and emotional support strategies in these situations.
Expressing Emotion: Sexual harassment victims sometimes “put up with” harassment lest they risk losing their job, religious community, or peer support. A mental health professional can create a safe environment in which the client can express the pain and difficulty of these choices.
Avoiding Self-Blame: Some victims of sexual harassment believe that they brought the harassment on themselves. “Well, I was wearing a pretty skimpy outfit.” “We did date for a while last year, so I guess he thought it was okay.” “I should have said something, but after she did it twice, I felt like it was too late.” Fielding suggests that therapists can help their clients “let go of the guilt for how you should have handled the harassment” and can reassure clients that “no, it’s not your fault, you didn’t bring this on yourself.”
Discouraging Downplaying/Denial: Often victims will not identify their experiences as sexual harassment immediately and will downplay the mental and emotional effect that it has on them. Therapists can draw connections between a client’s social experience, their interpretation of the event, and the incumbent physiological distress to validate their trauma.
Building Empathy: Physical therapist Ziadee Cambier’s research on addressing inappropriate patient sexual behavior offers another strategy: understand where problematic behavior might come from and find empathy for a harasser.1 Cambier notes that abusers may act out because of poor boundaries, cognitive impairments, adverse effects from medication, or feelings of fear and powerlessness.1 When the origins of a harasser’s behavior are understood, the behavior becomes easier to process and deal with day to day. However, this does risk prolonging abusive relationships and should be carefully managed.
When Marginalized Bodies Flip the Script
Sexual harassment is by definition unwanted and uncomfortable attention and behavior, but inappropriate sexual behavior can be complicated by societal narratives about who is beautiful, sexual, and worthy of attention. Lucie Fielding recalls getting catcalled for the first time after her transition as a complicated, but ultimately pleasurable, experience, because her body was finally seen as feminine and attractive. She explains that harassment is predicated on “whose bodies are coded as desirable,” so marginalized people such as transgender, disabled, and fat individuals may have different responses to receiving unsolicited sexual attention.
Fielding is quick to acknowledge that a marginalized identity does not make harassment acceptable, but that therapists must be careful not to overlay their own interpretation of a patient’s experiences. Rather, mental health professionals can work to build up a client’s understanding of being sexual and desirable and find ways that desirability can be expressed or experienced in empowering ways and on their own terms.
For clinicians and clients alike, a purely interpersonal approach to addressing sexual harassment may ring hollow. Systems analysis and community activism are gaining traction as modalities within the therapeutic discipline, particularly in the social work school of thought. Feminist theory argues that sexual harassment is maintained by structural inequalities that normalize and perpetuate abuse.
To combat structural problems, we need to incorporate tools for addressing sexual harassment on a systemic level. Practitioners can provide the most benefit to their clients if they acknowledge the structural elements that reinforce their clients’ suffering and equip their clients to navigate toxic environments by encouraging them to engage in undoing those power structures.
One example is Communities United for Restorative Youth Justice (CURYJ), which hosts weekly femme healing circles at their Oakland, California, office. Indigo Mateo, the Healing Justice Program manager, explains that CURYJ’s healing circles make space for youth to tell their own stories, fight victim isolation, engage in political education around patriarchy and oppression, and participate in healing through art.
“CURYJ is hosting these circles because young women and femmes need our own space to cleanse ourselves of the shame caused by sexual violence and counteract the lack of healing justice in our communities,” Mateo said. “That’s why we’re incorporating art, storytelling, siblinghood, and political development into our time together.”
Mental health providers can encourage their clients to participate in community healing, political activism, and direct service as a way of redirecting their anger or hopelessness into tangible change.
There is no one way in which victims of sexual harassment cope with their experiences, because no two people experience harassment the same way. Different interpretations of trauma are all normal, and clinicians who are able to validate their clients’ feelings, triggers, and needs will be in the best position to aid healing. That healing may come in a variety of forms: one client may channel their fear from being stalked into an awareness campaign in their community. Another may find healing by translating their discomfort into a standup comedy routine. Still another may find that a session of emotional processing allows them to put the experience behind them.
Clients interested in joining the femme healing circle at CURYJ can reach out to Indigo Mateo at firstname.lastname@example.org or 732-770-7753.
- Cambier Z. Preparing new clinicians to identify, understand, and address inappropriate patient sexual behavior in the clinical environment. J Phys Ther Edu. 2013;27(2):7-14.
- Fitzgerald, LF, Drasgow, F, Hulin, CL, Gelfand, MJ, Magley, VJ. Antecedents and consequences of sexual harassment in organizations: a test of an integrated model. J Appl Psychol. 1997;82(4): 578-89.
- Vogt, DS, Pless, AP, King, LA, King, DW. Deployment stressors, gender, and mental health outcomes among Gulf War I veterans. J Trauma Stress. 2005;18:115-127.
- Cortina, LM, Berdahl, JL. Sexual harassment in organizations: a decade of research in review. In: The SAGE Handbook of Organizational Behavior: Volume I – Micro Approaches, Barling J, Cooper CL, eds. London: SAGE; 2008;469-497.
- Scarduzio, J, Sheff, S, Smith, M. Coping and sexual harassment: How victims cope across multiple settings. Arch Sex Behav. 2017;2:327-340.
This article originally appeared on Psychiatry Advisor