Empathy - Einfühlung : An Absolutely Necessary Factor for Minimizing Re-Traumatization of Sexually Assaulted Victims

Having counseled many sexually assaulted victims, one thing that always sticks to my mind is that rape victims are re-traumatized when they were physically examined by physicians for treatment and investigation. Further re-traumatization occurs as these victims were interviewed by prosecuting attorney(s) and attorney(s) defending perpetrators.

Imagine what it would be like for a woman, whose sexual part was violated traumatically, upon being forcibly undressed and her leg tore open with violent forces, to be put on a physician’s examination seat, being asked to open her legs – for the sake of necessary medical treatment and obtaining legal evidence.

As they were put in the examination room, the victims have to open their legs, shortly after their perpetrators forcibly tore open their legs.  Even for the sake of necessary medical care and legally required investigation, this procedure is re-traumatizing, given that it is conducted shortly after the traumatic assault.

Victims of traumas, including sexual assaults, almost always experience and exhibit catatonia. They can hardly mobilize their bodies and body parts. This is particularly so with the parts affected most. But, an examining physician and assisting nurse(s) constantly ask victims to cooperate medical procedure and legal investigation by opening legs – when victims’ bodies are still catatonic.

In order to heal from catatonic effects of trauma, victims need some time and safe space. However, post-sexual-assault medical and legal procedure must be conducted as soon as possible to prevent medical complications, including infection, and to obtain legal evidence for perpetrator prosecution.

Psychologically, it is better to wait until the victims’ emotional stability is recovered up to a certain level to go through the medical procedure that requires their legs to be opened again and to have their sensitive and sacred anatomical part touched by another person.  However, in reality, medically and legally, rape victims are to be examined as soon as possible upon the assaults to prevent pathophysiological complication and to preserve prosecutor evidence.  This is a dilemma in working for healing and justice for sexually assaulted victims.

As a mental health clinician and pastoral minister, I do all I can to facilitate the victims’ healing and new psycholospiritual growth, focusing on their unique inner strengths. For this, I gently guide their attention to unearth what is not destroyed and lost – whatever sustained the traumatic assault – to rebuild their personhood anew.  Spiritually and pastorally, I also apply some biblical narratives, such as the post-exilic restorative narratives, to ignite the victims’ new hope and strengths, for healing and post-traumatic growth. However, a mental health clinician, like myself, is not the first helping professional that victims have to see.  They have no choice but to have a re-traumatizing physical examination by a physician, followed by attorney(s)’s investigatory interviews.  Victims seek psychological and spiritual care after such re-traumatizing and stressful procedures are over.

By the time victims seek professional psychological and spiritual care, they have gone through additional traumas and stress, because of this frustrating reality.

Though re-traumatizing and highly stressful, these physical examination, which requires the victims to open catatonic legs, and distressing investigative interviews are necessary medically and legally. Thus, there is a dilemma between the psychological -spiritual interests for the victims and the medical-legal interests for the victims. 

Whether you are a physician, or an attorney, or a psychologist, or a minister, we the helping professionals need to be aware of this dilemma in engaging our respective tasks for victims of sexual assaults.

In my clinical and pastoral work I provide for victims, it is important that I acknowledge their most sensitive and sacred anatomical part was traumatically assaulted and desecrated by the evil forces of the perpetrators. I also recognize that not only they sustained the horrendous traumatic sufferings but also re-traumatizing medical procedures and prosecutor investigations, as they come to me for healing and post-traumatic growth.

In fact, it is critically important that anything associated to the victims’ strengths are noted not only by the victims themselves but also by others.  Psychologists, ministers, physicians, nurses, social workers, and attorneys, who get involved in the victims’ post-assault life in their respective professional capacities, play important roles in this regard.  As other persons acknowledge the victims’ strengths, it helps them recognize their own resilient strengths to prompt healing and post-traumatic growth. It will also help them overcome and transcend victim mentality, which could haunt them for the rest of their lives.

The victims certainly understand that what is needed to be done medically and legally must be cone as it should .  However, given the inevitable re-traumatizing nature of this post-assault medically and legally required procedures, it makes difference if examining physicians and nurses, as well as interviewing attorneys and social workers, more sensitively acknowledge the victims’ re-traumatization with their procedures, and conduct more empathically.

Medical and legal procedures should not be mere mechanical tasks to be done. The procedural tasks must always sensitively and empathically acknowledge sexually assaulted victims’ traumatization and  re-traumatization.  

In a way, this is similar to how physicians should tell their patients “bad news” – shocking, even possibly traumatizing diagnoses.  In this regard, I always advise physicians and medical students to place themselves in places of their patients and see how they think their patients would like to hear what they rather do not want to hear.  Telling physicians to think how they would want to hear if they were the patients is not enough, because it does not sufficiently acknowledge patients’ unique perspective. Physicians need to go beyond the sphere of their own perspectives in empathically placing themselves in patients’ distressed hearts and minds.

Empathy means to enter into the pathos of patients. The German word, corresponding to empathy in English, is Einfühlung. It literally means to enter (ein) into the feeling (Fühlung), pathos, of the patient. Another way to understand is to become one (ein) contact (Fühlung), indicating solidarity with the patient.  The latter interpretation is more closer to Einfühlung’s similar word, Mitfühlung.  Thus, whether physicians are examining rape victims or telling “bad news” to terminally ill patients – whenever physicians had to perform a task that can shock and (re)traumatize patients – procedures must genuinely embody the very meaning of empathy or Einfühlung.  In other words, treating sexually assaulted victims must be conducted in a way for clinicians are in solidarity with victims in the very traumatize hearts and minds of them.  This is no easy task at all, as we cannot be totally free from the sphere of our own personal perspectives.  But, this is a very important task that we constantly strive for – to serve victims more sensitively and compassionately.

We must go beyond our own professional and personal perspective in dealing with such sensitive clinical issues, whether we are serving rape victims or terminally ill patients.

I always tell physicians, nurses, attorneys, medical students, nursing students, and law students, that being a physician, or a nurse, or an attorney, means being an empathic psychologist first.

Being an empathic psychologist and minister, as well as a physician and attorney, means simply being compassionate fellow human first, reflecting the new command (mandatum novum )of Jesus – love your neighbor (John 13:34) as the Good Samaritan did (Luke 10:25-37). Practice this commandment – not just in our specialized professional capacities, but first and foremost, as a fellow human being reaching out to victims.

We know professionally that the procedures need to be done as soon as possible – though we know that the victims are still in trauma.  We work under the pressure. However, this is only our own professional perspective.  And, we need to go beyond this for the sake of empathy – Einfühlung.

Though there is no simple one-fits-all kind of formulate, we must balance traumatize victims’ perspectives with our professional perspectives under the pressure by placing our own hearts and minds into the victims’, because this is the only way we can become genuinely empathic.

For this, we also need to constantly examine and reflect our own professional perspectives in light of the victims at each case and at each encounter. In order to accomplish this objective, we must first establish rapport with them by providing gentle, genuinely compassionate, secure space and time.  Without this, post-assault medical and legal procedures sure to re-traumatize unnecessarily due to the empathy deficit on our side.

Though the case may be successfully prosecuted at the expenses of the victims’ re-traumatization, I do not think   that justice, in a true sense, is attained this way.  As a pastoral psychologist, I continue to address lingering effects of their initial traumas from sexual assaults but also re-traumatizations brought by the post-assault investigative medical and legal procedures, lacking the aforementioned empathic sensitivity.

In addition to trauma and re-traumalizations, shame and guilt, as well as a sense of powerlessness are important factors to be addressed both psychologically and spiritually, as these factors certainly further complicate victims’ complicated accumulative traumatizations from re-traumatizations from medical and legal procedures.

In order to prevent such psychological complications and their further lingering effects, we really need to take empathy (Einfühlung) more seriously in a way for us to be in solidarity with victims not in our own perspectives but in their shattered hearts and minds.  This is also an absolutely necessary condition to prompt post-traumatic growth.