Date of Award

8-31-2019

Document Type

Open Access Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Counseling

First Advisor

Lisa Cosgrove

Second Advisor

Laura Hayden

Third Advisor

Ester Shapiro

Abstract

The prevalence of sexual violence in the United States is a critical issue and the aftermath of sexual assault can have profound effects on psychological well-being. Rape Crisis Centers play a vital role in supporting sexual violence survivors. The framework through which Rape Crisis Center clinicians understand the experiences of survivors has a substantial impact on the course of counseling, how survivors interpret their own experiences, and survivors’ psychological health. A neoliberal medicalized framework conceptualizes distress post-sexual assault as a disease or disorder and places the responsibility on an individual to ‘fix’ themselves, situating the problem within the person, rather than in a sociopolitical context. This framework has become increasingly prevalent in Western society and has permeated psychology.

The goal of the present study was to explore the impact of a neoliberal medicalized discourse on clinicians’ understandings of survivor distress and provide a counter-dialogue to the often polarizing conversations as to whether medicalization is ‘good’ or ‘bad.’ This study aimed to answer: 1) How does a medicalized discourse impact how Rape Crisis Center clinicians make meaning of their clients’ experiences post-sexual assault? And 2) What are the advantages and disadvantages of using a medicalized framework to understand the aftermath of sexual assault for survivors who seek services? Engaging in qualitative inquiry, a modified version of interpretative phenomenological analysis was employed.

Analysis revealed four master themes titled, Wielding the Double-Edged Sword of the Medical Model, Navigating the Healing Process with Survivors, Stay in Your Lane: The Role of the RCC, and Understanding and Honoring Survivor Shame. The themes are discussed in terms of how medical neoliberalism subtly influences clinicians’ work. Implications for social justice are considered, especially as they relate to Rape Crisis Centers’ aims to increase access for marginalized populations. Recommendations for researchers and clinicians working with sexual violence survivors are provided pertaining to (a) how to critically adopt a medical framework, (b) how to empower survivors with information about medication, (c) alternatives to individual counseling for survivors, and (d) future research with survivors to further explore the effects of medical neoliberalism on their conceptualizations of distress post-sexual assault.

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