Working with victims of crime: A manual applying research to clinical practice (Second Edition)
7.0 Pulling it Together: Concluding Remarks
Crime victims deserve timely, effective interventions that help them cope with their victimization and return to the best level of functioning possible. This manual is designed to provide recent research information to help workers develop and deliver services. Those who deliver front-line services to crime victims often face people dealing with extreme distress, who have poor coping skills, mental health issues, little social support, who may have experienced repeated victimization and so forth. Basically, victims are a diverse group who have diverse reactions and require diverse services. It is important to note that all workers in victim services are dealing with these complex issues, from reception staff dealing with walk-in visits and telephone calls to those workers conducting groups and individual interventions. All these people can benefit from the information in this manual.
All workers should spend some time and effort in identifying and practising self-care activities. These skills will help them take care of themselves, their clients and their colleagues. Workers must be in their best mental state to help victims make decisions, learn new coping strategies, address supports, and build motivation. Further, workers can use the above research and theoretical information to help understand likely victim reactions and to improve intervention planning. By being forewarned, workers can adjust their interventions to the specific needs of each client. Such adjustments are central to bringing clients the best service possible. Workers should also note that the information and skills discussed above may help others affected by crime, such as a victim’s natural support system. Workers are likely very familiar with working with the victim’s supports in ensuring a healthy environment for the victim.
As noted above, one goal of this manual is to give workers a reference to key research findings and to make links to helping victims. This section summarizes much of the above research for quick reference. By using Casarez-Levison's (1992) model to anchor key research findings, readers may gain insight into what faces the crime victim coping with victimization and recovery. Workers may want to keep the following issues in mind when working with victims and their supports.
This stage focuses on the previctimization adaptation level of the person (Casarez-Levison 1992). Here workers will want to gather a relatively comprehensive history, either through a formal interview or through their normal ways of gathering information. The following elements should be covered:
- History of childhood physical and sexual abuse (Hembree et al. 2004; Messman and Long 1996; Nishith et al. 2000; Pimlott-Kubiak and Cortina 2003; Young et al. 2007)
- History of previous post-traumatic stress disorder (PTSD) (Brunet et al. 2001)
- Severity of previous PTSD episode(s) (Brunet et al. 2001)
- History of previous crime victimization or trauma (Amstadter et al. 2007; Byrne et al. 1999; Messman and Long 1996; Nishith et al. 2000; Norris et al. 1997; Ozer et al. 2003)
- Psychiatric history, especially depression (Boccellari, et al. 2007; Ozer et al. 2003)
- Family history of psychiatric problems (Ozer et al. 2003)
- Personality characteristics (Davis et al. 1998; Nolen-Hoeksema and Davis 1999; Thompson et al. 2002)
- Coping history (Dempsey 2002; Everly et al. 2000; Harvey and Bryant 2002)
- An inventory of strength and resources (Bandura 1997; Bonanno 2004; Bonanno 2005; Tedeschi and Calhoun 2004)
- Interpersonal relationship history (Kliewer et al. 2001; Mikulincer et al. 1993; Nelson et al. 2002)
- Crime characteristics, especially severity, have a profound effect on trauma (Gilboa-Schechtman and Foa 2001; Hembree et al. 2004; Norris et al. 1997; Ozer et al. 2003).
- Characteristics such as gender, age, culture, and history can affect the victim’s reaction (Boccellari et al. 2007; Brewin et al. 2000, Greenberg and Ruback 1992; Gabriel et al. 2007; Pimlott-Kubiak and Cortina 2003; Wilmsen-Thornhill and Thornhill 1991; Weinrath 2000; Yamawaki 2007).
- Secondary victimization by the system is a real risk (Amstadter et al. 2007; Campbell et al. 1999; Hagemann 1992; Norris et al. 1997).
- Interviewers need to be aware of problems associated with victim characteristics, such as intellectual disabilities (Cederborg and Lamb 2008) and other cognitive problems that might affect reporting.
- Dissociation during or immediately following the crime is a strong predictor of PTSD (Halligan et al. 2003; Ozer et al. 2003).
- Trauma memories are more disorganized than non-trauma memories (Halligan et al. 2003).
- Initial dissociation (shock) may be adaptive in some cases in that it may interfere with encoding into the long-term memory (Bromberg 2003).
- There may be a narrowing of attention (Holman and Silver 1998).
- There is a need for social support (emotional, informational, appraisal and instrumental).
- Gather information aimed at helping the victim make decisions.
- Gather information about resources and common reactions.
- Emotional reactions need to be experienced and processed (Green and Diaz 2008; Hill 2004).
- Assess the victim’s coping strategies.
- Many victims of crimes do not report the crime to authorities (Boeckmann and Turpin-Petrosino 2002; Garnetts et al. 1990; Herek et al. 2002; Janoff 2005; Kaysen et al. 2005; Kuehnle and Sullivan 2003).
- Crisis-intervention models may be useful in helping the victim overcome the initial challenges of surviving a crime (Calhoun and Atkeson 1991; Miller 1998). However, recent research shows no effect on later development of PTSD (Marchand et al. 2006), and some argue that debriefing is ineffective and possibly harmful (Kamphuis and Emmelkamp 2005).
- Active treatment may be initiated (Casarez-Levison 1992).
- Natural and professional supports could be accessed (Casarez-Levison 1992; Combalbert and Vitry 2007; Miller 1998).
- Applying the Transtheoretical Model of Change may help identify what level of service is needed (Prochaska et al. 1992).
- Dissociation may indicate later difficulties (Ozer et al. 2003).
- Interpersonal friction soon after the crime may be predictive of later PTSD (Zoellner et al. 1999).
- PTSD may be predictive of later anger problems (Orth et al. 2008).
- People with pre-existing personality disorder diagnoses (borderline personality disorder) can still benefit from treatment (Clarke et al. 2008).
- There may be active blocking of memories (Nordanger 2007; Thompson 2000).
- Victims may avoid crime-related reminders, either through drugs or alcohol or through active avoidance (Everly et al. 2000; Hagemann 1992; Janoff 2005. Manktelow 2007; Mezy 1988; Nordanger 2007; Wolkenstein and Sterman 1998).
- There is some evidence that viewing media reports of the crime can have a negative affect on victims (Maercker and Mehr 2006).
- Victims may engage in safety-oriented behaviours (Hagemann 1992).
- Victims may focus on meaning-making (Gorman 2001; Layne et al. 2001; Nolen-Hoeksema and Davis 1999; Thompson 2000).
- Victims may use social comparison to understand their experience of victimization (Hagemann 1992; Greenberg and Ruback 1992; Thompson 2000).
- Victims may engage in self-comparison activities focused on pre- or post-victimization changes (“survivor”) (McFarland and Alvaro 2000).
- Victims need to be informed that entering treatment may mean getting worse before getting better (Nishith et al. 2002).
- Treatments of PTSD including an exposure element seem to be effective (Bryant et al. 2003; Hembree and Foa 2003; Nishith et al. 2002).
- Self-efficacy may be important in treatment programs (Thompson et al. 2002);
- The treatment model can affect the program drop-out rate (McDonagh et al. 2005).
- Emotionally engaged clients recover faster (Gilboa-Schechtman and Foa 2001).
- Victims may avoid victim service providers (Boccellari et al. 2007).
- Being employed may increase risk of poor coping, possibly because of the addition of work-related stressors (Boccellari et al. 2007).
- Emotion-focused coping may decrease distress (Green and Diaz 2007 and 2008).
- Recovery does not mean returning to a pre-victimized state (Hagemann 1992).
- The Transtheoretical Model of Change may be useful in maintaining new, healthier behaviours (Prochaska, DiClemente and Norcross 1992).
- Victims may focus on how surviving indicates strength (Hagemann 1992; Thompson 2000).
- Any remaining negative coping strategies need to be minimized (Dempsey 2002).
- Activism is a possible long-term outcome of victimization (Hagemann 1992).
- Victims may attribute physical problems to dealing with the negative effects of trauma (Manktelow 2007).
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