Working with victims of crime: A manual applying research to clinical practice (Second Edition)

4.0 How do Victims Cope?

Workers should also be aware of how victims cope. The victim faces many different challenges: the shock of being victimized, dealing with the police and courts, the reactions of others, returning to “normal,” feeling unsafe, self-blame and so on. Researchers note that victims don’t seem to return to pre-crime levels of stress, although they can manage to function relatively well (Hagemann 1992; Norris et al. 1997; Resick et al. 2002). Although the passage of time may give a victim the opportunity to return to a “normal” life, victimization appears to have long-lasting effects (Gilboa-Schechtman and Foa 2001; Norris et al. 1997). By understanding coping options for victims, workers can help victims use this time to explore options and learn new, more effective coping strategies. Also, monitoring the use of these strategies helps workers assess client progress, because research shows that victims use coping techniques less and less as they get better (Calhoun and Atkeson 1991).

In addition, regular life stress is often overlooked when we focus on victim distress and coping. Victims of crime continue to deal with the same family, relationship and life stress as other people. Thus, the stress of being a crime victim is piled on top of the other stressors. Recent research has found that victims of crime who are employed are at increased risk of using poorer coping strategies (Boccellari et al. 2007). These researchers theorize that this is because added work stress interferes with effectively choosing healing strategies. Workers are reminded to look beyond the crime-related distress and coping to other stressors in the person’s life. They can then direct clients to appropriate supports. For example, a victim with poor reading skills who cannot read self-help booklets or fully participate in support groups could be referred to community literacy programs.

Before discussing specific coping strategies, we need to make a key distinction. The research literature highlights the differences between positive and negative coping. Positive coping focuses on changing ourselves or dealing directly with the problem (e.g. social support, problem-solving efforts, seeking information). Negative coping generally does not focus on the stressor or our reaction to it (e.g. blaming others, withdrawal, resignation, self-criticism, aggression, wishful thinking, use of alcohol or drugs). Dempsey (2002) found that using negative coping strategies could make the person feel worse.

This positive-negative distinction is not clear-cut. Some researchers have noted that certain coping strategies, such as avoidance or dissociation, may be helpful in dealing with the initial shock but become damaging as time passes (Hagemann 1992; Harvey and Bryant 2002; Ullman 1999). Further, cultural norms can be a factor as well, in that coping strategies seen as negative in general Canadian society might be seen as normal in certain subcultures (see Nordanger 2007 for a discussion on avoidance and grief).

Workers need to assess each person to decide if his or her coping strategies are helping survival or progress or if it is getting in the way. Think of the victim as someone hanging off a cliff and holding onto a weak branch: it may not seem safe, but until there is another more trustworthy option, the person will not let go! Workers need to work with their clients to help them replace coping strategies that are not working with more positive options – not just remove the negative strategies. Remember, victims of crime are a diverse group, and workers need to assess each person in order to understand his or her particular reaction. Table 3 lists common coping strategies that victim of crime might use. I will briefly discuss each in turn.

Table 3: Common Coping Strategies

Positive Coping Strategies

  • Information seeking 5
  • Self-comparison/emphasizing the positive aspects of surviving 1, 5, 11, 19
  • Social comparison 4, 5, 8, 19
  • Activities to regain control 4, 5, 26
  • Activism 5
  • Time to heal 3, 5, 15, 17
  • Emotion-focused coping 23, 24
  • Getting support 2, 4, 9, 14, 15, 23, 24

Negative Coping Strategies

  • Avoiding reminders of the crime 2, 5, 13, 20, 21, 22, 25, 26, 27, 28
  • Behavioural avoidance  - Use of drugs/alcohol
  • Denial and self-deception 13, 18, 19, 20, 26
  • Dissociation 6, 10, 15
  • Obsessing about the crime 4, 7
  • Self-harm 29, 30

Updated references

4.1 Positive Coping Strategies

Seeking information

Often, victims of crime simply want information (Hagemann 1992). Useful information might include details about the justice system, program options, and common reactions (Greenberg and Ruback 1992). Gathering information can also play a key part in the victim’s decision between different treatment options or even whether to seek help at all (Prochaska et al. 1992).

Cognitive reframing of victimization: Self-comparison and emphasizing the positive aspects of having survived

In research on sexual assault victims, Hagemann (1992) noted that some victims feel better by focusing on how they are now survivors. Thompson (2000) noted that sexual assault victims may initially embrace the term “victim” because it shows that the assault was not their fault. As they deal with their experience, they switch to “survivor” because it reflects strength, recovery, and being a fighter. This seems to help some victims regain control over their lives. When dealing with tough situations, people often need to make sense of what happened and then search for some personal benefit, no matter how negative the event was (Davis et al. 1998).

Put into lay terms, this point means: “That which does not kill you makes you stronger.” Getting through a difficult situation successfully seems to help victims see themselves as strong (Thompson 2000), and the tougher the situation the greater the effect (McFarland and Alvaro 2000).  In fact, people will often see themselves as having been much weaker before the event, even if that is not true (McFarland and Alvaro 2000). This may be done in an effort to see benefit in an obviously difficult situation (Davis et al. 1998). Tugade and Fredrickson (2007) discuss how resilient people are able to find positive meanings in negative events.

Cognitive reframing of victimization: Social comparison

Victims will often compare themselves to other victims in an effort to make sense of what happened to them. They may look to victims who are doing well as an inspiration to keep going (Greenberg and Ruback 1992). This is a double-edged sword, as they may also lose hope if they feel they aren’t making similar progress. Victims may also compare themselves to other victims who are worse off – they may feel better that they weren’t victimized as badly as someone else (Hagemann 1992; Greenberg and Ruback 1992; Thompson 2000). If they don’t know of others who are worse off, these victims will create fantasies of “it could have been much worse.” In these fantasies, they review the crime but add in even greater physical, emotional or personal damage (Greenberg and Ruback 1992). This seems to help people gain perspective, and may even relate to a focus on the positive aspects of being a survivor (Thompson 2000).

Activities for regaining control

Victims can also do things that make them feel more in control of their life. For instance, victims of assault might take self-defence classes (Hagemann 1992), while other victims might lay charges and go to court (Greenberg and Ruback 1992).

Activism

It appears that some victims heal by becoming advocates or activists (Hagemann 1992). They apply their experience on a social level, trying to change society so that it will create fewer victims or treat victims more fairly.

Emotion-focused coping

Emotion-focused coping involves activities that try to directly change how the victim feels (positive thinking, relaxation, expression of emotions, distraction). Recent research suggests that emotion-focused coping may help to reduce stress and improve the victim’s self-assessment of how he or she is coping (Green and Diaz 2007 and 2008). In contrast, these researchers found that problem-focused coping (strategies that focus on changing their actions in the situation) increased emotional distress. This link was stronger among women than men.

Use of social support

Crime victims often feel out of sorts (Casarez-Levison 1992) and may seek others for support (Greenberg and Beach 2004; Greenberg and Ruback 1992; Leymann and Lindell 1992; Norris et al. 1997; Steel et al. 2004). Research indicates that people who get positive social support show better adjustment (Nolen-Hoeksema and Davis 1999; Steel et al. 2004). Further, it appears that even the belief that they have support can make victims feel better (Green and Diaz 2007), especially if they are dealing with anger (Green and Pomeroy 2007). Both natural supports (family, friends, etc.) and professional supports (police, lawyer, clergy, medical, mental health) can offer help to the victim. Although the decision regarding where to go for support lies with the victim, those who use natural supports are also more likely to seek professional help, especially if they feel positively supported (Norris et al. 1997). Supportive people may provide information, companionship, reality checks, emotional support, and money or a safe place to live (Everly et al. 2000). Support also seems to reduce the victim’s anxiety (Green and Pomeroy 2007). A recent Canadian survey indicates that 60% of victims of violent crime and 80% of victims of non-violent crime seek out family support (AuCoin and Beauchamp 2007).

Norris et al. (1997) noted that some victims benefit from talking to other people about their experience and feelings. Telling their story seems to help make sense of what happened and of their emotions (Greenberg and Ruback 1992). It may help them let go of troubling feelings or get a reality check about thoughts, actions and feelings (Greenberg and Ruback 1992; Leymann and Lindell 1992; Nolen-Hoeksema and Davis 1999; Norris et al. 1997). Victims are often able to describe the type of support they want. The information in Table 4 will help workers think about support and match the victim’s needs to which type of support to provide or access. We should be careful not to get caught up in providing the type of support we think victims need rather than asking them for guidance.

Table 4:   Types of Support
(developed from Leymann and Lindell 1992). 

Support Type

Description

Emotional

Esteem, concern and listening with a focus on the victim’s feelings and reactions

Appraisal

Social comparison, affirmation and feedback targeted at helping the victim make sense of his or her experiences

Informational

Advice, suggestions, directives and information

Instrumental

Material support such as money, shelter, time or effort

Perceived support versus actual support

It is important for workers to realize that both actual support (e.g. going to a support group or meeting with a counsellor) and perceived support (e.g. believing help is available if it is needed) help victims cope. Perceived support results in reduced fear, depression and post-traumatic stress symptoms (Norris et al. 1997; Ozer et al. 2003; Steel et al. 2004).  A possible explanation for this finding is that people need to know that they can get support if they want it and that others are concerned about them. In fact, a poor reaction from supports is linked with increased victim distress (Mueller et al. 2008). Just knowing that their local community has a victim services office may help many victims cope – even if they never use the services. Needless to say, receiving actual support is also helpful to victims (Norris et al. 1997; Ozer et al. 2003). 

Professional supports versus natural supports

Some victims report that they find their natural supports more useful than professional support (Leymann and Lindell 1992); however, in some cases, they may still prefer to rely upon professionals. Recent research with victims of family violence shows that women dealing with “intimate terrorism” (ongoing violence based on power and control) were more likely to access professional supports than woman dealing with partner violence over specific conflicts (Leahy et al. 2004). Other research indicates that cultural attitudes about victimization (e.g. shame associated with being a victim of sexual assault) may influence choices in seeking out professional or natural supports (Yamawaki 2007). It is likely that the victim decides on the best source for support based upon her attitudes, expectations, needs and past experience.

Workers and victims should be aware that those in the victim’s natural support system might be less able to deal with the challenges facing the victim. Natural supports may initially be helpful, but they can make mistakes or become overwhelmed with the intensity of helping the victim cope (Mikulincer et al. 1993; Nolen-Hoeksema and Davis 1999). A recent survey examining crime victimization and PTSD showed that natural supports were not as helpful to people who had high levels of repeated victimization (Scarpa et al. 2006). In the worst case, the natural supports may not believe the victim or have a negative reaction, causing even more distress (Leahy et al. 2003; Mueller et al. 2008). Some victims describe feeling that their normal supports begin to avoid contact because they do not know what to do (DeValve 2005). In any case, a social network can “burn out” leaving the victim feeling abandoned, isolated and misunderstood.

Look back at Table 4 and imagine a friend trying to be emotionally supportive when the victim only wants information. This mismatch could result in his not going to that friend (or others) again because he feels frustrated and misunderstood. Each person has his or her own way of coping with victimization. If we try to get others to adopt our style of coping, they may feel that they have not been heard (Nelson et al. 2002). This is important because dealing with non-supportive people can add new layers of stress onto an already tough situation (Nolen-Hoeksema and Davis 1999). 

For these reasons, some victims may find it helpful to seek out professional support. In an ideal world, most professionals would have training in listening, empathy, challenging, and providing a range of therapeutic actions. Professionals should be better equipped to cope with repetitive stories and accounts. They should also be better able to identify and provide the specific support needed by the victim. Furthermore, with a professional, victims do not need to be concerned about damaging a personal bond, since the relationship is focused on dealing with the crime-related trauma.  Professionals should also be less likely to impose their views and work to meet the victim “where he or she lives.” Some researchers have warned that professionals and paraprofessionals with their own victimization histories may “over-promote” certain solutions because they worked for them (Salston and Figley 2003).

4.2 Negative Coping Strategies

Active behavioural avoidance

Avoidance can show up as behavioural avoidance, such as not leaving one’s apartment or taking time off work (Hagemann 1992), avoiding victim services workers or therapists (Gorde et al. 2004), and so forth. Generally speaking, researchers agree that avoidance is at best a band-aid solution and at worst ineffective and harmful (Scarpa et al. 2006). Research on female victims of assault (sexual or physical) found that those who knew their assailant and also withdrew from supports in the initial aftermath of the crime were at increased risk of developing PTSD (Gutner et al. 2006). This means that those victims who initially avoid social contacts may have increased problems (see benefits of social support above). In examining survivors of family violence, researchers found that avoiding help may be related to the stability of their living arrangements: victims in shelters or transition housing were more likely to use avoidance than those in the community (Gorde et al. 2004).

In some cases, initial avoidance of challenging situations may help victims slowly build on small successes. This may allow victims to take time to heal and gather resources to rebuild their lives and deal with other challenges (e. g. the criminal justice system). As they receive treatment focused on confronting their fear, they are likely to feel better.

Denial and self-deception

Acting as a type of psychological avoidance, denial and self-deception work to help victims temporarily erase the memories. Thompson (2000) discusses the active blocking of memories and feelings to help cope with overwhelming emotions. Stillwell and Baumeister (1997) indicate that people tend to bias their recall to make themselves appear more sympathetic. In researching trauma associated with living in a war zone, Mikulincer et al. (1993) found that people who cope by avoiding are more likely to deny or minimize their internal distress. Although these approaches may get in the way of seeking help, they may also lessen initial distress (Hagemann 1992). Ullman (1999) agrees, and indicated that although avoidance strategies are usually linked to greater problems, they could also be adaptive by helping the victim get through the initial trauma. 

Dissociation

Dissociation is a clinical term that means that there is a break in a person’s normal way of thinking, memory, identity or how he sees his environment. This is similar to what most people might call “shock”.  Although we all dissociate to some degree, people with a history of frequent and severe traumatic experiences seem more commonly to use it to cope (Martínez-Taboas and Bernal 2000). Workers need to remember that dissociation can be a natural way of dealing with trauma. Harvey and Bryant (2002) indicated that dissociation might help a victim cope with the initial trauma by getting in the way of recording memories during the crime. This cognitive change allows the victim to forget difficult elements of the crime or trauma and may result in reduced distress. However, mounting evidence around initial dissociation and subsequent problems is casting doubt on this theory (Bromberg 2003; Elklit and Brink 2004; Halligan et al. 2003; Ozer et al. (2003).

Dissociation can also be a negative coping strategy when used for too long. Halligan et al. (2003) indicated that specific elements of dissociation, namely emotional numbing, confusion or altered sense of time, and moodiness or impulsiveness, were more related to PTSD. They found that emotional numbing and confusion likely interfered most with dealing with the trauma. Elklit and Brink (2004) found that initial shock, dissociation, and numbing were related to the PTSD that followed six months later. Ozer et al. (2003) found that those who experience dissociation either during or immediately after a traumatic experience were more likely to develop PTSD; this link was most evident in those who later wanted mental health services. Further, others have noted that prolonged dissociation can interfere with the healing process or treatment (Bromberg 2003). Thus, dissociation is a double-edged sword; it may help in the short term, but it seems to place the victim at increased risk for later problems.

Substance misuse

Misuse or abuse of alcohol or drugs (self-medication through illegal drugs or overuse of prescription medication) is often mentioned in the literature as a complicating factor in victims of crime (Casarez-Levison 1992; Everly et al. 2000; Hagemann 1992; Mezy 1988; Wolkenstein and Sterman 1998).  Those who self-medicate to avoid their pain, etc. are likely to experience even greater challenges, since using alcohol or drugs can often interfere with decision making and coping (Kilpatrick et al. 2003). A study of victimization of adolescent girls and alcohol use showed that early initiation into drinking and binge drinking increased the chance of victimization (Champion et al. 2004). They also point out that those who abuse substances might be at increased risk for victimization. Specifically, people abusing substances may put themselves in unsafe situations, have poor ability to assess dangerous situations or people, and be more vulnerable to victimizers. Thus, substance misuse might be a coping strategy that increases the chance of future victimization (Champion et al. 2004). Morrison and Doucet (2008) recently completed a review of the literature on crime victimization and substance misuse, noting the importance of training, screening, improved case management and treatment strategies to improve working with this group.

Confrontation: Cognitively narrowing the focus

Holman and Silver (1998) pointed out that when people are presented with complex stimuli, their ability to process the information is weakened. Thus, they may slow down time in their heads to cope with everything that is going on. These authors point out that this should help them adapt, but some people become overly focused on the traumatic event, ignoring everything else (Holman and Silver 1998). This change in consciousness is similar to dissociation (Bromberg 2003), but the focus is on trying to deal with the stressor rather than ignoring it. Further, Greenberg and Ruback (1992) found that arousal, specifically anger, resulted in improved recall. Thus, focused arousal may allow the victim to pay closer attention to the specifics of the crime. However, recent research supports the conclusion that this focus can cause problems for a person trying to move beyond the victimization experience because they are unable to focus on other aspects of his life (Orth et al. 2008; Orth et al. 2006).

Deliberate (Non-Suicidal) Self-harm

Deliberate self-harm or non-suicidal self-harm is when a person deliberately causes themself harm. Although one often hears of people engaging in physical self-harm such as cutting or burning themselves, there is an argument that self-destructive behaviours such as prostitution, substance abuse, eating disorders and so forth also fall under the category of deliberate self-harm (Cyr et al. 2005; Dell 2008). In a study of women undergoing treatment for anxiety and depression, Peleikis et al. (2004) noted that having a history of childhood sexual abuse placed women at increased risk for self-harm. A Quebec study of female adolescents who were victims of sexual abuse showed that 62.1% had engaged in self-mutilation (Cyr et al. 2005). These researchers also found that those in the high self-harm group reported more problems with depression and dissociation. Research on female psychiatric patients showed a relationship between domestic violence and self-harm behaviours, indicating that it may be important to screen for this issue among these victims (Sansone et al. 2007).

Workers should also note that such self-harm is not a suicide attempt, but rather a behaviour focused on reducing emotional distress (Dell 2008). However, much confusion occurs because non-suicidal self-harm can be mistaken for suicidal behaviour (Dell 2008). In a study examining histories of abuse in people who truly wanted to kill themselves, those who had repeated attempts and reported childhood sexual or physical abuse also reported higher levels of self-harm behaviour (Ystgaard et al. 2004). 

4.3 Resiliency, Self-efficacy and Post-traumatic Growth

In examining coping strategies in victims of crime there is growing research that examines how people successfully weather challenges. Resiliency, self-efficacy and post-traumatic growth are three slightly different ways of looking at how people can apply strengths to dealing with trauma. Workers may be interested in these concepts as ways to improve their understanding of how people can move forward.

Resilience refers to a person’s ability to maintain a balanced state in the face of challenges (Bonanno 2004). It is not simply the absence of problems, but the ability to remain unaffected and actually stay healthy despite challenges. It is also not the same as recovery, which has an element of “bouncing back” after being traumatized (Bonanno 2005). Resilience is common (Bonanno 2004; Westphal and Bonanno 2007); as noted above, most people faced with criminal victimization do not go on to develop mental health problems (Ozer et al. 2003).

Truly resilient clients will be a rarity in clinical practice, but may appear on workers’ caseloads as they are preparing to testify in court. These victims may still need a range of support, but they are likely to present and handle the stress well. In clinical practice, it is more likely that workers will find themselves dealing with issues relating to self-efficacy and post-traumatic growth.

Self-efficacy refers to a person’s belief that he or she has the tools and resources to successfully handle a challenge or task (Bandura 1997). Researchers have identified self-efficacy as a characteristic similar to resilience that may make people less likely to develop a severe reaction to being victimized (Thompson, et al. 2002).  Self-efficacy is a merging of self-esteem with a belief that you can affect your environment. Thompson et al. (2002) noted that helping women develop high levels of self-efficacy about life skills might increase the chance they would leave their violent relationship. This challenges the “isolation” factor that one often sees in domestic violence.

Each victim has a different level of self-efficacy prior to the crime. Over a lifetime, individuals who experience successes will increase self-efficacy and confidence. Contrast this to a lifetime of experiencing an inability to cope, which decreases an individual’s self-efficacy. These previous levels of self-efficacy, in combination with the impact of the crime, will affect how the victim copes. For example, those who feel that they will receive help if they ask often feel better (Mikulincer et al. 1993). Thus, self-efficacy can play a central role in coping with trauma and seeking help. Also, these individuals may have greater coping skills to help them. Other victims may need to develop skills and build up self-efficacy to deal with stress. Many effective treatments for victims include activities that require them to confront and successfully deal with difficult memories and emotions or learn and practise new skills, which ultimately increases the sense of self-efficacy (Amstadter et al. 2007; Nishith et al. 2002; Resick et al. 2002).

“Post-traumatic growth” (PTG) refers to situations where a person who has been affected by the trauma learns new coping strategies or gains a new perspective by facing the problem. Overly resilient people may miss this growth opportunity since they are unaffected by the challenge (Pat-Horenczyk and Brom 2007; Tedeschi and Calhoun 2004).  It is important to note that PTG does not mean that dealing with trauma is a positive experience in these people’s lives. Even those people who report high levels of PTG also indicate many problems and difficulties related to the trauma (Calhoun and Tedeschi 2006). In other words, most people would rather have avoided the trauma altogether, but are able to recognize how they have grown.

When considering PTG, it may be useful to examine the different types of PTG that victims may experience. Calhoun and Tedeschi (2006) looked at PTG statistically and found three general categories of growth:

  1. Change in how the person sees herself or himself
    1. Personal strength: I can survive anything
    2. New possibilities: I want to explore new interests/ activities
  2. Change in how he or she relates to others: Connection and compassion
  3. Change in life philosophy
    1. Appreciation of life (enjoy the little things)
    2. Spiritual change

Workers may be able to identify growth processes within specific clients or within all their clients. Those victims with few skills and resources are likely to become quickly overwhelmed by trauma. Much work will be needed for the person to face the challenges brought about by the crime. Many people will have some skills to face problems but will also need to build new ones (PTG). Finally, some people are at the extreme and will be unaffected by trauma (resilient). Much research shows that victims are initially affected but that they use their personal and social resources (self-efficacy) to “bounce back” – this is PTG.

Workers may want to take a broader view of resiliency and incorporate the PTG perspective that many victims are, in fact, affected by the criminal victimization but are able nonetheless to rebuild their lives and potentially learn new ways of coping. Given this, what are some of the key research findings around resiliency and how can workers encourage growth and resiliency in their clients? Bonanno (2005) indicates that many of the activities we would identify as healthy living (personal resources, a good support network, pragmatism) also promote resilience. Researchers have identified several factors related to successfully facing challenges:

To increase resiliency, self-efficacy and the possibility of PTG, victims need to build on resources. Victims can build on strengths and learn to identify the positives, enjoy good days or positive supports, learn to relax and consider blessings or even make sure that they take time to truly savour a compliment. Workers can support these healthy choices. This is not to say these will be easy steps, especially with victims dealing with grief and loss. By practising strength-building activities, victims of crime will become primed to the habit of effectively dealing with setbacks (Tugade and Fredrickson 2007).

4.4 The Basics

Coping

Table 3: Common Coping Strategies

Positive Coping Strategies

  • Information seeking 5
  • Self-comparison/emphasizing the positive aspects of surviving 1, 5, 11, 19
  • Social comparison 4, 5, 8, 19
  • Activities to regain control 4, 5, 26
  • Activism 5
  • Time to heal 3, 5, 15, 17
  • Emotion-focused coping 23, 24
  • Getting support 2, 4, 9, 14, 15, 23, 24

Negative Coping Strategies

  • Avoiding reminders of the crime 2, 5, 13, 20, 21, 22, 25, 26, 27, 28
  • Behavioural avoidance  - Use of drugs/alcohol
  • Denial and self-deception 13, 18, 19, 20, 26
  • Dissociation 6, 10, 15
  • Obsessing about the crime 4, 7
  • Self-harm 29, 30

Updated references

Positive coping: social support

Negative coping: avoidance

Resiliency, self-efficacy and post-traumatic growth