Mental Health


Mental Health

Disclaimer: This guide is not intended to replace professional support, guidance, advice, or diagnosis.

Trigger warning: A trigger is a word or an event that can cause an action to take place. In this toolkit certain words can be triggering for survivors. Which means that reading those words or sentences can cause a survivor to either feel uncomfortable or anxious and might even take them back to an unpleasant memory. If while reading someone does experience this, it is best to do a quick grounding exercise.

Close your eyes and focus on your breathing. Tell yourself that you are safe and you are ok. Use your breathing as an anchor to help bring you to the present moment. Do this as many times as you want to or at regular intervals. You don't need to go through this toolkit by yourself, sit with someone you trust and ask them to go through it with you.

What is trauma?
Trauma is an emotional reaction to a terrible event. Individual trauma results from an event, series of events, or set of circumstances experienced by an individual as physically or emotionally harmful or life-threatening with lasting adverse effects on the individual’s functioning and mental, physical, social, emotional, or spiritual well-being. Trauma and its effects are subjective - they are experienced differently by each person. Trauma can involve physical injuries. It can also shape an individual’s beliefs, values, and goals for their life.

How can I recover from a traumatic incident that took place in the past if I can’t remember the details?
You may not remember the details of your traumatic experience. But, that does not mean that it did not happen. Some survivors find it difficult to accurately remember the details of the incident. Immediately after the event, you usually feel shock and denial. 

Longer term reactions include:

  • unpredictable emotions (feeling angry one minute, then sad the next minute), 
  • flashbacks, 
  • strained relationships with family/friends, 
  • physical symptoms like headaches or nausea. 

While these feelings are normal, some people have difficulty moving on with their lives. Psychologists can help these people find helpful ways of managing their emotions. It is important to focus on how you feel about the incident and/or any related memories and honor your experience, however difficult it may be.

How do I identify and cope with triggers?
As a survivor, it is important to try to be aware of your triggers during the recovery process. You can also work with a therapist or licensed professional to understand and overcome these triggers over time. Therapists use various therapeutic processes to work with individuals who have been through trauma. This is done in a controlled, safe environment in a step-by-step manner which will allow the patient to slowly accept, understand, and work through their trauma. It will leave them feeling empowered and more in control of dealing with the situation.

Everyone has the right to choose their own therapist. If this seems difficult, then before starting therapy they can have a quick phone call or video chat with the therapist to understand how they work. This step will help you to start feeling comfortable with the idea of therapy and speaking with a stranger about very personal information. It also helps the therapist to start building a friendly relationship with you.

What are some common feelings or emotions survivors of sexual assault may experience?
As a survivor you may have experienced many different changes in emotions and behaviour. 

  • You may recall feeling shaken or confused. 
  • You may not be able to respond to conversations or feel like you are not physically present when speaking. 
  • You may also feel out of control and find it difficult to connect with yourself and others. 
  • You may find that you feel afraid in places and with people that are not actually a danger to you. 
  • You feel scared and afraid a lot of the time. 
  • You may also find yourself grieving the loss of your identity or may feel like you are losing who you are as a person.

Feeling trauma in our bodies
Our mind and body are connected and we tend to hold a lot of stress and anxiety in our body. For example sometimes under a lot of stress we might get headaches or our shoulders might hurt. In this same way, we also tend to hold trauma in our body. Sometimes remembering our trauma might cause us to fall ill. 

Blaming Yourself
A lot of survivors also tend to blame themselves for what happened, showing a link between shame and trauma. This is why therapy becomes essential, because a therapist will help you identify feelings like shame and guilt. 

You may also experience flashbacks, suddenly seeing flashes of what happened. You may regret feeling paralyzed or frozen with fear during the incident and wish that you had reacted differently. Remind yourself that you did the best you could given the circumstances and, although you cannot change the past, there is a way to move forward that can bring hope and peace.

Should I seek help from a professional?
Therapy can help you become more aware of your feelings, behaviours, and triggers. If you are experiencing any of the emotional responses mentioned above and you find that they are affecting with your work, school, relationships, food, and sleep, then it is important to reach out to a trusted family member or friend, or seek professional help, like a therapist. If you cannot manage your day-to-day activities or are finding it hard to deal with negative emotions, you may want to consider getting help.

I have never been to therapy. What should I expect?
Therapy, or counselling, is the process of meeting with a therapist to help address problematic behaviours, beliefs, feelings, relationship issues, or to recover from traumatic experiences. Therapy can be a very empowering process and can help you regain some control over your emotions, so that you can lead a more fulfilling life. Therapy sessions are planned according to the survivor’s needs. You and your therapist can go through topics at a pace you are comfortable with. You can spend more time understanding a certain topic that you think you need to. It is a unique process that is centred around the needs and recovery of the survivor. 

Why should a survivor seek professional help?
Trauma is complicated in how it shows up in your life. It is different for every survivor and cannot be ignored. Emotional reactions may show through our thoughts, behaviors, actions, choices, world views, and interactions with others. Do not ignore the signals your body and mind are giving you. Therapy helps you come to terms with difficult experiences in your life and figure out a way to deal with those experiences. Professional help like therapy is an essential tool to the process of recovery.

Do I need to go to a psychiatrist or a psychologist?
Psychiatrists are primarily medical doctors and prescribe medications based on symptoms. Psychologists are trained in providing therapy, supporting individuals in managing trauma, anxiety, depression, relationships, etc. For example, if you are suffering from severe depression, consulting a psychiatrist can help you address the problem through medication. On the other hand, if you are struggling with confidence issues or social stigmas (pressure from society) as a result of the sexual assault, a psychologist can help address this.

Most psychologists and psychiatrists work together as a treatment team. For example, if you see a psychologist and they believe you may benefit from medication as well, they will refer you to a psychiatrist they trust.

What is the right form of professional help for me? Should I go to a psychologist, a psychiatrist, or a counselor?
Each licensed professional has a unique area of focus during therapy.

Counselors are professionals with a Master’s degree or higher in mental health counseling. They work with patients by talking with them. Counselors offer support to people going through emotional distress due to anxiety, relationship issues, eating disorders, sexual disorders, life changes, and/or substance abuse (drugs or alcohol).

Psychologists are professionals with a Ph.D. or Doctorate in Psychology. They perform the same duties as professional counselors, but they also provide additional psychological services, such as providing psychological or diagnostic tests and consulting with medical professionals regarding the appropriate treatment for their patients, such as medication. They have additional training in the provision of psychotherapy. 

Psychiatrists are medical doctors who complete specialized training in psychiatry. They diagnose and treat mood disorders, such as depression and anxiety, and serious psychiatric disorders, such as bipolar disorder and schizophrenia. Psychiatrists work in private practice, hospitals, or medical centres. Because psychiatrists are licensed medical doctors, they can prescribe medication. 

Is there a timeline for survivors to seek help?
There is no right or wrong timeline or duration for therapy. It depends on when the survivor feels ready to seek professional help and is willing to address their issues.

Will I need medicines? What will other people think?
Based on your emotional needs and symptoms, medication may or may not be prescribed. It varies from person to person. Survivors, at times, avoid seeking professional help due to social stigma, or fear of what people will think, but remember that it is important to stay focused on your recovery. 

What are the different affordable options available for seeking mental health support?
There are many organisations (private or non-profits) across major cities that offer counseling and therapy services to individuals at subsidized (discounted) costs; some even free of cost. These organisations adjust their fee based on the individual’s income. You can also consider group therapy and support services which are cost effective and can also help you build a support system and connections with other people. 

Does going to counseling and therapy sessions mean that I am emotionally weak?
It takes a lot of courage to recognise that you need help to address distressing emotions, behaviours, or traumatic experiences. Counseling helps you plan active steps to your recovery, while also giving you the space to practise them. While it can be a long and challenging process, it enables you to feel more empowered and stronger. Many patients in therapy report they benefit a great deal from having a safe space to talk about their trauma, without judgment, and receive an objective opinion on their struggles from a therapist.

During the course of your recovery you may also reach a realisation that recovery is not only about breaking the silence and talking about your trauma, but also about understanding how your trauma is showing up. These triggers and emotions can impact you even today. It is important to stay alert to the signs your mind and body give you and seek professional help to cope with them, when you feel ready. 

Will I be made to revisit painful memories or past experiences?
The process of therapy and counseling is much more than revisiting your past memories. 

  • It is a process of discovering and understanding your emotions, triggers, behaviours, and experiences. 
  • You and your therapist may feel the need to revisit and remember the incident for the purpose of closure (feeling as though the traumatic experience has been resolved). 
  • The therapist will help this process by creating a safe space in a contained environment (such as their office where you feel comfortable) and a way for you to express yourself. 

A therapist is there to work 'with' you every step of the way. They reinforce the belief that you are not alone in this process. Also, you do not have to do anything that makes you feel unsafe. If your therapist asks you something that you are not ready to talk about, you can always bring this up in your therapy sessions. 

How long will I need therapy for?
The purpose of therapy is to allow you to cope with your trauma. Once you feel more empowered and in control of your feelings and emotions, your need for therapy will lessen. If you find yourself in need of support again, do not hesitate to return to therapy. 

How do I find a therapist?
There are a number of counselling centers, private practices, and non-government  organisations that offer professional mental health services. You can learn more about the organisation or professional by looking up their website and additional information. You can compare the different treatments they offer, the payment options, and find a service that is most convenient for you. If you are a school or college student, you can seek professional help from the counselor available on campus.  You can also ask your doctor or someone you trust for references. Here is a list of verified therapists that work with survivors of sexual violence in India. 

What kind of therapy is available for survivors of sexual assault?
The effectiveness of any therapy session depends on the survivor’s comfort level with the therapist and how much they work during the sessions. It may be a long process that requires trust and commitment from both the therapist and the survivor seeking therapy.

In general talk therapy, patients are encouraged to share their thoughts, feelings, and concerns about their traumatic experiences and any related issues.  Research shows that getting support from an empathic professional is extremely therapeutic. In addition, there are a number of therapies specifically designed to treat the symptoms of Post-Traumatic Stress Disorder.

Listed below are the types of therapy designed to treat trauma:

Cognitive Behavioural Therapy or CBT
CBT is a form of psychotherapy that focuses on how a person's thoughts, beliefs, and attitudes affect their feelings and behaviors. Practitioners base CBT on the theory that problems arise from the meanings people give to events, as well as the events themselves. Unhelpful thoughts can make it difficult for a person to function confidently in different situations. CBT can have a positive impact on how people feel and act and equip them with coping strategies that help them deal with challenges. Through CBT, you can learn how to cope with maladaptive thoughts (negative thoughts or problems in adjusting or adapting to the environment), avoidance of stressful situations, and other problematic reactions you may be experiencing. Through CBT, the survivor could overcome certain limitations and work on recovering from trauma. 

Prolonged Exposure Therapy or PE
Prolonged Exposure Therapy is a form of cognitive behavioural therapy that helps individuals confront their fears or recover from traumatic events. The survivor is exposed to the traumatic event or similar events, places, people and objects that could possibly trigger their memories and experiences with the trauma. The survivor then actively addresses their trauma-related memories and signs, learning to control their emotional responses to it.

Eye Movement Desensitisation and Reprocessing or EMDR
This is a form of therapy used to treat emotional distress. EMDR deals with negative feelings associated with memories of traumatic events. The therapist uses finger motions in front of your face and instructs you to follow these hand motions with your eyes. At the same time, the therapist will ask you to recall a distressing event. They will ask you about the emotions and body sensations that go along with it. The therapist will then guide you to shift your thoughts to more pleasant ones and create a safe space in your mind. You will be asked to rate your level of distress before and after the session. This process has been shown to increase survivors’ abilities to cope with memories and feelings about their traumatic experience.

Group Therapy
Working with other survivors helps you realise you're not alone. You can draw from the strengths of others and also help inspire others.

Some therapists also use psychodynamic therapy. Psychodynamic therapy is a form of therapy that helps a survivor explore their early experiences with attachment figures and caregivers (such as parents) to help identify and provide more insight into our relationship needs and patterns with partners. This form of therapy can be immensely helpful for those who have experienced trauma from someone in their life or from someone known to them.

Telling Others About Your Trauma
Trauma affects you deeply and can play out differently within relationships and interactions you have with people. If you choose to tell your story, when and how you share your story is up to you. Who you confide in and rely on is your decision. You may find talking about sexual violence to be emotionally troubling as the person you are confiding in might react strongly. 

If and when you choose to share your story with members of your family, friends or other loved ones, you might see strong reactions in them. They may become extremely upset or angry, and feel as though they have failed to protect you from harm. The reaction your family can have is also affected by their parenting values and belief system. This can lead to extremes of behaviour where they may appear over caring on one hand or even blame you. It is okay to ask your support system to change their behaviour to more positive behaviour to help you in your recovery.

It is helpful to recognise that:

  • The person you have told may not be able to or willing to provide you with the support you need. Remember, you are not alone. If one person is not supportive, it does not mean that others will also not be supportive. 
  • You have the right to refuse to answer any questions that you find uncomfortable or inappropriate. 
  • It is your right to express your feelings when and where you feel safe and on your terms. You also have the right to share as much or as little information as you feel comfortable expressing.
  • You may feel more comfortable talking about your experience with other survivors of sexual assault. There are support groups available both online and offline for survivors.  
  • You may choose to speak out publicly. 
  • You may prefer to use alternative ways to express what you feel. Arts, literature, dance, and music can be beneficial tools for understanding our emotions and communicating with others. 
  • There are organisations and professionals available for guidance and support on disclosing (informing) about your trauma to others. Do not hesitate to seek help if you need it.
  • You might also choose not to speak out at all and that is OK. Do not feel pressured to share because someone else is sharing their story. Do it only if and when you are ready.