Open and accepting body language - Keeps arms uncrossed
- Keeps hands in view
- Stays facing the patient
- Makes eye contact
- Does not block the door
- Gives patient full attention (avoids typing or appearing distracted)
- Asks for permission to make physical contact
Attitude shifts - Stigmatization → Normalization
- Disempowerment → Empowerment
- Victimization → Resilience
- Questioning → Believing and validating the patient
- Biases and assumptions* → Confront biases and empathize
Approach - Is nonjudgmental
- "Risky sex" → "Sex without a condom"
- Encourages patient agency
- "I need to" → "Is it okay if I..."
- "Victim" versus "survivor"¶
- Is patient
- Explains diagnosis, options for treatmentΔ
- Explains concept of trauma
- Normalizes the experience
- "Many people have experienced trauma."
- "It is normal to feel this way."
| Fearful body language - Trembling
- Refuses examination or touch
- Limited or no eye contact
- Self-protective posture (huddling, crossing arms, curling)
Negative self-talk - "I am ruined/broken/worthless."
- "I am crazy."
- "No one will ever love me."
- "I feel so stupid for reacting this way."
- "I was the one who had done something wrong."[1]
- Feelings of powerlessness[1]
Signs of emotional distress[1,2] - Crying
- Difficulty breathing
- Dissociation
- Flashbacks
- Flat affect
- Anger and/or aggression
| Sensitive and attentive - Narrates, explains necessary touch: "Inform before you perform"[1]
- Avoids unnecessary touch
- Exposes one body part at a time
- Is sensitive to modesty
- Is not afraid of silence and hesitation
- Does not appear shocked, afraid, or disgusted
- Asks about patient's concerns: "How do you feel about..."
Empowerment language - "You are strong; you survived."
- "It's okay, this can be hard."
- "It is normal to feel stressed about this."
- "I'm so glad you are sharing this with me."
- "I believe you. It took a lot of courage to tell me about this."
- "It's not your fault. You didn't do anything to deserve this."
- "You survived something very difficult that was not your fault."
- "This has had an impact on your life."
- "I am so sorry that happened."
- "You are not alone."
De-escalation - Gives space for the patients to tell their story; lets them take the lead◊
- Summarizes periodically: "It sounds like you had very traumatic experiences in childhood..."
- Uses grounding techniques
- "I am amazed by your strength to survive and talk about the experience of sexual violence."
- "Thank you for your courage in sharing this with me."
- Responds to dissociation and flashbacks
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