Clinical

Management of
Rape
MODULE 5: STEP 1: LISTEN, INQUIRE ABOUT NEEDS
AND CONCERNS AND VALIDATE THE SURVIVOR
Objectives

To be able to
To become familiar demonstrate L.I.V
with the steps in [Listen, Inquire and
providing CMR Validate] when dealing
with a rape survivor
Step 1 Listen, inquire about needs and concerns,

Step 2
and validate the survivor
Obtain informed consent and prepare the
Steps for
survivor clinical
Step 3
Step 4
Take the history
Perform the physical and genito-anal
managemen
examinations t of rape
Step 5 Provide treatment
Step 6 Enhance safety and refer for additional
support
Step 7 Assess mental health and provide
psychosocial support
Step 8 Provide follow-up care
Step 1: Listen, inquire
about needs and
concerns, and validate
the survivor
Active listening dos and don’ts
Do Don’t
How you act
Be patient and calm. In humanitarian Don’t pressure her to tell her story.
settings, there are so many pressing
needs and demands, but the few extra
minutes you offer her could make all the
difference.
Your attitude
Acknowledge how she is feeling. Let a Don’t judge what she has or has not done
woman know that you are hearing what or how she is feeling. Don’t put words in
she is telling you, e.g. “I hear how difficult her mouth. Avoid phrases such as: “You
this has been for you”; “It sounds like a shouldn’t feel that way,” or “You should

Listen
very scary situation.” feel lucky you survived”, or “Why did you
do that?”
What you say
Give her the opportunity to say what kind Don’t assume that you know what is best
of help she wants, if any. In order to do for her.
this, you may ask questions such as “How
can we help you today?” or “What would
you like me to do for you today?”
Encourage her to keep talking if she Don’t interrupt. Wait until she has finished
wishes. Ask, “Would you like to tell me before asking questions.
more?”
Principles of Active Listening
Effective communication and
listening happens through a Effective communication makes the
combination of verbal and non- speaker feel heard.
verbal skills

Violence survivors are often

By contrast, active and supportive
silenced by abusers, family
listening allows survivors to be
members and others in the
heard – an important step towards
community – and even health care
healing.
providers.
Techniques for inquiring about needs and concerns
Technique
Phrase your questions as invitations to speak.
Examples
“What would you like to talk about?” Inquire
about
Ask open-ended questions to encourage her to talk, “How do you feel about that?”
instead of asking questions that can be answered
with just “yes” or “no”.

needs
Reflect her feelings back to her in your words so she “It sounds as if you are feeling angry about that.”
knows that you have listened/observed and “You seem upset.”
understood.

Ask for clarification if you don’t understand. “Can you explain that again, please?”
“Could you tell me more about that?”
and
concerns
Help her to identify and express her needs and “Is there anything that you need or are concerned
concerns. about?”
“It sounds like you may need a place to stay.”
“It sounds like you are worried about your children.”
Summarize what she has expressed. “You seem to be saying that....”
Things to avoid
Don’t ask leading questions, such as, “I would imagine that made you feel upset, didn’t it?”
Don’t ask “why” questions, such as “Why did you do that…?” They may sound accusing.
 “It’s not your fault. You are not to blame.”

“Help is available.” [Say this only if it is true.]

“What happened has no justification or excuse.”

Validate “No one deserves to be hit by their partner or anyone.”

“You are not alone. Unfortunately, many other women

face this problem too.”
“You are valuable. Your life and your health are
important.”
“I am worried that this may be affecting your health.”
Objective
To apply or practice skills in first-line
support when dealing with a survivor
of sexual violence

• Listen
• Inquire about needs and concerns
• Validate
Role play
Bekele
Almaz Addis
Bekele is an 8 year old
Almaz is a 37 year old
Addis is a 15 year old. living in a camp in an
mother of three. She
has been married for 15 She is brought to area of conflict. On his
your clinic by her way home two he was
years and her husband
father. He tells you held at a checkpoint by
is very abusive. She
three armed men. After
suffered a miscarriage that she was attacked
beating him, they took
last year due to his by some men when turns to rape him and
violence. Four days ago, collecting firewood held him in a hut for 2
he beat her badly and this evening and that days. He managed to
raped her. She comes to
they raped her. She is run away and made it to
your clinic to seek help
very silent, unable to the health clinic today.
for her physical injuries
communicate and He was brought to the
as she has significant
appears fearful. clinic by his mother. He
bruising and is unable to
is badly beaten and is
raise her right arm.
weeping uncontrollably.
 Divide into small groups of three (or four if parents
are involved)
1. A client/patient (and a parent)– tell the
health worker why they are there and
respond to questions asked by the Health
worker
2. A provider – provide care and ask relevant
Role Play questions
3. An observer – observe the verbal and non-
verbal communication between the health
worker and the client and at the end of the
role play, provide feedback to the Health
Worker on his or her skills in providing first-
line support
 To those who played the role of the clients:
• How did the health worker respond to your disclosure of violence? What did he or she say
or do or NOT say or do?
• How did you feel about the response the health worker gave you when you disclosed?
• Did you feel that you were listened to? If yes, what made you feel that and if no, what made
you feel that?

To health workers:
• How did you feel about asking the client about her violence – did you hesitate – if so why?
• How did you feel if and when she disclosed her experience of violence or if she did not
Discussion disclose?
• What did you say to the client who disclosed her experience of violence to you?

To the observers:
• What did you observe about the communication between the health worker and the client?
• Was there eye contact between the two? What was the posture of the health worker and
the client like (relaxed, tense, sitting straight, leaning)?
• Was the client forthcoming about her experience of violence or reluctant?
• Was the health worker uncomfortable or relaxed in asking and responding to the client
while she was disclosing violence?
• Was the health worker attentively listening, responding empathetically, asking about the
client’s practical needs?