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Secondary Victimization of Rape Victims: Insights From Mental Health

Professionals Who Treat Survivors of Violence

Article in Violence and Victims · February 1999

DOI: 10.1891/0886-6708.14.3.261 · Source: PubMed

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Violence and Victims, Vol. 14, No. 3, 1999
© 1999 Springer Publishing Company

Secondary Victimization of Rape Victims:

Insights From Mental Health Professionals
Who Treat Survivors of Violence

Rebecca Campbell
Sheela Raja
University of Illinois at Chicago

Rape victims may turn to the legal, medical, and mental health systems for assistance,
but there is a growing body of literature indicating that many survivors are denied help
by these agencies. What help victims do receive often leaves them feeling revictimized.
These negative experiences have been termed "the second rape" or "secondary victim-
ization." If indeed secondary victimization occurs, then these issues may be raised in
rape survivors' mental health treatment. In the current study, probability sampling was
used to survey a representative sample of licensed mental health professionals about
the extent to which they believe rape victims are "re-raped" in their interactions with
social system personnel. Most therapists believed that some community professionals
engage in harmful behaviors that are detrimental to rape survivors' psychological well-
being. Implications for future research on secondary victimization are discussed.

Sexual assault has widespread effects on women's psychological and physical health (see
Koss, 1993), and as a result, rape victims may contact several community agencies for assis-
tance, such as the legal, medical, and mental health systems (Campbell, 1998). Although a
number of agencies offer rape-related services, previous research suggests that rape vic-
tims are often denied help, and what help they do receive, often leaves them feeling re-vic-
timized (Campbell, 1998; Campbell & Bybee, 1997; Cluss, Boughton, Frank, Stewart, &
West, 1983; Frohmann, 1991, 1997a, 1997b; Heilbrun & Heilbrun, 1986; Konradi 1996;
Madigan & Gamble, 1991; Martin, 1997; Martin & DiNitto, 1987; Martin, DiNitto, Maxwell,
& Norton, 1985; Martin & Powell, 1994; Matoesian, 1993; McGaughey & Stiles, 1983;
Sloan, 1995; Spencer, 1987; Williams, 1984; Williams & Holmes, 1981;Wmkel&Koppelaar,
1991). These negative experiences have been termed "the second rape" (Madigan & Gamble,
1991), "the second assault" (Martin & Powell, 1994), or "secondary victimization" (Williams,
1984). Analysis of these interactions between victims and social systems may uncover ways
to promote a community response to rape that is psychologically beneficial to victimized
women. Therefore, the focus of this study is to assess the scope and impact of secondary
victimization. A state-wide survey of mental health professionals was conducted to ascer-
tain the extent to which secondary victimization is a salient clinical issue for rape
survivors.

261
262 R. Campbell and S. Raja

The Problem of Secondary Victimization

Despite the promise of rape legislative reform in the 1970s and 1980s (see Berger, Searles,
& Neuman, 1988), rape victims continue to face difficulties accessing community resources
(Campbell, 1998; Martin & Powell, 1994). Using an organizational theoretical framework,
Martin and Powell (1994) differentiated between "responsive" and "unresponsive" rape
processing. Responsive processing is "practices that prioritize rape victims' well-being in
legal (and allied) organizations" (p. 862). Victims' needs are paramount, and every effort
is made to avoid victim-blaming and promote recovery. Unfortunately, this model of ser-
vice delivery is rarely practiced, and instead unresponsive processing is normative. Unresponsive
processing places emphasis on the needs of the organization—the police, the prosecutor's
office, the hospital. Police and prosecutors are preoccupied with "case wins," so only the
rape cases they perceive as likely convictions are actually prosecuted (Frohmann, 1991,
1997a, 1997b). Hospital staff are focused on processing patients quickly, so rape victims
receive, at best, bare minimum services (Campbell & Bybee, 1997). In such an unrespon-
sive model of case processing, victims are often blamed for the assault and denied help,
which further traumatizes survivors and slows recovery. Martin and Powell (1994) demon-
strated that unresponsive treatment stems from institutional practices that orient service
organizations to ignore victims' needs. What system personnel assume to be the needs of
victims actually has very little to do with what survivors want, and everything to do with
sustaining the values of the organization. As a result, several feminist scholars have called
for a focus on the "politics of rape victims' needs" (Fine, 1993; Fraser, 1989; Martin &
Powell, 1994). Survivors' actual needs would force an organization to provide individual-
ized, empathic care. But instead, normative practice is more highly valued. The rape event
continues as victims' needs are once again subjugated.
When rape victims' needs are ignored at the organizational level, the treatment sur-
vivors receive from individual system personnel can be quite devastating. Such negative
treatment was termed "secondary victimization" by Williams (1984), and this definition
guides the current research:
[Secondary victimization is] a prolonged and compounded consequence of certain crimes;
it results from negative, judgmental attitudes (and behaviors) directed toward the victim,
[which results] in a lack of support, perhaps even condemnation anoVor alienation of the
victim (p. 67) (text added by current authors to amend definition).
Secondary victimization is the unresponsive treatment rape victims receive from social
system personnel. It is the victim-blaming behaviors and practices engaged in by commu-
nity service providers, which further the rape event, resulting in additional stress and trauma
for victims.
The risk of secondary victimization may stem from three sources. First, research on rape
myth acceptance suggests that system personnel may be treating victims in an insensitive
manner. Across several studies, police, prosecutors, judges, and doctors have been found
to ascribe to victim-blaming attitudes, such as believing women provoke rape and often lie
about the occurrence of rape (Best, Dansky, & Kilpatrick, 1992; Campbell, 1995;
Campbell & Johnson, 1997; LeDoux & Hazelwood, 1985; Ward, 1988). But rape myth
acceptance does not necessarily constitute or produce secondary victimization. Yet, reports
of victims' accounts have indicated that they have been directly told by police, prosecutors,
and doctors that they were not believable or credible, and even in the absence of such direct
communication, many women still felt doubted in their interactions with system personnel
Secondary Victimization 263

(Campbell, 1998; Frohmann, 1991; Madigan & Gamble, 1991; Russell, 1990; Warshaw,
1988).
Second, secondary victimization may occur not only because of what service providers
do, but also because of what they do not do. The denial of assistance is quite common, which
can cause stress for rape survivors. A recent study by Campbell (1998) found that even for
survivors who had the assistance of a rape victim advocate, 67% had their legal cases dis-
missed, and, over 80% of the time, this decision was made by legal personnel and contra-
dicted the victims' wishes to prosecute the assault. A similar picture has emerged for the
medical system. The National Victim Center (1992) found that most rape victims were not
advised about pregnancy testing and STD and HIV exposure during the emergency room
medical exam. Campbell and Bybee (1997) reported that less than 20% of the victims in
their sample received information about the psychological and physical health effects of
sexual assault, and only 7% were given a referral for follow-up medical care. Victims wanted
these services, but system personnel did not provide them. These refusals of help may be
another factor contributing to the secondary victimization of rape victims.
Finally, for those rape victims who are able to obtain desired services, it is not known if
this assistance is actually helpful. The research addressing this issue is mixed. For exam-
ple, both Matoesian (1993) and Sloan (1995) concluded that the procedures of legal pros-
ecution are harmful to women's well-being. Similarly, Cluss and associates (1983) found
that rape victims whose cases were prosecuted were more distressed than those whose cases
were not prosecuted. By contrast, Frazier and Haney (1996) found that survivors held pos-
itive attitudes toward investigating officers, but were frustrated by the overall response of
the criminal justice system. Less research has been conducted in the medical system, although
Parrot (1991) noted that the physical intrusiveness of the rape exam procedures often
leaves many women feeling violated and re-raped. In addition, many emergency rooms
and primary care settings do not routinely screen female patients for a history of vio-
lence/sexual violence (M. P. Koss, P. G. Koss, & Woodruff, 1991; Walker, Torkelson, Katon,
& Koss, 1993). As a result, medical care often does not address the somatic consequences
of violence against women (Felitti, 1991; Golding, 1994; Kimerling & Calhoun, 1994; Koss,
1993; Koss & Heslet, 1992; M. P. Koss, Woodruff, & P. G. Koss, 1991; Parrot, 1991;
Waigandt, Wallace, Phelps, & Miller, 1990). The type of help offered to some rape victims
may not be perceived or experienced as beneficial.

The Current Study

Previous research indicates that rape victims who seek community assistance could be at
substantial risk for secondary victimization. The verbal and nonverbal behaviors of system
personnel, as well as the general process of seeking help, may leave some women feeling
doubted and re-violated. A challenge for research on secondary victimization is that the
emotional trauma of rape may leave many victims reluctant to discuss their experiences
with researchers. Those who have had negative experiences with community systems may
be particularly hesitant to participate in research studies. Therefore, for the exploratory
focus of this research, an informant sample was surveyed: mental health professionals.
This sample was chosen for two reasons. First, if secondary victimization is indeed nega-
tively affecting rape victims who seek community assistance, then these issues may be raised
in mental health treatment. In other words, mental health professionals may bear witness
to this problem by what they see and hear from their clients. Given this insight, mental
health professionals are well positioned to evaluate the scope and impact of secondary
264 R. Campbell and S. Raja

victimization, and can speak to its detrimental mental health effects. Second, although the
focus of most prior research has been the legal and medical systems, mental health work-
ers are also "community professionals." They too could be contributing to the problem of
secondary victimization. Therefore, we can survey therapists to ascertain the extent to which
they have concerns about their own profession's treatment of rape survivors.
To that end, therapists were asked whether the behaviors and practices of community
system personnel can be harmful to rape victims' psychological well-being. Due to the priv-
ileged therapist-client relationship, it was not possible to ask the participants about specific
rape survivors they have treated and the extent to which secondary victimization occurred
in specific cases.1 Instead, this informant group was asked to draw upon their collective
experiences with rape survivors, and their perceptions of the scope and impact of sec-
ondary victimization were assessed.
In addition to collecting this descriptive information, this study examined how the par-
ticipants' clinical experiences related to their perceptions of secondary victimization. Four
work history variables were explored. First, whether therapists have had professional train-
ing on sexual assault may affect their beliefs about secondary victimization. Many train-
ing workshops emphasize the psychological impact of assault and the emotional sequelae
of this trauma (Campbell, Raja, & Grining, in press). Therapists who have participated in
formal training on sexual assault may have a broader understanding of the variety of fac-
tors that can cause distress for rape victims. Therefore, it was hypothesized that mental
health professionals who have received formal training on sexual assault would be more
likely to perceive the community response to rape as potentially harmful to rape survivors.
Second, the therapeutic model guiding a clinician may affect how s/he assesses trauma
in rape victims. The mental health professionals in this study were asked to describe their
therapeutic orientation(s) (e.g., cognitive behavioral, psychodynamic, feminist). Of partic-
ular interest was whether those therapists who endorsed a feminist orientation would dif-
fer in their perceptions of secondary victimization from those who do not use such a model
in counseling. Feminist therapy explicitly addresses gender inequalities and societal oppres-
sion of women (e.g., Brown, 1994; leda, 1986; Skodra, 1992; Wyche & Rice, 1997); there-
fore, it was hypothesized that feminist therapists would be more likely to perceive contact
with community professionals as potentially harmful to rape survivors.
Third, the degree of experience mental health professionals have treating rape victims
may affect their perceptions of secondary victimization. The more survivors a therapist has
seen, the greater the likelihood s/he will have worked with clients who felt revictimized by
social system personnel. It was hypothesized that therapists with more experience treating
rape victims would be more likely to perceive contact with community professionals as
potentially detrimental to survivors' recovery.
Finally, beliefs about secondary victimization may be influenced not only by the expe-
rience therapists have treating victims of violence, but also by specific characteristics of
the clients with whom they work. Whom mental health professionals treat may affect the
degree to which they believe secondary victimization occurs. Previous research by Campbell
(1998) and Campbell and Bybee (1997) suggested that female rape victims of color receive
less help from community professionals. Therefore, it was hypothesized that therapists
who work with more women of color would be more likely to perceive contact with social
system personnel as harmful. In addition, other research has supported that women of
lower socioeconomic status receive less community support (Davis & Proctor, 1989; Gordon-
Bradshaw, 1988; Pinderhughes, 1989). Therefore, it was also predicted that therapists who
Secondary Victimization 265

worked more with lower-income clients would be more likely to perceive risk for rape sur-
vivors who contact social systems.

METHOD

Sample
The sampling frame for this project was all mental health professionals who were regis-
tered with the Illinois Department of Professional Regulation (IDPR) as a licensed profes-
sional counselor (LPC), licensed social worker (LSW), licensed clinical social worker
(LCSW), or licensed clinical/counseling psychologist (CP) (14,119 providers). This sam-
pling frame was then stratified to differentiate mental health professionals who practiced
in Cook County (the Chicago Metropolitan area) from those who did not practice in Cook
County (the remainder of the state). To obtain a representative sample of mental health
providers, systematic probability sampling was used to select 1,000 cases for this project
(see Levy & Lemeshow, 1991). One in every 14 Cook County professionals and one in
every 14 non-Cook County professionals were mailed written questionnaires. Fifty-six
surveys were returned due to changed addresses and expired mail forwarding orders. Of
the remaining 944 questionnaires, 415 participants returned the questionnaire for a response
rate of 44% (of the total surveys sent [1,000] response rate = 41.5%). The response rate was
equivalent across the two geographic regions surveyed (the Chicago Metropolitan area vs.
the remaining counties in the state).
To select the sample for this study, all participants were asked to rate their degree of pro-
fessional experience counseling rape victims on a 4-point scale: 0 = no experience; 1 = a
little experience; 2 = some experience; 3 = a great deal of experience. Experience treating
rape victims was rated subjectively because objective verification, via providers' records,
was impossible due to therapist-client privilege. For the analyses in this study, the thera-
pists who had no experience were excluded (final N = 286).
Respondents ranged in age from 26 to 75 years with a mean age of 46.44 (SD = 10.18).
The majority of the sample was female (75%) and almost all respondents were White (93%).
Most were married (64%) and had children (72%). Thirteen percent held an MA degree,
57% an MSW, and 16% a PhD. Many participants described their therapeutic orientation
as cognitive-behavioral (55%), psychodynamic (48%), interpersonal systems (41%), and/or
client centered/Rogerian (24%). Less frequently endorsed orientations included: cognitive
(only) 18%, behavioral (only) 14%, self 16%, feminist 16%, Gestalt 10%, and Adlerian 5%
(percentages total more than 100% because the participants were asked to circle all orien-
tations that apply to their work). On average, the respondents had 13 years experience see-
ing clients (mean = 13.37, SD = 8.21), and 99% had a current client caseload. Many of the
participants were in private practice (36% total, 20% alone and 16% in a group practice),
13% were employed by a social service agency, 16% by a hospital, and 12% by a commu-
nity mental health center.2

Procedure
Mailing labels were obtained from the Illinois Department of Professional Regulation (IDPR)
for all licensed mental health professionals in the state. Using the sampling procedures
described above, three mailings were sent to the selected participants: (1) an introductory
cover letter to explain the study, request participation, and provide a phone number for
266 R. Campbell and S. Raja

questions or comments about the project; (2) the questionnaire packet 1 week later (a sec-
ond cover letter re-iterating the purpose of the study, consent form, questionnaire, and
postage-paid return envelope); and (3) a follow-up postcard 2 weeks thereafter to remind
participants to complete and return the questionnaires. So as not to bias the participants,
the cover letters did not mention that the focus of this study was secondary victimization.
Rather, they were asked to participate in a survey of mental health professionals' experi-
ence and training on issues of violence against women. In lieu of financial incentives for
participation, all respondents were offered a mailed written report of the study's findings
upon the completion of the research.

Measures
The written questionnaire used in this study was created by the investigators as there are
no established instruments in the literature from which to work. To assess participants'
beliefs about the secondary victimization of rape survivors by community professionals, a
standardized definition of 'community professionals' was first provided: community pro-
fessionals included police, doctors, and mental health professionals. For some questions,
participants were asked to reflect more generally upon all of these community groups, and
in other items, they were asked to consider each type of community service (legal, med-
ical, mental health) separately. Fifteen items assessed how much the participants agreed
with statements about the scope and impact of secondary victimization (5-point Likert scale;
1 = strongly disagree to 5 = strongly agree).
From this pool of 15 items on secondary victimization, 13 were retained and 4 subscales
were rationally created for the canonical correlation analyses. Two items were dropped
because participants had widely varying interpretations of these questions. The first scale,
General Harmful Behaviors and Practices of Social System Personnel (3 items) focused
on the degree to which contact with community professionals (police, doctors, mental health
professionals) can be harmful to rape survivors. Items in this scale included: "The behav-
iors of community professionals can further traumatize rape victims," "Community pro-
fessionals don't pay enough attention to how their own behavior could affect a rape vic-
tim's recovery," and "Community professionals may be doing more harm than good in
their work with rape victims." Scale alpha was .87 with corrected item-total correlations
ranging from .62 to .83.
Second, the Specific Harmful Behaviors and Practices of Social System Personnel scale
(3 items) assessed the degree to which specific services provided by different system per-
sonnel can be harmful to rape survivors. The items in this scale included: "Reporting a rape
to the criminal justice authorities can be psychologically detrimental to rape victims," "Rape
victims may feel traumatized by the medical rape exam," and "Mental health profession-
als engage in counseling practices that can further traumatize rape victims." The psycho-
metrics of this scale were: alpha = .86; range of corrected item-total correlations = .S9-.79.
Third, the Negative Impact of Contact With Social System Personnel scale (5 items)
assessed how contact with community professionals affects rape victims' psychological
well-being. In these items, the participants rated the extent to which they agreed that con-
tact with community professionals leaves rape victims feeling: guilty about the rape, reluc-
tant to seek further help, feeling bad about themselves, distrustful of others, and depressed.
Scale alpha was .87 with corrected item-total correlations ranging from .43 to .77.
Finally, although the focus of this study was potentially harmful effects of contact with
community professionals, the fourth scale assessed the degree to which such contact could
be beneficial. The Positive Impact of Contact With Social System Personnel scale
Secondary Victimization 267

contained two items (alpha =.74, corrected item-total correlation = .58): "It can be psy-
chological beneficial for rape victims to seek help from community professionals" and
"Community professionals do a good job helping rape victims."
This study also examined what factors relate to mental health professionals' perceptions
of secondary victimization. Four categories of variables were explored. First, whether ther-
apists had received formal training on sexual assault was expected to relate to their per-
ceptions of secondary victimization. A standardized definition of training was provided to
ensure a uniform frame of reference:
By professional training, we are referring to training in institutional settings, such as for-
mal education . . . Formal training could include: instruction in graduate school, clinical
case supervision, continuing education classes, and employment seminars. Formal train-
ing does NOT include: self-initiated reading, research, experience from clinical cases.

In light of this definition, participants answered whether they had received training on sex-
ual assault (coded 0 = no; 1 = yes). Second, therapeutic orientation was expected to affect
beliefs about secondary victimization. In these analyses, the focus was whether respondents
endorsed a feminist approach (coded 0 = no; 1 = yes). Third, experience treating rape vic-
tims was predicted to affect perceptions of secondary victimization. All participants in this
study have at least some experience working with rape survivors. Therefore, the analyses
examined differences between therapists with "a little experience" (1), "some experience"
(2), and "a great deal of experience" (3). Finally, general characteristics of the clients treated
by these therapists were expected to impact assessments of secondary victimization. The
respondents were asked to estimate what percentage of their total client caseload was: male
versus female; White versus people of Color; people with family incomes of less that $20,000,
$20,000-$50,000, and over $50,000.

RESULTS

The majority of the mental health professionals in this study believed that rape victims can
be further traumatized by their contact with community professionals. Table 1 presents the
item means and standard deviations for each question in each secondary victimization sub-
scale. For example, therapists tended to agree that the behaviors and practices of commu-
nity professionals can be harmful to rape survivors (on average, 84% agreed with the three
items in the General Harmful Behavior and Practices scale). With respect to specific com-
munity services, most participants (81 %) believed that contact with the legal system is psy-
chologically detrimental to rape survivors. The strongest agreement among the respon-
dents was in how they perceived the medical rape exam: 89% believed this exam is
traumatizing for rape survivors. In addition, 58% felt that mental health professionals engage
in harmful counseling practices. Despite the presumed social desirability bias of this ques-
tion, it is still quite telling that over half of the participants expressed concerns about their
own profession's response to this population. Turning to the perceived impact of contact
with community professionals, 80% of the sample agreed that contact with community
professionals can leave rape victims feeling guilty, reluctant to seek further help, bad about
themselves, distrustful of others, and depressed. By contrast, less than half of the partici-
pants (48%) believed that contacting community professionals had positive effects for rape
victims. There were no significant differences in agreement rates on these items as a func-
tion of the participants' age, gender, race/ethnicity, marital status, type of professional cre-
dentials (e.g., MSW, PhD), or work setting.
 TABLE 1. Mental Health Professionals' Perceptions of the Secondary Victimization of Rape Survivors
% Agreed Item Item
ITEMS With Item M SD
General Harmful Behaviors and Practices of Social System Personnel (a = .87)
1. The behavior of community professionals can further traumatize rape victims 86 3.95 1.04
2. Community professionals don't pay enough attention to how their own behaviors could affect a rape victim's recovery 87 4.18 .83
3. Community professionals may be doing more harm than good in their work with rape victims 79 3.67 .89
System Specific Harmful Behaviors and Practices of Social System Personnel (a = .86)
1. Reporting a rape to the criminal justice authorities can be psychologically detrimental to rape victims 81 3.80 1.03
2. Rape victims may feel traumatized by the medical rape exam 89 4.27 .75
3. Mental health professionals engage in counseling practices that can further traumatize rape victims 58 3.63 .97
Negative Impact of Contact With Social System Personnel (a = .87)
1. Interacting with community professionals can leave rape victims feeling guilty about the rape 84 4.03 1.16
2. Interacting with community professionals can leave rape victims so upset that they are reluctant to seek further help 76 3.96 1.01
3. Interacting with community professionals can leave rape victims feeling bad about themselves 81 3.82 .84
4. Interacting with community professionals can leave rape victims feeling distrustful of others 89 4.33 .96
5. Interacting with community professionals can leave rape victims feeling depressed 70 3.76 .87
Positive Impact of Contact With Social System Personnel (a = .74)
1. It can be psychologically beneficial for rape victims to seek help from community professionals 56 3.34 .65
2. Community professionals do a good job helping rape victims 40 3.32 .76
Note. Agreement with each questions was rated on a scale of 1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree. Therefore, "% who
agreed with item" was computed by summing the percentage of participants who answered 4 = agree or 5 = strongly agree on each item.

<^
Secondary Victimization 269

To discover the dimensions along which mental health professionals' experiences as clin-
icians relate to their perceptions of secondary victimization, canonical correlation analyses
were performed. The first set of variables in these analyses consisted of the four secondary
victimization subscales (General Harmful Behaviors and Practices, System-Specific Harmful
Behaviors and Practices, Negative Impact of Contact, and Positive Impact of Contact). The
second set of variables was mental health professionals' work characteristics (Training on
Sexual Assault, Feminist Therapeutic Orientation, Experience Treating Rape Victims,
Percentage of Clients With Incomes of Less Than $20,000, Percentage of Clients With
Incomes of $20,000-$50,000, Percentage of Clients With Incomes of Over $50,000, Percentage
of Clients Who are White Women, Percentage of Clients Who are Women of Color).
Two significant canonical correlations were extracted. The first canonical was .40 (25%
of the variance of set 1, 18% overlapping with set (2) (Wilks's lambda = .84, %2(21,
N = 286) = 41.61,;? < .01). The second canonical correlation was .30 (19% of the variance
of set 2,41% overlapping with set 1) (Wilks's lambda= .92, x2(13, N= 286) = 28.01, /x.05).
Table 2 presents the canonical loadings for each variable in each set. These results suggest
that mental health professionals who had been trained on sexual assault, endorsed a femi-
nist therapeutic orientation in their work, and had more experience treating rape survivors,
were significantly more likely to agree that system personnel engage in harmful behaviors
and practices in their work with rape survivors, and that contact with community profes-
sionals has negative effects on rape victims' psychological well-being. In addition, thera-
pists who worked more with lower income clients (incomes less than $20,000) and women
of Color were more likely to agree that community professionals engage in harmful prac-
tices and that contact with community professionals can be detrimental to rape survivors'

TABLE 2. Canonical Correlations Between Mental Health Professionals' Experience

and Perceptions of the Secondary Victimization of Rape Survivors
Canonical Loadings

First Second
Set 1 = Mental Health Professionals' Experience
Training on Sexual Assault .61 .09
Feminist orientation .47 .11
Experience Treating Rape Victims .70 .02
% of Clients With Incomes of Less Than $20,000 .63 .08
% of Clients With Incomes Between $20,000 and $50,000 .12 .16
% of Clients With Incomes Greater Than $50,000 -.08 .69
% of Clients Who Are White Women -.09 .63
% of Clients Who Are Women of Color .58 .10
Set 2 = Perceptions of Secondary Victimization
General Harmful Behaviors and Practices of Social System Personnel .84 .30
System-Specific Harmful Behaviors and Practices of Social System
Personnel .81 .29
Negative Impact of Contact With Social System Personnel .79 .23
Positive Impact of Contact With Social System Personnel .05 .60
Proportion of Variance Set 1 .25 .41
Proportion of Variance Set 2 .18 .19
Canonical Correlation .40 .30
270 R- Campbell and S. Raja

well-being. By contrast, mental health professionals who treated more White women and
clients with incomes above $50,000 were more likely to report that contact with social sys-
tems can have a positive effect on rape survivors.

DISCUSSION

Secondary victimization is a daunting problem for rape victims—survivors of violence are

violated not only by the original perpetrators but also by the community systems that
intend to provide help. Secondary victimization has been documented in a variety of con-
texts with different populations: the treatment of battered women in emergency rooms (see
Stark, Flitcraft, & Frazier, 1979), sexual harassment victims in the workplace (see Fitzgerald,
Swan, & Fischer, 1995), and gay and lesbian hate crime victims in the courtroom (see Berrill
& Herek, 1990). The current study examined mental health professionals' perceptions of
the scope and impact of the secondary victimization of rape victims. In this study, a state-
wide representative sample of licensed mental health professionals, who had experience
treating rape survivors, validated that secondary victimization does indeed occur. Supporting
the work of Martin and Powell (1994), Frohmann (1991, 1997a, 1997b), and others, the
majority of our sample believed that interacting with community professionals can be
detrimental to rape survivors' mental health.

Therapist Background and Secondary Victimization

Mental health professionals' training and experience as clinicians was related to their beliefs
about secondary victimization. Therapists who had participated in formal training on sex-
ual assault, had more experience treating rape survivors, and endorsed a feminist orienta-
tion were more likely to believe that community professionals engage in harmful behav-
iors, which have a detrimental impact on survivors' well-being. However, it is not known
whether heightened awareness of secondary victimization (through formal training and clin-
ical experience) increased the likelihood that these therapists would specifically inquire
about secondary victimization, or if clients spontaneously report secondary victimization
more often to certain types of therapists (e.g., feminist therapists). Alternatively, beliefs
about secondary victimization could influence therapists' decisions to seek training, spe-
cialize in treating victims of violence, and adopt different treatment paradigms. Future
research should examine in more detail what issues are commonly raised by rape survivors
in mental health treatment as well as what factors influence mental health workers' deci-
sions regarding professional training and practice specializations. These results linking ther-
apist background and secondary victimization should be viewed with some caution because
the participants' experience treating rape victims was subjectively rated. Follow-up work
in this area should strive for more objective assessments (e.g., ascertain the number of vic-
tims counseled).

Therapist Clientele and Secondary Victimization

Characteristics of therapists' clientele were also related to their perceptions of secondary
victimization. Therapists who treated women of Color and low-income women (household
incomes less than $20,000 per year) were more likely to report that community profes-
sionals engage in harmful behaviors that adversely affect survivors. Violence against women
Secondary Victimization 271

of Color has traditionally been viewed as a less serious crime, deserving less social atten-
tion (Bernard, Brandon, Fox-Genovese, & Purdue, 1992; Mama, 1989a, 1989b; White,
1985). The degree to which stereotypes of black women as "promiscuous and immoral"
continue (Davis, 1981, p. 177), it is possible that community professionals also hold these
beliefs, and treat rape victims who are women of Color particularly negatively. Similarly,
stereotypes about poor women may adversely affect service providers' beliefs and behav-
iors toward victims. The exploratory results of this study suggest that secondary victim-
ization may be more pervasive among rape survivors who are poor and/or women of Color.
These results should be validated in future work by comparing the first-person accounts of
lower-income rape survivors and/or rape survivors of Color with reports from service
providers.
Therapists who work more with White women with household incomes of more than
$50,000 were most likely to believe that community system contact could be beneficial.
There are several potential explanations for this finding. First, upper-middle class White
women may not be subject to the same prejudices as low-income women and/or women of
Color, particularly when it comes to rape. For example, police often decide whether a vic-
tim's story is "credible" based upon her cooperativeness, age, race, and socioeconomic sta-
tus (Frohmann, 1991,1997a, 1997b; Martin & Powell, 1994; Rose & Randall, 1982). Second,
upper-middle class White women may be able to afford higher-quality and personalized
community services. The results of this study suggest that sexism and racism may be inter-
twined, and women of differing races and income levels may have differential experiences
seeking community services following a rape.

Conclusions and Future Directions

The results of this study suggest that community service providers may be engaging in
harmful behaviors and practices, which negatively affect rape survivors' mental health.
Yet, mental health professionals are themselves "community service providers." Over half
of this sample of therapists (58%) felt that mental health professionals engage in harmful
counseling practices. Thus, the results of this study validate previous findings that mem-
bers of the legal and medical communities contribute to secondary victimization (e.g.,
Frohmann, 1991, 1997a, 1997b; Martin & Powell, 1994), and extend this literature to sug-
gest that therapists are aware they too can be part of this problem. In other work with this
sample of Illinois mental health professionals, Campbell, Raja, and Grining (in press) found
that 85% of therapists believed that practitioners need further training on violence against
women. Instruction on these issues is typically not provided in graduate school or clinical
case supervision; learning how to treat victims of violence often comes through participa-
tion in voluntary continuing education programs. It is possible, therefore, that practition-
ers are concerned about the secondary victimization effects of counseling because of this
limited focus on violence against women in the educational training of mental health pro-
fessionals. Taken together, the results of these two reports suggest that mandatory training
on violence against women is needed for therapists, and that such training must address the
risks of secondary victimization so that mental health workers do not further traumatize
rape survivors.
Educating therapists addresses the secondary victimization caused by the mental health
system, but the results of this study also suggest the need for further training for all
community professionals (e.g., legal and medical personnel). Rather than limiting the
focus to treating secondary victimization once it has occurred, the prevention of secondary
272 R. Campbell and S. Raja

victimization must be a long-term goal. The Long Island College Hospital and Junior League
of Brooklyn (1998) issued an instructional video, "Restoring Dignity: Frontline Response
to Rape," designed to teach service providers about the beneficial and detrimental effects
they may have on rape survivors. In addition, mental health professionals can play an
active role in the prevention of secondary victimization, not only by seeking additional
training in their own field, but also by advocating for changes in other social systems.
Therapists can work with local rape crisis centers to provide input on advocacy efforts.
Two important limitations of this study are worth noting. First, given the exploratory
nature of this research, the sample was limited to licensed mental health professionals—
the community providers who may have been most likely to have heard about and observed
the negative impact of contact with social systems. Future research should validate these
findings in a sample of rape survivors and other groups of community service providers
(see Campbell et al., 1999, for validation results). Second, a limited number of items in the
questionnaire assessed the potential positive impact of contact with community systems
(due to the study's focus on the potential negative effects). In follow-up research, social
system personnel, as well as rape survivors, should be asked in more detail about both pos-
itive and negative experiences with community agencies.
The primary purpose of this research was to explore the extent to which mental health
professionals believe rape victims may be further traumatized by their contact with social
systems. Overall, these data suggest that mental health professionals see secondary vic-
timization as a salient issue affecting rape survivors' psychological well-being. Low-income
women and women of Color may be at particular risk. These findings add to a growing lit-
erature that indicate that the psychological trauma of sexual assault occurs not only
because of the assault itself, but also because of society's treatment of rape victims.

NOTES
lr
This decision was reached in consultation with 10 clinical/counseling psychologists,
and 10 clinical social workers, who advised the research team to exclude questions about
specific clients.
2
These percentages are slightly different from those reported in Campbell, Raja, and
Grining (in press), as the focus of this study was the 286 mental health professionals who
had experience treating rape victims.

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Acknowledgment. This research was supported by grants from the Program for Mental Health Services
Research on Women and Gender (NIMH Grant Number: R24 MH54212-02) and the University of
Illinois at Chicago Campus Research Board awarded to the first author. The authors thank Tricia
Grining and Crista Russo for their assistance with data collection, and Mary Koss and two anony-
mous reviewers for their thoughtful comments on this manuscript.

Offprints. Requests for offprints should be directed to Rebecca Campbell, Department of Psychology
(M/C 285), University of Illinois at Chicago, 1007 West Harrison, Chicago, IL 60607-7137.

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