Psychologist John Duffy, author of "Parenting the New Teen in the Age of Anxiety," practices in Chicago. He specializes in work with teens, parents, couples and families.
(CNN)In my clinical practice, I have worked with more than 25 women and girls who have reported to me being raped or otherwise sexually assaulted. Many of them had unwittingly ingested a drug secretly given by the assailant, leading to confusion, weakness or unconsciousness before these encounters. I've been overwhelmed by their courage in sharing their harrowing stories. The resulting symptoms have varied enormously, including anxiety disorders, depression, rage, crippling fears, post-traumatic stress and deep-seated guilt.
And I'm well aware that many more of my clients may have been through such an ordeal without revealing it to their therapist.
For these and so many survivors of sexual violence, the Bill Cosby accusations unveiled a particular horror. The idea that one man could allegedly victimize so many women and be released from his sentence was unimaginable. In fact, over the past several years, more than 50 women have accused Cosby of sexual misconduct. Despite denying the allegations, in 2018, he was found guilty in a single case, and had been imprisoned since that time.
My female clients, especially teenage girls and young adults, celebrated the conviction, heartened by the idea that men, even very powerful men, can be held accountable for their violent crimes against women. As with a number of other #MeToo moments, young women felt a degree of agency, influence and hope when Cosby was convicted. On Wednesday, however, that verdict was overturned, based on a ruling that Cosby's due process rights had been violated, despite the fact that he had admitted to acquiring Quaaludes to give to women he wanted to have sex with and pursuing younger women under oath.
Cosby has denied any wrongdoing and said the sex and drug-taking were consensual in court deposition.
Immediate impact of Wednesday's reversal
Based on my client feedback, few of these women were surprised by Wednesday's reversal. I've been hearing a lot from teenage girls and young adult women. My clients have given me full permission to share these thoughts:
One client, only 18, suggested, "As far as I know, the guy who raped me only raped me. Today's news is probably great for him, but I'm scared. Not just of him, but all men."
Meanwhile, a 20-year-old college student told me, "That guy who assaulted me is super popular on (that campus). You don't think they're going to find a way to get him off those charges?"
And a 27-year-old professional, drugged and assaulted after a work event, expressed hopelessness: "This just makes me so angry, fearful and sad. After all of the attention on sexual assault against women, I hope women and men continue to stand up against it."
For many, anger, fear and hopelessness have been immediate reactions. Some women now continue to worry that they won't be believed if they are sexually assaulted, while others fear the justice system will fail them regardless.
It's unclear whether women are less likely to report a sexual assault in the wake of this type of reversal. However, Andrea Constand, the defendant in the case, and her lawyers issued a statement Wednesday evening, suggesting that the new majority decision "may discourage those who seek justice for sexual assault in the criminal justice system from reporting or participating in the prosecution of the assailant."
The psychological implication for women and girls
As noted above, the psychological fallout of sexual assault is devastating. Along with the symptoms cited, many of the women I've worked with have suffered ongoing relationship difficulties and intimacy issues, as well as significant trouble trusting men. In the extreme, eating disorders and suicidal ideation are not uncommon. And clinically, these issues are all quite resistant to psychological treatment, as the therapeutic relationship needs to be based in trust, a commodity often reasonably lacking in victims.
I have worked with sexual assault victims who have gone through the process of prosecution without a satisfactory outcome, and in these cases the psychological fallout can be far more complicated. They may distance themselves from family, friends and caregivers, truly feeling that nobody will be able to help them. In these circumstances, a profound sense of hopelessness tends to follow as well. Feeling a lack of power and agency, many of these women take their fears, anger and loathing out on themselves, self-harming or, in the extreme, attempting suicide.
A clinician's perspective
Further, as a clinician who has worked with women who have been assaulted and failed by the system, I can tell you that these situations are agonizing and ongoing. The hopelessness of being doubly victimized reads an awful lot like grief in therapy. My patients have grieved for the loss of their own innocence, their faith in humanity, and far too often, their own sanity. A good night's sleep without nightmares is a rare treat. A date with a significant other or new partner too often feels foreign or dangerous, and sex for many of these victims is not a consideration for years.
Mostly, I hear that a victim's sense of safety, which before the traumatic event had typically been taken for granted, is now entirely elusive. Men no longer feel like allies to them, they tell me, but overt threats. And the possibility that justice may not be served too often feels like an overwhelming, untenable breach for an already compromised psyche.
Along with individual therapy (preferably with practitioners who specialize in rape and sexual assault), group work focused on sexual assault always proves helpful. The Rape, Abuse & Incest National Network and the National Alliance on Mental Health in particular have proven helpful to my clients (see "How to get help"). I have also found survivors cope best when they have an extensive support system of friends and family that they can turn to when they need to tell their story, be distracted from their story, laugh, or just be held safely. I also encourage victims to safely return to their routines: work, diet, exercise, meditation and so on. This will help them feel a sense of groundedness and normalcy in the aftermath of an assault.