Journal of Consulting and Clinical Psychology 1999, Vol. 67, No. 6, 847-858 Copyright 1999 by the American Psychological Association, Inc. 0022-006X/99/$3.00 Community Services for Rape Survivors: Enhancing Psychological Well-Being or Increasing Trauma? Rebecca Campbell, Tracy Sefl, Holly E. Barnes, Courtney E. Ahrens, Sharon M. Wasco, and Yolanda Zaragoza-Diesfeld University of Illinois at Chicago This research examined how contact with the legal, medical, and mental health systems affects rape survivors' psychological well-being. Although community services may be beneficial for some victims, there is increasing evidence that they can add trauma, rather than alleviate distress (termed secondary victimization). This study examined how secondary victimization affects rape survivors' posttraumatic stress (PTS) symptoms. Adaptive and snowball sampling were used to recruit a sample of 102 rape survivors. Victims of nonstranger rape who received minimal assistance from either the legal or medical system, and encountered victim-blaming behaviors from system personnel, had significantly elevated levels of PTS. This high-risk group of rape survivors had PTS levels significantly higher than all other victims in this study, including those who did not seek community assistance postrape. However, for these high-risk rape survivors, receiving sustained mental health services after these negative experiences was associated with a significant decrease in PTS. "They were raking me over the coals, making me feel like a slug, making me feel guilty for doing all the actions I did that day, and treating me like I was the one who raped, the offender, not the victim." —A rape survivor on filing a police report "Worst experience ever. And it was because of the doctor. He was very rough. And he was saying, 'Open your legs. Stay still. Open them further.' I'm saying, 'Excuse me?' I feel like saying, 'I have just been raped!' He was just so crass, so rude about it. Really cold.. .. And then when he scraped [taking the vaginal swabs], I jumped, and he says, 'You gotta stay still!'" —A rape survivor on the medical rape exam "My therapist kept talking about my need for attention. How I made bad choices in life because of my need for attention. How I got myself raped for attention. Those words hurt as much as the rape itself." —A rape survivor on mental health counseling These rape survivors' narratives speak to the detrimental effect community services may have on women's psychological well- being. 1 To date, the rape victimology literature has focused pri- marily on assessing the prevalence of rape and its impact (e.g., Atkeson, Calhoun, Resick, & Ellis, 1982; Golding, 1994; Kil- Rebecca Campbell, Holly E. Barnes, Courtney E. Ahrens, Sharon M. Wasco, and Yolanda Zaragoza-Diesfeld, Department of Psychology, Uni- versity of Illinois at Chicago; Tracy Sefl, Department of Sociology, Uni- versity of Illinois at Chicago. This research was supported by National Institute of Mental Health Grant R24 MH54212-02 from the Program for Mental Health Services Research on Women and Gender and by the Great Cities Institute, Uni- versity of Illinois at Chicago. We thank the members of the University of Illinois at Chicago Women and Violence Project for their assistance in data collection and Deborah Bybee and Linda Skitka for their consultation on data analyses. Correspondence concerning this article should be addressed to Rebecca Campbell, Department of Psychology (M/C 285), University of Illinois at Chicago, 1007 West Harrison, Chicago, Illinois 60607-7137. Electronic mail may be sent to rmc@uic.edu. patrick et al., 1985; Kimerling & Calhoun, 1994; Koss, 1993; Koss, Gidycz, & Wisniewski, 1987; Riggs, Kilpatrick, & Resnick, 1992), as well as developing effective therapeutic interventions (e.g., Foa, Rothbaum, Riggs, & Murdock, 1991; Frank et al., 1988; Resick & Schnicke, 1992; Rothbaum, 1997). Nevertheless, as these narratives suggest, rape survivors' experiences with the legal, medical, and mental health systems may "hurt as much as the rape itself." The trauma of rape, therefore, may extend far beyond the actual assault, and intervention strategies must address the difficulties rape survivors encounter when seeking community help. A growing body of research suggests that survivors are often denied help by their communities, and what help they do receive may often leave them feeling revictimized (Campbell, 1998; Campbell & Bybee, 1997; Frohmann, 1991; Madigan & Gamble, 1991; Martin & Powell, 1994; Matoesian, 1993; Williams, 1984). These negative experiences have been termed the second rape or secondary victimization (Madigan & Gamble, 1991; Martin & Powell, 1994; 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. Sexual assault has widespread effects on women's psychologi- cal and physical health (see Koss, 1993), and as a result, rape victims may contact several community agencies for assistance, such as the legal, medical, and mental health systems (Campbell, 1998). The services provided by these systems are often difficult to access and potentially stressful for rape survivors. Most rape survivors never get their day in court. Only 25% of reported rapes are accepted for prosecution, 12% of defendants are actually found guilty, and 7% of all cases result in a prison term (Frazier & Haney, 1996). In addition, Campbell (1998) found that even for survivors who had the assistance of an advocate, 67% had 1 The quotations are from rape survivors interviewed in this study. 847