Welcome to Rape Culture, Joe

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Valdosta State University's remarkably inept recent posting of Rape Prevention Tips for Women triggered a number of blog posts on Rape Culture in which the bottom line was as follows: There is only one cause of rape, and that is the presence of a rapist. Tips for preventing rape, therefore, should be targeted at rapists. (Anna posted a great one in the Comments section, here.)

Personal Failure at Forever In Hell was one of the bloggers responding to the VSU gaffe. In response she got, perhaps inevitably, the usual mansplaining troll who took her to task for her "tone", among other things. He criticized her for being angry and anti-male. Fannie, of Fannie's Room took him on, and her post is so right on that I feel compelled to reproduce a goodly chunk of it, verbatim, here. (The last time I asked someone to attempt such a flip-flop, I got totally flamed. I hope she does not, because seriously, this is really good.) I would ask every man who does not believe that we live in a Rape Culture to try this one on for size:

"A good flip-flop comparison would be to imagine a world in which women routinely kicked men in the balls really hard for no reason at all, so much so that men wore protective cups on their genitals at all times and, if they didn't, they knew full well what they were asking for. One wonders, how would men react if the ball-kicking led to the formation of Ball-Kicking Prevention Tips that advised men to never walk alone at night, to avoid dangerous neighborhoods (especially where groups of women congregated), and blamed men for Getting Their Balls Kicked if they chose to move in the world like how people got to move?

It's not so much that the tips are not useful. Some of them are. But wouldn't the men rightly be angry about living in a culture that seemed to focus more on all the ways men could limit their lives to avoid getting kicked in the nuts, as opposed to how we could make women feel less entitled to attack men in the first place?

. . . .

Welcome to Rape Culture, Joe."

Right on, Fannie! There's really not much I can add to that.

Always Be Aware of Your Surroundings

Do you monitor the internetz for potential rapists? Perhaps you should.

I myself have one of those automatic Google thingies set up to scan for variations on my name and report links to me in a weekly e-mail ('course that's not why I do it, but never mind). Perhaps that's how this rape victim discovered a Craigslist ad in her name asking for a partner to act out a rape fantasy. Or not.

In any event, by the time she found out about it and got Craigslist to take it down, a real-life rapist had already seen it and was happily on his way to her house to fulfill some of his deepest fantasies.

Turns out she was set up by her ex-boyfriend.

So if we are responsible, as so many rape-prevention experts advise, for maintaining a constant awareness of our environment, now I guess we are to not only acquire eyes in the backs of our heads (this would be especially tricky if, whether for religious reasons or simply because it is raining cats and dogs, you cover your head when you are out in public), figure out how to see around corners and through parked cars and tree trunks, but also be aware of every transaction on the internet around the entire world in every language all the time! Because you will have nobody to blame but yourself if you get raped because you were unaware of your surroundings.*

My goodness. When will I ever find the time to wash my hair?

*Nobody in the original article--not the reporter, Ben Neary (AP), or anyone interviewed, implied any such thing--but wait for it. It's only a matter of time. I'll bet you a guest post that someone, somewhere, will at least say that once the victim found the ad she should have taken extra precautions. Any takers?

You CAN Prevent Your Own Rape, You Know

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I heard it from an expert.

I've been at an otherwise pretty good two-day workshop that was supposed to be on the neurobiology of trauma, but turned out to be a whole lot about treatment. The seminar leader is a genuine nice guy, a brilliant researcher and clinician who has devoted his career to helping people recover from trauma.

In some ways, I think, that makes what happened today even worse.

He was telling us about a case of a martial artist who was raped, and suggested that women like her get raped because they are unaware of their surroundings and/or are frightened into immobility due to past trauma. He clearly could not think of any possibility other than something about the victim. And I gotta give it to him, maybe she was spaced out--trauma survivors often are. Maybe she did freeze--trauma survivors often do. But still. Why be trying to puzzle out what it is about the victim that gets her raped? That makes me want to set my own head on fire.

Maybe it was a "blitz attack", which of course by definition would mean she wouldn't have known she was even being attacked until she was already down. Or maybe her rapist had a weapon: I have to ask--do men really believe that a martial artist can kick a gun out of an attacker's hand like good ol' Chuck Norris on the teevee? And then there's the rapist who comes in through the bathroom window in the middle of the night and has you under his control before you even wake up. Now how you gonna karate-kick his ass outta bed with your legs all tangled up in the kivvers? And then there was the woman I knew whose attacker told her if she cooperated, he wouldn't harm the children sleeping in the next room: All the martial arts training in the world won't trump that one.

And seriously, even assuming a normal (i.e., non-traumatized) level of awareness, how far can tracking your surroundings possibly take you? You can only watch your back-trail so closely before you get a crick in your neck--or worse, stumble into traffic. A guy who's determined to sneak up on you will. Or jump out from behind something: Can you see through tree trunks, around corners of buildings? I can't. And how aware can we be when we are sleeping in our own beds? 

The expert thinks it is empowering to teach a woman to kick the shit out of a model in pads and a helmet. He noted her proud stance after the class and said something to the effect of, 'Now she's in control of her own destiny.' The sheer illogic of this is stunning when a lifetime of training in martial arts didn't protect her. (I've seen this from a women's self-defense expert, too, who repeatedly tweets that it is up to you to be appropriately assertive--in control--so you don't get raped.)

Let us note that one in every six women in the U.S. will be assaulted in her lifetime. Maybe it's just me, but I think that's frequent enough to suggest that we are not, in fact, in control of our own destinies--at least not when it comes to rape. Indeed, that kind of thinking sounds to me like a form of privilege: The not-raped can believe they did/do something to earn/deserve that status ("I kicked the shit out of him!" or "I'm always aware of my surroundings." Always? Really?). That kind of thinking allows the not-raped to feel safe and secure in the fantasy that "it will never happen to me" and to look down on victim/survivors as people who screwed up somehow.

But I digress. I'm sure beating up on that guy in class was fun for her. And maybe all women should know some self-defense. But shouldn't anybody think that's going to necessarily prevent a rape (see above). Heck, it might get her hurt worse or even get her killed, because some rapists escalate when you fight back, either because it angers them or because they are excited by it.

These are all reasons why it is both cruel and ignorant to blame women for not paying sufficient attention to what every potential rapist within arm's reach might or might not be doing, or for not fighting off a dude who outweighs her, has a longer reach, has got the drop on her, or who is carrying a weapon--or all of the above. I'm sure the presenter didn't mean to blame anybody, but that is, precisely, victim-blaming.

My stance has always been (and I learned this at Grady's Rape Crisis Clinic back in the '70s, by the way--I don't get original credit for it) that whatever the woman does and survives is the correct thing. I wasn't there. You weren't there. The expert wasn't there. She was. She read the situation and handled it instinctively--and survived. That right there gets her a grade of A+.

The scary part, again, is this guy is a recognized expert who amply demonstrated a high level of sensitivity at other times during a career spanning decades. If he can have a mental lacunae like this. . . well, I just despair sometimes.

And of course he's not the only professional to do this, nor is it always a man. A recent report of a "female" getting raped in a park caused a female psychologist to nearly throw herself onto Twitter to warn "girls" not to go to parks alone or after hours. I clicked on the link and found that the original news article had never specified the victim's age, the time of day, or whether she was alone. Never mind that none of these things is in the least bit relevant anyway, because rape, dear readers, is caused by rapists.

Trust Means Letting Go of Control Over the Outcome

Vigil for Dr. Tiller       Image via Wikipedia

What is Blog for Choice Day?

Each year, NARAL Pro-Choice America poses a question to pro-choice bloggers before the anniversary of Roe v. Wade, and then asks them to blog their answer on January 22.

In honor of Dr. George Tiller, who often wore a button that simply read, "Trust Women," this year's Blog for Choice question is:

What does "Trust Women" mean to you?

Ironically, I was inspired to this post by another disabled feminist blogger's expressed opinion that abortion is just another way for upper-class Caucasians to get rid of  "bad babies", which is to say, fetuses who might already be defective in some way or who have the genetics for a future disability. 

The blogger is right when she points out that we have such a prejudice against the disabled in this country that we often disapprove of either disabled women having children, or women in general having disabled children. For example, she points out that we even frown on older women conceiving because of the mere risk of problems. The gist of her post is that no, she does not trust women: She thinks we are all out to kill her and her kind.

She notes that people who think that raising a disabled child is a terrible burden are making a basic logical mistake: It's not the child's disability that is the biggest problem. It's the lack of affordable health care, accessible child care, and so forth. In other words, that baby is facing all the societal prejudices against disability from day one. And by extension, the miserable lives that the able-bodied envision for those of us with disabilities is premised on the same logical error: It is often not our disabilities that are our biggest problem, but the attitudes of others (including the unwillingness to hire us at comparable pay), the lack of accessibility everywhere we wish we could go but can't get in, the lack of decent health care in this country, and the ignorance of our health care providers about our specific needs.

About all this my sister blogger and I are completely in agreement. But also, and unfortunately, there is little social support in the United States for any woman to raise any child. If she is a single, young, unemployed woman of color? Fuggedaboudit. No support. Indeed, she is likely to be punished in any number of ways, large and small but equally cruel, every day for the entire dependency of that child. And this, my dear readers, is why most women seek an abortion. Not because the child is going to be disabled but because the woman in question simply cannot have and raise a child. Any child. Maybe especially not a disabled child, and maybe especially not if the woman herself is disabled, but the bottom line is that any woman may find herself unable or unwilling to carry a fetus to term.

Find me one case of one of these mythical Caucasian upper-class women with, say, a hereditary crippling disease, selectively aborting pregnancies until she gets a "good" one, and I'll buy you dinner. I can safely make that bet because the fact is that "abnormalities in the fetus" is the least-frequent reason cited, world-wide, for seeking an abortion. 

The able-bodied aren't the only ones making logical errors here. Sometimes disability advocates and pro-lifers do, too:  pro-choice is not synonymous with pro-abortion, but some people have an annoying habit of conflating the two. I am not personally acquainted with any pro-choice folk who think that there is any circumstance in which a woman should have an abortion. What we want is for women to never again be forced to carry every pregnancy to term, irregardless of her personal circumstances.

Which brings us to what "Trust Women" means to me. The dictionary definition of trust is, "reliance on the integrity, strength, ability, surety, etc., of a person or thing; confidence." You will note that there's nothing in this definition about outcomes, only about process. We, as women, if we trust each other, must rely upon each other to make our own best, ethical decisions about our own bodies. Pro-lifers do not trust us: They have one specific outcome in mind and that's what they want come hail or high water, whereas people who are pro-choice by definition express confidence in each woman's strength and integrity, in her ability to make the right decision. Pro-life is a paternalistic approach that treats women as children; pro-choice respects us as the adults that we are.

To me, "Trust Women" means just that. Trust us. Trust each other.

Stupid EOBs, Edition 1

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An EOB, for the unitiated, is an Explanation of Benefits. More often, they are better described as Obfuscations of Benefits.

This one is from Aetna. It purports to explain why they did not pay me for a session:

 "The member's plan provides benefits for covered expenses at the plan's recognized percentile level of charges received by Aetna for the same service."

I feel like I need a shower now

A recent thread on a professional listserv I belong to has taken up the topic of using client/patient testimonials on psychotherapy websites, in brochures, and for other marketing materials. A couple of people responded to the original poster that he should not do it. And then this:

My [partner] is an attorney and we looked into this before I obtained my testimonials. It is true that in [State] testimonials are not allowed regarding current clients. However, clients that you have terminated with are fair game.

"Fair game"? Egad. What a way to look at one's patients. Would you want to see a therapist who looks at you as the marketing equivalent of a deer in his crosshairs?

The commenter goes on to say,

Some of my clients fill out a form. . . and some I speak with over the phone. The phone interviews are much more productive because you can discuss what may be relevant to your marketing needs, e.g., getting them to talk about specific results that have come from our work together rather than just praise about me.

Finally, the commenter refers the original poster to the website of a practice coach who says, and I quote:

. . . through the course of your work together perhaps a client spontaneously expresses how he or she is benefiting from seeing you.

When this happens, you should write down what the client said about how he or she benefited from your service and then ask permission to use these statements in your promotional materials.

Seriously. I need a shower.

As the commenter notes, certain states' licensure laws do not expressly prohibit soliciting testimonials from former clients. Our ethics code does not specifically forbid it either. However, it is my position that ethical behavior ought to consist of more than simply not doing what is expressly forbidden. Striving to be as ethical as we can should include having our clients' best interests at the forefront of our minds at all times, acting like a professional (as opposed to, say, a used-car salesman), and maintaining our professional objectivity in any given case. It is a vital part of our professionalism and essential to our objectivity that therapy is about the client's needs, not ours.

Taking notes during a session with an eye to posting clients' statements on your website is hardly keeping your eye on the therapeutic ball. Even if you wait until a client is "former" to ask permission to use a quote, how can you help but think in terms of that client's potential effect on your bottom line rather than doing your best work at the moment? Sometimes our best work is going to make the client uncomfortable--anxious, sad, even angry. We may hesitate to say what they need to hear, as opposed to what they want to hear. What if a client wants us to violate a boundary in some way? We may give in, gratify that wish for them instead of helping them work it through, so we can get a good ad out of it. We're only human: If we walk into that consulting room with any agenda other than the therapy, we are at risk for skewing things to get our needs met at the client's expense.

Waiting until the client is no longer a client to ask for a testimonial does not keep it from being an issue with active clients. Clients who found you through promotional materials using testimonials know perfectly well, even if you haven't mentioned it yet, that this is on the table. How will this affect their work with you? Will they use criticisms for leverage? Will they worry that if they don't give you a testimonial that you will not write as good a letter for their probation officer, or give them whatever else they are needing from you? Conversely, will they spontaneously offer testimonials in order to win your good will? Clients know we're only human.

Clients who form strong, long-term relationships with their therapists are particularly desirous of pleasing us. Might such a client be even more reluctant to hide relapses if they have the extra, added pressure of knowing we need a success to bolster our practices? Could they feel pressured to look like they are getting better than they are, faster than they are, to help us out? Nobody knows the answers to these questions, because nobody's researched it. It would be unethical. But we can make educated guesses, and our best guess is that any or all of these things could happen; our best guess is that this testimonial business is bound to affect the work. It can't not.

Our ethics code and state law do prohibit soliciting testimonials from "persons who because of their particular circumstances are vulnerable to undue influence." Many therapists think that this latter category includes former patients. We are uncomfortable with the legal and ethical distinction between current and former patients that allows certain behaviors toward the latter. Psychodynamic therapists argue that transference, the displacement of feelings from parent to therapist, lasts forever. To them, "once a client, always a client" is the rule. Even if you aren't psychodynamic in orientation, it is difficult to define "former." I've had clients return after a hiatus of as long as 10 years, and probably these folk considered themselves my clients even when they weren't active in therapy.

Contact after a brief period is very common. Perhaps the client you just saw for a 5-session Employee Assistance Service (EAP) assess-and-refer gives you a testimonial--or refuses one--and six months later needs you to testify to your work in court. Will you be squeamish about testifying to things that will hurt your client's case? Will you not want to go if they wouldn't give you a nice sound-bite for your website?

Even if they never come back or need you again for anything else (like court), on what magic date do you stop having most of the power in the relationship such that a client would truly feel free to refuse you? There is no research that I am aware of which would tell us how many days, weeks, months, or years it takes after therapy ends for us to stop being an authority figure to our clients. On what magic date would we no longer be using our position and prestige to get our "marketing needs" met by the client? By the time we get done with a course of therapy, we know things about a person, things we can use to get what we want. On what magic date to we un-know these things? I think the commenter above intuitively recognizes, even as she fails to consciously consider, that power when she recommends telephone interviews: We can exercise a lot more influence, due or otherwise, on the phone than we can through the mail.

The American Psychological Association (APA) ethics code also forbids dishonest or misleading public statements, in which they include your advertising. There is plenty of research to show that, psychologically, humans want things to work. We are hard-wired to believe that a treatment or a product did work for us, and the more time and money we put into it, the stronger is this bias. Asking a client if something was helpful is not going to get the same kind of objective information as, say, before-and-after psychological testing might. Plus, presumably, if a client tells you, "Heck no, you bite," are you going to post that on your website? No. For these reasons, your promotional materials are apt to be misleading, if not downright dishonest, in direct proportion to your dependence upon testimonials.

Bottom line? Just because we can do a thing doesn't mean we should. What we should do is strive to go as far beyond the minimum standards outlined by legal and ethics codes as we possibly can. I simply do not believe that we can do our very best possible work if we are thinking about how what we are doing is going to look in a brochure, and I do not believe for one minute that clients will have the freedom of action or sense of absolute privacy that are the sine qua non of productive therapy if they know they will be used in an ad. There is a risk throughout the therapy and well after it that we will be using our position as the client's therapist, and the power and insider information that goes with it, to get our needs met. Finally, testimonials are not an honest means of advertising.

I tell my ethics students that, "There's illegal, unethical, and just plain tacky." Testimonials may not be illegal, and they may not be unethical, but they are surely tacky. In fact, I would go so far as to say that they are downright sleazy.

Just sayin'.

Haiti Earthquake: Stress Management Tips From The APA

Haiti Earthquake: Stress Management Tips From The APA

No time to blog it right now--just wanted to put the link up for you.