The Lifelong Trajectory of Harm After Rape.The Labor of Recovery.
Jessica Muñoz, LMHC | Evidence-Based Trauma Therapy for Sexual Coercion, Sexual Assault, Marital Rape & Coercive Control8 min read
Rape can profoundly change how a survivor assesses threats,
moves through the world, believes in themselves, and makes decisions—in ways that are not recognizable in real time.You are still living your life. Studying, working, forming relationships, perhaps parenting. You may not notice how much effort goes into feeling safe, how often you question yourself, or how frequently you say yes when you want to say no. It may be years before you recognize a pattern.The harm unfolds longitudinally. Yet, in my view, funding the response to gender-based violence reflects a misplaced hyperfocus on crisis settings. For some survivors, managing the trauma symptoms becomes a lifelong labor. Recovery is possible. Trauma symptoms can, at times, fade into the background or they can sit like el diablo on your shoulder every day. But much like recovery from alcoholism or anorexia, reaching a stable baseline does not necessarily mean the work of maintaining it is over. For some survivors, that work continues for decades. We need to consider what it asks of a person—and who pays for it.PTSD requires symptoms lasting more than one month, alongside other criteria. Symptoms may appear early or the full disorder may emerge later. The diagnostic threshold cannot tell us when every trauma symptom will become apparent. Receiving a diagnosis and recognizing how trauma has changed your life are different things. (VA National Center for PTSD)When conceptualizing harm from rape, we must look beyond the physical assault itself and include any grooming, coercion, or exploitation before and after the rape. Retraumatization must also feature in how we conceptualize that harm. Survivors often have their autonomy taken away a second time by institutions meant to help. Encountering 'help' that feels like an attempt to discredit them can further deepen their self-doubt. Even a survivor’s own plaintiff attorney can contribute to that harm when their approach lacks trauma literacy.These effects can follow someone into work, friendships, and intimate relationships. Appeasing others may feel safer than disagreeing. Fawning is an automatic attempt to stay safe: someone may appear agreeable while feeling threatened, and an exploiter may take advantage of that response. Avoidance can narrow opportunities. Disconnection can make relationships harder to sustain. Difficulties compound while the survivor still has to earn a living and manage everyday responsibilities. (VA National Center for PTSD)Harmful attachment patterns that develop within a relationship with a perpetrator can persist long after the assault. These may include a trauma bond: a strong emotional attachment to someone who is abusive, reinforced by cycles of harm interspersed with affection, reassurance, or relief. It does not mean two people bonding over shared trauma. Recognizing abuse does not necessarily make the attachment disappear.And one trauma can be followed by another. A national U.S. household study published in 2012 found that 58.8% of adult women who reported sexual victimization had experienced it more than once. This describes their histories, not an individual survivor’s predicted future. (Study)When survivors cannot access the support they need to manage trauma symptoms, they may face increased vulnerability to further victimization by abusers and retraumatization by systems meant to help. Research links greater PTSD symptom severity with increased risk of interpersonal revictimization; this does not make survivors responsible for another person’s abuse. (Systematic review)I recently heard plaintiff litigator Carrie Goldberg describe how vulnerability can be catnip to abusers. She nailed it.The precipitating event for my own trauma was a rape while I was working in Miami Beach. My rapist is now deceased and was never held accountable. In the year following the rape, I met the man who would become my abusive husband. He initially presented himself as a protector, offering protection from the intolerable sexual harassment I was experiencing in my job as a manager at Soho House in the early 2000s. He was later convicted on three felony charges linked to domestic abuse in Manhattan criminal court.The rape altered the trajectory of my life. Looking back, I can see how its aftermath desensitized me to abuse, grooming, and coercive control. My sense of what was threatening—and what looked like protection—had changed in ways I could not recognize in real time. That did not make me responsible for the abuse that followed. The responsibility belongs to the people who abused me.My own survivorhood has required expensive labor that, at times, I could not afford as someone rebuilding—all while being a mother, completing graduate school, and becoming a licensed provider.Exploitation does not only look like a pimp. It can happen when an institution entices a survivor to publicly bleed out their story for fundraising.As a survivor, I have been invited to public speaking engagements and podcasts to do what felt like bleeding out, without trauma-informed preparation or payment. Afterward came the vulnerability hangover: Will my abuser find this? What will it cost me? As I spoke, powerful people acknowledged me and made me feel worthy—for a fleeting hour or two.Anger and hypervigilance can make the trajectory particularly consequential in public settings. A survivor who feels threatened may respond defensively, only to have their distress interpreted as aggression. Being forced to engage with systems that misread trauma symptoms can threaten a survivor’s liberty. SAMHSA identifies confrontation, restraint, and misinterpreting trauma responses as potential sources of retraumatization. (SAMHSA)Later life events can reveal other needs. Consider a wanted pregnancy after a period of stability: bodily disconnection reignited, intimate examinations, and questions about control. If seeking help after rape was frightening or dismissive, walking into a hospital may carry meanings others cannot see. Something joyful can coexist with renewed distress.The recognition of sexual violence as a source of lasting psychological harm has its own history. In 1970, Sandra Sutherland and Donald Scherl studied responses to rape. In 1974, psychiatric nurse researcher Ann Wolbert Burgess and sociologist Lynda Lytle Holmstrom described “rape trauma syndrome.” In 1977, Judith Herman and Lisa Hirschman published work on father-daughter incest. (Sutherland and Scherl, Burgess and Holmstrom, Herman and Hirschman)PTSD entered DSM-III in 1980, informed by work involving veterans, Holocaust survivors, and sexual-trauma survivors. Psychiatrist Judith Herman’s 1992 Trauma and Recovery and work on complex PTSD examined prolonged abuse and coercive control. DSM-5 in 2013 broadened recognition of changes in beliefs and mood. ICD-11, effective in 2022, included complex PTSD, with WHO clinical guidance following in 2024. (VA history, Herman, Diagnostic history, WHO)
We recognize that rape can alter the trajectory of a life. So why do we continue funding recovery as though its harm is short-lived?
The VA led the branding of PTSD, shaping its public image around veterans and influencing what people imagine treatment looks like. Two-week intensive programs delivering trauma-focused cognitive and behavioral therapies exist, alongside wilderness programs supporting veterans. Though these programs offer valuable support, their brevity should not become an expectation that someone’s needs will end when the program does. (Intensive treatment programs, Outward Bound)Today, recognition must translate into accessible, longitudinal care. Shelter, legal assistance, and immediate crisis support are essential, but they cannot substitute for sustained investment in the years, and sometimes decades, of recovery that may follow sexual violence.Safe Horizon describes its Counseling Center’s trauma treatment as time-limited. Sanctuary for Families also provides clinical services; in my experience, those services take a similarly time-limited approach. (Safe Horizon posting, Sanctuary for Families)Mount Sinai’s SAVI program offers psychotherapy regardless of how much time has passed since an assault. A Stony Brook Medicine referral directory lists its counseling provision as 16 weekly sessions. Accepting someone years after an assault, however, is different from providing access to years of treatment. (Mount Sinai, Stony Brook Medicine)Counseling often focuses on support, coping, and particular difficulties. Psychotherapy addresses emotional, cognitive, behavioral, and relational patterns and can be brief or longer-term. The terms overlap; a time-limited intervention can still be psychotherapy. What matters here is whether survivors can continue or return to clinically appropriate care as their needs unfold longitudinally. (American Psychiatric Association, NIMH)As an EMDR therapist, I believe in this evidence-based treatment. EMDR can substantially reduce PTSD symptoms. It is also marketed in packages called “EMDR intensives,” which concentrate treatment into a shorter period. Brief treatment can produce lasting recovery. But there are no guaranteed quick fixes for the whole trajectory of harm, or guarantees against distress being reactivated by later life events. Finishing treatment should not mean access to care has expired. (VA on EMDR, Example of intensive treatment marketing, VA/DoD treatment guideline)While psychotherapy can help survivors recognize patterns and develop different responses, concurrent body-based practices are an essential part of addressing bodily disconnection for some survivors. This bodywork takes money, time, and energy. If symptoms interfere with employment, paying for support can become harder precisely when it is needed. That is why financial investment in free bodywork programs for survivors, such as Strength Is Mine, is essential.The stakes can be life-threatening. A Swedish study of 3.1 million people found PTSD associated with approximately twice the risk of suicide, after accounting for several other psychiatric risk factors. Among participants with PTSD who died by suicide, the median interval from diagnosis was 2.4 years. This was not rape-specific, and risk can arise earlier. (Study)These findings strengthen the argument for responses to gender-based violence that offer longitudinal treatment of trauma—and value professionals with clinical experience treating trauma longitudinally.Civil compensation can help fund recovery. But representation, establishing liability, and collecting an award are different hurdles. The survivor who receives no settlement still carries the costs. (National Crime Victim Bar Association, Office for Victims of Crime)Somebody has to pay for the labor of recovery. Where institutional investment falls short, the financial burden is shifted onto the very people doing the work— mental health providers and lived-experience experts who are too often expected to donate their labor.A Manhattan District Attorney’s Office job posting advertised $65,058, requiring a relevant master’s degree and professional licence, with Spanish bilingual skills preferred. In New York City, no less. In my view, that is not a livable wage for the life and professional responsibilities we expect a provider to sustain. (NYC job posting)A second concern is the gigification of psychotherapy—making skilled clinical work operate like Uber. Health insurers are investing in mental health tech platforms: Cigna Ventures and Optum Ventures backed Alma’s 2022 funding round; Health Care Service Corporation invested in Headway in 2023. These relationships raise serious questions about market competition, potential antitrust concerns, and whether providers’ bargaining power over reimbursement rates and working conditions is being eroded. Providers still carry substantial liability and clinical responsibility, and survivors need them to be able to sustain that work. (Cigna Ventures, HCSC)Providers also need access to personal therapy. This conversation must extend beyond vicarious trauma to our own biases, worldviews, and emotional baggage. Preserving survivors’ raw cultural narratives, without censoring them through our worldview, requires us to examine what we bring into the room.Being truly trauma-informed requires a journey of self-examination. Personal therapy is essential to doing that work with depth and rigor, alongside supervision, consultation, and cultural engagement outside of a professional position that carries power. Providers need to pay for their own personal therapy. Their compensation must allow room for that care.Investing in survivors means investing in mental health: adequately paid providers, support for their own clinical and personal work, and longitudinally accessible care. It also means ensuring institutions are capable of responding to trauma without staff members’ service delivery being filtered through their own life stories.For some survivors, recognizing and changing patterns takes years. One year may still be early in their individual process.Their opportunity to receive care should not have ended before they could see what they needed.
Thank You for Inquiring
“I endeavor to protect the raw, unedited voice of trauma — for that's where truth, justice, and healing live.”— Jessica Muñoz, LMHC
Licensed Mental Health Counselor
Jessica Muñoz Therapy LLC