In this episode, Steph Curnow is joined by consultant clinical psychologist Dr Kerry Young to discuss the paper "How to Treat Someone Suffering with PTSD Following Rape in Adulthood", published in The Cognitive Behaviour Therapist.

Kerry shares the motivation behind the paper and reflects on over two decades of clinical experience in trauma services.

Listeners will gain insight into:

• Why evidence-based trauma-focused therapy for PTSD following rape is so effective
• Common myths that prevent therapists from engaging in this work
• Practical guidance for assessment and treatment using CT-PTSD
• The importance of addressing dissociation, self-blame, and shame
• Strategies therapists can use to protect their own wellbeing while doing this work
• The powerful impact this intervention can have on clients’ lives

This episode also highlights the invaluable video resources linked to the paper, which show exactly how to put the guidance into practice. Kerry offers encouragement to therapists: if you know how to do CT-PTSD, you already have the skills to help survivors of rape and it’s some of the most rewarding work you can do

Read the full paper here

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Transcript:

Steph: Hello and welcome to Let’s Talk about CBT- Research Matters, the podcast that explores some of the latest research published in the BABCP journals with me Steph Curnow. Each episode, I'll be talking to a recently published author about their research, what was the motivation behind it and how they hope it will impact the world of CBT.

Today I’m talking to Dr Kerry Young. Kerry is one of several authors on the paper How to Treat Someone Suffering with PTSD Following Rape in Adulthood published in the Cognitive Behaviour Therapist.

Hi Kerry, welcome to the podcast. So, it's so nice of you to come on and talk to us today about this paper. I think most people will probably know who you are already, but for any listeners that don't, would you mind just introducing yourself and telling everyone a bit about you and the areas that you work in?

Kerry: Yes, hi. So I'm Kerry Young. I'm a consultant clinical psychologist and I've worked in specialist trauma services. I worked it out just now for 28 years. I'm a bit tired. And at the moment I run a PTSD service for refugees and asylum seekers in West London near Paddington station.

Steph: So, the paper we are talking about today is How to Treat Someone Suffering with PTSD Following Rape in Adulthood. That's the title of the paper and it does exactly what it says on the tin. So, I really wanted to get you onto the podcast to talk about it because it's such a comprehensive and helpful paper. Would you mind just talking a little bit about where the motivation to write this paper came from? How did it come about?

Kerry:  Yeah, so as I said, I've been working in trauma services since the late 1990s. And I think when you start out working in specialist trauma services, you really appreciate how treatable PTSD is. So we would be expecting, if we treat PTSD for someone really not to have any symptoms anymore. So it really is a wonderful thing to treat. And over the years, I've done more and more supervising in other services. And in fact, I've been part of the NHS England funded top up for NHS Talking Therapies to work with PTSD. And what I think all of our supervisors noticed doing this is that people are a bit sheepish about treating PTSD following sexual violence. There's lots of myths and there's lots of things that get in the way, but for good reasons, I think. But we were, all of us, I think, feeling really worried, not just in NHS Talking Therapies, but in other people we supervise that, you know, if someone has PTSD to rape or sexual violence, their chances of getting someone to treat it in an evidence-based way were quite variable, I think. And I just found that really upsetting really, because you'll hear all of these stories about people being raped, you know, maybe in their teens, in their twenties, and it changing the whole course of their life. And them going through the rest of their life really feeling to blame for what happened or feeling really bad about themselves. And this sort of one moment really kind of can change the course of someone's life and that's very particularly the case if they have PTSD. And so what I was noticing is that people are flashing back to being raped day in, day out, dreaming about it when they're asleep. And it’s reinforcing this, they're feeling really bad about themselves, feeling really responsible for what happened and then, making choices about their life on the basis of that. And I just sort of thought, I think we all thought, oh my God, you know, if we could just 10 sessions and the person will stop re-experiencing it, they'll be able to make choices about themselves and their lives that aren't based on re-experiencing rape. And we just thought, how can we get people to do this evidence-based therapy? And it's not just me that's written the paper, you'll see there's an enormous number of people who've written it. So don't think for a minute it was just me, but we thought, well, look, I think the problem is that people really just don't know quite how to do it. They don't know how to ask these questions about body parts and stuff. And there's lots of myths about what you should and shouldn't do. So we thought, look, we'll just tell them. We'll just tell them how to do it and show them how to do it. And so what's brilliant about this paper is this film showing you how to do it. And then hopefully people will just have a go. So that was what was behind it.

Steph: Yeah, yeah. And that really nicely segues into my next question then, which was to say, in the beginning of the paper, you do talk about, about therapist fears and maybe some myths around working with sexual violence. I think it'd be really helpful if you could just take us through some of these and actually what might be barriers for therapists working with these clients. As you just said, you know, there are so many that are shy about working with this.

Kerry: Yeah, and I just want to make it clear that we're all a bit shy of working with sexual violence. When they invent the thing that means we don't have to talk about it with people, I'll be the first to sign up but there isn't anything else that works as well as trauma-focused therapy. Please don't, I don't want people to think I'm thinking they shouldn't, you know, not want to talk about this stuff because I think it's very natural. There's lots of myths, I think. People often think that someone has to be stable to be able to do this work. They need to be in stable housing. They need to not be waiting for a court case. It all needs to be well in their life. And actually, so often that's the reason why people don't do the therapy. And actually, that is not the case at all. And there's very good evidence in fact, there was a great systematic review that came out last year by someone called Vanessa Yim that really looked into that and found out that actually even when you're in a war zone or even when you're still in a domestically violent relationship, you can still benefit from trauma-focused therapy. So the stability thing is a myth. Now obviously some people might not want to do it when they're unstable, but we shouldn't make that choice for them.

In other myths, the things like you can't sort of on a similar vein, you can't treat people who've been raped and have PTSD if they're substance misusing. Again, that's one of those really kind of widely put about beliefs. And actually, again, the evidence not only doesn't back it up, but backs up the opposite, that people can benefit from trauma focused therapy while they're still actively substance misusing. And if you treat the PTSD, the substance misuse comes down alongside it. those sorts of things. So people don't have to be stable. They don't have to not be drinking or taking drugs. And then I suppose the main thing that people worry about is, because the therapy involves talking about the rape in some detail, people think it will be too shame inducing for the client. And on the surface, that makes perfect sense. You think, yeah, no, fair enough. But if you just think about it a little bit more, what the problem with rape is nobody can really tell anybody about the details of it. Not even your best friend, I don't think would you would say this happened and then this and then this. And so people tend to feel ashamed when they've been raped and they never really get the chance to tell anyone exactly what happened. And then, so if you actually, you're with a therapist and you tell a therapist exactly what happened and the therapist goes, oh no, I'm so sorry, poor you, that's just dreadful, what a horrible man. I'm so sorry that happened to you. And the therapist remains compassionate and caring and doesn't blame them and doesn't run out of the room horrified, the client learns that actually the person isn't judging them, and it actually reduces their shame. So the act of telling something that you're ashamed of tends to actually reduce the shame because someone reacts nicely to it. And indeed there's research that backs that up that actually talking about sexual violence reduces the shame associated with it, doesn't increase it. So I think that's the big one. And I suppose related to that, people often think as well that talking about sexual violence will be too much for the client and that they'll just drop out of therapy or something. And again, that's just not backed up by the research. The dropout rate for PTSD to rape is incredibly low. It's no higher than any other PTSD treatment. And in fact, all of the early PTSD research that was done in the 80s was done in America and almost all of it was on rape and sexual violence. So, we've known for 40 odd years that actually trauma focused therapy really works with that client group.

Steph: Yeah. And I remember when we had Nick Grey on the podcast quite a while ago now, and we're talking about PTSD more generally and misconceptions around it. We were talking about then, is it that we're worried about the client and the client can't handle it? Or is it maybe the therapist is actually shying away from it and the therapist is actually thinking, can I handle this? Can I manage it?

Kerry:  Yeah, well, yeah, no, you're right. I should have said that really. And I think that's really understandable. It's not something we do in everyday life. And I think it's a particular skill in working with PTSD to, you know, I often say to trainees when they're working with me, if you get an overwhelming urge not to ask about something in trauma work, that's your cue that you should. And it's a really paradoxical thing to do to get someone to talk about something that's really upsetting. And it is upsetting, it is upsetting listening to somebody talk about being raped, because, particularly with reliving, you kind of have to picture it yourself in your head, you're sort of there nearly, it's uniquely upsetting. There's no doubt about it. And I suppose it's only, it's only really worth doing to you yourself, I think, if you know it's going to help. Yeah? And so whenever I sit with someone and they're talking about sexual violence, which is basically every day in my job, I take a breath and I say to myself, I'm going to help you. Yeah? I'm going to make you stop having to think about this. And I say it to myself in my head and I'm confident that I can make it stop for people. So it's sort of easy for me to put myself through it because I know I can help. And I think if you don't know you can help, you're not quite sure what to do, you are exposing yourself to some horrible stuff without really quite being sure why. And so again, I wanted the paper to be a bit of a rallying cry to say it is worth listening to this stuff. You will help people. And the research on vicarious traumatization and burnout around PTSD therapy is that if you know that you can help and you know that you're being affected, you're much, much less likely to be traumatized by what you hear. Yeah, so I mean, I think there are some things that you can do to help you cope. And think we're going to come on to them in a bit.

Steph: Yes, yeah, we'll definitely come on to that in a later question. It must be really difficult for a client coming to seek treatment following a rape. I think that must be a really brave and difficult thing to do. Would you be able to talk us through some of the things that therapists maybe should be taking into consideration when assessing clients in this context? And also, how do they know it's PTSD?

Kerry: I mean, it's quite hard to know if it's PTSD and lots of things look a bit like PTSD as well. I think the first thing that that's useful to know is that the rate of PTSD after one rate is 50%. Okay. So it's incredibly likely. It's the most likely thing that someone's going to suffer from after a rape. And of course, once it's more than one rape, you get this load effect. So the more times you have been raped, the more likely you are to get PTSD. So it is quite likely. So I would definitely have PTSD glasses on when assessing a survivor of rape. But yes, someone has come to you. If they have PTSD, the key thing about PTSD is that the person can't bear to think about the rape. One third of the symptoms of PTSD are avoidance. And so the person is really, really not going to want to talk to you about it. So they've done the most incredibly brave thing to come to talk to you because they sort of know you're going to ask them about it, and they can't stand it. So, you know, really making sure that you're, I'm sure most therapists would anyway, really encouraging the enormous effort that someone's gone to, I think, pitching up for therapy for PTSD following rape is a bit like sort of, I don't know, pitching up to a doctor and saying, go on chop off my arm or saw it off really slowly. It's going to feel that painful, you know, in anticipation. Obviously it's not in reality. So it's an incredibly brave thing to do. So really, really encouraging people. And then coming in very quickly with something encouraging about how treatable it is. So if someone has PTSD to one off rate, I would be expecting them to get all better, to stop re-experiencing it in 10, 12 weeks. So it's not something that has to be with you for the rest of your life. I mean, you're not going to be unaffected by it, but you shouldn't have PTSD to it with a good bit of evidence-based treatment. So coming with a very kind of positive now then, this is worth talking about.

And then how do you know it's PTSD? I mean, I think the real key to knowing if something's PTSD is thinking what exactly it looks like. So with PTSD, I sort of think about it like imagining that your brain has made a multi-sensory video of the rape. So it's got a picture track and a soundtrack, but there'll also be a body sensation track, smell, taste. So you've got this multi-sensory video and then it's as if that's shoved away somewhere in your brain. And then to have PTSD, you're going to have to have actual bits of that video pinging into your head when you absolutely don't want them to. So it might just be a frozen image of it, or it might be a clip of film with sound in it, or it might just be the taste of something or the smell of something that that belongs to that recording. But the key is it does belong to that video. So I often talk about it a bit like as if, old video tape and there's some sort of pixie sitting in your head, chopping up bits of it and throwing them into your mind. It has to be part of the original recording. And then because this multi-sensory video is so frightening and so shame-inducing and so disgusting, you will do anything at all to get it out of your head again. So it's like its burning oil, like someone has just poured burning oil into your mind. Oh so frightened, so ashamed. So you just immediately try and do something to push it out. And those are the avoidance symptoms of PTSD. And if you know that talking to someone will make this stuff come into your head, you're going to avoid talking to them. If you know that walking down a certain street will make it ping into your head, you won't go there. And if you know that seeing a man will make it come into your head, you're going to avoid men and you're going to avoid anything that makes this stuff come into your head. But I think it is quite difficult to really pin down PTSD. And of course, the person who has PTSD is not going to want to talk about it. So it's quite hard to really get that. There's a very good film hyperlinked into the paper telling you how to assess PTSD that really goes through it in about an hour of very sort of fine detail. But yeah. It's really sort of thinking about, it part of this film? And really encouraging the person that you can do something very early on, I think.

Steph: Yeah, and it's one of the really lovely things about this paper as well. And we very much want people to encourage people to go and read the paper really thoroughly as well, because each bits that we're talking about will have so much more detail in the paper. And one of the really lovely bits is that you have interspersed all the sections with videos too, so people can really see in really practical terms how this can work.

Kerry: We thought that was really important. So we thought it's really important for people to see someone saying the words, you know, when he did that, what did that feel like? How did that, you know what did you think? What happened next? Then what? You know, just to show that you can do this and you can say these words out.

Steph: So should we get into the guidance that you've laid out then for working with clients experiencing PTSD after rape? As we've already mentioned, this is kind of a how-to guide for working with this client group and there's so much information in there. Are there any particular parts of the guidance that you would particularly like to highlight or to point out? It's a very long paper, so it could be quite a long record if we went through it all.

Kerry:  I'm sorry it's such a long paper people. What I suggest you do is actually ignore Steph and don't read the whole paper in one go. What I suggest you do is you decide hopefully at the end of listening to this to try treating someone in this evidence-based way and then just read the few bits that are relevant to the session you're going to do next and then read the next bit. Otherwise you forget it.

Steph: Yeah, maybe that is a better way of doing it.

Kerry: Yes, apologies for that. But at least because you can watch the films as well, to be fair, I think watching the films and reading the paper is the perfect combo. But you could always just watch the films. But I shouldn't say that in front of someone who works for journal. So I suppose the message is that you do not have to do anything different in terms of the bare bones of what you're going to do. You're going to do Cognitive therapy for PTSD, that's what we're going to take you through in the whole paper. You're going to do the same outline that you do for anybody in a car accident, in a disaster, mugging, whatever it is, you're going to do the same basic process of CT-PTSD. And the paper kind of runs through it in that order too. And there are just a few sort of little flexes that you need to think about or things that we're just going to say a bit more on. And so the first thing is that you're probably going to be dealing with dissociation. Now you might in other areas too, but we know that people are most likely to dissociate during a trauma if it's an inescapable trauma like a rape. And to be fair, I have never met someone with PTSD to a rape who didn't dissociate. It's an entirely adaptive thing to do when you're being raped. And in the paper, there's a load of stuff about how to explain it to a patient, including a film, how to manage it and so on. So number one is expect dissociation and we've got film and words on that.

Number two, and I think this is really important, is you're going to have to give this person of all people a really good rationale for why you think reliving this event is a good idea. Yeah? And they need that because it's a very paradoxical thing to ask someone for details about rape. It's going to feel very uncomfortable for you and it's going to feel very uncomfortable for them unless you really, really know why. And so we can talk about evidence and so on, but in the end, I think you need a sort of user friendly explanation. the explanation that we give in the paper, I think is genius even though I made it up myself.

Steph: I think that's fine. Own it. Own it.

Kerry: Which is a lock and key metaphor. So we talk about the hotspots in trauma, the moments that we're going to update has been a bit like a lock and our updates are a key. And so if you wanted to design, if you were, what's his name? So what's it Timpson and you were making keys, you'd want to make, I can't remember his name, you'd want to. James Timpson, lovely guy, you'd want to make, if you wanted to make the best key to most likely slide into a lock, in order to make the best key, you'd take a mould or something with the lock, wouldn't you? I don't know how they do it. And so when we're really going into loads of detail with hot spots, know, what can you feel, what can you smell, what can you taste, we're doing that because we're trying to understand every single indentation in a lock. And we're not doing it for the hell of it. We're not doing it for any other reason than the better we understand the lock, the better we can design a key to update that moment and help someone stop re-experiencing the trauma. So a very good rationale is really important. And again, we show you how to explain that and how to do it.

So expecting dissociation, a very good rationale. And then just, you're going to talk about rape, you're going to talk about people's body parts, how to do that. And there's a film in which we just get some outlines of people's bodies and look at which parts of their bodies involved in this incident. And then we agree what terms we're going to use, because you don't want to use a term that someone finds offensive. And then that's very straightforward explanation that's dealt with, two or three minutes. I think the other thing that is worth knowing again, you're just doing normal CT-PTSD. But you know, it's only really the kind of understanding the hotspots and updating them where you're going to have to go into loads of detail. With the reliving, you can do the best you can. You'll see in the paper that we don't go into loads of detail with that. We're only doing reliving so that the person can tell us what the hotspots are. And in fact, most people who are raped don't remember quite big parts of what happened anyway. So the reliving is not such a big deal and there probably will be lots of gaps in it.

In terms of updating hotspots again, the usual way, but just being aware already that you're going to probably have some very somatic elements to it, pain or smells or tastes. And so again, we go through in the paper and in the films how to update somatic elements of hotspots, which you do with another sensation. And the same really, some of the things that happen in during a rape, words might not update them as well as maybe images. And so we go through some of the ways in which you might want to use imagery to update hotspots, escaping or having your say. And there's a film of us doing a joyous imagery update of a hotspot that involved Michelle Obama and me telling off this rapist, which was a nice way to end our day of filming.

The last thing and the probably the most important thing. So doing normal CT-PTSD with just expecting dissociation, good rationales, bit sensory updating, bit of imagery updating maybe, how to agree the terms. But probably the most important thing is that every single person I've ever seen with PTSD following rape blames herself for it in some way. And the guilt will keep the PTSD going, the self-blame will keep the PTSD going. And so it's really, really, really important to get working on that and really not to accept someone blaming themselves for rape and to work really hard with every technique you can come up with to reduce that self-blame down as low as you can possibly get it. And I think in this regard, it's also worth just having a little chat with yourself as a therapist. think, you know, most therapists are lovely people, but we do come with our own stuff from our own background. And I think we do have to be super clear about the law and about what it says. And, you know, what it says very clearly is that there is no mitigation for rape. So even if you're really drunk or even if you're off your face on drugs or whatever, it is still a crime of equal level of severity. And that's really important because if we're aiming to help someone see that, we need to be very clear about it ourselves. And I always say to people when I'm teaching about this, and I think it leaves an appalling image in their mind, which they don't easily forget, is that I, a 56 year old woman have the right to be down the town centre of Oxford where I live at 11.30 on Saturday night with no clothes on, absolutely off my face on drink and drugs and not to be raped. And that if I am raped it is solely the responsibility of the person who chooses to rape me. It is against the law to have sex with someone if they cannot consent. So it's an image, it works better if you can see what I look like. But you know, I think it's a really important point. And that's not a radical feminist idea. That's the law. So I think we need to have that in our heads. Because we want to get people, we want to help people to get to something approaching that themselves, because nobody should be blaming themselves for a rape ever.

Steph: No, absolutely. It reminds me of something my supervisor has always said when we work with survivors of sexual violence, which is put the guilt and shame back where it belongs because it's not with you.

Kerry: Yeah, absolutely. There's one person who should be ashamed of himself in a rape scenario and that's someone who raped someone. And that self-blame and shame keeps PTSD going. It's not something we can leave. We need as therapists to try and reduce it with people somehow.

Steph:  Mm, yeah, I think that's so, so important. I think we've touched on this a little bit already, but is there anything you would like therapists to know specifically before they start this work with clients? And also, it's kind of a twofold question really, but then how do they keep themselves safe too?

Kerry: Well I suppose in terms of keeping yourself safe, I think it's very important that you know yourself as a therapist and a very high proportion of therapists are female and a very high proportion of women have got some sexual violence in their past, we know that. Now it depends what's happened and what therapy you've had or what you've managed to do with it, whether or not you think that if you have that in your past, you want to or can do the work. And there's no rules about that. But I do think it's really important that if you think that you can't because it's too upsetting for you, too close to the bone, that's fine. People should not be made to do this work by their managers. And there are, unfortunately, I write quite a lot of emails to managers saying, this is unreasonable. This is not trauma informed. You know, you have to be trauma informed with your staff and you should not be forcing them to see cases that are too triggering for them. There's a list of stuff I don't like to do, for example, I'm absolutely terrified of dogs and I don't want to do any traumas that involve dogs. I can't, because I just know it's going to make me too frightened. It's a minor example, but knowing yourself is important. So number one to looking after yourself is, you know, really knowing that it's a reasonable and sensible thing to do to opt out if it's too triggering for you. Number two, I would say is don't have an entire caseload of people who've been raped if you can help it. Now, obviously, if you work in somewhere where that's all you do, you've done that with your eyes open, but mix it up a bit. No matter how long in the tooth you are, no matter how good you are at it, it will grind away at you. So see some other kinds of trauma for a light relief or something. I think the key to keeping well is to know that it's worth it. Yes. So to know that you're going to be effective. And that's what the research tells us. So if you read the paper, watch the films, if you're still not sure attend some extra training on it. Get yourself feeling up to speed on it so that you know that it's worth putting yourself through this because it's going to work. And do what we do with our clients as well. If someone said something that you're finding particularly upsetting, say it out loud to somebody else in your team. So we have the system in our clinic, which we call the corridor march and blurt. And you know, I'm listening to terrible things all day, but it's just some things that get to me. And I never know which it's going to be, but I can feel it inside me when I'm listening to it. And that's my key really. And what I do is as soon as I finished with that patient, I walked down and I grab a qualified member of staff and I say, can I just tell you what they've told me? And I say it out loud and we've got that deal in our team that we all do it with each other. And you have to have that deal because we never really tell someone something upsetting deliberately. Yeah, we would kind of summarise it. No we need to say exactly what it was that was so upsetting, the exact words. And what we found almost without exception is if you say it out loud to somebody, it stops pinging around in your head. So yeah, I think that's it really. allowing yourself to opt out, the corridor march and blurt, spacing these kinds of cases out so it's not all day rape. More training, more supervision if you need it.

And then I suppose the final thing that I want to say about that is it is worth it. Yeah, I mean, I do, you know, I'm a terribly soft-hearted person and I can't watch horror films and I can't watch violent films. I never have been able to. It's got nothing to do with trauma and I'm a very soft person. But I do do this work because it's really worth it. I can't tell you what a buzz is to know that you have stopped someone re-experiencing being raped day in, day out in 10 sessions, in 12. So to know that you've done that is the best reason to have got out of bed this year. I know it's frightening but it really does feel good when you've done it. So I really, really want to encourage people to try it.

Steph: Yeah. And that reminded me what you said towards the beginning when you were saying you have to give a really good rationale for your clients. But imagine saying to someone in 10 to 12 sessions, we can fix this. That must be magical.

Kerry: Yeah, it's wonderful. It's, can't tell you what a buzz it is. And in a world in which there are, let's face it, some bad guys at the moment, particularly going around making everybody's lives miserable. We can't do much about that, but we can as CBT therapists, stop someone doing this kind of Groundhog Day, jumping back in time, re-experiencing being raped, feeling just ashamed, feeling full of self-blame, we can make that stop really in not very much time. Everybody who knows how to do PTSD knows how to do this.

 

Steph: And I think we've very clearly answered this question already, which would have been what impact do you hope the paper will have on the world of CBT? So I might slightly rephrase it and say, what impact do you hope it will have? But also, have you seen any impact already?

Kerry:  Well, I mean, the papers only just come out. We did make the films about a year ago and I have been giving them out to people I supervise and others. And people have come back saying, people write me emails quite a lot saying, I was going to have to do reliving to a rape and I watched your film and I thought, I can do this and I did it. And it was fine. And she said she was so relieved that we managed to do it. And now she's not blaming herself so much. So you get this really good feedback really quickly. What I wanted, and again, it's not just me, I did kick it off, but about 20 people wrote the paper bits and we sort of smudged it all together. Was that wanted someone, I wanted to be more confident that a woman or a man had been raped and turned up to a CBT therapist or psychologist somewhere, anywhere in the country, that their chances of getting effective evidence-based therapy was greater, so that they could stop re-experiencing rape all of the time. And alongside that, that they would get this evidence-based therapy so that they would get better. And really for me and my kind of sense of justice in the world, I don't want a single rape survivor blaming themselves at all. I just don't, it's wrong. And so I want to give people effective tools to help rape survivors stop blaming themselves because they are never responsible for being raped. And so within the paper, there is also a resource document that we put together of all of the sorts of reasons that people blame themselves and sort of arguments to go through to take them through that the therapist can use. And so every single sort of helpful thing is there in one document that you can look at with your patient. And in fact, there's also reference to a paper we did a few years ago on how to work with guilt in PTSD. And again, that has film showing you all the kind of responsibility too. So again, I think it's entirely possible if you know what you're doing to help people not blame themselves for rape. And for me, I just can't stand the idea of people blaming themselves for rape. And we've got the technology to make that stop or really reduce it. So that's what I wanted, I really hoped for. My colleagues, Sam Akbar and Millay Vann did a webinar for the BABCP on it two weeks ago, three weeks ago, and had 500 people came to that. And they're doing another one on the 20th of November for BABCP in the morning. I've offered to do one for NHS England as well, which would be free, I think. They haven't come back to me yet, but hopefully they'll say yes. Can't think why they wouldn't. When we looked at the films have been viewed 1200 times so far. So, they've only really been widely available for about a month, isn't it? So hopefully we're looking at thousands of people watching them, which should be brilliant.

Steph: Yeah, we're doing what we can to spread this paper far and wide as well so that people really do read it because it is, it's just so helpful. yeah, we really do. And maybe a slightly more left field question then, but if you had to do this all again, is there anything you would change about the paper or anything you'd want to do differently?

Kerry:  Hmm, make it a bit shorter. I don't know how to do that. There are a few films I wish we'd made actually, the more I thought about it. So I've probably made it longer unfortunately. I've made a few more films I think. No, I'm really very pleased with it.

Steph: Well, that's great. That's what we want. I always like it when people say, actually, I'm really proud of this. It's really good. And I always like to ask our guests, as the journals managing editor, it's always interests me. If they have any reflections on the peer review process, if you can remember it, not everyone can. So was it helpful? How did the review was fine looking at this paper? Because it is slightly different to some of the papers that we get in.

Kerry: Yeah. I was very interested to see what they made of it because, you know, it's not like quite a normal paper. There's no data. It's just, you know, this is what we think you should do in films as well. So my first sort of main thing was feeling very grateful to the poor people that had read this incredibly long paper and must have watched at least some of the films. And so I was really grateful. And I think it's very important because as I said, there's about 20 people who are authors on the paper but they're basically all my friends or colleagues. We've all worked together in the past and that's why we're authors. And so I was a little bit worried that we were a bit of an echo chamber and because we all think the same way. And so, you is there some massive thing we've missed out or is there some angle on it that we've just assumed,? So it's really helpful. And the reviews did point out some assumptions that we were making that we hadn't really thought about. And actually, you know, they just made so many detailed, helpful... There wasn't a single suggestion that I thought, that's ludicrous. I thought, gosh, that's a good point, let's put that in. So, it's so thoughtful, so much time was spent on it. It improved it. It did.

Steph: Yeah. And I remember me and Richard looking at this paper when it came in and being like, who are we to ask to review it? They're all authors. Who's going to look at it? They're all on it

Kerry: I don't know who you found because everybody that I would have thought of was an author on the paper.

Steph: Yeah, a real diverse mix actually, so we were really grateful for that.

Kerry: Yeah, well, we wanted, I didn't want it just to be clinical psychologist trauma specialists. I wanted a load of CBT therapists from NHS Talking Therapies there as well, and some survivors who are also therapists. So really wanting it as wide as possible.

Steph: What would be the one thing, if you could narrow it down to one thing, that you would like clinicians to be able to take away from reading this paper?

Kerry: That you have the skills to do this. If you know how to do CT-PTSD, you know how to do CT-PTSD with rape survivors. And please do it because I can't tell you how wonderful it feels to make someone stop re-experiencing rape. Honestly, if you do that once a year, it was worth you going to work for the whole year. Someone's life will change direction if they're no longer jumping back to being raped. How can you move forward if you're jumping back to being raped all the time? Day in, day out, even when you're asleep. So you can help someone change direction and sort put one of the terrible wrongs in the world slightly right. That was just wonderful.

Steph: Yeah, and that's a message that's really reiterated throughout the paper as well. And it's such a hopeful one as well, because in what is such a dark, dark topic, something that just can be just really hopeful that you can change someone's life and it will be, it will, it will be life changing for them.

Kerry: Yeah, and I know that sounds really like a megalomania thing to say, but someone's life does pivot around rape, particularly if have PTSD and goes down one direction. So you really can turn that the other way.

Steph: This has been such a lovely chat, Kerry. Thank you so much. Just before I let you go, what's coming up next for you? Is there anything else you're working on that we can look out for or that we should be looking out for?

Kerry: Yes, so despite promising everybody that I work with that we'd give it a rest, well that's not what's going to happen…

Steph: I know there's at least two papers in our system from you at the moment.

Kerry: We're on to something else now, which is I actually, so again, it's my experience of supervising around the country and in talking to all my colleagues, particularly the ones we've written the paper with, I think there is the same issue that's just slightly different with providing evidence-based trauma-focused therapy to adult survivors of childhood abuse. And I think that's people in NHS Talking Therapies particularly have been asked to do some of this work now. There was guidance last year that sort of said you can work with survivors of childhood abuse under certain conditions. And that's lovely, but you might say, how do we do it? Yeah. And if there's a lot of myths about rape, there's tenfold myths about childhood abuse. So we want to do exactly the same paper, hopefully not quite as long, on what to do with adult survivors of childhood sexual abuse in NHS Talking Therapies. And it will be do this, then this, consider this, films, films, films. And I'm thinking of calling it Don't silence the silenced. So I think that people who are adult survivors of childhood abuse go from service to service trying to find someone who will hear their story. And they were silenced as children and unfortunately, unknowingly, I think a lot of us silenced them as therapists. And again, I just don't want that to happen. I want us as therapists to help release people from jumping back in time to being scared little children all of the time. So that is the next project. And I have signed up already about 15 people to help me write it. Grudgingly they've signed up.

Steph: Well, that sounds amazing. I'm really looking forward to that coming out. Well, as well as all the other papers you've got on the go as well. I know you've been very busy. So thank you so much, Kerry, for talking to me today. It's been really great to hear about the paper and we really encourage people to go read it, watch the videos and really put it into practice. Thank you.

Kerry: Thank you.

Steph: Thanks so much for listening. You'll find a link to the paper we discussed along with any other useful resources in the show notes, so please do go and check those out.  If you enjoyed this episode please take a moment to rate, review and subscribe. It really helps others to find us. And if you have any feedback then I would love to hear from you. You can reach me at [email protected] or follow us on Instagram and BlueSky @babcppodcasts. Our journals are there too, sharing all the latest research as soon as it is published.  And don't forget to check out our sister podcasts, Let's Talk About CBT and Let's Talk About CBT Practice Matters. Whether you're new to CBT or just looking to enhance your practice, they're full of insightful discussions and some really helpful tips.

 Thanks for tuning again, and I'll see you next time on research matters. Bye