Exploring the Nexus of Empowerment Practice and Cognitive Processing Therapy in Rape Crisis Centers

Background: Empowerment is a hallmark of social work practice and the most frequently utilized practice approach in rape crisis centers (RCC; Edmond, Voth Schrag, & Bender 2020). Described both as a process and an outcome, empowerment has been distilled into specific social work practice principles (Gutierrez, 1990; Cattaneo & Chapman, 2010), but a lack of conceptual consensus in the literature makes operationalization for practice challenging. In contrast, Cognitive Processing Therapy (CPT), a manualized evidence-supported treatment (EST) developed to treat PTSD in rape survivors, is concretely operationalized, but not routinely used in RCCs (Edmond, Voth Schrag, & Bender, 2020). One potential barrier to the adoption of CPT in RCCs is the degree to which it fits within an empowerment approach to practice used in this service setting. This study explores how empowerment is operationalized by RCC counselors; and the extent to which CPT is perceived as an empowering approach to use with survivors.

Methods: This study uses qualitative data gathered from 19 focus groups conducted with counselors from 11 RCCs in Texas during 2019. It is part of a multi-year randomized controlled trial examining the effectiveness of a learning community as an implementation strategy for the adoption of CPT in RCCs. Fifty-three counselors from 11 RCCs participated in at least one of two 90-minute focus groups conducted at two time points within six months. The Principle Investigator used a semi-structured interview guide to conduct the focus groups, which were audiotaped and professionally transcribed. The data were analyzed in Dedoose using a six-step thematic analysis (Braun and Clarke, 2006). The codes and themes were initially generated by one of the authors and finalized through discussions among all three authors who reviewed, defined, and finalized themes and codes collaboratively.

Results: The sample was diverse with twenty-two (42%) identifying as Hispanic/Latino, sixteen (30%) as White, seven (13%) as African American, and eight (15%) as biracial, American Indian, or Asian. Most held a master’s degree (77%), were licensed (55%), and had worked in RCCs for 5.45 years. Empowerment practice was characterized as feminist, supportive, and strengths-based. More specifically, it was operationalized as survivors having voice, choices, achieving personal goals, and building skills. CPT was seen as empowering survivors with the skills needed to process traumatic memories, develop critical awareness, utilize more helpful cognitions, and regain control over their emotions, thoughts, and lives. Practitioners also acknowledged places of tension where they felt challenged by the structure and counselor-directed nature of CPT. Practitioners, however, identified strategies to work with these tensions, including tailoring CPT to fit clients’ needs and being flexible to address crises.

Conclusion & Implications: This study adds to the highly conceptual research base on empowerment with a practical application of its principles in action in RCCs. Results offer evidence for the congruence of empowerment practice and CPT, as well as specific strategies for working with tensions that may arise when these practices are used in tandem. This suggests that CPT is a good fit and an acceptable intervention option for this service sector.