“The assumption that telling the story will automatically be healing is optimistic,” said Nadine Wathen, a researcher at the University of Western Ontario’s Center for Research and Education on Violence Against Women and Children. “All women have different experiences of abuse — all people dealing with trauma do.”
In a 2009 study, a research team including Dr. Wathen tested the impact of giving women who visit emergency rooms and other health clinics a domestic violence questionnaire — a brief, confidential checklist. Providers got the results of the questionnaire before seeing the women, and advised them based on the added information; the study tracked them over 18 months.
The questionnaires made no difference: the women who got them fared no better or worse than women in a comparison group who did not.
“The underlying dynamic of so much abuse is coercive control, so pushing people to disclose can replicate those patterns of coercion” and backfire, Dr. Wathen said.
One of the more surprising recent findings was the discrediting of what is called critical incident stress debriefing: the practice, once common, of pushing people still reeling from a traumatic event, like an earthquake or school shooting, to talk through its effects.
Studies have found that such debriefings had no impact on subsequent symptoms of traumatic stress for most people — and made some individuals feel worse. The implication was that recounting a tale of trauma shortly after it happens does not necessarily contribute to healing it.
“It was hard to believe what the data were saying,” said Richard McNally, a professor of psychology at Harvard. “But you just don’t know what effect interventions really have until you test them.”
People do best when allowed to tell their stories in their own time, if they choose to do so at all, therapists said.
The details of a person’s trauma are another consideration. Memory is a shape-shifting, idiosyncratic process, with a life of its own.
For reasons no one understands, some people who were sexually abused as children exhibit no measurable psychological wounds as adults, research suggests; nor do they ruminate on past violations.
Others feel the wounds as freshly today as ever, reacting with extreme emotion to benign, random reminders in everyday life: a hand on a shoulder, a half smile from a stranger, the sight of a doctor’s office.
For such people, unloading their story — even in the safety of a supportive group, directly meting out justice to a perpetrator — can provide relief, but not resolution, therapists said.
“It’s often a beginning, not the end,” said Dr. Ducharme. “There will be more work to do.”
One of the most striking features of the recent court proceedings was the sight of so many survivors directly witnessing — and helping seal — the perpetrator’s comeuppance. Seeing justice done is widely believed to be a psychological balm in itself, a gratifying, if usually belated, repair of faith.
But justice does not always deliver relief, studies find, and the reason may lie in the type of trauma experienced.
In a study of torture survivors, Dr. Metin Basoglu, a professor of psychiatry at the Istanbul Center for Behavior Research and Therapy, found that symptoms of post-traumatic stress and depression did not depend on the victim’s sense that justice had been served.
“Testifying in court might be helpful not necessarily because of restoration of a sense of justice, but because of the exposure element the whole court process involves,” Dr. Basoglu said in an email.
The value in telling the story may not be that it leads to justice, then, but that it helps the speaker regain control of a narrative that plays out endlessly in his or her mind.
In treatment, Dr. Basoglu said, “we would have presented testifying at court as an exposure task to overcome or gain a sense of control over the distress and fear caused by the trauma.”
In that sense, the women who told of their abuse so publicly in Dr. Nassar’s trial were asserting control not only for themselves, but also for others who weren’t yet ready to step in front of the cameras.
“The women who did not report their stories — the important thing is that they should not feel guilty about it,” said Judith Alpert, a professor of applied psychology at New York University.
“They all have their reasons, and they’re good ones: fear that their family would fall apart, or how their spouse would react. It’s their choice, and what matters is what is best for them.”