Now is the time – A discussion on current sexual misconduct prevention and provider readiness | Magazine issue 4/2026 - Issue 70

Now is the time – A discussion on current sexual misconduct prevention and provider readiness

written by Julia L. Lancaster
edited by Lorenz Grolig

Reviewers: Laura Nohr & two anonymous reviewers

Editorial Assistant: Zoey Chapman

Despite many efforts to prevent sexual misconduct, this unwanted behavior persists in private and public spaces. Given the prevalence of sexual misconduct and the likelihood that mental health care providers will be called upon during their careers to support survivors, how prepared are they?

Last year I hosted a two-hour webinar on sexual exploitation and the possible effects on mental health. In preparation for the project, I interviewed four major crime detectives and a sexual assault therapist who has three years of experience working in a SAFE ( Sexual Assault Forensic Examiners) center. Two topics consistently reemerged: the prevalence of unwanted sexual behavior and the importance of providing robust survivor care in efforts to reduce or prevent trauma reactions [1]. What follows are current evidence-based treatment suggestions and community resources to increase providers’ preparedness to support survivors of unwanted sexual behavior. Throughout the main text the term “sexual misconduct” is used; however, the terms “sexual assault” and “rape” are used when referring to specific research or community resources.

Background

After an ongoing investigation, the World Health Organization (WHO) uncovered unexpected widespread allegations of unwanted sexual behavior during the response to the 10th Ebola outbreak in Democratic Republic of the Congo. When many of the allegations were found to be true, the organization shifted from using multiple terms of unwanted sexual behavior to one inclusive term: sexual misconduct [2]. The World Health Organization’s Policy on Preventing and Addressing Sexual Misconduct (PASM) describes sexual misconduct as a non-legal term that refers to the full spectrum of prohibited and unwanted behavior of a sexual nature [2]. According to the WHO “sexual misconduct” encapsulates crimes like sexual exploitation, sexual assault, rape, and sexual abuse. With the organization being of the collective mind that “all forms of sexual misconduct have the same root causes and drivers” [2]. The WHO’s internal audit and national statistics in the United States further underscores sexual misconduct’s widespread public health threat.

In the United States the National Intimate Partner and Sexual Violence Survey (NISVS) is considered one of the most comprehensive and inclusive surveys, measuring several forms of unwanted sexual contact and various predatory methods [3]. The findings show that in the United States alone nearly half of women (45.1%) experienced some form of contact sexual violence in their lifetimes, with 21.0% reporting completed or attempted rape, and more than 1 in 6 men (16.9%) in the U.S. experienced some form of contact sexual violence in their lifetimes, with 3.2% reporting completed or attempted rape [4]. In some cases, the rates are higher still amid those with disabilities, LGBTQ+ community, children, and other minority groups. The United States’ largest anti-sexual violence organization reports that an estimated 423,020 people age 12+ experience sexual violence each year [5].

Given sexual misconduct statistics, including unreported cases, mental health care providers are likely to be called on for services sometime during their career. But how ready are they? Current research continues to support counseling’s person-centered approach; however, with the possible psychological consequences and diverse survivors of sexual misconduct, other evidence-based treatments might better assist with presentations like posttraumatic stress symptoms and obsessive thoughts [6]. While not every survivor will go on to develop post-traumatic stress disorder ( PTSD), trauma-informed care means understanding that survivors of sexual misconduct are more susceptible to a range of psychological, physiological, behavioral, and interpersonal interferences such as disruption in intimacy, sense of safety, and trust. With effective psychotherapy, adverse outcomes can be mitigated, and individuals can experience healing from their trauma.

Prevention

Prevention efforts address sexual misconduct on three levels: primary, secondary, and tertiary. The primary level seeks to stop sexual misconduct before it occurs (e.g., sex education, bystander interventions, and workplace prevention policy). The secondary level addresses the immediate aftermath of sexual misconduct (e.g., crisis response, victim advocates, and forensic examinations), and the tertiary level of prevention seeks to provide long-term care (e.g., counseling, support groups, and legal advocacy) [7]. Depending on the type of mental health care services, providers typically offer support at the secondary and/or tertiary level, although there may be overlap among the different levels of prevention. Awareness is part of prevention, with both survivors and those supporting survivors benefiting from recognizing common trauma reactions for early intervention.

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Trauma Reactions

Sexual misconduct reactions may include acute stress symptoms like sleep disturbance, irritability, and complicated feelings of guilt, sadness, and anger. Reactions can be highly individualized and are in part based on the severity of sexual misconduct, individual factors, and other nuanced influences such as sociocultural considerations [7]. Reactions may also include reoccurring unwanted thoughts and images, avoidant behaviors, heightened arousal or automatic reactions, anxiety and depressive symptoms, suicidal ideations, eating disorders and interpersonal relationship difficulties [7]. Other possible symptoms may include substance use dependency or increased substance use.

After experiencing sexual misconduct survivors might believe they should be able to simply return to everyday responsibilities, even while their minds and bodies behave out of character. If you or someone you know shows signs of these reactions, it might be confusing, and in some cases embarrassing, especially if these reactions feel out of the ordinary and are automatic or feel outside of your control. However, it is important to know that these are natural reactions, and mental health care and other supports can help lessen many of these symptoms. Symptoms of sexual misconduct may also vary based on sex and gender.

Current sexual misconduct literature reflects a significantly small body of research on male survivors. This is in part due to the higher rates of male perpetrator to female victim, but it also speaks to narrow cultural norms and societal expectations about masculinity. Cultural norms may include myths that men cannot be raped, that male victims must be gay, and that sexual misconduct does not have a profound or significant impact on men [8]. Cultural norms also reflect heteronormative and cis-normative perspectives, which may minimize the experiences of gender-diverse individuals who experience sexual misconduct. However, sexual and gender minorities may be more likely than heterosexual and cisgender individuals to experience sexual misconduct [9]. Providers are ethically responsible for bracketing their own personal beliefs when necessary to ensure professional support for diverse clients.

The following section integrates community resources with clinical treatment options for more comprehensive survivor care. These approaches are ordered from primary to secondary and tertiary prevention.

Community-Based & Clinical Approaches

Rape Resistance Program

Rape resistance programs are considered a primary level of prevention, and one program shows unprecedently high results. In a 2024 #No Excuses Podcast Dias interviewed Dr. Zoe Petterson, an associate professor at Kinsey Institute [12]. Petterson highlighted an effective rape resistance program called The Enhanced Assess, Acknowledge, Act (EAAA), also known as Flip the Script. Created by Charlene Senn and colleagues in Canada, this program is primarily for women in college and has been shown to maintain two years post training efficacy, helping participants 1) overcome emotional and cognitive barriers to ultimately detect increased risk of assault, and 2) use effective resistance strategies more quickly [13].

A 2023 evaluative study of Flip the Script reviewed a randomized controlled trial with college women between the ages of 17 – 40. The outcomes were measured by the Sexual Experiences Survey–Short Form Victimization and showed a significant risk reduction of completed and attempted rape, attempted coercion, and nonconsensual sexual contact over a two-year follow-up period. At two years these results yielded reductions between 30% and 64% [13]. National and international academic administrators can purchase this program for their universities.

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Victim advocacy

Often considered secondary and tertiary prevention, victim advocacy services are provided by trained advocates who act as a liaison between the legal system and client. They may fulfill several functions such as connecting survivors to various resources and in some cases provide crisis counseling. Victim advocates are prepared to accompany survivors during vulnerable stages of recovery and reporting. For example, a survivor’s journey might include hospital forensic exams, law enforcement questioning, and court proceedings. Depending on the state, victim advocates might be the survivor’s only company in a district attorney’s office.

For anyone interested in becoming a victim advocate, these positions typically require a 40-hour training that extensively covers healthy coping mechanisms and how to respond to survivors of sexual misconduct. Training topics may cover dynamics of sexual assault, sexual assault advocacy, and biopsychosocial topics like neurobiology of trauma, and self-care. The websites National Organization for Victim Assistance and the National Center for Victims of Crime can answer questions about victim advocate duties and trainings [10], [11]. Additionally, providers are encouraged to check their city for sexual assault survivor centers. These centers may offer free or reduced victim advocate training rates in exchange for volunteerism. In addition to victim advocates, an alternative reporting tool might also be considered a secondary line of prevention.

Alternative Reporting Option

End Violence Against Women International (EVAWI) is an interdisciplinary organization working to combat interpersonal violence against adults and adolescents of all genders. At the request of community members and frontline responders, EVAWI created a free online alternative reporting tool. This multilingual, two-part comprehensive program offers a self-guided investigative interview that survivors can use to begin the process of reporting to law enforcement, if they choose to report. Seek Then Speak can be accessed by survivors and support people anytime and anywhere they choose with an option to report anonymously, and a safety exit feature is available if needed.

The first part, Seek, informs survivors of their rights and provides education on medical and forensic care, reporting to police, sexual assault, and victim advocacy. The second part, Speak, is a trauma-informed self-guided interview with prompts to collect details of the report. This alternative reporting tool has been shown to reduce survivor discomfort when sharing details of the assault to law enforcement and to increase rates of reporting, leading to more arrests, including those of repeat offenders [14].

This program is available to the public and is so user friendly that mental health care providers can guide their clients (who ultimately may or may not choose to report) through the program's options. For some survivors it is enough to share their story, and when survivors share their sexual misconduct stories with trauma-informed trained professionals, the process may help identify and address irrational self-blame or guilt. A counselor’s clinical care is usually considered a secondary or tertiary level of prevention.

Evidence-Based Treatments

Considering specific clinical treatment approaches, a 2024 systematic sexual assault literature review examined international data from 2006 – 2021. Twenty-two of the 42 relevant studies were conducted in the United States with research from 14 other countries. Participants ranged from ages of 14 – 99. The researchers divided the treatments and interventions into varying levels of recommendation from not recommended to strongly recommended. Their results found seven strongly recommended treatments: 1) Cognitive Behavioural Therapy (CBT), 2) Cognitive Processing Therapy (CPT), 3) Eye Movement Desensitization and Reprocessing (EMDR), 4) Person Centered, 5) Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), 6) Inference-based Cognitive Behavioral Therapy (I-CBT), and 7) Prolonged Exposure. Trauma-sensitive yoga was also strongly recommended when combined with other evidence based-treatments [6]. This study is relevant for both providers and survivors. Providers may supplement their current level of knowledge with continuing education and training opportunities in the above treatments. Additionally, survivors and those caring for them may choose to work with a licensed professional who is informed in these treatment approaches or has received additional certification or training.

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Summary

Despite concentrated efforts, prevention remains difficult to achieve because there are often unforeseen, nuanced variables in cases of sexual misconduct. Collective efforts to eliminate sexual misconduct’s widespread public health threat remain necessary in the areas of education, treatment, and recovery. With the World Health Organization’s recent policy update targeting sexual misconduct, now is a good time to ensure mental health care providers are prepared to support survivors. Awareness and action are essential, not only for survivors and their friends and families, but also for mental health care workers who will support diverse survivors. Part of being trauma informed is knowing that symptoms can range widely depending on many variables, and appropriate, timely care can help mitigate symptoms. In solidarity let’s join the WHO’s prevention efforts, integrating raising awareness, evidence-based trauma-informed approaches, and community resources for comprehensive survivor treatment.

References

[1] Lancaster, J. “Illuminating the realities of sexual exploitation and concealable stigmatized identities.” Office of Continuing Education at the Chicago School. Accessed: Jan. 20, 2026. [Online.] Available: https://calendar.thechicagoschool.edu/event/illuminating-the-realities-o...

[2] World Health Organization. “Preventing and responding to sexual misconduct: WHO’s three-year strategy.” Accessed: Jan. 20, 2026. [Online.] Available: https://www.who.int/publications/i/item/9789240069039

[3] Koon-Magnin, S. “Sexual assault and harassment in America: Examining the facts.” Bloomsbury Publishing, 2022.

[4] Leemis, R. W., Kudon, H. Z., Zhu, S., Smith, S. G., Chen, J., Friar, N. W., & Basile. K.C. “The National Intimate Partner and Sexual Violence Survey: 2023/2024 Sexual Violence Data Brief. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention”. CDC Stacks. Accessed: Jan. 20, 2026. [Online.] Available: https://www.cdc.gov/nisvs/media/pdfs/sexualviolence-brief.pdf

[5] Rape, Abuse, Incest National Network. “Statistics: Victims of sexual Violence.” Accessed: Jan 20, 2026. [Online.] Available: https://rainn.org/facts-statistics-the-scope-of-the-problem/statistics-v...

[6] Miles L.W., Valentine J.L., Mabey L.J., Hopkins, E.S.. Stodtmeister, P.J., Rockwood, R.B., & Maxley, A.N.H. “A systematic review of evidence-based treatments for adolescent and adult sexual assault victims.” Journal of the American Psychiatric Nurses Association 30(3),480-502, 2023, doi:10.1177/10783903231216138.

[7] Miele, C., Maquigneau, A., Joyal, C. C., Bertsch, I., Gangi, O., Gonthier, H., Rawlinson, C., Vigourt-Oudart, S., Symphorien, E., Heasman, A., Letourneau, E., Moncany, A. H., & Lacambre, M. “International guidelines for the prevention of sexual violence: A systematic review and perspective of WHO, UN Women, UNESCO, and UNICEF's publications.” Child Abuse & Neglect, 146, 2023, doi.org/10.1016/j.chiabu.2023.106497.

[8] Langdridge, D., Flowers, P., & Carney, D. “Male survivors' experience of sexual assault and support: A scoping review.” Aggression and Violent Behavior, 70, 1–11, 2023. doi.org/10.1016/j.avb.2023.101838.

[9] Murphy-Oikonen, J., McQueen, K., Miller, A., Chambers, L., & Knight, S. “Lived experience of sexual assault among gender diverse individuals.” Journal of Interpersonal Violence, 0(0), 2026. doi.org/10.1177/08862605261427743.

[10] National Organization for Victim Assistance. “Training programs: Become a more effective advocate.” Accessed: Jan. 20, 2026. [Online.] Available: https://trynova.org/training-programs/

[11] National Center for Victims of Crime. “National training institute.” Accessed: Jan. 20, 2026. [Online.] Available: https://victimsofcrime.org/national-training-institute/

[12] Dias, G. “Sex, Power, and Consent: Decoding Sexual Misconduct.” #No Excuse Podcast. Accessed: Jan. 20, 2026. [Online.] Available: https://www.youtube.com/watch?v=JiNZQR6MiAc&list=PL9S6xGsoqIBXeRKSKLnjYC...

[13] Senn, C. Y., Hobden, K. L., Eliasziw, M., Barata, P. C., Radtke, H. L., McVey, G. L., & Thurston, W. E. “Testing the effectiveness of a sexual assault resistance programme in 'real-world' implementation.” European Journal of Psychotraumatology, 14(2), 2023, doi.org/10.1080/20008066.2023.2290859.

[14] End Violence Against Women International. “Seek then speak resources.” Accessed: Jan. 20, 2026. [Online.] Available: https://evawintl.org/seek-then-speak-resources/