SEXUAL ASSAULT AND FORMAL SERVICE USE: UNDERSTANDING HELP-SEEKING AMONG WOMEN LIVING IN POVERTY by Victoria Kar-Yan Sit A thesis submitted in conformity with the requirements for the degree of Master of Arts Graduate Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education University of Toronto © Copyright by Victoria Kar-Yan Sit (2015) SEXUAL ASSAULT AND FORMAL SERVICE USE: UNDERSTANDING HELP-SEEKING AMONG WOMEN LIVING IN POVERTY Master of Arts (2015) Victoria Kar-Yan Sit Graduate Department of Applied Psychology and Human Development University of Toronto Abstract Despite the extensive and often long-lasting sequelae of sexual assault, a significant majority of survivors do not seek assistance from formal support sources. While past research has identified factors that influence help-seeking among survivors, limited attention has been paid to the role of socioeconomic status in shaping these decisions. Guided by Liang and colleagues’ (2005) three-stage help-seeking model, this qualitative study aims to develop an in-depth, contextualized understanding of the help-seeking processes of sexual assault survivors living in poverty, along with suggestions on how formal service use rates and experiences can be improved. Semi-structured interviews were conducted with fifteen women, and thematic analysis was applied to the data. Results reveal a number of barriers and illustrate the ways in which limited resources contribute to decisions to delay help- seeking, avoid certain support sources, or not seek help altogether. Drawing upon participants’ recommendations, implications for formal services and future research are discussed. ii Acknowledgements First, I would like to express my sincere appreciation to my supervisor, Dr. Lana Stermac, for her guidance, support, and encouragement throughout my Master’s degree. Her expertise, insights, and passion in this field of research continue to be inspiring to me, and were invaluable to this project. I would also like to thank my second reader, Dr. Margaret Schneider, for giving her time generously to thoughtfully reviewing this study. I would also like to take this opportunity to acknowledge the strong and courageous women who volunteered their time and energy to participate in this study. I am thankful for their willingness and openness to sharing their experiences and knowledge, and allowing us to learn from them. My thanks are also extended to my family and friends for the support they have given me over the past two years. Finally, I would like to acknowledge the Social Sciences and Humanities Research Council for providing the funding support that helped make this project possible. iii Table of Contents Abstract ................................................................................................................................................. ii Acknowledgements.............................................................................................................................. iii Table of Contents ................................................................................................................................. iv List of Appendices .............................................................................................................................. vii CHAPTER 1: Introduction and Literature Review .............................................................................. 1 Introduction........................................................................................................................................ 1 Sexual Assault and Violence among Women Living in Poverty ...................................................... 3 Understanding Vulnerabilities to Violence among Women Living In Poverty ............................ 6 Help-Seeking among Sexual Assault Survivors .............................................................................. 10 Barriers to Help-Seeking ................................................................................................................. 12 Feelings of Shame, Self-Blame and Fear of Judgment from Others ........................................... 13 The Belief that the Rape was not a Rape ..................................................................................... 14 Perceptions of Specific Service Providers ................................................................................... 15 Rape Myths and “The Classic Rape” ........................................................................................... 16 Poverty-Related Barriers to Help-Seeking ...................................................................................... 18 Issues of Accessibility ................................................................................................................. 19 Conceptualization of Psychological Issues .................................................................................. 20 The Stigma of Mental Illness ....................................................................................................... 22 Feelings of Self-Blame and Fear of Judgment and Discrimination from Others ........................ 23 Negative Perceptions of Specific Service Providers ................................................................... 25 The Current Study............................................................................................................................ 27 iv CHAPTER 2: Methods ....................................................................................................................... 29 Research Design .............................................................................................................................. 29 Participants ...................................................................................................................................... 30 Procedure ......................................................................................................................................... 31 Data Analysis ................................................................................................................................... 36 CHAPTER 3: Results ......................................................................................................................... 38 Sexual Assault Characteristics and Consequences .......................................................................... 38 Characteristics of the Sexual Assaults ......................................................................................... 38 The Impacts of Sexual Assault .................................................................................................... 40 Psychological and emotional effects. ...................................................................................... 40 Changes in beliefs and attitudes. ............................................................................................. 43 Isolation and maladaptive coping behaviours.......................................................................... 45 Influential Factors in the Help-Seeking Process .............................................................................. 46 Stage One: Appraising and Defining the Problem ...................................................................... 47 Conceptualization of medical and mental health issues. ......................................................... 47 Conceptualization of sexual assault ......................................................................................... 52 Stage Two: Deciding to Seek Help .............................................................................................. 55 Intrapsychic barriers. ............................................................................................................... 55 Issues of accessibility. ............................................................................................................. 60 The absence of informal support. ............................................................................................ 63 Stage Three: Selecting a Support Source ..................................................................................... 67 Perceptions of and past experiences with specific support sources. ........................................ 67 Fear of retaliation. .................................................................................................................... 74 v Recommendations for Improving Utilization and Quality of Formal Services ............................... 76 Changes to Service Provider Attitudes and Behaviours .............................................................. 78 Increased Accessibility of Information ........................................................................................ 82 Opportunities for Empowerment ................................................................................................. 86 CHAPTER 4: Discussion ................................................................................................................... 91 Discussion ........................................................................................................................................ 91 Influential Factors in Help-Seeking Processes ............................................................................ 93 Recommendations for Improving Utilization and Quality of Formal Services ........................... 96 Conclusion