Therapeutic Communication for Healing Psychological Trauma Experienced by Victims of Sexual Violence: A Literature Review

: Victims of sexual violence have psychological trauma. In handling victims of sexual violence, a holistic approach needs to be taken to overcome the trauma experienced. The holistic approach is carried out using therapeutic communication. Therapeutic communication is used to support the healing process in victims of sexual violence. This research aims to find out about therapeutic communication strategies that can be applied to heal psychological trauma in victims of sexual violence. This research was conducted using a literature review by searching through three databases (Google Scholar, PubMed, and Science Direct). The search used several keywords in English and Indonesian. The literature review research shows that there are several stages in therapeutic communication for victims of sexual violence, namely pre-interaction, introduction, work, and termination. In addition to these four stages, there are three stages in therapeutic communication used in trauma recovery: pre-counseling, counseling process, and post-counseling stages. The literature study was conducted with ten articles that discuss therapeutic communication in victims of sexual violence; there are three main discussions, namely, the first discusses the stages of therapeutic communication, the second discusses the techniques that can be applied in conducting therapeutic communication, and the last discusses the benefits obtained by applying therapeutic communication in handling victims of sexual violence. From the literature review study conducted, the application of therapeutic communication to victims of sexual violence has proven to help handle the healing of psychological trauma experienced by victims of sexual violence.


INTRODUCTION
Sexual violence is any act of degrading and attacking a person's body, sexual desires, and reproductive functions with violence or threats of violence, either psychologically or against a person's will and in a condition where the person is unable to give consent in a free state that utilizes the vulnerability of inequality, or dependence of a person based on gender which can result in physical, psychological, sexual suffering or misery, economic, social and cultural losses (Uyun et al., 2022).The prevalence of sexual violence in 2021 decreased when compared to 2016, which at that time reached 33.4%, a decrease in 2021 to 26.1%.It can be seen that from the perspective of place of residence, most physical and sexual violence tends to be experienced more in urban areas when compared to rural areas (Dhini, 2021).
Sexual violence is a severe problem that is not only physically harmful but can have a psychological impact on victims.This problem requires a holistic approach to overcome the trauma they experience.One of them is the application of therapeutic communication to victims of sexual violence.Therapeutic communication is carried out consciously with a purpose, and activities are centered on the patient's healing process (Hananah et al., 2021).
Therapeutic communication is one of the interpersonal communication that focuses on psychological trauma recovery.Interpersonal communication is the most effective communication because it is carried out directly between the communicator and the communicant so that they can influence each other (Hananah et al., 2021).Therapeutic communication is planned consciously and purposefully, and its activities are focused on the patient's recovery.Nurses with therapeutic communication skills will quickly build trust with patients, prevent illegal problems, provide professional satisfaction in nursing services, and improve the image of the nursing profession and the hospital (Nur et al., 2023).
Nursing is a type of professional service that is an important part of health care based on nursing knowledge and skills.Nursing is the activity of providing care to individuals, families, groups, or communities, both in sickness and health.As an integral part of the health care system, nursing includes health promotion, disease prevention, and the care of physically ill, mentally ill, and disabled people of all ages in all health services and other community settings (ICN, 2023).The purpose of this literature review research is to explore the role of therapeutic communication in supporting the healing process of victims of sexual violence and to identify how effective the use of therapeutic communication is for victims of sexual violence.

METHOD
The method used in this research is a literature review.The literature search was conducted through three databases: Google Scholar, PubMed, and Science Direct.The search was conducted using several keywords in English and Indonesian.The literature search in English used the keywords "Therapeutic" OR "Communication" OR "Therapeutic Communication" AND "Sex Offense" OR "Sexual Violence" OR "Sexual Abuse" OR "Sexual Traumas".While the search with literature in Indonesian used the keywords "Komunikasi Terapeutik" AND "Korban Kekerasan Seksual" OR "Korban Pemerkosaan" OR "Korban Pelecehan Seksual ."Theliterature search process begins with the identification of keywords that have been determined.The search results conducted by the keywords obtained 7.437 appropriate literature.Inclusion criteria in the literature search were selected based on the year of publication from 2018-2023.Exclusion criteria were selected based on the literature type, other than journals.Based on the inclusion and exclusion criteria, 1.939 literatures met the criteria.Furthermore, literature was selected based on the title and discussion of the literature.Ten kinds of literature fit the research criteria and could be continued to the analysis step.

RESULT
Several journals explain how therapeutic communication techniques are applied to individuals with sexual violence problems.A form of sexual violence is any act in the form of forcing sexual relations unnaturally, both incestuous and incestuous (Hananah et al., 2021).In this case, individuals who receive sexual violence need assistance from counselors so that excessive trauma does not arise.One of the ways that mentoring can be done is to use communication.According to research by Hananah et al. (2021), Juwita et al. (2022), andWahyuningsih (2022), communication is the most effective assistance that can be done so that victims can open up and tell stories.Communication is carried out so that the victim does not harbor his feelings and reduces the psychological burden he feels.Communication techniques carried out in assisting victims of sexual violence are therapeutic communication techniques.Therapeutic communication is communication used to aid the healing process (Wahyuningsih, 2022).
In therapeutic communication, counselors can communicate in both verbal and non-verbal ways.Verbal attitude provides words used as questions, suggestions, and prohibitions.Nonverbal is an action regarding appearance and body expressions such as silence, listening, and smiling.Verbal and nonverbal attitudes will minimize fear, help victims to dare to open up, and help them recover from trauma (Orwela, 2022) In the implementation of therapeutic communication for victims of sexual violence, each counselor in several studies Hannah et al., (2021); Juwita et al., (2022) and Wahyuningsih (2022) uses four stages, namely pre-interaction, introduction, work, and termination.The pre-interaction phase of the counselor identifies and seeks information about the victim and devises strategies to communicate with the victim.After the preparation has been completed, the counselor enters the orientation stage, namely introducing themselves, fostering trusting relationships, exploring thoughts, and formulating goals (Hananah et al., 2021).The counselor's work stage begins with communicating with the victim by sitting together, carrying out active communication, and digging deeper into the victim's problem (Herawati, 2022).Entering the termination stage, the counselor has the decision to choose whether the meeting and communication will continue another day or end.The meeting will continue another day if the communication process does not run smoothly, such as victims who are quiet, embarrassed, do not want to tell, and so on.The meeting will end if the counselor reaches the victim, does not encounter traumatic symptoms when communicating, already has a plan for the next life, and is completely healed (Wahyuningsih, 2022).In therapeutic communication, creating a pleasant environment must be taken care of.A pleasant environment will create a supportive atmosphere when the counselor dialogues with the victim.A supportive environment can be a safe, warm, quiet, and quiet room, a room of privacy and no people who can pass by, and a soundproof room (Moreira & Costa, 2021) The psychologist's demands and readiness in the mentoring process is a phenomenon of conscious experience regarding how he must be able to adjust the planning, preparation, and implementation of dynamic therapeutic communication because he is faced with various characters and reactions of different victims (Rosyana & Yuningsih, 2023).The communication strategy carried out to empower children and women as victims of violence and sexual harassment takes into account five components, namely the strategy for selecting communicators/roles, the strategy for determining messages, the strategy for selecting media, the strategy for selecting audiences, and the resulting impact (Faisal et al., 2023).
In several studies analyzing three different therapeutic approaches that marriage counselors might use, families and couples were educated about the various treatment options for sexually abused adolescents.This approach includes trauma-focused cognitive behavioral therapy (Devlin et al., 2019).In therapeutic communication, the companion provides solutions for the victim because the essence of therapeutic communication is to guide the patient in realizing his desires and what is needed to solve problems and achieve goals (Tiara & Pratiwi, 2018).

DISCUSSION
According to Hananah et al. (2021), there are four stages of therapeutic communication: preinteraction, orientation, work, and termination.The termination stage is divided into 2: temporary and final.The stages of therapeutic communication discussed are generally stages, while Herawati (2022) discusses the stages of therapeutic communication carried out by counselors.
According to Hananah et al. (2021), there are four stages of therapeutic communication: preinteraction, orientation, work, and termination.The termination stage is divided into 2: temporary and final.The stages of therapeutic communication discussed are generally stages, while Herawati, (2022) discusses the stages of therapeutic communication carried out by counselors.Juwita et al. (2022) argues that the stages of therapeutic communication that are important for child victims of sexual violence to heal their trauma include the pre-interaction stage, the orientation stage, the problem-solving stage, and the final termination stage.This opinion is very different from that conveyed by (Herawati, 2022).Psychologists communicate to collect various kinds of information with a certain strategy, namely positioning themselves as friends of the victim.After collecting much information, the psychologist will monitor the child's development.
Wahyuningsih (2022) also discusses therapeutic communication with child victims of sexual violence, only more focused on boys.Therapeutic communication is carried out by counselors in line with the opinion of Herawati, (2022).There are also four stages of therapeutic communication, but the stages are different.The stages are the preparation stage, introduction, assistance, and final assistance, which consists of temporary assistance and final assistance.In addition, there are techniques used by counselors, namely verbal and nonverbal techniques and entertainment or relaxation.
According to Orwela (2022), the stages of therapeutic communication are pre-counseling, counseling, and post-counseling, which means this communication is more appropriate for psychologists than nurses.In the pre-counseling stage, the victim is helped to dare to talk about the problem of sexual violence that is being experienced.Furthermore, in the counseling stage, the victim continues to tell her problems.After that, in the post-counseling stage, the victim will recover from the trauma.The communication carried out is more victims who reveal rather than psychologists.This opinion is very different from the stages of therapeutic communication described by (Hananah et al., 2021).Devlin et al. (2019) discussed related journals that also have similarities in discussing the stages of conducting therapeutic communication in healing trauma in children using three therapeutic approaches; where the therapeutic approach can also include therapies such as trauma-focused cognitive behavior, in addition to therapies such as play and expressive arts therapy, through eye movements and desensitization and reprocessing therapy.According to Orwela (2022), the stages in therapeutic communication are divided into three stages: the first precounseling stage, the counseling process stage, and the post-counseling stage.
Moreira & Costa (2021) explain that with play therapy using communication and interpretation, the play has several materials that reveal reflexivity as a source for expanding understanding of adverse situations and verbalization metaphors.The therapeutic approach to sexual violence requires a relationship between various contexts of social assistance, justice, and psychology to achieve the goals of social and family reorganization and psychological change for victims.According to Devlin et al. (2019), similarities with what is said discuss trauma.The stages of therapeutic communication are discussed in three stages, starting at the pre-counseling stage, the counseling process stage, and the post-counseling stage.
According to Dulwahab et al. (2020), explaining the stages of therapeutic communication, the first stage is referred to as the pre-assistance stage, which is carried out by extracting as much information as possible about the victim's condition.The excavation is carried out to the family and parties who can provide accurate information, and after collecting the data, the victim's classification is carried out.The second is the assistance stage, and the third is the postassistance stage.This is almost the same as what was said by Moreira and Costa (2021), which also discusses the stages and strategies in therapeutic communication through three stages, namely the pre-counseling stage, the counseling process stage, and the post-counseling stage.Tiara and Pratiwi (2018) argue that assistance or counseling is a necessity for victims of violence.In addition, the stages of communication are divided into five: the first interaction stage, the introduction stage, the orientation stage, the work stage, and the termination stage.This is similar to what Juwita et al. ( 2022) said, discussing only three stages: the orientation stage, problem-solving stage, stage, and termination or final stage, which is usually called the termination stage.Faisal et al. (2023) said that there are differences with other journals, which generally only have four or three in terms of strategies, techniques, or methods used in conducting therapeutic communication.Besides that, there are also five strategies carried out by the UPTD P2TP2A of North Sumatra city, namely strategies in selecting communicators or the role of communicators, strategies in determining messages, strategies in selecting media, strategies in selecting audiences, and strategies for monitoring the impact caused.

CONCLUSION
The application of therapeutic communication to victims of sexual violence is proven to help handle the healing of psychological trauma experienced by victims of sexual violence.Therapeutic communication is used in counseling by counselors or psychologists.In counseling, therapeutic communication is used in four stages: pre-counseling, counseling, and post-counseling.Therapeutic communication carried out in handling psychological trauma in victims of sexual violence can help reduce cognitive dissonance and help victims of sexual violence express feelings or problems experienced by victims.

Table 1 .
Results of Literature Review