Abstract
While literature on sexual revictimization is extensive, data on women's help-seeking and service experiences in regional/rural areas is scarce, particularly within Australia. This paper aims to fill this gap by examining the help-seeking journeys of victim/survivors of sexual revictimization in regional and rural Victoria, Australia. Using a material feminist approach, semi-structured interviews with victim/survivors (N = 11) were analyzed to understand the forces shaping their service experiences. The study offers policy, practice-based, and research recommendations to ensure holistic, trauma-and-violence-informed responses to revictimized victim/survivors, addressing their specific needs in underserved areas.
Introduction
Sexual violence is a long-standing human rights violation that continues to have disastrous impacts for women and children (WHO, 2021). Australian data indicate that 51% of women aged 27 to 33 have experienced sexual violence in their lifetime (Townsend et al., 2022). This data also found that women who experienced childhood sexual abuse (CSA) were twice as likely to report recent sexual violence, termed “sexual revictimization,” and 33% to 59% more likely to have reported recent domestic violence (Townsend et al., 2022). There is extensive evidence highlighting the negative health consequences of sexual revictimization across the life span, including mental health conditions such as depressive and anxiety disorders and higher levels of suicide ideation (Edwards & Banyard, 2022), post-traumatic stress disorder (PTSD; Ullman & Peter-Hagene, 2016), complex PTSD (Cloitre et al., 2009) and physical conditions such as cardiovascular diseases (Friedman et al., 2015) and endometriosis (Harris et al., 2018). These severe and wide-ranging health impacts underscore the critical importance of accessible, trauma-and-violence-informed support for victim/survivors of sexual revictimization.
Women's help-seeking experiences following sexual violence are pivotal in shaping their recovery, long-term wellbeing, and willingness to seek support in the future. The availability, accessibility, and perceived quality of services, including the level of support and validation received, can profoundly influence both future help-seeking behaviors and recovery (Kennedy & Prock, 2018). Conversely, fear of a stigmatizing response can discourage disclosure and increase the risk of future revictimization. Miller et al. (2011) found that victim/survivors who avoided support services due to stigma-related nondisclosure were less likely to experience posttraumatic growth—the positive psychological changes that can emerge from processing trauma. This, in turn, heightened women's risk of revictimization over the 4.2-month follow-up period (Miller et al., 2011). The impact of negative social reactions to sexual violence disclosures extends beyond heightened risk for future violence; it also perpetuates emotional and psychological harm and undermines recovery (McLindon et al., 2024). Longitudinal research demonstrates that negative social responses to women's disclosures, such as victim-blaming, skepticism, or minimization, are associated with increased PTSD symptoms for victim/survivors (Ullman & Peter-Hagene, 2016). Furthermore, this study found that women who had experienced revictimization and disclosed their experiences were more likely to receive negative social reactions over time (Ullman & Peter-Hagene, 2016), reinforcing patterns of silencing and distress.
Revictimization can extend beyond interpersonal violence, often emerging from systemic failures where inadequate or retraumatizing responses from service providers leave victim/survivors feeling unsupported, disempowered, or further harmed (Murphy-Oikonen et al., 2022). This phenomenon, known as “institutional betrayal,” refers to the failure of institutions to protect, support, or appropriately respond to individuals who depend on them. Institutional betrayal can take many forms, including dismissive attitudes, victim-blaming responses, inadequate policies, or systemic negligence that enables harm to persist.
Betrayal trauma theory (Freyd, 1998) suggests that harm inflicted within relationships or systems that are supposed to provide safety and care, such as healthcare, legal, or support services, can be particularly damaging as it violates fundamental trust. Empirical evidence demonstrates that institutional betrayal compounds trauma, increasing rates of anxiety, dissociation, and psychological distress (Smith & Freyd, 2013). These effects are especially pronounced in regional and rural settings, where service options are scarce, geographical isolation heightens barriers to accessing support and close-knit social networks amplify fear of stigma and confidentiality breaches (Campo & Tayton, 2015; Wendt et al., 2017).
Understanding how women who have experienced sexual revictimization navigate help-seeking and service response is essential for identifying both strengths of service provision and systemic failures that perpetuate harm and hinder recovery. While some literature explores revictimized women's service experiences, there remains a critical gap in understanding how regional and rural contexts shape women's access to and engagement with support services, particularly in Australia. This article addresses this gap by examining the help-seeking experiences of revictimized women in regional and rural Victoria, Australia. In particular, the paper aims to better understand how women seek help, engage with services, and navigate both the geographical and social environments specific to non-urban areas. The driving research question is “What are women's help-seeking and service experiences in regional and rural areas of Victoria, Australia, and how do these experiences take shape?.”
Regional & Rural Location
Evidence suggests that women in non-urban areas may experience higher levels of violence when compared with women in urban locations. In this study, both regional and rural areas are considered within the broader category of non-urban locations, where service accessibility varies. For this study, “regional” areas refer to larger “non-urban centers with a population over 25,000 and with relatively good access to services,” and “rural” areas include “non-urban localities of under 25,000 with reduced accessibility” (Roufeil & Battye, 2008; as cited in Wendt et al., 2017). Australian data indicates that those living in non-urban areas are 1.4 times more likely to experience partner violence compared with people living in major cities (AIHW, 2019). Beyond prevalence data, there is limited qualitative research exploring women's experience of sexual revictimization and sexual assault in regional and rural Australia, including the challenges victim/survivors experience when seeking help from support services (Corbett et al., 2024a). In addition to statistical data, it's imperative to comprehend the real-life experiences of non-urban women. Women's lived experiences of sexual violence and help-seeking are deeply influenced and contextualized by rural settings and infrastructure, family, community, and service sector cultural norms. Family violence research attests to the specific sociocultural forces that contextualize women's ability to disclose violence and seek appropriate support. For instance, a lack of public transport options and sparsity of services across regional/rural areas can create challenges for victim/survivors to access support (Campo & Tayton, 2015; Wendt et al., 2017). Furthermore, within regional/rural spaces, the intimacy of small towns means that community members, friends, and neighbors tend to know and talk about the activities of people in their community. Fear of stigma and community gossip actively deters women from seeking help, highlighting the importance of sexual assault outreach services being resourced to travel and confidentially support victim/survivors within other regions (Campo & Tayton, 2015; Salter et al., 2020; Wendt et al., 2017).
The mobility of victim/survivors adds another layer of complexity, shaping access to services and long-term recovery. Gendered violence is a key driver of displacement and homelessness, with many women forced to leave their communities to escape abuse, only to face ongoing instability and limited safe housing options (Homelessness Australia, 2024). Women who have experienced violence may move in and out of regional and rural areas, seeking distance from locations where abuse occurred. However, frequent relocation can disrupt service engagement, making it difficult for victim/survivors to establish ongoing therapeutic relationships or receive consistent support. This challenge is particularly pronounced for sexual assault support services such as Victorian Specialist Sexual Assault Services (SSAS) which operate within geographically defined catchments, making continuity of care difficult for those who move across regions (Sexual Assault Services Victoria [SASVic], 2024). Future research should explore how patterns of mobility impact service accessibility, engagement, and long-term recovery for victim/survivors in non-urban settings.
Sexual Assault Services
In Victoria, Australia, there are 18 SSAS across the state (8 metropolitan & 10 regional/rural) that provide free counseling and support for individuals who have experienced sexual violence, with services offering an afterhours team for recent sexual assaults (SASVic, 2024). Additionally, the Sexual Assault Crisis Line Victoria (SACL) operates a statewide, after-hours confidential phone service, offering immediate crisis counselling and coordinating afterhours responses to recent sexual assaults. This includes connecting victim/survivors to the Sexual Offences and Child Abuse Investigation Team (SOCIT), Victorian Institute of Forensic Medicine (VIFM), Sexual Assault Support Services, or Emergency Departments, when needed.
Despite the presence of these services, sexual assault support in regional and rural areas remains under-resourced and difficult to access. The issue is not necessarily a lack of services, but rather chronic underfunding, inefficient service agreements with Government funding bodies, and a failure to account for the additional complexities of supporting victim/survivors in remote locations (Victorian Auditor-General, 2018). A key driver of these inequities is the funding model itself, which fails to account for the logistical and operational challenges unique to regional and rural service delivery.
Sexual assault services in regional and rural areas face distinct challenges, including long travel distances, inadequate funding for outreach work, and high demand with limited staff, yet they receive the same base funding as metropolitan services. There are no additional provisions for essential costs within non-urban settings such as travel time, vehicle costs, rent in outreach locations, or the administrative burden of coordinating services across multiple sites. As a result, services must stretch limited resources across vast geographical areas, placing further strain on already overburdened staff.
These resource constraints are further compounded by a performance monitoring framework that prioritizes numerical outputs over service quality. The current performance metrics for SSAS in Victoria are primarily quantitative, focusing on the number of new referrals and the timeliness of initial responses (Department of Families, Fairness and Housing (DFFH), 2020). While these measures track service access, they fail to assess the quality, depth, or effectiveness of support provided to victim/survivors. This emphasis on throughput rather than meaningful engagement undermines the core principles of trauma-and-violence informed care, such as the ability to provide ongoing, flexible, and holistic support tailored to individual needs. Furthermore, critical activities such as advocacy and case coordination, essential for helping victim/survivors navigate intersecting legal, housing, and health systems, are not explicitly funded or recognized within performance targets (DFFH, 2020). Ultimately, a funding model that prioritizes short-term interventions over sustained, holistic care forces services to operate within a crisis-response framework rather than a long-term recovery model.
The overreliance on numerical targets at the expense of service quality has long been identified as a fundamental flaw in Victoria's performance monitoring framework for social services. The Victorian Auditor-General (2018, p. 8) has criticized the system as being “heavily output-driven” with an inadequate focus on quality of care, further describing it as “inefficient and ineffective” in ensuring that clients receive safe, high-quality services tailored to their needs (p. 63). Yet, despite these concerns, the same framework remains in place today. Meanwhile, extensive waitlists persist, with some victim/survivors waiting up to seven months for support (D’Agostino, 2022), exacerbating barriers to recovery and reinforcing systemic inequities in access to care.
Generalist (non-specialized sexual assault) services often become the default option in these areas, as there are fewer specialist providers available. Within Australia, 2 in 5 women who sought help for sexual violence did so via their general practitioner or other health professional (AIHW, 2020). However, studies have indicated that generalist providers, such as mental health practitioners and GPs, lack training and skills in trauma-and-violence-informed care to respond to sexual assault and gendered violence (Isaac et al., 2024; Salter et al., 2020; Wellington et al., 2021). Furthermore, biomedical models of health can encourage responses from health practitioners that dismiss trauma experiences and pathologize clients attempting to access services (Salter et al., 2020). The reliance on generalist services is particularly concerning given that sexual violence is a key risk factor under the Multi Agency Risk Assessment Management Framework (MARAM), meaning women who experience sexual violence in the context of family violence are at risk of being killed or almost killed (State of Victoria, 2021). This highlights the urgent need for specialist-led, trauma-and-violence informed responses to improve safety and prevent further harm.
The under-resourcing of sexual assault services in regional and rural areas places victim/survivors at a higher risk of ongoing harm and inadequate support, reinforcing systemic barriers to recovery. Without substantial funding reforms that acknowledge the realities of service provision outside of metropolitan areas, the ability of these services to meet the needs of victim/survivors will remain severely limited.
These barriers are further compounded by systemic oppressions such as homophobia, ableism, and racism, which shape not only access to formal support but also the quality and inclusivity of the services available. A systematic review by Bach et al. (2021) examining 41 studies found several communities, such as LGBTIQ + individuals, being underserved by sexual assault service systems. The review found that poor service delivery, inadequate staff training, and a lack of awareness led to discriminatory responses and confusion about how to support victim/survivors from marginalized communities (Bach et al., 2021). This is particularly concerning when we consider that many marginalized communities face a heightened risk of sexual violence due to systemic stigma, discrimination, and societal structures that normalize or enable violence against these communities. For instance, 1 in 2 trans and gender-diverse people have experienced sexual violence (Callander et al., 2019), while women with a disability are twice as likely to report sexual violence than women without a disability (Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability, 2021). The ongoing impact of colonization continues to have disastrous consequences for Aboriginal and Torres Strait Islander women who face disproportionate levels of gendered violence, being 32 times more likely to be hospitalized as a result of their injuries than non-Indigenous women (OurWatch, 2020). From an intersectional perspective, these experiences can be further compounded by geographical isolation in non-urban areas, where limited service availability and a lack of anonymity can create additional barriers to seeking help. Intersectionality elucidates how social structures traverse and interact to generate and sustain different forms of oppression. The disadvantage is embedded through multiple and overlapping structures such as gender, race, class, place, ability, and sexuality resulting in entrenched privilege and oppression (Crenshaw, 1991).
Although a substantial body of research on sexual violence exists, most studies have focused on urban settings, leaving rural contexts underexplored both globally and within Australia (Annan, 2006; DeKeseredy, 2021b; Wendt et al., 2017). Furthermore, available data on sexual violence in regional and rural areas is often examined under the umbrella of domestic and family violence (DFV), for example as intimate partner sexual violence (IPSV) (Cox, 2015). While sexual violence can occur within DFV contexts, it also exists as a discrete phenomenon outside of this context. This study therefore treats sexual violence, and in particular sexual revictimization as a distinct phenomenon to be studied, while also recognizing that differing forms of violence often co-occur. There is limited evidence of the effectiveness of service delivery responses for revictimization (Cox, 2015). This is alarming, as more generic support strategies and responses may not address the complex needs of victim/survivors who have experienced revictimization (Coles et al., 2015; Cox, 2015). Indeed, recent research confirms that response services were reluctant to inquire about and respond to disclosures regarding sexual forms of violence (Tarzia, 2021).
Given the limited availability of rural-specific data on sexual violence, this paper draws on DFV research as a point of comparison to highlight the shared structural barriers affecting women's access to services. The barriers women face when accessing services for DFV in non-urban areas, such as limited transport options, and scarce housing resources, are similarly relevant for sexual assault services. Community stigma and concerns about confidentiality can further isolate victim/survivors, leaving them solely responsible for negotiating their own safety (Campo & Tayton, 2015; DeKeseredy, 2019, 2021b; Wendt et al., 2017). With evidence suggesting over half of Australian women aged 27–33 have experienced sexual violence (Townsend et al., 2022), it is critical to better understand the service experiences of revictimized women to inform policies and practices that address the lived realities of this complex trauma.
Theoretical Framework
This paper used a material feminist approach (Barad, 2007) to explore, analyze and interpret interview data. Material feminism enabled the conceptualization of sexual violence as a phenomenon that is co-constituted through a multitude of material-discursive human and non-human forces (Barad, 2007). Material-discursive forces refer to the interplay between tangible, structural, material conditions (such as geographical isolation and economic constraints) and discursive elements (such as community gossip and professional attitudes) and the way both shape experiences of and responses to sexual revictimization. These forces do not operate separately but co-construct the realities of victim/survivors’ help-seeking experiences, shaping not only the accessibility and availability of services but also how victim/survivors perceive and engage with them. By examining these intertwined forces, this study highlights how systemic and structural inequalities, along with dominant cultural and institutional discourses, influence both the response to sexual violence and the lived experiences of those seeking support. People who harm others should be held accountable for their use of violence; however, we are also interested in critically examining how community infrastructure is entangled within women's lived experiences, and how particular responses and/or lack of response can create the conditions of possibility that enable revictimization.
Material feminism acknowledges that the material world is not made up of “fixed” or essentialist attributes but rather exists in a constant state of becoming where everything is intricately interrelated (Fox & Alldred, 2022). A focus on relationality asks us to refrain from relying on grand theories such as a “top-down yet all pervasive patriarchal social relation” and instead, consider the range of relations, events, and actions that enable sexual violence to occur (Fox & Alldred, 2022, p. 10). This is not to deny that patriarchy is a significant driver of sexual violence, but to recognize that the micropolitics of sexual violence are also embedded and embodied in the everyday lives of women. As articulated by Fox and Alldred (2022, p. 12), material feminisms conceptualize structuralist theories of gendered violence such as patriarchy and misogyny “as produced and reproduced by a drip, drip, drip of gendered affects within the everyday assemblages that constitute the social world.” From this perspective, our article sought to explore how support services are one part of multiple elements interconnected in women's experiences of violence. For instance, how service responses of minimization, victim-blaming, and shaming scaffold community acceptance of perpetration, and how experiences of violence and trauma are interrelated with material landscapes and community discourses.
Method
Procedure
The data analyzed in this article was drawn from a larger research project exploring women's experiences of sexual revictimization in regional/rural areas (see Corbett et al., 2024a, 2024b, 2024c). The study received ethics approval from the lead researcher's Human Research Ethics Committee (HEC21343).
Women's service-seeking experiences are not static events but are continually shaped by material-discursive forces, demanding a methodological approach that captures their fluid, relational, and deeply contextual nature
Recruitment of participants occurred through community organizations situated in regional and rural Victoria, Australia. Staff at these services facilitated the recruitment process by disseminating information to clients who matched the inclusion criteria. To be eligible, participants had to identify as a woman (cis or trans), be over 18 years of age, and reside in a regional or rural location. Additionally, they were required to have a history of revictimization, while currently living in a safe and stable housing environment. Participants were required to have stable housing to ensure they had the necessary stability to engage with the study safely. Discussing trauma can resurface distressing experiences, and those in unstable living situations or ongoing crisis may face heightened risks of retraumatization. Ensuring stability helped create a safer environment for reflection, reducing the likelihood of triggering or exacerbating distress during participation. This study specifically focused on revictimized women, whose experiences of compounded trauma and systemic barriers can shape help-seeking and service interactions differently. This approach allowed for a targeted examination of service responses, institutional accountability, and gaps in support structures.
Initially, 12 participants were recruited for the study; however, 1 withdrew after encountering a recent incident of sexual revictimization. Eleven participants engaged in the first semi-structured interview. Of these, 10 returned for the second interview, which occurred 2–3 months later. These follow-up interviews were designed to allow participants the chance to convey additional insights and reflections on the topics or experiences that were brought up in the initial session.
The interviews were an opportunity for participants to discuss how differing elements interacted and influenced their experience seeking support and services after experiencing sexual revictimization, aligning with our material feminist framework outlined above and its emphasis that phenomena emerge from complex networks of relations. Rather than seeking a singular truth, the interviews enabled comprehension of multiple realities and diverse perspectives on sexual revictimization experiences. They also provided an important avenue to platform women's voices, ensuring data on sexual revictimization is grounded in the real-world lived experiences of victims/survivors and told in their words.
Four participants lived in rural areas and seven lived in regional areas. Most of the women were born and grew up in rural areas. Their ages ranged between 20 and 70 years. Most participants were Caucasian (N = 9), with two identifying as Culturally and Linguistically Diverse (CALD). As children, most participants experienced CSA (N = 10), many women also reported co-occurring child physical and emotional abuse, neglect, and witnessing FV. As adults, women experienced intimate partner violence (IPV), intimate partner sexual violence (IPSV), and sexual violence by strangers and known persons.
The semi-structured interviews explored a range of key themes related to women's experiences of sexual revictimization and help seeking in regional and rural Victoria. The interview structure allowed for open-ended discussions while ensuring consistency across interviews. Participants were first asked about their community and living environment, reflecting on both the benefits and challenges of residing in a non-urban setting as a woman. The interviews then explored their experiences with support systems, focusing on their first time seeking help for sexual violence, their most recent attempts to access services, and how their perceptions and expectations around support had evolved over time. Discussions also examined the impact of repeated sexual violence on their lives, including how revictimization shaped their views on their community, their understanding of why sexual violence occurs more frequently in non-urban areas, and the systemic factors that perpetuate harm. In addition to service experiences, participants reflected on their personal relationship with trauma, discussing what trauma means to them, how it manifests in their daily lives, and what makes them feel safe or unsafe. By examining these interconnected themes, the interviews provided a nuanced understanding of how geographical, social, and institutional forces shape the service experiences and recovery journeys of revictimized women in regional and rural areas.
Interviews ranged between 1 and 1.5 h and were conducted by the lead author. Each participant was financially reimbursed for their time in accordance with standard research practices acknowledging its value. Interviews were audio recorded and transcribed verbatim, and participants assigned pseudonyms.
Data Analysis
Thematic analysis was used to identify and analyze themes and patterns within the interview data (Braun & Clarke, 2006), which enabled our analytical approach to be driven by material feminist theory (Barad, 2007). The data analysis was carried out by the first author, who initially closely examined the interview transcripts, identifying recurring themes. Subsequently, a thorough analysis was performed through multiple readings, and to enhance reliability, Nvivo software was employed to organize codes into major and sub-themes. To ensure the validity of the thematic data, cross-checking and consensus-building among the research team was undertaken, involving discussions to confirm the major themes and sub-themes derived from the data.
Material feminism, employed as our analytical framework, facilitated an in-depth examination of women's help-seeking behaviors and service experiences by acknowledging the intricate co-constitution of these processes involving diverse actors and systems. Within the regional and rural context, this framework accentuated the important role played by geographical forces such as isolation, or limited infrastructure, influencing women's decisions regarding support. Furthermore, our approach enabled a nuanced exploration of the embodied impact of sexual violence and subsequent experiences with support services, as well as the ways community discourses impact decisions regarding help-seeking. By adopting a material feminist perspective, we were able to conceptualize help-seeking and service experiences as extending beyond the individual, taking into consideration the multiple material-discursive forces and structures that both empower and constrain women's decisions and behavior.
The themes and sub-themes identified in our analysis provide the structure for the findings presented below. The first major theme, Experiences seeking sexual violence support, includes three sub-themes: “More than just counselling—holistic support,” “The importance of trust and specialisation in counselling” and “Adapting to support victim/survivors’ realities.” The second major theme, Generalist services & inappropriate responses, captures two key sub-themes: “Trauma-insensitive responses from generalist services” and “Over-reliance on medication as a default response.” The final major theme, Structural barriers and community dynamics shaping support access includes the following sub-themes: “Geographical barriers and limited-service availability,” “Constantly eyes on everyone, constantly” and “Materialising service needs: beyond traditional support models.”
Findings
Women detailed a range of health-related service needs including hospital emergency departments, GPs, psychologists, psychiatrists, counselors, and sexologists. They also highlighted the need for practical resources such as employment, income, housing support, support in shopping for food, and legal and police response. Participants stressed the importance of connection with other women to build a sense of community. Specialized sexual assault counseling was noted for its positive impact on wellbeing, providing holistic support for traumas related to recent and historical events, such as childhood sexual abuse. However, women also reported inappropriate and retraumatizing experiences with generalist (non-specialized sexual assault) services, which often involved invasive or irrelevant questions and a lack of understanding of complex trauma. Barriers to accessing support included distances to medical care and a lack of confidentiality and stigma regarding sexual violence in small towns. Geographical isolation and community density not only co-constituted challenges and barriers for seeking support but also influenced the type of support needed. Experiences of violence and trauma, women's material surroundings, ongoing community stigma, and the threat of seeing the perpetrator actively constricted women's ability to exist freely in their community. These findings will now be discussed in further detail below.
Experiences Seeking Sexual Violence Support
More Than Just Counselling—Holistic Support
Participants described the life-changing impact that specialized sexual violence counseling had on helping them process past and current trauma. Mandy returned multiple times to a family violence organization for immediate safety and material support when leaving violent partners. Later when she was able to access specialized sexual assault counselling to process her childhood trauma, she reported being able to heal and subsequently has not entered another violent relationship since. For Courtney, specialized counseling offered her the chance to address her chronic pain conditions, as well as relational issues of others maintaining control over her: And the other thing was, [sexual assault counsellor] was the first person that turned around and ever said to me “I believe you” (…) she made me realise that it wasn’t my fault. And she made you feel comfortable and she just understood, she really understood everything. And then would come up with different ways to help relieve pain (…) It wasn’t just the sexual abuse (…) it was everything to do with my life and it didn’t matter if I spoke about those things as well. I’ve got fibromyalgia, I do have endometriosis, I have depression, anxiety, I have arthritis. Look, I have a list of things and I can keep going. But yes, I really do. I do believe that a lot of that has contributed, has come from that. You are growing up in the fear of life, you are growing up being attacked through your life. Is this normal, is it not normal? You can’t tell anybody so you’ve got these deep secrets inside you and you just want to explode and you can’t. So I figure it comes out in illnesses. And you know I had glandular fever at [age – early teens], you become tired and I do, seriously since I’ve been to [specialised sexual assault counsellor], my pain has not been as severe as what it used to be. [My sexual assault counsellor] last week actually managed to pinpoint it and I said, “Hooray, we’ve hit the devil on the head. This might be it” (…) about the inner child. That was through some questions that she was asking and just talking to me and through the counselling session, she’d say, “Look, can I halt you there? We’ll address that point” and she’d help to unpack it a bit (…) So because of her own personality and her gentleness, which is what it really takes, she’ll sit there and look at you the whole time and you’ve got her whole attention, whereas with a lot of other people, psychologists and that, you haven’t, they’re too busy writing (…) those rights I haven’t felt for a long time and it's only really beginning to happen now. And that wouldn’t have happened if I didn’t speak to my counsellor and say, “I can’t sleep in that bed anymore”. And it was through her, that you know she spoke to one of the [program] workers that I have. And I, surprisingly, was given funding to change my mattress, and my bed (…) and I didn’t even know she was doing that. See it was all in the background, ‘cause it was a wraparound support.
The Importance of Trust and Specialization in Counselling
Key to participants being able to process past and current trauma was the trusted relationships that were built with counselors “who actually ‘got it’.” Mandy described a distrust of counselors who were not specialized in gendered violence stating “I would go to a counselor and not feel comfortable talking about it because I thought, ‘what sort of bloody training have you got? You’re not really going to help me’”. For Mandy, ongoing specialized sexual assault counseling that was trauma-and-violence informed supported her to heal from experiences of child abuse, as well as DFV and IPSV: I got very long, ongoing support from [specialist sexual assault organisation] for that. I don’t even know how long, but it was all over the phone, which was fine, because it was lockdown and things. So fantastic, brilliant. I couldn’t speak more highly of what she did to help me. Because the method she used was very pertinent to me (…) She goes into how your body feels and then something from your childhood trauma comes up. Because, as we all know, we hold those patterns of beliefs that we form as children, and, so, (…) it was like wading through shit to do it. Because you were resisting it but it's tuning into that wounded child and the emotions that we hold and releasing those, so … yeah, they were very effective sessions. Totally changed, 100%. I now know that I can trust. I’ve learned that skill of trust. Because as a child victim of abuse and then later on in my marriage, the trust just goes. And I’ve learned that I can now speak about it with no repercussion. I’m safe, I’m safe. And that is due to, I guess, to the professionalism and an organisation such as [specialist sexual assault organisation].
Adapting to Support Victim/Survivors’ Realities
While specialized sexual assault counseling had a positive impact on participants’ lives, for this to be of benefit, the service needed to be flexible, and women needed to have agency and choice regarding the counselor they saw. For Courtney, flexible service delivery meant that she could take a break from therapy and come back when she needed: When [specialist sexual assault counsellor] and I were doing the sessions and everything, a lot of stuff did come out, but we didn’t quite finish it off. But I was happy to finish the sessions. It was time to have a break, it was time to just try and move on a little bit, continuing knowing that I can come back at any time. It's a very unrealistic expectation that you would be able to meet a woman's need while sleeping rough. There's no fixed address. Even if you stayed at a friend's, by the time you go on and do the referral with [a specialist sexual assault organisation] and then by the time you go through the waiting list period, you’re not there anymore. You’re not in that region anymore. So, the only support that's really out there is 1800RESPECT and Lifeline. But that's if you’ve got credit, that's if you’ve got electricity to charge your phone. But also lack of numbers of counsellors too. So, like, if you’ve got this one and that one to pick from and then if you don’t like either of them, then … Well, yeah. You’re stuffed. Or online and that was shit because you couldn’t really … you can’t see them. You could do Skype and that was terrible for me because of the cues, I find it hard to pick up on people's cues. And also, it's so stilted and delays (…) And also, you try and do it from home with kids at home and finding a private space.
Summary
Participants experiences of revictimization throughout their lives led to ongoing complex trauma. Specialized sexual assault counseling enabled women to deal with current violent experiences, as well as behavioral and attachment patterns that had been formed during childhood. This therapy reinforced their right to feel safe and set boundaries in relationships. Participants emphasized the need for holistic, long-term, flexible and trauma-and-violence informed counseling.
Generalist Services & Inappropriate Responses
Trauma-Insensitive Responses From Generalist Services
Participants described a spectrum of experiences with generalist services such as GPs, psychologists and psychiatrists, counseling, and hospital care. These experiences ranged from unhelpful to retraumatizing, reinforcing ongoing gaps in trauma-and-violence-informed training for specialist mental health practitioners and GPs. For Chloe, her initial encounter with a psychiatrist left her with a sense that her concerns had not been addressed adequately. The psychiatrist's response, marked by dismissal and the sharing of inappropriate information, ultimately exacerbated Chloe's distress: It was actually kind of awful (…) I saw this psychiatrist. It was like this white man, like middle aged, and I’m in the room myself and it was like – “Oh, I’ve had this experience with sexual assault”. He was like – “It's just depression and anxiety. Like, that's not a factor at all”. And I was kind of like … “great”. Then this guy was completely awful. He basically told my 10-year-old sister I’d tried to kill myself. And I was like … “not necessary”. The very first time I went to do something about it, I was on a waiting list. And when I rang them I said, “I need someone to get the information out of me, I can’t just freely open it up”. Anyhow I got in, this lady cost me a fortune, and she never really done anything for me or asked me any questions or anything. And then I went back the second time, and then basically she just said to me, “Oh there is nothing, it's like you don’t need any help and we won’t bother with this anymore”. And I thought okay, so I left there. The communities are also isolated which means there's no help, there's nowhere to turn. I’ve been ill and I’ve gone to the doctor, and he said, “Your husband's got the crook back go home and have a Panadol”. And I’m the one who ends up having a nervous breakdown because he's being looked after. I had said to the doctor why hasn’t childhood PTSD been addressed? (…) he said, “Even now doctors don’t address it, they don’t recognise it”.
Over-Reliance on Medication as a Default Response
Participants described healthcare providers defaulting to medication rather than addressing the root causes of trauma. While medication can play a role in mental health support, the absence of trauma-and-violence informed response and assessment can leave victim/survivors feeling unheard and disempowered. For example, Chloe felt dismissed by her GP who prescribed anxiety medication without engaging in a meaningful discussion about her concerns: I had one [GP] where I went to her and I was like, “Hey I’m really anxious at the moment”. And then she just prescribed this random medication. And was like “Take this when you feel anxious”. But I was like “Okay I feel like this is the time when you’re actually supposed to ask questions”. I ended up on a tower at [local park] trying to go off the tower. And luckily a passer-by seen me and the police came and dragged me down (…) the hospital wouldn’t take me because I was a danger to myself by trying to take my life, they couldn’t put me in a hospital ward because they seen me as unsafe, I guess (…) [police] took me to Psych Services (…) and I was in there for about 10 days. And it was just constantly like temazepams, Effexor which are an antidepressant, loading me up. And then after that time, they opened the door, “see ya” and I was back at the tent again. So I had the issue of being homeless, I developed a dependency on temazepam and drugs, like prescription medication. It was absolutely horrific. Hallucinating, you know, all of that (…) I walked out there with a wide bag full of prescription medication and that's what I did to numb out.
Summary
Participants reported varied experiences with general practitioners, psychologists, psychiatrists and emergency departments ranging from unhelpful to retraumatizing. Many services lacked trauma-and-violence informed care, leading to systemic revictimization. These practitioners frequently failed to inquire about CSA or interpersonal violence, dismissing women's concerns and missing the link between gender-based violence and health issues. Over-reliance on medication for complex trauma left participants feeling disempowered and abandoned. However, one participant described a positive experience with a GP who acknowledged her frustrations and provided a supportive referral to specialized sexual assault counseling.
Structural Barriers and Community Dynamics Shaping Support Access
Residing in regional/rural locations meant services were often not available locally and participants had to travel long distances with significant costs to access support. This was further contextualized by a fear that confidentiality would be breached in small towns, forcing women to look for support outside of these communities or go without. Participants service needs were actively formed not just by violent experiences, but by a range of material-discursive forces that contextualized women's ability to live and access support within their communities.
Geographical Barriers and Limited-Service Availability
For several participants, limited medical services within regional and rural areas meant they were required to travel long distances for medical treatments. Courtney suffered from endometriosis and was required to seek medical treatment in the city. Her experiences of child abuse meant she did not trust others to look after her children, and without family to support her, as well as having “to pay to get there and get back,” she eventually stopped seeking treatment: See, I don’t have a mum, I have nothing to do with my dad. I was a full-on single mum, like it was me and that was that. So it was very hard. And I didn’t trust anybody to look after my children (…) Because of what happened to me. Yeah, there was no way in the world anybody was allowed to go near my children like that (…) I actually stopped having the surgery in the end. I moved down to [rural location] and she said, “You need to find somebody closer. It's too far for you to come” and I thought, “Do you know how hard it is to find somebody? You’re my link. You’re what's keeping me going here.” Mum would arrange for us to stay with her friends and there were times where that was unsafe too (…) we were exposed and vulnerable to perhaps people that weren’t – like the women took care of us but they maybe weren’t aware of some of the predatory men that were around. I definitely felt really vulnerable and unsafe and I felt like a bit of a homeless kid wandering the streets a lot. When mum was down in [city location] having her cancer treatment, and those were the days mum would be gone for, you know, three months, not like now, he would bring people into the house. So, he’d pass out drunk and I would have men, strange men coming into my bedroom assaulting me while he slept.
Constantly Eyes On Everyone, Constantly
Participants regularly disclosed the ways the intimacy of regional and rural communities posed barriers for seeking support. This ranged from fear of confidentiality breaches to conflicts of interest, and fear of community stigma. The importance of having access to specialized sexual assault counselors who could counteract these barriers and provide outreach to isolated areas was highlighted as a crucial service by participants. Mandy resided in a small country town and was reluctant to reach out to the local psychologist for fear that her confidentiality might be breached: I was really wary about talking about it because what if, you know, they broke their code? I know they shouldn’t but you just don’t know in a small country town. And the fact is I didn’t want to see them down the street, if I disclosed stuff. Like, you know, really private details to them. For instance, there's only one psychologist in [rural location] that everyone kind of just gets referred to in [rural location], local. There's no other psychologists there (…) My neighbour was saying she was seeing the same psychologist and I’m just like, “Oh”. I left. I said, “I’m not going to come and see you.” Accessing help and trust, who to tell, who can I go to tell. Who has seen my car outside [specialist sexual assault organisation] coming into [specialist sexual assault organisation]? Constantly eyes on everyone, constantly. I’d taken myself up to triage at [rural location] hospital, one of the women apparently knew [my ex-partner] (…) and [my ex-partner] has told them, “Patsy has been sexually abused” so I’ve already got that ahead of me, you know, I wasn’t going to get the compassion and also [my ex-partner] being told [by the community], “Don’t get involved with her”, it was like, “Oh, for goodness sake”. (…) and so I was having to deal with that stigma the whole time.
Materializing Service Needs: Beyond Traditional Support Models
Participants’ experiences of cumulative violence, from CSA and other forms of child abuse to sexual violence and DFV in adulthood, intersected with multiple forces that impacted women's ability to heal and recover and influenced the form of service support that women required. Geographical isolation and community density were active in restricting women's participation in daily life, however, this also combined with elements such as community gossip and stigma, or experiences of PTSD symptoms, to produce particular contexts of distress. In this way, services needed to consider the complexity of participants’ experiences in developing response strategies.
When Rosa left a DFV relationship, she was forced into homelessness while the community around her sided with the perpetrator. Geographically isolated regional and rural communities with limited supermarket options, a lack of housing resources, poverty, tight-knit communities, disbelief of women's disclosures of violence, gossip, stigma, misogynistic discourses that are overly blaming of mothers, and embodied responses of fear all combined and intersected to produce conditions that meant when Rosa needed to buy food or was out in public, she experienced intense panic attacks. These material-discursive forces directly co-constituted her experience, and by extension, the form of holistic service response that Rosa might need. Without a service that supported her to complete commonplace tasks such as shopping, she faced significant retraumatization: They immediately labelled me as not a good mother, a terrible horrible person, homeless, that's the way the community seen me. When I’d go up to the supermarket, I would see mothers that had sat across the table from me at mothers’ club meetings (…) they would shun me. I faced a lot of backs and a lot of shoulders. And it got me to a point when I went to the supermarket, if I’d seen anyone, I’d hide. I’d run outside (…) And that affected me for a long time. Being able to go somewhere without having a full anxiety attack (…) Oh the anxiety attacks. I can remember many times I would go in and see prevalent people and I would run outside and I’d be shaking, I’d feel like I was being choked, I’d actually urinate in my pants. Just, oh, it was just horrific.
The distance and density of regional and rural communities also meant that participants regularly feared bumping into men who perpetrated violence against them. This actively restricted women's movements and ability to remain connected and active in the wider community. The importance of service workers who were cognizant of how participants’ distress and trauma shifted with other material-discursive forces within their community was paramount in understanding how to provide comprehensive support. For example, understanding how a trip to the supermarket was integrated into Rosa's experience of violence and trauma would have broadened awareness of the type of support she needed. For many women, experiencing violence within communities deterred participants from participating in public community life, significantly impacting their ability for healing and recovery. While Chloe was in her final year of high school, she was sexually assaulted by a stranger outside of her school, which impacted her ability to finish her education, and meant she avoided the regional town center: I had this really bad experience with like a stranger – it was like a sexual assault experience – and it was like right near my school in like the middle of the day. That was really hard because I had to go back there like every day (…) I get anxious when I know exactly what happened there. I don’t want to go anywhere near it kind of thing (…) I don’t really like going to like the centre of town because it's like that's sort of where the school is so it's just kind of the – it's widened.
Summary
Participants experienced a lack of trauma-and-violence-informed care in regional/rural areas, meaning many participants had to travel to receive appropriate treatment. Limited health services within regional/rural areas meant frequent travel to cities, which was particularly challenging for mothers, and left younger participants vulnerable to sexual assault. Geographical isolation increased the likelihood of participants’ confidentiality being breached when accessing services in regional and rural communities, which highlighted the importance of outreach services. Participants’ narratives emphasized they needed support beyond therapeutic interventions, such as shopping assistance, to enable healing and recovery within communities.
Discussion
This article sought to explore women's help-seeking and service experiences within regional and rural areas within Victoria, Australia, including how these are co-constituted through material-discursive forces within specific communities. Our approach centered on comprehending support within the broader context of participant's community and life journey, rather than viewing sexual assault services as a simple or linear response to participant experiences of sexual trauma. Experiences of sexual violence, help-seeking behaviors, and service support are intricately tied to geographical, cultural, social, and temporal forces. To gain a deeper understanding of this, a broader and more nuanced approach was essential, one that extended beyond identifying individual factors or barriers to a specific service provision. Participants’ experiences of compounded abuse, violence, and trauma, influenced by the material-discursive forces identified, necessitate that service responses attune and respond to this specific context beyond more traditional and generalist approaches.
Our findings align with previous research (Tarzia et al., 2020), emphasizing the importance of trusting therapeutic relationships and the need for tailored and flexible recovery interventions (McLindon et al., 2024). Sexual violence and ongoing abuse cause significant mental and physical health issues (Tarzia et al., 2017). Ensuring services meet women's needs is difficult in regional/rural areas (Fennell et al., 2018; Hooker et al., 2021a; Owen & Carrington, 2015), indeed many participants in this study experienced a range of inappropriate and retraumatizing responses from psychologists, psychiatrists, and generalist health providers. Women also faced significant barriers to accessing services including a lack of specialized services in local regional and rural communities, fear that confidentiality would be breached, and the imposition of having to travel long distances to access medical treatment. These barriers were actively contextualized by the communities and regional/rural landscapes that women resided in, and in turn contributed to the form of support women required.
Participants emphasized the critical importance of specialized sexual assault counseling, highlighting its holistic support for addressing various traumas, including childhood abuse and sexual revictimization. They described how specialist sexual assault counselors attended to emotional, physical, and psychological well-being by believing and validating their disclosures, providing trauma-and-violence informed care, addressing physical pain, and offering flexible, wraparound support like acquiring material resources. This aligns with recent research on women's expectations of primary healthcare support after disclosing IPV, which values empathy, validation, understanding, practical support, and empowerment (Tarzia et al., 2020). While dedicated counselling sessions for sexual trauma are essential, our findings highlight the need for additional support structures within communities which are often overlooked in formal or funded responses to sexual violence, despite being crucial for recovery. For instance, Governments and service providers should consider multi-modal safety strategies to support victim/survivors navigating tight-knit communities. This could include mobile and virtual advocacy for real-time support, allowing victim/survivors to stay connected online while moving between locations or have a support worker accompany them to services or daily activities. Discreet, multi-service access points are also critical for maintaining privacy. Together, these measures enhance safety, accessibility, and autonomy for victim/survivors facing social and geographic barriers.
Despite the benefit of sexual assault services, our participants found it difficult to access appropriate healthcare services. This was not simply because there were limited services within geographically isolated areas, rather specialist mental health and primary health care practitioners lacked trauma-and-violence informed care approaches which, in many cases, retraumatized and disempowered participants.
In our study, participants regularly experienced dissatisfying and re-traumatizing experiences with mental health specialists and GPs. This aligns with prior research showing CSA victim/survivors’ dissatisfaction with GP services (Coles et al., 2015) and Australian mental health practitioners’ limited understanding of trauma and sexual violence (Isaac et al., 2024). Implementing woman-centred, trauma-and-violence informed care (Coles et al., 2015; Isaac et al., 2024; Levine et al., 2021; Tarzia et al., 2020) and providing training for rural health practitioners (Hooker et al., 2021b) are essential for improving victim/survivors’ experiences in mental health and primary care settings. The Readiness Program run by the Safer Families Centre at the University of Melbourne demonstrates promise in strengthening GPs’ capacity to recognize, respond, refer, and record disclosures of DFV (Gleeson et al., 2024). However, there remains a critical gap in training programs specifically designed to improve healthcare responses to sexual violence and CSA disclosures. Future research should also evaluate the effectiveness of such interventions specific to regional and rural contexts.
Women's ability to heal from complex trauma and sexual revictimization, including the ability to exist freely within their community, was both enabled and constrained through various forces. Long, costly distances to medical care, a lack of confidentiality in small towns, and re-traumatizing healthcare experiences impeded recovery and access to support. Geographical isolation and community density meant gossip and community stigma towards victim/survivors was embedded and embodied within their everyday existence. Any combination of these forces restricted women's ability for recover, including their right to feel safe within their community. These challenges shaped the type of support needed, such as assistance with groceries to avoid community shaming. The pervasiveness of this shame necessitated multiple points of support across women's lives, yet mental and primary healthcare systems often fell short. Addressing stigmatized beliefs about sexual violence and gender inequality is crucial, as these contribute to an acceptance of violence against women (OurWatch, 2021).
Current funding policies for sexual assault counseling services focus on individual victim/survivors (State of Victoria, 2021), which positions women as responsible for identifying, healing, and recovering from sexual trauma. Our findings indicate one of the main deterrents for women being able to heal and exist within their community was ongoing stigmatized attitudes from generalist services and community members. Addressing victim/survivors service needs requires funding to engage with community beliefs about violence against women. While the research evidence base for community-level interventions within Australia is limited, evaluated programs such as The Men's Program, which aims to engage men in deconstructing rape-supportive beliefs and increase bystander action, shows some promise (Hooker et al., 2021a).
Strengths and Limitations
The research paper has enabled a deeper understanding of revictimized women's help-seeking and service experiences in regional and rural areas, centering victim/survivors lived experiences and voices. A key strength of this study is its use of an established theory to guide analysis and interpretation. Other strengths include member checking of transcripts to enhance accuracy of the data and ensure that participants’ narratives were authentically represented.
There are several limitations to consider. Participants were recruited through community organizations, meaning the sample predominantly reflects the experiences of women who have already engaged with services. As a result, the perspectives of those who lack access to formal support or actively avoid service use due to stigma, distrust, or other barriers, are not captured. Additionally, while the study includes women from a range of regional and rural settings, it is specific to non-urban populations within Victoria, Australia and may not be generalizable to other geographic or socio-political contexts. Future research should seek to explore the experiences of those who remain outside formal service systems to provide a more comprehensive understanding of barriers to support.
Recommendations
Policy
Government service agreements for sexual assault support services must recognize the distinct challenges faced by regional and rural areas, including geographical isolation, limited transport options, and community stigma. While the introduction of brokerage funding in recent years has provided some additional resources, current funding structures still fail to account for the higher operational costs of rural service delivery. To address this gap, funding models should include a dedicated regional and rural funding boost to support sustainable service delivery in non-urban settings.
Effective recovery from complex trauma requires sustained, trauma-and-violence informed support. Specialist sexual assault services need secure, long-term funding for flexible counseling and case management that adapts to victim/survivors’ evolving needs. Group-based programs have shown promise in supporting the recovery journeys of revictimized women in regional/rural areas (Corbett et al., 2024c). However, this form of support lacks dedicated funding. Resources for planning, staffing, venue costs, and evaluation are essential to make group work accessible.
Current funding primarily addresses service provision for victim/survivors rather than broader cultural change. Investment in community-level prevention initiatives is needed, including campaigns addressing rural-specific stigma and misinformation about sexual violence to reduce victim-blaming and increase trust in services.
Practice
Generalist medical and psychological services must receive ongoing, evidence-based training to effectively recognize and respond to sexual and gendered violence. This should include structured education on the physical and psychological manifestations of trauma, as well as best practices for inquiring about and responding to disclosures of childhood sexual abuse (CSA) and sexual violence. Emerging evidence suggests that Primary Health Networks (PHNs) can play a critical role in strengthening healthcare responses to DFV (Gleeson et al., 2024). PHNs should be resourced to commission specialist sexual assault services (SSAS) to deliver tailored training and resources specific to CSA disclosures and sexual violence.
Service providers should adopt a trauma-and-violence informed approach that recognizes how trauma manifests in everyday life, from housing insecurity and financial stress to difficulty with routine activities like shopping
Telehealth and online counseling should be a core part of support services in regional and rural areas, addressing geographic and confidentiality barriers by allowing victim/survivors to access care beyond their local community. These options enhance privacy and reduce logistical challenges such as limited public transportation.
Sexual assault support services (SSAS) in Victoria are highly skilled and knowledgeable in the field of sexual and gendered violence. They are well placed to lead community campaigns and programs that seek to educate and prevent violence from occurring. SSAS need to be appropriately funded to engage in community education and prevention.
Research
Longitudinal research should assess the effectiveness of trauma-and-violence informed, interdisciplinary support models in regional and rural contexts. Studies should focus on how trauma-and-violence responsive interventions (e.g., wraparound services, practical material aid, long-term counseling) affect victim/survivor outcomes and service engagement.
Future research should assess the effectiveness of the Readiness Program interventions (Gleeson et al., 2024) specific to regional and rural contexts, ensuring they address the unique barriers to service access and support in non-urban areas.
Conclusion
This article explored revictimized women's help-seeking and service experiences in regional and rural areas in Victoria, Australia, highlighting both the transformative potential of specialized sexual assault counseling and the significant barriers posed by generalist health and mental health services. While trauma-and-violence informed counseling provided vital support, participants frequently encountered retraumatizing responses from generalist services, many of whom lacked an understanding of the complexities of gendered violence and its long-term health impacts. Beyond individual service experiences, women's access to support was shaped by broader structural and cultural forces, including geographical isolation, limited-service availability, and pervasive stigma that deterred disclosure and reinforced victim-blaming narratives.
Our findings indicate that Australian mental health (psychiatrists, psychologists) and primary care (GPs, hospital, and emergency response) are failing to meet the needs of revictimized women in non-urban settings. Addressing this gap requires systemic reforms, including the integration of trauma-and-violence informed care into consistent and ongoing generalist training, expanded funding for specialist sexual assault services, and targeted interventions that challenge harmful community attitudes that perpetuate silence and shame. This study contributes a material feminist perspective to the field of revictimization research, offering a nuanced understanding of how geographical, cultural, social, and temporal forces co-construct women's help-seeking experiences.
Footnotes
Acknowledgments
We offer our deepest thanks to the women who courageously shared their stories with us. Your voices, experiences, and reflections are the heart of this work. Without your openness and trust, this research would not have been possible. It is through your generosity that we are able to better understand the complexities of revictimization and move toward more compassionate, effective forms of support.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Australian Research Centre in Sex, Health and Society, La Trobe University, The Centre Against Sexual Assault Central Victoria.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.