FACSAFoundation.org Shattering The Silence Tour Documentary Project | Page 64
18) Did this person go to jail? Circle One
Yes
Doesn’t
No
Apply
19) What happened to the perpetrator? Fill In The Blank
__________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
__________________________________________________________
20) After the sexual assault, I had feelings of Circle all that apply and/or make a comment.
Self-Loathing
Guilt
Anger Depression
Unworthiness
Alone
Suicide
Unloved
Numbness
Rejected _________
20) I received counseling for the trauma I endured from being sexually assaulted. Circle One
Strongly
Agree
Disagree Strongly
Agree
Disagree
Doesn’t
Apply
21) I used these methods for my healing and recovery. Circle All That Apply
Books
Professional
Pastoral
Self-Help
Exercise
Counseling
Meditation
Counseling
Prescription Medication
22) I have developed the following because of the pain and trauma of sexual assault.