The low reporting and conviction rates for rape in England and Wales are a significant concern. Only 16% of survivors report rape to the police, and only 1.6% of reported rapes result in conviction. One contributing factor is the prevalence of rape myths, which are false but widely held beliefs that blame survivors, cast doubt on allegations, excuse perpetrators, or suggest that rape only occurs in certain social groups. These myths are categorized into four groups by Smith and Skinner (2017) based on Bohner et al. (2009): myths blaming the survivor, myths casting doubt on allegations, myths excusing the perpetrator, and myths suggesting rape only happens in certain social groups. Existing research has demonstrated the unchallenged presence of these myths in the legal system, contributing to low conviction rates and secondary victimization of survivors. However, there's a gap in understanding how these myths manifest in the conversations of professionals who support rape survivors, such as sexual health staff. This study aims to fill that gap by examining how rape myths operate in the everyday conversations of sexual health clinicians.

Several interpretative repertoires frame discussions about rape. Crawford (1995) identifies three: the victim-precipitation model (blaming the survivor), the socio-structural repertoire (rape as part of sexual oppression), and the miscommunication repertoire (rape as misinterpretation of consent). Gavey (2005) notes a shift towards the socio-structural repertoire in sexual healthcare. Research with young men and women (Kitzinger and Frith, 1999; O'Byrne et al., 2006, 2008; Hansen et al., 2010) shows a nuanced understanding of subtle sexual refusal cues, challenging the miscommunication model. However, rape myths contribute to a rape-supportive culture that minimizes the impact on survivors and blames them (Carmody and Washington, 2001). Studies show that rape myths go unchallenged in the legal system, negatively impacting survivors' well-being and contributing to under-reporting (Fávero et al., 2020; HM Government, 2021; Smith and Skinner, 2017; Smith, 2018). Even professionals, like therapists and police officers, can exhibit rape myth acceptance (McKay, 2001; Fávero et al., 2020), possibly due to compassion fatigue or avoidance of discussing trauma (Suarez and Gadalla, 2010; Fox and Carey, 1999). Idisis et al. (2007) found that both therapists and non-therapists tend to blame the survivor, possibly due to Anderson's (1996) functional theory of cognition. This study employs a “ground-up” approach, examining how rape myths feature in situated conversations, complementing the existing “top-down” literature on interpretive repertoires.

A focus group was conducted with five female sexual health clinic staff (three health advisors, a clinic administrator, and a clinical psychologist). The 90-minute conversation focused on three written summaries of rape cases seen at the clinic: a drug rape by a stranger, ongoing anal rape by a partner, and a rape by a man met in a park. The conversation was audio-recorded and transcribed verbatim, with excerpts transcribed using Conversation Analysis (CA) conventions (Sacks et al., 1974; Hutchby and Wooffitt, 2008; ten Have, 2007). The focus group was facilitated by one of the researchers (Catherine Butler), a clinical psychologist at the clinic. The initial setup question, "As we hear these stories, what do they evoke in us, how do they make us feel, and what are our first reactions to them?", was designed to elicit personal responses, disrupting the usual professional discourse and making visible tensions between professional and lay accounts of rape. Conversation Analysis (CA) techniques were used to analyze the transcripts, focusing on the everyday work of situated interaction and drawing on feminist developments in CA (Kitzinger, 2000; Kitzinger and Frith, 1999; Stokoe, 2006; Wilkinson and Kitzinger, 2008). The analysis involved identifying analytically useful episodes based on repeated themes, deviations from existing literature, and apparent tensions between professional and lay accounts. These excerpts were then analyzed in detail, describing the unfolding of the conversation and framing it in relation to existing rape myths literature and clinical practice standards.

The Conversation Analysis identified three recurring themes in the clinicians' talk: (1) assessing the 'relatability' of the cases; (2) diagnostically reconstructing the events; and (3) apportioning blame and justice. Regarding relatability, clinicians' ability to empathize with survivors varied. In some cases, age and perceived poor decision-making were emphasized, leading to distancing from the survivor. In others, shared experiences (e.g., being in a relationship) facilitated empathy. The diagnostic reconstruction of events often focused on the survivor's actions and potential preventative measures, sometimes bordering on victim-blaming. While acknowledging external factors like drug use, the focus remained on the survivor's behavior, even when a clear external factor existed. Discussions about justice and blame were difficult to initiate, indicating a reluctance to address this aspect within their professional role. Clinicians prioritized offering belief and acknowledgment to survivors, viewing this as a more achievable and valuable form of support. The analysis revealed the use of various rape myth repertoires, extending beyond Crawford's (1995) framework. Clinicians engaged in both "othering" and relating to survivors, exhibiting a complex interplay of distancing and empathy. This reflects findings in other research about language interpreters (Butler, 2008) and the potential for secondary trauma among clinicians (Herman, 1992; Suarez and Gadalla, 2010). The 'just world' thesis (Lerner, 1980; Hafer, 2000) was evident, suggesting that survivors could prevent rape through different behavior. However, this can subtly lead to victim-blaming, although less so with acquaintance rape (Gravelin et al., 2019). The study also noted the presence of Karpman's (1968) drama triangle's "rescuer" role, which was notably absent in discussions, possibly because addressing justice was considered beyond their professional remit. The clinicians' emphasis on offering belief to survivors highlights the importance of acknowledgment in supporting survivors (Walsh et al., 2016; Kilpatrick et al., 2007; Zinzow and Thompson, 2011), especially those who have experienced drug-facilitated rape (Littleton et al., 2006).

This study demonstrates the complex interplay of rape myths and professional discourses among sexual health clinicians. The findings highlight the risk of secondary trauma for clinicians due to repeated exposure to traumatic narratives. Clinicians utilize various strategies to manage this, but these strategies sometimes verge on rape mythologizing. While not explicitly blaming victims, the focus on survivors' actions reflects the 'just world' thesis, which can subtly contribute to victim-blaming. The difficulty in initiating conversations about justice and perpetrator blame suggests a need to redefine professional boundaries and broaden the scope of support provided to survivors. The study's focus on the interactional context reveals how clinicians' talk serves a protective function, mitigating the emotional toll of their work, however, it is imperative to explore the impact of this on survivors. The study's findings underscore the need for training that addresses secondary trauma among clinicians and equips them to navigate the complex emotional terrain of supporting rape survivors without resorting to rape myths. Training should provide resources for mitigating the risk of rape mythologizing when working with clients whose circumstances seem distant or incommensurable, emphasizing empathy while maintaining appropriate professional boundaries.

This research reveals significant tensions and strategies within the work of sexual health clinicians supporting rape survivors. The study highlights the risk of secondary trauma among clinicians and the subtle ways rape myths can infiltrate professional discourse. Training should focus on recognizing and mitigating these risks, emphasizing empathy and acknowledgment without resorting to victim-blaming. This model of using conversation analysis to inform training can be extended to other professionals involved in supporting rape survivors.

The study's artificial conversational setting may not fully reflect the natural flow of conversations in a clinical setting. The small sample size limits the generalizability of findings. The focus on a specific clinic may restrict the applicability of the findings to other contexts.