About this worksheet
Military sexual trauma refers to sexual assault or repeated threatening sexual harassment experienced during military service. What distinguishes it clinically from other sexual trauma is that the harm and the chain of command often occupied the same place: reporting, safety, housing, career and discharge were entangled, and the person frequently had to keep working alongside the perpetrator or their friends. Jennifer Freyd's concept of institutional betrayal describes the second injury, and it is regularly the layer that has never been named in treatment. This page is written for pacing. It contains no prompt asking for a narrative of the assault, because that detail belongs in a paced protocol with a clinician rather than on an intake page. Instead it asks what changed about the client's beliefs regarding safety and authority, what has never been said out loud and to whom in role terms, and it offers five markers of what happened afterwards: being disbelieved, reporting feeling more dangerous than silence, continuing to work alongside the person, career or record consequences, and there being nobody whose job it was to protect them. It closes on the present — how safe the body feels in ordinary settings, which avoidances are protective versus which are shrinking the client's life, one relationship or space where they are not braced, and what they want from treatment in their own words.
When to use it
- MST presentations in veteran and serving populations, and equivalent institutional sexual harm in policing, faith settings and residential care.
- First and second sessions, where a paced page matters more than detail.
- When hypervigilance around authority, supervision or help-seeking persists after trauma-focused work.
- Alongside the moral injury worksheet where betrayal by an institution is the dominant theme.
- Not a narrative exposure page; do not use it to gather an account of the assault.
How to use it
- 1
Say what the page will not ask
Naming the absence of a narrative prompt up front changes what a client is willing to write.
- 2
Work the belief shift
What they believed about safety and authority before, and after. This is the formulation, and it usually predicts the treatment obstacles.
- 3
Ask what has never been said
And to whom, in role terms. Disclosure history matters more than event detail at this stage.
- 4
Check the aftermath markers
Five items. Ticking them is often the first time the institutional response has been treated as part of the injury.
- 5
Separate protective from shrinking avoidance
Some avoidance is sound risk management. Only the life-shrinking kind is a treatment target.
- 6
Ask what they want from treatment
In their words. Control over the plan is itself reparative where the last system removed it.
Frequently asked questions
What is military sexual trauma?+
Military sexual trauma, or MST, is sexual assault or repeated threatening sexual harassment experienced during military service. It is an experience rather than a diagnosis, and it can result in PTSD, depression, substance use and moral injury.
Why is MST different from other sexual trauma?+
Because the harm and the command structure frequently overlapped. Reporting could threaten safety, housing, career and discharge status, and the survivor often had to continue working alongside the perpetrator — so escape and disclosure carried costs civilian survivors do not face.
What is institutional betrayal?+
Harm caused when an institution that people depend on fails to protect them, or responds to a report with disbelief, retaliation or silence. In MST it commonly maintains hypervigilance around authority and help-seeking long after the assault itself.
Do clients have to describe the assault?+
Not on this page — there is no narrative prompt by design. Detail belongs in a paced trauma protocol with clinical support, at a point the client chooses.
What treatments are used for MST?+
Trauma-focused therapies such as CPT and prolonged exposure have evidence in MST populations, but working the assault alone leaves institutional betrayal intact. Most clinicians treat both threads, and add moral injury work where betrayal dominates.
Worksheet — Military Sexual Trauma Worksheet — provided by TherapistAssist for clinical use. Not a substitute for assessment or treatment.
