Sex Therapy
With Survivors of Sexual Abuse

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Tenet 5: More Sex Is Better

In traditional sex therapy, the main criteria by which we judged success was how regularly and frequently clients were having sex. I used to ask lots of questions about frequency and evaluated success by how much a couple conformed to the national average of engaging in sexual activity once or twice a week. This focus on quantity often ignored issues of quality. Working with survivors taught me that with physical and sexual interaction, high quality is more important than large quantity.

Jeannie¹, a 35-year-old survivor of childhood molestation, and her boyfriend, Dan, sought therapy to address sexual intimacy problems. They planned to marry in the next year. It was concerning both of them that Jeannie would "check out" during sex. "I feel like I'm making love to a rag doll," Dan lamented. She agreed to sex to please him, fearing he would end the relationship if she declined too often.

For Jeannie, more sex brought on more problems of dissociation. The sexual contact she was having was getting in the way of her recovery from sexual abuse and her ability to create an honest intimacy with Dan. In therapy, as the reality of what was going on emerged, the couple decided to take a vacation from sex for awhile. Jeannie needed time and permission to validate her inner experience. The break from sex enabled her to honor her real feelings, learn new skills, and eventually be able to say yes to it without anxiety. Jeannie also learned that Dan loved her for herself, supported her getting in touch with her inner feelings, and viewed sexual interaction as less important than emotional intimacy and honesty.

When survivors progress in healing and start having sexual relations more regularly, it's not uncommon for the frequency of their sexual interactions to vary. To ensure positive sexual experiences, survivors often need to give themselves a safe, comforting envirornment and plenty of time for intimate relating. Sex emerges from mutual good feelings and a sense of emotional connection between partners. The high quality and specialness of sexual encounters become more significant than how often they occur.

Tenet 6: An Authoritative Behavioral Goal-Focused Style Works Best

In traditional sex therapy, the therapist's role was primarily to present a program of exercises and help clients follow that program to achieve functioning. Therapists offered sex education and worked to improve couples' communication. The therapist was the authority, suggesting techniques, pacing interventions, and monitoring progress. Little attention was paid to how a therapist's style might be influencing the progress of therapy. Working with survivors has taught many sex therapists that their therapeutic style is as important as any intervention.

For many survivors, sex is one of the most difficult areas to address in recovery Just hearing the word "sex," or saying it can bring on a minor panic attack. Survivors can easily unconsciously project feelings toward the offender and the abuse onto the therapist and the sexual counseling. After all, therapists seem invested in survivors being sexual, and the process of therapy strains a survivor's sense of control and protection. This high potential for negative transference needs to be addressed if sex therapy with survivors is to be successful.

To minimize negative transference, I suggest therapists adopt the following premise: Do the opposite of what happened in the abuse. For instance, because the victim was dominated and disempowered in abuse, it makes sense that therapy should focus on empowering the client and respecting his or her reactions to it. Therapists need to explain techniques and interventions, encouraging clients to exercise choice at all times. Suggestions, not directions or prescriptions, should be given. Rather than admonish clients for their resistances and relapses, therapists should reframe these as inevitable, seek to understand, and work with them.

Because sexual abuse involved a traumatic violation of boundaries, it's important that sex therapists be extremely good at maintaining clear emotional and physical boundaries. Talking about sex can stir up sexual feelings. It's inappropriate to combine sex-focused sessions with touch.

Several years ago, I was appalled when a prominent sex therapist told me how she held and rubbed her female client's hand during a session to demonstrate different stroking techniques for masturbation. Therapy needs to be a safe place physically and psychologically for everyone, at all times.

It's also important for sex therapists not to dominate the content and course of therapy. Personally, I find I'm most effective when I establish a therapeutic relationship with the client in which we're working together. The client sets the pace and direction and presents the content; I provide encouragement, support, guidance, creative ideas, insight, information and resources.

The Value of Change

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There is no question that the challenge of treating survivors of sexual abuse has revolutionized and improved the practice of sex therapy Personally, I know that the changes I have made in how I perceive and practice sex therapy have made me a better therapist with all of my clients, regardless of whether they were abused. Other sex therapists seem to agree that the practice of sex therapy has become more client centered and respectful of individual needs and differences. Learning about the dynamics of sexual trauma has helped therapists become more aware of the conditions necessary for sex to be positive and life affirming for everyone.

Endnotes

 ¹ This is a pseudonym, as are all names in this article.

 ² For more information on techniques, see The Sexual Healing Journey, HarperCollins, 1991.

 ³ For a description of these techniques, see William Masters et al., Masters and Johnson on Sex and Human Loving, Little Brown and Co., 1986.

Wendy Maltz, M.S.W., is clinical director of Maltz Counseling Associates. She is the author of the Sexual Healing Journey: A Guide for Survivors of Sexual Abuse and Caution: Treating Sexual Abuse Can Be Hazardous to Your Love Life.

Written: 10/94. Last reviewed: 10/05

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