Sex Therapy with Survivors of Sexual Abuse - Fantasy and Pornography Are Benigne

Written by Wendy Maltz, M.S.W.

Helping Mark recover involved helping him make connections between what happened to him in the past and his present behavior. He needed to learn the difference between abusive and healthy sex. Sex, per se, was not the problem. It was the type of sex he had learned and developed arousal patterns to that had to change. Healthy sex, like healthy laughter, incorporates choice and self-respect. It is not addictive.

To help people overcome fears of sex, sex therapy involves teaching conditions for healthy sexuality. These include consent, equality, respect, safety, responsibility, emotional trust, and intimacy. While abstinence can be an important part of recovery from sexual addictions, it won't be enough unless new concepts and approaches to sex are also learned.

Tenet 3: Fantasy and Pornography Are Benign

In traditional sex therapy, therapeutic use of sexual fantasy and pornography was generally viewed as benign and often even encouraged. Because the goal of therapy was functioning, fantasy and pornography were seen as therapeutically beneficial: giving permission, offering new ideas, and stimulating arousal and interest. Books on becoming orgasmic frequently recommended that women read something juicy, like Nancy Friday's collection of sexual fantasies, to "get them over the hump" and be able to climax.

In the early years of my practice, like other sex therapists I knew, I kept a collection of pornography in my office to lend out. While most pornography was degrading to women and contained descriptions of sexual abuse and irresponsible sex, the common attitude in the field was that "thinking it" is not "doing it." The implication was that sexual thoughts and images are harmless; as long as you don't act out a perversion, it's not damaging.

Through working with survivors, sex therapists have learned that sexual fantasies and pornography can be very harmful. Reliance on them is often a symptom of unresolved issues from early sexual trauma.

Joann and her husband, Tim, came to see me for marital sexual counseling. On the very rare occasions when Joann was interested in sex with Tim, she would manipulate the lovemaking in such a way as to encourage Tim to have forceful anal sex with her. Sexual contact invariably concluded with Joann curled in a ball on the bed sobbing and feeling isolated. Tim had some difficulty understanding why he went along with this scenario, but what I found equally curious was Joann's response when I asked her why she did it. Joann shared that ever since she was about 10 years old, she had been masturbating to fantasies of anal rape. They turned her on more than anything she knew.

In the beginning of their marriage, Joann was able to have sex without the fantasies; but as stresses with Tim increased, she found herself more and more drawn to them. Often the fantasies would intrude during sex. She felt controlled by them, filled with shame and disgust.

Joann's behavior had its roots in early abuse by her father. He would spank her in a sexual manner or penetrate her anally with his finger as he masturbated himself. The sexual fantasies Joann developed were not harmless or enhancing her sexuality. They were upsetting and unwanted, symptoms of unresolved guilt and shame from the abuse she had experienced in childhood. Her fantasies were reinforcing abuse dynamics, reenacting the trauma, punishing her unjustly, and expressing deep emotional pain at the betrayal and abandonment by her parents.

For survivors, using pornography and experiencing certain sexual fantasies are often part of the problem, not part of the solution. Rather than condemn certain sexual behaviors, I encourage people to evaluate their sexual activities according to the following criteria:

• Does this behavior increase or decrease your self-esteem?
• Does it trigger abusive or compulsive sex?
• Does it emotionally or physically harm you or others?
• Does it get in the way of emotional intimacy?

Sex therapists can help people understand the origins of their negative sexual behaviors by showing compassion and not condemning. Survivors benefit from learning ways to gain control over unwanted reactions and behaviors.² They can develop new ways of increasing arousal and enhancing sexual pleasure such as staying emotionally present during sex, focusing on body sensations, and creating healthy sexual fantasies.

Tenet 4: Use Standardized Techniques In a Fixed Sequence

Another tenet of traditional sex therapy was the importance of using a fixed series of behavioral techniques. Sex therapists relied heavily on "sensate focus" exercises that were developed by William Masters and Virginia Johnson³. Versions of these techniques exist in the standard treatments for low sex desire, pre-orgasmia, premature ejaculation, and impotence. These structured step-by-step behavioral exercises were designed to improve self-awareness, sexual stimulation, and partner communication. Through working with survivors, however, we have learned that sex therapy techniques need to be expanded, modified, and individualized. Time must be spent teaching appropriate developmental skills and pacing therapy to prevent retraumatization.