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

There is no question that the challenge of treating survivors 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.

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