Sex Therapy with Survivors of Sexual Abuse - Use Standardized Techniques In a Fixed Sequence

Written by Wendy Maltz, M.S.W.

One day in 1980, the bulb on my little projector broke and I could not show Fred and Lucy the tape on the first level of sensate focus exercises. Instead I gave them a handout and complete verbal instructions. They were to take turns lying down and massaging each other in the nude. The next week they came back and reported on how it went. Lucy said the exercise was all right, but Fred's belt buckle kept hurting her as she passed over it. Even though they had been given specific instructions to take their clothes off, Lucy, an incest survivor, said she never heard them. Instead, she adapted the technique to make it less threatening.

Standardized techniques performed in a fixed sequence generally don't work for survivors because these techniques fail to respect the important needs survivors have for creating safety, pacing experiences, and being in control of what's happening. Just being able to sit, breathe, feel relaxed, and stay present while touching one's own body can be a challenge.

Survivors need a lot of options for exercises that offer opportunities to heal without being overwhelmed. I rely on the techniques for relearning touch described in my book The Sexual Healing Journey. These techniques can easily be modified, adapted, and rearranged in different sequences by survivors themselves.

It is essential that sex therapists assess a client's readiness before suggesting a particular sex therapy exercise. I often find that a client's curiosity about an exercise is a good indicator of readiness to try it. Starting, stopping, and shifting among different techniques. Nudity, genital exploration and exchanging sexual touch with a partner are often advanced challenges, generally not appropriate to suggest in the early stages of therapy.

Sexual healing is generally an advanced type of healing work for survivors, less important than issues such as overcoming depression, improving self-esteem, resolving family-of-origin issues, and securing physical safety and health to name a few. Any sex therapy therefore needs to take a back seat to general recovery issues that might arise. Sex therapy needs to be integrated with other aspects of resolving sexual abuse.

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. Ths 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.

Jeannie, 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 Athoritative 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.