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Ruth Cohn
   
Articles

Coming Home to Passion: Restoring Loving Sexuality After Childhood Trauma and Neglect

1. Introduction

In the long and arduous journey of healing from childhood trauma and neglect, sexuality is often the last frontier. It is particularly complex and challenging in that sexuality is a place where body and psyche, nervous system and emotion, vulnerability and attachment intersect and entwine with perhaps everything that is essential to being a person. For those whose trauma was sexual it is all the more complicated, especially if the abuse predated full and healthy sexual development and experience. This book is an introduction to and overview of an approach for restoring loving sexuality for couples struggling to complete the journey together. That intention in and of itself is a show of courage and faith.

How This Work Began

I came to this work with couples through a back door, about 10 years ago. After some years of specializing in work with adults sexually abused as children, I began to notice some disturbing patterns. Although many of my sexually abused clients had partners, some of them quite long term relationships, the majority complained bitterly about their partners. They “don’t understand,” “aren’t supportive enough,” “hound me for sex.” I also began to see that as my clients became more involved in their therapy and appropriately so, it often seemed that the therapy relationship with me became deeper and more primary than the “intimate” partnership. Sometimes that meant that the spouse or partner might come to resent me or jealously compete with me. This concerned me. Having the two most important people in my clients’ lives be at odds with each other, seemed to recreate an insidious dynamic of many incest families. It also seemed odd and misguided to me, that my clients would find their deepest connection and healing in a relationship that would in effect, end when they were “all better.” I thought it would make a lot of sense and be a lot more joyful to heal in a deep and loving relationship that they would then get to keep when their healing work was done. All the way around, I felt that I needed to do something to address these partners.

I subsequently decided to offer one-day workshops for partners of survivors of childhood sexual abuse. My idea was to provide education and support: education about trauma and trauma recovery so that they would become better support people for my clients; and support for them in being patient during my clients’ long and painful healing process. Admittedly I was setting out to do something to help my trauma survivor clients.

The response I got for the first workshop was impressive. What was most interesting and perhaps surprising was that when I entered my office the morning of that first workshop, I found myself in a room full of survivors of childhood neglect. I then began to make an important discovery: invariably survivors of childhood trauma appear to partner with survivors of childhood neglect.

Each and every individual in that room had a story to tell, however in most cases they had no idea that they had a story to tell. The range of neglect covered the spectrum. Some were people who had raised themselves from early ages, feeding themselves by climbing up on a chair for cereal boxes; getting themselves up and out to school. They had absent, mentally ill, alcoholic, depressed or otherwise disabled parents. Others may not remember anything being amiss about their childhoods, they may not even remember much at all. There was simply a missing experience of anyone ever having had any concern for their emotional well being or even existence. Many of them were highly competent and successful. Among that first group were a physician, a professor who had published twelve books, and a CEO of a sizeable company.

Children of neglect are an invisible population. Until very recently, they were not only neglected in their families, but also by the psychology literature, and the larger psychology field. And as I was just beginning to discover, they disappeared in their relationships with my trauma survivors. I soon began to see that in the trauma-neglect partnership, trauma survivors had gotten all the blame and all the help, and the neglect survivors although they were spared the onus of responsibility for the relationship problems, they got virtually no attention or help either. They were told to be patient and wait, (live indefinitely without sex;) essentially to quietly take care of themselves. This was precisely what their childhoods had prepared them for.

I soon began to see that dynamics got created between trauma and neglect survivors where they readily recreated their family dynamics with each other, (much as all people do in their intimate partnerships,) and then succeed in keeping each other “triggered” all the time. (We will discuss triggering in some detail later.) I began to see that for more than my original reasons, working with couples was essential to keep them from making each other worse. From that point this work began to evolve. The area of sexuality became a focus as I began to see that as the place where complicated dynamics get the most entrenched. This approach continues to be a work in progress. And this book is but an introduction to it.

Acknowledgements

In the development of this work I have had some very important teachers. First and foremost is my husband Michael, from whom I have learned the most valuable things that I know about relationship and dynamics and love, and the kind of change that is possible for two people. Not far behind, are the numerous courageous and dogged couples who cared enough for each other and themselves to invest themselves in the work of relationship healing. I include vignettes from their stories, all disguised to protect their confidentiality, and I thank them deeply. My greatest inspiration and teacher about trauma, and a veritable hero in the field of trauma research, theory and practice, is Dr. Bessel van der Kolk. I feel a profound debt of gratitude for his immense contribution. About sexuality intimacy, and most specifically the biology of love and sex I have learned immeasurably from Dr. Pat Love, a brilliant theoretician, speaker and writer, and clinician. And in the essential areas of work with the body, I thank Dr. Peter Levine, and my teacher of Sensorimotor Psychotherapy, Dr. Pat Ogden.

2. About Sex
The Beginning: The PEA Effect


One of the best kept biological secrets is the existence of a peptide-hormone-neurotransmitter cocktail of Phenylethlyamine, dopamine and norepinephrine. The shorthand for the whole mix is “PEA” short for Phenylethelamine. Understanding the “PEA effect” may change how you view both your partner and your relationship history with that person.

Nature designed us to be turned on to the same person long enough to procreate. This is of course in the service of evolution: the preservation of the species. Regardless of sexual orientation, these phenomena appear to occur universally to all of us. What this means, is that when we meet a new potential mate, there is a spiking in the secretions of the peptide PEA, hormone levels and the other chemicals mentioned above. The result is the euphoria we all know and associate with falling in love. During the requisite amount of time required to “meet, mate and procreate,” roughly six to eighteen months, the chemical mix insures that sexual desire levels are heightened. A normally lower desire person suddenly feels amorous and open to sex, and may believe, “Ah… I’ve finally found someone who turns me on.” A normally higher desire person will be delighted, and may believe “Ah… I’ve finally found my match.” This is a stage when partners spend lots of time together, filled with curiosity and interest. They can get by on little sleep or food, and seem to notice only the positive traits of the new beloved. It is an exciting time and for many couples sex is easy, fun, frequent and passionate. All is well with the world.

After the six to 18 month time period, however, hormone and other body chemicals return to their normal baseline levels. Alas, nature is not concerned with our staying together, only with the survival of our species. When this return to baseline occurs, we once again tire and need sleep, chemically enhanced moods no longer color our perceptions with a rosy positive glow, and our levels of sexual desire return to what they usually are. At this point many couples wonder “Where did it go?” Some may think “I love you but I’m not in love with you.” Unprepared for the change, it is distressing and feels as if something were mercilessly lost or taken away.

Although I have not researched this formally, my observation over the last 15 years of working with survivors, is that the PEA effect over-rides the sexual inhibitions resulting from trauma. What this means is that during the PEA enhanced stage of relationship all of my survivor couples shared, for a time, a sexual relationship that felt passionate, fun, easy and “normal.” For these couples it is even more than the usual loss when the PEA wears off. For them that is when the sexual trouble begins. And because sex “worked” before and now does not, this can feel like a cruel deception or trick. A partner might wonder “What do you mean you ‘can’t’? You used to be able to.” And it seems to make no sense. This is where the neglect survivor partner can readily and angrily feel “You are withholding from me!” This is where trauma survivors can readily and desperately feel “Something is very wrong with me, and you don’t understand! Furthermore, you don’t care!”

For many couples this juncture leads to a long and bitter sequence of discord. Many develop a painful pattern of adaptation (that will be described in more detail below,) involving repetitive cycles of triggering, suffering and despair. Many couples are so stymied as to stop having sex altogether. Ultimately, a great distance erodes between them and they feel hopeless to find their way out of it. For many it is a long time before help is sought. That is why it is so important to me to educate trauma survivors and their partners about these dynamics. Many suffer much too long, or allow their destructive patterns to get deeply entrenched.

The literature on sexual healing for trauma-neglect survivor couples has been inordinately weighted in the direction of the trauma survivor. Trauma is an experience profoundly affecting the capacity for trust and relationship, and this is well known. Inexplicably, rather than focus on relationship and the dynamic couple issues as a source of difficulty and healing, the sexual problem has historically been cast as the trauma survivor’s “problem.” The partner is counseled to be supportive and patient and “wait.” The trauma survivor gets all the “blame” and all the help. The neglect survivor again gets neglect: that is no help; but also is free of responsibility. This is certainly not my view of the way out!

The good news is that healing is possible, that loving sexuality can be restored. It takes time and diligent, hard work on both partners’ parts, but a whole new level of intimacy is to be found on the other side.

Libido and its Levels

In the 1980’s, the “Diagnosis du Jour” in the sexuality field was “desire discrepancy,” creating a good deal of confusion in the general public about what is normal. It is now well known that libido levels, or how intensely and how often a person desires sexual activity, correlates to the hormone testosterone in both women and men. Men and women with higher baseline levels of circulating testosterone have a generally higher level of desire; and those with lower testosterone levels have a lower baseline of desire. Both are normal, just different.

It does not help that the media are filled with popular articles about the “normal” or “average” frequency of sexual contact between partners, and it certainly does not help that in the Hollywood depictions of sexual relationships, all are ever ready for sex: men always have reliable, instant erections and women are eternally lubricated and hot to go. Because these topics are not necessarily things we discuss openly, we are all prone to compare ourselves with what we do know and see.

Again, natural selection would insure that higher desire individuals pair up with lower desire individuals, (again, these phenomena seem to cut sexual orientation lines.) If too many low desire people ended up with low desire partners, what might happen to our birth rate? The point here is that in most couples there is a difference in levels of desire: one partner wants sex more often than the other. Often one or both feel adamantly “justified” in being “right” about this. In a famous Woody Allen split screen sequence, on one side of the screen you have Woody whining “We never have sex. We only have it three times a week!” On the other side of the screen and equally adamant Diane Keaton is shrieking “All we do is have sex! We have it three times a week!” The fact is, the differentness of perception, perspective and appetite are normal, and negotiating sexual frequency is another of the innumerable normal negotiations inherent in being a couple. It is terrible and wounding to be blamed by your partner or told that there is “something wrong with you,” you are “frigid” or a “sex addict” by a sexually frustrated partner; or in fact a partner who simply has a different desire level or pattern.

It is also true, that we generally lack empathy for the experience of the hormone level that we do not have. In fact few people even stop to think about what it might feel like. A low libido person most likely has no idea how physically and emotionally uncomfortable it feels to walk around with a frustrated need for sexual expression; how it affects the mood, the self concept, mental concentration and physical agitation, and how lonely it might feel. You may have noticed that your partner appears to be in particularly good spirits after “getting laid.” You may even have had contempt about that. In fact, higher libido individuals may be significantly affected physically and emotionally by the experience of being sexually active with their partners. The release of chemicals such as oxytocin and vasopressin , not only from the sexual release, but the physical and emotional contact, may significantly change their state. It may in fact change their whole day. Similarly, not having that expression for “too long”, may result in anxiety, physical agitation, mental preoccupation with the gnawing desire and general irritability.

In turn, a higher libido person has no idea how difficult it is for a low libido person to engage in sexual activity when there is nary a spark of desire and arousal anywhere to be found. It may be like trying to eat after a large meal. Touch may feel physically irritating. It may feel like “work” to try and make anything happen in a tired or un-aroused body. (This is without the additional emotional and physical negatives of post trauma symptoms.) And a higher libido person may find it hard to comprehend, that a lower libido person, (if they are lucky enough to have an orgasm,) is likely to feel pretty much the same after it as before it. An orgasm may not particularly change their perception of color, humor and possibly even closeness at all.

It is an intimate process for a couple to discuss their libido levels and feelings associated with making and not making love. I have seen many couples reach much greater understanding by sharing in a general way, how they are sexually “wired.” And understanding often eliminates a lot of judgment; and erroneous interpretations of partners’ behavior.

Trauma and Sexuality

Trauma by definition is overwhelming experience. It is stimulation that is too powerful for the organism to process by its usual means. The hallmark features of trauma are a sense of helplessness and defenselessness. The threat is too great and unstoppable. Shattered are both the sense that the world is a safe place, and that one can trust one’s own body for self- protection. Trust is one of the most massive and costly casualties of trauma. Hardest hit of all is the realm of relationship.

Generally, survivors of trauma are profoundly injured in the area of trust. If the trauma was interpersonal, that is if it was inflicted by another person, particularly a person in a role or position of trust, like a parent, family member, priest, teacher or friend (which statistically childhood sexual abuse most often is,) there is the additional factor of betrayal of trust. When an additional important person failed to protect the survivor, betrayal mistrust is compounded. It is a terrible loneliness being so unable to trust and rely on any other person. This loneliness may be the most painful wound left by trauma. It is also very lonely trying to win the trust of a trauma survivor, as trustworthy as one might be. For trauma survivors, trust and safety are core issues to be healed.

Safety is a necessary ingredient for sexuality. Even animals in the wild will immediately dispense with sexual activity when there is a predator in the vicinity. It is said that safety is the key to passion; that when the safety is created between partners, passion will follow. No wonder sex is so often excruciatingly difficult for survivors of trauma, even when the trauma itself was not sexual in nature.

When the trauma was in fact sexual in nature, there are additional complications. Being touched or positioned in particular ways can trigger memory of the sexual trauma, for some even being touched at all. The impact of the trigger may be to get emotionally upset: angry, scared or sad; to freeze, or to numb out and become emotionally and mentally absent. This of course will be very troubling and painful for both partners.

Both the trauma response cycle and the sexual response cycle are in the domain of the autonomic nervous system. This system, comprised of its sympathetic and parasympathetic branches operates spontaneously and automatically, and outside of voluntary control. The sympathetic branch energizes the body for action, speeding up the heart, contracting the blood vessels and preparing the muscles for movement. The parasympathetic side is the braking or calming branch, which opposes the sympathetic system, inhibiting its action and quieting the body down.

The natural response to threat is to initially be energized for action. The sympathetic nervous system kicks the fight-flight instinct into gear and the body responds accordingly. Once defensive action is completed, the parasympathetic system spontaneously brings the body back down to its normal baseline arousal level. Heart rate and respiration, blood flow and musculature, slow down. Other bodily functions that were stopped to mobilize energy and alertness in the direction of the threat, (such as digestion,) resume. The body settles to its normal state.

In the case of trauma where the threat is such that the natural defensive responses of fight and flight are thwarted or impossible, as noted above, the natural cycle is disrupted. There is likely to be a freeze of some sort, and the energy for action along with the stress hormones, get blocked or held in the muscles and tissue. The cycle does not complete and the normal parasympathetic settling does not occur or does not occur completely or properly. What remains in the body is continued high arousal, muscular tension, anxiety, and probably a continued hyper-vigilance or on-alert stance. From there it is easy to get activated again by even much lesser stimuli. There is a sense of lack of resolution and general “dysregulation.”

The healthy sexual response cycle follows a similar physiological course as the healthy fear response. Once stimulated, the sympathetic system energizes the body with arousal that peaks out in orgasm, and then settles back to baseline. The arousal curve has a similar shape.

In the body, excitation or arousal can feel very similar from different causes. The quickening of the heart rate and breath that comes with excitement can feel enough like fear, that it might activate the trauma response. For some trauma survivors, sexual excitement may feel enough like fear as to be frightening. The very fact of getting turned on or excited may be a trigger, due to the way the body is wired.

Obviously, healthy sexuality is all about flow and letting go. Erection and engorgement of sexual organs are a function of the free flow of blood and fluids. Pulsation is about the free movement of sensation through smooth muscles. Tension and constriction of muscles, breath and fluids, resulting from fear and anxiety, make spontaneous and uninhibited flow next to impossible. Working with the body- specifically traumatic arousal is crucial for trauma survivors, and especially regarding sexual healing.

Neglect and Sexuality

What I have to say about adult survivors of neglect is based not on formal research, but on my observation of many dozens of clients individually and in couples over the last 15 years. There is however, a growing body of research about the importance of a consistent, attuned relationship between mother and infant for the development of the infant’s brain and nervous system. And there is significant research on the mother-infant attachment pattern in which the caregiver is referred to as “dismissive” and the infant as “avoidant,” which is relevant to this group. By and large, the population of children of neglect, has been largely neglected by the psychology field until quite recently. We are now learning that in many ways neglect can be as damaging or more so than many forms of overt abuse.

When infants are neglected, they soon discover that their cries are not heard or responded to. So they cease to cry. They may grow to become children who do not express or show emotion, because it makes no difference to anyone, and does not work to gain attention. As a result they feel quite helpless and behave quite passively in relation to others. They may be anxious and often angry about the lack of attention, but they adapt, often by becoming impressively and painfully self-reliant at early ages. Of necessity they train themselves not to need anyone. Naturally they are very conflicted about their needs. From lack of mirroring, they may not know or they may lose touch with what their feelings or needs are. The anxiety, frustration and anger may be well outside of their awareness.

Often these children are barely touched. They lack the soothing comfort of being held, and the infant research even describes that “dismissive” mothers, often have an aversion to their babies’ bodies, and do not want to touch them. The children may suffer from a sort of “skin hunger” in addition to all the other unmet needs. As adults, they bring all the disconnection from and conflict about their need, to relationships. Often by adulthood they have mastered the art of “not needing” anything from anyone. So relationship is not easy for them or with them. Giving and receiving may be complicated at best.

Where the adult children of neglect have found a way to manage virtually all their other human needs on their own, sex presents a problem. It is not as if one cannot take care of one’s sexual needs oneself, but sex alone is a very different thing. What I have observed among my neglect survivor clients, is that somehow, this need prevails as one that they feel entitled to have met by another person.

Mira Rothenberg describes a void of loneliness in children of neglect in her book Children with Emerald Eyes:

Sometimes there is sex to fill this void. And the sex is then strange. There is little giving, but there is taking, there is devouring of you and whatever you can give to fill this void. The exquisite giving and taking is no longer. The balance is disappointed. Because it is to take, to calm, to quiet this awful howl of loneliness and the hunger that derives from loneliness. To feed, so that for once, for this one short while, the need, the plea, the want is filled.

So if sex is the one acceptable need, or the one need that a person is entitled to have met in relationship, it can hold a particularly weighty place in relationship. And when the relationship is with someone who is conflicted about sex, or grew up to believe “sex is the only thing that I have to offer that is of any value” or “I am nothing but a sex object,” the writing is on the wall for the problems that will unfold.

David was a child of terrible neglect, although he grew up in an extremely wealthy family. His father was a politician, so his family moved often and lived in many exotic places. No one was concerned with David’s adjustments to numerous schools. David’s mother was manic depressive and the chaos of her mood swings left David not only on his own with his own needs, but hyper attuned to hers. If he could pre-emptively take care of her, it was a way for him to take care of himself. The things he wanted or was promised, rarely came to pass. His father was absent, his mother was preoccupied, forgetful or out of control. He got disappointed on a regular basis. Sometimes it seemed that his mother purposely denied him things just because he had said he wanted them.

When David and his partner Lois came to me for therapy, they had a well developed dynamic established that was devastating for both of them. David had a high libido and would approach Lois to make love. Lois, a survivor of childhood sexual abuse, had deep seated self hatred and feelings of worthlessness. Her various abusers had instilled the belief that she was unimportant, except for their use of her as a sexual object. They used and discarded her at will and she believed that she did not matter in any way other than to satisfy their sexual whims. Because it felt to her that in David’s eyes the only thing she had to offer was sex, she was often triggered by his overture. She would stiffen and say no. He would then be triggered back to his childhood where anything he did want was ignored or purposefully with held. Once triggered, he might feel angry, perhaps become insistent. His anger or perceived “hardness” would remind Lois of her coercive abusers. Lois would become intensely emotional: she would perhaps get angry or start crying. David would be reminded of his “hysterical” mother and her outbursts, which always insured that he would either be ignored or wind up as a caretaker. He would become angrier, and not sympathetic to Lois’ trauma and pain. Then she would be completely convinced that she did not matter and was unimportant. Her emotional pitch would increase, as then would David’s irritation and hardness in response to her. This same cycle of escalation happened over and over again resulting in terrible pain, rage, fatigue and utter despair.

Time after time Lois would try to explain to David “no means no!” and that because of her trauma it was very important that he respect her wish to not have sex when she did not want to. What both did not realize, until we began our work, was that each time there was an interaction around sex, there was not one hurt person but two. It was not only important to be delicate about how the request for sex delivered, but how the response was delivered as well.

This is one variation of our theme: survivors of neglect get terribly triggered around sex as well, in their own way. The sexual impasse, or the dynamic of difficult sexuality surrounding trauma and neglect is just that: a dynamic. It involves two people. Two people’s history and two people’s vulnerability. It involves two people’s triggered reactions. And it always, unequivocably always takes two to escalate.

3. Finding the Way Through
Information Helps


Education about trauma and neglect is a good place to start. There is a bibliography at the end of this book, and an abundance of good information is to be had. I also include some basics here. To be precise, the overwhelming experience we tend to think of as overt trauma is referred to as “shock trauma.” From the beginning of traumatic stress study, when trauma was called “Shell Shock,” or “Battle Fatigue,” it was referred to as a “physioneurosis,” because it is so clearly bodily. During and after the traumatic event, the impact on the entire organism is profound. By definition, trauma is greater than what the nervous system and the body are designed to contain and process normally, so our usual physical and psychological functions are compromised or adapted to cope with it. It all begins in the brain.

The amygdala, a small almond shaped structure deep in the brain’s limbic system, is one of the first checkpoints on the journey of processing experience. The amygdala takes in information brought from the body and the five senses, and has the task of screening the incoming stimuli, and distinguishing the “significant” from the “insignificant.” For the purposes of the amygdala, significance is measured in relation to surivival. An experience or stimulus with no associated threat is insignificant, and gets sent along to the hippocampus, which is the brain’s the filing system. A stimulus that represents danger, however, is significant. With this the amygdala gets busy in its function of activating the fight/flight response via the sympathetic nervous system and the adrenal system, which produces stress hormones. As mentioned above, the body goes into high gear to defend itself, and the directive to do so originates in this little structure of the brain.

The hippocampus, also part of the limbic system, makes categories, filing information separately by subject. Under ordinary circumstances, when information is unthreatening it is sent there, to be sorted. It is not processed there. This step is rather like moving and organizing computer files without reading them for their content and meaning. That processing will go on in the left prefrontal cortex. Under normal circumstances then, unthreatening information, screened by the amygdala and sorted into “files” by the hippocampus is sent along to the prefrontal cortex. The prefrontal cortex has the capacity for processing information: opening the “files” or bits of life experience, understanding what the information means; analyzing it; thinking about it; locating it in time and space; associating emotions with it; incorporating it into one’s ongoing life story; and putting it to language. These elaborate and sophisticated functions, are the domain of the left prefrontal cortex, and take place only when information is delivered there.

The capacity to regulate affect, to calm down after any sort of arousal, is also located there. The prefrontal cortex, under usual circumstances processes the raw information received from “files” in the hippocampus, making it understandable, verbalizeable, and ready to be logged in memory as part of the ongoing autobiographical narrative of life.

We now know that in trauma the overwhelmed brain is unable to carry out the usual processing sequence. The amygdala denotes significance to threatening experience, and activates the defensive response or fight/flight instinct. For example, the brain’s thalamus would sense sounds in a child’s dark and empty old house, and pass this sensory information on to the amgydala. The amygdala discerning the approach of footsteps toward the bedroom where the child is vulnerably alone in bed as potentially dangerous, and activates the fear response. Perhaps this is a familiar sound, perhaps not. Attention narrows to focus on the sound, the child’s breath quickens and becomes shallow, the heart picks ups speed, stress hormones begin coursing through the body, muscles tense.

Perhaps the stimulus in fact turns out to be traumatic: a rageful and intoxicated father bursts into the room of the already frightened child. The over-stimulating information of the traumatic event: the crash of the door hurtling open; a blast of chill air from the hall; the visual image of a large and shadowy figure stumbling towards the bed; the smells of alcohol and sweat; the menacing voice and incongruous words “Daddy loves you!” the emotions of lonely terror and apprehension; and the knowledge “I will be hurt!” all this plethora of sensory and cognitive information are sent to the hippocampus. However this huge glut of information stops there. All these metaphorical file folders from the various sense organs, emotions and bits of orienting cognitive information, get stuck. The “unopened files” would normally be sent on to the prefrontal cortex to be opened and combined with each other and all the rest of the brain’s knowledge and information about the world, and the autobiographical story of life, but they do not move. The overloaded hippocampus is unable to move them on to the prefrontal cortex for “opening, reading” and processing.

By definition, trauma is overwhelming experience. The stimulus is too great to process by the normal means. So the files do not get opened, read and the information sorted and put together into a single picture story of the event with meaning, emotions and words to go with it; and it does not get placed in its appropriate location in the ongoing autobiography of life. Instead the event may stay in these compartmentalized fragments that don’t make sense. It may not fit in anywhere with the child’s self image or personal world view. Making sense of the event, identifying with it; putting it in its chronological place in the past, and speaking about it may be impossible. The unprocessed material does not get put away or stored properly as memory. It may feel as if the experience never really ends.

The amygdala, once overwhelmed by such magnitude of danger and stimulation, becomes overactive. In the interests of protecting the organism from more terrible experiences, it develops a hyper-sensitivity to danger. So is goes into high alert for sensory, physical and emotional stimuli reminiscent in some way of the past trauma. Anything resembling the past source of danger can easily “trigger” or activate the system. Unprocessed past experience, because of its timelessness may readily be re-experienced as if it were happening right now. This is what we mean by triggering. Sensory inputs like a sound; a word, a facial expression, a social interaction, a visual image, etc, that might resemble the original trauma, may seem to the amygdala to be the return of real danger. Survival mode fight/flight reactions are readily deployed. The anticipation of danger, keep the survivor in a chronic state of hyperarousal. The traumatic event lives on and on in the traumatized body, mind and life.

Trauma recovery consists largely of accessing the unprocessed material and processing it; integrating and weaving it into a coherent life story; massive grief and mourning; and relearning (or learning) how to live safely and relatedly, in the world. Often the unprocessed trauma story is fragmented, or composed of snippets of connected or disconnected sense memories like flashes of visual scenes, smells or sounds; body sensations and emotional sequences. For this reason, activations or “triggering,” as well as accessing and working through the memories, greatly involve the nonverbal and the bodily.

Additionally, we have learned from ground breaking brain research in the early 1990’s, that in the moment of trauma, the prefrontal cortex shuts down. This means that the functions of analytic thought, meaning-making, sense of time and place, and ability to speak, are at least temporarily disabled. During trauma and also during moments of triggered trauma activation it may in fact be physiologically impossible to think or speak. For many trauma survivors and their partners, it is a relief to learn they are not “stupid” or “with holding” in those moments.

About the physiology of neglect, less is known. Where the impact of trauma comes from over-stimulation, the impact of neglect comes from under-stimulation. The survivor of trauma suffers largely from what did happen. The neglect survivor suffers from what failed to happen, the manifold missing experiences of growing up. We do know that the neglect survivor similarly has a dysregulated nervous system. A child ultimately learns to calm his or her own body down from the experience of being consistently enough soothed and attended-to, held and cared for by a caregiver. When this does not happen the child must resort to bucking up and self reliance. Much holding in or denial of feeling, and much anxiety comes with this. My observation has been, that neglect survivors are readily prone to triggered activations as well.

Triggering, Dynamics and Systems: “It’s always 50-50 and 90/10”

Chaos theory has now been able to provide insights into the orderly patterns that operate in a variety of seemingly random processes. A main characteristic of such systems is that initial conditions are very important for the eventual patterns that emerge, while seemingly small influences can have far-reaching consequences. Following even mild perturbations, chaotic systems can fall into new, seemingly unpredictable states of organization.
- Jaak Panksepp

In general, couples have a handful of interactions that repeat themselves ad nauseum across a spectrum of innumerable themes. So what looks like a chaos of conflict between them is really quite patterned and redundant. I call these “core dynamics,” because they reflect the interplay between core issues and beliefs of the two partners. Once core dynamics are identified and understood, settling down the painful conflict is simple–not easy or quick but simple.

So what do we mean by core issues and beliefs? Core beliefs are the conscious and unconscious conclusions that children reach on the basis of their experience. For example, when a child’s needs and feelings are repeatedly ignored and not addressed by caretakers and adults, that child adapts. Part of the adaptation is a world view that includes the belief “My needs are not important and will not be attended to by other people.” There may or may not be awareness of this belief, it may be so obvious to the child as to be like “ambient air.” But they breathe and live by it. Similarly, a child of abuse will readily conclude “I am unimportant, I don’t matter, or I am an object for the use and disposal of others.”

I want to be very clear that many if not most survivors of abuse and trauma are also significantly neglected. Particularly (but not exclusively,) if there is abuse within a family, they would have to be for it to continue for any length of time, or for the child to receive no help for it. Similarly, many neglected children live in a milieu of significant violence and often abuse as well. Often both experiences are present. Core beliefs and subsequent core dynamics reflect that one or the other experience predominates in the person’s character. Often, however, both partners to some extent have both experiences.

So what happens when core belief encounters core belief? When this critical mass occurs, the result is a system that I call a “cycle of escalation.” For example, David and Lois described above, had an insidious pattern that might begin when David first opened his eyes in the morning. He would see dirty dishes and clothes Lois had left around the house the night before, and immediately be reminded of the chaos of his childhood home. He had told Lois so many times of his need for order, especially as he began his day. So he would be angry and greet Lois for the day scowling and complaining. Lois’s day would begin with his scowling face and she would be reminded by his anger of the chronic criticism, demeaning and humiliation she received from her abusive brothers and father throughout her childhood. She had been exhausted before she went to bed, meant no harm and had intended to clean up before David got up. She would flip into the feelings of that little girl who felt worthless and unimportant. She would become despairing and begin to cry and withdraw. David would become more frustrated, now not only were his needs not being addressed but he had a “hysterical woman” on his hands, again just like his childhood. His aggravation would intensify. Lois would feel more misunderstood and more hopeless, become more emotional, would withdraw further into despair, becoming more unreachable to David. He would become still more frustrated and disparaging of her and their life. And there went the day.

Notice how David “triggered” or his old limbic brain registered painful memory, Lois triggered in reaction, and then what followed was a chain reaction of trigger and counter trigger in increasing intensity. Of course they felt the relationship was damaging to them. During this stage, the constant activation and reactivation of the trauma and neglect experience can in fact be retraumatizing, another reason why I view couple’s work as so essential.

There are some essential principles to remember about core dynamics. First and foremost, it takes two to escalate. This means a cycle only ensues when both partners trigger. If only one partner gets activated the whole interaction will fizzle like a dud firework. If Lois’s response to David’s frustration were to validate it or own her oversight, the day might have been saved. Or if David, seeing how upset Lois had become, was able to catch and own his disproportional reaction to the stimulus and tone it down, Lois would probably have calmed down. This is where it is so essential for couples to learn what their patterns are. It is in the interests of both to learn to manage their own vulnerabilities or hot spots, and also to avoid triggering their partner’s.

What is most difficult about this process is that we are training the prefrontal cortex to intervene with material that was largely unprocessed cognitively as mentioned above. This means that the original experiences are in the brain with sensation and emotion unanchored from understanding and meaning, and also dislocated from time and place. When triggered, people characteristically cannot think, so part of the work of processing is bringing the thinking brain online, so that sense and volition become available to action. It is easy to see that one’s partner is unable to think. It is much more difficult to recognize it in oneself!

That is where the essential 50-50 principle comes in. Both trauma and neglect survivors have tremendous conflict surrounding blame and responsibility. With abuse there is generally much confusion about having brought it on oneself. The beliefs “I deserved it,” or “It is my fault” are insidious and common. Many children are told as much. Some trauma survivors lapse into a victim mentality even simultaneously with feeling guilty, and have a lethal mix of helplessness and overly responsible omnipotence.

Neglect survivors similarly have strong reactions about responsibility. Their initial experience is helplessness, there is virtually nothing they can do to get attention or care. Their adaptation is often self reliance, so that then they are responsible for everything. They might feel both pride, rage and a self righteous superiority about this. Again, they exhibit great conflict. So partners will readily tangle about whose “fault” the problems are. The truth is both and neither: both because it always takes two partners equally to escalate; and neither because blame is not a useful paradigm. Neither partner is more pathological (ie “sick”) and healing the system takes the concerted effort of both. Each effort on the part of either individual, helps the whole system move toward equilibrium and ultimately recovery.

Finally, it is always 90-10. This is also vitally important and terribly elusive when one’s prefrontal cortex is off line. For many it is hard to believe even with a fully functioning thinking brain. Whenever there is an intense or “disproportional” emotional charge of emotion something from childhood has been activated. This is not to say your partner did not do anything, but the significance of the actual present time stimulus is about 10% and the remaining 90% is old stuff. This is both difficult and very good news. It is difficult because in the moment of conflict is feels absolutely undeniable and obvious that “you did this to me! You made me feel this way!” It is good news because what it means is that the actual present time relationship is only a fraction of the problem. The remainder is wounding from childhood, that one would most likely want to heal anyway. It requires the most immense humility to grasp this, but once one does, it is incredibly freeing to the relationship.

Processing

Generally core dynamics show themselves early on. I spot them very soon after meeting a couple and seeing them interact. Those core beliefs are amazingly omnimpresent, especially as one begins to become aware of them. It becomes easy to see how the same fight is playing out on the whole range of themes. This also makes the work simpler, because whatever the topic, we are in fact working with the same material and patterns. The sexual conundrum is another expression of the core dynamic, perhaps in some ways the most difficult one, but the same one nonetheless. So this means as we work with all the other big and little episodes, we are advancing the cause of the sexual relationship, because we are addressing the core material issuing from trauma and neglect. Even though for many couples, it is hard to talk and work directly on sex for a good long time, what they may not realize is that we in fact are working on it. Once we explicitly get to it, it may in fact move quite smoothly or even dissolve as an issue in its own right.

So what do we mean by processing? In short, processing of experience means moving the fragments of disconnected memory that were unable to arrive there initially, to the prefrontal cortex. In Peter Levine’s words, they are “re-membered” as in the pieces are assembled or put together in a coherent way. Thoughts, feelings, bits of sense memory like sights and sounds, words, emotions and body sensations are brought together and sense is made of them. They are put into words and shared. They are then stored and put to rest as memory. Once processed fully, they are much less likely to be ignited by triggering, or if they are, it might be possible to think and know “Oh yes, there is that old stuff again.” With unprocessed memory, we are swept up in it. There is no awareness, or very little, that it is not the original event, that it is not all happening right now. Processed memory is recalled, not relived.

Much of what these couples need to do to heal, is process their experiences of trauma and neglect by working through the daily interactions that are plaguing current life. David and Lois revisited one of their painful encounters about sex. As Lois expressed the painful feelings that had come up for her when David did not heed her “no” what emerged was a memory of the physical and emotional experience of her sexual abuse. In the dialog with David, she slowly recounted it, as she was experiencing the emotions and sensations in the moment. In effect she was “re-membering” the body, emotional and cognitive bits of memory, linking them together and also to the experience she had just had with David, and putting it all into words. This is what we mean by processing. In addition, she simultaneously had the missing experience of “witnessing” and contact. Always before that, she was all alone with that terrible pain. In this case, David and his love were empathically in it with her.

Softened by her sharing, David was able to share with Lois another story about his lonely neglect. Her unavailability to him felt to him like his massive childhood loss. It reminded him of how when he was growing up and moving from place to place, his only reliable friends were his pets. He could remember each home in each country by which animal he had there. And every time his family moved, which was at least twice a year for the first 15 years of his life, he would have to leave his pet. “Either they ran away or something happened to them, or I just had to leave them behind. No one ever wondered how I felt about leaving my pets…” And his aloneness touched Lois’s heart and changed something inside of her.

Together both partners process their respective experience, and also develop deep compassion for the other. It is profoundly intimate and connecting, while also subtly changing their experience of each other. Little by little their interactions change, triggering becomes less and less. “Ownership,” or knowing “this is my part of what caused us to rupture just now, this is what I am responsible for;” conscious thought and compassion in the moment become possible. Not overnight, but over time.

Working With the Body

As stated above, trauma and neglect and their dysregulations are very much in the body. And when the trauma is activated, very often cognitive thought and speech are inaccessible. Some memory may never have had any words or clear story line, but may only be feelings of terror, anxiety, rage or pain. It can be worked with anyway. The first time Kim and Pat talked explicitly about sex, Pat was filled with body sensations. First came the words, “I’m not supposed to talk about this.” Then there were no more words, just mounting tension, a feeling of building pressure inside, and many different intense body sensations. Our work in that moment was to drop the thoughts and follow the movement of sensation through the body.

As described above, in the moment of trauma when the amygdala trips the defensive response of fight or flight, the child cannot fight or flee. The child freezes and the movement impulse along with all the stress hormones and emotions get locked in the body.

Another form of trauma processing is sensorimotor sequencing, which is where we carefully and slowly, with painstaking mindfulness, allow the movement sequences to complete. This involves, dropping the story line, which often is not even available, and just tracking the movement of sensation through the body and out. Pat did not know what was happening as we simply followed in minute detail as the pressure turned to numbness and then tension as it moved through. Kim witnessed this processing, remembering many a strange episode when Pat had had weird body feelings followed by strong emotions and run out of their bed.

Once the sensations had taken their course, Pat slowly calmed down and became able to speak again. A piece of trauma processing was completed, and not immediately but soon thereafter, we were able to speak more freely about explicit sexual matters. Sensorimotor work is essential for many survivors of both trauma and neglect.

In neglect survivors, I often observe tremendous tension and anxiety that have no words, probably harkening back to infancy, when they were first denied the touch they so craved and needed. Rage and terror may also be wordless and immense, or just the sensations of rage and terror without comprehension. Many neglect survivors also were left so alone, and so buried their emotions, that they are very cut off from them. Alex’s father died in a terrible industrial fire when Alex was six. Nothing was explained about Daddy being gone. Sometimes when Chris withdrew without explanation, Alex had an intense stomach burning sensation. It took a long time to translate that sensation into what it was: the buried grief and abandonment of that little six year old child. Slowly, Alex began to recover and learn about emotions through the experience of attending to body sensations, and ultimately became able to process them.

Finally, many activations are wordless. Many a cycle of escalation begins with a facial expression. Jackie had a hair trigger for an angry face. As a child, her father’s angry face was the only tip off that a violent outburst was imminent. When She saw anger in Sandy’s face, she would begin to panic and withdraw. Sometimes Sandy was perturbed about something having nothing to do with her, or was not in fact angry at all. Jackie’s triggered response might feel like rejection, or could activate Sandy’s belief “I can’t just be myself with you;” and one way or another could kindle an episode between them without a sound. Becoming aware of the unspoken both internally and interpersonally, and putting it into words, is another sort of integration and putting together of pieces.

And of course the body is the vessel of the sexual interaction. For many trauma and neglect survivors, the body has been a source of shame and suffering. To many, largely cut off or dis-identified from their bodies, it may be a stranger, enemy or both. Many couples have never looked at or spoken with ease about their own or each other’s bodies. Bringing the body of both partners more into awareness, individually and in the relationship field as well advances the sexual endeavor.

A Word About Antidepressants and the Sexual Conundrum


Trauma and neglect both readily bring with them a legacy of depression. I believe one of the most under-rated symptoms of depression, and the one that has perhaps the most impact on relationship is the often-unbearable irritability, where “everything you do goes on my nerves!” Depression is also a well-known killer of sexual interest and pleasure, so for many reasons it is an important to address it in our work. Getting a handle on the daily triggering escalations in the couple, help a lot with depression, as can therapy.

For many people medication is a great help in both toning down the vulnerability to being triggered and making daily life together more live-able; while also widening the window of tolerance for the difficult work of recovery to proceed. For many, medications can be a godsend. The SSRI antidepressants (the most well known being Prozac, Zoloft and Pacsil for example,) are a tremendous boon to the treatment of Post Traumatic Stress Disorder, and several have even been approved by the FDA specifically for use with PTSD. Unfortunately, it is also well known that diminished libido and sexual dysfunction are common side effects of the SSRI’s.

There is a range of sexual side effects, and not everyone suffers the same side effects to the same extent, but many people taking SSRI antidepressants, complain of anywhere from mild to severe loss of sexual interest and sensation, inability to get an erection, inability to have an orgasm to all of the above. Again, it does not all happen to everyone, but there is a significant tendency for some sexual side effect for many people.

Doctors are often quick to minimize the individual and the couple’s frustration and further loss in the area of sexual intimacy, in the interests of managing depression. For many people, however, orgasm and sexual energy may in fact not be a small price to pay for relief from depression. Sexual recovery is hard work. It is important to convey to prescribing psychiatrists and physicians, that sexual recovery is an important area of priority and focus for the individual and the couple. There are medications that have lesser or no sexual side effects, and they may be worth trying first. Other non-pharmaceutical treatment options are also being studied. It is well worth being educated and informed about options, and keeping and expressing priorities clearly.

Interestingly, my experience has been that often seriously depressed clients show significant improvement, and feel much better as they become connected with their intimate partners. I was also curious to run across a study recently showing couple’s therapy to be superior to medication in the treatment of depression. This of course is not news to researchers like Dean Ornish and Paul Pearsall who have long expounded on the many healing properties of intimate relatedness.

Conclusion


This is of necessity a bare introduction to what is a broad and complex process. Many important subtopics have been left out. My hope above all is that it will inspire a sense of possibility and optimism, and a desire to discover and learn more. It is a grave injustice that any human being be robbed of the opportunity to freely and fully love. It is my passionate intention to help restore that innate and fundamental birth right. Daily I see that it can be done. Many survivors of trauma question whether sexuality is even a worth while objective, “Is there anything in it for me?” Many survivors of neglect have come to wonder “Is a satisfying sexual relationship even a reasonable expectation in an intimate partnership?” To both I respond with a resounding “Yes!” Arriving there together can feel very much like coming alive.

4. Recommended Reading

Books about Trauma

Herman, Judith (1992). Trauma and Recovery. New York: Basic Books.

Levine, Peter A., (1997). Waking the Tiger: Healing Trauma. Berkeley: North
Atlantic Books.

Rothschild Babette (2000). The Body Remembers. New York: W.W. Norton.

Scaer, Robert, (2001). The Body Bears the Burden: Trauma, Dissociation and
Disease. New York: Haworth Press.

Books About Relationship

Amini, F., Lannon, R. and Lewis, T.(2001). A General Theory of Love.
New York: Vintage Books.

Gottman, John (1999). The Seven Principles for Making Marriage Work.
New York: Simon and Schuster Inc.

Gottman, John (1994). Why Marriages Succeed and Fail. New York: Simon and
Schuster Inc.

Hendrix, Harville (1988). Getting the Love You Want. New York: Henry Holt and
Company.

Love, Pat (1999). Hot Monogamy. New York: Penguin books.

Love, Pat,(2001). The Truth About Love. New York: Simon and Schuster.

5. References

Cassidy, Jude & Shaver, Phiullip R. (1999). Handbook of Attachment The Handbook of Attachment: Theory, Research and Clinical Applications. New York: Guilford.

Gottman, John (1999). The Seven Principles for Making Marriage Work. New York: Simon and Schuster Inc.

Gottman, John (1994). Why Marriages Succeed and Fail. New Yor : Simon and Schuster Inc.

Hendrix, Harville (1988). Getting the Love You Want. New York: Henry Holt and Company.

Kollman, Maya (2000). Risking Intimacy: A Day for Same-Sex Couples. Paper presented at the 2000 Family Therapy Network Symposium, Washington D.C.

Love, Pat (1999). Hot Monogamy. New York: Penguin books.

Love, Pat (1999, March/April). What is this thing called love? Family Therapy Networker, (pp. 34-44).

Mitchell, Stephen A., (2003). Can Love Last? The Fate of Love Over Time.New York: W. W. Norton.

Ornish, Dean (1998). Love and survival: The Scientific Basis for the Healing Power of Intimacy. New York: Harper-Collins.

Panksepp, Jaak, Affective Neuroscience: the Foundations of Human and
Animal Emotions. New York. Oxford University Press. 1998.

Rauch, S. L., van der Kolk, B., Fisler, R.E., Alpert, N. M., Orr, S.P., Savage, C.R., Fischman, A.J., Jenike, M.A. & Pitman, R.K. (1996). A symptom provocation study of posttraumatic stress disorder using positron emission tomography and script-driven imagery. Archives of General Psychiatry, 53, (pp. 380-387).

Reaney, Patricia (2000, August 1st). Couples therapy better than drugs for depression. London. Reuters Wire Service.

Rothenberg, Mira, (1987). Children with Emerald Eyes. New York: E.P. Dutton.

Schore, Allan, (1994). Affect Regulation and the Origin of the Self: The Neurobiology of Emotional Development. Hillsdale, New Jersey: Lawrence Erlbaum Associates.

Siegel, Daniel, (1999). The Developing Mind: Toward a Neurobiology ofInterpersonal Experience. New York. Guilford Press.

Siegel, Daniel, Toward and Interpersonal Neurobiology of the Developing Min. Infant Mental Health Journal, Vol. 22(1-2), 67-94 (2001) p. 81.

van der Kolk, Bessel, Burbridge, J.A, and Suzuki, J. (1997). The psychobiology of traumatic memory: Clinical implications of neuroimaging studies. In R. Yehuda and A. C. McFarlane (Eds.), Annals of the New York Academy of Sciences, 821 (pp. 99-113).

van der Kolk, B., McFarlane, A.C. & Weisaeth, L. (Eds). 1996). Traumatic stress: The Effects of Overwhelming Experience on Mind, Body and Society. New York: Guilford.

© 2004