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
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.
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
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
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
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
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
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.
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
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
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
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
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
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.
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
Levine, Peter A., (1997). Waking the Tiger: Healing Trauma.
Rothschild Babette (2000). The Body Remembers. New York: W.W.
Scaer, Robert, (2001). The Body Bears the Burden: Trauma,
Disease. New York: Haworth Press.
Books About Relationship
Amini, F., Lannon, R. and Lewis, T.(2001). A General Theory
New York: Vintage Books.
Gottman, John (1999). The Seven Principles for Making Marriage
New York: Simon and Schuster Inc.
Gottman, John (1994). Why Marriages Succeed and Fail. New
York: Simon and
Hendrix, Harville (1988). Getting the Love You Want. New York:
Henry Holt and
Love, Pat (1999). Hot Monogamy. New York: Penguin books.
Love, Pat,(2001). The Truth About Love. New York: Simon and
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
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.
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.