Last month one of my client couples gave birth to a child.
Always a joyous event, this birth had particular significance
to me. When I first started seeing this couple, just over
2 years ago, they had had virtually no sexual relationship
in some four years. At that time the wife, a survivor of childhood
sexual abuse, longed for a baby. The husband pined and bristled
for a sex life. Both seemed a distant dream. Restoring a regular,
reliable and satisfying sexual life was a primary goal of
the therapy and achieving it a major milestone. This baby
brought a new meaning to the term “love child”
and was one of those awesome rewards of the difficult work
Sexuality is among the most challenging issues in recovery
from sexual trauma. When I first ventured into that area,
I was dismayed to find that the literature reflected the same
major oversight as had the early theory and practice of general
sex therapy. Somehow it did not see fit to address the relationship
as either a significant factor or potential resource in the
maintenance or healing of the sexual problem. The books I
read focused on the trauma survivor, who was saddled with
the responsibility for the problem and who got all the attention.
The non-sexually abused partner was essentially entreated
to be supportive and patient, and wait. What this translated
into for the average couple, was that the abuse survivor got
all the blame and all the help. The partner got off the hook
in terms of personal work, but received little else. Getting
to know these couples, I rapidly discovered that the persistence
of the sexual impasse is decidedly dynamic and relational.
Locating The Dynamic
Once in the room with survivors of sexual abuse and their
intimate partners I made two major discoveries. First of all,
survivors of childhood sexual abuse invariably partner with
survivors of childhood neglect, at the very least emotional
neglect. These children of alcoholic, depressed, mentally
ill, overwhelmed, deceased or otherwise absent mothers in
effect seem to have raised themselves, perhaps their siblings
too. Often the sexual trauma survivor partner has a neglect
history as well; and often the neglect survivor partner has
experienced childhood trauma. But in each couple is one whose
primary wound is trauma and the other for whom neglect is
At its essence the experience of childhood sexual abuse is
annihilation. The feelings and humanity of the child are disregarded,
the perpetrator being preoccupied with self gratification.
The child is in effect used and discarded, often treated as
if nothing unusual has happened. Overwhelmed and uncertain,
this child grows up with the core beliefs “I am unsafe
in the world,” and even more importantly “I don’t
The child of neglect grows up in an environment of deprivation.
These children are left to fend for themselves in fundamental
ways, and learn early not to think of other people as resources
for them. They tell heartbreaking stories of finding ways
of registering themselves for school in second grade; climbing
on a chair to get themselves food; never ever having anyone
interested in knowing how they feel. They are self reliant,
resigned, and deeply anxious and conflicted about it. These
kids grow up to believe “I will never get what I need
in relationship.” Often unaware that they even have
a story to tell, they think of the trauma survivor partner
as the one with the pain.
My second discovery was the dynamic interaction of these core
beliefs between the partners in the couple, which generally
goes as follows: “Partner A,” the neglect survivor
driven by the belief “I will never get what I need,”
perceives or fears that needs will not be met, and becomes
anxious, possibly angry.
“Partner B,” the trauma survivor, compelled by
the belief “I don’t matter,” experiences
that anxiety as demand, and fearing coercion/anihillation,
withdraws. A experiences the withdrawal of B as proof: “my
needs will be thwarted or ignored,” and becomes more
anxious. B experiencing the heightened anxiety as increased
demand withdraws yet further. A cycle of escalation ensues
that goes on and on and on.
This dynamic is glaringly evident in the realm of sexuality,
as sex is perhaps the one need that the neglect survivor might
acknowledge or feel entitled to put forward as requiring the
participation of another person. But in fact the dynamic is
threaded through the entire fabric of the relationship. The
two may keep each other thus triggered virtually all the time,
their life together becoming a living minefield of their re-enacted
childhoods. For this reason couple’s work may be essential
to both of their recovery or even to keep them from getting
The Work of the Therapy
Once identified, this dynamic provided both a starting place
and a map for relationship work with survivors of trauma and
neglect; and most specifically a way to approach the sexual
conundrum. In effect, the work came into crystalline focus
and what before seemed an insurmountable tangle became simple.
Simple while also perhaps being the hardest thing all three
of us, clients and therapist, will ever do.
Research, theory and practice around trauma has burgeoned
in the last 10 years. We now understand that core elements
of post traumatic stress are dysregulations of affect and
attachment. Trauma, overwhelming the nervous system, disrupts
its capacity to process experience and maintain a baseline
physiological and emotional equilibrium. The system swings
between hyperarousal, (anxiety and preoccupation with danger;)
and hypoarousal (depression and dissociation) without the
capacity to modulate. Interpersonal, particularly familial
abuse distorts existing and future attachments, while also
destroying the most powerful potential resource for soothing
and safety when it is most needed. The wounding around relationship
is perhaps the most tragic and severe of the sequelae of abuse.
Research about neglect is nascent, with attachment theory
having much to contribute, and findings are similar and parallel.
I find the theory and structured dialog of Harville Hendrix’
Imago Relationship Therapy to be exquisitely suited to this
population. Grounded in attachment theory, Imago theory views
current relationship difficulty in light of re-enacted or
projected childhood experience. The structured dialog lends
order and predictability to the potentially frightening task
of expressing feelings, rendering it safer. The emphasis on
coming to understand one’s partner’s world without
necessarily agreeing, facilitates differentiation and boundary.
And the rhythm of the dialog, the ebb and flow of understanding
and being understood, appears to ease the dysregulated nervous
system, and quiet the bodies of both partners.
The couple’s work consists of psychoeducation about
trauma and neglect; and dogged conversation in dialog. Although
there is no substititute for solid trauma work, much trauma
processing also goes on in the couple’s work. Over time,
both partners learn to recognize their reactions to each other
as being largely expressions of their past. Blame and defensiveness
are gradually replaced by compassion and safe connection.
Sexual intimacy, rather magically emerges ultimately from
A necessarily cursory introduction to the most challenging
work I have ever done, leaves much to say. Not for the faint
of heart, this is undoubtedly the most awesomely rewarding
work I do.