This article is part of the December MAMFT newsletter, in which presenters for the 2017 Couples Conference, Tangled Truths, provide thoughts on sex therapy and trauma.
A common interaction in couples where at least one member has had sexual trauma is sexual avoidance. I’ve come to see avoidance of sexual intimacy as a normal human protective response to a stressor that often brings up strong negative feelings, such as hopelessness, powerlessness, disgust or fear/terror. [The rest of the journey in working with these couples who present with sexual avoidance and want to “get over it,” has been my figuring out over many years how to work relationally and successfully with that normal human response.]
Sexual trauma survivors and their partners are often at a total loss to imagine what therapy could look like, having experienced years of hopelessness around the issues. So they do what makes sense – walk away from the hot stove and avoid.
What I’ve learned over time is that a good trauma-informed couples therapist has to be able to help the members of the couple simultaneously do three potentially very difficult things.
First, partners have to develop trust for the relationship and the process. This task is always that most challenging, and the more the abuse impacted the clients, the harder it is. Can I, as the partner of the survivor of trauma, help them understand that I am there to help them? Can I, as the partner who survived the trauma, recognize that the very help that I need may be tough and painful? There may be times when the survivor of sexual abuse may be tempted to see their partner as the perpetrator or bystander. If I, as the therapist, don’t set up the expectation that this work is going to be tough and work to get buy in from the protective parts of each partner, therapy is going to stall early and/or they will not stick around.
The second one is to help each member of the couple develop the developmental skills to talk through things that are difficult. I usually don’t start with sex unless they demonstrate they can handle it. Developing both the self-differentiation and the other-differentiation to be able to know and speak your own truth, and handle your partner’s knowing and speaking their own, is the most critical skill in helping couples to successfully shed the old dynamics and grow into the new sexual dynamics, or even growing a sexual self, in some cases.
The third critical skill is to have fantastic resources to help you and them. Read books and journal articles that give partners language and contexts for their very normal problems. Use resources developed by trauma specialists to help you understand levels/types of dissociation in both partners and recognize when you are dealing with structural dissociation and how to handle it. Having a model with a lot of structure that weaves in trauma theory and gives you places to plant your feet in these challenging waters is critical. I use the Ellyn Bader’s Developmental Model of Couples Therapy, which is grounded in differentiation theory, attachment theory and the neuroscience of trauma, all of which I am using in every single session with couples.
I hope to see you all at the Couples Symposium in January where the entire day will be devoted to how to help couples struggling with the effects of sexual trauma.
Katherine Waddell, LMFT, is the co-director of the Couples Center of the Pioneer Valley in Northampton.