Sexual Abuse and Incest; Treating the Victim and the Couple
Lisa Thomas, LCSW, LMFT, DAACS
For this final paper, research and discussion will be about the topic of sexual abuse and incest. This paper topic is very important to explore due to the shocking number of children and adults that become the victims of this crime and have lasting effects within their lives as well as their relationships. This paper will define what sexual abuse and incest are and how they relate to the individual and the couple when working in a therapeutic setting. Important factors for the therapist to consider are how to council the victim, how to counsel the offender and how to counsel a couple that may present as one of each (offender and survivor).
Current treatments used within practice will also be discussed for current abuse victims and survivors. Finally, the work of guiding a couple through their past issues in order to lead them to more connecting and positive sexual experiences will help strengthen their courtship as well as better connect the couple both spiritually and emotionally.
What is Sexual Abuse?
Sexual abuse can be defined on a spectrum as wide as being seduced to have relations with a close relative to a rape at the hands of a violent stranger. Often, there are long-term sexual problems that are a direct cause to the trauma the victim has experienced. Some of these sexual problems can include; Avoiding or being afraid of sex, approaching sex as an obligation, experiencing negative feelings such as anger, disgust or guilt with touch, having difficulty feeling aroused or feeling sensations, feeling emotionally distant or not present during sex, experiencing intrusive or disturbing sexual thoughts or images, engaging in impulsive or inappropriate sexual behaviors, experiencing difficulty establishing or maintaining an intimate relationship, experiencing vaginal pain or orgasmic difficulty and experiencing erectile or ejaculatory difficulty (Maltz, 1992).
The National Committee to Prevent Child Abuse (children aged 0-18) reports that in 1997, 8% of the child population was reported as being or having been sexually abused. This means that 84,320 children were sexually abused or molested and the incident was reported and confirmed by Child Protective Services throughout the United States ( www.projectangelfire.com ).
Although many people believe that child victims of sexual abuse are always traumatized by the abuse and angry with the offender, sometimes this is not true. Some victims he time, as being a traumatic act ( www.projectangelfire.com ).
A very high degree of psychological damage can occur if the offender makes the victim feel physical pleasure during the offense(s). This will produce a level of guilt or shame that is very powerful. Moreover, the victim is less likely to disclose the abuse and more likely to minimize it. This would be because the victim may feel partly to blame for the abuse because the experienced pleasure (this is a grooming technique). If not dealt properly with an experienced clinician in a therapeutically safe environment, the shame produced can be so intense it can create suicidal ideations, a loss of "self" and self-destructive behaviors. It remains important for the victim to receive counseling to deal with abuse at some point in their existence so the feelings of then cannot destroy the opportunities for connection and healthy relations now ( www.projectangelfire.com ).
The Survivor; Treatment Approaches
As a clinician treating a sexual abuse victim or survivor, many options are available to deal with the pain and begin to attach new meaning to sensual touch. The first and most important step is trust in the therapeutic relationship. The client must feel at ease with both the clinician and the treatment plan for the most work to be accomplished therapeutically. Next, the client must express a desire to explore the abuse and be open to moving forward (inches are fine) in a sexual way. Finally, the clinician should follow the client through the healing process and incorporate any partners the individual may have into the therapy.
When forming a treatment plan, it is important for the clinician to access whether sexual abuse may be a primary cause of any sexual problems the client may be experiencing. The therapist should gather information through sexual histories and address grief issues related to the loss of sexual innocence. Next, work on resolving ving feelings towards the offender. The client may want to confront the offender directly in a controlled setting (ex., therapist's office) or confronting may be exercised through letters or Gestalt exercises. Next, encourage the client to rid the belief that sex is a mandatory obligation and focus them on connecting with their partner around setting up regular times for talking and practicing sexual exercises. Encourage the couple to create a non-sexual contract, moving towards developing freedom from meeting each others sexual needs. Then, assist the survivor to consciously separate the partner from the offender. For success, the client must feel that sexual contact is within their control (Zacharias, 2002).
To focus the client on trying to assist in undoing the harm, create a process for resensitizing the numbed areas of the body. Enable the survivor to remind themselves of how they are a different person now from when the abuse occurred. Teach the partner how to be helpful and supportive to the client during flashbacks of the abuse. Assist the client in developing new meanings for sex and differentiating between sex and sexual abuse. Recreate new views and experiences of intimacy. Help the client learn about improving sexual self awareness by assigning self-stimulation exercises for the client. Setting up Gestalt exercises of body parts can also aid in the healing process. Finally, designing couple sensate and presensate focus exercises are supportive. Help the couple to define and set limits of comfort to their sexual experiences. Use sensate exercises to diminish stress and help the couple to make adjustments to any developmentally delayed experiences (Zacharias, 2002).
Specific Techniques for Couples
Many couples, especially when one partner has experienced sexual abuse, are afraid of intimacy. By being disconnected from sex, one can get the act done and over with quickly if it is painful for them either mentally or physically. When trying to get a couple to reconnect and they are at the stage in therapy where they can trust each other and are ready to participate in hands on experiences, Tantra may be a good option for them to explore.
The word Tantra refers specifically to a series of esoteric Hindu books that describe certain sexual rituals, disciplines and meditations. Ancient Tantra is a spiritual system in which sexual love is a sacrament. It is a system that can elevate a couple's relationship to the art of love. We refer to it as the Art of Conscious Loving. The intimate goal of Tantra practice is unity of the couple. Followers aspire to a spiritual connection or union to experience the individual self as part of the indivisible all. To help attain unity, partners employ techniques of visualization and meditation and they practice ritual sexual union and a highly developed form of communication with their partner (Muir, 1989).
Tantra sees everything in the reality of masculine and feminine energies that in the higher reality are simply unity. In contemporary terms, one might say that the goal is to achieve self-actualization or personal integration. The seven chakras are also important as they exist as both generators and reservoirs of energy and psychic consciousness. Couples will benefit from learning about the sacred chakras because it is said that when one's chakras are in tune, one can achieve harmony (Muir, 1989).
Specific Tantra Exercises for Couples
One technique for couples to practice is called nurturing meditation. To practice nurturing meditation, couples should assume the "nurturing" position. They lie together spoon-fashion on their left sides (for reasons of energy flow), the partner on the inside enveloped in the arms of the partner on the outside. Sometimes, the man will be on the inside enveloped by the woman, sometimes the woman will be on the inside enveloped by the man. Whoever feels most in need of nurturing, whoever has experienced the most stress that day, or is the most tired, should take the inside (Muir, 1989).
The purpose of the position is to create the balance necessary for harmony, to influence a synchronicity between the partners, to adjust their separate energies so that they are vibrating on the same frequency. Breathing techniques are then added in to harmonize the couple together as they breathe in and out simultaneously. Recharging breaths and reciprocal charging breaths can also be used as one partner breathes in while the other breathes out in an attempt to exchange and give energy to one another. The nurturing meditation exercises allow couples to communicate on at least three levels; on the conscious level, skin to skin; on the more subtle respiratory level, breath to breath; and on the most subtle level, chakra to chakra (Muir, 1989).
Other stages of intimacy and connection for the couple to share can be the six stages of intimacy. These are Conflict; which is reduced by having the couple create three-hour blocks of time for sacred moments together. Competition; where the couple must focus on their shared goals. Cooperation; where an agreement is made about how sacred space will be made and shared. Co-creation and experience; where the couple is encouraged to build an alter that is sacred to them. Communion; experienced by massage and slow touching between the couple. Finally, Celebration; where the couple has a meal together or shares a laugh (Zacharias, 2002).
Presenting Couple
The couple that will be presented in this paper have been seeing me since November of 2001. We have had twelve sessions and they generally prefer to be seen every other week. They were referred to the Center for Marriage and Family Therapy Training Center through their church. Presenting problem was that the heterosexual couple, married less than one year, was in crisis. The male client, had had sexual relations, mainly oral sex, with a family babysitter who had been visiting from out of town. The female babysitter was 14 years old. This male client is 38 and his wife is 36. The married couple also has two male children ages 15 and 4.
This incident was reported as having happened one time. It was exposed when the babysitter told the wife and the wife then drove the babysitter to the airport to put her on the next plane home (back east). When the babysitter returned home, her parents filed formal charges including sexual relations with a minor by a person in a position of trust and statutory rape. This incident happened in August of 2001. The couple had made the call for therapy in November of 2001. In those 90 days, the male, whom we will call "Dave" had completely abstained from drinking. He self-reports that he was intoxicated at the time of the incident and had been drinking around a 12 pack of beer everyday for at least the past 12 years. The couple reported that Dave's drinking was causing major problems between them because often, he was so drunk by the time she would return from work that quality "couple time" was out of the question. She also felt responsible for most, if not all, of the care of their two sons.
In therapy, we first focused mainly on the goals of our sessions. The couple identified they wanted to remain together, Dave wanted to remain sober and that they needed to be less angry at each other and begin talking about what the real problems were between them. As we became more aquatinted and the couple began to trust me as their provider, they were able to reveal more of what their childhood experiences had been like. Dave reported a traumatic upbringing that included inconsistent parenting often by only his mother. Around the age of 10, Dave reports being brought to a boys home and simply left in the care of the facility. His two older siblings, ages 12 and 13 at the time went with him.
Dave stayed at the facility until the age of 17 and reports being physically, emotionally and sexually abused by both the children in the facility and the staff. Upon his release from the facility, he was homeless and began burglarizing homes for money and food. He was using drugs and drinking "very heavily" because he was so depressed. He eventually graduated to robbing liquor stores, and at the age of 19, was sent to jail for three years for robbery. He reports this was almost a "good thing" since he was housed, fed and sober for a time. He decided to try and find his biological father upon his release. When Dave located his dad, it was a positive experience. His father put him to work and let him live with him and his new wife, Dave's new step-mom. Things were good for about a year, Dave's drinking was stable but still apparent. Then, another crisis struck.
Dave's father had a major heart attack and died. Dave once again felt all alone and moved in with his girlfriend (who is now his wife). He began to drink so heavily that eventually, she kicked him out. He says the next few years are a fog of working construction and drinking in the evenings. He had several relationships but they failed due to his drinking. Finally, one day he got a call from his now wife, "Dee". She had shocking news. They had a 14-year-old son together.
Dee 's story is similarly rocky. She grew up in a home with one sibling who was much older (10 years) and was close to her parents until about the age of 10. Around this time, her father began to molest her and didn't stop until she moved out of the home at 17. She told her mother many times but her mom never believed her. Dee reported she became so afraid of her father that she would never undress fully, but would layer clothes and peel layers off from underneath as to not expose her naked self. She even reports showering with her clothes on in case her father came in the bathroom. She said the house did not have locks on the doors.
She is afraid of intimacy and sex and began drinking when she was 16. She drank heavily when she moved out and met her now husband at a sports bar. They dated and she became pregnant after three months. She was ashamed to tell Dave the truth, so she broke up with him, got sober, worked three jobs to support herself and relied on her mother for child care once their son was born. She kept his birth a secret until he was 12, when she decided it was time to tell him the truth. She looked Dave up in the phone book and called to tell him he had a son. They began seeing each other again, and moved in together. Dave was still drinking daily, but Dee said she didn't pay attention because she was getting some help from him with money and the child's care. Soon, Dee was pregnant again. Finally they married and have been for almost one year at the time they came for therapy.
Sex for this couple has never been easy since both clients have sexual abuse in their pasts. Dave attributes his bad judgement regarding the babysitter as a consequence of his drinking and is seeking separate offender counseling dictated by the Courts. This couple claims they want to have a better sex life, but resist moving forward with exercises and suggestions such as massage and alone time since they fear what might happen. They report they have not had sex in about seven months. Even before the perpetration incident, they say sex was rare and Dave failed to maintain a full erection for the duration of the lovemaking. The couple claims most of the time, she would simply perform oral sex on him and that would be the end of their intimacy. They come to sessions regularly and want change to occur. They present as "willing to work hard" but sometimes they do not follow through on homework assignments and claim they couldn't find the time. Hence, they say therapy has been extremely helpful for them and has helped them to continue their relationship.
Treatment Plan
In treatment, we have focused on getting the couple back connected both emotionally and physically using education and homework assignments. We have discussed non-genital touch including massage, hugging until relaxed and communicating with one's partner during foreplay so that trust can be increased. We have also talked about different types of orgasm (vaginal and clitoral) and Dee has expressed what she would like to have done to her. David has also revealed to Dee some of his fantasy in session including what he prefers and what he feels turns him off. The couple now has some basis to begin with when they decide to cross over from foreplay to intercourse.
Schnarch talks about several techniques that will be incorporated into our sessions once the couple makes a decision to begin having intercourse again. Eyes open orgasm is a practice that tunes one's self into one's partner and allows one to see what their partner is experiencing so that they can do more or less of what they are doing based on the response of their partner. Most importantly, communication and carving out time as a couple to build communication skills is imperative (Schnarch, 1997).
Conclusion
In closing, this paper has been a good experience because it allowed me to expand on my knowledge base to become more of an expert on sexual abuse. When working with a couple in which at least one person has been a victim, it is important to discuss one's past experiences related to sex and try and connect those past feelings of fear into the present. By guiding a client through those old feelings of fear in a new and safe setting, hopefully the client can release some of those past feelings of anger, hurt and rage and begin to reconnect and fully trust their partner.
