Monday, 08 February 2016 01:02

Couples Therapy in the Treatment of Sexual Trauma

The following article was written by ISW founder and trauma expert, Debra Taylor, MA, MFT, CST




     Sexual trauma has consistently been reported to have a severe impact on a person’s ability to participate in a fulfilling couple relationship.  Studies to date have found that many survivors of child sexual abuse report relationship problems, believe their relationships are less healthy than others’ relationships, and feel unable to depend on their partners.  Survivors of childhood sexual trauma experience higher rates of divorce than those who were not traumatized.  Survivors of sexual trauma also report sexual difficulties:  lack of sexual pleasure, sexual dysfunctions, or dissatisfaction with their sexual relationship.

Sexual traumatization affects not only the victim, but also the survivor’s spouse or intimate partner and often is expressed in ongoing conflict between partners.  Partners of survivors of sexual trauma report feeling isolated, angry, frustrated, dissatisfied, and unable to communicate well with the survivor.  If and when the trauma survivor seeks help, therapy is usually conducted individually and partners report feeling left out of the process, viewed as perpetrators, and forced to wait until the conclusion of therapy in order to have a relationship with their spouse.  How can therapists best help couples facing the relational and sexual impacts of sexual trauma?  Should partners be expected to put their relationship and sexual needs on hold while the survivor works individually in therapy?  Should partners be integrated into trauma treatment with the survivor, and if so, when?

 In Trauma and Recovery (1992), Judith Herman wrote:  “Recovery can take place only within the context of relationships; it cannot occur in isolation.”   Most of the trauma literature assumes this recovery relationship applies exclusively to the therapeutic relationship and the client’s experience of safety with the therapist.  Somehow healing and recovery from trauma and its effects have become the domain of mental health professionals.  Yet, in the middle of the night when the trauma survivor is experiencing a traumatic nightmare or flashback it will be the intimate partner that is present, not the therapist.  Perhaps therapists have overlooked “the brilliance of ordinary people in healing themselves and the people they love” (Johnson, 2002, p. 7).

Couples in which one of the partners is a sexual abuse survivor often come to therapy because of relationship distress or sexual problems. Often survivors function sexually in the early stages of romantic relationships but begin to struggle or completely breakdown sexually after their relationship moves into being “family,” either after marriage or the birth of children.  Frequently the survivor or the partner does not understand that their relationship problems or sexual concerns are related to the childhood sexual abuse.  Many traumatized individuals have difficulty getting close to a partner or staying close to others because they careen between hyperarousal, anger, numbing, and dissociation.  Integrating the partner into therapy could give the survivor an ally in the often difficult and lengthy process of recovery from complex trauma and could enable the partner to participate in healing rather than be left out.  Johnson believes “couple interventions can make a crucial, and to date almost unrecognized, contribution in the treatment of traumatic stress” (2002, p. 9).

Over the decades several case studies and small research studies have pointed to couple therapy as a realistic mode of conducting trauma therapy. Attachment theorists, in particular, state that an essential component of posttraumatic healing is the creation of loving, supportive bonds between romantic partners.   Attachment theorists and therapists also assert that the three behavioral systems of attachment, caregiving, and sexuality must be integrated to develop a secure, healthy adult pair bond.  Sidestepping the sexual concerns or relational conflicts between the survivor and partner, while understandable in the midst of the individual problems of the survivor, may in the long run lead to further relationship dissatisfaction and even marital dissolution.  Focusing on the couple and their concerns, even sexual concerns, early in trauma therapy may prove to be the best strategy.

There are several resources available to couples and therapists to guide them as they attempt relational and sexual healing from the effects of sexual trauma (Maltz, 2012; Cohn, 2011; Greenman & Johnson, 2012).  While there are currently no definitive studies that have proven the value of couple therapy over individual therapy for child sexual abuse recovery, the conclusion of recent research reinforces the notion that “directly intervening with people’s most central interpersonal relationships might result in important changes not only in the patient with psychopathology, but also in their partner and in their ongoing relationship” (Baucom, Whisman, & Paprocki, 2012, p. 267-268).



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