Childhood Sex Abuse: The Long, Hard Road to Sexual Healing

 
For survivors of childhood sexual abuse, recovery is painful. It typically takes years. It can threaten—or destroy—survivors’ relationships with the
perpetrators and family members who maintain relationships with them. Survivors’ sexual relationships often don’t survive the process. But with therapy, survivors can recover and build healthy, happy, deeply nurturing sex lives.

Therapeutic approaches vary, but Staci Haines, author of Healing Sex: A Mind-Body Approach to Healing Sexual Trauma who herself survived child sex abuse and now is a therapist for other survivors, combines traditional talk therapy with hands-on efforts aimed at reintroducing survivors to their bodies. A focus on the body, sometimes called somatic therapy, helps survivors feel comfortable in their own skin, a process that eventually enables them to experience erotic pleasure.

One focus of talk therapy is overcoming survivor guilt. Survivors often think the abuse was in some way their fault. Eventually, they understand that they where children. They had no power in the abusive relationship, and as a result, are not to blame for what happened. This allows them to forgive themselves. It also allows them to get angry at the abuser, an important step in healing.
Talk therapy also explores survivors’ dissociation, aversion to sex, having sex only to keep their lovers happy, faking pleasure, and faking orgasm.
On the body/somatic side of therapy, the goal is to overcome dissociation and learn to enjoy sensual touch. “To feel is to heal,” Haines says. “It can be very intense to relive what survivors experienced during their abuse, the feelings deep in their bodies. But this is critical. Body awareness allows survivors to move beyond dissociation, and eventually experience real sexual pleasure.
However, before sexual healing, most survivors need a period of celibacy, or perhaps sensual contact—hand-holding, cuddling, hugging—but not genital play. For some, the sexual time-out lasts several months, for others, years.

“When I first started therapy,” one survivor recalls, “I couldn’t stand being touched. For a time, my lover and I had no physical contact. Then I wanted to be in his arms, to feel close to him, but all I could tolerate was being hugged. Eventually, we began to explore being more sexual.”
To gain comfort with physical pleasure and sexual sensations, an important tool is masturbation. “Know thyself,” Haines explains. “Masturbation is the foundation of sexual self-education. During masturbation, survivors can relearn how to be fully present in the moment, how not to disappear while having sexual feelings—without all the complications of partner sex. Masturbation allows survivors to relearn how to experience sexual pleasure on their own terms. It gives them power. By time they return to partner sex, they have more sexual self-knowledge, which forms a healthy foundation for enjoyable sex.”

Haines’ program of guided masturbation is similar to the masturbation-based program for teaching pre-orgasmic women how to have orgasms. Both programs put the woman in control, and allow her the luxury of discovering her own sexuality in her own way on her own timetable. Not surprisingly, many survivors experience difficulty with orgasm. For them, the masturbation program is even more crucial.
But masturbation often triggers flashbacks. When flashbacks strike, Bass and Davis, co-authors of The Courage to Heal: A Guide for Women Survivors of Child Sexual Abuse, advise, “Open your eyes. Ground yourself in the present. Understand that touching yourself, or being touched by a lover, is not abuse, even if it conjures up painful memories. Tell yourself that it’s your right to receive loving touch, that touch is pleasurable, and that you deserve pleasure. It’s not harmful, shameful, or wrong.

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Masturbation begins the process of sexual self-rediscovery, but the real challenge for survivors is to return to partner sex. One key is for survivors to have total control over it. This can be very difficult for survivors’ lovers. But over time, survivor’s need for hyper-control usually subsides and sex can become more reciprocal, relaxed, playful, and loving.

Flashbacks—and the situational “triggers” that send survivors careening back into the dismal past—are frightening, but Haines counsels survivors to use them as tools in healing: “Suppose the abuse involved having the survivor’s father on top of her. Having her husband in the same position might trigger flashbacks. Some survivors might tell the husband: ‘I can’t have you on top of me—ever.’ They orchestrate sex to avoid all the situations that trigger any reliving of their abuse. But most survivors have lots of sexual triggers. If they set up their sex lives to avoid them all, pretty soon, they have can’t have sex at all.”
Instead of avoiding flashback triggers, Haines urges survivors to embrace them: “Embracing triggers means not shutting down when they come up. It means thinking: ‘Okay, my husband is on top of me. I’m triggered, thinking about my father. I’m slipping back into the past. I’m not present in the here and now. But instead of avoiding this type of sex, I’m going to turn into this trigger, and really feel it.’”

Embracing flashback triggers is similar to the emotional process of confronting any fear: The more you face it, the easier it becomes. Over time, triggers lose their ability to traumatize survivors. “Over time,” Haines explains, “survivors emerge from their trauma to a place where the emotions surrounding the abuse no longer control them, or limit their lives, including their sex lives. It’s a place where survivors can honestly say: ‘In the past, I was a victim, but I'm not anymore. In the past, sex was used against me. It isn’t anymore. Today, sex can be pleasurable.’”

A recent study by University of British Columbia researchers used variants of “talk” and “body” therapies to reduce survivor’s sexual distress. They enrolled 20 survivors in a cognitive behavioral therapy (CBT) that helped them re-interpret their stories from abuse to personal empowerment. Half of the group also learned mindfulness meditation (MM), which focuses on nonjudgmental awareness of the present moment. MM trains people to observe their thoughts, whatever they may be, and then let them go. At the end of the month-long study, both groups reported less sexual distress, but compared with the CBT-only group, those who also learned MM reported greater relief.

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The Stages of Recovery (adapted from The Courage to Heal)
• The Emergency Stage. Emotional turmoil as memories of the abuse surface.