Sexual Intimacy in Marriage, Research Paper Example

Sexual Intimacy in Marriage for Survivors of Childhood Sexual Abuse: Implications as a Therapist

Introduction

Abuse is broadly defined as the improper use or treatment of something in order to gain benefit. There are many different types of abuse, including verbal and physical. One form of verbal abuse typically involves demeaning an individual about the way they look or act, while one form of physical abuse involves unwanted contact, whether this contact is damaging or otherwise. Sexual abuse falls within these two scenarios. It occurs without an individual’s permission and can result in both psychological and physical damage. Sexual abuse can include actions such as verbal sexual harassment and physical assaults.

Childhood sexual abuse is a form of sexual abuse that is common. Children are typically easier to victimize due to their inability to protect themselves. As a consequence, children fail to report that they are being abused, either because they don’t fully understand that what is happening to them is inappropriate, because their abuser is threatening them, or because they don’t know how to explain what is happening to an adults. When individuals who were abused as children enter adulthood, they typically suffer psychological issues as a consequence of their former abuse. However, they are unable to cope with this damage easily because it occurred in the past during a period in time in which they were considered weak. In therapy, it is therefore important to make them understand that what happened to them is no fault of their own and emphasize the removal of aberrant behaviors.

There are many types of therapy that can be used treat adult survivors of childhood sexual abuse. In all therapy processes, recovery involves discussing both the damaging events and their symptoms with a therapist or members of a group. Once the patient recognizes the reason he behaves certain ways, steps can be taken to reverse them. In addition, therapy should be used to re-establish the patient’s feelings of self-confidence and self-worth in order to prevent occurrences of severe depression and other related disorders.

Background

Childhood sexual abuse negatively impacts future intimate and sexual relationships. This phenomenon is independent of whether the abuse occurred in one or both partners. It affects the adult relationship by preventing a substantial level of intimacy, causing a breakdown of communication, and creating a feeling of distance, which can contribute to other problems in the relationship as well. It is therefore necessary to describe the manifestation of the issues commonly observed in individuals who have been abused as a children during their adult lives. Second, it is useful to utilize an understanding of this abuse to treat these individuals in counseling and to ensure that they are able to overcome their past.

Attachment theory is commonly used to define adult relationships and is a useful guide to indicate when they have become problematic (Johnson, 2005). The theory states that adult bonds are divided into three elements, attachment, caring, and sexuality, and that it takes approximately two years for a romantic bond to become an attachment bond. It is known that childhood sexual abuse is a traumatic experience and is a risk factor for mental illness as an adult. Common disorders include suicide attempts, post-traumatic stress disorder, anxiety disorders, depression, eating, and sleep disorders. In extreme cases, schizophrenia is observed (Spataro et al., 2004). Symptoms of these disorders relate to the failure of an individual to form or lose romantic attachment. For example, individuals with post-traumatic stress disorder may be less likely to condone physical interactions. As a consequence, this individual becomes removed from the relationship due to the inability to feel attachment or participate in sexuality, thus emphasizing the importance of the attachment theory. Therefore, this theory can be used as a guideline to examine damaged relationships and help heal the afflicted individual.

The feeling of separation that exists in couples with history of sexual abuse relates primarily to the affected individual’s ability and willingness to communicate their problems to their partner. When this phenomenon continues for a prolonged period of time, it can detract from a feeling of intimacy (Gurman et al., 2002). As a consequence, there is a need to emphasize emotional expression in treatment of these individuals. It is human nature to avoid discussion of traumatic experiences, but failing to share the emotions that result can contribute to abnormal behaviors and a feeling of hopelessness. When an individual in a romantic relationship begins to act this way, his or her partner may begin to notice and feel that there is no trust between them.

As discussed above, it is clear that the expressive ability of sexually abused individuals is impaired and contributes to difficulties in relationships. However, there are many components of the expressive ability that contribute to this impact and these components will have different effects on different individuals. For example, the expressive ability of sexually abused partners is typically limited and they will not usually not express what they are experiencing as a result of the abuse. In addition, some also lack self-efficacy, which indicates that even when they recognize they should talk about the abuse, they are uncertain of how to do so. A concept known as expressive motivation occasionally causes sexually abused individuals to communicate with their partner. Triggers for this type of communication include strong emotions and mistaken assumptions about awareness (Wiersma, 2003).

A greater understanding of the barriers that sexually abused individuals face is necessary to determine which therapeutic techniques are capable of assisting the healing process. Since a majority of anxiety stems from their lack of ability to communicate effectively with their partners, Emotion Focused Therapy (EFT) and Eye Movement Desensitization and Reprocessing (EMDR) therapy would be useful in the resolution of this problem. EFT and EMDR are effective treatments in therapy for clients who are having dissatisfaction in their current adult intimate and sexual relationships due to current distress from childhood sexual abuse.

Benefits of Emotion Focused Therapy

In order to create an intervention to benefit the emotionally distressed couple, it is first necessary for the therapist to study the client’s case and determine how to prepare the couple for therapy. In this situation, it is essential to identify the emotional experience that has control precedence in attachment situations and in responses to trauma (Johnson, 2005). The goal of the first stage of therapy, stabilization, is to determine the interaction patterns of the couple and to rid them of the distress that destabilizes their relationship. This calls for a need to create a safe context in which both partners feel free to discuss the ways in which trauma has impacted them. Next, the emotional responses of both partners should be tracked to help them understand their interaction patterns. In future stages of therapy, there is a need to restructure the bond between partners and integrate the lessons learned in therapy. Emotion Focused Therapy (EFT) can assist in several of these steps.

Research has shown that emotionally focused therapy for couples and sexual abuse survivors is an effective technique. A case study of childhood sexual abuse survivors and their partners indicated that EFT helped increase relationship satisfaction and lead to clinically significant decreases in trauma symptoms (MacIntosh et al., 2008). Before the implementation of EMT to treat individuals with trauma related to childhood sexual abuse, the standard of care was individualized therapy, which proved ineffective. However, the observation that treatment of trauma is most effective when afflicted individuals feel that they are being supported led to the understanding that group therapy would be preferable. In addition, despite the strong association between childhood sexual abuse and mental instability, studies report that these individuals feel longing for relationships and stable attachments.

EMT has been found to have a broad range of efficacy. This therapeutic technique is beneficial because it fosters communication between two individuals. Although the use of EMT will be discussed in the scope of repairing relationships damaged as a consequence of childhood sexual abuse, the technique can be used to repair other failed relationships as well. This technique is particularly relevant to couples facing trauma because it helps couples receive social support and identify dysfunctional interactions. Strengthening bonds between two individuals bolsters the afflicted individual’s ability to cope with traumatic memories. In addition, these individuals will no longer need to deal with these traumatic experiences by dissociation and withdrawal from society and will instead seek support of their partners, which will further strengthen their relationship.

The primary role of the therapist in EMT is enabling the couple to identify where gaps in communication exist and how this is impacting their relationship. The therapy is primarily performed by discussions between the individual that had experienced childhood abuse and his or her partner. The therapist will track the progress of the individuals and clarify the meaning of this progress to the clients so they are able to fully understand the value of their conversations. As the afflicted partner recounts the traumatic experience, the unaffiliated partner will provide support, which will eventually contribute to enhanced communication and reduction of trauma symptoms.

Experimental evidence has shown that the EMT technique is useful for couples in which one partner has experiences trauma and for couples in which both partners have experienced trauma. In both situations, therapy is enacted similarly. As mentioned previously, the first step of therapy, stabilization, is necessary to begin to shape the relationship as a secure base in which both individuals can rely on one another (Johnson, 2005). The specifics of EMT will be discussed below.

Benefits of Eye Movement Desensitization and Reprocessing (EMDR)

EMDR is a psychotherapy approach that is commonly used to treat trauma symptoms. It is unique in that it is able to treat unprocessed memories of adverse experiences. This is a useful therapeutic technique because a majority of the mental distress that results from childhood trauma is due to manifestations of suppressed memories. EMDR is related to the adaptive information processing (AIP) model in which any illness that is not caused by a pathogen is a consequence of unprocessed early life experience (Shapiro, 2014). Since it is reasonable to consider that trauma related to childhood sexual abuse falls under this category, EMDR is a reasonable candidate for therapy.

The EMDR theory approach states that when patients act in a dysfunctional manner, it is because their perceptions of their current experiences are marred by unprocessed memories. Therefore, this scenario has a clearly identifiable target for treatment. Psychotherapy is therefore an ideal way to assist these patients because it allows patients to recognized repressed thoughts and feelings and to use this realization to mediate their symptoms. Psychiatrists boast that this treatment could aid healing in as few as four sessions (Posmontier et al., 2010). Therefore, this is an advantageous therapy in light of the negative psychological impacts of sexual abuse. Since many victims are afflicted by depression and thoughts of suicide, a quick intervention that is able to target the cause of their mental state is helpful.

Psychotherapy sessions that utilize EMDR attempt to trigger saccadic eye movement, which mimics the rapid eye movement (REM) stage during sleep (Posmontier et al., 2010). It was found that patients with PTSD who experience saccadic eye movement are benefitted by the reprogramming of negative thoughts into positive ones (Greenwald, 1994). Since many individuals who experienced sexual abuse related trauma as children, EMDR as therapy for this patient population was explored (Rothbaum et al., 2005).

Treatment of Trauma Patients with EMT

To create a safe context in which both parties feel safe communicating with one another, it is essential to allow them to explain how trauma has impacted the relationship, to allow them to reflect and validate those experiences that are poorly defined, to assist the couple in developing safety rules and personal limits, and educating partners about the impacts of trauma and how they can manifest in the relationship (Johnson, 2005). The necessary components of creating a safe context include a reflective atmosphere in which clients feel they are listened to and accepted, the confirmation of the therapist’s understanding of the situation, the ability of the therapist to direct the conversation to the most relevant issues, to pace the session in a manner that allows the emphasis of key topics, and to organize the experience in a manner that prevents the clients from feeling overwhelmed. This process is necessary because it allows the therapist to direct the therapy in a manner that minimally interferes with the communication occurring between the clients. However, the adjustments and structure that the therapist offers will enhance the emotional response of the clients and efficacy of the therapy.

Next, it is essential to determine the client’s ability to accept what has occurred during therapy; this phase is known as validation. This step helps the clients become more aware of the conversation that has just taken place in addition to helping them understand the context of their problems. Furthermore, it destigmatizes issues that stem from the afflicted client’s trauma and removes the sense of failure and shame typically felt. The most effective way to ensure that this occurs is to treat both members of the couple equally in the sense that they have something that they can contribute to their relationship and that they have equally responsibility in turning their weaknesses to strengths.

In early sessions, it may be necessary to help the clients unfold their experiences. However, as the therapy sessions continue, the clients should be able to do this themselves. Despite this, the therapist should constantly utilize empathic inference to draw a connection between each client’s emotional interactions and responses to paint a complete picture of their situation. In addition, therapist involvement is also required to help clarify and add to certain events that are deemed significant. The last step of creating a safe context in therapy is determining how the couple will solve problems regarding safety issues. The therapist should discover how the couple handles negative emotions and self-destructing behaviors, how they recognize these behaviors, and what should be done either individually or in therapy when this occurs.

The next step of therapy involves clarifying interactional patterns and emotional responses that shape these patters. Attack and alienation reflect distress in the relationship and this step requires identification and modification of behavior to prevent this occurrence. To do so, it is essential for the therapist to track and summarize interactions after each therapy session to determine events and patterns that are relevant to the couple’s behavior. Repeating patterns should be brought to their attention and assessed as a group. Once these patterns are identified, it is necessary to identify the emotions that are the basis of these behavior patterns. This will elucidate the connection between attachment insecurities and emotional response, which will help the non-traumatized client understand the basis of their partner’s reactions.

Once the basic issues underlying the couple’s relationship problems are identified, the therapist must focus on restructuring the bond between partners. First, the emotional experience of the couple will be focused on. At this point, both partners are aware of their fears and insecurities that constrain them and this step will begin to help them get past these fears. The restructuring of emotion can include containment of feelings or expression and will depend upon the individual case. Next, both partners must create a new sense of self in relation to their partner’s feelings in an attempt to evolve past relationship difficulties. Finally, the therapist will guide interactions between the couple to provide a tighter bond between the two that will allow for greater accessibility and responsiveness. It is important to note that progress may be difficult at this stage because this is where the greatest change is being made. However, it is necessary for the therapist to assess which techniques are working and revise the approach if the couple is not improving.

The last stage of EMT is integration, which helps each partner define themselves, their relationship, and their resilience to traumatic stress. To do so, the therapist must help the clients integrate their newly developed emotional experiences and self-schemas into their sense of self. Next, the therapist should assist the couple in defining their relationship based on their newfound ability to interact and communicate. It is important to remind them that after therapy ends, that they can trust each other and act as support if any future problems are to arise and that it is essential to continue communicating after therapy. In this sense, individuals who experienced childhood trauma will feel that they are supported and this new understanding will help reduce some of the anxiety they suffer.

Treatment of Trauma Patients with EMDR

EMDR consists of eight phases. When a therapist first identifies a patient in need of treatment, they must acquire the patient history in order to enact a plan of treatment. This first phase involves the need for the patient to confide in the traumatic event that occurred in full detail. In addition, the therapist will identify the dysfunctional behaviors exhibited by the client. Finally, the client will be referred as a candidate for EMDR provided that their medical history allows them to be eligible. A contraindication for treatment is heart disease (Posmontier et al., 2010).

Phase 2 of EMDR prepares the client for therapy by defining their role in the process and making them aware of what it entails. The therapist will identify the number of sessions necessary for treatment and explain that the role of the client is to facilitate the revelation of traumatic experiences. In addition, it is essential to warn the client that he or she may experience negative thoughts. The next part of the process involves informing the client to contact the therapist if any negative thoughts are experienced outside the clinical setting. Lastly, the client will be taught relaxation techniques to counter disturbing thoughts.

Phase 3 of EMDR allows the client to choose a traumatic event for assessment. This includes defining how the client feels about his or herself as a consequence of the event’s occurrence. In addition to a description of the feelings, the client will be asked to rate how disturbing the memory is on a scale of 1 to 10. The therapist will then ask the client what he or she wants to believe about his or herself, and these positive beliefs will again be rated on a scale of 1 to 10.

Phase 4 involves the desensitization of the traumatic event through description and then experiencing bilateral brain stimulation. The client will then be asked to focus on what is on his or her mind towards the end of the bilateral brain stimulation and this will continue until the disturbance is cleared from the neural pathway memory (Shapiro, 2001). This process will be repeated over several sessions.

Phase 5 focuses on the strengthening of positive cognition associated with a positive target image to replace the disturbing thought. In Phase 6, the client will imagine his or herself in the disturbing situation but in a scenario where they took action to prevent it. This should then be followed by positive thoughts followed by bilateral brain stimulation. The client will be asked to scan his or her body to determine whether there is any physical sensation that indicates the presence of the traumatic event. If these are present, desensitization will be emphasized in future sessions. Lastly, phase 7 focuses on closure to determine whether the reprocessing is complete, and phase 8 calls for reevaluation of progress at the beginning of each session.

Strengthening the Sexual Relationship

After treating the underlying symptoms of childhood sexual abuse, it is essential to restore the sexual relationship between the afflicted individual and his or her partner. This will reinforce the healing that has occurred during therapy and provide the patient with a person that he or she can rely on during times of emotional struggles. This component of treatment differs from the aforementioned because rather than focusing the symptoms of a psychological disorder, strengthening the sexual relationship may involve treating physical consequences of a psychological disorder.

Broadly, sexual disorders includes issues of desire, arousal, and orgasm. In the case of adult childhood abuse survivors, desire and arousal should be primarily considered. At the start of therapy, many of those who were abused as children avoid sexual contact because it triggers memories of their abuse. After EMDR and EMT therapy, these feelings should be minimized. Therefore, this is an ideal opportunity to determine whether the afflicted couple is able to reestablish sexual contact, and if not, to help them do so.

Recent studies claim that Functional Family Therapy is an ideal treatment for inhibited sexual desire (Regas et al., 2007). This form of therapy is related to the lasting effects of EMDR and EMT. The first step emphasizes communication, and the second step aims to minimize hopelessness and increase self-worth, which these two therapy methods should have already accomplished. Therefore, it is necessary for the therapist to dig more deeply into the afflicted couple’s relationship to define blame and other negative patterns. Furthermore, stress reduction should be a goal of this phase as well. A relational assessment will then allow the couple to discuss their values and goals to find a commonality; this will improve communication skills and the feeling of closeness using the foundations of EMDR and EMT. Next, the need for behavior changes will be identified and resolved. After this is accomplished, relapse prevention will be initiated.

Conclusion

EMT and EMDR are useful therapies for adult victims of childhood sexual abuse. EMT is effective because it emphasizes communication between the afflicted individual and the partner, which allows the patient to recognize the root reasons for distress and work towards finding a solution as a member of a team. EMDR is effective because it helps the patient identify bad memories and feelings related to the abuse and allows them to partially remove or cope with these memories. Both EMT and EMDR provide a solid foundation for the development of a strengthened sexual relationship. Functional family therapy builds upon this foundation to allow the couple to realize the source of their sexual distress and change negative behaviors to positive ones and further foster communication between the two. It is possible that a combination of EMT, EMDR, and functional family therapy would be an ideal response to strengthen the relationship between adult survivors of sexual abuse and their partners. It would be useful to conduct a clinical study of this relationship to determine the efficacy of this method, which would help many individuals in distress.

References

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