Sexual trauma is different for each individual who survives it. Some individuals experience trauma as children, whereas others are adult survivors. Some clients may be very communicative about their trauma, while others may have difficulty talking about it at all. Helping professionals who work with traumatic sexual abuse survivors must take these individual differences into consideration as they choose and implement interventions.
Consider the following case study and identify intervention strategies appropriate for your role and responsibilities as a helping professional.
The Case of Beth and Don
Beth has been married to Don for 3 years. Beth and Don are seeking couples counseling because the couple wants to start to try to have children, but their lack of sexual relationship threatens to make that an impossible dream. Beth and Don admit that they have never consummated their relationship.
Don has known since early in the couple’s dating relationship that Beth was raped by a stranger about 6 months before they started dating. Since that time, she has been unable to even think about having sex without having a panic attack and crying. Beth appreciates that Don has been extremely patient and understanding as she has undergone extensive therapy to work on her posttraumatic stress disorder (diagnosed by her individual psychotherapist). However, she admits that she is afraid that he will leave her because she is “not willing to have sex with him right now.”
Beth and Don both make clear that having children is an important goal of theirs. Beth says, “I have always wanted to be a mother. I know that having sex is a necessary step to making that happen. It’s killing me that I’ve still not been able to have sex with Don. I just want to get over this once and for all and be able to have sex like a normal couple and have kids, too.”
Post by Day 4 an analysis of how Beth’s traumatic sexual history may be impacting her marriage. Identify an intervention that you would choose to assist Beth and Don. In your rationale, discuss the underlying theory of the intervention and how it will address the couple’s intimacy problem.
Read a selection of your colleagues’ postings and comment on a differing perspective.
Respond by Day 6 to at least two of your colleagues’ postings that presented a different intervention strategy. Identify the similarities and differences in your individual interventions. Share any insights gained from your readings and comparison.
Colleague 1: Kelly
RE: Discussion – Week 10
Analysis of how Beth’s traumatic sexual history may be impacting her marriage
Beth’s history of sexual trauma can create problems with communication, trust, intimacy, self-esteem, and enjoyment of activities with can impact her marriage (Boyd, 2011). An individual’s sexual schema, or their perceptions of their sexual self, is formed by past and current experiences and generalizations about the sexual self (Hitter, Adams & Cahill, 2017). The sexual schema influences personal decisions about sex and can impact sexual satisfaction (Hitter, Adams & Cahill, 2017). Like Beth, survivors of sexual trauma often experience difficulties with sexual intimacy (Baggett et al., 2017). Beth has been diagnosed with PTSD that may have developed because of the fight, flight, or freeze response triggered by the traumatic event (Baggett et al., 2017). Beth has become avoidant of the cues that trigger that stress response and consequently avoids sexual contact with her husband. Many factors influence marital satisfaction, including a safe and mutually pleasurable sexual relationship (Ziaee et al., 2014). For long-term satisfaction in their marriage and to fulfill their desire to have children, Beth and Don’s sexual intimacy issue needs to be addressed.
Identification of an intervention to assist Beth and Don
An assessment of Beth’s PTSD symptoms should be conducted before implementing any intervention. Once the assessment is complete, and the focus areas are identified, the intervention that I would use to assist Beth and Don is a sex-positive, trauma-focused approach that includes a psychoeducation component (Baggett et al., 2017). A sex-positive approach is based on the understanding that sexual pleasure is a normal, essential part of human behavior and well-being (Baggett et al., 2017). The sex-positive framework is based on modeling the acceptance of healthy sexuality, openness in discussing topics that may be difficult for the client, and promotes a positive perspective of sexual intimacy (Baggett et al., 2017). This approach can help Beth reclaim her sense of sexuality that may have been damaged because of the sexual trauma and give her the tools to articulate her desires and boundaries in a sexual relationship with Don (Baggett et al., 2017). The psychoeducation component of the intervention can help Don better understand PTSD and the resulting symptoms that Beth experiences. This approach can also help Beth and Don discuss and establish mutual goals and communicate about power, safety, and trust in their intimate encounters (Baggett et al., 2017).
Baggett, L. R., Eisen, E., Gonzalez-Rivas, S., Olson, L. A., Cameron, R. P. & Mona, L. R. (2017). Sex-positive assessment and treatment among female trauma survivors. Journal of Clinical Psychology, 73(8), 965-974. https://doi-org.ezp.waldenulibrary.org/ 10.1002/jclp.22510
Boyd, C. (2011). The impacts of sexual assault on women, https://aifs.gov.au/publications/impacts-sexual-assault-women
Hitter, T. L., Adams, E. M. & Cahill, E. J. Positive sexual self-schemas of women survivors of sexual abuse. The Counseling Psychologist, 45(2), 266-293. https://doi-org.ezp.waldenulibrary.org/10.1177/0011000017697194
Ziaee, T., Jannati, Y., Mobasheri, E., Taghavi, T., Adbollahi, H., Modanloo, M. & Behnampour, N. (2014). The relationship between marital and sexual satisfaction among married women employees at Golestan University of Medical Sciences, Iran. Iranian Journal of Psychiatry and Behavioural Sciences, 8(2), 44-51. https://www-ncbi-nlm-nih-gov.ezp.waldenulibrary.org/pmc/articles/PMC4105603/
Colleague 2: Stephanie Bailey
RE: Discussion – Week 10
Week 10: Interventions for Survivors of Traumatic Sexual Abuse
Traumatic Sexual History and Intervention
The first step is ensuring Don and Beth often realize female survivors of sexual assault report significant challenges to their sexual interactions and relationship functioning following the assault, and with time these barriers can be overcome (Tambling, 2012). Women who are survivors of similar situations as Beth’s are at a significantly higher risk of developing physical, psychological, and interpersonal difficulties (Tambling, 2012). While survivors go through a process of recovery after sexual trauma, their partner is often affected. A common problem males experience after their partner’s sexual trauma relates to Don and possibly his concern for his wife, creating problems with communicating with his wife in the context of sexuality (Tambling, 2012). Beth is experiencing symptoms of PTSD after her sexual trauma. Cognitive-behavioral type treatment methods generally result in improvements in PTSD-like symptoms over time after post-sexual assaults like Beth’s (Tambling, 2012).
Working with Beth and Don, the social worker must have an effective plan in establishing productive and positive sexual activity and strengthen relation functions in their marriage (Tambling, 2012). Both individuals want to have children, and this is a primary goal within their marriage. Solution-focused therapy may be helpful for the couple overcoming barriers caused by the sexual assault. Solution-focused therapy is naturally empowering to the client by focusing on what Beth and Don are already doing well, amplifying expectations to problems, emphasizing their strengths, and making behavioral modifications (Tambling, 2012). Both of them can achieve changes and enhance their sense of mastery over difficulties; if the social worker helps set clear and achievable goals, Beth is likely to experience a sense of control over the problem (Tambling, 2012). Discussing the assault, and the psychological outcomes of the event, with trusted counselors, can grow a supportive network and offer opportunities for Beth to feel safe and comfortable and understand triggers. Such techniques aid Beth and Don in exploring exceptions to the problematic behaviors and thoughts and build a supportive community within and around the couple that value the individuals and their experiences (Tambling, 2012). Through therapy and Behavioral modification techniques working together to reduce or eliminate triggers, Beth can feel an enhanced sense of safety (Tambling, 2012). Together these techniques can utilize traditional solution-focused methods to create positive therapy outcomes for Beth and Don and facilitate a safe place to begin the process of conceiving children (Tambling, 2012). Which is the goal for the couple.
Tambling, R. B. (2012). Solution-Oriented Therapy for Survivors of Sexual Assault and their Partners. Contemporary Family Therapy, 34(3), 391–401. https://doi.org/10.1007/s10591-012-9200-z