I was recently interviewed by an Australian production company about my work with adult men that have been victims of childhood sexual abuse (CSA). The focus was on the research concerning this subject as well as how I specifically work as a clinician with men who present to me with these difficulties in my therapy office. For those who don’t know, I’ve written the definitive meta-analysis of sexual outcomes of adults who have experienced CSA, and my research won an award for original scholarship and was published in a peer-reviewed academic journal. You can access it here.
Anyway, the interviewer asked me a number of very poignant and powerful questions, and I thought this blog would be a good venue for discussing some of the most salient points that came out of the interview. Even though the interview focused on men, my thoughts in this article are applicable to all individuals. Once the interview is live, I will post it on my media page, so be sure and be on the look out for it and keep checking this site.
The foremost question that the interviewer wanted to know, and that is also on the forefront of a number of my clients’ minds is to what extent does CSA effect adult sexuality? This is a very complex question because it incorporates a number of contextual factors. According to both the research and my clinical experience, people experience trauma very differently and a lot of it depends on a complex mix of environmental and psychological factors. First, not everyone experiences trauma from a childhood abusive event. Indeed the following external criteria are most predictive of subsequent traumatic effects– 1) the extent and duration of violence and aggression employed, 2) whether or not the child knew the abuser, ie, whether they felt betrayed and 3) perhaps most importantly, how did the family react to disclosure of abuse, were they supportive or reactive?
Age and gender of the child also play a big part. The younger the child, especially younger than age 6, the more likely the child is to behave in ways that re-enact the trauma. For example, the child may display aggression and try to touch other children inappropriately. Adolescents (older than age 12) are more likely to display signs of inhibition and dysfunction and struggle with fears around sex. Likewise, male children are more likely to re-enact, while female children are more likely to become afraid and inhibited. In my scholarly article (linked above), I theorize that younger children do not yet have enough awareness to make sense of their experience so they attempt to re-enact as a means of making sense, while older children have enough knowledge and awareness to develop a phobic response to their trauma. Likewise, boys are more likely to have learned different messages about sexuality, and may tend to have internalized less social negativity, but this is all theoretical of course.
Let’s move on to some of the therapeutic questions I encountered in the interview. I was asked to provide some examples of interventions I may use with clients. As mentioned above, every individual reacts differently to life experiences, even if those events on the surface may appear very similar. So, before going any further, it is important to understand the mindset I take on, which is one of open-mindedness, curiosity, and establishing safety. I don’t want to assume anything. In addition, I don’t want to lead my clients or influence them unnecessarily, for example, by reacting strongly to a trauma revelation. Indeed, as I have discussed above, people are often traumatized by the reaction of others around them more than by the event itself.
Moving along, once I have obtained a good sense of the client’s life story and narrative, I mentally construct a hypothesis of the nature of the difficulties and how we can work together to resolve them. In order to tackle this issue, we need to understand what trauma is fundamentally, which is an anxiety response. So, I am very attuned to signs of anxiety in the client and one of my goals is to help the client modulate and manage their levels of anxiety, both in session and when they are going about their lives. As I’ve discussed in a previous article, when someone starts feeling anxiety, two fundamental physiological changes take place. First, their breathing becomes more belabored and shallow. Second, they withdraw into their own minds, as their thoughts may start to race and become obsessive. To counteract this, I teach my clients to focus on taking slower, deeper breaths and to draw their attention into a mindful observation of their bodies. The human mind is very poor at multi-tasking, so if the individual is focused on noticing their physical sensations, it prevents them from spiraling down the rabbit hole with their thoughts.
As I describe in my book Modern Sexuality, to help my clients diminish the intensity of their fear and anxiety response, I need to help them progressively expose themselves to low-to-moderate levels of anxiety, which they learn to tolerate. In this way they undermine the intensity of the anxiety and expand their comfort zones. One of the most pernicious aspects of trauma, or any other mental health difficulty, is the reinforcement of experiential avoidance. This means that when anxious or depressed, the client tends to withdraw and avoid experiences that could exacerbate the feeling. Unfortunately, this type of avoidance only reinforces the depression and anxiety because the very act of avoidance proves to the individual that the depression and anxiety are justified. Only by challenging that narrative through small and carefully controlled graded steps can the individual start to challenge their feeling of being stuck and/or victimized.
Indeed, the very essence of empowerment is to find behaviors and activities that provide pleasure and a feeling of self-agency. These are vital aspects of living that sexual abuse survivors may often feel robbed of. So a major part of the work is to learn to manage the anxiety and then plan small, concrete steps to face the anxiety in tolerable levels, while finding aspects of life (in this case sexuality) that feel empowering and pleasurable. As I’ve mentioned before, it is not enough to feel less pain; we must be in contact with pleasure as well in order to feel the powerful motivating force to move forward and make changes in our life.
Overall, the interview lasted about 45 minutes and covered a lot of ground, only some of which I was able to address in this article. This is one of the most important and pernicious difficulties of our age, so developing knowledge and collaborating on best principles is a key mission of my work. Once again, stay tuned and keep checking the site, as I will post the video as soon as it become available.