Working with Couples to Address Childhood Sexual Abuse
by Les Simmonds
A significant number of couples present for therapy, with one or both of the partners having experienced sexual abuse as a child. Many of the clients who experienced childhood sexual abuse have engaged in individual therapy to address the multitude of issues precipitated by the perpetration visited upon them. Individual counselling is the traditional approach to addressing childhood sexual abuse however, the impact of the abuse frequently generates relationship difficulties for example trust, of which many aspects are best responded to within the couple-counselling context. Couple counselling approaches have been successfully employed as an alternative to a therapist and an individual client working through the myriad of issues which result from childhood abuse and trauma. Emotionally Focused Therapy (EFT) is notable in the literature as a comprehensive systemic approach to working with people who have experienced trauma and abuse as a child (Johnson, 2008).
The systemic approach outlined in this article is less prescriptive than EFT and can be used to complement individual therapy, or applied as a standalone therapeutic intervention. The framework used is strongly influenced by the Metaframeworks approach (Breunlin, Schwartz, & Kune-Karrer, 2001), which is summarised at the end of this chapter. The Metaframeworks approach provides a set of theoretical ideas which create links between past and present and the internal and external worlds clients bring to the therapeutic process. Themes common to this work: safety, ambivalence and commitment are described as tending to be sequential in nature, while at the same time, possessing fluidity as they enter and exit the therapeutic process over the course of treatment.
Sexual difficulties are often present in couple counselling, and their prevalence within the sexual abuse context is exacerbated. In this article, whilst not a sex therapy manual, a number of commonly presented issues related to love and sex are illustrated within the case studies presented.
The First Session
Session One with a couple requires one and a half- two hours to complete and comprises three parts. The first part involves describing the process of working with issues related to childhood sexual abuse within a couple-counselling context. Included within this description is the ability of a couple-relationship to provide a real-life context for healing past trauma. For example, a victim of sexual abuse may find it difficult to trust another person at a deep emotional level after, for example, being abused by a supposedly loving and caring stepfather etc. Repairing such a breach of trust can hardly have a better context than in one where a person has chosen to live with another for the rest of their lives. Within this description it is important to highlight the shared nature of the counselling process and that the focus is not just on the person who has been abused more so, that the healing will develop from shared story-telling and mutuality of the couple developing understanding and intimacy.
The second phase is to see each partner individually to assess several aspects of the relationship. From a practice point of view, it is important to see the female partner first in order to ascertain if physical or sexual abuse is currently present in the relationship. If the therapist determines this is the case, the remainder of the session can be managed in a way that does not place the female at further risk. For example, the individual session with the male client would avoid addressing safety in the relationship and focus on the need for each person to engage in individual counselling to address one specific issue or another. This approach allows for female clients to develop a safety plan etc. It is clearly understood that some women are abusive in relationships however, the risk of a male partner being hospitalised etc is minimal compared with female to male violence and this thinking determines the sequencing of the session and does not predetermine who could be abusive in the relationship. Under no circumstances should couple-counselling of this nature be undertaken where abuse or the threat of abuse is present. If it is safe to proceed, the following questions are useful primers and the rationale for each set of questions is provided.
Couples often feel afraid to discuss the feelings and thoughts they have about each other. A number of reasons cause people to fear talking openly about what bothers them in their relationship. For example, you might be afraid to tell your partner that you don’t have loving feelings toward them, because they might respond by leaving you. Some people are afraid to face their own feelings and others fear their partner’s anger. Whatever the reason, people in couple therapy need to talk about thoughts and feelings in order to have the kind of relationship they desire.
• Do you feel safe enough to talk about your thoughts and feelings with your partner? If not, what stops you?
• On a scale of 1-10, how safe do you feel talking to your partner about your thoughts and feelings?
• What events/actions would increase your sense of safety?
• What actions/events would decrease your sense of safety?
Ambivalence in relationships usually means people are unsure about what they want. For example, do I want to stay in this relationship? Or, do I want to leave? Many people feel ambivalent about their relationship when it becomes mundane and/or things are going wrong for them. Facing up to the ambivalence is an important step in dealing with the issues that promote it.
Are you experiencing ambivalence? What makes you feel more positive about your relationship? What makes you feel less positive?
It requires commitment from a couple to face up to their relationship issues and to successfully work with them.
On a scale of 1-10:
• How committed are you to working on your relationship?
• What motivates you to rate your commitment at the level you have?
• What needs to happen to increase your commitment?
The third phase brings the couple back together to reflect on their thoughts re safety, ambivalence and commitment. In reporting back, the therapist’s task is to reframe what was discussed in the second phase of the interview. For example, a client may have said that they “do not trust their partner when it comes to sharing their feelings with them”. Having asked the client individually if they would like to be able to trust their partner, and if the answer is affirmative, the therapist could feedback with the couple that the client would like to develop a more trusting relationship. By identifying relational themes such as trust and intimacy, and highlighting them in feedback and conversation with the couple in a manner which signifies positive change, the therapist creates a series of threads that are woven throughout the therapeutic process. Therapists must take care in this process to be led by the client and to ensure collaborative practice is the cornerstone of the therapeutic endeavour.
The identification of key themes signals the final stage of the first session; providing a summary of the content which has been raised throughout the process and future steps for counselling as a conclusion to the process. A sense of hopefulness should be conveyed to the clients, even if the imminent future looks bleak. For example, a couple may disclose that they are on the brink of separation however, regardless of how black it seems at the moment, “you have taken the courageous first step of sorting your difficulties out”.
Any issues relating to safety, ambivalence and commitment are dealt with following the initial session and precede any therapy relating to the abuse. However, many clients who have experienced abuse may find it difficult to experience a full sense of safety, and a collaborative judgement between the therapist and client needs to be made regarding the question of whether it is safe enough to proceed. This approach in itself often creates an increasing sense of safety and a measure of whether to proceed may be based on the ability of clients to be respectful and caring of each other.
In the author’s experience, the number of sessions between couple’s ranges from eight to twenty and the decision to continue beyond eight is made on the couple being able to show signs of progress. Difficulty in making progress, more often than not, relates to the quality of the couple’s relationship, and referring the client who has experienced the abuse to individual counselling, while continuing to work with their relational issues may be the most responsible course of action.
Safety, Ambivalence and Commitment
The absence of safety in a relationship pre-determines the initial counselling process which is the creation of a safe and secure relationship. The absence of safety and commitment excludes the use of this couple-focused approach in working with sexual abuse. If violence exists in the relationship, safety planning, empowering an abused partner to leave the other and/or the enrolment of the perpetrator in a programme, becomes the focus of treatment. Often the treatment combines offender treatment, safety planning and empowerment of the abused person. Couple-counselling can be a useful adjunct to the above however, it should not be put in place if the violence is ongoing in the relationship.
Abusive relationships aside, couples frequently report feeling unsafe sharing their deepest thoughts and feelings with one another, and the approach taken involves a continuation of the questions asked individually in the second phase of the initial interview. The use of reflexive questions (Neden, 2012 & Tomm, 1987) to begin building a safe context, evolves into a plan for action developed by the couple. For example, questions such as “If your relationship was a safe haven, how would you go about sharing your deepest thoughts and feelings with each other”, “In what way would you talk with each other?”, “What impact would talking in this way have on how you felt about one another?”, “How would this way of thinking and feeling impact on the intimacy between you both?”, “If the intimacy grew between you in the way you described, what would happen to the level of trust in your relationship?”and “If the trust between you grew to the extent we just talked about, how safe would you feel in your relationship?”
The use of reflexive questions in this context is for the therapist to support the couple to paint an intricate picture of a safe and trusting relationship and the concretisation their possible next steps. For example, questions might include, ‘what would be the first step you could each take in building this safe trusting relationship’? How could you support each other to do this’? ‘When could you start’? ‘What do you think could go wrong’? ‘What could you do to deal with that difficulty if it arose’?
It is important for the clients to make a contract with each other outlining the steps and actions they will take to increase safety in their relationship. In consolidating this piece of work the author finds it helpful to the client’s if a letter is sent as a follow-up to the session which summarises the conversation and the contract the couple developed. Without exception, the belief that clients wish to move towards a healthy and fulfilling relationships is held at all times and the reason for failing to achieve this is that they are constrained in some way. These constraints are seen as being located in one or more of the six Metaframeworks outlined in the synopsis at the end of this chapter.
Ambivalence and Commitment
Ambivalence towards a relationship is driven by numerous relational difficulties for example, conflict, lack of intimacy and love, frustration, boredom, unfulfilling sex, loneliness and hurt etc. Relational difficulties deprive couples of meaningful connection and over time, distance and isolation lead to separation or a sense of hopelessness. The antidote to ambivalence is commitment, fuelled by connection and friendship (Gottman, 2002). The exploration of what moves a couple to become less ambivalent and more committed, is central to dealing with this issue. The questions used, continue the theme started in the first session and identify which behaviours move a person towards a greater commitment to the relationship, or away from it. The identification of what could bring commitment to the relationship, illustrates a solution or way to foster positive change. Motivational Interviewing (Hohman, 2012) explores ambivalence by engaging clients in reflection on the ‘good things’ and ‘not so good things’ about making an identified change. The benefit of making the change must outweigh the cost of this change, in order for the client to resolve their ambivalence.
If ambivalence towards the relationship is identified, it is the practice of the author to spend a considerable portion of time working with this issue in the way described above. The resolution of ambivalence precedes commitment and committing oneself to a potentially difficult process is dependent on the type of contract entered into. It is unreasonable to ask clients for an open-ended, iron-clad commitment which they are unlikely to live up to. With this in mind, the contract the therapist discusses with many couples involves approximately twelve weeks, in which the couple focus on supporting each other while working to create positive change in their relationship.
When the issues of ambivalence, safety and commitment are resolved, the second stage of working therapeutically with the abuse can begin. However, the separation between the two stages is difficult to delineate, as many survivors of sexual abuse may have trust issues which, when dealt with in the couple relationship, work towards healing emotional wounds experienced in childhood.
Steps Towards Healing
1. The client’s family of origin story and the development/identification of ‘Parts’
2. The impact these ‘Parts’ play in the current relationship
3. Managing the internal and relational worlds
4. The abuse story and the impact it has had on the survivor
5. Towards healing
Two Cases in Point
James and Sandy, two forty-one-year-olds married with two children, sought counselling after James left the relationship for another woman. James spent one week with the woman he left Sandy for and returned to the relationship after he thought he had made a mistake and had become depressed; experiencing overwhelming guilt and shame. In reuniting with his partner, James started talking about the sexual abuse he had experienced aged 5-10 years, at the hands of his uncle. The same uncle introduced him to pornography which was an addiction James had struggled with since childhood. James was an elder in the church and prior to leaving his wife, used to view pornography and masturbate up to seven times a day. The couple were referred to the author by a family therapist to help James deal with his addiction to pornography.
Cheryl and Joe, two thirty-six-year-olds married with three young children were referred to the author by a Couple and Family Therapist, due to a number of issues relating to Cheryl’s childhood sexual abuse remaining unresolved. In addition to the relationship counselling, Cheryl had engaged in individual counselling over a number of years to resolve issues she identified as originating from the abuse and trauma she experienced as a nine-year-old child. The presenting issues included a high level of conflict in the relationship, Cheryl’s lack of trust in her partner to support her emotionally, a lack of intimacy and little or no sexual contact between the couple.
The Clients’ Family of Origin Story and the Development/ Identification of Parts
The couple are informed that they are to become observers of each other’s lives in a special way, and the importance of this is that deeper understandings create relationships which provide a context for healing past hurt and trauma. Each person is interviewed separately, while the other looks on. It is important for the observer to be silent and they are asked to imagine what it would have been like to grow up in that family? Trust, love and warmth, caring, respect, availability, understanding gender roles and belief in self are some of the themes which are explored during this part of the session. The author interviews the survivor of abuse first, as this seems an obvious fit for the clients in so much as the presenting issues relate to the abuse and trauma.
The client is asked to choose a time that comes to mind when they were growing up in their family. They are asked to describe family members and talk about the kind of relationship they experienced with them. Questions such as “How would you describe your relationship with your mother/father etc?”, “Who did you feel closest to?”, “How did your mother and father relate to each other?”, “What did you learn about being a man/woman from your mother/father?”,” What did they teach you about your self-worth?”, “How did they teach you this?”, “What kind of feelings did this evoke?” and “What did you learn from them about how to relate to members of the opposite sex?” are asked. This type of questioning is usually conducted at a measured pace and tends to transport clients back into the reality of the past, with the client and the observer typically becoming very engaged in the process.
Joe and Sandy
In the case of James and Sandy, it emerged that James’ father was cruel and emotionally abusive. For example, he used to tell James how ugly he was and made hurtful comments at the table, such as, “pass me the salt, big nose” or “you’re so ugly, no girl will find you attractive”. On the other hand, James was favoured by his mother; however, she did not show him warmth through hugging or touching. James described his childhood to Sandy, talking about how the conflict between his parents and his experiences of emotional abuse led him to withdraw into himself, feel worthless and compartmentalise various aspects of his life. He talked about how he learned from his parents to portray one-self as being a devout Christian outside the family, while living differently within it.
During the therapeutic conversation, James’ development in his family of origin was discussed in terms of a ‘Part’ of him which learned to withdraw from conflict hurt and abuse, while another ‘Part’ self-soothed through masturbation. Other ‘Parts’ learned how to pretend that James was confident etc; while in the background he was left feeling worthless as other ‘Parts’ of him sought love and acceptance.
Sandy also grew up in a religious household and her sister was sexually abused by a member of the family’s church. Sandy’s mother refused to go back to the church while her father continued to be part of the congregation. This created a rift in the family and engendered considerable conflict between Sandy’s mother and father. Sandy took her father’s side and believed her mother’s actions created disharmony and unhappiness in her and her family’s life. A ‘Part’ of Sandy believed mothers should never create dissension in the family, while others blamed her mother, feared conflict and worked towards maintaining peace at any cost.
Metaframeworks: A Brief Synopsis
Metaframeworks is a systemic approach, which uses the core concepts of systems theory, including pattern information, relationship, level, context, feedback, recursiveness, and circularity.
The perspective is supported by a biopsychosocial model, viewing systemic interactions as multilevel and interacting in a reciprocal manner on biological, psychological and social levels. Metaframeworks organises six overarching frameworks into domains: Organisation, Sequences, Internal Family Systems, Development, Gender and Culture, which classify a range of ideas for therapists to use as a lens in understanding human systems.
These Metaframeworks provide the vehicle for therapists to hypothesise how problems presented to them by families are generated, and also as a guide to find solutions to these issues.
This perspective believes people search and work towards finding solutions to their problems and inherently have the ability to do so, if not constrained in some way. The constraints to solving problems for human beings are biopsychosocial and can be viewed from one of the six Metaframeworks. For example, a person can be constrained by an interactional sequence they are embedded in or how their couple/family system is organised.
The approach of a Metaframework’s therapist is to work collaboratively with couples/ families so they can identify and lift the constraints that stop them finding the solutions to the problems they present in therapy.
Relational development involves attraction, liking, nurturing, co-ordinating meaning, rule setting and meta rules. These processes can be seen as occurring in stages. For example, attraction precedes liking. However, all the processes are in place at the beginning of a relationship and are recursive, for example, nurturing strengthens liking. Each process involves action and meaning. For example, a man might provide support to a woman (nurturing) however, the woman must see that support as a nurturing act.
The feedback we receive comes in the form of what we are told and what we observe. Reading feedback is not necessarily a question of our understanding of what is being conveyed. It is also about understanding the attributions to meaning we give to the information.
Complete human systems are multi-level entities with biological, psychological and social levels. Biological and mental processes are at the individual level and individual, dyadic or triadic relationships are within groups and families. These families reside within a larger social system; the community. Systems are nested within other systems, and they interact in a recursive manner.
Individuals and groups operate within a context and behave differently, depending on the context. The novel, ‘The Lord of the Flies’, shows how radical behavioural changes in people occur as a result of a changed context.
Six Core Domains
All social systems organise themselves, and theorists have used the notion of hierarchy and control as a way of understanding how a particular system functions, or should function. This mechanistic view lends itself to a leadership style, which is rigid and not easily adaptable in today’s rapidly changing environment. In order to move away from this mechanistic view, the concept of leadership balance and harmony is used to understand how organisations function.
The concept of leadership balance and harmony addresses power and control issues within organisations, and at the same time meets the need for social systems to utilise the strengths of each individual member, and be flexible enough to adapt to an ever- changing environment.
Metaframeworks: A Brief Synopsis continued:
The key ideas, which underpin the latter concept, are:
• All members of a family are able to take a leadership role, depending on their skill and ability.
• Boundaries are important and are based on functions, ethics, and the stage and development of each member of the family. For example, a family member should not be put in charge of others if s/he is unable to resist the temptation of using the power of their position for personal gain.
• Resources need to be spread equitably and one family should not be given unwarranted preferential treatment.
• Leaders (mainly parents) are charged with creating balance and harmony through the equitable sharing of resources, encouraging others to take up a leadership role, and ensuring appropriate boundaries are maintained.
Sequences are patterns of action and meaning that occur within social systems. These patterns may last for a couple of minutes and involve a minor spat with a father and son, which is quickly forgotten. Patterns may last throughout the day, for example, a family might have breakfast at 7.30am and dinner at 7pm. This can be thought of as a routine. Patterns may come and go throughout the year, for example, a husband might go on an overseas trip twice a year and have an affair. This can be thought of as a pattern that ebbs and flows. Finally, patterns can be generational and may involve age-old rivalry or recurring crises.
These sets of sequences are often interlocked, for example, an argument between a husband and wife can come about because he drinks too much at dinner.
The way men and women relate to each other is a significant issue in couple relationships, families, communities and society. We have all been socialised to think about the roles women and men should play in our society. Men and women play out these beliefs both consciously and unconsciously within families and other social groups. A man may seek to take a dominant role in a relationship, even though he considers himself to be an advocate of gender-balance. At the same time some women may take a subservient role without giving it a great deal of thought.
Others social groups may hold onto outdated views about the role women and men should play, and be extremely vocal about them. Either way, the organisation of families and the interactional patterns that are played out within them, can be hugely influenced by the members’ beliefs about gender.
Effective leadership recognises the influence of gender-based beliefs in couples, families and groups and seeks to promote balance and harmony through equality.
Culture is not just about ethnicity, it includes race, class, religion, gender and economics. The beliefs we hold and the way we behave are, to a large extent, culturally prescribed. The families we belong to have their own culture and how each member fits in with their own family and the community they live in will to a degree depend on how flexible they can be. For example, how would the daughter of a strict Muslim family fit with the culture of a New Zealand secondary school and not face problems at home? Recognising, understanding, and respecting different cultures is an important consideration for therapists, and supporting effective leadership within families to create a workable cultural fit with their local community is imperative.
The development metaframework goes beyond the traditional family life cycle concept and looks toward how people develop at a biological, individual, relational, family and societal level. Also examined is how development at one level constrains development at another.
Internal Family Systems
The Internal Family Systems Framework allows people to develop a systemic map of their internal process and lead them to create balance and harmony within. The ability to create balance and harmony within enables people to be ecologically sensitive and more connected to others and nature.//
Most people think of their mind as a single entity. In fact, we operate differently depending on the time, place and situation. It is as if we have a set of personalities that come into play at different times. These personalities make up the entity we call the mind and are best described as parts because that is how most people refer to them. For example, someone might say, "There is a part of me that wants to kill him for the way he has behaved, but another part of me loves him". These parts, like members of an external family, vie for control, interact sequentially, organise into alliances and sometimes go to war with one another.
All parts in their natural state want something positive for the person and desire to play a valuable role in the internal family system. Each part’s positive intentions are different from the positive intentions of other parts and conflict among parts is inevitable because of this.
Our picture of the inner world is incomplete without the self. The self can be differentiated from parts and it has the ability to assume a position of leadership in re-organising the internal family and in dealing with the external world.
Cheryl and Joe
Cheryl was the oldest of five children raised in a traditional catholic family. She felt close to her father and considered her mother cold and unresponsive to her emotional needs. In describing her upbringing, Cheryl talked about being treated like a slave by having to complete numerous household chores including looking after her brothers and sisters, while her mother met her own selfish needs. Cheryl spent a considerable amount of time at a neighbour’s home and described that family as being more able than her own in meeting her needs- ‘her adoptive family’. A ‘Part’ of Cheryl desperately sought love, while other parts raged at being emotionally rejected and looked for any possibility that she was being ignored or left out.
Joe was brought up in an emotionally deprived environment. Hugging, touching and affirming was not a part of daily family interaction and completing chores etc was of prime importance. Joe’s father was extremely controlling and Joe was treated like a farm labourer; working from dawn to dusk. He sought acceptance from his family and they treated him with little or no respect. A ‘Part’ of him learned to withdraw from derision and conflict whilst others sought to work obsessively to reduce anxiety or stave off the possibility of rejection.
The Impact These ‘Parts’ Play in the Current Relationship
The clients sharing stories of growing up, seeks to develop their understanding of each other’s difficulties and painful experiences. Asking each person of the other’s experience fosters connection and empathy between the couple. It is within this context that couples identify sequences which create difficulties in the relationship and the various ‘Parts’ that come into play during these interactions. For example, in public, a part of James portrayed himself as a caring husband and father who always ‘did the right thing’. A ‘Part’ of Sandy saw James in this light, even though away from the public glare he became anxious and withdrawn. Parts of Sandy mothered and took care of James and refused to consider the obvious. This interaction only increased James’ anxiety about being useless and defective. His feelings of being defective played into an unsettling concern that he may be attracted to men. The ‘Part’ of him that self-soothed through viewing pornography and masturbating seven times a day, which proved he was only attracted to women, became increasingly extreme.
‘Parts’ of Cheryl sought love and protection from Joe who felt unable to meet Cheryl’s need for overt love and warmth. Feeling rejected, Cheryl attacked Joe who withdrew from conflict as he became increasingly involved in work and practical endeavours. This left Cheryl feelingly increasingly isolated and angry as Joe’s parts became more and more extreme.
In identifying these parts and their place in the couple’s interactions, a pathway towards change opens up. For example, during therapy Sandy became hurt and angry, saying that “I have been married to you all these years, and it has been a lie!” In reviewing this statement during a session, another explanation was developed: a ‘Part’ of James is a good father, while another was addicted to pornography. Reflecting on this proposition, Sandy believed that the whole of her marriage wasn’t a sham, although this thinking didn’t take away the fact that James’ behaviour had led to considerable pain for her. Integral to this reflection, was Sandy’s insight that problems could be dealt with and the exploration of hurt and resentment provided the opportunity to engage in healing.
Cheryl and Joe were able to reflect on their interactions as ‘Parts’ of them raged or withdrew in response to feeling rejected and needing to retreat in the face of anger.
Managing the Internal and Relational Worlds
This phase of the therapeutic process includes explaining the notion of the ‘Self” to couples. The ‘Self’ noted in ‘Metaframeworks, A Brief Synopsis’, at the end of this chapter is viewed as a Conductor or Leader of our ‘Parts’. The ‘Self’ can calm or soothe an angry part or, a part which feels rejected can be reasoned with or provided with an explanation etc.
Following this explanation, a set of strategies is developed in collaboration with the couple to deal with their parts which become extreme. For example, Cheryl could ask Joe to be hugged or told that she is loved, as opposed to saying “you don’t love me”. Equally, Joe could talk about “being afraid” rather than withdrawing. Teaching client’s relaxation techniques is another way to support people, for example, to manage their anxious part. Numerous strategies can be applied, depending on the practitioners’ discipline, for example, CBT. However, key points to follow when using this approach are:
1. Identify parts and the sequences they are involved in. For example, a rejected part accesses an angry part and the subsequent outburst leads to shame or worthlessness etc
2. Create an understanding of the self and reflect on how the parts can be managed when they become extreme
3. Reflect with the couple on strategies to change unhelpful sequences and manage their parts in a relational way
The Abuse Story
The telling of the abuse story is conducted in a similar way to the couple telling each other about their family of origin. However, in this session the person who has experienced the abuse tells their story to the therapist while the storyteller’s partner listens.
Jamie’s story involved being abused by an uncle over a number of years. Keeping quiet, compartmentalising his feeling and pretending nothing happened interlocked with the development/interaction of his parts arising in his family of origin. Cheryl was abused by a young man; a sibling in her adoptive family, and she felt she had to stay silent about the abuse to avoid being rejected. After several months, Cheryl told her mother about the abuse and she was told that she was making it up. This rejection of her truth intensified her feelings towards her mother and confirmed her unimportance. However, her father heard through her mother about the abuse and confronted the adopted family, which resulted in Cheryl becoming alienated from the people who provided her with emotional support. No action was taken against the offender.
The role of the therapist is to validate the storyteller’s experience and to reframe meaning where appropriate, for example, taking responsibility for the offender etc. At the story’s conclusion the therapist asks the storyteller’s partner to recount his/her thoughts and feelings re the abuse. At key times for example, when hurt or courage is brought into the conversation, the therapist asks the person to express those thoughts to the storyteller. This expression brings intimacy, support and validation into the conversation, creating a context of healing. The session concludes with a reflection from the couple re the experience.
The movement towards healing cannot be fully conceptualised in a sequential way, as therapeutic moments occur throughout the process. However, the platform for the therapeutic process is trust, safety and commitment to sharing, compassion, loving and supporting. The two case studies in question are typical in the sense that childhood difficulties such as James’ cruel upbringing and feeling of being unloved and rejected seem to reappear in adult relationships for example, James’ compartmentalisation of his life and Sandy’s constantly attempting to make things right. Cheryl’s and Joe’s relationship highlighted the struggles of their childhood, with Joe unable to express his love to Cheryl in a way that enabled her to feel wanted and special. This was compounded by Joe’s family treating Cheryl badly and Joe not standing up for her because his anxiety led him to withdraw. In moving toward healing, James and Sandy agreed on a process which entailed James talking to Sandy about his anxiety and wanting to watch pornography to self-soothe. In a systemic sense, this supported James to manage his internal world, create a stronger sense of intimacy with Sandy who in turn, felt an increased security in their relationship. Cheryl and Joe learned to understand each other’s feelings and communicated their own in a way which reduced conflict and hurt in their relationship. A turning point was when Joe stuck up for Cheryl in relation to his family and other people in their lives who were not respectful to her. In turn, Cheryl developed a trust that Joe wouldn’t turn his back on her and the part of her that defended herself against rejection, felt calm and stable.
Two Important Tools
Measuring Eroticism and Intimacy in Relationships:
The diagram below depicts two axes, one measuring intimacy and the other measuring eroticism on a scale of 1-10.
The therapist explains to the couple that successful intimate relationships often score highly, for example between 7 and 10 on both scales. It is important to point out that couples need to determine the kind of relationship they want and if they are satisfied with how the relationship operates, that is the best measure of success. For example, some couples are happy to score high on intimacy but low on eroticism. In James’ and Sandy’s case, James scored the relationship high on intimacy and low on eroticism. Sandy scored the relationship low on both scales. Cheryl and Joe scored the relationship low on both scales.
Sensate focusing, developed in the 1960’s by Masters & Johnson, is a useful tool in dealing with sexual dysfunction. The sensate focus process is widely available on the internet and there is no need to detail it within this chapter. Used in this context, couples find it a useful tool to reduce anxiety in their sexual relationship, improve communication and enhance intimacy and trust through touch. In teaching sensate focusing, it is important to enlist the services of a therapist skilled in massage. This therapist must be sensitive to the needs of the couple. For example, as initially Cheryl’s and Joe’s touching involved only hands, face and feet. With James and Sandy, James’ back was ‘off limits’ as it triggered feelings associated with his abuse. Gradually, over several weeks, the couples progressed to touch which involved the whole body. This process created considerable trust with the couple involved in both case studies and was highly complementary to the psychological trust which developed throughout the therapeutic process
In concluding the therapeutic process, James and Sandy reported a high level of trust which had developed in their relationship and both scored the relationship high on the intimacy/eroticism scales. James noted that he hadn’t viewed pornography or compulsively masturbated for six months. He felt free of his abuse and reported that on several occasions when he felt the urge to view porn, the desire disappeared after talking with Sandy about being drawn back into his old lifestyle and its accompanying anxiety. Sandy felt she was in a rewarding relationship with a whole person. Cheryl and Joe reported increased intimacy in their relationship and Cheryl discovered a trust in Joe that he would protect and love her. Cheryl had reached a point in her abuse where she considered it was time to let it go and the final step was to confront her abuser. In addition, Cheryl wanted to increase eroticism in her relationship with Joe. At the time of writing, Cheryl and Joe were faced with a major financial difficulty and a new baby (two months) which required their full attention. A three-month break in therapy was agreed to before continuing to complete the process.
On completion of therapy, a suggestion is made that the couple create and engage in a meaningful ritual to symbolise the success of the journey they have undertaken. The therapist does not have any involvement in creating the ritual and explicitly states that what the couple do to symbolise their success is personal to them and not part of the therapeutic process.
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