CPPNJ - The Center for Psychoanalysis and Psychotherapy of New Jersey

Saturday, December 17, 2011

Sexual Abuse -- New Statistics, New Hope

The numbers are staggering.

According to a just-released government survey, nearly one-third of women report they had been victims of sexual violence — rape, beating or stalking — at some point in their lives. Additionally, one in seven men had experienced severe violence at the hands of an intimate partner and 1-to-2% had been raped.

The high numbers surprised even some experts. They point to a problem in our society that is poorly addressed and that has profound implications for its victims.

Not surprisingly, the report showed that people who survive sexual violence suffer from physical and psychological problems, including diabetes, chronic pain, difficulty sleeping, increased risk of smoking, depression and Post-Traumatic Stress Disorder.

Part of the toll comes from the fact that rape is not only an act of sexual violation, but of power and control exercised over a helpless victim. The survivor must contend not just with being brutalized physically (often by someone he or she trusted), but also with the violation to her or his sense of self integrity and safety. The experience can be overwhelming, particularly when it stirs up memories of earlier examples of vulnerability, betrayal and shame going back to childhood.

In my practice, I have worked with many such individuals. Some report anxieties and inhibitions around sex, as well as guilt, anxiety, anger and mood swings. It can take a toll on their sense of confidence and trust, and on their ability to grow close in intimate relationships. Because of shame ("What will people think of me?"; "Maybe it was my fault") many do not talk about what happened to them. Some are afraid that to speak about it — even in therapy — would leave them once again feeling trapped with the very overwhelming feelings and memories they are trying to avoid.

Unfortunately, denial rarely works. In order to shut down anything associated with the experience, the person numbs her or himself (sometimes with alcohol, food or cigarettes), reliving what happened in flashbacks or through persistent fears and hypervigilance. They are always mobilized and on the lookout for danger. Some isolate from friends and loved ones. Without being able to deal with what happened, the trauma lives on within them, and gets created with others around them.

Since my practice includes men who have been physically and sexually abused — many, but not all of them gay — I wanted to address the special challenges they face. Both male and female survivors have to battle stigma and shame, but a man who is overpowered is often deemed weak and unable to fight back. There is a great hesitation to report crimes for fear of how the police and others will react, whether they are gay or straight. Much of the abuse takes place in romantic or sexual relationships, which can lead to guilt, stigma and self blame. Women who know their attackers often struggle with this as well, although in somewhat different ways.

Regardless of the circumstances, a goal of therapy is to create a sense of safety that allows the patient to feel she or he can talk about what had happened without being judged or overwhelmed by their feelings and memories. The therapist is careful to move at a pace that feels comfortable to the patient, in a way that is respectful of her or his need to feel in control.

The ability to speak the unspeakable before a carrying, nonjudgmental other can help relieve shame and give the person a sense of control and understanding. To the degree that the experience stirs up pain from the past, the ability to shed new light on earlier experiences — and to see how they connect to the person's current reactions and coping skills — can be profoundly healing and self-esteem enhancing. Ultimately, the person can move from feeling like a victim to a survivor who might actually grow stronger from the experience.

-- Eric Sherman, LCSW


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