Coping With Trauma: Managing Sexual Abuse Triggers

I've written about trauma related to sexual abuse in a prior article (see my article: Overcoming the Trauma of Childhood Sexual Abuse).

In the current article, I'm focusing on sexual abuse triggers, which are common experiences for many adults who experienced childhood sexual abuse (see my article: Coping With Trauma: Becoming Aware of Triggers).

Managing Sexual Abuse Triggers

Sexual abuse occurs regardless of age, gender, sexual orientation, race, ethnicity or other identifying factors.

Childhood sexual abuse can be especially confusing because children are emotionally and physically vulnerable. 

Sexual abuse often occurs when children are told they can trust certain adults, including a parent, sibling, other family members, family friends, babysitters, teachers, pastors/religious leaders and others who turn out to be sexually abusive.

Managing Sexual Abuse Triggers

When children are sexually abused by people they're told they can trust, they often don't know how to react to the abuse or what they should do.  

Worse still, people who sexually abuse children often threaten children if the children reveal the abuse. They might tell them that the child will get in trouble or that they could be taken away from their parents. This often forces children into silence.

Even when children reveal their sexual abuse to adults, adults might not believe them--either because the adults are in denial about the situation or they might have their own blind spots about sexual abuse because of their own unresolved experiences.

What is a Trigger?

Generally speaking, a trigger is an experience that brings back a previous traumatic experience.

The trigger can result from something you see, hear, smell, taste or feel (tactile). 

    Examples of Sensory Triggers

Here are some examples of sensory triggers:

• Visual Triggers: 
• You see someone who looks like the person who sexually abused you.

• You see a location that looks similar to where you were abused.

• You see a TV program, movie or a broadcast news story that reminds you of your experience.

• Sound Triggers:
• You hear a sound that is similar to what you experienced as part of your trauma (e.g., the sound of someone coming up the stairs might remind you of what you heard just before the person who abused you entered your bedroom).

• You hear a song you heard when you were being abused.

• You hear a voice that is similar to the voice of the person who abused you.

• Scent Triggers:
• You smell alcohol which is similar to the smell of the person who abused you.

• You smell cologne, which is similar to the scent of the person who abused you.

• You smell the type of food that was being cooked downstairs while you were being abused in your bedroom.

• Taste Triggers:
• You taste a particular food that is associated with your experience of sexual abuse.

• You taste a particular alcoholic drink that was given to you by the person who abused you.

• You taste a particular candy that your abuser gave you.

• Touch Triggers
• You experience a sense of touch by someone in your current life (e.g., a hug from a friend or a touch on the shoulder) that reminds you of how you were touched by the person who abused you.

• You experience a sexual touch by your partner as being similar to what you experienced with the person who abused you.

• You experience the sensation of a particular fabric that you associate with your history of abuse.

    Examples of Other Types of Triggers: A trigger can be anything. Here are just a few examples of other types of triggers:

• You feel triggered by your partner's compliments because the person who abused you would compliment you.

• You feel triggered by a stranger's gaze because the person who used to abuse you also gazed at you in the same way.

• You feel triggered when your friend gets angry with you because the person who abused you got angry with you whenever you tried to set boundaries with them.

How You Experience Triggers

Some triggers can transport you back to the original trauma in terms of bringing you back directly to that experience in the form of a flashback.

Managing Sexual Abuse Triggers

Depending upon your particular experience, you might feel like you're actually back in that memory and lose awareness of your current surroundings. Or, you might remain aware of your current surroundings, but the experience brings a strong reminder of the traumatic memories.

Other triggers might not completely bring you back to the original trauma, but you might experience the emotions related to the abuse (see my article: What Are Emotional Flashbacks?).

Coping With Guilt and Shame

Many people who were sexually abused as children are aware on an intellectual level that they were not to blame for being abused.

But, on an emotional level, they might experience guilt and shame and blame themselves for the abuse (see my articles: Overcoming Shame and Overcoming Guilt).

Coping with Shame Related to Childhood Sexual Abuse

In retrospect, you might be experiencing guilt and shame for not being able to stop the abuse (What is the Difference Between Guilt and Shame?).

You might also feel guilt and shame for experiencing physical pleasure, which is a normal bodily response--even though you didn't want the abuse to occur.

No matter what your experience of guilt and shame, you were not to blame for what happened to you.

Coping With Guilt Related to Childhood Sexual Abuse

Managing Sexual Abuse Triggers

• Getting Emotional Support From Trusted Loved Ones: If you have trusted people in your life who know and love you, you can seek emotional support from them. Just being able to talk about what happened to you, instead of keeping to yourself, can be helpful--but only if you're sure this person will be supportive.

• Practicing Grounding Techniques: Grounding techniques help you to calm yourself when you're being triggered (see my article: Grounding Techniques).

• Accessing a Supportive Part of Yourself: The sexual abuse trauma can be located within a traumatized part of yourself, but you also probably have other positive parts that can help with positive self talk to help you when you're feeling triggered.

• Seeking Help in Trauma Therapy: Supportive loved ones can be helpful, but they can't help you work through the unresolved trauma. A skilled mental health professional who is trained as a trauma therapist can help you to overcome triggers, develop a more resilient self and help you to free yourself from your traumatic history (see my article: Overcoming Your Fear of Asking For Help).

How Does Trauma Therapy Work?

Trauma therapy helps clients to process unresolved trauma (see my article: How Does Trauma Therapy Work?).

There are different types of trauma therapy including (but not limited to):

• EMDR Therapy (Eye Movement Desensitization and Reprocessing): How Does EMDR Therapy Work?

• AEDP (Accelerated Experiential Dynamic Therapy): What is AEDP?

• Parts Work Therapy (Ego States Therapy and Internal Family Systems [IFS]): What is Parts Work Therapy?

• Somatic Experiencing: The Benefits of Somatic Experiencing to Overcome Trauma

• Hypnotherapy (also known as Clinical Hypnosis): What is Clinical Hypnosis?

About Me

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, AEDP, EFT (for couples), Somatic Experiencing and Sex Therapist.

I work with individual adults and couples.

As a trauma therapist, I have helped many clients to overcome their history of trauma so they can live more fulfilling lives.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

Overcoming the Trauma of Childhood Sexual Abuse

Childhood sexual abuse is more prevalent than most people think, and the psychological effects can be much more far reaching than had been recognized in years past. 

It's only been relatively recently that people have even begun to talk about childhood sexual abuse more openly, and people have sought psychological help to overcome its effects. 

Years ago, this topic was considered taboo and survivors of childhood sexual abuse often kept these traumatic secrets to themselves, often to their detriment.

Overcoming the Trauma of Childhood Sexual Abuse

Childhood sexual abuse is a very broad topic and there have been many books, articles, and TV programs about the psychological effects. One blog article can hardly do justice to such an important topic.

What is Childhood Sexual Abuse?
Broadly speaking, childhood sexual abuse is any form of sexual touching, kissing, inappropriate undressing or any other form of sexual behavior with a child. Childhood sexual abuse is a boundary violation that often has severe detrimental effects on the child.

Who Engages in Childhood Sexual Abuse?
Anyone who is around a child is a potential sexual perpetrator. Often, the sexual perpetrator is someone who would, under normal circumstances, be trusted with the child, including one or both parents, another family member, a teacher, a religious leader, babysitter, or other people.

Often, people who engage in childhood sexual abuse have been sexually abused themselves and they are repeating this pattern.

Regardless of the circumstances of how or why this occurs, adults who engage in childhood sexual abuse are responsible for their behavior both morally and legally.

Can a Child Ever be Held Responsible for Sexual Abuse?
Many survivors of childhood sexual abuse often feel responsible for the abuse for a variety of reasons. First, let me answer my question with a resounding "No." Children are never responsible for their own sexual violation. However, as adults, as previously mentioned, they often feel that they brought it on themselves in some way which, of course, is not true because children don't have the developmental capacity and often don't have a way to stop the abuse.

Often, when survivors of childhood sexual abuse begin psychotherapy to deal with the aftermath of the abuse, they talk about the sexual acts "feeling good" and they have a lot of guilt and shame about this. When a survivors of sexual abuse tells me this, I help them to distinguish between what might feel good in their body or on an emotional level from their feelings of being responsible.

Perpetrators of childhood sexual abuse have an uncanny way of selecting children that they sense are vulnerable.

These children are often lonely or neglected in some way and they're craving attention. To a child who craves attention, sexualized attention is better than no attention at all. Even if they feel uncomfortable, many children go along with the perpetrator because he or she might be nice to them in other ways: spending time with them, taking an interest in things that interest them, giving them gifts and so on.

If the perpetrator happens to be someone who would normally be considered a trusted family member, friend, or clergy, children who are being sexually abused can become very confused and doubt their own feelings of discomfort or that the abuse is even happening.

In some of the more egregious forms of childhood sexual abuse, perpetrators often threaten the children or threaten to harm a family member if the children reveal what's going on.

Psychological Effects of Childhood Sexual Abuse:
Each person's experience will be different and the psychological effects will be different. Experiences can vary depending upon age, temperament, the relationship with the perpetrator, whether there are explicit memories or only vague feelings or sensations, and so on.

The important point when considering the psychological effects of childhood sexual abuse is that no one goes unaffected because it is such a personal boundary violation.

Often, without realizing it, adults who were sexually abused as children have difficulty with sexual intimacy in their relationships.

Before I go on, I want to caution that not everyone who has difficulties with sexual intimacy has been sexually abused. There are many varied reasons why a person might have difficulty with sexual intimacy, including physical reasons, other types of violations or breaches, depression, anxiety, and so on. So, no one should automatically assume that because they're having problems being sexual with a partner that this means he or she was sexually abused.

The following scenario, which is a fictionalized account and does not represent any one person or persons, illustrates the possible psychological effects of childhood sexual abuse:

Alice:
Alice was in her early 20s when she met Bob at a friend's party. They were instantly attracted to each other, they had similar interests, and they began dating soon after they met. It was important to Alice that she get to know Bob before they became sexually intimate, so she wanted to wait a while before they had sex. Bob was becoming increasingly fond of Alice, so he didn't mind waiting.

After they had dated for a couple of months, Alice felt like she was ready to be sexually intimate with Bob, and she let him know. After a romantic dinner, Alice and Bob went back to his apartment. His roommate was away, so they had the place to themselves.

Alice felt warm and close towards Bob, and she was excited about taking their dating relationship to the next level. Other than kissing, Alice had never had sex with any of the other young men that she had dated in the past, but she felt that there was something special about Bob.

As they were sitting on the couch, listening to music by candlelight, they began to kiss. Alice enjoyed kissing Bob and she was feeling increasingly passionate. But when Bob touched her breast, Alice froze both physically and emotionally, and she began to feel confused.

On the one hand, Bob's touch felt tender and exciting, but on the other hand, it also started to make Alice feel queasy. She tried not to pay attention to the queasy feeling in her stomach, but it continued to get stronger and her confusion increased.

At the point when Alice felt that she was going to vomit, she pushed Bob's hand away. He realized immediately that she was upset and asked her if she was all right. Alice didn't know what to say. She felt her whole body go rigid and cold, and she felt that she wanted to run out of the apartment. Aside from feeling confused, she also felt ashamed.

Without words to express what was going on with her, Alice told Bob that she had to go and she rushed out of his apartment and went back to the apartment that she shared with friends. Bob was stunned, and he tried to talk to Alice, but she left in a hurry and told him not to follow her.

Over the next few weeks, Bob tried to call Alice. She heard his voicemail messages, but she was too confused, ashamed and guilty to call him back. She didn't even feel comfortable talking to her close friends about what happened. She just knew that she never wanted to feel that disgusting, queasy feeling again. So, she continued to avoid Bob and, after a few weeks, he stopped calling.

This was the beginning of a long line of disappointments for Alice whenever she tried to be sexually intimate with men. Aside from getting an upset stomach and feeling ashamed, confused and guilty, Alice also felt a sudden emotional revulsion whenever she began to be sexually intimate with a man. Each time that she attempted to be sexually intimate, Alice hoped that the experience would be different, but it never was.

By the time Alice was in her 30s, she had experienced so many physical and emotional upsets with sexual intimacy that she no longer wanted to date. She tried to tell herself and her friends that she was "just fine" being alone. But the truth was that she was very lonely and she wanted to overcome whatever was causing her to feel so uncomfortable and mistrustful.

Struggling with this issue on her own brought no relief, so her best friend recommended that Alice see a psychotherapist. Alice had always thought that people who went to therapy were "crazy," but her friend explained to her that, quite to the contrary, many people went to psychotherapy for everyday, ordinary problems, and they weren't "crazy." So, Alice obtained a recommendation from her doctor and made an appointment with a psychotherapist.

During the first session, the psychotherapist took a family history as part of the initial session. This is standard practice. When the therapist asked Alice if she had experienced any sexual abuse or molestation, Alice's first inclination was to say "no," but she hesitated.

She knew that her Uncle John used to touch her breasts whenever no one else was around. She also knew that this began when she was about nine years old. But she wasn't sure what to say about it because whenever he touched her, she felt confused and she continued to feel confused about it.

Uncle John tended to be kind and generous with her, especially after Alice's father died when she was four years old. He took a special interest in her, taking her to the park, teaching her how to ride a bike, taking her to the movies, and listening to her in a way that her mother, who was depressed after Alice's father died, never did any more.

One day, soon after her 12th birthday, when she was alone with her Uncle John, he sat next to her on the couch, as he had many times in the past. However, this time, he offered her a sip of his beer. Alice never tasted beer before and she knew that her mother wouldn't like it, but she also thought that Uncle John would never ask her to do anything that was wrong. So, with some hesitation, she tasted his beer, and he encouraged her to drink more.

She didn't think much about it because it just felt like any other activity that she shared with Uncle John. But after a while, Alice's head began to spin. Uncle John had already drank quite a few beers and he asked Alice to sit on his lap. Alice had not sat on Uncle John's lap since she was about four or five years old, so she thought this was odd. When she hesitated, Uncle John said he felt hurt that she wouldn't do this. Not wanting to hurt his feelings, Alice sat on Uncle John's lap, even though she felt uncomfortable.

As Alice continued to drink more beer, she could hardly keep her eyes open, but she saw the expression on Uncle John's face change. She had never seen him look at her like this, and she wasn't sure what was happening or if she could even trust what she was seeing because she was pretty drunk by then.

But when Uncle John put his hand up her blouse and began fondling her breast, she felt confused. On a physical level, part of her felt good and excited, but and her stomach was also queasy. All the while, Uncle John was telling her how beautiful she was and that she was his favorite niece.

Soon after that, she passed out, and when she woke up, she was in her bed and her mother came home. Uncle John came up to her room to say goodbye. Alice remembered vaguely what happened, but Uncle John looked at her so kindly, the way he always looked, and she began to doubt her own recollection of what happened that day.

The next time that Uncle John babysat for Alice, she turned down his offer to drink his beer and she told him that she didn't feel comfortable sitting on his lap. Uncle John turned away from her and turned on the TV. He refused to talk to her, and this upset Alice greatly. He was the only one who took any interest in her in the family, and she loved him very much.

When she could not get him to pay attention to her, she went up to her room, feeling very lonely and sad, and she cried herself to sleep until her mother came home.

The following time, it was much the same, and Alice felt desperate for Uncle John's attention. So, she told herself that it wasn't so bad, after all, to drink beer with Uncle John and sit on his lap. When she told him this, Uncle John transformed into her Old Uncle John, kind, attentive and warm.

She didn't drink as much beer as she did the first time, but she acquiesced to Uncle John's wishes and allowed him to fondle her breasts. She fought off the queasy feeling in her stomach and told herself that this was a small price to pay to have Uncle John's attention.

So, this continued on without Alice revealing this to anyone. Uncle John told Alice that no one would understand the "special relationship" that they had together and he told her not to tell anyone so it would remain special between the two of them.

Around the time that Alice turned 15, Uncle John no longer wanted to spend as much time with Alice, which she didn't understand. He had many excuses as to why he wasn't available. But Alice found out from her mother that Uncle John was now spending more time with Alice's cousin, Lisa, who was a year younger than her.

One day, when Alice went over to Lisa's house to look for Uncle John, she found the door open so she walked in. She walked into Lisa's bedroom, where she heard Lisa and Uncle John laughing. At first, she could not see anything because the room was dark.

Then, when her eyes adjusted to the darkness, she saw Uncle John having sex with Lisa. She was stunned. It was obvious that they were both very drunk, and Uncle John shouted to Alice, "Get out of here! You're too old for me now! Lisa's my favorite niece now" and Uncle John and Lisa both laughed at Alice.

Lisa ran out of the house and never told anyone what she saw. After that, she never wanted to spend any time with Uncle John. Whenever she saw him at family functions, he acted like the Old Uncle John, as if nothing had happened. This confused Alice, and made her doubt what happened to her with Uncle John and what she saw when she went to Lisa's house. She thought to herself, "How could this be the same Uncle John who always took care of me?"

All of these thoughts were swimming around her head after the therapist asked her about childhood sexual abuse. Over time, Alice was able to talk about what happened and she realized that her uncle was a pedophile, and she was sexually abused as a child. She also began to connect the queasy, frozen feeling that she had as an adult when she was sexual with men to the feelings that she had as a child with Uncle John.

Alice had to work through a lot of anger, sadness, and bitterness. Just talking about the abuse and knowing that she got emotionally and physically triggered whenever she was sexual was not enough to resolve her trauma.

Talking about it was only the beginning. Alice's therapist used EMDR therapy, which is a mind-body oriented psychotherapy, to work through the trauma. It took time and effort, but Alice was able to overcome her trauma and, eventually, she had a healthy relationship with a man that she met soon after that.

The psychological effects of childhood sexual trauma can occur at any time. Many people don't realize that the sexual abuse is effecting them, and they often blame themselves for any sexual difficulties that they have as adults.

Very often, regular talk therapy is not enough to overcome the trauma. It might provide you with intellectual insight about what happened and how it is effecting you, but it's often not enough to help you heal.

Mind-body oriented psychotherapy, like EMDR, is often more effective in overcome sexual trauma and trauma in general.

The fictionalized case that I presented is about a girl, but sexual abuse also occurs to boys. It can be just as confusing and depressing for a man to deal with these feelings when they are triggered as it is for a woman.

Getting Help in Therapy
If you're a survivor of childhood sexual abuse, you're not alone and you can overcome your trauma with help from a licensed mental health professional who specializes in this area.

To find out more about EMDR therapy, see my article:  EMDR Therapy - When Talk Therapy Isn't Enough.

I am a licensed New York City psychotherapist, hypnotherapist, EMDR, and Somatic Experiencing therapist.

To find out more about me, visit my website: Josephine Ferraro, LCSW - NYC Psychotherapist

To set up a consultation, call me at (917) 742-2624 during business hours or email me.

The Counterphobic Defense

In my prior articles, What is the Counterphobic Defense? and The Counterphobic Defense and Hypersexuality, I discussed a particular type of counterphobic response, hypersexuality, which I defined and gave a fictionalized scenario to describe how childhood sexual abuse could lead to hypersexuality.  

As I mentioned in my prior article, this fictionalized account is not about any one client--it is a composite of many different cases with all identifying information changed.

Fictionalized Scenario About Hypersexuality as a Counterphobic Response:

When we last left off in the prior article, Marie, who had been sexually abused as a child by her stepfather and who, subsequently, acted out sexually in a hypersexual manner, met a man, Tom, whom she really liked.

The Counterphobic Response:  Getting Psychological Help

But, unlike her other encounters with men, which were sexual but non-intimate and where she felt "in charge" and empowered due to her counterphobic response, Marie felt emotionally vulnerable and ambivalent about this relationship.

Her fear of being emotionally vulnerable troubled her so much that, at times, she was tempted to break off her relationship with Tom.  At the same time, she knew that this was the only healthy relationship that she had ever had and she knew she needed psychological help to overcome her fears.

Marie went to several different psychotherapists.  Each time they would get close to the core of her problems, including the early childhood loss of her father, the guilt she felt for her father leaving, the emotional abandonment by her mother, and her feelings of helplessness when her stepfather sexually abused her as a child, Marie would find a way to sabotage the treatment.

Either she would stop going to her therapy sessions or she would find faults with whichever therapist that she was seeing and then she would leave.

In her treatment with a male therapist, she attempted to seduce him, and when he set limits with her, she left treatment (see my article:  Boundary Violations and Sexual Exploitation in Therapy).

All the while, her boyfriend, Tom, tried to be patient with her ambivalence and moodiness towards him.  He knew that they loved each other, but he couldn't understand why Marie would be kind and loving to him one day and then annoyed and dismissive with him on another day.  And whenever he asked her what was wrong, she had no answer for him.  She only knew that she was terrified of being in this relationship, but she was too afraid to tell him this, so she gave him no answer.

Finally, he gave her an ultimatum:  Either she get psychological help for whatever was affecting her or it was over between them.

Faced with the possibility of the end of their relationship, Marie would have thought she would be relieved.  It would have put an end to her fears.  But, instead, she realized that she was more afraid of losing him and the relationship that they had than she was of being in the relationship, so she knew she had to get psychological help and stick with it.

When Marie came to see me for her first therapy session, it was obvious that she was very frightened.  She seemed like she was going to bolt out the door.

During the consultation, I explained how I worked and told her that I usually start with psychological resourcing (e.g., developing coping skills and mechanisms) before I deal directly with the trauma, and we would go at whatever pace she felt comfortable with because I could titrate the work so she would not become overwhelmed.  Marie seemed relieved about this.

I also explained that, given her significant childhood trauma, this would not be short-term therapy, so she would need to know that it required a commitment to do the work involved with trauma therapy.

Once she was in therapy and Tom realized that she was committed to getting psychological help this time, he agreed to remain in the relationship as long as she remained in treatment.

Marie and I worked on resourcing to help her develop coping mechanisms that she never developed before.  There were many times that Marie wanted to leave therapy, but she remained.

After a few months of her developing internal resources to do the trauma work, she and I agreed that she was ready to deal her counterphobic response and the underlying trauma.

We used EMDR (Eye Movement Desensitization and Reprocessing) therapy to deal with her early childhood losses and sexual abuse as well as her feelings of sadness, anger and helplessness.

Despite her trauma, Marie had a lot of strengths  She also came to her weekly sessions regularly.  The coping tools that she developed during the initial stage of therapy helped her to deal with her fear and ambivalence about her relationship with Tom.

The Counterphobic Response:  Getting Psychological Help

As she continued to work through the trauma and used her coping skills to deal with her fears, she was able to allow Tom to get closer to her.  She was no longer tempted to act out sexually with other men when she felt afraid.  Instead, she was able to communicate her fears to Tom, and they were able to talk it out.

Marie became increasingly aware that there was no "quick fix" for her problems, but she remained motivated in treatment, even though it was difficult at times.

When Marie divulged her history to Tom, including her hypersexuality, he was understanding and willing to be supportive in any way that she needed.

As she became psychologically healthier, Marie began to understand what it felt like to feel genuinely empowered as opposed to the pseudo empowerment she felt, which was related to her former counterphobic response.

The Counterphobic Response:  Getting Psychological Help

By the time Marie completed her treatment, she was more emotionally open and vulnerable with Tom than she had ever been with anyone.  They made plans to move in together and talked about getting married.

Getting Help in Therapy
Overcoming the counterphobic response, whether it involves hypersexuality or other counterphobic responses, is challenging but it is possible.

If you think you're affected by a counterphobic defense in your life, you could benefit from getting help from a licensed mental health professional.

Getting psychological help could make the difference between you living a life where you are constantly trying to quell your fears through compulsive or dangerous behavior and living a fulfilling and meaningful life with a genuine sense of empowerment.

About Me
I am a licensed NYC psychotherapist, hypnotherapist, EMDR and Somatic Experiencing therapist who works with individual adults and couples.

To find out more about me, visit my website:  Josephine Ferraro, LCSW - NYC Psychotherapist.

To set up a consultation, call me at (917) 742-2624 during business hours or email me.