• Germayne Tizzano, Ph.D.

Supporting Healthy Sexuality for Women in Treatment and Recovery

Published in the Summer, 2014 Connecticut Women's Consortium Newsletter

A publication produced by the CT Women's Consortium and the CT Department of Mental Health and Addiction Services in support of the CT Trauma Initiative

Women with sexual trauma histories, child sexual abuse, and adult sexual violations are at significant risk for substance abuse, addiction, mental-health disorders, recurrent violent interpersonal relationships, chronic physical health conditions, and poverty. A woman who has experienced sexual trauma lives a life of desperation, often fighting for her survival. If the traumatized woman has developed an addiction to drugs and/or alcohol, she may turn to sex work to maintain her addiction. Subsequently, she can become vulnerable to incarceration and repeated traumatization. Consumed by her need to forget past events, the addicted woman lives only for the next "high" she views as essential to her survival. Through intervention by family, children's services, or the criminal courts, and often not of her own will, she enters treatment. The abused woman all too often continues to recreate the cycle of despair, sabotaging all efforts to assist her in changing the course of her life.

Elizabeth, also known as Liz, is a case study of someone deeply affected by sexual trauma. Sexually abused by her father from age three until she left home for college, Liz was never protected from exploitation and trauma. She coped through perfectionism in school and sports; always keeping up the front that was modeled at home. All is well and right in the Richardsons' family was the mantra she maintained as the focus for her survival. Once Elizabeth left home to attend college, she thought she had left behind the well-kept secrets of her family life. While in college, she maintained a life of rigidity including a demanding, meticulous schedule of academics and athletics. In spite of being a straight "A" student, she harbored deep-seated anxiety, depression, and sadness only a survivor of sexual abuse would recognize. Her body became trapped in the bindings of untreated anorexia and bulimia, yet she continued to do everything in her power to wear the mask of normalcy.

Eventually, her internal world of violation penetrated her ability to keep up a front. Liz drank without regard, sought out pills, and then heroin, to numb out terrifying feelings she had been working so hard to suppress. As Elizabeth's world spiraled out of control she engaged in abusive relationships that mirrored the rage she knew as a child. Liz dropped out of college and sought comfort from partners who violated her. At 21, she became pregnant, and gave birth to her daughter Anna who was immediately taken away from her by the family and children's court because Elizabeth had tested positive for opiates at the time of Anna's birth.

Elizabeth and other women like her who have been violated multiple times do not understand why their lives are so difficult. To survive the ravages of childhood requires numbing, dissociation, and a disbelief that those who were supposed to protect them could breach their trust and desecrate their bodies. Maladaptive attachments in the developing brains of young children and adolescents offer short-term survival and long-term consequences in unhealthy patterns of living and sexual intimacy.

Women like Liz have the right to healthy sexuality and intimacy and providers can develop strategies to assess women's sexual health capacity. Treatment centers that serve people with substance abuse are in a position to provide the "Elizabeths" of the world with a safe place to explore their experiences of sexual trauma, – and the drug and sexually linked triggers that can lead to the re-occurrence of substance abuse. Unfortunately, professionals in a position to help abused women frequently focus on sobriety and restrict dialogue on sexuality and intimacy that can be the underpinnings of substance abuse and relapse. Professionals that serve women affected by trauma and substance abuse in the criminal justice system, mental health/addiction services and family planning programs have consistently shared their uncertainty in talking about sexuality with sexually abused women. The reasons for this avoidance are many.

Firstly, there is the high potential for incidence of vicarious trauma for therapists who are counseling women on sexual trauma. Many therapists may have their own history of sexual abuse that they may not have resolved. For these reasons, it is imperative that clinician self-care not be ignored while developing sexual recovery programs for women. Additionally, therapists have expressed their concern that discussing sexual trauma may result in overwhelming unmanageable distress for the woman who has been violated. Some therapists also fear that their training and skills are limited around sexuality. When these hesitations are compounded with unresolved personal or vicarious trauma, the challenges inherent in integrating sexuality as part of the treatment process are clear. Therefore, optimal supervision, ongoing peer support, training, and educational tools for therapists need to be part of the planning and implementation process for client sexual recovery. Ideally, from the first day of treatment, women could be provided information and a review of the agency's commitment to fostering healthy choices and rights regarding sexuality. A sexual recovery plan and psycho-educational programs can help provide woman ongoing tools and support toward achieving healthy intimacy with sobriety.

The curriculum, Sanctuary for Change, (Germayne Tizzano, Ph.D.), is tailored specifically to the sexual health needs of women with histories of trauma and abuse and/or who are victims of intimate partner violence. Based on the research of Dr. Albert Bandura, (1977), Sanctuary for Change focuses on building skills and positive expectations to help women make informed decisions regarding sexual health. The Sanctuary curriculum draws on the relational and cultural theory of Miller and Gilligan (1976), which posits that women are motivated to grow in relationships with others, and that these interpersonal connections can create a renewed sense of courage, strength, and self-worth. The Sanctuary for Change model is designed to help women with histories of abuse come together to safely acknowledge the detrimental impacts of their traumatic experiences on their ability to make sexually healthy choices. Through small group discussions, hands-on activities, and self-reflective tools, women develop an individualized program of recovery aimed at sexual health goals. Participants who have attended Sanctuary for Change have shared how enlightening and beneficial the program has been for them. Previous attendees report practicing healthy sexual choices, screening for HIV, talking with their counselor about their sexual preferences, being gentler to their bodies, and selecting partners who respect their choices. The Sanctuary program offers the chemically dependent woman an opportunity for a new set of values, beliefs, and practices regarding her own sexuality, introduced within the safe social context of the classroom. This opens the door so that she can discover the courage within to redefine who she is and commit to healthier sexual choices.

Submitted by Germayne Tizzano, Ph.D. Editorial contributions by Muge Galin, Ph.D. and Mary Lee Stocks, LISW

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