An Exercise to Help Navigate the Effects of Sexual Trauma

By Kate Balestrieri, Psy.D., CSAT-S, CST

PACT Level 3 Candidate, PACT Ambassador

For a sexual trauma survivor, the idea or act of being sexual with their partner can be ripe with hopes, pleasure, fears, frustrations, and shame. For the partner of a sexual trauma survivor, sex can be just as daunting; fear over what to say, what to do or not do when their partner feels triggered. Couples can become paralyzed or at war over difficulties in communicating their needs around sex. This is where a PACT therapist can be of invaluable assistance.

Consider Marco and Elana*. Elana endured sexual abuse at the hands of a family member when she was approximately six. The secondary trauma of invalidation and alienation following her eventual outcry left her hesitant to discuss the experience as an adult with any partners, even her long-time partner, Marco. She was in therapy for a long time and, for the most part, experienced few flashbacks or intrusive thoughts about the abuse  as an adult in her early 30s.

Marco respected Elana’s privacy around the topic though always wondered why she found discussing what she had been through so challenging. Elana had the tendency to clam up whenever the topic of sexual abuse was in the air, whether related to her experience or on TV. She repeatedly told Marco not to push her to talk when it came to sex or sexual abuse; she’d talk if she needed to. Autonomy was critically important to her around this topic.

Over the span of their five-year relationship, their sex life was uninhibited. They enjoyed lovemaking frequently — multiple times a week, without hesitation, fear, or hiccups. The sexual bliss they both endorsed abruptly changed when Elana experienced a traumatic flashback during a moment of sexual intimacy. Startled and confused, Elana began to cry and told Marco she’d had a flashback.

Marco, gobsmacked with fear and confusion, froze and backed away from her on the bed. He said he was sorry she had that experience. Elana withdrew into a fetal position and reported other signs of dissociation in the moment. Marco went to sleep, assuming she would bring it up in her own time as she had over the years consistently asserted she would do. The couple never spoke about what happened that night — and their sex life was never the same.

In seeking couples therapy the following year, their main goal was to figure out what had sent their sex life off the rails, so to speak. Neither immediately attributed the shift to the night of Elana’s flashback, but both later admitted they knew that was the moment everything changed. Now they had sex only once or twice a month, and it was fraught with apprehension. Elana no longer experienced orgasms with Marco, and they both expressed a sense of grief over a lost sexual and emotional connection.

Within the span of a few months, Elana and Marco were able to share their fears with each other. They cultivated a space of deep repair in their emotional connection. In the bedroom, however, Marco and Elana struggled to move to a place of liberated arousal and play once again.

The Staging Exercise

With this couple, the PACT staging exercise proved to be a helpful intervention. Staging can evoke a little anxiety for a couple but, with the help of a PACT therapist, the exercise can prove to be an incredibly resourceful and empowering vehicle for change.

The mission of the staging exercise is to provide couples with a granular process within which to examine the efficacies and mis-attunements of their interactions. Four steps are necessary to curate an effective staging exercise.

1. Choose a high-conflict or repeating event within the partnership.
2. Identify the events precursors and antecedent.
3. Set the scene with the couple.
4. Play the scene in real time.

The fifth step, changing the outcome, is an added bonus. It allows the couple to co-create an ending that provides coregulation, hope, and empowerment vis-à-vis staging a foundation for new procedural memories, for the intended event, and also for the process of curating coregulation.

The exercise is, of course,  feasible to do in the therapist’s office. However, perhaps one advantage of couples therapy conducted via telehealth platforms is that therapists are able to work with couples in their own environment. 

A key element of the staging exercise, the activation of procedural memory, allowed this couple to bypass their cognitively warm and fuzzy conceptualization of the events. When in their bedroom, they were able to recreate the foundation of their intimacy initiation. Though this exercise was intended to address their sexual play or, rather, sexual stagnation, clothing remained intact throughout the session. 

This partnership was not fraught with conflict, but the loss of sexual freedom, connection, and satisfaction was a repeating event that brought much distress to them as individuals and rocked the foundations of their bond. The event was clear, and addressing their sexual shift was Elana and Marco’s primary goal. While Elana’s experience was not a high-conflict event, the residual effect had paralyzed their sex life in a pivotal way. They recognized that the night of Elana’s flashback was the night everything changed for them, but they did not know why. Despite their best efforts to talk it through, words had proven insufficient. 

In setting the scene, Marco and Elana carefully walked through their own internal dialogue as they prepared to be intimate. Elana was clear in her thoughts before the flashback. She was aroused and reported being “hot for Marco.” She recalled nothing was out of the ordinary in her mind or physical state. She had not felt triggered leading up to that moment and felt genuinely baffled as to why she’d had a flashback. 

Marco stated that he felt good that night; he had some red wine before Elana got home, and they were naked in bed. They both laughed and endorsed it as a pretty normal night, except for the red wine. Marco generally preferred rosé, but friends had given them a bottle from an up-and-coming vineyard, unbeknownst to Elana. She hated red wine. The perpetrator of her sexual abuse drank it, and she would smell it on his breath. Marco was not aware of this trigger.

The scene was set, and the couple, eager participants, were ready to reenact. They positioned the video camera for the session toward their bed and ran through the events of their foreplay, intimating their actions. Marco recalled Elana was not as enthusiastic with regard to kissing that night, and he thought he may have had bad breath. Elana burst into tears in the session when Marco remembered that detail out loud. She had not put two and two together and suddenly understood that his breath was the likely trigger for her flashback. 

After Marco consoled Elana, they continued with the scene until the point of Elana’s flashback. Both got quiet and looked away from each other. The events of this moment held the key to their breakdown. Elana noted feeling shame, upset with herself for ruining the mood, and confused about the impetus for her flashback. Marco noted feeling scared. He had never seen Elana so upset. He felt both powerless and responsible but impotent in his ability to help, given Elana’s previous insistence that she would be the person driving any discourse around her sexual abuse. So he gave her space on the night in question and again in the session by sliding back across the bed and rolling over. 

As he moved away, he did not notice that Elana was oscillating between looking down and away, and looking back at him. She vividly recalled checking back to see where he was because she felt such strong levels of derealization and was hoping he would help her get grounded. This confused Elana even more, as she normally liked to be alone when she was triggered. When Elana saw him turn away in the session, she exclaimed that she felt abandoned and alone and triggered even more because her family both invalidated and ostracized her after her outcry. 

Marco became nauseous in the moment because his effort to give Elana what he thought she needed had added fuel to her distress. He felt terrible and froze in place in a manner similar to the original event. Somatically, the mix of arousing and distressing sensations left both Elana and Marco overwhelmed. 

To complete the staging exercise, a different outcome was necessary to give their bodies the experience of a bottom-up coregulated resolution. Brought back to the moment after Elana’s flashback, Marco immediately rushed to comfort Elana, holding her in his arms. This did not offer the experience that Elana needed to feel more grounded and, when he noticed Elana brace at his touch, Marco felt dejected.

The couple tried again from the point of Elana’s flashback, and this time the therapist encouraged Marco to ask Elana some questions, namely around what she might need in the moment. When he observed that she responded without bracing or shutdown, Marco felt encouraged and reached out to embrace Elana again. She braced and bristled, and they both shut down.

Upon guiding them back to the point of Elana’s flashback, the therapist encouraged them to play the scene forward, through the questions that Marco asked before but to stop before he hugged her. When they arrived at that moment, both froze and looked at the therapist. After directing them back into each other’s care, the therapist prompted Marco to obtain Elana’s consent and affirmative interest in being touched before he touched her. 

He did, and Elana’s body completely relaxed. She began sobbing and opened her arms to hug Marco. He wrapped his arms around her, and Elana cried in his lap. Neither had recognized the mixed messaging she experienced in her body; the desire for safe connection with an inherent protective response that was encoding all unexpected touch as a threat. 

Elana and Marco practiced the staging exercise at home on their own a few more times with different possible outcomes to further investigate what both of their bodies responded to in terms of comfort and satisfied relational needs. At their next session, they both boasted that their sex life had seen significant improvements since the staging exercise. Even though cognitively Elana knew that Marco was a safe and non-violating person, hearing him ask for consent and giving her body time to assess if she was safe solidified him as a safe person for her somatically. Once she knew that in her bones again, the couple resumed their uninhibited sex life together and felt a renewed sense of connection.

*The names and identifying details of this couple have been changed to protect their confidentiality.