Sexual abuse is one of the most traumatic experiences one can undergo. It is no wonder that in the case of Beth and Don an incident of sexual abuse in Beth’s life had the ability to severely impact their marriage. It is important when working with this couple to help Beth recognize her understandably misguided thinking and rationalize why her thinking is negatively affecting her emotions and her body. Cognitive behavioral therapy (CBT) is an effective way to do this. There is evidence in survivors of childhood sexual abuse with Post Traumatic Stress Disorders of the benefit of writing programs that utilize principles of CBT (Harte, Hamilton, Meson, 2013). While Beth underwent her trauma in adulthood, it is still possible these methods can help her. She and Don can write down or otherwise reflect on moments when Beth is feeling anxious, identify what their thoughts are and reassure themselves that she is in no sense of danger when with her loving husband.

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Cognitive behavioral therapy is a way to reveal underlying negative thinking patterns that may be obscured to the person’s rational mind and then work actively to face those false thoughts. For example, one problem in this case may be that because Beth now links sex to trauma, she has forgotten how to relate sex to please and now primarily relates having sex to having children. One extremely important factor in her intervention would be the suggestion that her and Don can slowly work their way into greater physical intimacy with smaller, controlled acts that remind her that sexual interactions can be a pleasant bonding experience between two people (Hensley, 2002). The idea of two people bonding is another important theme to relate to Beth and Don in their therapy. Beth stated that she wanted to be like a “normal couple.” This may be more of a response to underlying guilt from the abuse itself or from the repercussions the abuse has had on her marriage. It is important to remind them that there is no such thing as a “norm.” Instead sexuality and life experiences are as variable between people as each individual history.

While is strategy has potential, implementing it on a day-to-day basis may not be easy. For example, if Beth begins to start having a panic attack, Don may want to retreat any advances because he does not want to see her in pain. In addition Beth needs to push through her anxiety, take deep breathes and make attempts to challenge her fears. Another difficulty in this case is that there may be underlying issues that the couple is not comfortable sharing with one another or with a professional. Both parties might not wish to offend one another. Patience can sometimes cause a person to hide his/her feelings from a spouse. While done with the best intentions, this does not promote healthy behavior for a couple (Hensley, 2002)

There are many strengths Beth and Don can work with to improve their marriage. It is quite clear from his loyalty and patience that Don has immense love and respect for his wife. Similarly, Beth is willing to work on diminishing her own negative feelings about sex in individualized therapy. This demonstrates the resilience of her character and her willingness to participate actively in processes that will lead to bettering herself. While this is not always the case in clients who have suffered from sexual abuse, Beth is an open and determined woman, which is a good predictor of her possibilities for success.

    References
  • Harte, Christopher B., Hamilton, Lisa D., Meson, Cindy M. (2013) “Predictors of Attrition from an Expressive Writing Intervention for Sexual Abuse Survivors,” Journal of Child Sexual Abuse, 22 (7).
  • Hensley, Laura G. (2002) “Treatment for Survivors of Rape: Issues and Interventions,” Journal of Mental Health Counseling, 24 (4).