As a psychotherapist specializing in the treatment of chronic pain and sexual health, I have found in my work a significant link between chronic pain and sexual trauma. For example, when looking at fibromyalgia and sexual trauma, the results are stunning. People who experienced attempted sexual touch by an adult, or forced sex with an adult represented a high percentage of people with fibromyalgia according to an ACE Study. I find it is helpful to use the Adverse Childhood Experience Study (ACE) when assessing childhood sexual abuse and chronic pain. The ACE Study provides evidence of lifelong impact of childhood trauma in chronic pain, addiction, and suicide. The questionnaire includes 10 questions on childhood trauma, with each positive response being worth one point. After using the ACE Study, I then implement the Five E’s based off of the work by Teater and Teater. The first E is for Empathy. It is critical to ask person-centered and open-ended questions. People with chronic pain often feel misunderstood when they see professionals because of the stigma attached to it. I remember when I had a client who suffered from fibromyalgia and a history of sexual abuse looked at me in the first session and said “I know you think I making all of this up and you will most likely not believe me when I tell you my body hurts all over….I have gone to several medical professionals …..they don’t know what to do with me…so here I am with you. Are you going to tell me the same thing?” This client clearly thought I perceived her as a pill seeker and she thought I believed she was faking her illness. Once I established empathy and she did not feel judged, were able to establish trust.
The second E stands for Evaluate.This is when I conduct a thorough psychosocial evaluation and employ the West Haven- Yale Multidimensional Pain Inventory. The WHYMPI is a 52-item self-report tool broken into three parts, and it takes 20 minutes to administer. Part I touches on perceived interference of pain, support or concern from spouse or significant other, pain severity, perceived life control, and affective distress. Part II of this tool looks at the person’s perceptions of the degree to which spouses or significant others display solicitous, distracting negative responses to their pain behaviors and complaints. Part III assesses the client’s report of the frequency with which they engage in four categories of common everyday activities. This assessment tool uses a range of 0 (no pain at all) to 10 (worst pain imaginable) to rate pain. There are several different pain scales, but I find this one to be the most helpful because it places an emphasis on couples. The third E stands for Educate. I find it helpful to educate my clients and their significant others on the psychological factors associated with chronic pain and illness. Medical professionals often do not do this, and clients find it helpful. The next E stands for Encourage. When individuals and couples walk into my office, they are often flooded with discouragement. We discuss how pain is overwhelming and the goal here is to inform our clients change is possible. The final E stands for Engage. At this point, this is when I engage the client who may feel discouraged and pessimistic. This goes along with encouraging the client or couple as well.
When I work with individuals and couples who experience chronic pain with a history of sexual trauma, I find the emotional aspect of pain is usually more problematic than the physical aspect. These emotions include anger, fear, anxiety, depression, pessimism, and learned helplessness. So, what are the interventions I use with my clients who experience chronic pain with a history of sexual trauma? First, it is critical to build a trusting therapeutic relationship with the client or the couple. Second, I help the individual address if there is still negativity, guilt, and shame concerning traumatic experiences. I find it is also critical to reinforce the idea they have the right to be a proud survivor of their trauma. It is all about the client feeling safe. The client may already have a trauma therapist and they are referred to me for couples sex therapy. I also help the client process lessons learned from past traumas. Cognitive approaches are excellent to use here such as cognitive restructuring in addressing negative and faulty thinking patterns…victims of trauma carry all types of emotions and some of these cause agony.
When working with a couple, I help them identify the barriers that prevent them from having sex and intimacy. Often, it is centered on shame and guilt, and it is helping balance the past and present with the goal of moving forward in their relationship. This is where active listening and empathy become paramount in the session. It is important to note there may be sexual dysfunction due to the severity of pain. Medications may also play a factor as well. If I am seeing a couple, I think it is important to help one partner act as a support system for the other with chronic pain and a history of sexual trauma. Once therapeutic rapport is established, we process the sexual trauma with the focus of the one partner being a strong survivor, restructure the sexual relationship (there may be resentment from both partners) and then I work with the couple promoting desire, pleasure, eroticism, and satisfaction. My objective is to ultimately get the couple to a place where they can feel hope and optimism. I think as clinicians, it is critical to build on this foundation of hope.