Conceptualizing Sexual Assault

Recognizing and defining sexual assault is crucial in supporting survivors through their healing journey. The initial step is permitting survivors to choose their preferred terminology to describe their experiences. Many individuals seek sex therapy not only for specific sexual disorders—such as Genito-Pelvic Pain Disorder, Anorgasmia, or lack of sexual desire—but also to address deeper emotional scars that may resurface during intimacy.

RAINN defines sexual assault as any sexual contact or behavior conducted without the explicit consent of the victim. Common forms of sexual assault encompass:

• Attempted rape
• Fondling or unwanted sexual touching
• Forcing an individual to engage in sexual acts, including oral sex
• Penetration, commonly referred to as rape

It’s important to recognize that sexual assault can occur when a victim cannot consent due to factors such as incapacitation, age, or disability.

Respecting the Survivor’s Language

When a client describes a non-consensual experience without labeling it as assault or trauma, therapists must navigate this delicately. The decision to avoid these terms can arise from several influences:

• Feelings of shame or guilt, often stemming from perceived blame
• Disassociation through repression and compartmentalization of their experiences
• Normalization of harmful behaviors in certain cultural contexts
• Misunderstandings regarding consent and communication
• Internalized societal stereotypes and biases

Even if clients do not categorize their experiences as trauma, research indicates that such events can significantly contribute to adverse mental health outcomes, including post-traumatic stress disorder, depression, and anxiety (Systematic Review, 2020). Hence, it is essential for therapists not only to be educated about trauma but also to approach sexuality with sensitivity and understanding. This knowledge enables therapists to facilitate healing and assist survivors in forming healthy, consensual relationships moving forward.

Initial Psychoeducation in Trauma-Informed Therapy

Instead of imposing labels, trauma-informed therapists allow clients to steer the therapeutic process, including the terminology used in discussions. This practice fosters trust and alliance. A suggested early intervention involves educating clients about the mind-body connection in the context of trauma, with an invitation to pause the conversation at any moment if they feel overwhelmed.

Therapists may introduce the four primary trauma responses, known as the 4Fs, as follows:

• Fight: Physical or emotional reactions such as aggression or sudden outbursts.
• Flight: Avoidance behaviors, including leaving situations or distancing oneself emotionally.
• Freeze: Physical immobility or dissociation, where the person feels unable to react.
• Fawn: Over-accommodation to others’ needs, including faking enjoyment or suppressing objections.

These reactions often correlate with disassociation, a state where an individual feels disconnected from their body. The therapeutic exploration of how trauma impacts brain function is another crucial aspect, illustrating that the frontal lobe, responsible for rational thought and decision-making, can become incapacitated during traumatic episodes.

Understanding Trauma Types: Big ‘T’ vs Small ‘t’

Clarifying the distinctions between types of trauma is vital in therapy. The categorization can be summarized as follows:

• Big ‘T’ Trauma: Includes significant events like conflict, natural disasters, severe accidents, physical or sexual assault, and other life-threatening experiences.
• Small ‘t’ Trauma: Consists of emotional disregulation, bullying, financial abuse, gaslighting, and other forms of chronic stress or psychological harm.

Clients may relate to experiences from both categories, and recognizing these distinctions is essential for addressing their concerns effectively. Moving forward, therapists can introduce somatic inquiry interventions, which will be explored in subsequent discussions.