Identifying and treating the sexual repercussions of incest: a couples therapy approach

Given the significant number of adults who were sexually victimized as children and the serious negative effects that sexual abuse can have on sexual functioning, clinicians need to be prepared to recognize and treat the intimacy concerns of adult incest survivors. Broadening the definition of incest to include nontouch sexual abuse, this paper describes types of sexual problems commonly expressed by survivors, such as sexual dysfunction, fear of sex, conditioned negative reactions to sex, flashbacks to the abuse, and mind-body dissociation. The intimate partner of the survivor is viewed as a secondary victim of the incest, who often displays a unique set of sexual and emotional concerns as well. A four-stage couples therapy approach is presented which includes identifying the problem, working together on incest resolution, changing old sexual intimacy patterns, and creating positive sexual experiences. This model is a dynamic combination of incest resolution therapy, sex therapy, and couples therapy. Therapeutic dilemmas and considerations are discussed and recommendations given for increasing the effectiveness of therapy. An argument is made as to why a couples therapy approach is the preferred method of treatment.