Structured sexual therapy with severely dissociative patients

Individuals and couples often have a desire to increase their sexuality even in the face of severe past physical and sexual trauma. Requirements for effective therapy include the establishment of a safe environment, cooperation of a partner to allow the patient to be in control, and an exploration of past sexual abuse to avoid recapitulation that may trigger flashbacks or dissociative episodes. It is also helpful if permission is given to a sexualized ego fragment to become more assertive and help the patient reconcile sexuality as ego-syntonic. The partner needs to develop ability to bring the patient back to the present when dissociating. Clinical examples demonstrate these concepts.