June is Pride Month, I think around the world. In San Francisco where I live, the skies are more than ever splashed with the color of waving rainbow flags. I love those flags, and always wanted to get one for our house, partly because I love color, especially the vivid brightness of primary colors; and partly because although I am a straight, long-time- married lady, I have been a card-carrying PFLAG (Federation of Parents and Friends of Lesbians and Gays) member, since I learned of it, and since well before we had the alphabet of variations of “queer.” (When I was growing up, “queer” was an insult reserved for the generically un-cool, unpopular, often me. Now it is an acceptable and at least here in SF, a much-used general term for the range of “non-hetero” sexualities.) I was drawn to the notion of justice and acceptance for people of all genders and sexualities not only because I have always been passionate about justice and equality, but even more because the freedom to love and be loved by whomever we want and choose has always seemed so essential and vital to me. Especially being for a long time, a perennially lonely romantic. It was a natural progression, and there were many reasons and catalysts for my subsequent and ongoing fascination with the wide world of sexuality. I thought a fitting celebration of June would be to blog about sex this week, and to broach the topic of Neglect Informed Sex Therapy, perhaps cracking the wall of silence.
I do have a persistent complaint that sexuality is so glaringly neglected in the trauma field, and in the psychology field at large. It is ironic, because going back to our psychological founders, sexuality was originally viewed as the basis of so many things. The trauma field at most, largely addresses sexual trauma, and that through a narrow lens (more about that follows). And sadly, in actual practice, there is a paucity of actual mention of sexuality. I routinely hear from clients that few practitioners of any kind have inquired about sexual matters, from medical professionals, to even couple’s therapists. Is it shame, fear, or tabu that stops us from speaking about it, or ignorance? The outcome of this silence is that our clients wind up feeling as if they are not supposed to speak of such things, or they are simply supposed to “know.” So many walk around not knowing, perhaps wondering anxiously, if they or their partners are “normal.’’ If they do not have an overt “sexual abuse” history, there is nothing to talk about. Oy vey, meanwhile we are bombarded by stimulation of every sexual ilk, including lots of advertising for erection/ desire-enhancing pharmaceuticals. I am on a mission to help us out of this lonely silence; to become more fluent and comfortable at speaking aloud about this neglected topic and learning to actually utter the explicit words out loud, creating permission for more frank and less shame-ridden conversation and inquiry.
Regulation
When I teach, I like to expand my understanding of the important term regulation. My view is that regulation is the “ground zero” of development and so pivotal to what should happen in the early mother infant resonance. I think of regulation as having two related, distinct, and important lines of meaning/definition. One is in the arousal, and (ultimately emotional) sense, the other in the attachment/interpersonal sense. By arousal, I am referring to the necessary function of the mother or primary parent in helping the infant to recover and return to baseline form the inevitable experience of getting one way or another “upset.” Of course, an infant at times will fuss and cry, if they are hungry, cold, scared, lonely, bored, startled… Getting upset, means their vital bodily signs like brain activation, heart rate, breath, even skin conductance or other functions, will escalate in some way. If the caregiver responds promptly with needed supplies, whatever is indicated be it food, a cozy blanket, soothing comfort, touch company, or stimulation… the infant will settle. The caregiver helps bring the infant from hyperarousal, back to the comfortable base level where all is experienced as more or less, well. In effect, the caregiver regulates the little one, so ultimately, with luck, they learn to self-regulate.
The other form of regulation as I think about it, relates to relationships, and the all-important dynamic of rupture and repair, (which also happens to be the theme of the Oxford Trauma Conference 2024!) This is the essential process of returning to the desired baseline of attachment after a disconnect. Again, ruptures are inevitable, mistakes are a fact of life, one or the other member of a dyad will get upset about something or even “nothing,” and the connection is broken. If the caregiver promptly and accurately responds to the child’s distress, and bridges the chasm of disconnection, the child can recover, and again over time learn how to achieve such reconnecting and ultimately healing repair, themselves. It is safe to be human, to make the inevitable periodic misstep. This experience is of course sorely lacking in the world of neglect. Generally, regulation of both kinds is severely and tragically absent in the neglect experience. The infant is often hopelessly lost at sea emotionally and relationally.
Sexuality, perhaps more than most other bodily functions involves a delicate balance of regulation: sympathetic and parasympathetic, requiring that we be both and simultaneously excited and relaxed. Or as Harville Hendrix puts it “safety and passion.” Even animals in the wild will stop their mating if a predator is anywhere near. The same is true for us. Add to that the profound interpersonal ambivalence endemic to the neglect experience, and sexuality presents a morass of challenges.
The Dilemma “Undressed?”
The now familiar “dilemma without solution” has a unique expression in the sexual sphere. How do we achieve the sexual union and keep it free/safe for the “risk” of attachment?
I have observed a host of “creative” adaptions including cyber-sex or sex with “inanimate” partners; serial infidelities; serial monogamies, anonymous sex, sex with sex workers, being a sex worker, partnering with someone who is unable or unwilling to have sex, abstinence… to name a few. You get the idea. Often of course, loneliness, ultimate dissatisfaction, or the pain of a “betrayed” partner bring these people to our offices. Or they may have too much shame, fear, or denial to show themselves. I have noticed a trend for people who are entering midlife, the 50-ish-year-old range, “suddenly” being visited by grief about what they have missed, or fear that their window is closing, and wanting to do something about it, or understand it better, or open up the channel in a long sexually dormant partnership. It may be surprising to learn how many apparently committed couples have not had sex with each other (or anyone) in years or even decades. Again, they may be very reticent to speak… That is where again, it behooves us to break that silence, to delicately inquire, or to learn to.
Neglect Informed Sex Therapy
We need to create a whole new field that puts sexuality on the table. Along with neglect, we need to shine to light on sex, and even the two together. Peter Levine’s lovely new autobiography (An Autobiography of Trauma: A Healing Journey, Park Street Press 2024) is a must-read. I will put no spoilers here! I will only say, that Peter reminded me of two other categories of sexual trauma, which also readily coincide with neglect. Both are under-rated for their impacts and grossly overlooked: having a parent intrude on or somehow discover innocent sexual play between child peers. Young children will be naturally curious and want to try things with one another. Among children close in age, consensual and mutually enjoying themselves and each other, this is harmless and natural. Being “caught” by a parent (often especially if it is same-gender play) who is shaming, punitive or moralizing can be hideously traumatic, as can the same with regard to masturbation. Impacts can be much greater than one might imagine. I am encouraging us to break the silence, initiate the conversation, say it out loud, and widen our definitions of sexual freedom for all. Happy Pride!
This week’s song:
