Acknowledging Sexual Abuse

There are no degrees of sexual abuse. All abuse has an effect. There are degrees of effect. It is the breaking of that trust that affects a person’s self-esteem and their ability to trust, and it creates another wound that needs healing.

It is scary looking at sexual abuse, dealing with it, acknowledging it. Some very unpleasant facts are coming out of the closet, or rather being dragged out, because the disbelief and denial is so great that it is proving a block to acceptance, understanding and therefore a block to action, to healing.

I have a friend who participated in a sexuality workshop and at some point memories began to surface of an early sexual abuse by her father. She felt distressed and stirred up and went to her homoeopath for help because the distress had affected her physically. Her homoeopath pooh-poohed her memories and suggested that it was her imagination, that as she had no evidence she was on rather shaky ground and didn’t she know that all daughters have unresolved sexual feelings towards their fathers? My friend described the conflict that then ensued within herself; because the major part of who she was wanted to believe that she made it up.

The first response to abuse is denial. It goes so deep that not wanting to believe that someone we have trusted and loved can betray our trust can hurt us so thoroughly. Denial is the self-preservation mechanism that suppresses the pain and the hurt and is often accompanied or followed by amnesia because this makes life half-way bearable.

Anyway, back to my friend and her sticky consulting room situation. She knew something was wrong and then fortunately her homeopath told her a tale about her own childhood; how at some point in her growing up her father had warned her not to get too close to him, because she had become attractive to him and he did not know what he might do, that he might lose his self-control. My friend, who was training to be a psychotherapist, spotted that her homoeopath had an unresolved sexual abuse from her own childhood, the denial of which had kept her from validating her patient’s experience of sexual abuse.

This story is interesting because it illustrates what happens if the patient spots the game; in this case my friend said that she put her own feelings in a safer place to deal with elsewhere. This is an abuse of a different type; this swapping of roles, where the patient looks after us, and it was not intentional, but as professionals we do have a responsibility to deal with these situations if they arise.

If you doubt your patient’s experience you add insult to injury. It is imperative that you validate your patient’s experience however whacky. They may be suffering from a delusion. You have to be seen to be believing them, otherwise they will dam up and lump us with the rest of their world that did not believe them or abused them. It is by believing them that we can get their case, that we can start the process of healing.

Embarrassing Words

OK folks! It’s confession time now. In my first year in practice I did not ask about my patients’ sexuality and I did not have any highfalutin’ ideals and principles about not asking them. Oh no! I was just plain embarrassed. There were many words I could not say without going red. Without having a hot flush. Words like MASTURBATION, ORGASM, SCROTUM, LABIA, CONDOM. Some words I could say if I said them very fast like PENIS or VAGINA. These words had not been used in my family. They were wicked, wicked words, and I was once punished for bringing one of them home from school. I learnt that talking about sex was wicked. It was years before I understood what all the words meant. Oh, sure I learnt to do it, but I had learned not to talk like many others. So I kept my mouth and my eyes shut too!

As a baby homoeopath, if my patients talked and in talking offered, of their own accord, details about their sexuality I wrote furiously and made listening noises and hoped and prayed I would not blush and then I moved on once they had finished, and breathed a sigh of relief.

So I took myself rather urgently in hand and completed the Spectrum Sexuality Programme. Spectrum is a psychotherapy centre in London. I sorted myself out and got myself educated and learnt to talk, learnt what is normal and what is a true perversion, what is healthy and what is diseased; with regard to sex, with regard to myself and sex, and with regard to others and sex. I discovered there is a lot of rubbish talked about sex, that does not take the individual into account.

Sex In The Consulting Room

And you know what, now I can talk about sex and now that I like to talk about sex, I still very rarely ask my patients questions about their sexuality. Firstly because I have found that I can prescribe effectively without having that information, but more importantly because I know when to ask those questions; when it is appropriate, and that is a learnt skill. Generally speaking, however, I am an effective prescriber without bringing sex into the consulting room.

Sometimes patients initiate talking to me about sex and then I am happy to listen and ask questions and I will respond appropriately, with reassuring statements, and an appreciation of the trust that has been confided in me. I may be able to build their sexual difficulty into my prescription, in which case I say so. It may be that my patient needs a referral to a counsellor or a therapist who specialises in sexuality. Sometimes I am able to affirm a patient’s ‘normality’. Many people do not know what is normal, are too frightened to find out, and carry myths from their childhood like sacks of cement.

Sometimes I do ask about a patient’s sexuality and then I put my questions in a context. I believe it is deeply intrusive to ask questions about a person’s sexuality without firstly putting them into a context. A professional context.

The first person I question is myself. Why am I wanting to delve into this area? Is it important or relevant to my prescribing to find out about my patient’s sexuality? If it is, I share my thoughts with my patient. I make clear statements about why it is relevant. To educate him or her about the way I work. I create a safe boundary. I may reaffirm that the consultation is confidential, that nothing that is said will go beyond these four walls.

I ask questions like, “Is it OK with you if I ask you some questions about your sexuality?” (or sex life). If I know a person is in a relationship I may ask, “Is there anything that is bothering you in your relationship? Are you happy with your sexual relationship?” You may already have some information about a patient’s intimate relationships that you can build on carefully. Once you have opened the door, people will volunteer information and you can take it from there. We do need to start out with a non-threatening question that leaves it up to our patients to pick up the threads.

So, with regard to your own practices, I suggest that you check out your patients’ willingness to talk with you about their sexuality. If there is the slightest hesitation, do not do it at that point. You can ask them again, as and when trust develops. Or offer them the choice of coming back to it in their own time.

What we are wanting to do is find out if sex is working for a person at this point in their life. Is there disease, pathology that relates to this area that we can prescribe on? Is this person limited by their own sexual dysfunction? If so, how?

Use the tone of your voice, your posture, your expression, your words, to convey that you are OK, that you are trustworthy. Do not take notes or just jot down key words and fill them in later, it is very threatening if we are seen to be writing down every word about, for example, a painful childhood incident of sexual abuse.

Sexual Health

People are rather concerned with achieving various goals, with getting it up and getting it off. How we express our sexuality has a lot more to it than just the sexual act itself that culminates in being able to achieve an orgasm. Intimacy, love, tenderness, friendship, affection, compassion and bonding make up a ‘holistic’ intimate relationship, and we may choose to have that intimate relationship not with a person of the opposite sex.

My definition, for what it is worth, of a healthy sexual relationship is that it be between one or more consenting adults where both people explore or negotiate this intimate relationship within an atmosphere of trust and safety, where both the ‘no’ and the ‘yes’ are responded to. Where the power balance is more or less equal.

Labelling Abuse

I sometimes see or hear of abuse being acted out in a relationship, and because of the way I work, I am committed to taking a position if that happens, if I spot abuse and my patient has not. I am thinking right now of a woman I saw recently who had been married for fifteen years, who has four or five children. Her husband demanded sex of her every night, sometimes more than once a night. Sometimes she wanted to make love and sometimes she did not, but it did not matter to him whether she did or did not and an awful lot of nights she lay there gritting her teeth whilst her husband ‘did it to her’ and he had never noticed.

There are several issues here – there is the issue of her ability to say ‘no’ and be heard. We can only do that if we know that what is happening is wrong. When I labelled his behaviour as abusive she cried with gratitude because she had had that feeling, but in talking to her GP, for example, she had not had that support.

I will not collude with perpetrators of abuse either. If a patient comes to me and says, “I have just beaten up my wife and now we are together again,” I will ask if he has agreed to a “non-violence contract” and if he has not, I will not treat him. That is partly because my own safety is important to me, and I am not going to put that at risk.

My guess is that some of you are thinking, “If only we can get the right remedy, then we do not have to say any of these things or do any of these things.” For example, the woman with the over-sexed husband – if we just give her Staphysagria, or Sepia, or whatever, won’t it just sort itself out? There are many levels of healing, not just with little white pills. Patients are expecting more of their practitioners – are expecting a higher level of integrity, more inter-personal skills.

I think we need a level of understanding and sophistication (as practitioners) to be able to deal with these situations. And that is why I believe that a training in interpersonal skills as well as on-going supervision or patient management, some form of looking into ourselves, is so vital.

My experience, which is also born out in my eight years of practice is that people repeat their patterns, their mistakes. We can help our patients understand consciously how they became ill, understand the part they had to play in letting stress get the better of them, begin to be aware of the different choices they might make, and prescribe a good remedy. In my own practice, I hope that the next time a similar situation surfaces for a particular patient, that he or she may be able to deal with it differently, as it happens, and not fall ill with the stress of it – and therefore not need me.

Sex In The Forbidden Zone

There are many books out now on sexual abuse. I want to introduce you to one that I recommend on professional sexual abuse. It is called Sex In The Forbidden Zone by Peter Rutter.

Professionals in most of the health care professions are thrashing out this issue of sexual abuse, what constitutes sexual abuse and what does not. When is it OK to commence an intimate relationship with an ex-patient? Is it for example, an issue of time? Or what?

Peter Rutter takes the position that people in a position of power (be they teachers, clergy, lawyers or doctors) enter into a relationship with a person who comes to them for help (their students, parishioners, clients and patients) with a particular contract, often unspoken. A contract of trust. These relationships have a particular psychological dynamic that, he believes, is difficult to change.

This book deals with this issue in great depth and with great sensitivity. If you are interested in clarifying sexual abuse as a professional, read it! I cannot recommend this book too highly.

Sexual Abuse and The Society Of Homeopaths

What position does the professional body that represents us, The Society of Homeopaths, take with regard to this issue? How many of you have read our Code of Ethics carefully and thoroughly? You may be interested to check out the Code of Ethics of the British Association for Counselling. It is interesting to look at the other ‘sister’ organizations to look at how they deal with these issues in their professional communities.

I believe that we have to update our attitudes and beliefs towards sex. A lot of them date from the 19th century in all its glory. We need to be aware of differences between the more old-fashioned attitudes towards sexuality and the growing body of evidence and opinion that is exploring a more holistic, healthier belief system,which supports the healthy expression of a person’s sexuality – even if it does differ from a conservative ‘norm’.

Traditionally homeopathy has taken a rigid stand against certain sexual practices regarding for example, homosexuality and masturbation as perversions. In the light of an expanding awareness in the areas of psychology and sexuality, there is a growing acceptance that people can express themselves in different ways sexually and still be OK. Be healthy and normal.

Conclusion

I have asked many questions today. I do not pretend to have all the answers with regard to this issue. I am hoping to stimulate you to thinking about your own attitudes and beliefs, both your personal and your professional attitudes and beliefs. There are no simple answers. It is a complex topic. We are all working to a common goal of health and healing – this is a part of our healing, as a profession. We have a responsibility to be sensitive and aware. Habitual secrecy and denial have made this a taboo subject. It is like the Emperor’s New Clothes – people are afraid to talk about something that is obvious to them but is being studiously ignored by everyone around them.

This is a newish topic. It may be new for you, may have sparked off memories of events that happened to you, or others in your life. Many people have been abused and not known or recognized that that is what they were doing simply because their abuse was learnt behaviour. How many of you here today feel that you have an issue to work on around your own sexuality? How do you think that your own difficulty may affect your attitude to your patients or your attitude to a patient with a similar difficulty?

I am not wishing to lay blame; to say you did this or this wrong, that you should have done it this way. All I am asking of you is this; that you think this through for yourselves, each and everyone of you; that you talk with your friends, peers, colleagues and even your family if you can, that you evolve with this issue of sex in the consulting room, that you share your thoughts and feelings with each other with me, with this journal and with the newsletter.

I value this being a continuing debate. Let us face this issue and deal with it in order to heal it, for ourselves and our patients. We need to be open to dealing with our mistakes. After all we are all trying to get better, because it is by talking, by being honest and open, that we can work through it and forgive and heal the old wounds, and create a healthy model of which we can all be proud – for ourselves and our patients.

POST SCRIPT – Summer 2006

Gosh. Sex. That presentation caused quite a stir. A presentation I gave on Confidentiality a number of years ago is the only other topic that has resulted in people shouting at me in public places.

After Sex in the Consulting Room I received a letter – from a psychotherapist who was a homeopathy student – asking why I hadn’t stated explicitly that engaging in a sexual relationship with a student or patient was unethical. It has always astonished me that more people didn’t ask me this question. Mostly I was scared. Our Code of Ethics at the time was a bit vague. Our community had simply not addressed this ethical issue directly. I felt it to be an extremely sensitive area. Our history seems to have given us tacit permission to engage in intimate relationships with our students and patients. Starting with Hahnemann. And Melanie of course. A love story. Because we hadn’t addressed this issue and because there was so many sexual misbehaviours going on I wanted simply to raise the wide variety of issues that fell under the umbrella of ‘sex’ at that time. I didn’t want people to get stuck on thinking I was telling them with whom they should or shouldn’t have sex.

Innumerable practitioners and students told me afterwards how uncomfortable they had always felt asking about patient’s “sex lives”, how relieved they were to have an opportunity to think about it and change how they addressed this topic – and to share their solutions. I now ask people “How is your sexual energy” and I may follow it up with “Do you have any problems or difficulties in that area you would like to address?” or “Is that part of your relationship/marriage working well?” In any case I’m more interested in their history in intimate relationships – sex may or may not be a part of that history.

I am thrilled that the Board of Directors of the Society of Homeopaths picked up this baton and created ethical codes that are in line with other professional organizations, codes that provide us with appropriate guidelines and protect both patients and students from harm. Of course these guidelines protect us as well – giving us clear boundaries to adhere to. My goal was to open up the topic for dialogue and that has happened in spades! Issues around sex and sexuality are taught more sensitively in schools and we are more open and respectful in general in how we deal with this subject with each other and our patients.

If humanity does not opt for integrity we are through completely. It is absolutely touch and go. Each one of us could make a difference.

—Buckminster Fuller

REFERENCES

1 Peter Rutter, Sex in the Forbidden Zone, 1990, Unwin Hyman, reviewed in The Homoeopath 1990,10: 2.

2 Spectrum Incest Intervention Project, 7 Endymion Road, London N4 lEE.