EMDR Therapy and Sexual Health

Guest Blog Post by Quandra Chaffers, LCSW

Tell us a little bit about you, your experience becoming an EMDR therapist, and what led you toward working with sexual abuse and/or sexual health.

I like to brag that I was an instant believer in EMDR. My supervisor in graduate school touted the power of EMDR in a course about psychotherapies for women. I did not take the course, but I did partially choose the school because she would be guiding me in my goal to become a psychotherapist who could treat survivors. My journey to combat sexual abuse started in college following a Take Back the Night Event. Take Back the Night was a national effort to provide solidarity to survivors and awareness about the pervasiveness of sexual assault on college campuses. The following day, most of the young women in my homeroom were tearfully disclosing their childhood molestations and Freshman-year rapes. I was devastated and incensed! I could not understand how I could be one of 4 women in a classroom of roughly 25 who was yet untouched by sexual abuse, but so many of my peers who had been touched could believe they were the only ones. It started me on a path towards volunteering with many anti-violence organizations, including San Francisco Women Against Rape (SFWAR), one of the oldest non-profits to combat sexual abuse. After grad school, I worked with the Young Women’s Christian Association (YWCA) Women’s Resource Center and treated as many as 80 clients a year, often using EMDR to heal trauma caused by sexual abuse.

I now boast over 12 years of treating sexual abuse and continue to use EMDR almost exclusively in my private practice. Helping survivors heal their trauma symptoms through the power of EMDR showed me that healing is not to be symptom-free but pleasure-filled. When people overcome their trauma, they naturally find healthy relationships. They come out. They have consensual sex, sometimes for the first time in their lives! They correct misinformation about their bodies. They communicate their deepest desires. Hence, my trauma work naturally led me to sex therapy. I wanted to give my clients the most accurate information about sexual health as they were already asking me questions about sex and what is normal.

How does EMDR therapy work alongside sex therapy principles? What successes have you seen?

Francine Shapiro taught us that adaptive information processing adds new information to the otherwise stuck trauma narrative. When a survivor gets stuck in processing because they don’t know why they shut down during sex with their non-abusive partner, we might add new information about why that happened. We might normalize the experience and tell them why their body behaved as it did. This then un-sticks the process and allows them to resolve the distress.

In EMDR, we identify commonly held negative beliefs for survivors often shaped in childhood molestation, like “I’m broken,” and reshape them with positive counter beliefs like “I’m normal.” Much of sex therapy is teaching people that they are normal by countering shame in this way. Some negative beliefs about their sexuality are formed in childhood and shaped by our sex-negative society. For example, we teach people that contracting an STI is an indication of being promiscuous rather than a normal hazard of being sexually active, even when being monogamous and careful. After all, many people contract skin-to-skin contact infections such as herpes when they are in committed monogamous relationships because that is when people are most likely to have unbarriered sex. As such, EMDR can help people adopt positive beliefs like “(I have an STI, and) I am valuable” and “I am healthy (even with an STI).”

Survivors of sexual abuse sometimes hold negative beliefs instilled by their abusers. Abusers sometimes teach their victims misinformation that serves to keep the victim silent, confused, or reliant. One such example is being told that they orgasmed because they wanted the abuse when, in fact, their body reacted as all bodies do to direct stimuli. EMDR and sex therapy often dovetail here. In EMDR, we take a detailed sex history to understand many events leading up to their presenting concerns. We determine what abuse, sex education, slut shaming, attachment concerns, and medical issues might impede their sexual health. We correct misinformation with psychoeducation about what’s normal. We also help clients ground in their bodies by giving them better-coping skills to manage their symptoms.

We also don’t just tackle problems of the issues in the past. We provide people with the confidence to conquer similar sexual problems in the future. A survivor who has shame about orgasm during their sexual abuse might, for instance, present with the inability to orgasm in their current healthy relationship. EMDR and sex therapy might help disentangle orgasm from complicity for such a client. Moreover, EMDR and sex therapy might create new positive connections to orgasm, such as sexual empowerment.

Are there any cautionary measures you would like to mention regarding using EMDR therapy with people working toward sexual health?

There are many. I have encountered EMDR clinicians who try to use EMDR in a way that mimics conversion therapy. Many of our certifying and licensing bodies now outlaw attempting to change a person’s sexual orientation. We understand that people are born queer or straight, trans or cis. Diversity in sexual identity and sexual orientation is to be celebrated. Still, some clinicians will try to target normal variations in sexual preferences through EMDR to eradicate those preferences. Some clinicians will erroneously target kinks and fantasies, similar to how conversion therapy tries to target homosexuality. Kinks can be distressing to some. They can also be too narrow in their presentation to the point that some people cannot engage with partnered sex without the kink. If that is the case, targeting the touchstone memory of this kink will not necessarily help. We need to provide behavioral interventions to diversify their repertoire, and we need to teach them realistic expectations about sex. Sometimes, it takes a while for people to create other pathways to orgasm and pleasure, and narrow kinks have often been practiced over the years with very limited variation. The kink does not need to be cured. Contrarily, if the client has been sexually violent, then treatment typically includes the help of a sexual offender clinic. But most kinks are not violent, even BDSM (bondage, dominance discipline, sadism, submission, masochism). Most kinks can be practiced in safe, healthy ways with other consenting adults. Most kinks do not need intervention on the kink itself.

In that way, clients will sometimes seek out therapy because they fear their desires. Let’s say a cis-gendered, heterosexual client is hiding cross-dressing from his wife. When the clinician does a floatback, they discover that the cross-dressing is rooted in a foundational memory of his female cousins letting him play dress up with them. The memory is primarily joyful and full of bonding with the girls in his life. However, an adult discovers him and shames him for the play, telling him vehemently that boys don’t do that. While the memory of cross-dressing is pivotal, it’s not scarring and, therefore, not an appropriate target for reprocessing. The shaming by the adult is the appropriate target for processing. Sex therapy can address other distress, such as marital difficulty. Perhaps his wife is frustrated that he can only usually orgasm if cross-dressing is involved in some way. Sometimes, the solution is diversifying the client’s sexual repertoire over time. The solution is NOT convincing him that his cousins sexually abused him. The solution is NOT to force him into conventional patterns of sexual arousal that we deem normal for men.

Are there any myths you’d like to bust about using EMDR therapy and/or sexual health?

I think there are myths in many different common sexual concerns that I would debunk. Vaginismus is a condition with many stigmatizing myths. I have many women suffering from vaginismus in my private practice. Vaginismus is an involuntary contraction of the vaginal walls that makes penetration difficult or impossible. Some women (and trans people with vulvas) cannot even insert their finger, let alone a dildo or a penis. This condition is not rare. More liberal estimates suggest up to 17 percent of people deal with this condition. With vaginismus specifically, I find clients dismayed that previous therapists have tried to convince them that their condition is a result of repressed childhood sexual abuse. A fair amount of people with the condition have no sexual abuse history. They have just absorbed a lot of sex-negative messages throughout their lives that we, as EMDR clinicians, can target the same as any instance of childhood molestation. For example, a young girl who witnessed her older sister shamed for becoming a teen mom does not need sexual abuse to absorb that sex is dangerous and will make you a pariah. Our bodies do not absorb qualifiers like “Don’t get pregnant (until you’re married).” Our bodies absorb absolutes like “don’t get pregnant,” Period.

Through EMDR therapy, she might be able to tolerate penetration if she undoes her beliefs about sex. Even so, EMDR clinicians need to know that many women with vaginismus do like sex and often want to be sexual. People with the disorder are not all frigid. Vaginismus does not mean you cannot have sex in all situations. Some people can have pleasurable solo sex and penetrate themselves with toys but close off to people. Sometimes they tolerate penises or dildos, and sometimes, they can’t. Also, some people can hold sex-positive beliefs but still close up instinctively. Other myths are that vaginismus can be cured by just relaxing. Clients are trying to relax, and it’s not working. Yet another myth is that vaginismus is just in people’s minds, which tends to imply that vaginismus is not a real condition. It is real. Vaginismus is a medical condition that must be treated with the ongoing consultation of a physical therapist or a physician. Because different localizations and causes of the condition will call for different treatments, also, vaginismus can be either secondary or primary. Primary vaginismus means that the condition is unexplained by a different condition. Secondary manifestations are often the results of other health concerns causing pain, such as psoriasis, surgeries, or endometriosis. People instinctively tense up against sex when sex is painful. Vaginismus might persist even after the primary medical concerns are resolved.

Are there any specific complexities or difficulties around sexual health that people recovering from sexual abuse might deal with? How does this affect therapy?

We talked about complexities such as shame, but there are many. Some survivors might struggle to form healthy relationships due to difficulties in trust, self-worth, and intimacy. Sexual abuse ruptures our relational capacity. Some people seek therapy to develop a healthy relationship or maintain a budding one. Sex therapy requires us to teach relationship skills in tandem with EMDR, such as communication skills, co-regulation, boundary setting, and repair.

Survivors also might reenact abuse in ways that require our compassion. The behavior might be worth ridding, but we also need to talk about it in ways that are not judgmental. I sometimes work with people who do not like the sex they are having but they almost feel compelled to seek it out. They may put themselves in dangerous situations with people unsafe partners. They recreate certain acts because they return to a cold case and try to solve the crime with no new evidence.

I tell my clients that they cannot selectively numb. Some people come to EMDR and sex therapy because they cannot “let go” during sex. They are checked out in many places of their lives as a result of sexual abuse, and the bedroom is one of those places. This requires us as therapists to teach skills to become embodied inside and outside the bedroom.

What multicultural considerations might EMDR therapists need to keep in mind regarding EMDR therapy and sexual health?

There are hundreds of races, cultures, and ethnicities in the world. We will never be experts in all of them. Hence, we, as EMDR therapists, must practice cultural humility in our work. It’s more important for therapists to be aware of their backgrounds and how that plays out across from the client than it is to become versed in every possible racial, cultural, or ethnic background. For example, I, as an American citizen, do not have to filter my experience of rape through the lens of our American immigration system the way an immigrant would. However, some clients must filter the sexual abuse and their healing through the lens of their immigration status or the status of their family. I have a client who processed with me that her sense of safety was at points dependent on whether her abuser would be deported to their home country. For some survivors, they are happy for their rapist to be removed far from them but also conflicted that our immigration system is punitive and disproportionately harsh to non-citizens.

A lot of my work with this client also centers on her pleasure. Her family’s upbringing in Christian fundamentalism meant having to hide many normal aspects of her sexuality. I relate to this, having grown up in the same religion, albeit not as strict. Like her, I was not allowed to date until college. I relate to growing up in a household where no one spoke about sex. However, I did not internalize a sense of needing to keep my sexuality a secret in the way my client did. It’s important to remember that our meaning-making can differ even when we share the same backgrounds as our clients. We cannot draw shortcuts to their healing through generalization. We must listen to every unique experience.

Moreover, we must challenge stereotypes. There are certain groups like black people, gay men, and polyamorous people who are more often discredited when they disclose sexual abuse. They are discredited in the way all discredited but they are doubly scrutinized – once as a survivor and once as a representative of their whole population. They are discredited by being labeled “hypersexual.” They are even more susceptible to victim blaming when they are in questionable situations that challenge the notion of the perfect victim. Therefore, we as EMDR therapists must understand that sexual abuse is experienced differently at the intersection of race, sexual orientation, and sexual identity.

What is your favorite free resource to suggest to other EMDR therapists about this topic? (ie: article, podcast episode, video, handout)

There are many great podcasts on sexual health issues, including Sexology by Dr Nazanin Moali, Savage Love Cast by Dan Savage, Smart Sex Smart Love by Dr Joe Kort. The Mayo Clinic is a good resource for more on vaginismus and other conditions related to sexual pain. A wonderful site for free educational material is O.school. EMDRIA also has a podcast on EMDR Therapy and Sexual Trauma.

What would you like people outside the EMDR community to know about EMDR therapy and sexual health?

If you want to grow in your understanding of sexuality issues, you should seek out consultation and additional training. The American Association of Sexuality Educators Counselors and Therapists (AASECT) is a good resource.

As a trauma specialist, Chaffers helps teenagers and adults overcome intimate partner violence and sexual abuse. She is also a kink & poly knowledgeable sex therapist. She specializes in areas of sexless marriages, painful sex, and problematic sexual behaviors. For more than 10 years, she has honed her skillset in cutting-edge therapies such as Eye Movement Desensitization & Reprocessing (EMDR) to mitigate the effects of Post Traumatic Stress Disorder (PTSD) and other mental health issues that result from exposure to trauma.

Chaffers is a sexpert because she attacks the issues of sexual violence as a trifecta—community educator, therapist consultant, and psychotherapist. Before transitioning into private practice, she worked for three semesters at Washington University in St. Louis as an adjunct professor. She taught graduate students a better understanding of developmental psychology as it applies to sexuality across the life course. For four and half years, Chaffers treated on average 90 survivors per year as a case manager-therapist at the YWCA St. Louis Regional Sexual Assault Center. As a volunteer of Rape and Violence Ends Now (RAVEN), she co-facilitated batter’s intervention programming for siz years, working to rehabilitate men who have been abusive.

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EMDR Therapy and Sexual Health