10 Healing and re-learning sex after sexual assault: Advice from a sex therapist and reluctant survivor
Juan Camarena, PhD
“And the day came when the risk to remain tight in a bud was more painful than the risk it took to blossom.” – Anais Nin
In the following chapter I describe my sexual assault, the methods I used to heal from the experience, and suggestions I give to clients of my psychotherapy practice. I also discuss how my social location made a difference in how I healed. If you’ve had a nonconsensual sexual experience, before reading this chapter, please ask yourself the following:
- Am I feeling safe to think about my own experience(s) as I read someone else’s story?
- What thoughts, body feelings, or emotions would tell me to take a break or stop reading?
- Will reading this and thinking about my own experiences, be uncomfortable, but helpful in my own growth?
- Will reading about sexual assault and recovery be harmful to me in some way?
After you answer those questions for yourself, you can skip different parts of the chapter by paying attention to the subheadings. Please also remember, that the information contained in this chapter is not meant as a substitute for therapy from a qualified professional and there are no one-size-fits all interventions or easy answers. Healing is meant to be a process of learning and re-learning, which takes time and intention.
There are many definitions of the term ‘sexual assault.’ Legal definitions tend to focus on specific behaviors that differentiate it from sexual harassment or rape. As a therapist, educator, and survivor, the definition of sexual assault can seem ambiguous and dependent on the person’s experience of a nonconsensual sexual interaction. Many clients and students ask, “Does it count as assault if _____________?” I believe that the question is much more powerful than the answer. After reading this chapter and researching the legal definition in your own state or province, I challenge you to come up with a definition for yourself and your body.
The details of my assault
There are key parts of my assault that I do not remember. I wish I could remember all of it, as if remembering every detail would make me “know” if the incident was my fault. It has been ten years later at the time of writing and I still feel a small lingering doubt, which I accept as the part of me that is still human and vulnerable and hurt. I can have this doubt and still be healed, integrated, pleasured, and grounded in my sexuality.
I went out with a good friend to blow off some steam, go dancing, and enjoy the kind of freedom I feel when I’m in the middle of a sweaty dance floor. I don’t like to dance on the outskirts of the dance floor. I like to dance in the center, where the base from the music can fill my chest, and I dance and laugh and sing along without being anyone’s teacher or therapist. It’s often on the dance floor where I can exchange glances, flirt, and feel desired. My friend and I went to a bar and had a cocktail and a shot, laughing and planning the rest of the evening. We then walked to the club and waited in line where we met a tall, handsome stranger from the East Coast. He said he was visiting and didn’t know anyone, so we chatted and invited him to hang out with us.
The three of us danced, had two more drinks, and at some point, I got separated from my friend. From the moment of having our second drink and hanging out, there is a large gap in my memory of the evening. I have cloudy images of me using the restroom and meeting up with my friend. But for the most part, I recall us all having a drink together and then waking up to someone having sex with me. I remember that it took a little time for me to understand what was happening, and then I gathered all my strength and pushed him off of me. I looked around, gathered my clothes, and realized I was in a hotel room. I found my phone and walked out of the room, not sure where I was, but knowing I had to get home.
I don’t remember the stranger’s reaction or his face, I just remember the feeling of, “I have to get home.” The next flashes of memory are of me crying and throwing up in my bathroom at home. I remember telling my husband, “That’s not what I wanted…I’m sorry…I’m so sorry.” He was scared and tried to ask me about what happened but I didn’t really know. I could only say what I remembered.
I spent most of the next day in bed feeling dissociated, ashamed, wiped out, and trying to remember what happened. I called my friend, who told me that we were having a lot of fun and then he lost me after a trip to the bathroom. He had assumed I was fine and that I left with our new friend but he was concerned that I didn’t text him or check in with him. He described me as coherent, alert, and “not fucked up.” In retrospect, we had three cocktails and a shot over the course of the evening, not enough to make us drunk, have a hangover, or black out. I recall that as I spoke to him, I felt a mix of dread and confusion. I wasn’t sure what had happened but I knew it was bad and that I was at fault. “I should have known better…I’m a sex therapist…I’m a teacher…I’m almost 40 years old…”
The aftermath
In the days that followed my assault, I dealt with paralyzing guilt and shame. I wanted so badly to remember if I had initiated the sex, if I was just drunk and trying to cover up bad behavior, how I got to the stranger’s hotel room, and what this incident would mean for my marriage. My husband was concerned, supportive, and asked if I wanted to file a police report. I wasn’t sure about what the incident meant to my life or marriage, but I knew that I didn’t want to tell this story to the police. If I was unsure of the details, how could I report another man of color to the police? Would I be seen as just another gay dude who got too drunk? Would the police believe me? Did I believe me?
There were things I knew: I didn’t want to have sex that night, I stopped it when I could, and I had a significant gap in my memory which was odd for the amount of alcohol I drank given the time that passed, our dancing, and my tolerance. In my recovery process I would have to come back to these truths over and over, especially when a cloud of shame would envelop me and I could hear my mother’s and grandmother’s voices saying, “ya vez, eso te pasa por andar de…”. Translated loosely, the message is, “you see, that’s what happens when you are out doing…” It was a familiar refrain for when we as children did something we were not supposed to do. That phrase was the intersection of Catholic and Mexican mom guilt used to control us and instill rule following. The message was clear: If you were making the correct choices, none of this would have happened.
What made my process unique, and privileged, is that I had a therapist to turn to when I was confused about what happened. I had seen this therapist off and on for ten years. He had helped me through some very tough times related to being Queer, being a Mexican American therapist, and being a cis man in a cis woman-dominated field. He was my first Latino therapist role model. So while I had a trusted person to help me talk about the experience, there was a part of me that worried about how he would react. As much as I knew he could help me, there was still a part of me that felt ashamed to talk with him. Would he secretly judge me? Would he lecture me? Would he tell me that I didn’t do anything wrong, while knowing I had? While the process of going to therapy facilitated my overall process of healing, there was a chasm between the cognitive part of my brain which understood my therapist only wanted to help me, and the part of my soul which told me I was bad.
From survivor to healer and back again
My own experience allowed me to feel a deeper level of empathy with my clients than I’d ever felt before. As a therapist and counselor educator, I was known for my direct approach and Gestalt-inspired frankness, but over the years I had grown a thick skin that protected me from my clients’ and students’ pain. Being a therapist for many years meant that I’d heard many stories of abuse and exploitation, but I was able to stay more cognitively present than emotionally present. For example, I could be present and make eye contact and nod and track the client closely, but my emotions were somewhat disconnected. After my assault, I had to relearn where my pain ended and my clients’ pain began; I had to relearn boundaries. Re-orienting and re-thinking our relationship to others is a common task after a traumatic experience.
Boundaries
The following sections are things that I have learned from my experience as a sex therapist and survivor that others might consider after experiencing a sexual assault. When someone violates your sense of physical and emotional safety, it is a normal reaction to consider how much closeness or distance you want from people moving forward. Some important questions to consider: What are signs that you are feeling overwhelmed with the amount of time, touch, or connection that you feel with friends? With lovers? With family? In this next part of your life, the recovery phase, you may want to consider with whom do you feel safe (or mostly safe). Paying attention to how your body feels around someone who you intellectually know is safe (regular breathing, regular heartrate, no tightness in your chest or stomach) is an important step in determining how much time you want to spend. It is also a good indication of how you want to be touched by them. This might be a good time to consider letting go of relationships or situations that feel unstable.
Unhelpful thoughts
Just as trusting others will take some practice, so will trusting your own thoughts. The most common thoughts for those that have experienced nonconsensual sexual experiences are ones of self-blame and focusing exclusively on what the survivor “should” have done differently. You can test if a thought is helpful or not by how much time you spend with that thought, how you feel emotionally when thinking it, and how your body feels. For example, I struggled with the thought, “If only I was sober, none of this would have happened.” Do you spend an inordinate amount of time thinking this thought, looking for evidence to reinforce it? Do you have shameful (“I am bad”) or guilty (“I did something bad”) thoughts that follow? Does your stomach feel tight, or do you feel short of breath while thinking this? If so, you may have discovered what therapists call a cognitive distortion. These are common thoughts that have an outsized reaction. These thoughts are normal after having unwanted sexual experiences because our brains try to understand how we could have avoided the danger, even though in reality someone else caused the danger and unwanted experience. Try challenging these thoughts by looking for evidence to the contrary, by identifying facts that contradict the distortion. Talking with your therapist about thoughts that are helpful (“I am safe now”) or unhelpful (“Why did I go out that night”). Both are important parts of the healing process.
Common reactions to sexually traumatic experiences
Experiencing sexual assault can have negative impacts on how you understand and experience your sex life. The three aspects that most psychological literature address are: cognitive issues, emotional challenges, and somatic impacts (Almas & Pirelli, 2017). Cognitive (brain or thought-focused) issues can include unwanted memories, reliving the experience(s), and thoughts that feel uncontrollable. Emotional reactions can include having reduced or no sexual desire, fears or phobias about sex in general or specific sex acts, fear of losing control, shame, guilt, anger and irritability, anxiety and worry, and fear of being an abuser. It may also feel like your emotions are more difficult to control or you may not understand why you are feeling a specific emotion at any given moment.
Somatic reactions, the responses that show up in your body, can also be intense. Thoughts and emotions are in a constant feedback loop with your body. While researchers debate which occurs first, emotions or thoughts, most professionals agree they both have a direct impact on sensations in the body. For those of us who have experienced sexual trauma, there can be a sense of losing touch with your body (dissociation), pain in specific areas of the body, involuntary tightening of the pelvic, vaginal, or anal muscles, difficulty with ejaculation, delayed orgasm, or difficulty achieving orgasm. Many of my clients describe a pattern of feelings, like shame and guilt, that lead to thoughts of self-blame, which then lead to stomach aches, headaches, or chest tightening. When faced with engaging in sex, even when they want to, survivors can feel a disconnection with their bodies that leads to difficulty staying present during sex. Feeling distracted or having difficulty focusing on the moment-to-moment feelings of sex can directly impact feeling pleasure and achieving orgasm.
What is discussed much less often by researchers and therapists is the spiritual or soul wound that some of us feel. Some survivors compare the phenomenon to the experience of having had surgery and been left with a feeling like things in your body don’t feel the same or an indescribable violation. When someone takes control over your body and/or you feel out of control about what happens to your body, there can be an impact that is difficult to describe and therefore difficult to heal. If you believe that you have a sixth sense or spiritual self beyond the traditional five senses, this can also be impacted. In his 2006 book, Healing the Soul Wound: Counseling with American Indians and Other Native Peoples, Dr. Eduardo Duran describes this phenomenon from an indigenous or American Indian perspective. Dr. Duran describes a harmonious connection between body, mind, and spirit and how trauma can disrupt that relationship, leading to suffering. Dr. Duran also encourages others to pay attention to not only your own suffering, but to understand how that suffering is related to a historical suffering (of your family/peoples), and how the traumatic incident impacts your community of people. Therefore, healing can have individual, family, community, and spiritual/religious components.
What healing can look like
As I stated before, I had a lot of feelings about how my therapist would react or judge me for what happened to me. I quickly realized that he really wanted to connect with me, empathize with me, and help. Knowing he wanted to help and his ability to be present were some of the most healing parts of our work together. Even when I doubted my ability to feel better, he was confident that I could, which allowed me to practice feeling a sense of hope. In the following section I’ll describe elements that were important in my healing and some things that I suggest to my clients, though what the interventions have in common is a desire to cultivate a sense of groundedness and courage.
Perhaps because I am a therapist and I have a therapist myself; I believe in the power of working with a licensed psychotherapist (i.e. Clinical counselor, Marriage & Family Therapist, Clinical Social Worker, Psychologist). In addition, finding someone with experience in helping people heal from sexual trauma is especially helpful. A good therapist will help you identify thoughts, feelings, and behaviors that are (and are not) helpful and suggest alternatives. They will also help you feel supported, believed, and more hopeful. While you might find helpful suggestions for dealing with trauma online, on social media, or in books, none of those may be sufficient by themselves. There are also newer types of therapy like Eye Movement Desensitization and Reprocessing (EMDR), Brainspotting, Biofeedback, and psychedelic-assisted psychotherapy that could be helpful.
Also, therapy doesn’t have to take years to be effective. You should feel a difference in a few sessions and it’s okay to ask your therapist how long they think it will take you to accomplish your specific goals. There are many different types of therapy and approaches to working with trauma, but the key element is your relationship with your therapist. If you don’t feel like you are getting your needs met by your therapist, try bringing up your concerns. If they hear your feedback AND make changes, that is a good indication of a good working alliance between you and your therapist. However, if you’ve given your therapist a few sessions and you still don’t feel understood, believed, or connected to them, it is okay to switch therapists.
In addition to therapy, cultivating caring and loving relationships is a key element to healing. When I use the word cultivate, I mean putting effort into relationships through consistent communication, being fully present when together, and taking a genuine interest in each others’ lives. When we engage with someone who feels safe and has demonstrated that they are safe, that allows the wounded part of us to relax and begin the process of trusting again. Having a sense of connection and trust is an important part of deciding with whom you will share your experiences. It took me weeks to disclose my assault to my sister and closest friends, but when I did, they responded with more love and care than I imagined possible. I didn’t get the blame or shame that I feared, and they were looking for ways to support me, which I did not anticipate.
In addition to finding safe people, finding safe communities can also be helpful. These spaces are not only to discuss traumatic experiences but are places that feel supportive of different parts of you. For example, online support groups and in-person support groups are great for connecting with others with shared experiences of sexual assault, and they can be normalizing and healing in different ways than individual therapy. In addition to those types of spaces, attending a supportive church, a meditation group, a yoga class, or a hiking group can assist in reconnecting with a sense of social safety. It is especially helpful when you can find a group that shares your interests, your ethnic background, your gender identity, or any other identities that are important to you. Feeling a part of a community is especially important if you don’t have a set of close friends or if you are looking for safer social connections.
Sex after sexual assault
Because people’s experience of sexual assault can vary widely, the impacts on a person’s sex life can vary dramatically. For some, engaging in sex with a trusted partner is an important reclamation of an important part of their identity, and for others, taking a break from sex helps a person redefine what they want their sex life to look like. The choice to engage in sex or the choice to take a break from having sex (with yourself or others) are both valid choices. Consider these guidelines when determining what may be helpful to you:
Do you have a sense of what specific sex acts might feel comfortable and safe vs. which ones feel scary?
Do you feel like you have the power to take a break at any point in the sexual process? For example, if you start to feel distracted, anxious, or fearful, do you feel like you could ask your partner(s) for a time out?
Has masturbation brought up any disturbing feelings or thoughts?
Do you engage in sex as coping (using it to numb or distract) rather than for pleasure?
Do you engage in sex to be liked or feel attractive to others?
Just as connecting with trusted friends is an important part of the recovery process, so is having a trusted sexual partner when you engage in sex. Choosing a partner or partners who are capable of pausing or stopping when you don’t feel present, or who check in with you occasionally (i.e. “Does this feel good?”) can be very important. Choosing when and where you have sex and pausing or stopping sex at any time are key elements of reclaiming sexual safety. Here are some additional considerations:
Ask yourself, do I want sex or do I want physical connection? What type of touch am I in the mood for? What would I really like? What does not sound good today?
Practice asking for what you want. For example, letting your partner know what you’d like is a key element to a sexually satisfying experience, which most people were not taught to do.
Be prepared to negotiate and collaborate. Your partner also has wants and may not be into what you’d like at that moment. Ideally, a brief conversation happens before engaging in sex but can also happen during the act.
Practice asking for a break to determine what you want to do next. For example, say you need to use the restroom if you need some additional time or space to decide what you want. You can stop or continue with an activity that feels safe or comfortable.
Sex after sexual assault allows for an opportunity to do sex differently than before and can be understood as the next version of your sexuality. This new version could be very different. You may have difficulty with erections, lubrication, skin sensitivity, or you could not feel pleasure in the same way as you did before. What used to get you to orgasm quickly may no longer be the same. Before jumping into internet searches about sexual dysfunctions, please pause, breathe, and know that the pressure to “fix” something can lead to opposite results in sexual healing. In other words, the most effective libido killers are stress, pressure, anxiety, expectations, and a hurried approach toward orgasm. Engaging in this type of sex can actually be more harmful than helpful. By pressuring yourself into a sexual experience your body (or mind) isn’t ready for, you may be replicating what happened in your sexual assault. This is my number one rule in recovering your sex life: Do not do anything you don’t want to do, and if you aren’t sure, pause and reflect for at least 15 minutes.
Dissociation
One of the results of sexual trauma can be dissociation, which is an impairment of perception, memory, or consciousness that can range from briefly daydreaming to long periods of memory loss (Bird et. al., 2014). Many clients describe feeling like your brain took a time out, or having difficulty verbally responding for a short period, or things are happening around you and you can’t pay attention to them. Two types of dissociation include depersonalization (feeling detached from your body), and derealization (feeling like things are surreal around you; Bird et. al., 2014). The feelings of detachment or numbing are key parts of dissociation, and it is different than ordinary forgetting (Figley, 2012). Dissociation is the brain’s way of shutting down when it is overwhelmed, and people tend not to have control over when or for how long it happens. Many of my clients have an ambivalent relationship with dissociation. While it can be disorienting and scary, it can also feel comforting when the person feels overstimulatedover-stimulated or triggered. Because sexual activity can be a reminder of past sexual trauma, many people (including myself) have felt dissociated at different stages of consensual sexual activities. I strongly discourage my clients from engaging in sex when feeling numb, disconnected, detached, or not fully present. Doing your best to know situations that sometimes lead to dissociation (for example, a particular kind of touch or sexual act), recognize when you start to “go away” in your mind, and take a break, is much better than “pushing through” to get to the end of a sexual experience.
The role of substances
All the considerations for engaging in recovery-oriented sex that I’ve described require some level of sobriety. Because you may be relearning your body and your body’s responses to stimuli, try not to use substances that may cause you to lose or dull body sensations. I also recommend staying away from specific substances that can cause you to dissociate, such as ketamine or psychedelics (Thal et. al., 2019) as well as heavy alcohol use (Noël et. al., 2018). If you feel like you need to numb yourself to engage in sexual activity, that could be a sign you need to slow things down. Also, many prescription medications can cause sexual side effects, such as specific types of anti-depressants used to treat trauma, so this could be a factor in how your body responds (or doesn’t) to sexual stimulation. Pleasure requires a certain degree of surrender, or letting go, which is connected to our sense of safety. It can be difficult to reclaim body safety during sex while drinking a lot or using recreational drugs.
Considerations for partners of sexual assault survivors
Partners can have their own reactions of anger, hurt, or confusion even if the experience didn’t happen to them or if your experience was a long time ago. The ideal situation is to have a partner that will demonstrate patience, understanding, and abide by your boundaries. If your partner is having trouble managing their emotions about your assault, I recommend having them process their reactions with their own mental health provider. Also, if your assault is causing relationship distress, couples therapy is helpful to set boundaries that feel good to all parties, increase empathy for each other’s experiences, and answer questions about what is “typical” or “normal” in the recovery process. I found it helpful for my partner to have a separate space where he could talk about his feelings and react in ways that made sense to him, without me having to do that type of labor. Because he was taking care of his own emotional needs, he could be centered and patient with me, which was what I needed the most. My suggestions for partners include:
- Practice not taking things personally. Depending on when the sexual assault happened for your partner, they may feel a lot of anger and hurt that they don’t know what to do with yet.
- Stay present physically and emotionally when your partner is activated (having a difficult time emotionally or having memories they can’t make sense of).
- Don’t wait for your partner to tell you they are dissociated; they cannot control that process. Instead, check in with them gently and try to make eye contact if you notice your partner doesn’t seem present.
- A refusal to engage in sex may not be personal. It’s a good thing for survivors to take a break from sex and reset their own sexual values. This can lead to better sex later, rather than pushing your partner before they’re ready (which will lead to bad sex that is hard to get over).
- Re-engaging with sex is a partner issue for the both of you; it is not a survivor issue alone. Through couples therapy, both of you can learn how to adapt and feel connected and pleasured in new ways.
- Create your own support system when you feel frustrated at the pace of recovery; this process can take a while. The fastest recovery happens when partners don’t put pressure on survivors to go back to “the way things used to be.”
The reverberations of trauma mean that different parts of our lives are impacted, not just our sexual or romantic partnerships. Traditional trauma recovery states that the incident happened to an individual, which fits nicely for those that grew up in families where individuality is valued. For those that grew up in families where interdependence is seen as a healthy way of being, you may struggle with messages that center around what the survivor wants, and that the incident only happened to them. There are also those, like me, who grew up in the U.S., which values individualism, while having roots in another country (Mexico, in my case), which values close family connections. For those of us that value both individualism and close connection, it is important for us to know when we want family support and help and when we need to consider things carefully before sharing them. I encourage my bicultural clients to make sense of their experience somewhat, so they can be prepared for others’ reactions and feelings. Also, you do not have to share details about your trauma(s) to people in order to feel close to them. Think carefully about sharing specifics that could leave you feeling open, dissociated, or numb. It can be a gift to feel supported by your family or community or close friends, but it can also be taxing to answer questions and be present with others’ difficult emotions.
Social location and healing
Unfortunately, our ability to heal is impacted (or determined) by our identities, access to healthcare, and proximity to helping resources. Connected to this idea, is the concept of social location, which is the combination of race, gender, social class, age, ability, religion, sexual orientation, and geographic location (Kubiak, 2005). My healing was impacted by the facts that I am middle class, a therapist, an educator, have health insurance, am neurotypical, can access helping resources without assistance, and live in a metropolitan area with health providers that look like me. Acknowledging these privileges does not negate my pain or mean my healing was easy; it means that I had a head start compared to others. Other parts of my identities made my healing more complex. Being a Mexican American cisgender male contributed to me feeling a degree of agency, like I could fight back, in the context of my sexual assault. But it also meant that I felt a distinct stigma with seeking help, discussing the details of the assault, and a deep sense of shame associated with Catholicism. Being Queer, I worried that people would assume that I was hypersexual and this incident was just a “normal” part of my community.
If you are reading this and have survived a sexual assault (or know someone who has), consider how parts of your identity impacted experience of and recovery from the assault. Did the perpetrator victimize you because of your gender and race? Did any physical or emotional disabilities impact the way you were able to respond to the assault? Did you have a cognitive understanding of what happened and that it was wrong? Would people in authority (like police or medical providers) believe you if you told them? Did you have easy access to a therapist? As you consider your own advantages or disadvantages in the context of the assault and recovery process, they do not negate that your experience was real, only that your journey to healing is impacted by dysfunctional systems. By considering how sexism, racism, ableism, homonegativity, transphobia, class status, religious discrimination, etc., impacted your experience of assault, you can understand why the experience itself was so harmful and how these biases can complicate the experience and people’s responses to it. The assault reflected those systems violating your body.
However, our identities and bodies are also powerful elements in creating ways for us to recover and heal. People around the world have been dealing with traumatic experiences for centuries before psychotherapy was invented. Consider how your elders or ancestors dealt with difficult experiences. If you don’t know, you may want to research them. Some cultural examples include: massage, acupuncture, yoga, spiritual ceremonies, meditation, praying, eating certain types of food, taking tonics, or using medicinal herbs. Keep in mind that many of our elders didn’t consider a separation between body, mind, and soul. Many people have a tradition of calling upon ancestors for support or guidance, as a way of seeking knowledge from those who have suffered greatly and passed before us.
A final note about love
I had a mentor in graduate school, Denny Ollerman, who would often ask the question, “Do you have enough love in your life?” I think of this idea when I’m faced with a decision around forgiving, softening, or connecting when I would rather focus on my hurt or anger. I frequently encourage my clients to consider what would happen if you leaned into love as a guiding force in your healing journey? While traumatic experiences can feel consuming of our thoughts, feelings, and behaviors, directing our focus to acts love for ourselves and others can help. If you made a conscious effort to find and feel more love in your life, what would that look like? How could that be helpful to you? Are there times you turn away from love and care out of a sense of withholding or punishment?
Our reactions to sexual assault can disrupt the way we think, feel, behave, and interact with the world. It can impact the way we trust and create the need for new boundaries and ways of being with ourselves and others, especially during sex. Because of the uniqueness of our identities and different types of assault that are possible, there is no “right” reaction and no one way to heal. I’ve offered suggestions and questions that were helpful to me and have been helpful to my clients and students in the 20 years I’ve been practicing therapy and educating graduate students. In sum, I hope you can turn towards the love and care that is required to honestly examine your experiences, to heal, and to know that your story is important and valid.
References
Almas, E., & Pirelli Benestad, E. E. (2017). Addressing sexual problems after sexual violence and abuse through a combination of trauma theory and sex therapy. Journal of Sexual Medicine, 14(5), e232–e232. https://doi.org/10.1016/j.jsxm.2017.04.120
Bird, E.R., Seehuus, M., Clifton, J., & Rellini, A. H. (2014). Dissociation during sex and sexual arousal in women with and without a history of childhood sexual abuse. Archives of Sexual Behavior, 43, 953–964. https://doi.org/10.1007/s10508-013-0191-0
Duran, E. (2006). Healing the soul wound: Counseling with American Indians and other native peoples. Teachers College Press.
Figley, C. R. (2012). Encyclopedia of Trauma: An interdisciplinary guide (C. R. Figley, Ed.). SAGE Publications Inc.
Kubiak, S. P. (2005). Trauma and cumulative adversity in women of a disadvantaged social location. American Journal of Orthopsychiatry, 75(4), 451–465. https://doi.org/10.1037/0002-9432.75.4.451
Noël, X., Saeremans, M., Kornreich, C., & Jaafari, N. (2018). Dissociative tendencies and alcohol use disorder. Current Addiction Reports, 5, 517–527. https://doi.org/10.1007/s40429-018-0225-
Thal, S. B., Daniels, J. K., & Jungaberle, H. (2019) The link between childhood trauma and dissociation in frequent users of classic psychedelics and dissociatives. Journal of Substance Use, 24(5), 524-531. https://doi.org/10.1080/14659891.2019.1614234
