“The survivor of sexual trauma may not have cognitive awareness of the experience, although their body has retained the memory and implicit feeling,” says psychologist Stephen Porges. “Trauma therapies try to create a dynamic interaction between the more diffuse implicit bodily feelings and the more explicit memories with a goal of shifting the client’s personal narrative to one of greater self-understanding and self-compassion.”
Porges is a distinguished university scientist with the Kinsey Institute at Indiana University—where his work combines psychology, neuroscience, and evolutionary biology—and a professor of psychiatry at the University of North Carolina, Chapel Hill. Porges developed the polyvagal theory, which he uses to examine how the autonomic nervous system affects the behavior of people who have experienced trauma. Sexual trauma, Porges has found, becomes locked in the body, suggesting that a way toward healing for many may lie with therapies that focus at least in part on the body.
A Q&A with Stephen Porges, PhD
How do you approach the issue of sexual trauma?
Everything has to do with the response of the body. When we use the word “trauma,” we don’t define it by the event; we define it by the response. This means that for some people, a particular event will be devastating, while others will walk through it.
In terms of health outcomes, it is important to separate the evaluation of the intentionality of the event—which could vary in degree of malevolence in terms of sexual trauma—from the individual’s response. From a polyvagal perspective, the individual’s response is much more important than the event or the intention of the perpetrator. If we don’t emphasize the importance of the individual’s response, we may end up blaming and shaming people for their reactions, especially when their responses are disruptive to their ability to regulate their body state, when others appear to be unaffected by the same events. These reactions are reflexive and not voluntary; they’re at the level of the body. Sexual trauma triggers life-threat type responses.
How is sexual trauma different from other forms of trauma?
When investigating health-related concerns, sexual trauma seems to have greater impact than other forms of trauma, probably because it is an intrusion into the individual person’s physical and psychological space. So the person can’t avoid it.
How do the brain and the body process sexual trauma?
This question assumes that brain and body reflect different processing systems. As trauma research has evolved, the distinction between neural regulation of brain and body has been dispelled. Currently we would discuss sexual trauma as being manifest in implicit bodily feelings—which are housed in areas of the brainstem that are influenced by both higher brain structures and the organs and structures of the body. These feelings are distinct from our cognitive awareness and our visual images and memories. Often following sexual trauma there is a major shift in implicit body memories—because the events are so catastrophic to the individual they’re literally erased from their memory.
The survivor of sexual trauma may not have cognitive awareness of the experience, although their body has retained the memory and implicit feeling. Trauma therapies try to create a dynamic interaction between the more diffuse implicit bodily feelings and the more explicit memories with a goal of shifting the client’s personal narrative to one of greater self-understanding and self-compassion.
Can you talk about the short-term and long-term effects?
There is variation in the terms used to describe trauma and trauma responses. Researchers and clinicians frequently define trauma in terms of the features of the event. Usually they distinguish between acute and complex trauma. An acute trauma is quite well-defined as a specific event such as rape, car accident, surgery, or the death of a loved one. Acute trauma results in a massive shift in the survivor’s ability to regulate behavioral state, especially through social interactions. Following an acute trauma, the survivor is immediately different.
Researchers distinguish acute trauma from more complex trauma: Complex trauma is frequently characterized by constant or chronic abuse. These abuses may occur within a relationship in which the survivor is constantly emotionally or physically abused or psychologically manipulated. The physiology of these two trauma categories is probably different, although both may be expressed with similar diagnostic features. Both acute trauma and complex trauma could be characterized by clinicians as including symptoms of post-traumatic stress disorder, but the actual manifestations in the body may be different.
What are the available treatment options and tools?
There’s a disconnect between scientific knowledge and clinical treatment, when it comes to how survivors of sexual trauma are treated. Too many people who have experienced sexual trauma go unwitnessed. What does it mean to be witnessed? Following the trauma, has the survivor been engaged in a conversation during which the focus on the survivor is expressing personal feeling? Has a trusted person asked the survivor to “Tell me how you feel”? This process would allow the survivor’s implicit bodily experiences to find a voice and not be suppressed and dissociated from the event. In our society, the reaction is often to turn everything into a legal issue, which would focus, not on feelings, but on documenting the event and gathering evidence to prosecute the perpetrator. As a society, we frequently forget or minimize the importance of witnessing the survivor’s reaction. Following sexual trauma, survivors frequently immediately start a defensive strategy that includes dissociating the experience from their conscious awareness. Instead, the survivor needs to be present with another individual and witnessed.
The treatments that appear to be the most successful for survivors of sexual trauma frequently incorporate a physical component (i.e., somatic therapies, body psychotherapies). These treatment models enable the survivor, in a sense, to regain contact, or become present with their body. One of the adaptive functions involved in surviving a traumatic experience, such as rape or severe physical abuse, is dissociation. Dissociation enables the body to become numb, and for the sense of awareness to be blunted as mental images move toward an altered reality from the physical event. Dissociation has profoundly devastating effects and is difficult to treat. Medication frequently does not work. Forms of talk therapy may often lower the threshold for reactivity. Dissociation is a powerful adaptive strategy that may functionally protect the trauma survivor from re-experiencing the trauma. Thus, talking about the trauma may trigger dissociation. Therefore, therapies are moving in a different direction, toward an understanding of implicit bodily reactions, and trying to empower our consciousness to create a different personal narrative in which we are no longer shameful of bodily reactions, but understand them as neurobiological adaptations.
Can you explain polyvagal theory and how it relates?
Polyvagal theory emphasizes that the way we react to the world is a function of our physiological state. This is important in dealing with people who have experienced sexual trauma. If survivors of sexual trauma shut down, or go into dissociative withdrawing, their physiological state changes. Their autonomic nervous system changes in the way it regulates the organs of the body. In this changed state, the survivor’s perspective of the world is very biased. From a polyvagal perspective, the trauma-induced shift in physiological state results in trauma survivors seeing virtually everyone as a threat. The clinical histories of survivors of sexual violence frequently indicate that they want to have relationships, but they find it hard to be trusting and become intimate. Their bodies won’t allow proximity and pleasurable physical contact. Polyvagal theory explains the biobehavioral, the physiological, and the psychological experiences that follow traumatic events. Polyvagal theory also provides clues to reverse these debilitating features. It does this by focusing on strategies to shift the physiological state to enable the individual to be calm and to feel safe.
Stephen Porges, PhD, is a distinguished university scientist at the Kinsey Institute at Indiana University Bloomington and a research professor in the Department of Psychiatry at the University of North Carolina at Chapel Hill. He is an emeritus professor of psychiatry at the University of Illinois at Chicago and an emeritus professor of human development at the University of Maryland, College Park.
Excerpted from the book The Sex Issue by the editors of goop. Copyright © 2018 by GOOP, Inc. Reprinted with permission of Grand Central Publishing. All rights reserved.
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