Open Book

In the Bedroom

Countering the destructive effects of trauma on intimacy

Eric McCullum
In the Bedroom

This article first appeared in the July/August 2002 issue.

Emotionally Focused Couple Therapy with Trauma Survivors: Strengthening Attachment Bonds
By Susan M. Johnson
Guilford.  228 pp. ISBN: 1-57230-735-8

Though I saw David and Louise more than 10 years ago, I still think of them from time to time. A year before I saw them, Louise had recovered memories of childhood sexual abuse and immediately sought intensive individual therapy. But the idea to come to marital therapy had been David’s. They’d been living in separate bedrooms for six months and hadn’t had sex in weeks; some days, Louise wouldn’t even speak to him.

“I want to help,” David said plaintively in our first session, “but Louise won’t let me in. It was never this way before. I feel like I’m living with a different person.”

“I just wish he’d leave me alone,” Louise said, as she looked away from him out the window of my office. “I need to work it out with my therapist before I can talk to him about what happened.” As a tear ran from the corner of her eye, she added, “Why can’t he understand how hard it is?”

Two weeks later, Louise began the session by announcing, “I talked it over with my therapist, and she thinks it will interfere with my therapy if we come to couples counseling.” I never saw Louise again, though David and I met several more times to see how he could support her as she struggled with her demons. Session by session, I watched as the spark of the relationship died out in his eyes.

“I can’t keep going like this much longer,” he told me finally. “I need something back from her. At least I need to feel like I’m helping.” David and Louise separated soon after that.

I thought of David and Louise when I read Emotionally Focused Couple Therapy with Trauma Survivors by psychologist Susan M. Johnson. Instead of focusing on the individual trauma survivor while the partner is admonished not to “interfere,” Johnson believes the couple relationship can be an important source of healing. Traumatic experience plays itself out, not only in an individual’s symptoms–flashbacks, dissociation, self-mutilation–but also in the individual’s intimate relationships. One of Johnson’s clients explains the seemingly impossible tangle of such relationships this way: “I need to know he’s there, and I get so angry when he isn’t. I test him, I suppose. But then when he comes closer, I can’t bear to be touched, so I space out and withdraw.” Trying to negotiate this minefield, one man commented, “I never know what to expect. One false move and she blasts me with both barrels. The problem is I never know what’s going to be a false move.”

Taking attachment theory as a theoretical foundation, Johnson claims that trauma is not only an individual violation, but a “violation of human connection.” It makes what could be a dependable and solid sense of closeness to others feel dangerous. After all, Louise didn’t hate David: in her icy distance, she wanted to feel close to him. But at that point in her life, the prospect of intimacy terrified her. Remembering how closeness to her father had led to abuse made David’s wishes for connection seem too much like a replay of the traumatizing past. Despite therapeutic intervention they were receiving, the cycle had spun out of control, leaving them desperate and isolated.

In her emotionally focused approach, Johnson’s goal is to help a couple like David and Louise create a safe place to confront the abuse together. Her first step is to clarify the underlying emotional responses that shape a couple’s negative interactions. Louise’s withdrawal in the face of David’s bids for closeness would be understood in light of her ambivalence about feeling close and fearing further abuse. David’s seeming rejection of Louise when he’s rebuffed would be seen as coming from his feelings of hurt and impotence. According to Johnson, this process of emotional exploration deescalates mutual blame and increases hopefulness. Once the partners reach this point, they can begin to tolerate the vulnerability necessary to look together at some of the “softer” emotions that flow from trauma: fear, shame, sadness.

The second stage of Johnson’s approach focuses on the emotional vestiges of trauma–helping partners talk directly about their traumatic experiences and reevaluate their meaning. Louise might begin to talk about how ashamed she felt of the abuse, and how much to blame she thought she was. As her husband and her therapist counter this belief, she might begin to challenge the shame and disgust she feels about her body and her sexuality. Slowly, she and David might experiment with more physical closeness, closeness that isn’t a source of fear for her and another minefield for him.

The final stage of Johnson’s approach is marked by the growing integration of new emotional and interactional experiences. As clients gain successful experiences of intimacy, they experience themselves differently, not as broken victims of the past, but as competent adults, who can give and receive the fundamental currency of a relationship. The effects of the abuse may still be felt, but Johnson’s clients in the last stage of therapy say things like, “I know I can reach out for him now, and he’ll comfort me. I’m not all by myself in the dark.”

Johnson’s book provides many valuable caveats. Despite the importance she attaches to couples work, she sees individual therapy as useful, even mandatory, in cases of severe abuse. She reminds us that childhood physical and sexual abuse aren’t the only traumas couples face: her book also has chapters on the trauma of physical illness and combat. Trauma influences all relationships. Combat veterans, for instance, because they’ve avoided death in a war zone, may be preoccupied with feelings of guilt about surviving and “living on borrowed time.” These feelings can lead to a stronger attachment to fellow veterans than to a partner, and to the formation of a “bunker mentality” at home; traumatized couples typically take longer to achieve the same level of functioning we’d expect from other clients. But throughout, her optimism about the healing power of human intimacy shines through. It’s a vital message for us when we sit with couples mired in immense hurts from the past. I only wish I’d had this book in hand the first time I met David and Louise.


Eric McCollum, Ph.D., is an associate professor and clinical director at the Virginia Polytechnic Institute’s MFT training program.