Members Clinical Corner

MCC Commentary: Ruth Blizard

For this edition of MCC, Ruth Blizard discusses a challenging conceptualisation and topic in her commentary on the paper `Weaponized sex: Defensive pseudo-erotic aggression in the service of safety’ by Rick Kluft (JTD, 18, 3, 259-283). Pam Stavropoulos Editor, MCC Richard Kluft’s (2017) article, “Weaponized sex: Defensive pseudo-erotic aggression in the service of safety,” offers an insightful explanation of why a minority of women survivors of severe, chronic sexual abuse engage in sexual behavior that may appear to be aggressive, but is ultimately self-destructive. The title is densely phrased, and deserves some deconstructing to clarify its meaning. Taken by itself, “weaponized sex” might imply predatory, aggressive sexual activity, intended to harm another person. However, Kluft clearly describes “defensive” action in “the service of safety.” Further, “pseudo-erotic” indicates that the behavior is not primarily sexually motivated. Rather, when perceiving threat from the therapist (or from someone in society), the survivor uses sexual action to placate or distract from attack. Kluft’s conceptualization rests on the idea that one inborn, evolution-based, motivational system -namely sex – may be activated in the service of another, self-defense. Liotti (2017) clearly delineates how attachment, sex, survival defense, and predation are separate action systems. He describes how being required to activate competing systems simultaneously can be disorganizing. We are familiar with how disorganized attachment may result when a child is frightened by a caregiver, and cannot simultaneously activate attachment and self-protection. Notably, one of the frightening behaviors leading to disorganization is sexualized caregiving (Lyons-Ruth & Jacobvitz, 2008). Thus, survival defense is aimed at protecting the self from threats to life, and is enacted via freezing, flight, or when all else fails, killing a predator. By contrast, predation is targeted toward getting food, and enacted through destructive aggression. Kluft presents several vignettes from his own practice in which he was able to contain the sexualized behavior while asking, with openness and curiosity, how the behavior had been learned and what purpose it served. This enabled the patient to contain the behavior and explore how it had protected her in the past, in contrast to causing further victimization in the present. His vignettes clearly illustrate how to 1) understand the historic purpose of the seductive behavior, 2) contain it, and 3) reinterpret it to the patient. For example, one patient began to dance suggestively and unbutton her blouse, saying “Mommy says my big breasts are what all men like,” (p. 276). Kluft responded by asking about why her mother taught her to dance that way, followed by asking whether she’d taught her normal childhood games. The patient returned to her seat, wept for several minutes, and then discussed crucial memories of being forced to perform sexually. The survivors described by Kluft usually come from environments in which they were required to perform sexually for multiple perpetrators, often in exchange for money. Parents may have taught them from an early age to perform these acts. Failure to perform as directed would bring horrible punishments. When something in the therapy reminds survivors of such situations, they automatically engage in over-learned, seductive behavior to deflect a threat or avoid punishment. Middleton (2017) comments on similar self-defensive behavior in survivors who continue to be abused in adulthood. The extent and severity of sexual abuse they have survived is generally greater than for most individuals with DID, forcing them to make extreme adjustments merely to survive. They have been conditioned to associate sexual arousal with their attachment relationships, requiring simultaneous activation of three competing systems – attachment, sex, and self-protection – which is a highly disorganizing experience likely to cause dissociation (Liotti, 2017, Lyons-Ruth & Jacobvitz, 2008). It is likely to be triggered in their attachment to the therapist, and may be perceived as threatening. It is not clear whether Kluft’s patients are sexually aroused when they are engaging in weaponized sex. His clinical observation is that the primary purpose of their behavior is defensive; to protect themselves from anticipated punishment for failing to deliver sexual services as required earlier in life. What’s important is that they are activating over-learned, stereotyped, complex behaviors with competing intentions: 1) used in the past for sex work and designed to be sexually seductive, and 2) currently intended to deflect anticipated punishment. According to Kluft’s observations, the behavior itself is not primarily intended to achieve sexual goals: 1) reproduction, 2) pair bonding, or 3) sexual gratification (see Liotti, 2017). Rather, Kluft’s therapeutic explorations of childhood antecedents frequently reveal the behavior was learned, under duress, to comply with parents or pimps who sold the survivor for sex. In therapy, when the patient perceives she may be under threat, sexualized behavior appears as an automatic, self-defense measure, intended to deflect the horrific punishment inflicted on her in the past. Kluft chose the term “weaponized,” because its primary purpose is defensive, and it can do irreparable harm to a therapist who is ill-prepared to contain it. As a male therapist, Kluft makes clear his observations on weaponized sex are speculative, drawn from many years of treatment of women with DID, and intended to stimulate further study and discussion. He is to be credited for finding a way to understand the hidden purpose of this behavior. Most male therapists either terminate such patients, fearing legal action, or worse, lose control of their professional boundaries and take advantage of the woman sexually (see Kluft on revictimization of sexual abuse survivors, 1989, 1990). Little has been written about how often this happens with the various combinations of male and female patients and male or female therapists. Because male patients re-enacting sexual trauma may threaten the physical safety of female therapists, attempts to contain such behavior are riskier, often leading to treatment termination. A striking exception was a female colleague who told of a male patient who began to remove his pants and masturbate. She had the presence of mind to tell him to put his pants back on while she stepped out. When she’d gathered herself, she returned to the consulting room and inquired about his history of sexual trauma. Therapy was able to proceed with an exploration of how his mother had abused him. This colleague emphasized that she only felt safe enough to do this because staff were present just outside her office. In my own clinical practice and supervision of others, I have been aware of a few cases of female therapists sexually exploiting female survivors. It is unclear whether any of these patients were openly seductive toward the therapist. Although sexual reenactments by female patients toward female therapists are less common, they may stem from a history of mother-daughter incest, still a poorly recognized phenomenon (Haliburn, 2017). Avoidance reactions to sexualized transference by female patients, on the part of both female therapists and patients, may often account for premature termination of treatment, perhaps explaining how seldom it is written about. Recently, a colleague discussed a case of a woman, disabled by obsessive-compulsive cleaning behavior, who presented the therapist with detailed, graphic descriptions of her sexual fantasies about her. Kramer (1985) discusses compulsive behavior in the service of a cognitive style of `knowing and not knowing’ about early maternal incest. The discomfort of the therapist in hearing such detailed fantasies may be an indicator of how intolerable this knowledge is for the patient. Regardless of gender, therapists may become disorganized when faced with contradictory patient behavior – simultaneously seeking attachment or self-protection in the guise of sex – and react by terminating treatment. This is often the case with those benighted patients frequently disparaged as “borderline” (Howell & Blizard, 2009). Kluft’s observations about weaponized sex resonate with my own treatment of female patients abused by multiple family members, including mothers. While such patients have not acted out sexually toward me, they have indicated that my no-touch policy has made them feel safe. Several have thanked me for not hugging them, as other therapists or AA colleagues have insisted. One was concerned I’d had sexual relations with a female patient who was a friend of hers because I had made a home visit. One patient with DID was sold for sex in childhood, by both mother and father, to customers of both sexes (Blizard, 1997). While she did not directly enact weaponized sex with me, she did describe using it with men. She would go into bars as a sexualized female part and seduce men. Before they could take advantage of her, she would switch into an aggressive male part and provoke them into a bar fight. The seductive behavior was intended to defend her from her father or pimps, and then the fighting defended her from sexual abuse. There was a concurrent attachment-related motivation – she said that as a child, no one wanted her, except when they wanted her for sex. Kluft’s conceptualization shows clinicians how to help patients understand how weaponized sex is: 1) reflexive, self-protective behavior, 2) saved them from brutal punishment in the past, and 3) perpetuates their abuse in the present. Patients can then learn to inhibit it, and to develop more constructive means of defending themselves appropriate to current circumstances. Only then can a path toward healthier patterns of attachment – without self-destructive and self-degrading elements – be pursued. References Blizard, R. A. (1997). Therapeutic alliance with abuser alters in dissociative identity disorder: The paradox of attachment to the abuser. Dissociation, 10(4), 246-254. Haliburn, J. (2017). Mother-child incest, psychosis, and the dynamics of relatedness, Journal of Trauma and Dissociation, 18(3), 409-426. Howell, E. F. & Blizard, R. A. (2009). Chronic relational trauma disorder: A new diagnostic scheme for borderline personality and the spectrum of dissociative disorders, in Dell, P. F. & O’Neil, J. A., (Eds.), Dissociation and the dissociative disorders: DSM-V and beyond, 495-510. New York: Routledge. Kluft, R. P. (1989) . Treating the patient who has been sexually exploited by a previous psychotherapist, Psychiatric Clinics of North America, 12, 483-500. Kluft, R. P. (1990) Incest and subsequent revictimization: The case of therapist-patient sexual exploitation, with a description of the sitting duck syndrome. In Kluft, R. P., (ed.) Incest-Related Syndromes of Adult Psychopathology, Washington, DC: American Psychiatric Press, 263-288. Kluft, R. P. (2017). Weaponized sex: Defensive pseudo-erotic aggression in the service of safety, Journal of Trauma and Dissociation, 18(3), 259-283. Kramer, S. (1983). Object-coercive doubting: A pathological defensive response to maternal incest, Journal of the American Psychoanalytic Association, 31S, 325-351. Liotti, G. (2017). Conflicts between motivational systems related to attachment trauma: Key to understanding the intr-family relationship between abused children and their abusers, , Journal of Trauma and Dissociation, 18(3), 304-318. Lyons-Ruth, K. & Jacobvitz, D. (2008). Attachment disorganization: Genetic factors, parenting contexts and developmentsl transformations from infancy to adulthood. In J. Cassidy & P.R. Shaver (Eds.), Handbook of Attachment, 2nd ed., (666-697). New York: Guilford Press. Middleton, W. (2017). Extreme adaptations in extreme and chronic circumstances: The application of “weaponized sex” to those exposed to ongoing incestuous abuse, Journal of Trauma and Dissociation, 18(3), 284-203.