“This is not something that is commonly talked about in the profession,” a conversation with therapist Andrew Pari

Andrew Pari is America’s leading authority on the arousal response in sexualized violence and related taboo topics in the sexual assault field. He is the founder and director of Sexual Assault Awareness. And he’s also a psychotherapist with over 20 years experience treating sexual assault survivors.

We spoke to Andrew about his work on researching and treating clients who experience arousal during sexual assault. You can see video of this conversation here, and audio is here.

This conversation has been edited and condensed for clarity.

Could you talk a little about what led you to start researching the experience of people who experience sexual arousal during or after sexual assault?

A couple of decades ago I found my way back to doing sexual assault work. And I had an assumption that this was regularly discussed, because I had been working with clients for a long time. And arousal was an issue that came up. And looking back now I think it was my, I don’t know how to put this , I didn’t know that this wasn’t something that was commonly discussed in the field. So I was commonly discussing it and I would raise it with my clients and it would be an issue and we would process that along with other things.

And I remember talking to a female colleague, again a number of years ago, about a struggle one of my clients was having. Arousal was one of this client’s issues, but it wasn’t the issue that I was bringing up, but just mentioned it in the context of consulting on this case. I mentioned that and my colleague said, Oh, well that’s the issue at a deep psychological level, she’s carrying a lot of guilt because she really wanted this to happen.

It kind of blew my mind that that was a response I got from someone in the field who does the work I do. And it sent me on this journey going back into all of the books and all of the texts that I had read, where I thought arousal as part of sexual assault was pretty common knowledge. And what I discovered was it absolutely wasn’t. It was barely talked about in the field. Like some of the classic texts that I had been trained on, maybe there was one line in an entire book, saying that oh, this is something that might happen.

So it sent me on this deep dive and made me realize this is not something that is commonly talked about in the profession. It’s commonly known by survivors, certainly. And it’s kind of anecdotally known, I think, by people who do the work I do. But it’s not really talked about.

And so I took a leap. I went on to Reddit, the social media website, this is about 10 years ago. I did this whole post, basically, on a rape recovery forum, saying, this is my specialty, this is what I do. And this is some of the things I encounter. And I just want to have a discussion with people about arousal in the context of sexual assault, because it’s a thing that happens.

And it blew up, it became huge. It was one of the top 300 conversations of all time or something. I started getting invited to conferences to speak about my work.

You mentioned a conversation with your colleague where she said that arousal was because the person wanted to be sexually assaulted. And you said that’s not what’s happening. So what is happening? It sounds like a common experience that people have, so what causes that?

Simply put, it’s a physiological response. There’s stimulation happening to a very sensitive part of the body. And that combined with fear sets off this whole trigger of hormonal and physiological reactions that result in arousal and orgasm. We don’t know exactly the percentage, but I’m going to say somewhere around a third of people experience this.

And I think a lot of it is very context dependent. One of the things that I’ve found is that when there is more build up, and she knows what’s going to happen, there’s much more likely for there to be an arousal response there than in a sudden, forceful, violent attack.

And also, typically, the less violence the more reactive the [assaulted] woman or man may be. Not that it doesn’t also happen during violent attacks. It does.

But there really was no research on this, and no studies on this. And I actually had a grad student a couple of years ago who made that the subject of her PhD dissertation. So we now have, as of one year ago, the first qualified data saying not only that this is a thing that happens, but we have some pretty good data saying how often it happens and some of the context. We also have information on how it creates inhibition in disclosures to therapists to reporting to being able to disclose to partners. Because it does have this whole other level of shame.

Because even though we may know that it’s physiological, that individual thinks this is only her that’s going through it. And she may think, I wanted this, I’m a slut, there’s something wrong with me, all of these distorted beliefs.

It sounds like people aren’t necessarily wrong to be nervous about disclosing, because it sounds like there’s a lot of stigma even among therapists. Is that right?

Certainly in the lay public there is. But yeah, I’ve done presentations in front of rooms filled with therapists, police officers, lawyer, and at feminist and crime conferences. And yeah, it’s amazing to me sometimes where I see the nodding heads and where I see the looks of confusion.

I’ve also had accusations like, how dare you say these things, you’re a monster, you’re insinuating that, you know, women are getting off on rape, you know, all of this stuff. And then I just point back to my PowerPoint, and I’m like, if you were listening to me, that’s not at all what I was saying.

The group, the professional group that more often than not really gets it is sexual assault trained nurses, because they are trained in the human body and physiology. And when I’ve done talks with nurses, that’s where I really see that, Yeah, of course, that makes sense. Even if they weren’t aware of it, it makes sense to them, and it fits for them. But I’ve presented at some pretty high level psychology conferences, and I always walk away a little bit surprised.

One of the other things you talk about in some of your work is that sometimes people have fantasies about being raped, and you talk about how that can interact with the actual experience of sexual assault. And you’ve had some success in helping people heal from sexual assault by by doing some BDSM guided therapies. Is that right?

I want to be clear this is very new.  It’s a methodology I’ve developed over the last several years.

As far as actual application, I have a few clients I am working through using that methodology. And so far, so good.

And really, it’s an advanced form of exposure therapy, which is a lot of what I use traditionally with my sexual assault clients. And very simply, exposure therapy is taking the person back to that time, having them go through verbally the experience and the emotions and thoughts that go with it. It’s a verbal talking through of what happened, and it’s very successful and has a lot of positive elements.

This new methodology is a physical reenactment of what happened. And so what I have seen, and what’s been reported to me is that the timeline of being able to work through these things is a lot faster. Realizations and aha moments and things to be able to bring back into therapy and talk about—that happened at a much more rapid rate after an enactment than after the months and months of working through exposure therapy through talking.

So what did these reenactments look like? Are clients doing a reenactment at home with a partner?

Generally, yes. We discuss the actual experience that happened, we discuss what I call trauma points, or trauma moments, meaning very simply, where’s the emotional weight for you now in what happened with you? Is it a image? Is it a memory? Is it a smell? Is it a sound? Is that a position that you were held in? Is it something that was said? Like, what are those things that still weigh you down. And then we build those into a scenario.

But as far as who plays the role of the perpetrator, it’s a huge question mark. As you probably know, in the US — it’s different in other countries, but in the US the concept of sexual surrogacy is illegal. We do have trained sexual surrogates, people who are trained to be able to physically interact and enact with people, but in America, it’s considered a form of prostitution.

So for a lot of women, they’ll say, well, I want to do these enactments. But I don’t want to do it with my boyfriend or my husband because I don’t want to put him in that position. I don’t want to make him feel like he’s harming me. Or I don’t want to taint the relationship we have which is very loving. So what do I do?

When I do presentations, I get one of two questions. The first is, are you doing the enactments? Which I say no, I’m the therapist. So I’m not there in the room. I’m not taking on the role of perpetrator. I’m the therapist helping you coordinate behind the scenes.

And then the other question is, who do I find to do this? There are dominants in the BDSM world. But I am not saying go out and find someone. Because there’s a lot of bad actors out there. There’s a lot of dominants, who think they know what they’re doing and don’t.

One of the things I’ve been asked to do is to develop a training for dominants around this, I have not to date. But there are dominants who would be very well qualified to be able to do this. And then there’s also a lot of scary people out there.

What is the healthy outcome here? Because one thing you’re working through is how assault affects experiences of arousal. So is the goal to no longer have certain fantasies?

I will quote, a woman I interviewed who said, it suddenly felt like the fact that I had been raped wasn’t a big deal anymore. That was her revelation, coming out of an enactment, was it was this huge relief, this huge release. And this sense that what she had been through, she had still been through, but it was more of a bad memory than a present trauma.

With exposure therapy, the goal of treatment is to move this from a present nightmare to a past bad memory of a thing that happened. So I’ve had women approach me who say, I feel ashamed, dirty, disgusting, I don’t want to enjoy these things. And I have other women who will say, I’m afraid to go to therapy, because I’m really enjoying this, I’m afraid if I work through it, I won’t have the same level of arousal and enjoyment that I do.

So those are obviously two very different things. And my response is, I don’t necessarily know what the outcome will be. What I do know is that this won’t impact you the way that it currently does. And my experience is that when we work through this, it often frees them up to make that choice. So some women can enjoy more vanilla sex, or can enjoy other kinds of things with a husband or boyfriend. And other women find that the trauma and the horror of it doesn’t live with them anymore. But they’re now freed up to enjoy the pieces that they enjoyed about it.

Do the people you’ve worked with tend to have been assaulted as adults? Or are these people who have had experiences of child sexual assault?

I’ve certainly worked with women who were molested as very young girls had rape or sexual abuse as teenagers, and then on into adulthood. What I have found though, is that and I’m not saying this is a rule because it isn’t, but post pubertal events seem to lead to more desire for these reenactments.

And one last comment: if anyone listening to this would like to contact me or is being triggered or needs to talk about things that are coming up for them, I take on new clients all the time. So feel free to reach out to me.

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If you or someone you know is a survivor of child sexual abuse, you can find resources and support here.