Milestones of sexual development explained

Childhood sexual abuse can, and often does, lead to issues with adult sexuality. But, it does not follow that everyone who has intimacy blocks was a victim of abuse. Which begs the question: Are there other types of childhood trauma that lead to physical intimacy concerns?

Aline Zoldbrod, Ph.D., has a theory that may provide the answer.

In her book “SexSmart: How Your Childhood Shaped Your Sexual Life and What to Do with It – Transform Your Sex Life” Zoldbrod introduced a concept called the Milestones of Sexual Development, steps that humans need to reach in order to feel safe in their own bodies and to later enjoy intimate relationships. Using body mapping, where a patient can show areas on their own body that are off-limits to touch, Zoldbrod has developed a method of helping to identify past issues that could be limiting the ability to enjoy a sexual relationship.

A psychologist and certified sex therapist with a private practice in Lexingon, Mass., Zoldbrod has been writing about intimate relationships and sexuality throughout her career. On the occasion of the publication of a new article in Current Sexual Health Reports, New England Psychologist’s Catherine Robertson Souter spoke with her about her ideas about family environments, trauma and sexuality.

Q: How did you get interested in the idea of non-abuse-specific sexual trauma?

A: I have been a sex therapist for 25 years. Sex can be such a powerful and healing force but my patients were having trouble feeling good about their sexuality, even when they loved their partners and did not report any specific sexual trauma. I had been wondering, what does it take for a person to be both emotionally and sexually intimate with the same person? That is not as easy as it sounds.

Early on, I noticed that many of my patients’ problems with sexuality stemmed as much from attachment disorders, specific gaps and unmet needs, as from their biology or their relationships. But when I went looking for books that discussed what I was seeing in my office, what I call the “Milestones of Sexual Development,” I did not find a book that described the sexually significant interpersonal events that I was talking about.

Q: How do you define these Milestones?

A: I was looking at what has to happen for someone to be able to put emotional and sexual attachment together. I started taking it apart and looking at what had to happen as a developmental process for each stage, the same way that Erik Erikson talks about developmental stages.

The first one is that the person is loved and then that the person has been touched nicely and that their associations to touch are that it is safe and a nice sensation. They learn that “I am good, I am loved.” To me, touch is ground zero.

The next is empathy. You need to have received empathy and to have learned that it is safe to have feelings that will be noticed and taken care of. Then, learning to trust, learning that it’s safe to relax and let someone else soothe you. Developing a good body image. Getting good self esteem. Learning to socialize and play. I talk about 13 different milestones, and most of them are not explicitly “sexual.”

Gender identity is an interesting milestone in that, if you are a woman and you saw your mother being beaten, it makes it hard to be sexual as a woman because you don’t want to be vulnerable or get too attached and be like your mother.

Q: In your article, you have taken the idea of the milestones a step further, identifying a specific type of trauma that would result from a child not being helped to reach those developmental phases.

A: Developmental Sexual Trauma is what I call the damage done by missed milestones and other kinds of  “nonsexual” abuse. Re-search has shown that non-sexual abuse and neglect potentiate the negative consequences of overt sexual trauma in childhood.

The prevalence of childhood neglect, physical, emotional and non-sexual abuse (along with witnessing family violence), is much higher than is generally acknowledged. A study done by SAMSHA in 2011 said that 60 percent of Americans grew up in a family with at least one kind of trauma.

Q: How does your use of body mapping fit into this?

A: It is a very good screening tool. I don’t believe it is appropriate to assign behavioral sex therapy exercises without knowing what is stored, often implicitly and unconsciously, in people’s bodies. I have found that patients don’t recognize or report on their developmental sexual trauma. Most people feel that their family was “normal” and happy, or “it wasn’t that bad.”

So I started doing body mapping, having people draw representations of how they feel about being touched. Sex is embodied; enjoying sexuality is not a cognitive process. It is not very mysterious if you were not touched nicely or you can’t  trust your father to stop tickling you or you can’t get your mother to make your brother stop hitting you, that you will have all these feelings of danger stored in your body.

I tell them to draw a picture of their body front and back, just the outline and color it in thinking of a partner that they love, using the same colors as a stop light. Green means, “yes, go, you can touch me there any time you want.” Red means “do not touch me there” and yellow means “depends.”

You will find people who don’t have much green on their body at all. That is a sign that something went really wrong.

It is not uncommon for sex therapists to be completely baffled about why people don’t like sex because women in particular will come in and say I used to and not now.

Q: They have changed in their sexuality? How does that come from childhood trauma?

A: This is my hypothesis: as (human behavior researcher) Helen Fischer wrote, when you fall in love, you have different chemicals in the more romantic stage. I think the chemicals you have override some of the stored feelings of danger. She describes how, after two years, you are in a different hormonal system. I think all stored feelings in your body come out again.

Q: The Milestones were first published in 1998. How have they been accepted?

A: When I have lectured to people who know about sexuality they agree that it makes sense and they can even guess them, too. But I still think touch gets short shrift when people are talking about sexuality.

My point is there are all these people who have been traumatized and who don’t feel safe in their bodies. Unless we notice what is happening to them and we have a way of assessing it, we are not going to be able to treat them and we are not going to be able to fix it.

I think professionals tend to think of sexual abuse in a very simple way and it is not. It is very complicated.