1. Ahsen Özakkaş, M.D. – Psychotherapy Institute TURKEY ESH 2017
A CASE OF SEXUAL TRAUMA
Ahsen Özakkaş, M.D. – Psychotherapy Institute TURKEY ESH 2017

2. Introduction
Attack therapy is an intensive therapy program of forty sessions aimed at symptomatic relief and modification.
This standardized program is based on psychotherapeutic techniques integrated from
behavioral,
cognitive,
dynamic and
existentialist perspectives.
Rather than theoretical integration, our integrative approach is similar to Lazarus’ multimodal therapy that is eclectic in nature, integrating different techniques and strategies from various perspectives.

3. Patient History
The patient is 32 years old, male, married, high school graduate, no child, lives in Europe.
His presenting complaints were multiple phobias, panic attack and anxiety disorder.
The preliminary diagnosis was multiple phobias and panic attack.
It was understood that these symptoms caused significant distress, which led to anxiety disorder and secondary depression.
Integrative psychotherapy was indicated with an intensive start in the form of attack therapy and hypnodrama for symptomatic relief.

4. His detailed history revealed a different and interesting etiological factor.
When he was a teenager, he lived in a rural village in Anatolia.
He is the third child of a family with five children.
Her parents are together. The parents were farmers, and his older brother was a tradesman.
When he was years old, he was sexually abused by a woman 10 years older than him.

5. The patient’s family had a two-storey house in the village, and he had his own room upstairs. The patient spent much time in his room, reading and daydreaming.
One day when he was resting on his bed, his door was opened suddenly and a woman came in.
She was a young divorcee who returned to the village after her divorce and who was known to be promiscuous. She immediately got undressed and jumped on him.
He was shocked with this unexpected behavior at first. She kept on harassing him and somewhat forced him to intercourse.
The patient was both aroused and also felt afraid of getting caught by someone from his family and guilty about acting in contradiction with his morals.
His first sexual experience thus occurred in serious distress, panic, fear and worry, complicated by arousal and pleasure. The entire experience became a complex trauma.

6. This was repeated many times later on.
The patient often found himself waiting for her to visit.
In rural life in Anatolia, the villagers know one another for many years and are usually relatives, so it is quite common and normal for people to go into each other’s house comfortably.
The abuser woman also developed a good relationship with the patient’s mother, visiting her often and helping out with the chores. So she could come and go without anyone getting suspicious.
When she came to help his mother with the housework, she would sneak up into his room to have sex with him.

7. The patient was constantly worried about getting caught by his family or other villagers, and being accused of sexual harassment, even rape.
It will turn into a serious pathological picture that will affect his sexual life in future.
These sexual experiences filled with fear and worry and catastrophizing developed into a kind of behavioral learning and cognitive distortion.

8. One day when he returned from the town to the village, he saw a crowd in front of his house from a distance. There were gendarmeries in front of the door.
It evoked telegraphic thoughts and images in his mind. The first thought he had was that the gendarmeries in front of the house might be there to arrest him upon complaint from the woman and the villagers.
With this thought and fantasized images, he experienced tremendous fear, loss of control and panic attack. He had palpitations, his hands numbed, and almost blacked out. He forced himself to walk and arrived at the house, only to see that the gendarmeries were not interested in him and were taking some furniture out of the house.
When he asked around what was happening, he was relieved to hear that his brother had unpaid debts and the gendarmeries were there to accompany the debt enforcement officers who were confiscating some furniture from the house.

9. However, this fearful experience remained with him.
He had panic attacks in any sort of heightened excitement.
Especially in his encounters with women, he experienced such panic attacks after any sort of closeness.
His experience of sexual abuse at a young age developed into panic disorder associated with sexual experience later in his life and in his marriage.
Sexuality became distressing, fearful and unsettling.
He could never shake off his anxiety that he would have a panic attack when he had relationships with women later when he was living abroad. He withdrew from sexuality due to such fears and worries.

10. In addition to the panic disorder, he developed many phobias, including sensitivity to the dead and funerals, sensitivity to ambulances, avoidance of mosques, claustrophobia, autophobia, acrophobia, and so on.
He had witnessed a childhood friend run over by a truck and the following burial procedures.
This incident along with his sexual trauma in adolescence are found to be the underlying causes of these fears.

11. Treatment
Hypnotic trance was used to reveal the unconscious aspects of this story at an intellectual and emotional level.
Age regression allowed us to explore all aspects of his relationship with the woman who sexually abused him.
These traumatized memories were re-framed and partially modified.
Ego strengthening work was done.

12. The patient was also helped to gain a sense of control that he had lost.
Desensitization and exposure was done under hypnotic trance to help him overcome his feeling of disempowerment and enslavement, and re-adjust his reaction to the woman over the years.
We also used re-enactment, narrative change, re-framing and desensitization to help him free himself from the feared pressure of the society.

13. The patient imagined the woman as a snake in his spontaneous imaginations and induced dreaming.
The images of being able to kill the snake and get rid of it helped eliminate his fear of the woman and of sexuality.
All of his phobias related to the traumatic memories were eliminated through hypnodrama, hypnotic techniques and hypnotic desensitization.

14. The patient repeated and reinforced therapeutic experiences under hypnotic trance regarding his sexual experience, sexually-related panic disorder, and multiple phobias.
It is seen in this case that traumatic sexual experiences may sometimes be the underlying cause of panic disorder.
In the cases of sexual abuse in the literature, victims are usually women.
This case is chosen to document an example of sexual abuse of men, and sexual traumatization of adolescent or pre- adolescent boys in a way that could lead to panic disorder.

15. In addition to this significance, it also shows that men and women with similar traumas can be helped for symptomatic relief with desensitization under hypnotic trance.
More case studies should be added to the literature to gain fuller understanding of the issue.

16. THANK YOU…