A female victim of incest asks, 'I've had tons of therapy but still can't let my fiancé get too close. Can I ever lead a normal sexual life?' Which statement by the nurse would be therapeutic?

• A. Can you share with me some of the strategies you've been using?
• B. You should try to avoid intimacy for now.
• C. It's unlikely you'll ever have a normal sexual life.
• D. Maybe you should end the engagement.

Answer: (A)

Opening with a supportive, trauma-informed approach is key: the nurse should invite the patient to discuss her coping strategies, validating the effort she’s already made in therapy and staying at her pace. Asking her to share the strategies she’s been using offers a nonjudgmental, collaborative doorway to explore what has helped her manage fear and trust, while still allowing space to address intimacy and boundaries with her fiancé. This approach reinforces empowerment, safety, and autonomy, which are crucial for healing after incest and for rebuilding intimate functioning.

The other responses aren’t as therapeutic because they either push avoidance, dismiss the patient’s potential for healthier intimacy, or judge the relationship. Encouraging avoidance can reinforce withdrawal and fear of closeness; declaring that she’s unlikely to have a normal sexual life imposes a diagnosis of hopelessness; and suggesting ending the engagement shuts down support and opposes collaborative problem-solving.