Harvey Weinstein uses a walker as he arrives at a Manhattan courthouse to attend jury selection in his trial on rape and sexual assault charges, in New York. Credit: Mark Lennihan | AP

Last week, the world watched as disgraced movie producer Harvey Weinstein shuffled into the court room for a criminal trial for two of the women who accused him of sexual assault and harassment.

Meanwhile, on the same day on the other side of the country, it was reported that new criminal charges were filed against him in Los Angeles County, alleging that Weinstein raped one woman and sexually assaulted another in 2013.

These are just the handful of charges against Weinstein that will see their day in court. From countless reports — including that infamous New York Times article that launched a global #MeToo movement — these cases represent but a fraction of the people who have accused him of sexual misconduct.

To make sense of such alleged behaviors, one must start by realizing that rape, sexual violence and harassment fundamentally have nothing to do with sex.

Jeffrey Epstein, Roger Ailes, Bill Cosby, Larry Nassar. For men like them and others, it’s not about sex. It’s about power, domination, control and also humiliation.

I have evaluated and treated thousands of patients who are survivors of childhood sexual abuse, rape, intimate partner violence and trafficking. Harassers and abusers get pleasure in subjecting victims to their control and demonstrating their power over the victim. Perpetrators, particularly serial perpetrators, are master manipulators. They not only take pleasure in psychologically controlling their victims but also getting away with it. This explains why abusers may attack a variety of victims, or engage in “sexual” behaviors that hardly seem satisfying to ordinary people — it’s not about sexual attraction or intimacy.

Humiliation is at the core of the perpetrator’s process, and almost every victim of sexual assault describes intense shame after the attack. The point is to render the victim helpless, with loss of all control over the situation. It’s profoundly humiliating. And what does humiliation do? It silences the victim. Shame is a powerful, distressing emotion that we all try to avoid. It makes us want to hide, to bury what happened and never speak of it again. Perpetrators manipulate shame so victims blame themselves for the attack and make them feel complicit in what happened, which protects the perpetrator.

Shame also increases the likelihood for abuse to happen again. Perpetrators initially groom victims by establishing a seemingly positive relationship with them. When the sexual assault begins, the victim typically feels confused because of the “positive” relationship that preceded it. The victims almost always feel intense shame: that the rape is their fault. Perpetrators amplify that idea, convincing the victim of an alternate, reversed reality that justifies their behavior and blames the victim. Survivors of repeated childhood sexual abuse may be particularly vulnerable to repeated exploitation. Almost always, in childhood, they were victimized by attachment and authority figures. They learn that relationships are based on repeated betrayals and exploitation, making later exploitative attachments seem “normal.”

Understanding the dynamics of humiliation is difficult, since shame is universally avoided. In my clinical work, when traumatized patients begin to appreciate how shame and humiliation have been used against them, it is a powerful beginning of freedom from the perpetrators’ psychological control.

This process takes time and care. Through a variety of therapeutic approaches, victims can begin to recognize normal, healthy attachments and how abusive relationships distort them. And we can refute trauma-based beliefs such as “It’s all my fault” and “This is all I’m good for,” and begin to restore their dignity and sense of self.

Humiliation can silence victims of abuse for a lifetime. But multiple women broke the cycle of shame and humiliation and called out Weinstein for wrongs they perceived, and now he will have his day in court. This could help the women replace any alternate reality that he might have created for them, if he’s guilty, with the truth.

Sexual attacks are never about sex. They are about power and humiliation. We can only hope that justice is served in such cases, and the humiliation lands right back where it belongs: squarely on the head of the perpetrator.

Richard J. Loewenstein is the founder and medical director of The Trauma Disorders Program at Sheppard Pratt Health System in Towson, Maryland. This column originally appeared in The Baltimore Sun.