Quote from Stephen Dorsey on April 30, 2021, 9:06 am

Hi GGeorgina:  I do appreciate your courage  both in addressing a counseling situation that you have never personally encountered, and your willingness to do so when the situation presents itself.  I feel we were exposed to a lot of really helpful information in this course, and have some great tools already to invite a conversation with a male survivor.  The psych-ed piece you mentioned, that men can be aroused even when sexually abused, and that is just a naturally bodily function, not a sign that you "really wanted it:" that very concept could be huge for a survivor who may have never discussed his abuse, and has carried great shame about it for years or decades.  Just being an empathic, fearless therapist who can step into the story of a male sexual abuse survivor, and speak hope and truth into his life - well, I guess that is why we are here.

Quote from elainekdowell on April 30, 2021, 9:08 pm

When working with male survivors of sexual abuse, I imagine that it would be important to ease into the process of labeling the experiences as abusive and shift the language slightly at first. During the intake process, the therapist might ask more broadly about first sexual experiences rather than blatantly asking about any unwanted or abusive encounters, since there may be a greater chance of minimization. As a clinician, it would also be important to continually connect the male client’s experience of sexual abuse with his other presenting problems (especially if he was not seeking counseling directly for the sexual abuse, but disclosed it at some point in the counseling process).

Given the cultural narrative around male sexuality and gender identity the client might struggle with questions around masculinity and what it means to be a victim of sexual abuse. This is where there may be a greater need for psychoeducation around trauma, abuse, and what constitutes unwanted sexual experiences. If the abuser was a woman, the client may struggle to view the experience as abusive. If the abuser was a man, the client may struggle with confusion around his bodily reactions and arousal to the abuse. Obviously, there is a lot of nuance to each unique experience of abuse.

As far as different treatment priorities with male survivors, there may be more need to emphasize the emotions attached to the abuse, particularly the unexpressed emotions that are coming out in other areas. There may be more expressed anger, in contrast to a female abuse survivor, and it would be important to unpack what other emotions are accompanying the anger. Fear would probably be an important emotion to recognize, especially because this can be seen as an emotion that men should not display. Ultimately, there would be a lot of overlap with the type of work done with female survivors of sexual abuse, but these considerations could make a huge difference in how quickly rapport and trust is built along with a willingness to engage the healing process.

Quote from coriander39 on April 30, 2021, 9:24 pm

Natalie, I like the phrasing you use for your intake. I think it is a great way to elicit that information since many, men and women alike, do not even realize that what they experienced was abuse. Trauma is not area I have traditionally worked in although I am completing more training in the area to broaden my skillset and I have already had to explain to people more than once that what they experienced was abusive, whether it is sexual or otherwise.

To address what a few people said about the physical bodily response that men may experience during the abuse, (this may not be an original thought and is likely obvious) I wonder if it would be helpful to educate them how not only is this normal for men, but women who are abused often are faced with the same reaction. It may not be any more helpful for some, but I wonder, since women’s arousal is often more complicated (and less obvious) then men’s, if that would assist them in processing how normal it actually is.

Quote from elainekdowell on April 30, 2021, 9:48 pm

Quote from Natalie Lassiter on April 29, 2021, 12:51 am

For my intake, I ask the question “Has anyone ever made you see or do something sexual, or have you ever seen or heard someone else being forced to do something sexual?” I have found that this phrasing is helpful for both men and women to tell me abuse experiences they have been through that they may not have previously labeled as abuse. When I work with male survivors of sexual abuse, there is typically a reluctance to label it abuse or assault, and so I tend to follow their wording for the abuse while I am building rapport and trust. Typically, once I feel the client trusts me, I will gently challenge the label they have for the abuse and suggest an appropriate label. If they fight me on it, I back off and keep focusing on safety and stabilization. Because of the male arousal response and the likelihood of erection and maybe ejaculation during abuse experiences, I find that I have to do a lot of normalizing the body’s arousal response and response to stimulation, and work around shame and self-blame with men. These are responses I also see in women, but it seems to be talked about less with men and men tend to invalidate their own experiences more. I find a reluctance in clients to see early exposure by another person to porn as sexual trauma, as well as sexual trauma where the perpetrator was a female. I also find that I have to do more education on dissociation and check in with male clients more often about dissociation because I don’t spot it as quickly as I do with female clients. I have found that the best way for me to approach these issues with male clients is to be heavy on education about sexual abuse at first and then work on helping them to categorize their experience  and normalize their response to it and begin working towards healing.

Hi Natalie,

I appreciate your thoughts about how you approach therapy with male survivors of abuse. I have not yet worked with any male abuse survivors so I was writing from a more hypothetical place. It is helpful to read what has worked well for you in you clinical experience. I like the questions you include in your intake because that does seem to open the door right away for clients to share that information while also steering away from abuse language initially. Additionally, you raise a really good point about the reluctance men might have to label early exposure to porn as potentially abusive, especially since porn is often viewed as such an accepted part of men's experience. I imagine this plays out with covert sexual abuse as well. Thanks for sharing your insights!

Quote from meaganturner16 on April 30, 2021, 10:21 pm

@nataliewolfelpcgmail-com,

I appreciate the concrete phrasing you use in your intake paperwork. Often, it seems that people, men in particular because of the lack of societal discussion, guess at the definition of “abuse” or “assault” and whether or not their experience “counts.” I love that you don’t force the label on a client if they do not feel that it fits, but rather continue with safety and stabilization, meeting the client where they are and treating their symptoms. I have not yet worked with a male survivor of sexual abuse, but even with women I find that because of their body’s physiological arousal response, they feel shame and guilt over the experience. It’s important to address that feeling of being betrayed by their body when it reacted naturally but against their will. Normalizing their experience, their body’s response, and the reasons that they are normal, as you’ve suggested, sound like a promising treatment route!

Quote from serobinson on May 1, 2021, 3:50 pm

As far as I know I have not had the chance to work with males that have a history of sexual abuse. This is a part of our intake form and something I also cover in session, but from the males I have worked with none have identified being a CSA survivor. My approach then is based off of knowledge and other therapist's experience rather than my own.

First, with males or females I always want to hear their story. Especially in the beginning of our relationship I allow them to express as much or as little as they want. When working with males on other issues I make it clear that I am there to walk with them, but they are very much so in control. Something I have noticed when working with male clients on other topics but similar to CSA is that there are a lot of stigmas for how a man should and shouldn't act. I try to be careful that they don't feel pressure from me on any imposed roles. But I am also listening to them to see if maybe there are some unhealthy beliefs that they hold. This would be helpful with a male CSA survivor as they may feel it is not masculine to describe their abuse. Depending on how old they were, the relationship to the perpetrator and if the perpetrator was a male or female would all contribute to how the client may view themselves and the situation. For example, a male child that was abused by an older male teen may feel ashamed about the abuse but especially so if he was aroused by the abuse. This then could affect how the client views himself, his sexuality and effect his sexual behaviors.

There are studies that show a strong correlation between male CSA survivors and sex addictions. One particular study showed that female CSA survivors related more to internal responses such as depression and anxiety whereas males relate more to external sexual behaviors (Aaron, 2012). This would be something to screen for as well as other addictions due to comorbidity. This is another aspect that could bring shame and guilt in the client’s life. So again, it would be wise to approach the issues with no judgment, allow the client to express their story, and watch for unhealthy beliefs especially based on societal roles. I would also want to explore what healthy sexual relationships look like but start first with intimacy outside of sexual intercourse. If a male has experienced abuse as a child, he may have an insecure attachment style that would need to be addressed by building trusting and intimate relationships.

 

Aaron, M. (2012). The Pathways of Problematic Sexual Behavior: A Literature Review of Factors Affecting Adult Sexual Behavior in Survivors of Childhood Sexual Abuse. Sexual Addiction & Compulsivity, 19(3), 199–218. https://doi.org/10.1080/10720162.2012.690678

 

Quote from serobinson on May 1, 2021, 4:04 pm

Gerogiana

I also have not worked with males in regard to sexual abuse. I agree this was a difficult response to formulate however I think it is good for us to process now what that may look like when working with future male clients.

I agree that allowing the client to formulate their narrative and think of terms that support them whether than forcing any particular label. However, I think it is also good to help them as to not to minimize their abuse. Sometimes giving them some words to think about or see if they relate to might help. Even just using a list of emotions has helped some of my clients. I work with women in sexual trauma/affair recovery. I haven't been in this realm very long... but I have noticed that many clients will try to minimize what happened to them. It seems they feel if "I can just get over this it will all be fine or go away" or "maybe it's not that big of a deal." Sometimes I have to remind them that they matter and addressing the issues that hurt them and still hurt them matters too. This is when it has helped, if they have no words to use but want to explain, that I may use a list of emotions or hurts. I remind them that these may not relate to them but some of them may just give words that they need. This helps them to express rather than suppress and try to avoid.

Quote from serobinson on May 1, 2021, 4:12 pm

Quote from nkeeter on April 21, 2021, 2:02 pm

When working with men, and sometimes adolescents, I try to stay away from terms like "abuse" or "assault" as they seem to be somewhat conditioned to believe that "men don't get abused." What I find more helpful is to use terms like "unhealthy or unsought sexual experiences." This seems to give men the ability to look at the experience in a way that does not undermine their sense of autonomy.

Depending on whether the "abuser" was another male, which may stir up quite different feelings, or female may also have a great deal of bearing on how a therapist would approach client processing. Allowing for "client story" and interpretation of events to take a fair amount of time to change organically might take a great deal of patience, but have a long lasting difference in outcomes. A man may believe that a male abuser was actually trying to do harm, but have a far different interpretation if the power differential favored a woman, of whom he may say "she was just trying to initiate me into sex."

Nick

Thank you for your post. I agree that allowing the client to share their story and process it in their timing is very important. Also, that is a very valid point about the perpetrator being a male or a woman. I have not worked with males in regard to CSA before. I would be curious to know if there is a certain sexual behavioral response later in life this is more common if the perpetrator was a male vs a female. I am sure too, that society and cultural perspectives of these two things plays a role in the survivor's life. I remember there was an incident or two a while back on the news where a female teacher had sexually abused a male student. Even though I was younger I still remember thinking that the way it was talked about seemed much different than if it was a male teacher to female student.

Quote from courtneyrhanks@gmail.com on May 7, 2021, 3:01 am

It is my understanding that it is not uncommon for male sexual abuse survivors who were abused by males to struggle with sexual identity, especially if the survivor was ever aroused by the abuse. I have personally seen this in my practice, where shame is overwhelming if the client identifies as heterosexual but had physiological reactions to the abuse. It would be important to provide psychoeducation as to normalize biological processes that can occur during abuse.