Opening The Door

A Treatment Model For Therapy With Male Survivors Of Sexual Abuse

Adrienne Crowder

• Publisher: Routledge
• Year: 2014
• eBook ISBN: 9781317758532
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

The first book available to comprehensively address the treatment of sexually abused males, Opening the Door: A Treatment Model for Therapy with Male Survivors of Sexual Abuse is based on current research and the carefully evolved techniques of 41 therapists who have developed expertise in working with sexually abused males. It discusses both the approaches that these therapists bring to their work and presents interventions they have successfully applied in treatment. Written in clear, concise language, Opening the Door features a four-phase treatment model and presents, in detail, the therapeutic tasks necessary for each phase. This model makes clear the significant parallels and distinctions between the processes of therapy and abuse. These processes are discussed throughout the text to ensure that therapy will be a healing rather than a harmful experience. The volume presents information about the frequency of male sexual victimization, the impact of this victimization on the individual, primary differences between male and female victimization, and the issues victims typically bring into therapy. The four-phase treatment model for male survivors and the therapeutic tasks of each stage is then addressed. This model serves as a framework for presenting specific therapeutic interventions. Chapters examine such areas as the essential processes that pertain to all therapeutic modalities (individual, group, etc.) when treating male survivors of sexual abuse; contracting with clients, assessment guidelines, and methods of evaluation; individual therapy with male survivors; a two-stage group treatment model for male survivors, which discusses contraindications for group treatment, screening criteria, general ground rules for the group, and effective interventions; critical issues in treating male survivors, including engagement strategies, therapeutic impasses, and client/therapist gender dynamics; and the therapeutic process as it applies to adolescent male survivors, with particular emphasis on how treatment must be carefully tailored to the developmental needs of this group. Included are guidelines for working with adolescents and several interventions that contributors have successfully used with this population. Since working extensively with abuse survivors can exact significant personal costs, the book provides important self-care strategies for therapists to incorporate into their work and lives and discusses seven ways in which to recognize and manage counter-transference. The volume also contains a highly comprehensive list of written, video, and training resources that will provide therapists with numerous avenues to expand their clinical practice and knowledge, as well as seven appendices that include the DES Questionnaire and the Dean Adolescent Inventory Scale. Opening the Door will be an invaluable resource for all mental health practitioners who help male victims of sexual abuse to transcend survivorship and learn to live healthy, productive, and vital lives.

Chapter 1
Introduction

Sexual abuse is an activity that is perpetrated in secret. The offender is often in a position of trust, and always in a position of power, in relation to his or her victim. The victim acquiesces to the authority of the offender because he or she is threatened or seduced into compliance. Often a victim’s cognitive and affective immaturity renders him or her unable to appropriately judge the potential risk of the behaviors that constitute the abuse.

In many ways the therapeutic process is isomorphic to that of abuse. Therapy occurs under a mantle of confidentiality. Clients enter therapy in good faith, with the expectation that a therapist will have their best interests at heart. Therapists are invested with the authority to determine the kinds of interventions they believe will best assist their clients’ recovery. As in situations of abuse, clients generally have no immediate way to judge the long-term effects of their therapy or the skills of their therapist.

The difference between therapy and abuse, however, lies in the fact that ideally therapy is driven by the clients’ needs, whereas abuse ignores the victims’ needs. If therapy is to be effective in restoring clients’ autonomy and well-being, therapists must manage treatment in ways that do not suggest or replicate the dynamics of the original abuse.

Opening the Door has been written to assist clinicians who work with, or are intending to work with, male survivors of sexual abuse. Throughout the text, the parallel processes of therapy and abuse are discussed; the important distinctions between these two processes that ensure that therapy is a healing rather than a harmful experience form the basis of the treatment model that is presented here.

The raw material that forms the basis of this book was gathered from interviews with 41 therapists who have developed expertise in working with male survivors of sexual abuse. The text discusses both the similarities and differences in approach that these therapists bring to their work. It also presents applied interventions that they have developed to enhance their work.

This book is written for mental health practitioners (therapists, social workers, psychiatric nurses, doctors, crisis center workers, etc.) who are offering therapeutic services to adolescent and/or adult male survivors of sexual abuse. The information presented here is not meant to be prescriptive. Rather, it is meant to stimulate your own thinking and creativity. You are invited to take this information and improve on it by adapting it to suit your own therapeutic style and experience.

Throughout the text, I assume that each person’s recovery process from childhood sexual trauma is unique. In addition, I assume that the kinds of formal treatment that are discussed here form only one part of any individual’s healing journey. Although this text, of necessity, deals with the political and cultural components of abuse, its primary focus is on the personal and psychological aspects of recovery from sexual trauma.

Definition of Sexual Abuse

Throughout this book, the term “sexual abuse” will be used to describe overt or covert sexual behavior between two individuals when the following conditions exist:

1. the nature of the sexual act(s) is developmentally inappropriate for at least one of the participants;
2. the balance of power and authority (meaning psychological power, economic power, role status power, etc.) between the two individuals is unequal; and
3. the two individuals have an established emotional connection (such as that between a child and a caregiver, or a child and authority figure).

Any definition of sexual abuse necessarily carries culturally determined values and beliefs about sexuality, self-determination, and social roles. In the broadest sense, sexual abuse can be defined as:

…sexual activities that a child does not understand, to which a child cannot give informed consent or which violate the social taboos of society. (Krugman, 1986, as cited in Banning, 1989, p. 566)

The nature of the sexual acts that constitute sexual abuse vary along a continuum of intrusiveness. Activities such as voyeurism, viewing pornographic materials, or age-inappropriate behavior regarding physical health (for instance, checking to see if a 12-year-old’s penis is “growing properly”) fall on one end of the continuum. Sadistic and ritualistic abuse constitute the other end.

It must be noted that a client’s perception of the intrusiveness of any specific sexual activity is subjective. His perceptions may change as he redefines his childhood experience through his adult understanding. It is the client’s experience that needs to be addressed in therapy rather than whether or not the behavior is objectively considered intrusive.

Language

This text focuses on therapeutic work with male survivors of childhood sexual trauma. For the sake of accuracy and simplicity, I use the pronoun “he” when referring to victims or clients.

The terms “victim” and “survivor” are both commonly used in abuse-related discussions and literature. Historically, these terms were adopted by the feminist movement to describe victims of rape. Rape victims are violently attacked during an incident that is outside the normal events of their lives. With sexual abuse, however, the trauma is usually repetitive and often seductive. Generally, the abuse is integrated into the child’s life and, in one way or another, his beliefs, feelings, behavior, and sexuality are conditioned by the abuse. Hence, to describe someone as a “victim” or a “survivor” of sexual abuse can minimize the internalized dysfunction that can occur as a result of the long-term and pervasive nature of the abuse. These terms also run the risk of overgeneralizing a client’s identity as a survivor of childhood sexual trauma, thereby discounting those aspects of the person that currently function in healthful and productive ways.

Given the limitations of language and a need to be succinct, I will use the terms “victim” and “survivor” throughout this text. However, the limitations of these terms noted above cannot be overlooked. Ultimately, both “victim” and “survivor” perpetuate an association with a history of abuse (Hunter, 1990). It is to be hoped that after successful therapy a client will identify the impact of his abuse as only a part of his life’s journey and not as its totality; ideally, he will see himself as “someone who was abused as a child” rather than as a “victim” or “survivor” of abuse. “The ultimate goal of therapy ought to be to transcend survivorship…. The individuality of personhood must be paramount” (Hunter & Gerber, 1990, p. 83). Readers are asked to bear in mind that the terms “victim” or “survivor” are used in this volume as a convenient shorthand rather than as empirical descriptors.

Throughout the text, the 41 clinicians who were interviewed about their work with male survivors are referred to as “the contributors” or “the clinicians participating in this research.”

Research Method

The material presented in this text has been compiled from two primary sources: namely, interviews with clinicians who provide therapy to sexually abused males and the current literature (most notably books and journal articles). The contributors who participated in this research were a nonprobability, purposive sample of clinicians who have therapeutic experience with male survivors of sexual abuse.

Data collection occurred in the following sequence: first, computer and library searches located relevant written materials about sexually abused males. Second, North American authors of books or journal articles were sent a letter outlining the nature of this research and inviting them to participate in it. In addition, these writers were asked to provide the names of other clinicians whom they knew to be working with male survivors, and these clinicians were subsequently contacted. Third, all the clinicians who agreed to participate in this research were sent a questionnaire to gather information on their clinical orientation, the demographics of their client population, and the resources they use when working with male survivors. (For a copy of this questionnaire, please see Appendix A.) Fourth, the written questionnaire was followed by a semistructured telephone interview to gather more in-depth information about each contributor’s clinical practice and specific interventions and techniques used. These phone interviews were conducted during the autumn of 1992 and the winter of 1993.

In total, 58 clinicians throughout Canada and the United States were approached and asked to take part in this research. Of these, 41 agreed to participate. Their names are listed in Appendix B. Thirty-one contributors returned the written questionnaire.

Thirty-two of the contributors are male; nine are female. The majority of the contributors have professional training in psychology, social work, or marriage and family therapy; however, clinicians with backgrounds in nursing and massage therapy are also represented. The contributors work in a variety of mental health settings, including community mental health clinics, family therapy agencies, hospitals, rape crisis centers, sex offender treatment programs, and private practice.

Contributors were asked to identify both their years of experience in providing sexual abuse treatment in general and sexual abuse treatment to male survivors in particular. As anticipated, given the greater cultural awareness of female victimization, the contributors had more years of clinical experience working with sexual abuse in general (providing therapy to female victims and their families) than with male victims in particular. To summarize:

• 68% of the contributors had provided general sexual abuse treatment for more than eight years;
• 23 % had provided general sexual abuse treatment for between six and eight years; and
• 9% had provided general sexual abuse treatment for fewer than five years.

With regard to male survivors:

• 32% of the contributors had provided sexual abuse treatment to this population for more than eight years;
• 42% had provided sexual abuse treatment to male survivors for between six and eight years; and
• 26% had provided sexual abuse treatment to male survivors for fewer than five years.

Although some contributors specialize in working with a specific developmental group, many work with a variety of ages:

• 93% of contributors offer therapy to adult male survivors (clients over 25 years of age);
• 90% work with young adults (aged 20-25 years);
• 58% work with adolescent male survivors (13-19 years of age);
• 35% work with latency-aged children (6-12 years of age); and
• 16% work with preschool boys under the age of five.

Contributors were asked to identify the different therapeutic modalities they offer to male survivors of sexual abuse:

• 97% of the contributors offer individual therapy;
• 77% offer group therapy; and
• 52% offer couple and/or family therapy.

Some contributors also offer regular workshops for male survivors and/or they provide regular training to other professionals regarding the treatment of male survivors of sexual abuse.

Limitations of this Research

Gathering the primary data for this book was a journalistic process rather than a scientific one. My intention in compiling this material was to create a practical resource for clinicians who work with male survivors of sexual abuse. Qualitative and exploratory research methods were used to meet this goal.

The contributors were located by virtue of either having published material on the subject of male sexual abuse survivors or knowing someone who had published in this area. Clearly some very knowledgeable practitioners may have been overlooked because they have not written about their work with male survivors or because they did not come to my attention during the initial stages of the research. In addition, some seasoned clinicians who were asked to participate in this research were prevented from doing so because of other work demands.

Therapy is a dynamic human interaction. It is by nature fluid and experiential. Translating therapeutic concepts and experience into written form necessarily entails some loss. Nevertheless, it is my hope that the treatment model described in this book will assist therapists in their work with male survivors.

Organization of the Text

The remainder of this text is organized into 11 chapters (with seven appendices). Chapter 2 is called “Prevalence, Impacts, and Issues” and presents information about the frequency of male sexual victimization, the effects of this victimization on the individual, and the issues that victims typically bring into therapy.

Chapter 3 presents a four-phase treatment model for male survivors. These phases are called Breaking Silence, the Victim Phase, the Survivor Phase, and the Thriver Phase. The typical therapeutic tasks of each of these stages of therapy are outlined and discussed.

Chapter 4 outlines essential processes that pertain to all therapeutic modalities (individual, group, etc.) when one is treating male survivors of sexual abuse. Contracting with clients, assessment guidelines, and evaluation methods are discussed.

Chapters 5, 6, and 7 focus on individual therapy with male survivors, examining the Victim, Survivor, and Thriver phases of therapy, respectively. Interventions that the contributors have developed for use during each of these treatment phases are intertwined with general theoretical considerations.

Chapter 8 outlines a ...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• Acknowledgments
• Chapter 1: Introduction
• Chapter 2: Prevalence, Impacts, and Issues
• Chapter 3: Treatment Model and Stages of Healing
• Chapter 4: General Therapeutic Considerations
• Chapter 5: Individual Therapy: The Victim Phase
• Chapter 6: Individual Therapy: The Survivor Phase
• Chapter 7: Individual Therapy: The Thriver Phase
• Chapter 8: Group Therapy with Male Survivors of Sexual Abuse
• Chapter 9: Critical Issues in Treating Male Survivors
• Chapter 10: Counselling Adolescent Male Survivors
• Chapter 11: Therapist Issues
• Resources
• Appendix A—Questionnaire
• Appendix B—Contributors
• Appendix C—DES
• Appendix D—Intervention to Manage Flashbacks and Intervention to Ground Clients in Here-and-Now Experience
• Appendix E—Behaviors That Support Group Process
• Appendix F—Dean Adolescent Inventory Scale
• References
• Index