The second
man was a therapist from a small city in the Midwest. He was
experienced in treating a wide range of individuals, and was
clearly earnest and serious about his work. A growing number
of men with sexual abuse histories were coming into his practice,
and he found that the principles of therapy he had learned during
his training did not always seem to apply to his work with them.
The professional books he had consulted helped some, but they
concentrated mainly on sexually abused women, and their framework
only partially fit the work he was doing with men. He tried
networking with other professionals in the conservative community
he lived in. Many seemed not to understand that men could be
sexually abused and felt he was on some private, quixotic mission,
possibly for dark countertransferential reasons. Some therapists
who worked with female rape victims were more helpful, but others
seemed to believe that men were rarely if ever abused, and that
any man coming for treatment about abuse was himself an abuser.
Feeling professionally isolated and overburdened, he turned
to the Internet for information. There, he found several useful
web sites, and also saw a notice for the conference where we
met. It was scheduled to begin two weeks later. Quickly changing
his vacation schedule, he traveled across the country to this
meeting. It was a revelation for him to talk there to other
therapists who for years had been grappling with issues related
to male sexual victimization. In workshop after workshop, he
learned more and more about work with this population, discovered
he had a lot to offer other practitioners about treatment, and
found a clinician in a city about three hours away from him
who was experienced in working with sexually abused men and
was willing to serve as a consultant and supervisor when they
returned home.
The third
man was an experienced psychoanalytically trained therapist
from a southeastern community. Of retirement age, he said he
came to the conference for help in writing an article about
treating patients with trauma histories. At first, his comments
at presentations focused on the intellectual and didactic components
of what was being addressed. He seemed to be trying to minimize
or deflect others from the wells of feeling that were being
tapped by the material. After listening to both therapists and
nonclinicians express their emotional responses to what they
were hearing, he rigidified his intellectualized approach until
he was confronted about this by another member of a workshop
he took. He grew silent, then, astonishingly, began to weep.
He poured out the story of his own childhood sexual abuse. In
the fifty or more years since these experiences, he had never
hinted about them to another soul except his analyst, and even
then he apparently had minimized their impact. By the end of
the conference, he found several kindred spirits, seemed looser
and far more open, and also achieved his initial goal of learning
more about the psychological impact of trauma.
The fourth
person I met at the conference was a woman who worked at a rape
intervention program in a big inner-city hospital. Her agency,
originally dedicated to working with women sexually mistreated
as adults or children, was treating increasing numbers of men
with sexual abuse histories. She saw many of these men for brief
therapy, and also ran short-term groups for them, sometimes
with a male colleague and sometimes alone. The men resembled
in important ways the women she was used to treating. She had
grown increasingly aware, however, of differences between the
two groups, and had come to this conference to crystallize her
thinking in order to work better with a male population.
As I address
a readership of individuals like these four, my writing, like
my clinical work, is informed by my background in interpersonal
psychoanalysis , family systems theory, and work with trauma.
I expect readers to have had diverse professional and theoretical
experiences, and I therefore discuss theory and research that
will be new to some but familiar to others. In particular, I
have emphasized the theoretical underpinnings that influence
my understanding of such important issues as masculine gender
identity, sexual orientation, family systems, dissociative processes,
and transference/countertransference phenomena. These theoretical
discussions are interlaced with the clinical examples that appear
throughout the book.
This book
is structured as follows: In the first chapter, terms are explained,
research is summarized, and the population of men described
in the book is defined. The second, third, and fourth chapters
develop ideas about how boys are likely to encode premature
sexual situations with women as well as with men, and how these
processes interact with internalized ideas about masculinity
and homosexuality. The fifth and sixth chapters analyze the
familial and interpersonal contexts of abuse and their influence
on a boy's responses to sexual trauma. The seventh chapter
describes the dissociative process that often helps a child
survive an initial abuse experience, but then is problematic
if it becomes his characteristic way of dealing with stress.
The eighth chapter demonstrates how early sexual trauma, chronic
boundary violation, and dissociation all influence an adult
man's interpersonal relatedness. The ninth and tenth chapters
focus on the vicissitudes of therapeutic relationships with
sexually abused men. The eleventh chapter concentrates on working
with sexually abused men in group therapy.
My writing
is deeply influenced by my belief that, for most sexually abused
men in psychotherapy and psychoanalysis, symptom removal is
not nearly sufficient as a goal. Instead, these men want and
need to develop a more nearly consolidated sense of self, a
greater attunement to their emotional lives, and an increased
ability to develop and maintain a tie with an intimate other.
And, I believe, this is most likely to happen in a therapeutic
experience that carefully examines the relational aspects of
all actions and internal psychological events.
I do not
intend to dictate to clinicians about how men sexually abused
as boys should be treated. To try to write such a book would
do a deep disservice to the uniqueness, complexity, and ambiguities
of each man's life trajectory and individuality. It would
compartmentalize the diverse experiences my patients had as
boys who were sexually betrayed and, later, as men who dealt
with their sexual betrayals in singular ways. It would also
falsely imply that I work the same way with men with similar
histories.
Instead,
my intention is to raise, delineate, and develop the themes
that often face the man with such a history and the clinician
working with him. I expect that each therapist treating this
population will develop distinct styles of working, based partly
on the sub-population he or she treats; partly on his or her
own personality as well as theoretical and professional interests;
and partly on the life situation of the man in therapy.
When I'm
in my consulting room with a sexually abused man, the themes
I outline in this book usually recede into the background as
the intricacies of his specific situation, history, and character
become the foreground of our work. No one is fully defined by
an abuse history. In my clinical illustrations, therefore, I
do not limit myself to issues directly related to sexual betrayal.
Instead, I try to describe individuals as they revealed themselves
to me, communicating the diversity, fullness, and uniqueness
of each treatment situation. (Readers wishing to integrate multiple
descriptions of these men may want to consult the Clinical Cross-References
in the back of the book.) Inevitably, however, my portrayals
lose some of the distinctiveness and complexity of each man
and of our work together as I use them to highlight a particular
theme or technique. For this, I apologize both to the reader
and to the men I discuss.
Most of
all, I give my heartfelt thanks to those who gave me permission
to describe our work. My relationships with the thirty-eight
men I have written about in this book have moved me and changed
how I look at human interaction. These men have courageously
faced terrifying pasts. As I once wrote, "Their stories
have stirred me, their resolution in the face of their histories
has astonished me. I have learned from them more than I can
say."