John (not his real name) was a white man in his mid-twenties. He was obese, had a shaggy beard and was identified as a gay man. John had come to a counselor after a referral because John had previously only described sexual experiences in his early childhood. After three sessions in the counseling relationship, John built a timeline of key events in his life. While talking about his sexual experiences and the development of sexual and gender identity, he moved uncomfortably in his seat.
"My brother and his friends used to have sex with me," John said suddenly, looking up just long enough to judge his advisor's reaction before returning his gaze to his clasped hands.
"How old were you when you had a sexual encounter with your brother or one of his friends for the first time?" Asked the counselor.
"I think I was 7, maybe 8 years old," said John, throwing another quick look into the advisor's eyes before staring again at his hands. "Does that make you disgusting?"
"No," said the advisor. "Honestly, at the moment I'm a little relieved that you told me. I suspected that you experienced some type of sexual abuse as a child, based on what I was told when you were referred to me. I expected you to mention it, but I didn't want to urge you to tell me until you were ready. "
"I wouldn't call what happened sexual abuse," John shot back. “I mean, I don't know what it was. They never made me do it with them. They just had sex with each other when I was around and they wanted me to do it too. ”He looked up to reevaluate the counselor. "I'm gay. I've known that for a long time. I just … I don't know what to think of it."
“How should I point out these sexual experiences that you had with your brother and his friends?” Asked the counselor.
"I don't know," said John. "It was just sex."
"OK," said the consultant. "I'll call them early sexual experiences until you think I should call them differently."
"I don't even want that to be the reason we're talking," said John. "I think the fact that my parents didn't care about me, ignored me, preferred my brother all my life, messed me up a lot more than sex at the age of 8."
"I hear you say that you do not want these early sexual experiences to be the focus of our visit," replied the counselor. “Would it be okay if we stayed there a minute longer? I just want to get some more information about these experiences. "
"What do you want to know?" asked John.
"I appreciate that you let me ask," confirmed the counselor. "How old were you when your brother and his friends stopped including you in these sexual experiences?"
"I think I was 11 or 12," replied John.
"So your brother is five years older than you?" The counselor remembered that from an earlier conversation.
"Yes," said John.
"You said you don't know what to think of it," the counselor asked. "How do you think about it?"
"Mostly just disgusting," he replied.
"That's why you asked if I was disgusted by it," the counselor considered.
"Yes. Can we talk about something else? "Asked John.
“I can tell you are really uncomfortable talking about it,” admitted the advisor, “and you said you didn't want this to be the focus, so we can go ahead and focus on what you want to talk about. But I would like to come back to these experiences that you made at some point, if that's okay. "
“At some point it will be okay. I'm just not ready today. I'm kind of sorry I brought it up, "said John.
"I think it took a lot of courage to bring it up without knowing how I would react," confirmed the counselor.
"My parents hate that I'm gay, so I never got to talk to them about sex or relationships," he said.
"So your parents know that you are gay, but you never told your parents about those early sexual experiences that you had with your brother and his friends?"
“No,” said John, “I've never told anyone before. I know if I did, my brother and his friends would simply deny it ever happened. Especially his only friend. He's a big deal, married with a couple of kids. If he admitted it, it would probably ruin his life. I don't want to talk about that anymore. Can we talk about something else now? "
“You are in charge,” said the advisor, “so we can go on if you want. How about we go back to the timeline? What other important events should we watch? "
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Why do adult male survivors say nothing?
This exchange between John and the counselor is very typical of an encounter with an adult man who experienced childhood sexual abuse (CSA). Adult male survivors of CSA often wait 20, 30, 40 years, or more before sharing their experiences with others. John had waited almost 20 years. In 2013, Scott Easton found that approximately two-thirds of adult male survivors who give their information in adulthood tell a spouse or intimate partner first. Others who reveal something will tell a lawyer, religious leader, or psychiatrist. John had only spoken to an attorney who was a survivor himself about "early childhood sexual experiences" after hearing that attorney speak on a public awareness forum. The lawyer John spoke to then referred him to an advisor.
Adult male survivors of CSA face significant barriers to disclosure. These barriers include gender norms, social stigma and questions about one's own sexual identity. John was about to reveal that he was gay. While John understood and accepted his sexual orientation, he still believed that the counselor might be “disgruntled” when hearing about his “early sexual experiences”.
John's conceptualization of his sexual experiences in early childhood is also a typical barrier. Many adult male survivors do not conceptualize (or want to) their childhood sexual experiences as CSAs. John shrank from the idea, preferring instead to call it "early sex experiences". This conceptualization of what can objectively be defined as CSA as something other than CSA happens for many reasons, including:
The perpetrator was female
Confusion about who instigated the sexual contact
The pleasure reaction, which includes sexual arousal, even if the arousal occurs during an act of abuse
At the time of John's sexual encounters, his brother and friends' sexual activity appeared to be normal behavior to John. It was something they just did. John also flinched at the thought that he had fallen victim in some way. This is a common male stereotype that can serve as a barrier to disclosure.
Not conceiving a CSA as a CSA can also serve as a barrier to disclosure when it comes to counseling assessment tools. Many assessment tools use the language of sexual abuse, assault, or victimization. If an adult male survivor does not conceptualize his experience as a CSA and a psychologist asks in an assessment whether the client has ever experienced sexual abuse, assault, or victimization, the client's answer would be "no". John denied having experienced CSA when asked directly about "experiences of abuse" in the standard initial assessment the counselor completed.
Adult male survivors of CSA face a number of other barriers to disclosure, some of which even well-intentioned mental health professionals can unwittingly perpetuate. For example, researcher Rhys Price-Robertson identified the victim-to-perpetrator narrative. Mental health providers and sexual abuse prevention professionals have rightly or wrongly emphasized that many CSA offenders have been victims of CSA themselves. This victim-to-perpetrator narrative can lead to a widespread perception that survivors of CSA become perpetrators.
Greg Holtmeyer, a CSA survivor, attorney and public speaker, calls this "vampire syndrome" because traditionally, if you are bitten by a vampire, you become a vampire. By claiming the victim-to-perpetrator narrative, mental health and sexual abuse prevention professionals may inadvertently maintain a barrier to disclosure by adult male survivors. If survivors believe this narrative, they are less likely to reveal their own experiences of abuse for fear of being suspected themselves.
Another narrative that professionals and prevention specialists should be careful about is the one that focuses on the male perpetrator / female survivor duality. This narrative is based on the fact that more female than male survivors report the abuse, but it ignores the reality that victimization of men is almost as high as that of women. In the 2011 National Intimate Partner and Sexual Violence Survey (a survey commissioned by the Centers for Disease Control and Prevention), researchers found that 12.3% of female victims of sexual abuse had a complete rape before 10 victims of abuse had experienced complete rape before they were the same age. The National Sexual Violence Resource Center reported in 2016 that 1 in 4 girls experienced some form of sexual abuse prior to graduation, but 1 in 6 boys experienced some form of sexual abuse before the same age.
This tells us that while more girls and women are bullied in the course of life, male victims often experience sexual abuse at a younger age than female victims. While women and young girls report sexual violence much more frequently than men and young boys, the lifetime prevalence of CSA is only slightly higher in women than in men.
The public narrative, which focuses on the duality of male perpetrators / female survivors, is intended to motivate the public to seek prevention and to inspire survivors to come forward for treatment. However, the same narrative can make adult male survivors feel isolated and alone. Adult male survivors rarely see their stories in treatment, advocacy, or prevention efforts. This could inadvertently lead to the silence of adult male survivors by increasing their sense of isolation. As professionals in mental health and sexual abuse prevention, we must ensure that our narrative includes all genders.
Request for disclosure and provision of support
In our research on the lived experiences of CSA disclosure by adult male survivors, we found specific interventions that can help psychiatrists elicit disclosure and support adult male survivors after disclosure. Such interventions include:
Using a timeline of important life events to identify sexual experiences in early childhood
Understand that the disclosure is a relational experience for the survivor reading clues from the psychiatrist as to whether the disclosure should continue
Use a balanced and honest affective response to the
disclosure (this is more encouraging than no response or an overly emotional response)
Empowering survivors by letting them choose how much and for how long they want to talk about their experiences (this promotes a feeling of security)
Granting clear informed consent, which supports the survivors' decision to disclose by including them in the decision-making process in connection with the notification requirement
John was in his third session before revealing that his brother and his brother's friends had sexual encounters with him when he was 7 or 8 years old. He had drawn up a timeline of major events in his life. This process of creating a lifetime axis is a powerful assessment tool. Such a timeline should be comprehensive and contain information about the person's education, professional history, hospital stays, suicide attempts, mental health, sexual history, family history, and any other life event that the person considers significant.
This type of assessment enables clients to name their own experiences in their own language and guides mental health professionals to avoid stigmatized language that clients may refute. A tool like this frees clinicians from asking clients to answer yes-no questions about experiences of abuse or assault. The counselor in our vignette had asked John to return to the timeline to discuss his sexual history, and on that occasion John began his disclosure process.
Another important element in supporting disclosure is understanding that survivors often experience disclosure as a relational experience. Psychiatrists have historically conceptualized the disclosure as a linear experience, with the survivor disclosing the disclosure and the skilled person receiving the disclosure. However, adult male survivors experience the disclosure as a relational reality. Many victims of CSA are conditioned by the abuse to take responsibility for the emotions of others. People who display predatory, abusive behavior will convince their victim that anger, disappointment and happiness of the perpetrator depend on the victim. As a result of this conditioning, victims learn to read others for emotional cues and change their behavior based on what they see. This leads to two important factors in exposing an adult male survivor and indeed every victim of abuse.
First, adult male survivors of CSA are very aware of the reactions of those to whom they disclose. John assessed his advisor's reaction after disclosing his early sexual experiences. In our research, we have learned that a petrified reaction to this disclosure can be as devastating to the survivor as an exaggerated emotional explosion. Adult survivors may interpret a lack of response as cold or indifferent and see the psychiatrist as aloof and disconnected. A psychiatrist's balanced affective response, empathetically synchronized with the survivor's own emotions, will encourage further disclosure.
The second thing that psychiatrists should remember when considering that disclosure is a relational reality is that they must own their emotional response. If a survivor sees a psychologist responding to the disclosure, they can take responsibility for that response. This is what those who committed the abuse conditioned the survivor. Mental health professionals can aid a survivor's disclosure by recognizing their own emotional response and making it clear that it is their responsibility as a mental health professional to manage their emotions. The role model of emotional management techniques is an effective tool to help survivors deal with their own feelings.
The adult male survivors we interviewed in our research described how the one to whom it disclosed took control of the information after it was disclosed and engaged them in activities they did not want to do. One participant described how a therapist felt debilitated after disclosing their experience with CSA. He stated that the therapist ignored his revelation and instead persuaded him to enter a 30-day alcohol treatment center because the therapist decided that this was a more important issue.
Another participant described how the counselor to whom he disclosed the information became curious about the client's perpetrator. The counselor and survivor then spent time in their counseling session looking to see where the perpetrator lived in order to satisfy the counselor's curiosity. This was done under the pretext of distinguishing whether the survivor should confront the perpetrator, which the survivor was not interested in.
Another participant in our research described how his mother, after sharing his CSA experience with his parents, called a "family reunion" without any deference to confront the perpetrator. The participant said he had no idea his mother had planned the meeting until he walked in and saw the family gathered in the house.
The participants in our research described experiences of disempowerment after their exposure – experiences in which they felt that their wants, preferences and concerns became secondary to those to whom they were revealed, including the counselors. In describing their experiences of disempowerment, all participants stated that they had stopped discussing the abuse with the person who reacted in this way.
Supporting the survivor's control or power over the situation becomes particularly difficult when considering mandatory reporting laws. Because of this, informed consent, which is clear and regularly reviewed, cannot be overemphasized. If the counselor needs to report certain actions by CSA, the abuse victims need to know before disclosing them. They should also be included in the reporting as far as they are able and willing to do so. You may not have a choice of whether to disclose CSA based on state and federal laws, but you can choose how the disclosure is handled and what your next steps may be .
When adult male survivors reveal themselves, they seek an affirmative, supportive relationship. They are looking for someone who can be with them in their pain without taking the experience, taking control, minimizing, or catastrophizing. They want someone to understand their experience as they understand it and to guide them on the path to recovery. Psychiatrists risk silencing or even retraumatizing CSA survivors by taking control of the situation and thus disempowering the survivors.
The experience of CSA is one of disempowerment. The perpetrator exercises power against the intended victim and deprives the victim of personal power. In that session, when John was revealed, the counselor pushed a little bit, but always asked permission first. When John said, "I don't want to talk about it anymore," the advisor paused and recognized John's power over his experience, including when and with whom he shared it.
As David Treleaven says in his work Trauma-Sensitive Mindfulness: Practices for Safe and Transformative Healing, it is more healing to allow trauma survivors to reveal themselves in such a way that they stay within their tolerance window than to try to do so to force more disclose than you are capable of. Allowing CSA adult male survivors to choose when, how long, how much, and to whom to disclose is a small opportunity to give them back some of their power. Strengthening these survivors encourages further disclosure.
Insertion of the edges
John stayed in counseling for almost a year. Sometimes he wanted the clinical focus to be on his relationship with his parents, his conflicts with intimate partners, or his work management. When he was ready, he would deal with the effects of the "early sex experiences" he revealed. Eventually, in these experiences, he even brought up the reality of incest and how it added another layer to his feelings of being "gross". John finished college not long after starting counseling. He “moved on” as much as he can.
Male CSA survivors face unique barriers to disclosure. To support this group, counselors need to be aware of these barriers and tailor their interventions to this population group. Remaining vigilant to the relational nature of the disclosure, being sensitive to the language used to describe these experiences, and having one's own emotional response to the disclosure aid further disclosure and healing. Male survivors come out in search of confirmation and healing. When counselors provide a supportive and empathic environment, healing occurs.
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The authors would like to thank Greg Holtmeyer (gregholtmeyer.com), CSA survivor, attorney, and international public speaker, who inspired research to support adult male survivors of CSA.
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James M. Smith is a Licensed Professional Counselor (LPC), a Government Certified Consultant, a Recognized Clinical Supervisor, and a Board Certified Elementary Health Provider. He is the director of curriculum, teaching, and assessment at Lincoln University's School of Education, Missouri, where he also teaches the consultant training program. He also looks after clients in his own practice, where he specializes in working with people with childhood trauma. Contact him at [email protected].
Adrian Warren is a faculty member at Walden University and LPC supervisor in Texas. He has worked in the mental health field for 17 years and as a counselor trainer for 12 years. In addition to teaching, he has a small private practice and is President of the Texas Counseling Association from 2021-2022.
Counseling Today provides an overview of unsolicited articles written by members of the American Counseling Association. For writing guidelines and tips for accepting an article for publication, visit ct.counseling.org/feedback.
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