Page two, The Relational Aftereffects of Boyhood Sexual Abuse

In a psychology where emotions are blurred this way, affection is highly suspect and is experienced as both sexual and abusive, erotic and violating. Abe, for example, at one point acknowledged that any interpersonal movement toward him, even a dinner invitation, could be experienced as hurtful and abusive. This distorted view of positive relatedness was poignantly highlighted by a verbal slip made by a man who once said, “I was depraved [sic] of love by my family.”

Long-term, arduous work is required in psychotherapy before a man can begin to allow himself to embrace more freely his own loving feelings. Cory inadvertently discovered he had begun to make this shift after his wife suffered a miscarriage. In wonderment, he said, “I had let myself love it. I didn’t even worry about the pain I feel now. And even though I cried all this week, I know now that I’ve opened up a big wonderful space in my heart where there had been a void -- and I can love my child -- I can love my child when I have me.”

Ambivalence about Being Sexual
The difficulty differentiating sexuality, love, nurturance, affection, and abuse has many consequences for relationships involving intimacy, sexuality, and/or love. It also affects a sexually abused man’s relationship to himself as a sexual being. Having experienced his first sexual arousal in an abusive context, he links sexuality to “coercion, nonmutual exchange, and sometimes violence. . . . The pairing of secrecy and sexual arousal often leaves a victim feeling very ashamed of his sexuality, especially if he senses that his sexual expression is deviant. Some survivors are unaware that their sexual behavior has been shaped by abuse processes and they believe that they are misfits or weird or crazy because of the nature of their sexual desires and expression” (Crowder, 1995, p. 32).

“Although incest is an abuse of power, it is also an abuse of sexuality” (Price, 1994, p. 224); this abuse causes distortions about all sexual situations. Experiencing erotic excitement becomes negatively charged. As Victor succinctly put it, “All pleasure is bad. Do you know why? It’s bad that my father is touching my penis. His touching my penis gives me pleasure. Therefore, it’s bad to have pleasure.” Victor elaborated on the ambivalence he developed about sexual arousal with his father: “I hated when my father talked to me while he touched me. He’d say, ‘You’re so big, you’re so hard, you know Daddy loves you and that’s why he does this.’ But I don’t think I ever believed him. I felt like a hooker when he said that. I’d rather he would have just touched me, and kept quiet. At least it felt good and I didn’t have to think about it being my father who was doing it. When he touched me, he’d open my pajamas and by the time I woke up he’d have fished my dick out and it would be hard. I’d let him touch it for a while -- then I’d get upset and I’d turn over. He’d beg me to turn back. Sometimes he’d sigh and say ‘OK, if that’s how you want it,’ and I’d feel guilty. I felt I wasn’t doing what a good son would do. So I’d turn around again and let him continue, and he’d be so grateful.” Noting one Pyrrhic victory in his struggle about sexuality and abuse, Victor forlornly concluded, “At least I never came with him -- I always made him stop before I came.”

An additional problem about being sexual involves the shame a sexually abused man attaches to having been abused. This shame often becomes associated with all sexual arousal (Rusinoff and Gerber, 1990; also see Hastings, 1998), so that arousal itself becomes shameful. Also, if a man restimulates memories and fantasies about his abuse experience, he may confuse these with sexual desire (Briere, 1995), which may add to his shamed and phobic response to sexuality. One goal of treatment in such cases is to separate out and attempt to repair these feelings.

Lorenzo described the process by which shame about abuse can get translated into shame about sexuality: “I realized one day that I was in the gym, looking around, admiring men’s bodies, not coming on to them, but feeling attracted and yet terribly ashamed of my desires. It was crazy -- I felt like a pedophile, even though these men were my own age and I have no interest in children. I couldn’t understand it, but then all of a sudden it hit me. The men who abused me had no shame about what they did. They invited me to come give them blow jobs when I was as young as eight and nine, and then I’d see them in church with their wives or on the street, and they were totally casual, pillars of the community. Sometimes it was as though they hardly knew who I was. So I took on their shame! I took it in. They couldn’t own it, so I did -- and I still do! I walk around feeling my desire, and feeling I’m terrible for having desire, that desire itself is abusive. I feel the shame they should have felt but never did!”

Not surprisingly, many sexually abused men feel ambivalent about being sexual at all. They have learned to be extremely wary both about their own sexual feelings and about sexual approaches from others. (In this, they resemble sexually abused women.) Sexual situations, or situations interpreted by the man as including sexual elements, tend to bring up the dissociative defenses he learned as a boy while being abused. Sexual dysfunctions are common among these men, including lowered or excessive sexual desire, sexual aversion, erectile disorder, inhibited orgasm, and premature ejaculation (Glaser, 1998). For example, Hugo, a gay man in his forties, was seventeen when he went through the last of a series of molestations by older male cousins. “I was trying to express my anger at the way I was being treated, so I willed myself not to have an erection, and I succeeded. I only meant for that night! But the result was I could never again have a spontaneous erection with anyone I cared about.” As a result, he spent years trying to negotiate satisfying relationships, knowing all the time how “defective” he was in comparison with the men to whom he was attracted and whom he tried to engage intimately. Not until the drug Viagra came on the market was he able to achieve erections regularly when he felt aroused. Only at that point did Hugo realize the extent to which his sense of masculinity and power had been compromised by his impotence. He had to mourn the losses to his self-concept from twenty years of battling paralyzing shame, self doubt, and feelings of inadequacy whenever he tried to be sexual in a related, intimate way.

Similarly, during the course of their psychotherapies, both Andreas and Cory became aware of severe dissociation during the sex act. Andreas “functioned” sexually with his wife but felt physically and psychically numb. Cory had felt physically paralyzed as a nineteen-year-old when a male college dorm counselor tried to seduce him. In adulthood, he continued to dissociate during sex with his wife: “Once I get things going in sex, I can just turn the machine on automatic and leave.”

Some sexually abused men avoid interpersonal sexuality altogether. Others may attempt to manage sexual relationships while suffering from the ambiguous intensity they experience during intimacy. The pain of this situation was summed up by Cory when on various occasions he said, laughing but only half-humorous, "The trouble with sex is there's always someone in your face," and “I don’t want any spontaneity in sex unless I know what’s going to happen,” and “If you really think about sex and all that happens in it, who would ever want it?”

Sexuality as Interpersonal Currency
On the other hand, a child whose sexuality has been compromised by early abuse and eroticized relationships learns that sexuality and seduction constitute his interpersonal currency. Having learned that his sexuality is valuable to others, he may make it the basis for his self esteem. If that happens, sexuality permeates all his interpersonal encounters. In addition, interpersonal closeness often becomes eroticized because sex is the only way for the man to feel intimate (or seemingly intimate).

Hungry for interpersonal contact but phobic about it, believing that sexual closeness is his chief opportunity to feel loved but experiencing love as abuse, a sexually abused man who allows himself to be sexual at all often solves his dilemma by engaging in frequent, indiscriminate, and dissociated sexual encounters. These are not free or joyous expressions of hedonistic, lusty sensuality. Rather, they represent a man’s imprisonment in an empty behavioral circuit from which he feels there is no exit. Incessantly pursuing sex, he nevertheless achieves very little intimacy. Nonmonogamous sex is not necessarily bad, but it is often not fully intimate (Glaser, 1998), especially when it involves compulsive seeking after partners. In these situations, a man usually looks for sexual release to allay his anxiety rather than because he feels sexually interested in or aroused by another person. He is momentarily soothed by impersonal expressions of sexuality, much as he might be by other compulsive or addictive behaviors like drinking, taking drugs, or overeating. Yet he does not feel loved once the sex act is concluded. These incidents leave him feeling empty and lonely, while the idea of fully pursuing interpersonal relatedness fills him with a dread of repeating his abuse history.

While it is not uncommon for men who have been sexually abused to become sexually abusive as adults (see below), these men, like their female counterparts, often enough find adult relationships in which they themselves are sexually abused or otherwise exploited. Such relationships often include boundary-less merging with the loved one, so that the man is eternally anxious about being left, never feels capable of having independent thoughts or feelings, and increasingly wants to devour and be devoured by his mate. Sometimes a man alternates impersonal compulsive sexuality with a drivenness to merge with a partner, with each tendency balancing and saving him from the excesses of the other. Either way, he ends up continuing to feel unloved while striving to regain a momentary sense of being loveable. Examples of how sexually abused men express these conflicts include Chet and Patrick. Chet, a straight man who became an icon of the underground counterculture, went to bed with countless groupies while simultaneously drowning in intense, boundaryless love affairs. Patrick was a gay man who would return to the city from holiday visits to his abusive family and go directly to the back rooms of gay bars, where he would fellate dozens of men.

Some men use their sexuality to get what they need, to bond to authorities, and to manipulate others if necessary. What may have started as a desperate means of keeping some sense of power in a relationship where he is outmatched becomes a man’s characteristic way of relating. This can create considerable grandiosity about his sexual prowess and unrealistic expectations about his influence over others (Shapiro, 1999). This grandiosity is an attempt to transform trauma and helplessness into omnipotence and control. In adulthood, it can turn into a general sense of unrealistic entitlement that is in line with a child’s developmental level, both cognitively and psychologically (Price, 1994).

On the other hand, a man may feel that he has nothing to offer but his sexuality. Ramon, for example, had a sense of himself as someone whose worth and power were defined by his sexual capacities and attractiveness. While his psychological dysfunction arose from a number of sources, his childhood sexual abuse was a central part of his personality organization:

A forty-year-old man who had successfully finished drug rehabilitation two years earlier, Ramon started therapy because he was deeply disturbed about memories of child sexual abuse that had been breaking through his thoughts since he had attained sobriety. A likeable man with remnants of the Latin good looks that had made him the object of many adults’ desire as a child and teenager, Ramon stuttered, cried, and seemed to be falling apart before my eyes as he tried to tell me about his first molestation. Left to shift for himself when his mother went to work after his father deserted the family, Ramon at age eight was clearly vulnerable to exploitation and abuse. Sam, a well-known neighborhood “character” who delighted children with his impromptu sidewalk puppet shows, invited him home, amused him with puppetry, then began to caress him and penetrated him anally. This was the first of many visits to Sam, who always treated Ramon in a loving manner while molesting him. With time, Ramon yearned to spend more and more time with Sam, the only seemingly caring and kindhearted adult in his life. Ramon described his relationship with Sam in conflicted terms: Continuing yearning, desire, and regret alternated with shame, anger, and depression. After Sam moved away, Ramon was picked up regularly by both men and women who would engage in sex with him. Money or expensive gifts were often exchanged for the sex. At fifteen, Ramon met an older, wealthy gay man who invited Ramon to live with him, which he did for a few years until the man lost interest in him. Ramon assumed he was no longer enticing to this man because he was getting too old to be physically attractive and was too stupid to be appealing on any other level.

Although concerned that being in therapy would make him discover he was gay or bisexual, Ramon said he sometimes did not care whether he was with a man or a woman, that his strongest motivation was to make sure his partner did not leave him. “They always left, even though they seemed to care so much about being with me. Every time I was with someone, I figured, I’ve got this one, they’re really attracted, they’ll stay. But they always left.” Interpersonally, his need was for nurture and kindness rather than for mature genital relating. While he worried about the stigma of being seen by others as bisexual or gay, and indeed as an adult had always chosen female partners, he sometimes acknowledged that the sex of his partner was not as important to him as a sense of being cared about and supported. His desperation about being abandoned, as he had been by his father physically and by his mother in many other ways, was the motor that ran his psychological machine. As he left the session during which he laid this out, he poignantly whispered as he passed me at the door, “I hope you don’t get tired of me.”

Ramon’s early experiences left him confused about his value. “There was something wonderful about knowing I was blessed with good looks and my body produced this liquid that felt so good and could make other people so happy too.” He then confessed, however, that he had never felt he was good for anything else, that he did not feel he had anything else to offer the world besides his body. “I know how to make men or women happy in bed, but that’s all I know.”

Ambivalence about the Abuser
The ambiguity and complexity of feelings concerning their abusers tend to influence sexually abused men as adults so that all close relationships become suffused with suspicion and irresolvable ambivalence. This is especially likely if the abuse occurred in the context of a seemingly loving relationship, particularly a familial one. Intense intermingling of love and hate for an abuser leads to highly charged, fluctuating feelings about loved ones in adult life. This ambiguity may itself be paralyzing and may lead to the linking of seemingly contradictory impulses. For example, we will see below cases where cruelty was eroticized as sadism and being violated was sexualized as masochism.

Consider the ambivalence Julian felt about his victimizer: Coming from a psychologically and physically invasive family in which emotions and boundaries were ignored, Julian was deeply ambivalent about the parish priest who simultaneously mentored, loved, and molested him. This priest made Julian his special altar boy, invited him to visit him in his rooms, and undertook to educate him in classical literature, languages, and music. He particularly taught Julian to idealize the male relationships described in Greek texts. These included intellectual mentoring, deep interpersonal commitment and intimacy, and physical sexuality, which started between them a few months after the mentoring began. This sexual activity eventually included kissing, oral and anal sex, and group sex with another boy. The priest maintained that their relationship existed on the highest plane possible for two human beings, that they had attained the ideal glorified by the greatest poets and philosophers of the ancient world. He reiterated that they experienced all forms of love together: love of beauty, love of thought, love of logic, love of art, and love of one another that was intellectual, sensual, and emotional. Julian did love this priest, and he craved the companionship and deep interest offered to him. Nevertheless, he was confused and conflicted about the sex that accompanied the priest’s mentoring. “He did so much for me! Anyone would think he was the best mentor a boy could ever have, and, except for the sex, he was.” With the priest’s encouragement, Julian learned to turn to him for sexual soothing whenever he was in trouble. This resorting to sexual pleasure whenever he felt stressed became the forerunner of Julian’s later sexual addiction. As an adult, he was a compulsive masturbator driven to furtively view peep shows; he seemed consumed by female pornography when he was anxious. He felt out of control, in the grip of the sexual impulses that flooded him at such times.

Nevertheless, because of his relationship with the priest Julian’s intellectual world opened up as it might never otherwise have done. As an adolescent, he was grateful for the intellectual and emotional expansion the relationship afforded him. Simultaneous with this, however, he was covertly enraged about the exploitation and mystification involved in their sexual activity. His grades improved dramatically and he eventually went on to attain an advanced degree. Yet as an adult he remained ashamed, conflicted, and secretive about his relationship with the priest.

Ambivalence toward the abuser may be resolved through denial of one or the other side of it. A boy may then either experience only the abusive or only the loving aspects of his molestation. Such a denial keeps a man stuck in an untenable psychological position, and he may swing abruptly from one side of his ambivalence to the other, unable to tolerate the paradoxical ambiguity (Pizer, 1998) of his relationship with a beloved but abusive adult.

For example, Quinn’s ambivalence about such a grandfather made him able to experience only one extreme feeling at a time. He did not permit his fury at his maternal grandfather to enter consciousness until after he remembered his sexual abuse from ages four till eight. Weekly molestations consisted of the grandfather fondling Quinn, performing mutual fellatio on him, and penetrating him anally with fingers and, at times, his penis. The interpersonal context of the abuse was one in which the grandfather was very affectionate to Quinn, telling him this was something they did because the grandfather loved Quinn so much.

Once Quinn recalled the abuse in his early twenties, he could no longer allow himself also to remember the loving, affectionate aspects of his relationship with his abusing grandfather. At that point, he got depressed and sought treatment. He was in a constant rage, barely able to talk about anything except his outrage at his grandfather and the parents who had not protected Quinn from him. While he proclaimed that he had worked through his victimization, and that he now considered himself a “survivor” rather than a “victim,” these claims were hollow indeed. He could not talk about anything but his victimization, and was angry if anyone suggested he “let go of it.”

Quinn’s healing did not truly begin until he gained the capacity to simultaneously feel both sides of his ambivalence. For the first few years in the group, his stance was nearly static, although he simultaneously began to develop a moderately successful business for the first time in his life. He had periods of massive depression, and when he talked it was about how angry he was at his grandfather, how images of his molestations kept haunting him while he was asleep and awake, how infuriated he was when anyone said he should be forgiving and/or “move on.” It was difficult to work with him on these issues except to listen and be supportive. Pointing out how he was stuck in his anger was perceived as undermining his victimhood, even though he counterphobically maintained that he no longer considered himself a victim.

A crucial turning point in Quinn’s treatment occurred three years after we first met. He had heretofore always talked about “my grandfather and what he did to me.” One day, however, he referred to “Grandpa” in this context. I asked him about this term of affection, noting that he had never used it for his grandfather before. He began to reminisce about how Grandpa had adored him. In a very different tone than usual, he talked about how he had felt comforted and loved in Grandpa’s embrace. As he spoke, he sounded shy and said he was scared that others would deride him for loving Grandpa, his abuser. He then said that, while he had never liked the sexuality with Grandpa, it had seemed a small price to pay to obtain the tenderness he craved. Recognizing his affectional needs had a dramatic effect on Quinn. For the first time, he was willing to consider antidepressant medication, which was effective in lifting his mood and stabilizing his oscillating self-esteem. His continuing rage subsided somewhat, and he was able to promote his business more productively. Acknowledging his needs for tenderness and love, particularly from a father figure, helped free Quinn from his furious and constant demands that his molestation be the center of everyone’s relationship with him. Instead, he finally reached inside for the hurt that had been covered by his fury. To his surprise, he was then finally able to start putting together a life in which his history of sexual abuse remained an important influence but was no longer the primary focus of his daily experience.

Abusive Relationships
Abusive relationships, whether overtly sexual or not, are another possible legacy of childhood sexual abuse. Research suggests that, contrary to conventional wisdom, about 75% of sexually abused boys do not grow up to be sexually abusing men, though about 75% of abusing men were themselves abused as boys (Lisak, Hopper, and Song, 1996). Nevertheless, Dimock (n. d.) has commented that in his experience, which is different from mine, most sexually victimized men have also been physically or sexually abusive to someone else. When this is the case, even if there was only a single episode in childhood and adolescence, it often creates a barrier to recovery because of the man’s subsequent guilt and shame.

The men I have worked with have not included adult abusers. An extensive literature exists about working with this population (see, for example, Maletzky, 1991). I have, however, worked with a number of men who as children or adolescents enacted sexual abuse with other children. Other men I have treated were covertly abusive or exploitative in their adult relationships._

Abusiveness is a product of identification with an internalized image of the victimizer, a clear example of identification with the aggressor. Consider, for example, Isaac, who was raped twice at age six in boarding school and had twelve separate encounters with sexual predators by age seventeen. At that point, he found a young man who seemed to like and nurture him. Ned, a man in his early thirties who worked in the family business, was a distant relative by marriage. Isaac idealized Ned as a mentor and older brother figure. Ned took an interest in Isaac’s sports activities and talked to him in a manner Isaac considered flatteringly adult. He felt like he had finally found the older brother or father he had been seeking. But when Ned attempted to seduce Isaac in the guise of giving him a haircut and rubdown, Isaac froze. When he then started to shake uncontrollably, Ned stopped the sexual approach. Soon after this incident, Isaac visited his father in another state where he lived with his second wife and Isaac’s half-sister and two half-brothers. Uncertain about what might happen with Ned if he returned home, Isaac precipitously decided to live with his father for his senior year of high school.

During the year Isaac lived with his father’s new family, he initiated sexual activity with his ten-year younger half-sister. Its aftermath left him guilt-ridden for decades, ashamed of himself and terrified of ever acting spontaneously on impulse. One day, his sister came into his bedroom while he was lying on his bed masturbating. He quickly covered himself but then asked her to come into the bathroom, where he locked the door. Lying on the floor, he told her to straddle his face, and he licked her vagina while he masturbated behind her. This sequence was repeated a second time a few weeks later. At the end of high school, Isaac went away to college in a distant state. There, he got heavily involved in pot smoking and flunked out. He moved to New York City, where he remained underemployed for many years in a low-level service industry job. Attending college sporadically over many years, he finally graduated at the age of forty-one, six years after first beginning psychotherapy.

Abusiveness can also be reenacted subtly in everyday relationships. Keith was involved in a covertly sexual relationship with a mother that led them both to descend into alcoholism until he went into rehab and cut himself off from her in his early twenties. Seemingly well-related, Keith nevertheless managed to maintain a personal remoteness from others. He was subtly exploitative as an adult while rationalizing to himself that as a victim he was blameless and had the right to do whatever he felt he needed to do. For example, he worked freelance in an industry in which people tend to be partially involved in a number of projects simultaneously, knowing that only some of them will materialize into paying work. Therefore, a certain amount of juggling of business ventures is necessary, and occasionally people have to back out after they have done a great deal of work on a project. After two situations occurred in which he withdrew from ventures because of more definite and substantial offers elsewhere, he talked with some surprise about the bitterness he encountered from the people who had expected to work with him. These people felt he had made a personal commitment to them and had then gone on to deceive and betray them. The sense of treachery went far beyond what might be expected in a business situation, and initially Keith was perplexed by it. As we explored how he cultivated business relationships, Keith conceded that he “seduced” potential work partners into wanting to work with him. “I feel they won't want me on the basis of my skills, so I pull out all stops. I show them how incredibly I understand their needs. I make sure they bond to me. Then if I pull out of a commitment or a semicommitment for reasons that are totally understandable from a career point of view, they feel personally betrayed. I never understand why, and I never get it that I’m hurting them. And if I do get it, I don’t care. I’m always the victim -- I can’t imagine anyone else being victimized, and certainly not that I’m doing the victimizing.” Keith said this matter-of-factly, communicating little sense even then that he really cared about whether he hurt people.

Sadistic and Masochistic Themes
A natural next step from repeatedly entering abusive relationships is actively to seek sadomasochistic sexual contacts (Wright, 1997; see also Ehrenberg, 1992). My experience with this subculture is small, but two different gay men have told me that every man they knew who (like themselves) was deeply involved in bondage and other sadomasochistic practices had been sexually or otherwise abused in childhood. While their claims may well have been exaggerations, they do suggest that clinicians should explore for a history of sexual abuse with patients involved in sadomasochistic behaviors.

Sadistic fantasies not acted upon are also common. Victor reluctantly told me after several years of treatment that he had recurring sadistic fantasies of tying men up and either tickling them till they screamed or bringing them nearly to orgasm but not allowing the orgasm to take place. He had never considered the possible connection between these fantasies and the fact that, in his own abuse, his grandparents had tickled him mercilessly as part of a sexual game, and that later, when his father abused him, Victor kept himself from reaching orgasm, in part to frustrate his father.

Many men who have been abused develop lifetime patterns of allowing themselves to be exploited in ways that are not explicitly eroticized. Abe and Owen demonstrate both erotic and nonerotic masochistic relatedness:

Abe at forty-five led a life in which he felt exploited or abused by acquaintances and colleagues. This continued a pattern set with his verbally abusive father and his vicious, narcissistic, fascinating, and seductive mother. By age twelve, Abe had regularly looked to be picked up by older men. Many of these men were interpersonally cold and hurtful to Abe during sexual encounters. They thus were abusive emotionally in addition to being pedophiles. At the time, however, Abe felt good about being chosen by them. It did not occur to him until decades later that he had perpetuated with them a pattern of being exploited and abused, and that they had been criminal offenders who took advantage of his neediness. Indeed, they were the first in a long line of inaccessible people with whom he reenacted the dynamic he had lived with both parents, especially his mother. He craved the love of these parent substitutes even as he chose them because they were incapable of giving it.

As an adult, Abe felt profound shame about his body and his sexuality. A semicloseted gay man, he was involved in a difficult but devoted relationship with another man that had lasted for over ten years but had not included any sex after the first year. Sexuality was reserved mostly for anonymous, compulsive, unpleasurable encounters or short, intense affairs with extraordinarily inappropriate and uncaring men. In the past, Abe had engaged in sadomasochistic and dangerous sexual behaviors, including being tied up and anally fisted during anonymous encounters. He recounted these incidents with great shame, never having told anyone about them before. He described a brief affair he had once had with a man who broke it off by saying he was disturbed by how much Abe wanted to be hurt and how much he had grown to want to hurt Abe. Though startled by the man’s words, Abe did not take in their meaning until an incident some years later, when he found himself in a sadomasochistic sexual encounter with a man whose hands were at Abe’s throat. Abe suddenly understood that he liked being choked this way. The implications of this discovery had a powerful effect on him and were influential in getting him to stop his alcohol and drug abuse, as he realized these substances promoted his pursuing to their furthest extremes the dangerous sexual behaviors he craved.

Several years after beginning treatment with me, Abe had stopped acting on his impulses to have compulsive, often masochistic sex, and began to bring up how he continued to re-create his abusive family in interpersonal situations. One day he said with great emotion that he realized he could not walk away from a particular professional group of people who over the years had ignored or derided his achievements. He was poised to enter a new contractual arrangement with them. He discerned how little he could ever get from these people, yet he was astounded and horrified to note that he was unable to give up hoping for validation from them. He cried out with passion, “I have to get them to recognize my worth! They become my mother and father, people who have no capacity to see beyond themselves, who care nothing for me, who don’t even think about me when I’m not there. But I keep trying to change them, I keep hoping they’ll turn around and say, ‘Abe really has something there -- we were wrong about him -- look, he’s terrific!’ And, even as I see that there is zero chance that they will do that, I also can’t give up on the possibility! I see it all, but it does no good -- I can’t stop myself from repeating it yet again!” He wept as he clenched and unclenched his fists, repeating over and over that he knew he could expect nothing from these people but was just not capable of leaving them. Yet, in all this we also saw that he had managed to encapsulate the abusive repetition to an important but isolated area of his life, and was simultaneously behaving very differently in other areas of his personal and professional worlds. And, indeed, he resigned from his work with this abusive group a few months later.

After six years of therapy, Abe finally began to address his sexual masochism directly. Following a successful professional endeavor, he was overcome with sadomasochistic fantasies, and clipped an advertisement for a leather-oriented dominator from the back pages of a gay newspaper. He did not act on his wish, but brought it up in therapy instead. We explored the multiple meanings of the fantasy: He wanted to be in pain, first, because he felt he should feel pain rather than good feelings about his success, since that was his familiar role. Indeed, he said he felt it was a betrayal of his mother to feel positively about himself. Second, he wanted to feel a more defined pain than the foggy suffering he experienced after good feedback about his work. Third, he said that perhaps if it got bad enough, he would be moved to say “Enough!” and stop it. And, fourth, by choosing to be in pain and by making it explicit and defined, he felt in control of it, rather than lost in its maelstrom.

Owen, another gay man, had what he called a long-term “affair” beginning at age twelve with Calvin, a man seventeen years his senior. Owen’s parents received various favors from Calvin, and closed their eyes to the sexual possibilities in the relationship between him and their son, even when Calvin treated the family to vacations they could not otherwise have afforded and shared a room (and bed) with Owen while Owen’s parents and several siblings shared a second room. Owen never felt that his early sexuality with Calvin constituted molestation, yet over time in treatment we discovered that the subtle effects of his having been exploited by both Calvin and his own family, and his willingness to be so exploited, were central to his psychology.

Shortly after starting treatment with me at the age of sixty-eight, Owen began a relationship with Jimi, a young man from a third world culture just barely over the age of consent. Owen was astounded, frightened, and intrigued when Jimi pursued him. He wondered why Jimi would be as interested as he claimed to be in a man fifty-one years his senior, and considered whether he was being suckered by a young hustler. The parallel to the “affair” between Owen and Calvin was of course unmistakeable. We talked about the similarities as well as the differences in the two relationships as he began a liaison with Jimi. Jimi came from a culture that venerated older people, a fact that Owen could not comprehend. In addition, Jimi seemed instinctively to see Owen as a mentor who would introduce him to an Americanized culture that was totally foreign to Jimi’s parents, who spoke no English and worked long hours at menial jobs. Owen, who considered himself ugly and undesirable, was both flattered and suspicious of Jimi’s attentions, and constantly worried that he was being exploited for his money. Indeed, Owen did spend a great deal of money on Jimi, who had virtually none, and he alternated between feeling generous and foolish for doing so.

It appeared that Jimi did genuinely care for Owen, and, while he profited from the relationship, he also gave a great deal to it. As Owen developed and deepened their relationship, we had the opportunity to examine and analyze Owen’s proneness to and suspiciousness about exploitation. This eventually led us back to the history of Owen’s relationships with Calvin and with his parents. Owen continued to view Calvin as not having abused him, since he enjoyed the sex, but he did finally recognize the exploitative aspects of the relationship. He acknowledged that he would never have been interested in Calvin had Calvin not pursued him. In addition he realized that his youth and vulnerability had attracted Calvin, who took advantage of them. Owen also looked differently at his parents’ acquiescence in his relationship with Calvin. He began to feel that his parents had taken advantage of him by asking him to act as a surrogate parent to his younger siblings while they put their energy into caring for his seriously ill sister. A subtle lifelong pattern had thus begun in which Owen learned to expect exploitation and to defer to others’ needs. We looked at how this had been true with his parents, his ex-wife, a previous analyst, friends, various former lovers, and me. In each case, and again with Jimi, Owen’s fear was that love would be withdrawn if the other’s needs were not satisfied. Since this was intolerable, he had allowed many exploitative relationships to develop throughout his life. Intimacy with Jimi became a testing ground for Owen’s abilities to change these patterns. He had to limit Jimi’s insatiable desire to take up his free time, to say no to requests for overly expensive gifts, to go alone to cultural events he enjoyed if Jimi refused to accompany him. Tempestuous at times, the relationship proved to be a catalyst for Owen’s growing ability to stand up for his own needs, even when being pressured to do otherwise by someone he loved and was afraid to lose.

Relational Reconstruction in the Therapeutic Dyad
The vicissitudes of intimate relatedness described thus far affect the therapeutic relationship as well. The primary need of a patient who has experienced incest or other childhood sexual trauma is to gain the capacity to relate to others in more functional ways. Relational restructuring occurs above all through the interactive and current relationship between patient and therapist. Attention must be paid early in treatment to enhancing the patient’s ability to relate (Davies and Frawley, 1994; Hegeman, 1995), a critical factor because it is in the present, emotionally alive therapeutic relationship that the scenario for abuse gets rewritten. And this can occur only if patient and therapist are able to co-construct a meaningful intimate relationship (Ferenczi, 1930; see Balint, 1968; Bromberg, 1991; and Hegeman, 1995).

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