Page three, The Relational Aftereffects of Boyhood Sexual Abuse

A sexually abused man is less in need of “insight” about his history and its aftereffects than of a relationship that permits him to let himself be known intimately without fear of interpersonal merging or exploitation. This is one reason that the relationship between therapist and patient must be active and genuine. The therapeutic relationship simultaneously gives the man a laboratory in which to reenact his old abusive relational scripts with new outcomes. If, for example, he relates through distrust because of his abuse experiences, he has conceptualized relationships as invariably headed toward some kind of betrayal. If he cannot trust, it makes sense that he will feel that the therapist is malevolent. He has an internal narrative in which life leads inevitably to traumatic conclusions. Encountering the therapist within an intimate relationship where distrust is not warranted, at least not in the way it was when he was a child, he experiences a new perceptual truth that propels him to resymbolize his conception of relatedness. He is changed because of a relational encounter that is experientially, not only conceptually, different from what he knew before (Bromberg, 1993)._ As he retells his history, he is also able to reconstruct and reconcile formerly bewildering and contradictory events in a new relational context. Traditional efforts at “reconstruction” without this new relational reality fail because the patient’s internal core personality remains untouched (Bromberg, 1995).

Davies and Frawley (1994) identify four paradigms recurringly found in therapeutic relationships with sexually abused women. They also apply to work with sexually abused men, though the clinical picture may look different. The four paradigms Davies and Frawley describe are:

* The sadistic victimizer relating to a furious but helpless victim,
* The collaborator in a seductive relationship where one participant is the seducer and the other is seduced,
* The powerful but idealized rescuer of an entitled child who demands rescue, and
* The nonabusing but uninvolved parent relating to an unseen and neglected child.

These four paradigms all involve two complementary relational models, each of which may be alternately enacted by both patient and therapist as they relate to one another. Thus, over the course of time the patient may enact the victimizer while the therapist enacts the victim; then the patient may enact the victim while the therapist enacts the victimizer; then the patient is the seducer while the therapist is seduced; then the therapist is the seducer while the patient is seduced; and so on. Through these models, patient and therapist fluctuate between the two roles in each paradigm, and in a single treatment every one of the models may occur at some point.

Such transference/countertransference reenactments are vehicles for communication to the therapist about the internal relational experience of the child as he was being abused. They are powerful tools, but they are also forceful and often coercive catalysts in the therapeutic relationship. It is important to remember that neither reenactments nor countertransference reactions to them are necessarily “mistakes.” Rather, they are unavoidable phases in the treatment of traumatized, dissociated patients. Reenactment compels the therapist to experience the patient’s original reactions to abuse, reactions that are his dissociated aftermath to a deeply traumatic childhood experience. To heal the patient of the trauma, the therapist must experience that trauma is some way. The reenactment may be symbolic of the abuse, but the feelings engendered in the therapist are very real. These may include helplessness, impotence, rage, inadequacy, shame, guilt, idealization, omnipotence, overstimulation, humiliation, torture, and fear (Price, 1994), all internal states with which the patient is very familiar.

I will now briefly discuss and illustrate with male patients each of Davies and Frawley’s four transference/countertransference paradigms, focusing on the inner experience of both participants:

The Abuser and the Abused Victim
It has commonly been noted that abused patients tend to identify with their abusers and then to be transferentially abusive to their therapists. In doing this, they are repeating with the therapist what happened to them as children. The abuser/victim relational configuration is particularly upsetting to work with for both patient and therapist because of its ubiquitous intense transference and countertransference enactments.

When the patient takes the position of the abuser, he retains a bond to the victimizer through unconscious identification. This stance also allows the patient to keep at bay his feelings of helplessness. He projects this helplessness onto the therapist, whom he may then devalue. In this context, the patient may demand special treatment from the clinician. Boundary violations of the therapist, such as making contact with people or institutions in the therapist’s personal life, are also likely at such times. When this happens, the clinician feels intruded upon and penetrated, often coming to dread therapy sessions. Yet it is crucial for this enactment to occur. In dealing with it, the therapist must walk a tightrope between ignoring the man’s abusive behavior, and thus becoming the unseeing parent, and expressing a feeling of victimization that may evoke excessive guilt in the patient.

Alternating and concurrent with abusive behavior toward the therapist is a dynamic in which the patient repeats a victimized relationship with the therapist, and the therapist reenacts the abuser’s role, usually (but not always) in some symbolic way. When the therapist enacts the abuser and the patient becomes a victim, the patient may react to the inequality of their relationship, feel victimized by the fee, or otherwise feel exploited by the therapist. In turn, the therapist may become intrusive or controlling. Often, a therapist who has usually been the victim in the transference/countertransference enactment may explode after months of abuse, instantly reversing the abuser/abused dynamic in the relationship.

The transferential reenactment of abuse may be subtle and symbolic. It may come through as a tendency to manipulate and exploit the therapist in covert ways. But the abuser/victim dynamic can be direct and overt as well. Witness my relationship with Abe, whose relationships with both parents had led him to deal with other people in ways that resulted in his feeling perpetually victimized. In the fifth year of his treatment, he was at a midpoint in his shift away from being a perennial victim. A man who had perceived, found, or created abuse in nearly every interpersonal situation, Abe had evolved to a point where he was no longer blaming all his troubles on others. Instead, he had just begun to see how he participated in setting up abusive relationships. During this period, we repeatedly delved into his expectations of abuse from me. Each of us experienced the other as abusive on occasion, and it was the live interactions between us about these feelings that got through to him.

For example, one day Abe exploded in rage when he felt I had not comprehended the extent of his vulnerability when I commented on his abrasiveness. I assume he was correct that there was at least a partial failure of empathy in my remark, though his reaction to it seemed nearly out of control. Abe snarled about my inability to empathize, and then castigated me about my defensiveness in the face of his attack. I felt assaulted, and no doubt I was defensive and counterattacking at least to some degree in my reaction. Yet, in general I remained attuned to him, continuing to talk to him, giving my point of view without invalidating his perceptions of me. Our interchange got very heated on both sides. I pointed out in several ways how he had escalated and compounded any abuse that might have existed in my original comment.

At the end of what had nearly become a screaming match, we both felt spent, but we had also somehow arrived at a point of mutual respect. I had been at least symbolically abusive in my original remark,as is nearly inevitable in working with an abused patient (Davies and Frawley, 1994). I had nevertheless reacted to his subsequent transferential victimization of me in a way that served as a model for how one can remain in a significant relationship but not permit mistreatment. On his side, he felt that I heard him. When we talked about our clash during the next session, I said at one point that I hated our arguments, that I found them difficult and draining, but that I simultaneously welcomed them, because they gave us an opportunity for a live encounter in which we affected one another, with each of us surviving and growing from it.

Abe brought up this comment a number of times in subsequent years as a revelation to him, a sign that I cared about him enough to endure a taxing and painful emotional state. He recalled the screaming marathons in his house as he grew up, which typically ended in violence, brutal punishment, or threatened suicide. He found it impossible to believe I cared enough about him to endure what had passed for human interaction in his family.

This led him to think differently about our relationship, and about relating in general. He saw that his negativity about interpersonal situations developed even when things were going relatively well. He became able to assert himself at times, to move away from rather than toward abusive situations, and to avoid most exploitative relationships. Yet he still feared being around people, and was often sure he had been or would be manipulated and misused. In the midst of his continuing despair, he said he was glad it was so clear that real abuse was no longer occurring. It made him realize that he carried around his abuse history and assumed it was recurring even when he "knew" it was not. As he said, this was an important differentiation.

What in our relationship helped him get to this point? It is true that I sat and listened to him for years, pointing out over and over how he was "arranging" continuing abuse, and noting things he might have done or said in a given situation to stop what he considered to be exploitation. At times, I rehearsed with him how to deal with tense interpersonal situations. I believe, however, that Abe’s most important shifts came from his overarching direct experience of our relationship as basically nonabusive. Especially compelling for him was my willingness, when things heated up between us, to stay related to him and even to acknowledge some personal shortcomings and errors. With time, Abe developed an enhanced capacity for tolerating the ambiguity of a relationship in which both highly positive and highly negative qualities coexisted. In addition, our relationship offered him the opportunity to encode linguistically his interpersonal experiences with me and with others.

The Seduced and the Seducer
Particularly noteworthy in any discussion of transference and countertransference in work with sexually abused men is the sexualized transference and its sequelae. Like many sexually abused women, men with a history of sexual abuse tend to expect every relationship to involve seduction by one party or the other (see Siegel, 1996). A child with such a history often grows up to be a seductive and seduceable adult. I noted above that sexually abused children learn that sexuality is their interpersonal currency, a means of bonding to authority figures whose love they long for, need, and fear. As adults in psychodynamic treatment they reenact this dynamic again and again, and the concentration of seductive energy in the therapy can overwhelm both patient and therapist. A sexually abused adult brings an intensely seductive manner of relating into treatment, sometimes to the point of outright attempts at seduction of the therapist. It is therefore not surprising that adults sexually abused in childhood have been found to be more often subject to sexual abuse by their therapists than other patients (Smith, 1984; Gabbard, 1989; Kluft, 1990; Lymberis, 1994). These, obviously, are “real” abusive countertransferential reenactments.

As Price (1994) puts it, “The sessions and the office may be cloaked in an erotic atmosphere and tension that may be difficult for the analyst to contain and tolerate” (p. 225). Thus, the ambiance of the treatment is filled with a sense of seduction, and therapist and patient each recurrently feels seduced by the other. The patient may be afraid of being flirtatious or seductive, fearing that this will bring on abuse. Concurrently, however, he may feel that this is the only way to get what he needs, having been trained to seduce in order to maintain a primary relationship. The therapist may feel both attacked and aroused by this behavior. Should the clinician feel sexual arousal from the eroticism of the material being presented, he or she may feel guilty and exploitative, and may want to withdraw emotionally from the overstimulating emotional field of the therapeutic relationship. Nonetheless, it is imperative that the therapist remain emotionally available. This must happen concurrent with the therapist conveying the idea to the patient that sexual feelings are acceptable and not instilling guilt and shame about the erotic energy in the relationship. It must simultaneously be communicated that one can set boundaries, not act on sexual feelings, but also not deny them.

In such instances the therapist must be careful to monitor countertransferential feelings about sexuality, love, nurturance, affection, and abuse, the same feelings the patient has trouble differentiating. It is important to articulate the differences among these feelings over and over, and to demonstrate, for example, that it is possible to be nurturant without having sexual designs. To do this with a sexually abused man, though, the therapist may have to sort through the same kinds of intense, inchoate feelings about the patient that the patient experiences in virtually every relationship of his life. For example, my treatment of Patrick required me to find new capacities to work with his enactments in many interpersonal spheres, but particularly in our sexualized transference/countertransference relationship. Patrick was the victim of profound sexual abuse by his father for several years starting at age two or three. Though severely depressed at his core, on a more superficial level he was openly seductive with me, frequently referring to me as his lover and jauntily offering to have sex with me. At such times, his manner was brittle and mocking, as though he were daring me to take his offers seriously. He laughingly recounted how he told his friends details of his sexual fantasies about me. On the occasions we were able to explore these fantasies in a more sober vein, what emerged was an image of me as an eroticized but loving father figure. He imagined he would feel safe in my arms, and was eager to perform all kinds of sexual acts on me to secure my permission for him to stay close to me. He imagined I would protect and support him, both emotionally and financially. At this point, at least, there was no hint of the other side of this transference, namely, that I would be the abusing and hurtful father as well.

In our work together, Patrick brought in all the eroticized themes of his life, often reenacting them with me so that I felt traumatized, disturbed, and exhausted. A subtle example occurred one day when he heard me cough and offered with a faraway smile to listen to my chest with a stethoscope for signs of bronchitis. On the face of it, this was a caring, if inappropriate, offer. But his dissociated smile, followed by a wolfish grin, made it clear that he was seductively interested in molesting me by invading my boundaries in the guise of taking care of me.

A far more glaring example occurred one day when he suddenly removed his trousers in a session, supposedly to show me exactly what had once happened when he overtly tried to seduce his father. When I told him to put his pants back on, he became angry, ridiculed me for being sexually constricted, and finally accused me of shaming him about his abuse experience. Outwardly, I worked with him in a reasonable manner about this, asking what he was trying to accomplish by taking his pants off, what he imagined my response would be, and what the meaning could be of his engaging in what he knew was unacceptable behavior with me.

But my interior life was chaotic as we struggled about the meaning of what he had done. I felt tantalized and seduced, stimulated to have exciting but bewildering feelings while feeling dimly that I might be humiliated because of the inappropriateness of those feelings to the situation. I felt Patrick had suddenly reversed the power relationships in the room by standing up while I remained seated and by being sexually aggressive, even though he remained affectively disconnected from his predatory sexuality. At the same time, however, he experienced me as abusing him by shaming him about early sexual experiences. I wondered how true it was that I was too constricted to deal with the complexities of sexual experience Patrick described and enacted. I wondered what would happen if my colleagues found out that my patient had partially disrobed during a session. I wondered whether in some way I had been unconsciously seductive with Patrick, and whether his getting undressed was a response to inappropriate behavior on my part. I wondered who Patrick would tell about what he had done, and what they would think. I imagined him ridiculing me to them, blandly and amusedly telling them how nonplused I had been when he had acted so flamboyantly and seductively with me. In short, I countertransferentially felt the anger, ridicule, abuse, excitement, coercion, arousal, and shame that Patrick had felt first as a child, and then again with me. This is what Herman (1992) would call my "traumatic countertransference" to Patrick.

What was the transferential meaning of Patrick’s behavior? As I see it, his disrobing was an attempt to seduce me as a reenactment of his relationship with his father. I believe Patrick was deeply ambivalent about the response he wanted from me. He was testing me to see if I would molest him, but he did not know what kind of outcome he hoped for. Patrick as a young man had actually tried to seduce his father, who apparently was no longer interested in him as a sexual partner, possibly because of Patrick’s age or the greater likelihood that the relationship would be publicly revealed. Patrick’s attempt to reestablish a sexual bond with his father seems to have come from a longing for the closeness that had accompanied the abuse, at least on a symbolic level.

Through his seductive behavior with me, therefore, Patrick wanted me to enact a seduction, on the one hand, in order to reexperience the painful intimacy he had once had with his father. Yet he was also hoping I would stop the reenactment. This would help him create a new narrative about the abuse. It would help him experience the possibility of a different outcome, an outcome in which his father substitute set limits on the sexuality in their relationship but not on the intimacy.

The Rescuer and the Needy Child
It is easy for therapists to be drawn into the role of omnipotent savior, as Davies and Frawley note, since “we have chosen, after all, to live our lives as professional helpers” (1994, p. 178). The therapist’s wish to heal deprivation and emotional starvation is magnified many times over when a man’s circumstances include a history of having been abused, neglected, violated, or otherwise victimized as a child. After all, in boyhood the man did need rescue but did not get it. The urge to make psychological reparations can be strong, and is further intensified by the man’s corresponding wish to find a caretaker who will, finally, protect and deliver him from his trauma.

Thus, the therapist becomes the rescuer in a therapeutic relationship when the horrors of the abuse elicit internal caretaking responses. Rescue fantasies recur throughout treatment, but they are especially likely when the patient is beginning to integrate experiences and mourn. At such a time, the therapist may get caught up in the poignancy of the patient’s situation. The patient may become like a wounded child who demands that he get recompense for his suffering. He may want to replace his childhood with a wonderful new one given to him by the therapist. If this happens, clinicians must try to balance their reactions, allowing the man’s long-buried yearnings for relatedness to emerge while also permitting him to rail against his original losses.

The flip side of this equation occurs when the therapist is needy in some way, and the patient tries to make things better. The therapist may feel, for example, that he or she has given and given to the patient, but is unappreciated. At such a moment, the clinician may have the impulse to retaliate through emotional withdrawal. On the other hand, when the patient becomes the rescuer, he is often acutely attuned to the moods and needs of the therapist. He may act to help the therapist partly out of a fear that if he does not do so the therapist will be unable to give to him. But he may also be acting out of loving wishes to nourish the therapist. Accomplishing this may have the added benefit of making him feel capable of being a nurturer.

To illustrate some of the ramifications of the patient’s wish for an idealized rescuer, consider Harris. A highly intelligent, self-contained professional man in his forties, Harris had been sexually abused by an alcoholic father for a period of years during latency. Otherwise, the father spent much of his time drinking, was verbally abusive to his children and wife, and never held a steady job. Harris grew up in a psychological fog, overresponsible for his mother and brothers but with no real goals in his own life. In early adulthood, especially after his father's death, he led a life grimly similar to his father's. He never worked steadily, took occasional courses at schools, and led what he called an “indolent” life, spending his evenings in bars picking up women for one-night stands.

By the time he was thirty, Harris was profoundly frightened. He started treatment with a woman analyst and began to work for a living, initially at a humiliatingly low-level job as a stockboy in a store. He put himself through college and professional school, marrying when he was about forty. Despite these obviously positive changes in his life, Harris maintained much of his psychological fog, with occasional flashes of inchoate rage, usually suppressed quickly or directed inward in some self-destructive manner.
He was referred to my group for sexually abused men by his female analyst. Having had a history of difficult relationships with male authorities, he was initially wary of me. But he quickly saw me as an expert who would save him from the aftermath of sexual abuse he was just beginning to face. In his first months in the group, he looked to me to be his nurturer, and protected me from attacks by other group members. He swiftly developed an idealized view of me as a fathering figure who was giving him what he had sorely lacked all his life from his own father. He defended me from criticism by other group members, often using methods so subtle I only detected them in retrospect.

This became apparent when another group member attacked me in the last moments of a group session because he did not like my practice of making summarizing comments at the end of a group. Because time did not permit us to deal with the issue, I elected not to make any such remarks that night. Harris came to the next group session in a fury, declaring that the other man had deprived him of what he needed from me. At first, Harris raged chiefly at this other man But it was clear that Harris's anger was as much with me, his transferential father, as with the other group member, his transferential sibling. He felt I had capitulated to unreasonable demands and was willing to cut Harris off from a primary source of nurturing from me. His struggle with these feelings helped us both to recognize the enormity of Harris's neediness, but it also signaled the end of his view of me as his rescuer.

With time, Harris dropped his idealization of me and instead voiced directly the transferential rage that had always lurked beneath it. He became painfully sensitized to any change in my tone, particularly one that conveyed to him a wavering of empathy, a condescension, or a patronizing attitude. Sometimes he startled me with the immediate fury of his response. At other times he kept his anger hidden, then spit it out at me later when I least expected it. He often told me about my many shortcomings as a therapist. He particularly focused on what he called my callousness and inability to see how hurtful I was, as demonstrated by my ignoring his directives about how to listen to him and my repeated failures to meet his needs. Eventually, he left the group for over a year, and on his return we were able to work through these issues more effectively.

The Ineffective Parent and the Neglected Child
If a boy grows up with a parent unable, unwilling, or not caring enough to see what is happening and save him from harm, he has to find a way to resolve this relational injury. A relationship between a nonabusing but nonseeing, ineffective, and uninvolved parent and a neglected, unseen, and unprotected child may result in profound attachment trauma that precedes any sexual abuse. Because the parent is loved and needed by the child, this relational constellation is split off from consciousness, with the child preserving the image of a loving, available parent. But, while he preserves the parent consciously as devoted and capable, unconsciously he may set up relationships in which people who seem accessible and loving are actually uncaring, unavailable, or unfeeling. If this kind of dynamic is replicated in the therapeutic dyad, the man creates a situation in which he seems to be establishing a positive relationship, but actually experiences the therapist as cold, callous, or rejecting. Out of this hurt, the man may become alienated, hurt, and despondent. Eventually, these feelings may turn to anger, and he may retaliate.

When a patient enacts the neglected child, he denies his own wishes and protects and caters to the therapist, feeling this is the only way to get his needs met. Therapists may not easily see the falseness of this presentation because it is initially experienced as positive relatedness from the patient. Over time, however, the patient becomes deeply disappointed in the therapist, and this disappointment can turn to covert rage. Eventually, he may develop an openly hostile transference, experiencing the therapist as not seeing him, not remembering important things about him, and not caring sufficiently about him.

All the aspects of this pattern came into play in my work with Abe, whose narcissistic parents were unable to see or care about his needs. He had always seen them as malevolent and hateful, but with time he acknowledged that perhaps they hardly knew he existed in the world. In a way, this was a graver injury to his self-esteem than thinking they wished him harm. In our work, Abe often seemed able to relate warmly to me, but he was quick to notice any failings on my part, and was then alternately hurt, depressed, and attacking. At such times, he saw me as he saw his parents, and he fluctuated between thinking I did not want him to succeed in life and believing I was not capable of feeling empathy for him. On my side, I frequently found myself burdened by the complicated interpersonal field we lived in, and periodically pulled back emotionally for relief from it.

On the other hand, a man may identify with the unavailable parent and turn on others who had expected emotional resonance from him. In the therapeutic relationship, he may seem indifferent, compassionless, or cruel. The clinician then becomes the neglected child countertransferentially, experiencing him- or herself as unwanted, unimportant, and unconnected to the patient. It is crucial that the therapist not abandon the patient emotionally during these periods. However, feeling wounded, unappreciated, or depressed, he or she may eventually be pulled to behave callously toward the patient, becoming, for example, sleepy or forgetful during sessions.

Both sides of the ineffective parent/neglected child paradigm were played out in my work with Patrick, whose overburdened mother managed to provide physical caretaking for her nine children but otherwise lived in a depressed, alcoholic haze. She continued to deny that the family had severe problems into her old age. Witness the oscillations in my relationship with Patrick as we approached the premature termination of his psychoanalysis:

After four and a half years, Patrick’s therapy benefits were cut off by his insurance company. While he had made some remarkable changes in therapy, he was still often moody, depressed, and isolated. He was highly changeable in his feelings about me and the treatment, and continued at times to question the veracity of his memories. He had developed a highly structured work and school life in part so he did not have to deal with emotional relationships.

As it became clear that the treatment would end, Patrick’s initially strong dissociative defenses reemerged and predominated in our work. In retrospect, I see that he was preparing himself for what a major trauma. The difference between this time and his childhood trauma, however, was that now I was able to break through his dissociation at times, and he sometimes expressed relief when I did

.Patrick had always voiced some ambivalence about the therapeutic process. It was demanding and painful, often leaving him depressed, frightened, and wondering if his memories were themselves simply a reflection of his craziness. He passively allowed the insurance company to resolve his ambivalence about treatment by dictating that he would stop. He seemed to feel it was natural that he not be cared for, and this combined with his usual resistance to treatment, making him proceed implacably toward the conclusion of our work.

As we approached our final session, I tried to talk to Patrick about his feelings about the termination. He responded formally in general terms. When I pressed him toward the end of a session about how he felt about our relationship ending, he said coolly, “Ours has been a professional relationship. You have always behaved as I would expect a competent professional to act.” I felt stung, and, internally, I recoiled. I recognized that on one level he was telling me that he was grateful I had acted appropriately and kept our boundaries clear by maintaining the professional frame of our work despite his efforts to break it. Yet I also felt his interpersonal distance repudiated the intensity of our therapeutic relationship. As I thought through my reactions, however, it occurred to me that Patrick was resorting to his usual dissociated way of reacting to anxiety and pain. In addition, he was reestablishing the rigid boundaries between us (indeed, between himself and everyone) that he felt were necessary in order for him to function in the world. I realized I had to ask more about his reactions. We had been alternating in the roles of unavailable, ineffective, and cold caregiver and needy, depressed, and wounded child. When he was feeling needy, as when he wanted my help in order for his medical benefits to continue, I was ineffective, and probably at that time he experienced me as unavailable and cold. When he was cold, I felt abused, wounded, and enraged. Each of us activated such responses in the other.

In the next session, I asked Patrick further about his feelings, reminding him of the many emotional ups and downs we had experienced, and doubting that his statement reflected everything that was going on inside him. He closed his eyes and was silent for a moment, then said quietly, but passionately, “I have been abused by my father and my brother. My other brother died of AIDS in my arms, and I had to go choose clothes for him to wear for his cremation, then scatter his ashes alone. My mother continues to act as though everything has always been fine in the family. If I can get through all that, I can certainly handle not seeing you!” Then he burst into tears and sobbed about all his losses as I sat with him, my own eyes filled with tears.

This declaration had many meanings. It was a needed rebuilding of boundaries between us. It was an affirmation for Patrick that he could indeed survive. But it was also a demonstration of a new ability to verbalize his trauma rather than to dissociatively sleepwalk through it. He broke out of his seemingly cold stance and grieved in this session and those that remained to us. His capacity to do this personified all the work we had done to allow him to mourn openly the childhood innocence he lost through abuse.

Conclusions
Trauma becomes especially pernicious when terrifying early dissociated experiences are linked to the very fact that one is in a relationship. This is a particularly apt way of considering what occurs when a traumatic relationship must be dissociated, as in chronic incest. In such cases, there may be a severe disturbance about having relationships at all because relating to others is itself linked to terrifying dissociated experiences. I have discussed how sexually abused men’s adult intimate relationships are affected by their histories. Themes that have recurred in my patients’ lives and treatments relate particularly to the areas of abuse, trust, and sexuality. I have therefore focused on interpersonal problems stemming from distrust, anxiety, and rage; from men’s difficulty differentiating abuse from other interpersonal dynamics; from their frequent ambivalence about themselves as sexual beings; from the emotional and sexual distance characteristic of their relationships; from the ways they relate to others through their sexuality; from the ambivalence some of them feel about their abusers; and from the propensity many of them have to develop relationships that are predatory and abusive, on the one hand, or masochistic and victimized, on the other. In addition, I have focused on how these dynamics emerge in the transference and countertransference of an evolving therapeutic relationship.

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References
Balint, M. (1968). The basic fault: Therapeutic aspects of regression. London: Tavistock.
Briere, J. (1995, October 5). Treating Male Survivors of Sexual Abuse. A workshop presented at the Sixth World Interdisciplinary Conference on Male Sexual Victimization, sponsored by the National Organization on Male Sexual Victimization, Columbus, OH.
Brod, H., and Kaufman, M. (Eds.). (1994). Theorizing masculinities. Thousand Oaks, CA: Sage.
Bromberg, P. M. (1991). On knowing one’s patient inside out: The aesthetics of unconscious communication. Psychoanalytic Dialogues, 1, 399-422.
Bromberg, P. M. (1993). Shadow and substance: A relational perspective on clinical process. Psychoanalytic Psychology, 10, 147-168.
Bromberg, P. M. (1995). A rose by any other name: Commentary on Lerner’s “Treatment issues in a case of possible multiple personality disorder”. Psychoanalytic Psychology, 12, 143-149.
Bruckner, D. F., and Johnson, P. E. (1987, February). Treatment for adult male victims of childhood sexual abuse. Social Casework, 68, 81-87.
Courtois, C. (1988). Healing the incest wound. New York: W. W. Norton.
Crowder, A. (1995). Opening the door: A treatment model for therapy with male survivors of sexual abuse. New York: Brunner/Mazel.
Davies, J. M., and Frawley, M. G. (1994). Treating the adult survivor of childhood sexual abuse: A psychoanalytic perspective. New York: Basic Books.
Dimock, P. (1988). Adult males sexually abused as children. Journal of Interpersonal Violence, 3, 203-221.
Ehrenberg, D. (1992). Abuse and desire. In D. Ehrenberg, The intimate edge (pp. 159-191). New York: Norton.
Ferenczi, S. (1930). The principles of relaxation and neo-catharsis. In M. Balint (Ed.), Final contributions to the problems and methods of psychoanalysis (pp. 108-125). New York: Brunner/Mazel.
Ferenczi, S. (1933). Confusion of tongues between adults and the child. Reprinted in Contemporary Psychoanalysis (1988), 24, 196-206.
Gabbard, G. O.(Ed.). (1989). Sexual exploitation in professional relationships. Washington, DC: American Psychiatric Press.
Ganzarain, R., and Buchele, B. (1990). Incest perpetrators in group therapy: A psychodynamic perspective. Bulletin of the Menninger Clinic, 54, 295-310.
Gartner, R. B. (1994, April). When the analyst and the sexually abused patient are both men. A paper presented at the spring meeting of Division 39 (Psychoanalysis) of the American Psychological Association. Washington, DC.
Gartner, R. B. (1996a). Incestuous boundary violations in families of borderline patients. Contemporary Psychoanalysis, 32, 73-80.
Gartner, R. B. (1996b). The de-masculinization of sexually abused men: Crises about gender identity and sexual orientation. A paper presented at the spring meeting of Division 39 (Psychoanalysis) of the American Psychological Association. New York, April.
Gartner, R. B. (1997a). Considerations in the psychoanalytic treatment of men who were sexually abused as children. Psychoanalytic Psychology, 14, 13-41.
Gartner, R. B. (1997b). An analytic group for sexually abused men. International Journal of Group Psychotherapy, 47, 373-383.
Gartner, R. B. (1999a). Betrayed as boys: Psychodynamic treatment of sexually abused men. New York: Guilford Press.
Gartner, R. B. (1999b). Cinematic depictions of boyhood sexual victimization. Gender and Psychoanalysis, 4:253-289.
Gartner, R. B. (1999c). On masculine strength, emotional detachment, and the praise of incest. Gender and Psychoanalysis, 4:307-316.
Gartner, R. B. (1999d). Sexual victimization of boys by men: Meanings and consequences. Journal of Gay and Lesbian Psychotherapy, 3:1-33.
Gelinas, D. (1983). The persisting negative effects of incest. Psychiatry, 46, 313-332.
Glaser, D. (1998, March 21). Unfinished business: Erotophobia vs. erotophilia. A presentation at “Trauma and Intimacy: Self/Other Adaptations,” a conference sponsored by the Masters and Johnson Treatment Programs at River Oaks Hospital, New York, NY.
Hastings, A. S. (1998). Treating sexual shame: A new map for overcoming dysfunctions, abuse, and addiction. Northvale, NJ: Aronson.
Herman, J. L. (1992). Trauma and recovery. New York: Basic Books.
Holmes, W., and Slap, G. (1998). Sexual abuse of boys: Definition, prevalence, correlates, sequelae, and management. Journal of the American Medical Association, 280, 1855-1862.
Horsley, K. C. (1997). A place for healing: Group leaders’ perspectives on groups for men sexually abused as children. Unpublished master’s thesis, Smith College School for Social Work, Northampton, MA.
Isely, P. J. (1992). A time-limited group therapy model for men sexually abused as children. GROUP, 16, 233-246.
Johanek, M. (1988). Treatment of male victims of child sexual abuse in military service. In S. Sgroi (Ed.), Vulnerable populations (Vol. 1, pp. 103-114). Lexington, MA: Lexington Books.
Hegeman, E. (1995). Transferential issues in the psychoanalytic treatment of incest survivors. In J. Alpert (Ed.), Sexual abuse recalled: Treating trauma in the era of the recovered memory debate (pp. 185-213). Northvale, NJ: Aronson.
Kluft, R. (1990). Incest and subsequent revictimization: The case of therapist-patient sexual exploitation, with a description of the sitting duck syndrome. In R. Kluft (Ed.), Incest-related syndromes of adult psychopathology (pp. 263-287). Washington, DC: American Psychiatric Press.
Lew, M. (1988; 2d ed.,1990). Victims no longer. New York: Harper and Row.
Levant, R. F., and Brooks, G. (Eds.). (1997). Men and sex: New psychological perspectives. New York: Wiley.
Levant, R. F., and Kopecky, G. (1995). Masculinity reconstructed: Changing the rules of manhood -- At work, in relationships, and in family life. New York: Dutton.
Levant, R. F., and Pollack, W. S. (Eds.). (1995). A new psychology of men. New York: Basic Books.
Lisak, D. (1993). Men as victims: Challenging cultural myths. Journal of Traumatic Stress, 6, 577-580.
Lisak, D. (1995). Integrating a critique of gender in the treatment of male survivors of childhood abuse. Psychotherapy, 32, 258-269.
Lisak, D. , Hopper, J., and Song, P. (1996). Factors in the cycle of violence: Gender rigidity and emotional constriction. Journal of Traumatic Stress, 9, 721-743.
Lymberis, M. (1994). Boundary violations in psychotherapy: Sexual and nonsexual. In A. Sugarman (Ed.), Victims of abuse: The emotional impact of child and adult trauma (pp. 165-186). Madison, CT: International Universities Press.
Maletzky, M. (1991). Treating the sexual offender. Newbury Park, CA: Sage.
Pizer, S. (1998). Building bridges: The negotiation of paradox in psychoanalysis. Hillsdale, NJ: Analytic Press.
Pleck, J. H. (1981). The myth of masculinity. Cambridge, MA: MIT Press.
Pleck, J. H. (1995). The gender role strain paradigm: An update. In R. F. Levant and W. S. Pollack (Eds.), A new psychology of men (pp. 11-32). New York: Basic Books.
Pollack, W. S. (1995). No man is an island: Toward a new psychoanalytic psychology of men. In R. F. Levant and W. Pollack (Eds.), A new psychology of men (pp. 33-67). New York: Basic Books.
Pollack, W. S. (1998). Real boys: Rescuing our sons from the myths of boyhood. New York: Random House.
Price, M. (1994). Incest: Transference and countertransference implications. Journal of the American Academy of Psychoanalysis, 22, 211-229.
Rusinoff, J., and Gerber, P. (1990). Crossing typological boundaries in treating the shame cycle. In M. Hunter (Ed.), The sexually abused male (Vol. 2, pp. 99-115). Lexington, MA: Lexington Books.
Sands, S. (1994). What is dissociated? Dissociation, 7, 145-152.
Sepler, F. (1990). Victim advocacy and young male victims of sexual abuse: An evolutionary model. In M. Hunter (Ed.), The sexually abused male (Vol. 1, pp. 73-85). Lexington, MA: Lexington Books.
Shapiro, S. (1999). When the therapist is a woman and the patient is a man. In R. Gartner, Betrayed as boys: Psychodynamic treatment of sexually abused men (pp. 279-294). New York: Guilford Press.
Siegel, E. V. (1996). Transformations: Countertransference during the psychoanalytic treatment of incest, real and imagined. Hillsdale, NJ: Analytic Press.
Smith, S. (1984). The sexually abused patient and the abusing therapist: A study in sadomasochistic relationships. Psychoanalytic Psychology, 1, 89-98.
Struve, J. (1990). Dancing with the patriarchy. In M. Hunter (Ed.), The sexually abused male (Vol. 1, pp. 3-45). Lexington, MA: Lexington Books.
Urquiza, A., and Keating, L. M. (1990). The prevalence of sexual victimization in males. In M. Hunter (Ed.), The sexually abused male (Vol. 1, pp. 89-104). Lexington, MA: Lexington Books.
Wright, D. (1997, September 19). Homophobia: The socially embedded barrier to recovery. A workshop presented at the Seventh World Interdisciplinary Conference on Male Sexual Victimization, sponsored by the National Organization on Male Sexual Victimization, Orinda, CA.

 

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