Relational
Aftereffects of Boyhood Sexual Abuse,
Richard Gartner, Ph.D.
This
article appeared in the Journal of Contemporary
Psychotherapy, (1999) 29:319-353.
Since 1980, there has been an outpouring of books
and papers on childhood sexual abuse. The emphasis
in them has nearly always been on sexually abused
girls and their reactions to the abuse as women.
But, as Holmes and Slap (1998) conclude, “the
sexual abuse of boys is common, underreported, underrecognized,
and undertreated”. Approximately one in six
boys experiences direct sexual contact with an adult
or older child by age sixteen.
Abstract
Despite
its high prevalence rate, the sexual abuse of boys
is undeerrecognized and undertreated. This paper
will examine the relational aftereffects of boyhood
sexual abuse that emerge in adulthood. The vicissitudes
of relational restructuring through the transference
and countertransference are explored, with examples
discussed of the various transference/countertransference
paradigms often encountered.
Since
1980, there has been an outpouring of books and
papers on childhood sexual abuse. The emphasis in
them has nearly always been on sexually abused girls
and their reactions to the abuse as women. This
focus on women misleadingly implies that the occurrence
of sexual abuse among boys is rare. But, as Holmes
and Slap (1998) conclude, “the sexual abuse
of boys is common, underreported, underrecognized,
and undertreated” (p. 1860). Approximately
one in six boys experiences direct sexual contact
with an adult or older child by age sixteen (Urquiza
and Keating, 1990; Lisak, Hopper, and Song, 1996).
Men
with sexual abuse histories are similar in many
ways to women abused in childhood, yet there are
differences as well. I have elsewhere (Gartner,
1999a; see also Gartner, 1994, 1996a, 1996b, 1997a,
1997b, 1999b, 1999c, 1999d) addressed a number of
issues related to the sexual abuse of boys and its
aftermath as boys become men. These include the
definition of sexually abusive situations for boys;
the social isolation and shame sexually abused men
often experience; the effects of masculine gender
socialization on processing boyhood sexual abuse;
the likelihood that boys will encode their sexual
activity (especially with women) as a benign introduction
to adult sexuality; the meaning and aftereffects
of same-sex molestation for boys; and the ways in
which encoding of abuse experiences are affected
by portrayals of sexual situations between boys
and adults in movies.
Sexually
abused adults often relate to other people in flawed
or distorted ways. Chronic disturbances in relationships
have been detailed throughout the clinical literature
on incest (for example, Gelinas, 1983; Courtois,
1988; Ehrenberg, 1992; Davies and Frawley, 1994).
In this article, using numerous clinical vignettes
to illustrate my points, I will focus on the impact
of boyhood sexual abuse on adult sexual and other
intimate relationships. I will also demonstrate
how these relational sequelae affect the therapeutic
relationship, often causing an intense transference/countertransference
interplay in the treatment.
Trust, Honesty, and Intimacy
When a child lives with chronic abuse and/or incest,
he grows up in an environment marked by a traumatic
relationship or set of relationships. He learns
to survey the world suspiciously and sees victimizers
everywhere. This is actually a functional reaction
when abuse is ongoing, a time when he may need to
protect himself from further hurt and exploitation.
However, this way of looking at the world often
creates severe difficulties when he leaves the immediate
world of his molesting environment. Having lived
with pervasive pathogenic family dynamics and dysfunctional
systems of relating, a boy in this situation is
likely to develop profound difficulties in interpersonal
relating. Through incest and abuse, he has developed
severe relational disturbances (Sands, 1994); relating
itself has become traumatic. Relationships are experienced
as fundamentally dishonest, dangerous, and mystifying.
Dishonesty in primary relationships leads a child
to grow up distrusting all relationships. One man
communicated his anguish about this dishonesty by
saying, “Our family motto was always, ‘If
you can’t say anything nice, don’t say
anything at all.’ But for me the best family
motto would be ‘If you can’t say anything
honest, say nothing.’”
Sexually
abused men may not understand what involvement with
others entails and what they risk or, alternatively,
do not have to risk when they are intimate with
others. Distortions about intimacy are a logical
extension of having had faulty, corrupt early relationships
with abusers and, often, other adults. Their understanding
of interpersonal relating was often valid in those
early destructive relationships, but such perceptions
interfere with their ability to create nonabusing
intimate relationships in adulthood.
Situations
involving trust, sexuality, intimacy, power, and
authority may pose particular problems to an abused
man. Abuse is likely to have occurred when he was
especially receptive to interpersonal approaches
as a boy (Briere, 1995). If he was undermined at
this vulnerable developmental stage, when he was
especially needy of contact with others, he may
be starved for intimacy while simultaneously remaining
phobic about it. He will have potent fears for his
safety in human relationships, and these will affect
the extent to which he can accept the interpersonal
closeness he often desires.
Many
men ignore such intimacy disorders in young adulthood,
only coming to acknowledge any deficits in their
relationships later in life. In early middle age,
when many abused men seek therapy, they may feel
more secure psychologically. By that time in their
lives they also may be forced to relate to others
more intimately. If they encounter problems relating
to partners, making career changes, or having children,
they may finally be moved to face developmental
impasses about trust and intimate relating that
were impossible to address in childhood or early
adulthood (Horsley, 1997).
Power and Authority
A child who has been fundamentally betrayed in a
relationship with a parent, caretaker, or other
parent substitute often expects similar betrayal
in future relationships, especially from those he
perceives as authorities. His ability to form attachments
is seriously compromised by his internalization
of authority figures as treacherous and undependable.
He consequently develops the sense that he will
be betrayed by those he cares about and trusts.
Wariness and anxiety about interpersonal encounters
influence all relationships for such a man.
For
Lorenzo , distrust stemming from molestations by
men in his small town was compounded by the reactions
of a trusted priest to whom he confided information
about the abuse and his own growing sense that he
was gay. By the time he was fifteen, Lorenzo had
had numerous exploitative sexual encounters in which
he sexually serviced older boys and men, all of
whom were publicly identified as heterosexual, and
many of whom were married. Confused about the meaning
of his own behavior, and only vaguely knowledgeable
about sexual orientation, he did nevertheless begin
to wonder if he were gay. He had no idea who to
talk to about this in the working-class mill town
in which he grew up. Then he remembered a priest
who had once served in the town for two years before
being transferred to a large city three hundred
miles away. He’d always thought this priest
was “cool,” and so he called him and
said he needed to talk to him. The priest came to
Lorenzo’s town for a visit, and Lorenzo first
told him about his abuse experiences and then said
he thought he was gay. “He looked at me and
said, ‘I knew you were gay the minute I laid
eyes on you!’ So, I said, ‘Why didn’t
you tell me?’ and he said, ‘Some things
are better to discover on your own.’ So, at
first he was good about it -- he invited me to visit
him, and when I did he took me around the city and
showed me gay neighborhoods, gay bars, gay shops.
That part was good, but then we went back to the
house he lived in with other priests, and I wanted
to get high -- I was a crazy kid in those days,
and I asked him where to get grass. He said, ‘No
problem, just go upstairs and ask Father Donald.’
So I went upstairs, and there was nice Father Donald,
and we got high together, and then he made a pass
at me.” Lorenzo laughed. “It was the
first time anyone serviced me, and I really liked
it. When I went downstairs and told the first priest
about it, he said, ‘Oh, sure, Father Donald
does that with everyone.’ Can you believe
this? He knew what was going to happen when he sent
me up there! Later, I found out he was gay too,
and had sex with other boys, though never with me.”
Lorenzo was talking faster and faster, and I asked
him to slow down and tell me what he felt about
all this. “I thought it was funny. And exciting.”
Then he paused. “But, you know, I’m
thirty-five now, about the age Father Donald was
then. I have no interest in fifteen-year-olds! My
nephews are that age! I’d never go near them
for sex.” I asked again how he felt about
what happened with the two priests. For the first
time, he seemed reflective. “It was a terrible
thing to do. They knew how fucked up I was about
sex with all those men, and how unsure I was about
being gay. I went to them for sanctuary! And they
just helpe__d me party with them.” Lorenzo
began to look sad. “In those days I really
believed in the Catholic Church. No more.”
His disillusionment with authority had been revealed.
The
power differential between child and abuser can
dramatically affect the boy in later life (Dimock,
1988). The anticipation of betrayal by an authority
may take the form of fears, fantasies, or even outright
expectations of inappropriate sexual advances. Thus,
in our initial meetings Seth focused on the facts
that my office is situated in a hotel and that I
have a couch in it that he felt could serve as a
bed. Reminded of the circumstances of his molestation
in a hotel room by a family friend, his anxiety
nearly overwhelmed him and interfered with his ability
to form a relationship with me.
Power
has been eroticized during sexual abuse. It was
through power and control that a boy was introduced
to sexuality, so his adult sexual relationships
are often driven by attempts to regain and maintain
control and power over an intimate other. Thus,
love relationships cannot be shared partnerships.
Instead, they become arenas for power plays about
who is in charge and in control. Lewis, for example,
had such a need for control in intimate relationships
that he had thrown partners across the room if he
even momentarily felt they were physically taking
charge during lovemaking.
To
an abused boy, vulnerability often becomes associated
with powerlessness. In adult relationships, he either
needs complete control, as Lewis did, or when feeling
vulnerable he anxiously reacts as if he were still
powerless and needed to appease authorities. For
example, when he was a young child, Abe’s
father explicitly gave him the impossible job of
keeping his capricious, imperious, and narcissistic
mother pacified. Predictably, he failed and consequently
became the focus of both parents’ rage. As
an adult, he anxiously gave presents to people he
felt he had displeased, as well as to those who
were abusive to him. He felt powerless and vulnerable
in relation to them, and hoped that these presents
could somehow placate them and keep them from attacking
him. It simply never occurred to him that he could
be directly confrontative or survive their disapproval.
Maintaining
Emotional and Sexual Distance
A common way to fend off the anxiety that accompanies
a sexually abused man’s interpersonal relationships
is to keep them as distant, formal, and emotionless
as possible. When relating is traumatic and he is
phobic about emotional attachment, he can only allow
himself to be emotionally removed. Consider how
this dynamic worked for Willem, and how it affected
the vicissitudes of his therapeutic relationship:
Openly
distant in his interpersonal relationships, Willem
maintained such a coolness in relation to others
that he believed he had no relationships whatsoever,
nor did he acknowledge or remember a history of
relating closely to others earlier in his life.
Deserted by his biological father, Willem was the
son of an alcoholic mother who had a series of husbands,
boyfriends, and one-night sex partners. Feeling
rootless because of his mother’s unstable
relationships, Willem had no doubt about the veracity
of his vague and disturbing memories of direct sexual
abuse, apparently by one or more of these men. He
also believed he witnessed his mother’s sexual
relations with them at times. Shortly after she
and her third husband divorced when Willem was twelve,
the mother died suddenly. He was never told the
cause of her death.
As
an adult, Willem had great success in a career that
required keen intellectual prowess and analytic
ability. He maintained that he had no feelings,
and indeed his emotional life was sparse, barren,
and brittle. He had acquaintances, but no friends,
and on the surface he had no capacity to bond to
others. He married in his mid-twenties, and when
his wife divorced him five years later he precipitously
tried to commit suicide in a particularly lethal
way. His life was saved, and he entered an inpatient
psychiatric facility from which he emerged more
openly vulnerable, needy, and dependent. He quit
his career, and was convinced to start outpatient
psychotherapy.
In
sessions with me, Willem was wary, seemingly waiting
for me to make a false move. Over the course of
our work together, he repeatedly demanded more connection
to me than he felt he had. Each time we addressed
this issue, however, he seemed to disappear. He
either canceled appointments because of other commitments
or came to sessions and just sat there, impassive
and impermeable. Nevertheless, we made progress.
In our early contacts, we went over Willem’s
history and saw how little he knew about his early
life or family origins. He then decided to try to
find out about his mother’s death. Obtaining
a copy of his mother’s death certificate,
he was shocked, and yet not totally surprised, to
discover that she had committed suicide. As he considered
his mother’s depression, alcoholism, and death,
his own suicide attempt became more understandable
as an unconscious repetition of hers. His need not
to rely on other people or to create bonds with
them also seemed reasonable in this context. As
he confronted these themes, he gained a clearer
sense of wanting to live and accomplish something
important in his own life.
Willem’s
commitment problem remained a constant in his treatment.
Despite this, he made remarkable strides in the
rest of his life. Having originally stated that
he had “no history,” meaning virtually
no early memories and no relationships with anyone
from his childhood, he eventually contacted the
sister and former friends whom he had not seen in
ten years. He began to observe with some emotion
that his pattern in adult life of moving from city
to city, job to job, and girlfriend to girlfriend,
reflected an understandable but devastating incapacity
to connect to others. Progress in these areas was
slow, but when he left treatment after two years,
he had partially healed and was no longer a man
without a history.
Rage: One Emotion Allowed to Men
Masculine gender norms endorse anger as one of the
few emotions open to men (Bruckner and Johnson,
1987; Lew, 1988; Sepler, 1990; Struve, 1990; Isely,
1992), and rage is the only affect many sexually
traumatized men can express (Dimock, 1988; Sepler,
1990). As Crowder (1995) puts it, “Anger is
powerful and energy-filled and it is an affective
state that is egosyntonic with masculine cultural
roles. Anger and rage can become a ‘catchall’
emotion for male victims. Because it is a powerful
and active emotion, expressing anger is more acceptable
than displaying more vulnerable emotions”
(p. 24). In many cases, underlying sadness, loss,
and desolation are hidden beneath this rage. But
Crowder (1995) notes that “male survivors
tend to be able to contact their anger and rage
at having been abused long before they can feel
their grief. They often display active and violent
revenge fantasies. Women survivors, on the other
hand, are initially more in touch with their sadness
and depression” (p. 38).
The
consequences of a furious mode of living in the
world are obvious in men who become sexually or
emotionally predatory or abusive as adults. Many
nonabusive men, however, also live with an unbridled
rage that affects their capacity for intimacy and
the quality of their relationships. In Quinn’s
case, discussed below, his anger stayed front and
center for years as he confronted his abuse by his
grandfather. While he never acted out his rage antisocially,
it frequently broke through, affecting his ability
to work with supervisors and clients, and influencing
his more personal relationships as well.
Quinn’s
considerable rage was easy to recognize, but consider
the monumental fury underneath Beau’s seemingly
quiet, passive, and polite exterior. This fury flowed
unchecked and periodically overwhelmed him, nearly
drowning him in its intensity. Beau, having had
emotionally unsupportive and victimizing parents,
was raped by three student athletes and a coach
in high school, and then was further victimized
by many other students. During his college years,
he continued to be sneered at and derided by classmates.
He was hospitalized for psychiatric reasons three
times between the ages of eighteen and twenty-six.
Each hospitalization was precipitated by an explosion
of temper following a dissociative episode in which
he felt the ground or furniture moving. During the
hospitalizations, his feelings emerged about the
rape and its aftermath, about being gay, and about
his extreme sense of being ostracized and not belonging
anywhere. He was emotionally isolated, telling himself
there were good reasons to distrust every group
he encountered: gays and straights, men and women,
every racial and ethnic group. He had superficial
friendships with one or two gay men and had had
two brief love affairs. Neither relationship lasted
long, and together they further embittered him.
Because
of problems relating to teenage boys at his job,
Beau, then in his late twenties, sought individual
psychotherapy. A few months later, he was referred
to my group for sexually abused men. Seemingly gentle
and soft-spoken, for the first few weeks after entering
the group he was quiet, hardly appearing to attend
to what others said. Eventually, he started to talk
about his trouble relating to the teenagers at work.
In particular, he focused on his susceptibility
to being sexually aroused by them and on his fury
at them because they resembled the high school students
who had abused him sexually and physically when
he himself was a teenager. At this point, group
members asked more about his internal experience.
As he described his feelings, he suddenly erupted
in a frenzy I have seldom seen outside an inpatient
unit. With his face distorted by rage and his body
moving half out of his chair, he railed inchoately
about his rapes and his fury at abusive men and
cruel women. After ten minutes of near-psychotic
fury, he collapsed, weeping and gasping for air.
The group was hushed as he exploded, but afterward
most of the men talked about identifying with his
rage, some in fear they might similarly erupt, others
in envy that they were unable to do so. Each understood
Beau’s rage from firsthand experience, and
seemed not to be afraid during his outburst.
Responsibility for Others’ Feelings
Boys often feel responsible for their sexual abuse,
a feeling that has several sources. Being responsible
for one’s fate is part of the socialized masculine
gender ideals every boy internalizes to some extent
(Pleck, 1981, 1995; Pollack, 1995, 1998; Levant
and Kopecky, 1995; Levant and Pollack, 1995; Levant
and Brooks, 1997; Lisak, 1993, 1995; Brod and Kaufman,
1994). In addition, boys often attribute their abuse
to having given off a message saying they were interested
in sex with their abuser or were vulnerable to predators
in general. This may be compounded by an abuser
telling the boy that this is happening because the
boy is so handsome and desirable, or because the
victimizer loves him so much, or because the abuser
knows this is what the boy “really”
wants. The abuser thus confirms that it is the boy’s
fault that he is being molested. In addition, incestuously
abused boys may have been told implicitly or explicitly
that they are responsible for their family’s
well-being, or for the mental health of one of their
parents.
The
boy’s sense of responsibility for his abuse
may build to a generalized sense of responsibility
for everything that happens to him and for the emotional
health of those around him. Its pervasiveness for
Victor, a man sexually abused by his father three
nights a week for several years in early adolescence,
came to light in the following incident: One day
Victor arrived back at his office from our session
and found that his supervisor had forgotten to cover
for him, although this was a standing arrangement
they had about his therapy appointment. He called
me anxiously and explained that we had to change
our appointment time so that this would not happen
again. The next day he called again and said he
would be able to keep the usual time. When he came
to his session, he began to talk about his reactions
to tension in the air at work. He said he had assumed
that the anxiety in the office when he returned
was about his absence, that he had gotten panicky
about his job, and so he had called to change our
appointment. Upon reflection, however, he realized
that his bosses were stressed about something unrelated
to anything that had happened when he was gone.
“When I feel tension in the air, I assume
it’s about me, and I have to give in or submit
to whatever is demanded, whether it’s at work
or with my family or with my lover.” By the
time he got to my office, he seemed both resentful
of his supervisors and of me because he assumed
I was put out by his call and I had not wanted to
accommodate his wish to change the appointment time.
I pointed this out and he agreed, “Yes, after
I give in or submit, I get very angry at whoever
it is I give in to, and I create scenarios about
their being disagreeable or uncaring about my needs.”
While
molesting Victor, his father would tell him the
abuse was happening because he loved him and because
Victor was so handsome. Victor’s resulting
sense of being responsible for the abuse was compounded
by the sexual pleasure he felt simultaneously with
his disgust and shame. In addition, he felt that
the nightly molestations calmed his father down
and kept the family somewhat more peaceful than
it otherwise would have been. He remembered how
he felt when his father got tense or angry. The
father would cry out, “If it weren’t
for all of you I wouldn’t have to be here
-- I’d be free!” Victor said he accepted
the blame for his father’s moods. He added,
however, that his current reactions of feeling responsible
for others were also colored by his history with
his mother. She would tell Victor he was perfect
and worth all the sacrifices she made: the job she
hated, the marriage she was stuck in. Feeling responsible
for his mother’s disappointments, Victor again
reacted with anxiety. He felt as trapped as each
of his parents felt in their marriage. The reactions
to the incident at work were influenced, then, by
the guilt and fear he felt in relation to both parents,
the responsibility he felt for their unhappiness
and for easing their pain, and the resentment he
ultimately felt about this dynamic.
Differentiating Abuse from Other Interpersonal
Dynamics
Men with sexual abuse histories may have little
real sense of the differences among sex, love, nurturance,
affection, and abuse. For them, these concepts are
roughly equivalent. As Price (1994) notes, “Intimacy
becomes identified with abuse, exploitation, sexuality,
engulfment, and enmeshment” (p. 213). Misidentifying
relational experiences is an adult sequel to the
sexually abused child's "confusion of tongues"
between the languages of tenderness and passion
described by Ferenczi in 1933 (see also Gelinas,
1983; Johanek, 1988; and Ganzarain and Buchele,
1990). Explaining his near-phobia about emotion-laden
experiences, Keith said, “For me, violation
means intimacy, and intimacy means violation. Someone
has an emotional flareup and I want to dive into
it. I fuck it, I become one with it, I feel those
raw emotions again, like I did with my mother. Then
I wind up being the caretaker of the person with
all the emotions.”
For
me, the best illustration of how sexuality, love,
nurturance, affection, and abuse get confused for
sexually abused men lies in Abe’s words. A
man who suffered from exceptionally inappropriate
seductive overstimulation as well as verbal abuse,
Abe said one day in despair: "No one will ever
love me unless I'm completely their servant. So
I bring gifts to people who have abused me, I allow
sadistic sex. I don't yet know to what lengths I'll
go to feel loved. I keep returning to that wonderful
cozy nest of abuse and incest. It's a sewer and
yet it's my spiritual home. Why do I continue to
allow abuse as an adult? Because when I'm being
abused, someone's attention is completely focused
on me. I know that's not love, but it really feels
like love." Abe summed up his family's confusion
of love and abuse in a motto often repeated to him
by both parents: "It's better that we shit
on you than that someone else kisses you."
In other words, their abuse was the best love he
could hope for in life.
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