John (not his real name) was a white man in his mid-20s. He was on the obese side, sported a scruffy beard and identified as a gay man. John had come to a counselor after a referral for what John had previously described only as sexual experiences in his early childhood. Three sessions into the counseling relationship, John was building a timeline of significant events in his life. While discussing his sexual experiences and sexual and gender identity development, he shifted uncomfortably in his seat.

“My brother and his friends used to have sex with me,” John said suddenly, glancing up just long enough to assess his counselor’s reaction before returning his gaze to his folded hands.

“How old were you the first time you had a sexual encounter with your brother or one of his friends?” the counselor asked.

“I think I was 7, maybe 8 years old,” John said, chancing another brief look into the counselor’s eyes before staring back down at his hands. “Does that gross you out?”

“No,” the counselor said. “Honestly, right now I feel a little relieved that you told me. I’ve suspected that you experienced some type of sexual abuse as a child, after what I was told when you were referred to me. I’ve been expecting you to mention it, but I didn’t want to push you into telling me before you were ready.”

“I wouldn’t call what happened sexual abuse,” John shot back. “I mean, I don’t know what it was. They never forced me to do it with them. They just would have sex with each other when I was around, and they wanted me to do it too.” He looked back up to assess the counselor again. “I am gay. I’ve known that for a long time. I just … I don’t know how to feel about it.”

“How would you like me to refer to these sexual experiences that you had with your brother and his friends?” the counselor asked.

“I don’t know,” John said. “It was just sex.”

“OK,” the counselor said. “I will call them early sex experiences until you think I should call them something else.”

“I don’t even want that to be the reason we’re talking,” John said. “I think the fact that my parents didn’t take care of me, ignored me, favored my brother for my whole life, messed me up way more than having sex at age 8 did.”

“I hear you when you say you don’t want these early sex experiences to be the focus of our visit,” the counselor responded. “Would it be OK if we stayed there for just a minute more? I just want to get some more information about these experiences.”

“What do you want to know?” John asked.

“I appreciate you letting me ask,” the counselor affirmed. “How old were you when your brother and his friends stopped including you in these sexual experiences?”

“I think I was 11 or 12,” John answered.

“So, your brother is five years older than you?” The counselor remembered this from an earlier conversation.

“Yeah,” John said.

“You said you don’t know how to feel about it,” the counselor prompted. “How do you feel about it?”

“Mostly just gross,” he responded.

“That’s why you asked if I was grossed out by it,” the counselor reflected.

“Yeah. Can we talk about something else?” John asked.

“I can tell that you’re really uncomfortable talking about this,” the counselor acknowledged, “and you said you didn’t want that to be the focus, so we can move on and focus on what you want to talk about. I want to be able to return to these experiences you had at some point though if that’s OK.”

“It’ll be OK sometime. I’m just not ready today. I’m kind of sorry I brought it up,” John said.

“I think it took a lot of courage for you to bring it up, not knowing how I’d react,” the counselor affirmed.

“My parents hate that I’m gay, so I’ve never been able to talk about sex or relationships with them,” he stated.

“So, your parents know you’re gay, but you’ve never told your parents about these early sex experiences that you had with your brother and his friends?”

“No,” John said, “I’ve never told anybody. I know if I did, my brother and his friends would just deny that it ever happened. Especially his one friend. He’s kind of a big deal, married, couple of kids. If he admitted it, it would probably ruin his life. I don’t want to talk about this anymore. Can we talk about something else now?”

“You’re in charge,” the counselor said, “so we can move on if you want. How about if we go back to the timeline? What other significant events should we look at?”

Why don’t adult male survivors tell?

This exchange between John and the counselor is highly typical of an encounter with an adult man who experienced childhood sexual abuse (CSA). Adult male survivors of CSA will often wait 20, 30, 40 years or more before disclosing their experiences to anyone. John had waited nearly 20 years. In 2013, Scott Easton found that about two-thirds of adult male survivors who disclose in adulthood first tell a spouse or intimate partner. Others who disclose will tell an advocate, religious leader or mental health professional. John had spoken to an advocate, who was a survivor himself, only about “early childhood sexual experiences” after hearing this advocate speak in a public awareness forum. The advocate to whom John spoke then referred him to a counselor.

Adult male survivors of CSA face significant barriers to disclosure. These barriers include gender norms, social stigma and questions surrounding their own sexual identity. John was comfortable disclosing that he is a gay man. While John understood and accepted his sexual orientation, he still believed that the counselor might be “grossed out” upon hearing about his “early sex experiences.”

John’s conceptualization of his early childhood sexual experiences also is a typical barrier. Many adult male survivors may not conceptualize (or want to conceptualize) their childhood sexual experiences as CSA. John recoiled at the idea, instead preferring to call it “early sex experiences.” This conceptualization of what can objectively be defined as CSA as something other than CSA happens for many reasons, including:

• The perpetrator was female
• Confusion about who instigated the sexual contact
• The pleasure response that sexual arousal includes even if the arousal occurs during an act of abuse

At the time of John’s sexual encounters, the sexual activity of his brother and friends appeared to John to be normal behavior. It was something they just did. John also recoiled at the idea that he had been victimized in some way. This is a common masculine stereotype that can serve as a barrier to disclosure.

Not conceptualizing CSA as CSA can also serve as a barrier to disclosure when it comes to counseling assessment instruments. Many assessment instruments use the language of sexual abuse, assault or victimization. If an adult male survivor does not conceptualize his experience as CSA and a mental health professional asks in an assessment whether the client has ever experienced sexual abuse, assault or victimization, the client’s answer would be “no.” John denied experiencing CSA when asked directly about “experiences of abuse” in the standard initial assessment that the counselor completed.

Adult male survivors of CSA face a host of other barriers to disclosure, some of which even well-intentioned mental health professionals may unknowingly perpetuate. For example, researcher Rhys Price-Robertson identified the victim-to-offender narrative. Mental health providers and sexual abuse prevention professionals have emphasized, rightly or wrongly, that many perpetrators of CSA were themselves victims of CSA. This victim-to-offender narrative can lead to a widespread perception that survivors of CSA will become perpetrators. 

Greg Holtmeyer, a CSA survivor, advocate and public speaker, calls this “vampire syndrome” because in the lore, if one is bitten by a vampire, one becomes a vampire. By asserting the victim-to-offender narrative, mental health and sexual abuse prevention professionals may inadvertently perpetuate a barrier to disclosure by adult male survivors. If survivors believe this narrative, they may be less likely to disclose their own experience of abuse out of fear that they will be suspect themselves.

Another narrative that professionals and prevention specialists should be careful about using is the one that focuses on the male perpetrator/female survivor duality. This narrative is grounded in the fact that more female survivors of sexual abuse than male survivors report the abuse, but it ignores the reality that male victimization is nearly as high as female victimization. In the National Intimate Partner and Sexual Violence Survey from 2011 (a survey that the Centers for Disease Control and Prevention commissioned), researchers found that while 12.3% of female sexual abuse victims had experienced a completed rape before age 10, 27.8% of male sexual abuse victims had experienced a completed rape before the same age. The National Sexual Violence Resource Center reported in 2016 that while 1 in 4 girls experience some form of sexual abuse prior to graduating college, 1 in 6 boys experience some form of sexual abuse before the same age.

What this tells us is that while more girls and women are victimized across the life span, male victims often experience sexual abuse at a younger age than do female victims. While women and young girls report instances of sexual violence at a significantly higher rate than do men and young boys, the lifetime prevalence of CSA is only slightly higher among women than men. 

The public narrative focused on male perpetrator/female survivor duality is meant to motivate the public toward prevention and inspire survivors to come forward for treatment. This same narrative, however, may leave adult male survivors feeling isolated and alone. Adult male survivors rarely see their stories represented in treatment, advocacy or prevention efforts. This could inadvertently lead to the silencing of adult male survivors by enhancing their sense of isolation. As mental health and sexual abuse prevention professionals, we must ensure that our narrative is inclusive of all gender types.

Prompting disclosure and providing support

In our research into the lived experiences of adult male survivors’ disclosure of CSA, we found specific interventions that can help mental health professionals evoke disclosure and support adult male survivors after the disclosure occurs. Such interventions include:

• Using a timeline of significant life events to identify any early childhood sexual experiences
• Understanding that disclosure is a relational experience for the survivor, who is reading cues from the mental health professional on whether to continue the disclosure
• Using a balanced and honest affective response to the
  disclosure (this is more encouraging than no response or an overly emotive response)
• Empowering survivors by allowing the choice of how much and how long they want to talk about their experiences (this encourages a sense of safety)
• Providing informed consent that is clear, thus supporting survivors’ choices to disclose by including them in decision-making tied to mandatory reporting

John was in his third session before he disclosed that his brother and his brother’s friends had engaged in sexual encounters with him when he was 7 or 8 years old. He had been building a timeline of significant events in his life. This process of building a life timeline is an effective assessment tool. Such a timeline should be comprehensive, including information about the individual’s education, work history, hospitalizations, suicide attempts, mental health, sexual history, family history and any other life event the person sees as significant. 

This type of assessment allows clients to name their own experiences in their own language and guides mental health professionals in avoiding stigmatized language that clients may refute. A tool such as this frees clinicians from asking clients to respond to yes-no questions about experiences of abuse or assault. The counselor in our vignette had asked John to return to the timeline to discuss his sexual history, and it was at this prompting that John began his disclosure process.

Another important element in supporting disclosure is understanding that survivors often experience disclosure as a relational experience. Mental health professionals have historically conceptualized disclosure as a linear experience, with the survivor disclosing and the professional receiving the disclosure. Adult male survivors, however, experience disclosure as a relational reality. Many victims of CSA are conditioned in the abuse to take responsibility for the emotions of others. People who engage in predatory, abusive behavior will convince their victim that the abuser’s anger, disappointment and happiness are dependent on the victim. As a result of this conditioning, victims become adept at reading others for emotional cues and change their behaviors based on what they see. This leads to two important factors when an adult male survivor, and really any victim of abuse, discloses.

First, adult male survivors of CSA are acutely aware of the reactions of those to whom they disclose. John assessed his counselor’s reaction after disclosing his early sex experiences. In our research, we learned that a stone-faced lack of reaction to this disclosure can be as devastating to the survivor as an over-the-top emotional explosion. Adult survivors may interpret a lack of reaction as cold or uncaring and see the mental health professional as distant and disconnected. A mental health professional’s balanced affective response that is in empathic sync with the survivor’s own emotions will foster further disclosure.

The second thing mental health professionals should remember when considering that disclosure is a relational reality is that they must own their emotional reaction. When a survivor sees a mental health professional react to the disclosure, the survivor can take on responsibility for this reaction. This is what those who perpetrated the abuse conditioned the survivor to do. Mental health professionals can support a survivor’s disclosure by identifying their own emotional reaction and being clear that it is their responsibility as mental health professionals to manage their emotions. The role modeling of emotional management techniques is a powerful tool in helping survivors manage their own feelings.

The adult male survivors we interviewed in our research described how, after their disclosure, the one to whom they disclosed took control of the information and engaged them in activities that they did not want to do. One participant described how a therapist had left him feeling invalidated after he had disclosed his experience of CSA. He stated that the therapist had ignored his disclosure and instead talked him into entering a 30-day alcohol treatment center because the therapist had decided that was a more important issue. 

Another participant described how the counselor to whom he disclosed became curious about the client’s abuser. The counselor and the survivor then spent time in their counseling session looking up where the abuser was living to satisfy the counselor’s curiosity. This was done under the pretext of discerning whether the survivor should confront the abuser, which the survivor had no interest in doing. 

Yet another participant in our research described how his mother, after he had disclosed his experience of CSA to his parents, called a “family meeting,” without any deference to him, to confront the abuser. The participant said he had no idea his mother had planned the meeting until he walked in and saw the family gathered in the home.

The participants in our research described experiences of disempowerment after their disclosure — experiences in which they felt their desires, preferences and concerns became secondary to those belonging to the one to whom they had disclosed, including counselors. In describing their experiences of disempowerment, each of the participants stated that they had ceased discussing the abuse with the person who reacted in this manner.

Support of the survivor’s control or power over the situation gets particularly tricky when one considers laws surrounding mandatory reporting. This is why informed consent that is clear and reviewed regularly cannot be emphasized enough. If the counselor is required to report certain acts of CSA, survivors of abuse must know this before they disclose. They should also be involved in the reporting in as much as they are able and willing. They may not have a choice, depending on state and federal laws, regarding whether CSA is disclosed, but they can have a choice about how the disclosure is handled and what their next steps can be.

When adult male survivors disclose, they are seeking an affirming, supportive relationship. They are seeking someone who can be with them in the pain they are experiencing without taking over, taking control, minimizing or catastrophizing the experience. They want someone to understand their experience the way they understand it and who will partner with them in walking the journey of recovery. Mental health professionals risk silencing or even retraumatizing survivors of CSA by taking control of the situation and thus disempowering survivors.

The experience of CSA is one of disempowerment. The perpetrator is exercising power against the intended victim and taking away the victim’s personal power. In that session when John disclosed, the counselor pushed a little with John but always asked permission first. When John said, “I don’t want to talk about it anymore,” the counselor stopped immediately, recognizing John’s power over his experience, including when and with whom he shared it. 

As David Treleaven says in his work Trauma-Sensitive Mindfulness: Practices for Safe and Transformative Healing, allowing trauma survivors to disclose in such a way that stays within their window of tolerance is more healing than attempting to force them to disclose more than they are able. Allowing adult male survivors of CSA to choose when, how long, how much and to whom they disclose is a small way of giving some of their power back to them. Empowering these survivors fosters further disclosure.

Bringing in the edges

John continued in counseling for nearly a year. At times, he wanted clinical focus to be on his relationship with his parents, his conflicts with intimate partners, or how he managed work. When he was ready, he would delve into the repercussions of the “early sex experiences” he had disclosed. Eventually, he even brought up the reality of incest in these experiences and how that added another layer to his feelings of being “gross.” John completed college not long after beginning counseling. He has “moved on,” as much as he is able.

Male survivors of CSA face unique barriers to disclosure. To support this group, counselors need to be aware of these barriers and adapt their interventions to this population. Remaining vigilant to the relational nature of disclosure, being sensitive in the language used to describe these experiences and owning one’s emotional reaction to the disclosure support further disclosure and healing. Male survivors disclose to seek affirmation and healing. When counselors provide a supportive and empathic environment, healing happens.

 

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The authors would like to acknowledge Greg Holtmeyer (gregholtmeyer.com), CSA survivor, advocate and international public speaker, who inspired the research to support adult male survivors of CSA.

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James M. Smith is a licensed professional counselor (LPC), national certified counselor, approved clinical supervisor and board certified telemental health provider. He is the director of curriculum, instruction and assessment in the School of Education at Lincoln University in Missouri, where he also serves as an adjunct instructor in the counselor education program. He also serves clients in private practice, where he specializes in working with people who have experienced childhood trauma. Contact him at jamie@koinoniacs.com.

Adrian Warren is a contributing faculty member at Walden University and an LPC-supervisor in Texas. He has been in the mental health field for 17 years and a counselor educator for 12. In addition to teaching, he maintains a small private practice and is the 2021-2022 president of Texas Counseling Association.

 

Counseling Today reviews unsolicited articles written by American Counseling Association members. To access writing guidelines and tips for having an article accepted for publication, visit ct.counseling.org/feedback.

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