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Section 12
Sexual Abuse Treatment

Question 12 | Test | Table of Contents

The counselor’s gender
Another question that frequently arises is whether counselors should be of the same gender as the survivors with whom they are working.  As female survivors seek counseling more frequently and have traditionally been the focus of the clinical literature, the question most often posed is whether female survivors should be seen by female counselors. While many clinicians identify the benefits to survivors of both female and male counselors, some have concluded that, at least initially, a female counselor is preferable.  Cole (1985), for example, took a strong stance advocating the use of female therapists in survivor groups.  She stated, ‘Female group leaders decrease the chances of revictimization of the client.  Male therapists may quite inadvertently revictimize incest survivors due to their own male enculturation and the client’s lack of knowledge and skill in setting emotional and physical boundaries with men’ (1985:81).  Faria and Belohiavek (1984) suggested that while a male therapist would allow survivors to learn to develop healthy relationships with men, a female counselor is preferable, as she can serve as a role model. Blake-White and Kline (1985) argued that female therapists are more effective as leaders of incest therapy groups, as it is usually easier for survivors to trust women.  These authors also pointed out that survivors may ‘perform for’ and ‘give away power’ (1985: 399) to men.  However, they have recommended that a male co-therapist, introduced at a later point, could benefit the group, as this would provide the survivors with an opportunity to explore their attitudes toward men. Hall and Lloyd (1989), while identifying the advantages of a female counselor, also acknowledged that if trust can be established with a male counselor, the survivor has the advantage of being able to establish a healthy relationship with a male.  Others maintain that the gender of the counselor is not a significant issue.  For example, Westerlund (1983) emphasized that the counseling style is more influential than the gender of the counselor in determining how issues of power are handled within the relationship.

Hall and Lloyd (1989) identified issues that might serve as potential difficulties for counselors of each gender. A female counselor, for example, may over-identify with survivors’ issues, become over-involved with their problems, and play the role of the ‘rescuer.’ Male counselors, on the other hand, might over-identify with the abuser, focus on issues of sexuality rather than abuse of power, or feel guilty about being male and attempt to overcompensate for this by being ‘kind’ to the survivor.

Less has been written regarding the gender of counselors with male survivors. Bruckner and Johnson (1987), who discussed group treatment for adult male survivors of sexual abuse, recommended the use of a mixed-gender team as co-leaders because having a female present in their groups seemed to facilitate the discussion of issues and feelings, although the participants also seemed to seek the female co-leader’s acceptance and permission.  Evans, who discussed the treatment of male sexual assault survivors and Vietnam veterans, stated that, ‘The key issue in gender identification with the client . . . is not the gender of the client and the survivor, but the gender attitudes’ (1990: 71). Counseling is hindered by male gender stereotyping, resulting in harmful beliefs (for example that male survivors are more to blame for their abuse than are females, males are unable to address personal issues, males are more competent and therefore male survivors are less in need of treatment than are female survivors).

So the literature recommends that a female counselor may be more effective, at least initially, in working with female survivors, although there are also some advantages to including a male therapist at some point in the process. Clinicians working with male survivors have not taken a similar stance (i.e. that male survivors should be seen by male counselors).  However, in general, counselors’ abilities to examine their own gender-related issues as these influence their beliefs and attitudes, and the ways in which power issues are handled within the counseling relationship, may ultimately be more important that the gender mix between counselor and client.

The gender of the client
Another key issue to be addressed is the differences in the counseling process for male and female survivors. Again, because traditionally the focus has been on the counseling need of the female survivor, the question most commonly raised is how the counseling needs of males differ from those identified for females. Because many female and male responses to childhood sexual abuse are similar (e.g. guilt, shame, anger), in some respects, many counseling processes and techniques to be discussed are applicable to both genders. But as the socialization of males and females differs, it can be expected that males will be confronted with different sexist biases, exhibit gender-specific presentations of symptoms, and have specific treatment needs (Hunter and Gerber, 1990).

Urquiza and Capra (1990), in their review of the initial and long-term effects of childhood sexual abuse on boys, cited several effects that were similar to those experienced by women and girls (e.g. self-concept disturbance, somatic complaints) , but identified two areas which ‘stood out’ for males: disturbances of conduct and acting out of compulsive sexual behaviors. The authors suggested that these effects are related to gender-based differences in coping with trauma, most specifically the use of externalizing behaviors by males. Struve (1990) suggests that the recovery of male survivors is influenced by their socialization, which leads them to believe that they should not be victims, that they can act on their feelings but not express them, and that they should have been able to protect themselves from their abuse.

Abuse by member of the same sex
A closely related issue is that of same-sex versus opposite-sex abuse. It is still generally believed that the sexual victimization of female victims by male perpetrators is the most common form of abuse. However, it is believed that males are the most frequent offenders against boys.

In addition to addressing the impact of socialization on males’ responses to victimization, the issue of same-sex abuse is also pertinent. The most frequently discussed, specific effect arising from the experience of male-to-male abuse is confusion related to sexual identity. Struve (1990) pointed out, for example, that if the abused boy perceives himself as experiencing pleasure or sexual arousal, which are normal physiological responses to stimulation, he may interpret those reactions as latent homosexual feelings, and this can lead to later identity confusion. Some researchers have found a relationship between sexual victimization by an older male in child­hood and later same-sex behaviors (Finkelhor, 1979). The male survivor often directs anger towards himself for not protecting himself from the offender, and therefore views himself as ‘less of a man’ (Struve, 1990).  He may then try to overcompensate for this failure, resulting in exaggerated ‘macho behaviors,’ homophobia, sexually aggressive behaviors, and, in some cases, sexual offending.  Counselors of male survivors need to be sensitive both to gender-specific issues of abuse and to issues related to same-sex abuse.

As Sepler pointed out, male victims inevitably experience their abuse from a different world view and self-view than do females. She warned counselors that a crisis experienced by the male survivor related to the abuse ‘may be unresponsive to, or further precipitated by, a program model that assumes universality when it comes to sexual victimization’ (1990: 76). For example, because males are raised to value mastery, they may be unlikely to acknowledge their powerlessness in the situation in the way that females might, and adapt by adopting a ‘pseudoconsensual posture or reciprocating with aggressive acts’ (1990: 78). By failing to acknowledge the male’s view and by working from a model of victimization based primarily on women’s experiences, counselors could increase the male survivor’s sense of isolation and alienation.
- Draucker, C. B. (2006). Introduction. In Counselling survivors of childhood sexual abuse (pp. 11-14). London: Sage Publications.

Personal Reflection Exercise #2
The preceding section contained information about gender issues in sexual abuse treatment. Write three case study examples regarding how you might use the content of this section in your practice.

Update
Moderators of Sexual Recidivism as Indicator
of Treatment Effectiveness in Persons
with Sexual Offense Histories:
An Updated Meta-Analysis

- Holper, L., Mokros, A., & Habermeyer, E. (2023). Moderators of Sexual Recidivism as Indicator of Treatment Effectiveness in Persons With Sexual Offense Histories: An Updated Meta-analysis. Sexual abuse : a journal of research and treatment.

Peer-Reviewed Journal Article References:
Pereda, N., & Segura, A. (2021). Child sexual abuse within the Roman Catholic Church in Spain: A descriptive study of abuse characteristics, victims’ faith, and spirituality. Psychology of Violence, 11(5), 488–496.

Pulverman, C. S., & Meston, C. M. (2020). Sexual dysfunction in women with a history of childhood sexual abuse: The role of sexual shame. Psychological Trauma: Theory, Research, Practice, and Policy, 12(3), 291–299.

Shevlin, M., Murphy, S., Elklit, A., Murphy, J., & Hyland, P. (2018). Typologies of child sexual abuse: An analysis of multiple abuse acts among a large sample of Danish treatment-seeking survivors of childhood sexual abuse. Psychological Trauma: Theory, Research, Practice, and Policy, 10(3), 263–269.

QUESTION 12
How do male victims experience their abuse from a different world view and self-view than do females? To select and enter your answer go to Test.