Counseling Male Survivors of Sexual Assault in the #MeToo Era

1. Counseling Male Survivors of Sexual Assault in the #MeToo Era Stephanie S.J. Drcar, Ph.D. & Stacey Diane A. Litam, Ph.D., LPCC, NCC  Cleveland State University

2. #metoo • A movement against sexual assault, violence, and harassment that gained national prominence in the fall of 2017 • "Me too" as phrase to promote "empowerment through empathy" was coined in 2006 by Tarana Burke, a social activist and community organizer • In the beginning the focus of the movement was "particularly Black women and girls, and other young women of color from low wealth communities, find pathways to healing." • "Our goal is also to reframe and expand the global conversation around sexual violence to speak to the needs of a broader spectrum of survivors. Young people, queer, trans, and disabled folks, Black women and girls, and all communities of color. We want perpetrators to be held accountable and we want strategies implemented to sustain long term, systemic change."

3. Prevalence & Context • Vary widely based on age and demographics of survivor, population, context, and definitions used in research • Research has found base rates ranging from 16% to 30% of men experiencing a forced, pressured, or coerced sexual episode perpetrated by a woman in one’s adult lifetime (Krahé et al., 2003; Struckman-Johnson, 1998; Struckman-Johnson & Struckman-Johnson, 1994) • A 2005 study found that 16% of males were sexually abused by the age of 18 (U.S. Centers for Disease Control, 2005) • Higher rates are found when definitions include non-physical coercive tactics and among gay and bisexual men (U.S. Centers for Disease Control, 2010; Peterson, Voller, Polusny, and Murdoch, 2011) 

4. Diversifying advertising campaigns • A recent advertising campaign in 2016 by The Rape, Abuse & Incest National Network (RAINN) highlighted the stories of male survivors of sexual assault • "No More" campaign • Organizations such as "1 in 6"

6. Male rape myths • (a) men cannot be raped; • (b) “real” men can defend themselves against rape;  • (c) only gay men are victims and/or perpetrators of rape;  • (d) men are not affected by rape (or not as much as women);  • (e) a woman cannot sexually assault a man;  • (f) male rape only happens in prisons;  • (g) sexual assault by someone of the same sex causes homosexuality;  • (h) homosexual and bisexual individuals deserve to be sexually assaulted because they are immoral and deviant; and  • (i) if a victim physically responds to an assault, he must have wanted it (Turchik & Edwards, 2012)

7. Barriers to reporting for children and adolescents  • Perceived lack of understanding • Limited support from adults (both personal and professional) • Perceived negative consequences for oneself and/or others • Love and/or desire to protect perpetrator • Emotional response to the abuse (e.g., guilt, shame, self-blame and responsibility for the perpetrator’s actions) • Facilitators of reporting for children: "Providing young people with information about sexual abuse that is developmentally appropriate"  (Lemaigrea, Taylor, & Gittoes, 2017, p. 49)

8. Barriers to reporting for adult men • College men who have experienced unwanted sexual contact, compared to women, are already less likely to be aware of and report their experience (Walsh et al., 2010) • Concerns of negative reactions (e.g., doubts about their sexuality, disbelief, and blame) may prevent male survivors from coming forward (Davies, 2002) • Men are more likely report shame, embarrassment, guilt, and fears of being perceived as gay as barriers to sharing their experience (Sable, Danis, Mauzy, & Gallagher, 2006) • Many of these challenges coincide with the tenets of the gender role strain paradigm

9. Impact of Sexual violence on men • "...anxiety, depression, hostility, intrusive thoughts, avoidance, dissociation, sexual concerns, dysfunctional sexual behavior, and impaired self-reference and a greater likelihood of engaging in tension-reduction activities such as self-mutilation, angry outbursts, suicide threats, and risk taking behaviors (Elliot et al., 2004; Frazier, 1993; Kalichman & Rompa, 2001; King et al., 2002; Ratner et al., 2003)." (Du Mont, Macdonald, White, & Turner, 2013, p. 2678). • Men may be more likely to report psychological impacts that are consistent with traditional gender role expectations (e.g., anger, alcohol use) • Evidence suggests that men may be more distressed, compared to women, following a sexual assault due to a threat to their sense of power, control, and masculinity

10. IMPACT OF SEXUAL VIOLENCE ON MEN • Some evidence suggests that cis-female perpetrators lead to less distressing symptoms for male survivors due to the congruence with the gender role socialization that many men experience (Peterson, Voller, Polusny, and Murdoch, 2011)  • Some men may experience confusion regarding their sexual identity, regarding either male or female perpetrators 

11. Unique manifestations of Trauma Boys and Men  • Avoidant coping strategies may be more common in sexually abused boys compared to girls (Simon, Feiring, & McElroy, 2010).  • Compared to women callers, men who used a crisis hotline: • Used the hotline due to limited or no support • Used the hotline to disclose experiences of sexual assault, often for the first time • Used hotline for crisis counseling or for referral • Were less familiar with other available agency services or community resources • Were less likely to receive referrals or for the call to be identified as "urgent" • Were more likely to demonstrate strong distrust of others (Young, Pruett, & Colvin, 2018). 

12. Treatment experiences • Historically, some rape crisis centers refused to provide services to men • "Honey, we don't do men" • Other research has found that clinicians can be highly insensitive to male survivor needs (Donnelly & Kenyon, 1996)

13. WHAT DOES THE RESEARCH SAY? • A greater need exists for male specific sexual abuse training, more direct therapeutic experiences with men, more male counselors, and more counselors with an awareness of personal abuse history (Paul & Paul, 2016).  • Male victims' cognitive appraisal and self-definition of the abuse contribute to the probability of self-disclosure (Ellkins, Crawford, & Briggs, 2017).  • Men are more likely to identify as a sexual abuse survivor if their perpetrator was a family member (Stander, Olsen, & Merrill, 2002).  • Sexually abused males have worse outcomes if they report co-occurring physical abuse (Dong, Anda, Dube, Giles, & Felitti, 2003).

14. Improving practice with Male survivors • Assessment • Be aware of how one's own internalized male rape mythology impacts your attention to unwanted childhood and/or adult sexual experiences • Ask follow-up questions • Be cautious of using labels that may not fit for the client (e.g., "sexual experience" versus "rape") • Consider the influence of race, ethnicity, and other identities. 

15. IMPROVING PRACTICE WITH MALE SURVIVORS • Not all boys and men have symptoms that constitute a PTSD diagnosis • Gender responsive and trauma informed care considers the influence of male gender socialization on their experience • Avoid probing for detail too soon and/or pushing for expression of feelings when not appropriate • Do not minimize the impact of the trauma • Establishing an underlying sense of safety while focusing on male survivors' strength and resilience are central to gender responsive and trauma informed care 

16. IMPROVING PRACTICE WITH MALE SURVIVORS • Empirically supported treatments exist for PTSD, as recommended by APA's Clinical Practice Guidelines (https://www.apa.org/ptsd-guideline/treatments/index) and The Society of Clinical Child and Adolescent Psychology (SCCAP): • Cognitive Behavioral Therapy (adults & children) • Cognitive Processing Therapy (adults) • Cognitive Therapy (adults) • Prolonged Exposure (adults) • Caveat: much of the literature on CBT approaches has focused on female survivors of interpersonal violence or male survivors of military-related trauma

17. IMPROVING PRACTICE WITH MALE SURVIVORS • Cognitive Processing Therapy • "A cognitive therapy that focuses initially on the question of why the trauma occurred and then the effects of the trauma on the clients’ beliefs about themselves, others, and the world through the use of progressive worksheets."

18. Improving Practice with male survivors • Challenging beliefs/"stuck points" • May be intertwined with beliefs on masculinity, sexuality, safety, and emotional expression • Exploration and challenging of "stuck points" • In what ways is your stuck point not including all of the information?  • In what way is your stuck point focused on just one piece of the story?  • In what ways is this stuck point focused on unrelated parts of the story? 

19. IMPROVING PRACTICE WITH MALE SURVISORS • Exploration and challenging of "stuck points" (continued) • Is your stuck point a habit or based on fact? • Does your stuck point include all-or-none terms? (e.g., either-or, black-white, right-wrong, good-bad)  • Does your stuck point include words or phrases that are extreme or exaggerated? (i.e., always, forever, never, should, must, can’t, and every time)  • Where did this stuck point come from?  • In what ways is your stuck point based on feelings rather than facts?

20. IMPROVING PRACTICE WITH MALE SURVISORS • The importance of relationship building and authenticity • Richard B. Gartner (2018) explores the importance of addressing attachment challenges through the use of the therapeutic relationships • Survivors of sexual abuse in childhood may have unhealthy attachment schemas and experiences that can benefit from the consistent, benevolent, and non-sexual care that comes from a counselors • Example of "Terry"

21. IMPROVING PRACTICE WITH MALE Survivors • The role of community in treatment • Support and relationship building with other male survivors can help challenge stigma, internalized shame, and facilitate the ability to communicate about a past traumatic experiences • Formalized communities for male survivors have struggled to exist due to funding issues, leadership challenges, and lack of support from the larger community (e.g., The Men's Project, 1998-2015) • The "1 in 6" project offers free, weekly online chat-based support groups  • "1 in 6" offers a long list of recommended book, documentaries, and other sources for survivors