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Working with perpetrators of child sexual abuse

By Lisa R. Rhodes September 16, 2022

Perpetrators of child sexual abuse are a clientele that some counselors may find challenging to treat. According to the Department of Justice Office of Justice Programs, the term “sex offender” refers to a person who is convicted of a sex offense, which is defined as “a criminal offense that has an element involving a sexual act or sexual contact with another” as well as one that is an offense against a minor.

As of April, 767,023 people were listed in the sex offender registries in the United States, according to SafeHome.org. This number, however, may not reflect the total number of people who have sexually abused children. The Rape, Abuse and Incest National Network (RAINN) reports that the majority of sexual assaults are never reported to law enforcement.

Courtney T. Evans, a licensed clinical mental health counselor with a private practice, Purpose in Grace Counseling, in Eden, North Carolina, says mental health treatment, specifically sex offender therapy, is a recommended form of counseling to reduce recidivism rates among perpetrators of sexual assault.

“While traditional therapy seeks to reduce feelings of anxiety and inadequacy, sex offender therapy seeks to confront the offender with thinking errors, promoting accountability and acceptance for actions,” notes Evans, a member of the American Counseling Association who specializes in treating people with trauma-related disorders, specifically children who have been sexually abused. “Sex offenders are given tools in counseling, but just like someone who attends Alcoholics Anonymous meetings long term, sexual offenders should engage in lifelong support.”

Risk factors

Community safety is the first goal of sex offender therapy, says Pablo Serna, a licensed professional counselor and independent contractor at Henger Enterprises, a therapeutic practice specializing in sexual offender risk assessment and evaluation and sex offender programming in Wisconsin.

Serna has counseled adult male sex offenders, including those who have abused children, for eight years. Most of his clients are mandated by the court to undergo sexual offense treatment or their probation officer may refer them to the practice where he works.

Serna treats perpetrators using group therapy, and he says group members can range from those who fully admit to an offense to those who admit they’ve done something wrong but are not willing to accept full responsibility for their actions.

“As a facilitator, I will introduce concepts in a general way prior to moving to [the topic of] offenses so members will grasp the idea before applying it to their offense,” Serna explains.

If a group member is reluctant to participate, Serna says he applies ideas from motivational interviewing. For example, he may empathize with the member about how group therapy can be uncomfortable or how the member does not want to be in the group. “I will admit I cannot make him participate and ultimately, he has the choice to participate,” Serna says. “Yet I point out discrepancies like ‘If you want your probation agent off your back, is not participating [going] to help with that?’”

The end goal for clients, Serna says, is to “prevent further victimizations by demonstrating an understanding of their [clients’] thinking and the risk factors that contributed to their offense and [having them] assist in developing interventions.”

Serna and his colleagues use a sex offender treatment curriculum that was developed by Joseph Henger, the president and clinical director of Henger Enterprises. The curriculum involves the perpetrator understanding the cycle of sexual abuse and relapse prevention to help them develop positive lifestyle changes. The curriculum’s main focus is to diminish deviant arousal and overcome pro-offending beliefs and behaviors, Serna says.

Serna and his colleagues also use Static 99R, an actuarial risk assessment tool developed by Karl Hanson and David Thorton. The Static 99R has 10 risk factors for assessing people who have been convicted of a sexual offense. The score of the risk factors characterizes a person’s relative recidivism as below average, average, above average and well above average.

The risk factors are divided into three categories: static, dynamic and acute. The static category refers to risk factors that do not change; the dynamic category notes personality traits or learning deficits that can change with an outside intervention, such as counseling; and the acute category refers to factors that are temporary or that can easily change because of the person’s environment or relationship with others.

According to Serna, static risk factors can include a person’s age, their prior criminal record, their gender and the relationship of the perpetrator to the victim. Dynamic risk factors are ones that can change over time, such as whether the person has any positive life influences, displays impulsivity, has problem solving skills, has an increased sex drive or any deviant sexual interests (such as voyeurism or exhibitionism) or if the person has cooperated with the probation, parole or correctional authorities involved in the assessment and management of their sexual offending behavior.

Dynamic factors, Serna says, can shed light on the person’s motivations to commit a sexual offense. He’s noticed that several of his clients who have perpetrated a childhood sexual offense have a few risk factors in common: a deviant sexual interest or attraction to children, an emotional connection to children or a hypersexual nature.

Clients often tell Serna that they feel they don’t fit in with their peers and that they feel more comfortable doing things that children do, such as playing video games. And a deviant sexual interest in children, he says, is often what allows perpetrators of sexual abuse to give themselves permission to cross social boundaries in order to have sexual contact with someone they know is a minor.

For others, a hypersexual nature plays a part in their motivations. “Some people are pretty indiscriminate” when it comes to sex, Serna notes. They want to have sex with whomever says yes or whomever is available. These clients define themselves by their sexual acts, he says, because it gives their ego a boost and helps them to feel better about themselves.

Although the assessment tool does not consider if the person was sexually abused in childhood or if it is even a risk factor for their behavior, Serna has found that the client’s own childhood sexual abuse can play a role. He has worked with clients who have abused children and tried to justify their actions by saying, “I was abused as a child. I learned to live with it, so I figured my victim would” or “The person is too young; they won’t remember it.”

Serna says other examples of distorted thinking include:

  • “She’s attracted to me; she’s older than her age.”
  • “I needed my sexual needs met. The person was there at the time.”
  • “I’m not going to take the time to find out how old this person is.”
  • “If a girl is able to have her period, she’s good for sex.”

Serna establishes some ground rules with his clients, including having mutual respect, not using objectified language (e.g., sexist or racist slurs), displaying respectful behavior (e.g., not falling asleep during group sessions), respecting the privacy of other group members and completing assigned therapeutic work.

Taking responsibility

Evans, an assistant professor of counseling at Liberty University, says the current treatment for perpetrators of sexual abuse focuses on the management of the offender. “Most programs are victim-centered approaches,” she explains. “The goal of counseling sex offenders is to prevent recidivism, while different acts and regulations pave the way for enhancing public safety and protecting victims through supervision, re-entry, registration and community notification.”

Evans says that sexual deviance (e.g., sexual interests for children over adults, abnormal preoccupation with sex) among people who sexually abuse children is often associated with an increased likelihood of sexual reoffending. “Child sexual offending may be part of a broader pattern of criminal behavior, underpinned by antisocial, impulsive and aggressive tendencies and a lack of empathy,” she notes. “This is why sexual offender counseling focuses on building empathy and taking responsibility.”

A cognitive behavioral technique that Serna uses in counseling is covert conditioning, a therapeutic approach created by John Morin and Jill Levenson. In their book Road to Freedom: A Comprehensive Competency-Based Workbook for Sexual Offenders in Treatment, Morin and Levenson note that covert conditioning helps perpetrators of sexual abuse control their arousal by linking “deviant sexual thoughts with images (pictures in your mind) of some of the terrible consequences of sex offending.”

Serna often asks clients to write a script about the distorted thinking or triggers that might occur before they decide to engage in a risky situation. Then, they write a second script that includes the negative consequences they will experience if they move forward with their desires.

The purpose of this exercise, Serna says, is for clients to attach the triggers for their behavior in risky situations to a realistic consequence, such as being incarcerated or dealing with feelings of shame or embarrassment.

When clients review the scripts repeatedly in group therapy, the recognition of their unhealthy thought patterns and the negative consequences “becomes automatic,” Serna notes. The scripts also include a part that allows clients to create a way to escape risky situations or distorted thinking patterns so they can apply and reinforce interventions with alternative thinking and behaviors, he adds.

People who sexually abuse children need to be aware of triggers, Serna stresses, but it is even more important for them to understand the problematic thinking and choices of their behavior and identify appropriate interventions.

“If they stick with me, they’re going to have a level of responsibility,” he says.

The importance of self-care

Although sexual offense therapy is an important tool in helping to reduce crimes of a sexual nature, it can also take a toll on the counselors themselves. In fact, research has found that mental health professionals who treat perpetrators of sexual assault often need psychological support themselves.

In an article on counseling sex offenders and self-care, which was published in Cogent Social Services in 2019, Evans, along with Courtney Ward, explored the impact of burnout and secondary/vicarious trauma on counselors who work with people who commit sexual abuse, and they found that mental health professionals who do this kind of work often “have a high rate of burnout and stress.”

Thus, “understanding self-care factors that influence well-being is essential,” Evans says.

In the study, Evans and Ward acknowledged that this kind of work can be difficult for some counselors because they are required “to engage in traumatic material in graphic detail while maintaining an empathic relationship with the client.” In addition, they noted that “perpetrators/offenders of sexual abuse are [often] in denial or demonstrate little or no remorse for their abusive behavior, which may exacerbate the impact on the counselor.”

Evans says the detrimental effects on counselors who work with this population can include changes in their self-perception, changes in their thoughts about other people and their environment, problems in personal and romantic relationships, changes in their sexual performance, and depression.

“Personal factors can make a counselor more prone to countertransference,” Evans adds. For example, a counselor who works with this clientele could become more protective of their own children because of the material they deal with in session. If this happens, Evans recommends clinicians seek supervision and feedback on ways to distance their own lives from their clients’ lives, which can also help counselors become more sensitive to the ways countertransference can occur.

Serna says he has managed to remain largely unaffected by the content of his therapeutic sessions with clients who have sexually abused others. He currently leads about 14 to 15 two-hour group therapy sessions per week with clients who have sexually abused children, enticed children, have downloaded/distributed materials online in which children are sexually exploited or have sexually abused adults. Some group members have also abused adults.

Yurta/Shutterstock.com

“If it came to that point [being emotionally affected], then I would know that I can’t do this anymore,” he admits.

Serna says he remains objective and requires clients to reflect on their distorted thinking and feelings because they impact their own lives — not his. “It’s up to the offender to evaluate their own thoughts, rather than me making a judgment about it,” he explains.

With a career that spans 15 to 20 years in the field, Serna has counseled a diverse clientele from the chronically mentally ill to families and adolescents. And he says these experiences have helped him to recognize his own biases and the necessity to lean on his training to maintain a professional distance from difficult clients.

“I’ve learned how to take a step back and be objective,” he says. “I feel like, as a therapist, my role is to be objective.  So, when I hear these things, the only way to help them [clients] is to be objective.”

Serna says he maintains boundaries with his clients by not disclosing any personal information, such as his relationship status or if he has children. And he practices self-care by running three miles a day, playing piano and guitar, drawing and taking art classes in his spare time.

“I think keeping these boundaries permits me to separate my personal and professional life,” Serna explains. “When I am frustrated at work, I know it’s a professional issue and will look [to] the resources I have.”

Serna says if he ever gets emotional because he’s feeling frustrated, he’s trained himself to say, “OK, Pablo, this is becoming your issue now.”

Evans suggests that counselors who want to work with this population be “self-reflective regarding signs and symptoms of burnout and engage in self-care activities for prevention and alleviation.” Some self-care strategies include meditation, mindfulness, journaling and personal counseling — anything that promotes emotional well-being.

Overcoming barriers

Most of Evans’ students have not expressed an interest in treating perpetrators of child sexual abuse, largely due to preconceived notions that most people who commit sexual abuse are predators and highly resistant to treatment, she says. Personal morals and beliefs may also prevent students from choosing to work with this population, Evans adds.

But for counselors who are interested in working with this clientele, Evans recommends they seek training and certifications (such as the National Association of Forensic Counselors’ Certified Sex Offender Treatment Specialists and the Certified Juvenile Sex Offender Treatment Specialists certificates) so they can better help this population. It is also important for counselor educators to prepare students to work with difficult clients, particularly those who abuse children, Evans says.

“I think that most counselors have so much empathy for children, as we all should, and this influences feelings and thoughts related to harm to children,” she says. “This is a positive attribute in counseling, [but] it also greatly impacts services to sexual offenders.”

Perpetrators of sexual assault are often victims of sexual offenses themselves, Evans continues, so she advises counselors to take preventative action by “working with those who have experienced trauma and doing trauma screenings and, if warranted, assessments on each client.” Evans says understanding the client’s lifestyle and private logic is essential in understanding their current behavior and preventing future maladaptive behavior.

“I hope that counselor education can instill [an] understanding of sexual abuse, … not only for the victims [but also for] the motives and proper treatment for offenders,” she says. “This is … the best way to treat the problem [and] to work preventatively.”

 

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Lisa R. Rhodes is a senior writer for Counseling Today. Contact her at lrhodes@counseling.org.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Breaking the silence around the childhood sexual abuse of Black men

By Lisa R. Rhodes August 30, 2022

In October 2019, Tyler Perry, the multimillionaire writer, actor, and movie and television producer, shared painful details from his childhood in an interview with People magazine. “I don’t think I ever felt safe or protected as a child,” Perry recounted, as he explained how his father, who he later learned was not his biological father, routinely beat him with a vacuum cord.

In addition to the physical abuse, Perry disclosed that by the time he was 10 years old, he had been sexually abused by three different men and a woman — all of whom were known by his family. 

“It was rape,” Perry said in the interview. “I didn’t know what was going on or the far-reaching effects of it.”

Perry is not the only Black male public figure to reveal that he was sexually abused as a child. Other Black male public figures, such as gospel singer Donnie McClurkin, have come forward to reveal the harmful impact of this early trauma. Despite these public disclosures, the silence that surrounds the childhood sexual abuse of Black men is deafening. 

“In many homes and social circles, the topic is still avoided — it’s taboo,” says Robin D. Stone, a licensed mental health counselor in New York City and a survivor of childhood sexual abuse. “In some cases, men haven’t shared with anyone that they’ve had this experience, that they have this history.” 

The fact that it is taboo means that Black boys who have been sexually abused rarely, if ever, tell anyone that they have been violated and the silence continues into adulthood. Stone, a member of the American Counseling Association, says the impact of childhood sexual abuse on Black men leaves them with psychological wounds that they learn to “pack away” for years.

The silence surrounding this issue makes it difficult to know how pervasive it is. According to a 2006 study by the Centers for Disease Control and Prevention, about 1 in 6 boys in the United States were sexually abused before age 18. And the Children’s Assessment Center acknowledges that race and ethnicity are key factors, with Black children being almost twice more likely to experience child sexual abuse than white children. 

Rebekah Montgomery, a licensed professional counselor and owner of Dove’s Heart Counseling LLC, a practice with offices in Ann Arbor, Michigan, and Detroit, agrees that sexual assault and any form of sexual abuse are rarely discussed in the Black community.

“You can learn proper coping skills, you can reframe your brain, but it is still going to be something that can trigger later in life,” says Montgomery, an ACA member who counsels Black male survivors of childhood sexual abuse. “When you awaken those sexual feelings as a child, especially before puberty, you develop unhealthy ideas about what sex is and what’s appropriate and not appropriate.”

Building trust and safety

The counselors interviewed for this article all agree that to build rapport with Black male clients, counselors must be willing to engage in direct, honest and open communication, which creates an environment where the men feel safe enough to trust the therapeutic process. 

“I feel when they come [to counseling], they want to say something [about the sexual abuse], but you have to build their trust because they live in a country where — because of the color of their skin — they don’t trust because things have worked against them in very purposeful ways,” says Damion Davis, a licensed professional counselor in Addison, Texas. 

“In some cases, African American men don’t trust counselors who are of a different race than they are because they assume that there won’t be a cultural understanding,” he adds. “If there’s not a cultural understanding, then they don’t feel comfortable disclosing things.” 

Davis focuses on creating a strong relationship with his clients. During the first session, he works to establish trust with his clients by asking them about their family connections, where they went to school or college, and where they grew up. He also allows clients to ask him questions, such as about his credentials and educational background. And he keeps a photo of his wife and daughter in his office to remind clients that he is human.

“It’s about mutual transparency,” says Davis, an ACA member and founder of the Davis Counseling Center PLLC. 

Montgomery says a personal connection is also important in her efforts to build rapport with clients. She discusses the ethics of counseling, confidentiality and her responsibility to ensure a client’s physical and emotional safety with every client who comes into her office. She also lets clients know that during therapy they can express whatever thoughts or feelings they may have.

“My office is a judgment-free zone. All thoughts and emotions are welcome,” Montgomery says. “I like the office to feel comfortable enough for you [the client] to feel the way you need to feel, at least for that hour.”

Montgomery says she is also open to clients asking questions about her credentials and counseling experience. “They want to know they’re in good hands,” she says. “They need to get to know me just as well as I need to get to know them.”

Counselors should also acknowledge if there’s a gender or racial/ethnic difference between the counselor and client, advises Stone, owner and founder of Muse and Grace Mental Health Counseling Services in New York City. Acknowledging any differences upfront can help create a safe space for male clients to share their experience or to ask the counselor questions, she explains.

“If there’s an elephant in the room, talk about it,” she says. “It’s there whether you name it or not.” 

Montgomery recommends counselors “take on the role of an expert learner” when providing treatment for clients of diverse backgrounds. “You have to be aware enough to listen and learn and apply your therapeutic techniques on a case-by-case basis,” she says. “It has to be an equal exchange of awareness, growth and learning to make it comfortable and [to] help them feel comfortable in the therapeutic environment.”

Disclosing the abuse

The results of this early trauma can lead Black men to seek counseling — but for reasons other than sexual abuse. Montgomery says some of the reasons why Black men come to her practice include anger management, depression, anxiety and sexual dysfunctions. Clients may come to counseling because they were caught looking at pornography while they were at work and are in danger of losing their jobs or because they’re having intimacy problems with their wives, she adds. 

Although these symptoms can often be traced to childhood sexual abuse, many men are often unaware of the origins of their problems, Montgomery notes. “During the therapeutic process, experiences with sexual assault emerge and often get identified as a feasible cause of their mental and emotional concerns,” she says.

The counselors interviewed for this article say a client’s reaction to the realization of childhood sexual abuse can result in a tacit attempt to accept the trauma, conflicted feelings about the experience, doubts about their intrinsic worth or concerns about their sexual orientation.

“Sometimes it’s a confirmation,” Montgomery says. “They’ve already been kicking around the idea. They never thought of it [the trauma] as being [sexual] abuse, but after we confirm that they were sexually abused, they say, ‘Yeah, I kind of figured it.’”

Montgomery says confirming childhood sexual abuse often starts with asking clients how the experience made them feel. “Most Black men recognize that the sexual abuse can cause conflicting feelings,” she says. “At the time of the abuse, they may have been conflicted by their physical enjoyment and the emotional toll the abuse left.” 

“Most men never disclose their sexual experiences, so we explore the unspoken rule of keeping the abuse a secret,” she continues. “We explore [state] laws that define sexual abuse/assault, including the age of consent, the difference between molestation and rape, and [the] potential consequences for someone who sexually abuses children.” 

Davis, a clinical assistant professor of counseling at Southern Methodist University, says he is often the first person his clients have told about their abuse. “It’s really hard [for them] to accept the fact that the abuse happened because it leads to feelings of low self-esteem, inadequacies and, of course, anger,” he notes. “They feel this way because being sexually abused for them is very emasculating. It makes them question their manhood. A lot of people, but definitely Black men, like to feel a sense of control.” But when the abuse happened, they felt they had no control over their circumstances, Davis says. 

It’s OK to express emotion 

Counselors may first have to help Black men understand that they are allowed to have feelings and emotions about the experience. Stone, author of No Secrets, No Lies: How Black Families Can Heal from Sexual Abuse, notes that boys, particularly Black boys, are raised to believe that expressing emotions and anything other than the binary feelings of anger/happiness or weakness/strength is not allowed. 

The taboo about childhood sexual abuse is so persistent because “many boys continue to be socialized in ways that leave them little room to be vulnerable and to express vulnerability,” Stone says. “If they aren’t able to access their feelings, they struggle socially and grow up to be men who struggle socially.”

Montgomery notes that hiding or suppressing emotions has been a survival strategy for African Americans, especially boys and men. Historically, expressing feelings or emotions carries a serious threat of violence and death — from lynching to being shot or killed by the police, she says. 

Montgomery learned that Black men can put up a wall of defense against feelings and emotions when conducting research for her doctoral dissertation, which explored connections between the low use of professional mental health services by Black men in the inner city and their exposure to chronic trauma.

“I was pretty shocked by the results,” she says. All 10 of the men she interviewed for the study recognized that they had experienced some form of trauma, such as police brutality, violence and the implications of racism. But they did not consider how being guarded toward others, expressing pent-up anger, being defensive or declining to address mental health issues such as depression or anxiety can be a problem, she says. 

Montgomery says the men responded to the trauma by developing a “coat of protection” that served as a valuable tool for survival. And she says she sees this same “coat of protection” in Black men who have survived childhood sexual abuse. Her study reinforces the importance of helping this clientele to express and process their feelings and emotions. 

When clients have a hard time expressing how they feel about the abuse or don’t know what word or words may fit what they are thinking or feeling, Montgomery asks them to do a Google search for “feeling words” on their smartphone, and then together they explore educational websites (such as psychpage.com/learning/library/assess/feelings.html) that list different feeling words, along with charts and pictures, to help them define the word or words that best describe their emotions or feelings. 

Some clients have a limited vocabulary to describe their feelings, Montgomery says, and this exercise helps them overcome that by increasing their vocabulary and awareness about the complexity of emotions. For example, they learn that sadness can also be described as disappointment, and someone who is mad may be resentful. And it reminds clients that “they have emotions and feelings and its OK,” Montgomery adds.

“We spend time identifying emotions and giving them a name,” she continues, “and we try to find the word that best fills in the blank” of how they feel about a situation or experience.

After selecting a word from the list, discussing its meaning and talking about whether it matches their emotions or feelings, clients can say, “I’m feeling disrespected right now” or “I’m feeling jealous right now.” And once clients can correctly name what they are feeling and understand its meaning, they will “always know what that feeling is in every situation,” including experiences from their past, Montgomery says. 

Monkey Business Images/Shutterstock.com

She also recommends using trauma-focused cognitive behavior therapy (TF-CBT) with this population. Although TF-CBT is typically used with clients who are under the age of 18, she says these techniques can also be beneficial for Black men who have experienced childhood sexual trauma because it will help them learn healthier ways to cope with the trauma. This approach allows them to process their feelings and emotions rather than avoid them, reframe thoughts and behaviors resulting from the trauma, develop new behaviors and skills that bring a more desired or healthier outcome, and create healthy relationships, she explains. 

Stone says that incorporating poetry and bibliotherapy into treatment can also help survivors process emotions. She often uses James Pennebaker’s expressive writing framework with clients who have experienced trauma. “His research shows that expressive writing helps to ease psychological and physical symptoms related to trauma and other disturbing experiences,” she notes.

This framework asks “the client to write their deepest emotions and thoughts about a disturbing experience for 15 to 20 minutes a day over four days,” Stone says. “I then invite them to reflect on what they wrote (not necessarily to share it with me) and to consider how what they wrote makes them feel, where they feel it in their body and what, if any, changes they may want to make in the way they think or in the way they are living.”

To help clients connect to a fuller spectrum of feelings, Stone also has clients practice connecting their experiences to feelings and then their feelings to bodily sensations. She uses a feeling wheel, similar to the one developed by Gloria Willcox, to help clients explore what their body feels like when they experience certain emotions such as insecure, embarrassed, bored or proud. This helps the client identify feelings and “become more fluent” in expressing how they feel, Stone explains.

Davis recommends counselors normalize clients’ feelings of anger, shame, guilt or embarrassment about the abuse. Normalization, he explains, helps to break down the stigma  associated with being a survivor of child sexual abuse. “It helps them to know that they were victimized, but they are not victims,” he says.

Counselors need to affirm these clients, Davis says, and let them know they can work through the trauma of the experience and deconstruct some of the negative stigma that is tied to being a Black man who was molested. 

“I tell them [clients] how they feel is appropriate because someone has taken advantage of them and together, we’re going to build them up from there,” he says. “I let them know they’re not the only man who has gone through this. … I remind them that the worse part of what they’ve gone through is over. They are in recovery mode.”

Reframing the narrative 

Davis uses narrative therapy to encourage clients to tell their own story about the abuse. This approach, he says, can help clients “define the trauma in their own words and control the details of it.” He says it’s not necessary for him to know the exact details of the sexual act, but it is important to hear the client’s story because survivors attach meanings to the experience and to the abuser.

“Many times, they don’t realize that the meanings they have attached are very negative and they assign it to themselves. They don’t assign it to the abuser,” he notes. So he works with clients to help them explore the meanings they have attached to the experience, and together they begin to pull away the layers so clients can see what happened to them without assigning negative thoughts and feelings to themselves.

Davis also encourages clients to “think about their thinking” and “put negative thoughts on trial.”

He once worked with a client in his 30s who was molested by another man when he was a teenager. When disclosing the abuse, the client said, “I should have known better.” 

Davis helped the client put that thought on trial. They discussed how the client felt sad, embarrassed and angry at himself because he thought he should have known how to prevent the abuse. Davis then asked him, “What evidence do you have that this thought is true?” 

Davis also asked the client to image a child who is the same age he was when the abuse occurred and if he would blame that child for being sexually abused by someone they trusted. The client said he wouldn’t blame that child. So Davis asked, “But you blame yourself?”

Reframing the issue in this way, Davis recalls, helped the client consider alternative truths about his own abuse and realize he was being unfair to himself in his thoughts and feelings about the abuse. 

Montgomery says she tries to reframe unhealthy behaviors in her work with clients who have been sexually abused. One client, in his late 40s, came to see Montgomery because he was angry and didn’t know why he felt this way or how to process those feelings. The client did not recognize that he had been sexually abused as a child or that his feelings of anger were due to the death of his abuser, she says. 

This particular case was complex, Montgomery continues, because the client grew up in an environment wherehe was exposed to women in the adult sex industry, and from the time he was a teenager, some of these women routinely had sex with him. Crime and violence were also a part of his environment, which compounded the trauma, she adds.

Montgomery learned that he had also been abused by a female family member, but he viewed all of these sexual experiences as a “rite of passage” into manhood. Montgomery says the client told her that he’d had sex with “hundreds of women,” but he did not recognize that legally he had been violated by his female sex partners. 

Black men often have a hard time seeing being abused by a woman as sexual assault or rape, Montgomery explains. “If you’re sexually abused by a woman, it’s like, ‘Congratulations! Good for you,’” she says. 

Hypersexual behavior can be a response to the trauma of being abused as a child and it can lead to unhealthy behaviors if not addressed, Montgomery notes. This particular client did not understand how years of indiscriminate sex with multiple partners as a youth was an unhealthy behavior that posed a danger to his well-being, she says.

Montgomery used psychoeducation with him to discuss the risks of hypersexual behavior, such as sexually transmitted infections, pregnancy, emotional baggage from multiple partners and problems with true intimacy in relationships.

Montgomery and the client also focused on harm reduction in session. She says they discussed what needs the client felt were being met when he had the desire to have sex with multiple partners and how he could meet those needs in another way. The client decided that when he felt the need for attention or to be loved, he would choose to have sex with only one or two partners rather than multiple women, go the gym or shooting range, or spend time with his children. 

The goal, she says, was to redirect the client’s energy from unhealthy behaviors to more positive choices. “We tried to help him tie his emotions to his behavior,” she explains, and to change that behavior so he wouldn’t cause harm to himself or others. 

Counselors may also have to help Black men who were sexually abused by a man process their feelings and emotions around their own sexual orientation. Because of negative stereotypes associated with homosexuality within the Black community, some Black men “may feel like their manhood was tainted because of what happened to them,” Davis says. Cognitive restructuring and psychoeducation about sexual orientation, he notes, can help clients articulate what their sexual desires are and learn that they, not the sexual abuse, define their sexuality. 

He also tells clients, “An experience that happened to you, that was not your choice or free will, doesn’t define your sexual orientation.” 

Reclaiming power 

Disclosing childhood sexual abuse can also result in victim blaming or self-blame, Stone notes, and blame can even come from peers or family members. There’s often the belief that the survivor “should have done something” to prevent the sexual act or in response to the abuse, she says. 

Stone advises counselors to help clients think about what it meant to be small and/or vulnerable and how much “social capital” they or the people who perpetrated the abuse had in their family or community. “I use ‘social capital’ to speak to the extent that one is known and trusted and has influence in a social dynamic, such as a family,” she explains. 

Boys are most often abused by someone who has social capital in the community, such as a coach, minister or family friend, Stone says. She suggests counselors discuss how much power or social capital the client thought they had in the situation by asking them, “Who do you think would have listened to you? Who might have taken you seriously? Who do you think would have been on your side if you had told them what had happened to you?”

Counselors can also acknowledge the strength it took for the client to survive the sexual abuse and to seek counseling, she adds. “It’s a radical act of self-care” to seek professional help, Stone notes, and counselors need to say so.

Davis says the low self-esteem that clients experience can also lead to feelings of fear and anxiety. “You feel you’re always on pins and needles because you’re waiting for the next thing to happen to you,” he explains. 

Davis uses imagery exercises and reframing thoughts to help men break from a victim mentality and reclaim their power. Approaching it this way allows clients to learn to “separate themselves from what happened to them,” he says. “I have them imagine who they were when the abuse happened, and I have them imagine who they are now, standing by that person.”

He also helps clients understand that because they were children when the abuse occurred, they couldn’t protect themselves. He then asks clients, “What are you and I going to do now to protect that 12-year-old you?” This question, Davis says, can lead to a discussion on ways the client can create healthy boundaries and a sense of safety so they aren’t afraid they will fall victim to sexual abuse again or be taken advantage of by others. 

“Many times, when a person experiences trauma, they get stuck there,” Davis says. “But I help them by reframing their thoughts and [bringing them] to the present day.”

Reaching out to black men

The counselors interviewed for this article all agree that the profession can do more to encourage Black men to come forward and seek mental health treatment. Montgomery suggests that counselors of diverse backgrounds and specialties advertise the fact that they treat people from marginalized groups and that they specifically treat men who have survived childhood sexual abuse. 

The Black men she interviewed for her doctoral study suggested some possible ways to improve the Black community’s access to mental health support services that she says can also apply to outreach efforts concerning sexual abuse for all Black men, particularly boys. These solutions include promoting the idea of positive mental health services in elementary schools; normalizing discussions about mental health, sexual abuse and other traumas; providing interventions for coping with and calming emotions early in life; and encouraging and normalizing help-seeking behaviors.

Counselors need to be “in places where Black men are,” Davis stresses. He plays in a basketball league with other Black men, and because many of them know that he is a counselor, they sometimes ask questions about mental health issues. When they do, he connects them with other mental health professionals who can help them. Davis also suggests clinicians reach out to universities and colleges, Black Greek fraternities and Black churches to find and connect with people who may be in need of counseling services. 

The counseling profession should reach out to Black men, he says, instead of waiting for this clientele to “reach out to us.”

 

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Lisa R. Rhodes is a senior writer for Counseling Today. Contact her at lrhodes@counseling.org.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Restoring relationships with survivors of human trafficking

By Lindsey Phillips August 4, 2021

Jenna Hershberger, a licensed associate professional counselor, was working on a crisis response team for a regional human service center in North Dakota when she received a call from a young woman reporting physical abuse. The woman was forthcoming about her medical complaints but not the state of her mental and emotional health. Hershberger could tell there was more to the woman’s story, so she asked to meet her in real life to discuss things further. The woman agreed.

During their in-person meeting, Hershberger, a therapist at the Village Family Service Center in Fargo, North Dakota, noted signs of potential sex trafficking. “Her presentation was really concerning. She was very tearful,” Hershberger recalls. The woman also kept mentioning how her “friends” had forced her to do things while she was under the influence of substances. The more the woman shared, the more convinced Hershberger grew that the people being referenced were human traffickers, not friends. When Hershberger asked where the woman was staying, she revealed that she was currently homeless.

After talking for a while, the woman finally acknowledged that she had been forced into sex trafficking and wanted to get out. She was scared and didn’t know what to do. Fortunately, Hershberger did. She found the woman a safe shelter for the night and helped her locate mental and physical health services.

“I’m in North Dakota … [where] prevalence rates [of human trafficking] are lower, yet it’s still happening,” says Hershberger, a member of the American Counseling Association. “The tragedy where I am and in Midwestern, rural areas is that people just seem to say, ‘Well, this doesn’t happen here.’”

Jared Rose, a licensed professional clinical counselor and supervisor with a private practice, Moose Counseling and Consulting LLC, in Toledo, Ohio, has also encountered a “that doesn’t happen in my community” mentality when it comes to human trafficking. He began working in anti-trafficking about 15 years ago when someone involved in an anti-trafficking organization in Toledo approached him because of his work with the LGBTQ+ community and with people infected with, affected by or at risk for contracting HIV, both of which often intersect with trafficking. When conducting trainings in rural Ohio counties, Rose has heard law enforcement say, “That’s not happening here.” This statement makes Rose cringe because he knows firsthand from his work with individuals who have been trafficked that it is happening.

Human trafficking, in fact, is more common than we think. The International Labour Organization reported that approximately 40.3 million people were in modern slavery globally in 2016. Sometimes people incorrectly assume that human trafficking is a problem only in developing countries, but the National Human Trafficking Hotline identified 63,380 survivors of human trafficking in the United States from 2007 to 2019.

Rose, an ACA member who wrote an ACA fact sheet on human trafficking awareness for school counselors in 2019, finds that too many counselor clinicians also remain unaware of the definition and signs of trafficking. “You could have the epitome case sitting in front of you,” Rose says. “And if you don’t even know what trafficking is, you’re going to miss it.”

Recognizing the Signs

The U.S. Department of Homeland Security defines human trafficking as the use of force, fraud or coercion to obtain some type of labor or commercial sex act. Rose, an assistant professor of counseling at Bowling Green State University, advises counselors to stay alert to signs of force, fraud or coercion with clients. “Take note of who they are with and where the power and control lie,” he says. For example, is someone else benefiting — often financially — from the client’s actions? Does someone else seem to be in charge or making all the client’s decisions for them?

Hershberger, a doctoral candidate in the counselor education and supervision program at North Dakota State University, also looks for visual signs such as bruising, scarring or branding. Individuals who are being or have been trafficked are often branded with “ownership” tattoos with the name of their trafficker or with symbols such as a star or cowboy hat. Because sex acts place a lot of strain on the body, survivors often discuss medical complaints such as dental issues, migraines or urinary tract infections, she adds.

Clients who have been trafficked “may appear overly compliant and submissive, or they might appear really abrasive and abrupt,” Hershberger points out. Counselors must recognize “that those strategies were adaptive at one time but they’re not right now.”

As it relates to falling victim to trafficking, Rose notes that the No. 1 risk factor for children is being unhoused. He prefers the term unhoused to runaway, he explains, because children are often abandoned or “thrown out” by their families. “Within a matter of two to three days of being out of the home, kids are approached [by traffickers], and one-third of those [unhoused] kids are going to get trafficked,” he says. “So, that piece of being unhoused — couch surfing, staying at a shelter, living on the street or whatever the case may be — puts them at significantly higher risk.” Children who are already vulnerable may easily fall prey to an adult who shows them attention or what they initially perceive as support, he adds.

Other risk factors include lower socioeconomic status, past trauma (sexual, physical, emotional, verbal or spiritual), being differently abled, substance use, and belonging to a racial or sexual minority group, Hershberger says. Given the complex trauma that these individuals experience, they often present with comorbid disorders such as substance use, bipolar and severe depression, she notes.

Counselors may overlook or miss signs of trafficking when they take the client’s circumstances or presenting issues at face value, notes Paige Dunlap, an associate professor of counseling at North Carolina Agricultural and Technical State University. For example, if a client is homeless or doesn’t have any identification, counselors may start to talk about the emotions, behaviors and social systems surrounding the client’s chronic homelessness and help them come up with a plan to find a more stable environment. But in doing this, clinicians may miss the larger picture, stresses Dunlap, a licensed clinical mental health counselor with a private practice in Greensboro, North Carolina. Perhaps the client was forced into sex trafficking after being taken from their home or fleeing an unsafe environment.

“There’s a lot of different risk factors. There’s a lot of different things to look for. There’s a number of populations that we are particularly concerned about, but at end of day, it all boils down to vulnerability,” Rose says. For that reason, he stresses that counselors need to be cognizant of that vulnerability piece in connection with their clients.

Sometimes counselor practitioners worry that they won’t be able to recognize the signs that someone has been trafficked, Rose says, but he reassures them they know how to read interpersonal reactions. They know when someone is looking to another person for answers. They notice when people’s stories do not match up.

Counselors also need to consider what a trafficking survivor might look like in their particular clinical setting, Hershberger says. For example, if a counselor is doing crisis work, they might have someone who is in denial about being trafficked or confront a situation that appears to be domestic violence.

The office setting may determine the likelihood of a practitioner encountering an individual who is currently being trafficked or who has gotten out. Counselors who work in public health settings or hospitals are more likely to see individuals who are currently being victimized when these individuals come in for a medical issue such as testing for a sexually transmitted disease or injury from abuse, Rose notes. Counselors working in private practice or at a community agency will typically see these clients after they have been extricated, he says.

Establishing trust and safety

People who have been trafficked may find it difficult to trust others. Before thinking about clinical treatment plans, counselors need to establish a sense of safety and a healthy therapeutic rapport with these clients, Hershberger stresses. These individuals have experienced “complex trauma in the sense that it’s repeated for long duration and often comes from people who should be caregivers,” she explains, “so it makes it really hard for survivors of trafficking to trust us. We need to be really authentic because survivors will pick up on it if [we’re] not.”

Hershberger, president of the North Dakota Association for Counselor Education and Supervision, advises clinicians to maintain an open-door policy with survivors of human trafficking, especially when they are working on engagement with the client. People who are dealing with significant trauma may be more prone to canceling sessions, so adhering to a policy of termination after two missed sessions will not help build engagement and rapport with these clients, she cautions.

Counselors’ innate desire to help clients heal can sometimes be an impediment to build-ing this relationship. Rose sees counselors who want to dive right into the trauma work before first building strong therapeutic and strategic foundations, which can take a long time. “The minute we try to push too much — even if our best intentions are there — is when someone can have [a negative] reaction” and feel that the counselor is forcing them to do something they don’t want or are not yet ready to do, he says.

Rose has also witnessed the inverse: clients who get frustrated when counselors don’t jump straight into the trauma work. When this happens, he explains to clients that although they may feel ready, their whole system may not be. To further illustrate the point, he compares trauma work to a physical wound: “If I start poking around at a wound and you don’t trust me yet or your entire system isn’t ready to allow that yet, you’ll immediately pull back and you’re not going to want me to go near it,” he tells clients. “And the same [thing] is happening cognitively and emotionally with trauma. If we start poking around and you’re not ready, then it’s going to fall apart on us.”

The need for clinical trauma care

Rose asserts that counselors are in a prime position to provide clinical psychotherapy and trauma-focused work. Rose is an executive member of the Lucas County Human Trafficking Coalition, and he was awarded the Social Justice Leader Award from the Human Trafficking and Social Justice Institute in 2017.

Mental health services geared toward survivors of trafficking are great at managing clients’ symptoms through art or expressive therapy or group work, but Rose finds this is often where their treatment ends. “It has to be more. It has to be evidence-based trauma work,” he stresses. “We can’t just treat symptoms. We have to treat the whole person, and we have to treat the trauma.”

“Folx that have been labor trafficked have all sorts of layers of trauma damage. … Sex traffic victims have all of the symptoms of domestic violence, emotional abuse, physical abuse, sexual abuse — all rolled into one very unpleasant package,” he continues. “And expressive therapy is not going to treat that trauma; it’s going to treat the symptoms. If we really want to help folx, we have to go deeper, and that’s where counselors really need to come into play.”

Rose, a certified therapist in eye movement desensitization and reprocessing (EMDR), recommends that counselors use an evidence-based trauma treatment that follows a triphasic approach that a) establishes a foundation, b) reprocesses and works through the trauma and c) plans for the future. Rose often uses EMDR when he’s working with this population because he finds it helpful to treat the root cause of the trauma. He also recommends trauma-focused cognitive behavior therapy, especially when working with children and adolescents.

Take the relational approach

Hershberger points out that traffickers differ from other sexual offenders (who are often described as socially awkward and desire a sense of belonging) in that they are often socially intelligent, charismatic and good at forming relationships. They gain the trust of vulnerable individuals by initially fulfilling their need for love, connection and belonging, she explains. For example, the trafficker could be the first person in the individual’s life to recognize and celebrate their birthday or give them special attention, such as taking them to get a manicure.

These acts can cause some survivors to form bonds with and defend their traffickers — a condition often referred to as Stockholm syndrome. Hershberger and Dunlap point out that something similar sometimes happens with individuals who experience domestic violence. “Survivors will often defend their trafficker because they didn’t have that sense of belonging or that family growing up. So, this is the first time they’re experiencing that — along with horrible kinds of trauma — but it’s hard for them to differentiate that,” Hershberger explains.

According to Hershberger, these trauma bonds illustrate survivors’ desire for human connection. Traffickers thwart this connection by exploiting this desire for their own gain.

“Human sex trafficking is the ultimate anti-relationship,” argues Hershberger, who recently presented on this topic at ACA’s Virtual Conference Experience. Survivors of sex trafficking have been forced “to exist in a world absent of authentic, growth-fostering relationships,” she explains. Thus, she recommends that counselors use a relational-cultural approach with this client population to foster an authentic growth-fostering connection.

To explain this approach, Hershberger presents Marie, a fictional client: When she was 14 years old, Marie lived in an abusive home where her mother’s boyfriend molested her. So, Marie was excited when Jake, a 24-year-old man, approached her and promised a better life as his “girlfriend.” He bought her nice things and told her she was “amazing in bed.” One day, he told Marie some money hadn’t come through at work and asked if she would help him by having sex with a few guys. When she resisted, he beat her until she complied. He forced her into sex trafficking, and she was having sex with as many as 10-15 men a night. (See Hershberger’s 2020 article, “A relational-cultural theory approach to work with survivors of sex trafficking,” published in the Journal of Creativity in Mental Health, for a more detailed discussion of this case study.)

Following a relational-cultural framework, Marie’s counselor first establishes a sense of safety and trust, and they are authentic, empathetic and consistent in their interpersonal interactions, Hershberger says. So, if the counselor makes a mistake by showing up late for session, they own that mistake, apologize and ask Marie how they can make up for it.

Marie may have internalized negative beliefs or self-blame such as “I’m only good for my body and others’ use” or “I’m not worthy of being loved.” The counselor can help Marie first identify and name these beliefs, and then they can work together to challenge these negative beliefs. The therapeutic relationship further challenges Marie’s distorted thinking about herself and relationships, Hershberger notes, and models what a healthy relationship entails.

To challenge Marie’s belief, the counselor could use self-disclosure and tell Marie, “I experience you as a creative, confident individual who is worthy of being loved.” Hershberger recommends that counselors use the client’s own words when reflecting positive attributes to help the client identify and own their strengths.

As Hershberger points out, traffickers try to keep victims in a constant state of uncertainty about their environment, safety or identity. So, the counselor’s role is to identify moments or thoughts that are unclear, such as Marie’s negative perception of her self-worth, and help her add clarity to them.

Hershberger names bibliotherapy and narrative therapy as useful approaches for empowering survivors of trafficking and helping them find their own voice. For example, the counselor could ask Marie what name her trafficker gave her and the name she wants to use moving forward. Then, Marie could journal about this new identity and the qualities associated with it.

The counselor could also add in creative techniques such as collage or relational imagery. For example, Hershberger once had a client who identified with the image of a wounded deer because they too had been hurt and abandoned. The wounding paralleled their own trauma around the physical abuse they had experienced while being trafficked. Later, Hershberger used this image to help the client think about what they wanted their future identity to be and to create a collage of their strengths.

The therapeutic relationship becomes a healthy relationship — one that is safe, dependable and empowering and that counters the disconnection and uncertainty survivors experienced when they were trafficked, Hershberger says.

Preparing to work with this population

The best way to understand what is going on with human trafficking in a specific area is to get involved and volunteer in the community, Rose says. One place to start is joining or attending meetings of local, regional or state trafficking coalitions and task forces. “You can learn more about what agencies are providing services for this population,” he says. “They need to know where mental health providers are, and you need to know where additional services are for survivors.”

Rose advises counselors to approach these partnerships with an attitude of wanting to learn and help. Communities don’t respond well to people who think they know what is best or have all the right answers, he says. Instead, inform these organizations of the crucial skills they may be missing. Counselors have “the clinical piece that a lot of these places need and strive for,” Rose notes. “There’s a lot of social workers, nurses and different helping professionals, but clinical mental health treatment may not be what they have.”

In addition to attending monthly meetings of North Dakota’s trafficking task force, Hershberger prepared to work with this population by reading case examples and familiarizing herself with these tough stories. She also reached out to other clinicians in the field to hear about their experiences. As she points out, “It’s one thing to hear terminology, but it’s another thing to hear somebody’s story.”

Rose and Dunlap recommend that counselors limit their caseloads (if they have that option) when working with this population. “You can’t hear the thing of nightmares for three, four or eight hours a day and expect to be OK by 6 or 7 o’clock at night,” Rose says. Both he and Dunlap, an ACA member who researches and works with youth with disabilities, survivors of human trafficking and criminal populations, have had to learn how to balance their clinical schedules better. They intentionally leave time between these difficult sessions so they can reflect, reenergize and regroup before seeing their next client.

Counselors must also remember that not every client-counselor relationship is the right fit, Rose says. For example, someone may refer a female survivor of sex trafficking to him because of his expertise in EMDR, but if she has been abused by men her entire life, she may not want to work with Rose regardless of his qualifications and reputation as a counselor.

“These clients have had people treat them really poorly their entire lives,” he points out. “Part of that therapeutic relationship is recognizing maybe I’m not the best counselor for every person I want to help, and that’s OK. Just giving [clients] that freedom and autonomy will help them along in their journey. They don’t have to work with me to fix the problem.”

Rose reminds counselors there are other ways to help serve this population without working directly with clients. Counselors can get involved in local agencies that work on human trafficking, provide education and trainings, or work on prevention, he says.

Hershberger understands how difficult it can be when counselors must refer a client. Because she was part of a crisis response team when she met the woman who was a survivor of human trafficking, she wasn’t able to continue working with her. The woman was referred to another clinician who worked for the human service center. “That was hard,” she recalls. “I couldn’t stay with her, and having that continuity of care would have been nice.”

Hershberger did have a chance to meet with the woman a few months later. With the help of her new counselors, she was making progress toward creating healthier relationships.

fizkes/Shutterstock.com

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Working with perpetrators of human trafficking

Paige Dunlap, a licensed clinical mental health counselor in Greensboro, North Carolina, once worked with an agency in Detroit that assisted individuals who no longer wanted to be engaged in gang activity. In sharing their stories, some of the group members disclosed that they had been directly or indirectly involved in trafficking other individuals. After recovering from the initial shock of hearing that, Dunlap started to think and educate herself about ways counselors could help perpetrators of trafficking.

“We as counselors don’t really talk about this hidden population” of perpetrators, she says. “We don’t know too much about them.”

Often people’s biases can cloud their judgment about these individuals. The more Jenna Hershberger, a licensed associate professional counselor in Fargo, North Dakota, researched and worked with cases of sex trafficking, the more she discovered the dichotomous thinking attached to it: People consider traffickers to be “bad” and survivors to be “good.” But it’s more complicated than that, she says.

“In the literature, we see that traffickers and survivors experience the same kinds of childhood traumas, such as sexual, emotional, physical and spiritual abuse,” she explains. But for individuals who become traffickers, “there is a distortion that happens in the way that they respond to the trauma.” Hershberger, a doctoral candidate in the counselor education and supervision program at North Dakota State University, acknowledges this is an area of research that mental health professionals do not fully understand yet. But initial clinical findings, as well as Hershberger’s own professional experience, indicate that traffickers often seem to have empathy deficits and endorse trafficking myths such as “people like this way of life.”

Dunlap, an associate professor of counseling at North Carolina Agricultural and Technical State University, says that traffickers and victims of trafficking often get enmeshed in that world for similar reasons. “There is a need for belonging in all of these individuals,” she says. Both groups often lack support systems, have limited work opportunities and are tempted by the promise of a “better” life, she explains.

Once individuals get involved in trafficking, it becomes difficult for them to leave, Dunlap points out. “It becomes almost an institutionalization for them too. … They don’t know how to function outside of that.”

“Getting those individuals into your office to do this hard work is really going to be tough,” she admits. “If you’re a counselor and you do happen to have these clients, the last thing they need is for your own biases to be stopping them from getting help, because they’re doing good just to be there.”

Hershberger hopes counselors continue to research ways to better help both the survivors and perpetrators of human trafficking. In doing so, she encourages counselors to consider a larger question: How as a society are we creating spaces in which people don’t know what a healthy relationship looks like so that they’re seeking out this subculture for a sense of belonging?

 

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Lindsey Phillips is the senior editor for Counseling Today. Contact her at lphillips@counseling.org.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Supporting disclosure for adult male survivors of child sexual abuse

By James M. Smith and Adrian Warren June 9, 2021

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?”

Tissen/Shutterstock.com

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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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Counseling survivors of sexual violence

By Amy E. Duffy November 4, 2019

After spending more than 14 years in the mental health field working with a variety of populations, including gang-affiliated youth, adults with chronic and persistent mental illnesses, combat veterans, and survivors of human trafficking, I am struck with an inescapable theme: Sexual violence plagues every facet of society. Sexual violence does not discriminate, regardless of demographics.

As a counselor, I entered this field to become a helper and to become a part of something bigger than myself. Fred Rogers could not have said it any better: “Look for the helpers. You will always find people who are helping.” This sentiment still rings true in my heart, but one thing the mental health field has shown me is that helping sometimes requires us to combat the systemic and institutionalized injustices that are prevalent in our society.

I recently found myself in a counseling session with a college-age cisgender female who was displaying feelings of hopelessness, crying profusely, and asking me “Why?” She was directly asking me why — after her sexual assault and after exercising every legal right available to her — the system was failing her. I was apologetic for her experience, but I found myself at a loss for words. She was correct; the system was failing her. Our society and our legal system have justice gaps that are expansive. I couldn’t think of an answer I could provide in that moment that would address her feelings of hopelessness.

In subsequent months, as I became aware of similar scenarios playing out with other clients, I began to feel both compassion fatigue and burnout begin to take root. As I’ve mentioned, my intention as a counselor is to help, and I felt that I was not helping enough. I know trauma and its associated treatment modalities like the back of my hand, but that didn’t mean I was doing my part to address the gaps in justice or systemic and institutionalized inequalities that were drastically affecting my clients and their shared experience with sexual violence.

Professional counselors cannot ignore the reality that 1 in 3 women and 1 in 6 men report some form of sexual violence over the course of their lifetimes (according to the National Intimate Partner and Sexual Violence Survey 2010-2012 state report). The Thomson Reuters Foundation conducted a survey in 2018 that concluded that the United States was the 10th most dangerous country for women among the 193 member states of the United Nations; it tied for third among nations where women were most at risk for sexual violence. The foundation defined sexual violence as “rape as a weapon of war; domestic rape; rape by a stranger; the lack of access to justice in rape cases; sexual harassment; and coercion into sex as a form of corruption.” Unfortunately, I have personally borne witness to each of these definitions of sexual violence while working in the mental health and counseling fields.

Given the epidemic of sexual violence, both domestically and globally, it is impossible for counselors to avoid contact with individuals who have survived such violence. To date, counselor education programs do not have a reputation for providing an adequate and thorough understanding of practices for working with this population in their curricula. In addition, progress in the field of sexual violence has been negligible, partially due to the significant gaps in research necessary to better inform prevention, policy and advocacy efforts. These absences of vital counseling resources triggered my desire to explore the Multicultural and Social Justice Counseling Competencies (MSJCC) in search of a plausible answer to this dilemma.

The MSJCC

The MSJCC, developed by Manivong Ratts, Anneliese Singh, Sylvia Nassar-McMillan, S. Kent Butler, and Julian Rafferty McCullough, recognize that individuals are part of a larger ecosystem in which privilege and marginalization coexist. The MSJCC provide a framework to best support survivors of sexual violence not simply on the intrapersonal level, as addressed within treatment models and counseling strategies, but on all socio-ecological levels, through advocacy and action. The MSJCC emphasize the importance of understanding individuals in the context of their social environment while advocating for social justice within that social environment.

In addition, the MSJCC framework acknowledges the need for understanding the complexities of diversity and multiculturalism within the counseling relationship, as well as recognizing the negative influence of oppression on mental health and overall well-being. This framework reinforces the need for counselors to recognize and uphold the reality of intersectionality, in which the various social constructs of race, ethnicity, gender, sexual orientation, economic status, religion, spirituality and disability contribute to a client’s unique worldview, experience and existence as a human being.

When counselors partner with survivors of sexual violence, both the counselor and the client need to recognize the roles that privilege and marginalization play in sexual violence and within the counseling relationship. Effective treatment and long-term healing cannot exist without this mutual understanding. The reality is that victim-blaming, rape myths and gender inequality are persistent elements in American culture and globally; these cultural characteristics constitute what is known as rape culture. Victim-blaming is the extent to which society holds victims of sexual violence responsible for their own victimization, whereas rape myths are stereotyped false beliefs regarding rape, survivors and perpetrators.

Within rape culture, the survivor is marginalized while the perpetrator is privileged, most commonly due to gender. The privilege of gender is then further extended and embedded into society within systems and institutions that protect the perpetrator. These systems and institutions are built upon the foundations of victim-blaming, rape myths, and gender inequality. For example, states such as North Carolina still have laws that blame the victim and support rape myths. These laws include the inability of a person to withdraw their consent to engage in sexual intercourse once consent has been provided. In addition, a person who voluntarily consumes alcohol and then is sexually assaulted is not protected under North Carolina criminal law because of the fact that they voluntarily incapacitated themselves.

Sexual violence is a gender-based violent act. Approximately 91% of sexual violence survivors are women, whereas roughly 9% are men (according to U.S. Department of Justice statistics on rape and sexual assault for 1992-2000). Each of these individuals has been violated in a perpetrator’s effort to oppress and exert power over the survivor. Within the counseling relationship, the counselor and client need to explore the perceived and actual characteristics of their respective marginalized and privileged statuses relative to the issue of sexual violence and in the full context of the intersectionalities described earlier.

Although toxic masculinity may be a newer term in our culture, the constructs associated with it have historically been interwoven into American culture and should be taken into account when applying the MSJCC framework with survivors of sexual violence. Toxic masculinity describes the rigid characteristics and attitudes that are often (falsely) associated with what it means to “be a man.” These characteristics include strength, violence, sex, power, and an absence of emotion and vulnerability. Toxic masculinity perpetuates sexual violence directed not only toward women but also toward men. Understanding the gender-based nature of sexual violence and social constructs such as toxic masculinity, it is vital for counselors to fully embrace the MSJCC framework and the ways in which it relates to survivors of sexual violence.

In my clinical opinion, a counselor should not enter the counseling relationship without fully understanding and accepting the reality that in American culture, 25% to 35% of people endorse rape myth acceptance and therefore engage in victim-blaming and the perpetuation of gender inequality. Counselors should also understand and accept that toxic masculinity is, in fact, a deficit for all genders. This understanding and acceptance is a component of counselor self-awareness within the MSJCC framework. Counselors must become aware of their own attitudes, beliefs and biases pertaining to sexual violence prior to engaging in a counseling relationship with survivors of sexual violence.

The MSJCC require ongoing self-awareness and personal reflection regarding the beliefs, values and biases possessed by the counselor. This is particularly important when working with survivors of sexual violence because of the socialized cultural beliefs to which all counselors have been exposed. If counselors have not adequately addressed their potential beliefs, values and biases, it can result in bolstering shame among survivors of sexual violence.

Expanding the role of the counselor

A primary concept of the MSJCC is the expansion of the counselor’s role. This expanded role is essential when working with survivors of sexual violence. Traditionally, the counseling process has occurred within the confines of an office setting and on the proverbial therapy couch. That scenario has never been adequate when addressing the needs of those who have experienced sexual violence and thus is long overdue for modification. With the inception of the MSJCC, counselors have a framework for expanding on their traditional role to provide best practices in the presence of a profound gap in justice for their clients. 

Social justice advocacy conducted within the MSJCC framework allows counselors to work at the intrapersonal, interpersonal, institutional, community, public policy, and international/global levels to address the systemic obstacles affecting survivors of sexual violence. In the remainder of this article, I will provide a hypothetical case conceptualization (representing a composite of numerous actual cases) to illustrate this multilayered application of the MSJCC framework by a counselor working with a survivor of sexual violence.

Counselor self-awareness: Beliefs, values, biases

The counselor identifies as Christian, is supportive of homosexuality and same-sex marriage, and opposes marital rape, recognizing that nonconsensual sex within a marriage is, in fact, rape. The counselor recognizes the value in people waiting until marriage to engage in sexual intercourse but believes that imposing this standard on others can inadvertently create significant pressure and shame, particularly if someone is then exposed to sexual violence. The counselor believes sexual intercourse should be between consenting persons who provide affirmative consent (with affirmative consent being defined as the presence of yes means yes rather than simply no means no).

The counselor also believes there is no place for aggression or violence within sexual intercourse. The counselor attributes this aggressive mindset in part to the prevalence of pornography, in which close to 90% of sexual acts include aggression against women (according to the 2010 article “Aggression and Sexual Behavior in Best-Selling Pornography Videos: A Content Analysis Update,” published in the journal Violence Against Women). The counselor believes that sexual violence is about power, control and dominance rather than a perpetrator’s elevated drive for sex or inability to control temptation, and that the latter beliefs reinforce rape myths and victim-blaming. The counselor also recognizes and opposes gender inequality in all spheres of life, including the sexual double standard that exists between men and women. The counselor has had consenting partners throughout her life span and has survived sexual violence twice.

The counselor has explored the antecedents to rape culture to identify her own experiences with these antecedents as well as with associated beliefs, values and biases. The counselor is opposed to traditional gender roles and finds them to be oppressive for all genders. The counselor believes that gender and gender roles should be fluid and not rigid and attributes this belief to being raised in a home where traditional gender roles were not always strictly enforced.

Regarding adversarial sexual beliefs and hostility toward women, the counselor recognizes her personal history of strained relationships with prominent female figures as a child, as well as significant “girl drama” during pre-adolescent and adolescent development. Historically, the counselor has interacted better with males and has had periods of doubting women. Regarding the acceptance of interpersonal violence, the counselor believes in standing up for one’s self, even if that means taking physical action. The counselor supports the Second Amendment but believes gun control is not adequate at this time. The counselor has historically enjoyed action movies but has recently begun exploring violence in the media.

To further understand how the counselor’s beliefs, values and biases could affect the counseling relationship when working with survivors of sexual violence, the counselor completed the Illinois Rape Myth Acceptance Scale (IRMA) and scored a 108 out of 110, indicating greater rejection of rape myths. The counselor also recognizes that this score is not reflective of the counselor’s lifelong involvement with rape myth acceptance and is aware of historically faulty thinking as an adolescent and young adult. The counselor acknowledges that self-reflection and development have contributed to her current IRMA score.

Privilege, marginalization and intersectionality

The counselor also examines the ways in which privilege and marginalization interact within the counseling relationship. The counselor is privileged due to being white, middle class, heterosexual and Christian, and having had the opportunity to obtain a higher level of education, whereas the counselor is marginalized for being a woman.

The client in this case conceptualization is privileged due to being heterosexual and Christian, whereas the client is marginalized for being a black woman of lower socioeconomic means who has not been afforded the opportunity to complete her education to date.

The counselor identifies the MSJCC quadrant of privileged counselor-marginalized client as the most appropriate to describe the counseling relationship. The counselor is also aware, however, that this is the counselor’s own perception of privilege and marginalization within the counseling relationship and that the client may have a different perception.

The socio-ecological model

The counselor begins at the intrapersonal level by sharing her worldview (as previously described) and bearing witness to the client’s worldview. The beliefs, values and biases of both parties are explored. Intersectionality is a main component within the intrapersonal level, with the social constructs of race, ethnicity, gender, sexual orientation, economic status, religion, spirituality and disability being explored by both the counselor and the client.

The counselor and the client also have an open discussion about privilege and marginalization, including the ways that they may enrich or create obstacles within the counseling relationship. For instance, both the counselor and the client have a shared experience and openly process their experiences of gender inequality and being discriminated against for being women. At the same time, the counselor openly recognizes the existence of white privilege and verbally acknowledges that her race has not made her life more difficult. The counselor also honors the specific incidences of racism that the client has experienced and is openly willing to share with the counselor.

At the intrapersonal level, the counselor and the client also discuss and process the client’s experiences with self-blame, victim-blaming, and rape myth acceptance. The client shares self-blaming beliefs such as, “I should not have gone out that night” and “I never should have had those drinks.” The client also shares victim-blaming attitudes that others have projected onto her, including how the client’s clothing was too revealing and how she could have been more assertive in her denial to engage in sexual intercourse.

Following the exploration at the intrapersonal level, the counselor begins to support the client at the interpersonal, institutional, community, public policy and international/global levels. At the interpersonal level, the counselor assists the client in exploring her various relationships and identifying a healthy social support network consisting of family, friends, neighbors and co-workers. During this time, the counselor also assists the client in implementing appropriate boundaries within those relationships that have been identified as being unhealthy or unsupportive. The client determines that several familial relationships are unsupportive due to significant victim-blaming attitudes and the demonstration of rape myth acceptance. The client then gives the counselor permission to provide psychoeducation regarding victim-blaming and rape myth acceptance to these family members and to challenge their beliefs that are further victimizing the client.

The family members resist the psychoeducation and continue to engage in victim-blaming and rape myth acceptance. Therefore, the client decides to implement boundaries to appropriately distance herself from these relationships. The client then makes an intentional effort to widen her social network by connecting with other friends and family members. After visiting a shared interest group with the counselor, the client decides to join the group in hopes of also making new friends.

At the institutional level, the counselor and the client begin to explore the social institutions with which the client is associated. During a session, the client shares that she has observed sexual harassment in her workplace and expresses concern that she will continue to be exposed to these interactions. With the client’s permission, the counselor reaches out to the employer and offers to provide an organizational training to the entire staff on sexual harassment and gender inequality in the workplace.

The client also shares that she has been a member of her church for more than a decade. She is finding it increasingly difficult to attend regularly, however, because of the feelings of shame associated with the church’s message regarding purity. The client also shares her perception that the church displays rape myth acceptance frequently during its teachings. With the client’s permission, the counselor reaches out to explore the possibility of meeting with church leaders about their own rape myth acceptance tendencies and to develop a plan with church leaders to provide a more supportive environment for survivors of sexual violence. Furthermore, the counselor uses this experience to develop a program to help all community churches create safe places for survivors of sexual violence.

The counselor’s work does not stop here. As an active member of the community, the counselor has various opportunities to address norms at the community level. For instance, when processing at the intrapersonal level, the client shared her experience with racism, disclosing that she often felt unheard during her school years and was frequently passed over when her hand was raised to contribute to class discussions. Instead, she received discipline referrals for speaking out of turn and being disruptive. The counselor validates the client’s experience with microaggressions and acknowledges this display of racism. The counselor then assists the client in connecting with a community volunteer opportunity in which the client will be tutoring school-age minority females. This gives the client an opportunity to empower not only herself but minority female youth as well.

The counselor also notices that the community has limited events to raise awareness about sexual violence, suggesting that the topic is unimportant, taboo, or not considered to be an issue within the community. With that in mind, the counselor decides to organize a committee of other counselors to coordinate an annual Take Back the Night event. The hope is to engage the community more on the topic and to create a new community norm of open discussion regarding sexual violence.

The public policy level is most closely associated with the gap in justice witnessed by survivors of sexual violence. For that reason, the counselor is intentional about making action at this level a priority. The counselor becomes knowledgeable about state and federal laws that affect survivors of sexual violence and openly shares this information with the client. The counselor attends public forums on the topic and provides expert testimony regarding the need for improved laws that protect survivors. The counselor also meets with state legislators to discuss how laws that reinforce victim-blaming and rape myth acceptance affect survivors of sexual violence and the communities in which they live.

At times, the counselor challenges the language used in sexual violence legal cases, including questions such as “What actions did you take to prevent the alleged sexual assault?” and statements such as “The victim chose to stay.” The counselor does this by reframing these retraumatizing questions and statements to be trauma-informed. In these instances, the counselor reinforces the truth that survivors cannot prevent their sexual assault from happening, nor does one’s decision to be in a specific environment suggest that survivors are responsible for being assaulted.

Similar to the public policy level, the international/global level requires the counselor to take action outside of the office and, at times, behind the scenes. The counselor educates herself on gender inequality on a global level, including human trafficking, farming disparities between men and women, unequal labor wages, lack of education for females, immigration, and child marriage. The counselor joins organizations that address these various topics, which have both direct and indirect associations with sexual violence. The counselor then disperses information on these topics on a blog linked to her website. Finally, the counselor participates in specialized training to complete immigration assessments for those seeking asylum in the United States and those hoping to gain access to their afforded protections under the Violence Against Women Act.

Conclusion

Sexual violence is epidemic in contemporary society. This epidemic is largely fostered by the prevailing rape culture in the United States and worldwide. Thus, it is highly likely that counselors will encounter survivors throughout their careers across a wide range of clientele. This article provides relevant background information on sexual violence and victimization, along with an application of the MSJCC, to promote a deeper understanding of sexual violence and to detail a promising framework for counseling and advocating for these survivors.

 

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Amy E. Duffy is a licensed professional counselor supervisor specializing in trauma and working in private practice in Raleigh, North Carolina. She is currently pursuing her doctoral degree at North Carolina State University, where she is studying gender inequality and sexual violence in her dissertation research. Contact her at amyeduffylpc@gmail.com or HarborBehavioralHealth.com.

Letters to the editor:  ct@counseling.org

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

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.