In nearly 20 years of working with male clients who have experienced sexual violation, I’ve seen countless men change so that they feel less in pain, less alone, more hopeful, and better able to look after themselves and heal from their trauma. I have written Helping Male Survivors of Sexual Violation to Recover: An integrative approach – stories from therapy, recently published by Jessica Kingsley Publishers, to encourage and embolden anyone in the helping professions who think they might not have the capacity or skill to support this client group, to trust that they certainly can be of use to them, whenever they offer a combination of warmth and rigorous thinking within the context of a secure therapeutic relationship.

When I read books about a certain area of therapeutic work in order to better inform myself, the parts that tend to catch and hold my attention, and then stay in my memory as a resource, are the case studies, vignettes and transcriptions of verbatim exchanges from a session. These give the flavour of who actually said what to whom, and they most clearly demonstrate why the therapist took the approach they did, and, crucially, what happened as a result, both within the room, and in the client’s life beyond the room.

It’s certainly of great use for my left-brain thinking self to read about theories and research findings. Yet my right-brain, deeper, slower, more relational, intuitive self needs to be shown how it actually feels in the room with the client, when those useful theories inform clinical practice. So, I have made up the stories I tell, in order to try and illustrate what it looks, sounds and feels like when a therapist works therapeutically, in an integrative way, with different men who have experienced a variety of sexually violating experiences. To do so, I’ve drawn on the nature of the real experiences and suffering of a wide variety of men I’ve worked with in different settings over the last 17 years, in an attempt to give a sense of what it was like to witness their trauma, courage and will to recover. I have, as the saying goes, told small lies to tell a big truth.

Sam: working with a male survivor’s rage

Sam had been describing how, throughout his teenage years, his mother, who had sexually used him when he had been younger, would still invent reasons to come into his bedroom after he’d had a shower, and would then often make comments on his body hair, spots or the size and appearance of his genitals, in ways that shamed him deeply.

SAM: And she’d call out if we were in the garden in the summer, on purpose, so like, other people out in their gardens would hear. ‘Ooh, Sammy’s got his shorts on! Careful you don’t pop out now, with that big old trouser snake in there.’ Or, at night, she’d be like all drunk and sloppy on the sofa, and if we were alone she’d say, ‘Give us a kiss goodnight, then. God, some girl’s going to be lucky to get you!’ and be all over me like she was my girlfriend, before I could get away or before my brother or dad would come in.

SARAH: It sounds so confusing and uncomfortable.

SAM: It was.

[Sam made a throaty, exasperated sound and clenched his fists. He had become increasingly more able to tolerate difficult and painful feelings, and talk about the emotions he was feeling while he was feeling them over past months, so I risked probing at this point.]

SARAH: What’s happening as you make that angry sound and clench your fists?

SAM: I... Ugh. I just don’t want to talk about it!


[There was a long pause.]

SAM: [Less angry and more anguished.] I just can’t!

SARAH: You look as if you’re in some discomfort right now.

[Sam was looking up at the ceiling and drawing some deep breaths, which was what he typically did when he was trying to quell any expression of his deep grief and hurt at the abuse in his childhood.]

SARAH: What if there was a way that you could express more about this – but it wouldn’t have to be by talking about it now, in this session?

SAM: Like how?

SARAH: Might you be willing to try an experiment?

SAM: Huh?

SARAH: Well, what if you could write down, in a pretend letter, the things you needed to get off your chest, about the way your mother was with you around sex?

SAM: What, a letter that I write to you, you mean?

SARAH: No. One that you write to your mother and you bring to the next session. It can take whatever form you like, short or long. But, and this is very important, it is not a letter that is actually going to be sent. You don’t write it in order to actually post it to your mother. But you do write it as if it is a letter directly to her. [Pause.] Would you be up for giving that a go?

SAM: You know I’m useless at writing, don’t you?

SARAH: That’s good, because the less confident you are about writing, the more effective it is, as an exercise, to help say what you really need to say.

SAM: [With an annoyed glint in his eyes.] Oh, you’re good, aren’t you! I can see how you can really turn the screws!

SARAH: You sound annoyed.

SAM: No, I’m not annoyed. I’m just...

[He went silent. My sense was that the wasp of Sam’s anger, so to speak, was now right in the room with us. I judged that he and I had enough of an alliance, and he had enough capacity to calm himself when he got into an ‘on’ state, to make it worth working with, in the here and now, in order to help dissolve the taboo in Sam’s mind about expressing anger towards a woman he had an emotional connection with. I was aware of the charge that my suggestion had for him, given the similarities between the times his English teacher had pressured him into writing, and what was happening in the session.]

SARAH: What’s happening for you now?

SAM: [Crossly.] What do you mean, ‘what’s happening?’

SARAH: I’m wondering what’s going on inside you, as your tone of voice, and the way you’re sitting and your facial expressions, have all changed.

SAM: [Taking a deep breath.] Honest to God, I’m not annoyed at you, Sarah. But I just... I hate situations where you get painted into a corner. And it’s... I’ve just said I can’t talk about some of this stuff, and you’ve said, ‘OK’. But now you’re telling me that if I don’t talk about it here, I’ve got to go and write about it, which for me, is probably worse! So... [He sighed out the rest of his breath, forcefully.]

SARAH: So, you feel that I’m painting you into a corner?

SAM: No! Oh, I just can’t explain!

[The parallels with the many times in Sam’s life when he felt caught between two awful alternatives, and felt no support from his environment, were very clear to me, and very unclear to Sam in that moment. Sometimes it’s much more useful for a client to have time to come to their own awareness about something, and the best thing a therapist can do is to button their lip and not break in too soon and suddenly with a supposedly helpful insight or interpretation. At other times (and I thought this was one of those times), the client is more likely to be helped by the therapist intervening somehow when there is a significant impasse. At these times, it’s likely that it’s only the therapist who can help to move the work on. This is often to do with the therapist being the only one who can name the thing that is taboo and is therefore kept deeply down in the client’s unconscious, and likely to remain there, unless the one who is more conscious about it can be proactive, to prove that the taboo can be broken without someone being punished for this. In Sam’s case, the taboo was to do with feeling angry with a woman he cared for. In the past, this had been his mother. In Sam’s day-to-day life, this was his girlfriend, Chelle. In the actual moment of the session, it was me. If anyone was going to name that Sam might feel angry with me, and that this might not have to automatically mean catastrophe, I thought it was going to have to be me.]

SAM: [After a pause.] Oh, just... all right, I’ll try and do a letter or whatever. Fine!

SARAH: Well, I appreciate you being willing to try. And I do also want to give some space to the part that is uncomfortable about feeling sort of... pressured into it.

SAM: Yeah, well... it doesn’t matter.

SARAH: Mmm. I’m not so sure that it doesn’t matter. I wonder if you’re feeling the way you may have felt at other times in your life when you felt a woman put you into an impossible position...

SAM: You mean... Chelle?

SARAH: Possibly. I was wondering if how you are feeling now is more to do with how you used to feel when your mother wanted you to be sexual with her.

[Sam’s eyes suddenly filled with tears, which no amount of looking up at the ceiling could prevent. He bowed his head and I could see the tears fall. He spoke in a whisper.]

SAM: I just don’t want to.

SARAH: Yes. I hear that, Sam. And I want you to hear that I’m not going to force you to do anything. [Pause.] I guess you already know, horribly well, how it feels to be made to do something that you really don’t want to do...

SAM: I can’t do it! I can’t put stuff down in words about what happened!

SARAH: Yes. It’s a very frightening thought – to put down in black and white what you felt...

SAM: [Lifting up a flushed, tear-streaked face.] But if I don’t... If I don’t write it or... whatever... If I never get it all out... Then what?

SARAH: It’s so painful to be caught like this. Caught the way you were with your mum, and then with that teacher, and others, where the choice seems to be to either put up with something humiliating, or lash out and cause harm. Not much of a choice, really, is it?

SAM: [Squeezing his eyes shut, putting both hands up to his face, and speaking loudly and emphatically from behind his hands.] I didn’t want it! I didn’t want to have to rub her back and let her touch me. Why would I want that from my own mother! I was just a little kid! Why would you want to make a little kid do that? [He sobbed, and put his hands down.]

SAM: But I didn’t say ‘no’ to her, did I! I didn’t stop it. So what does that make me? SARAH: You think it makes you...?

SAM: I dunno. Like, a little pervert or something. A dirty little, pervy kid, getting his rocks off. Either that or a coward... or... [Sam suddenly stood up, and looked towards the door.]

SAM: Right, I think I’d better just go now... [He hesitated.]

[I looked up at him and his pose put me in mind of an animal on high alert, like a deer that’s sniffing the wind for the hunter. Not angry any more, but hypervigilant. The session was at a turning point. There was the possibility of turning down the temperature of the work and helping take the charge out of what we were doing, in case Sam’s feelings became overwhelming and he got thoroughly retraumatised. And there was the chance to keep enough heat under the work to allow us to stay with his feelings and give them a chance to be expressed: for the whole cycle of his autonomic nervous system to have a satisfying completion, and for Sam to have the experience that he could express anger in the presence of a woman with no disastrous consequences.]

SARAH: Maybe we could find a way to help you feel less trapped, while you still stay in the room.

SAM: I think it would be better if I just went.

SARAH: I understand that, and of course, it’s always your choice whether you stay or leave. But I wonder if you did leave, whether you’d be getting caught in an old pattern of feeling you must put a woman’s needs before your own – that you have to protect me from seeing you angry? [Pause.] I would like to be able to support the part of you that needs to express some of your anger. If you stay, it would be easier to support that part, than if it gets taken away and put out of sight again.

SAM: [Still standing.] I don’t know if you’d want to see me angry. I’m not very nice.

SARAH: No, probably not. I don’t think I’m particularly nice when I’m angry, either. But there’s usually good reasons for me to get angry.

SAM: Hmph!

SARAH: How would you feel about staying in the room, but letting yourself picture leaving and doing whatever it is that you might want to do because you’re angry?

[Sam gave me a bemused look and then stared down at his feet. For a few moments his face played different expressions that suggested he was indeed imagining something, and was concentrating on this. There was a pause.]

SARAH: Would you be able to share some of what you pictured? SAM: [Slowly sitting back down, and then continuing to stare down at his feet.] I... thought of... storming out to your hall and like, just... trashing everything in it. [He looked up at me, cautiously.] I wouldn’t!

SARAH: I know. But it’s an energetic idea, isn’t it?

SAM: [With an uneasy laugh.] Yeah.

SARAH: How did it feel – imagining it?

SAM: I dunno.

SARAH: Frightening? Sickening? Satisfying?

SAM: Huh. Pretty good, actually.

SARAH: A kind of release?

SAM: Maybe. Like, knocking pictures off walls, and kicking in the door, and acting like a right nutter!

SARAH: Acting like a very frustrated person who is trying to make people aware of how upset they feel?

SAM: Mmm. Yeah. But that’s not how other people would see it, though, is it?

SARAH: Maybe things would calm down more easily if more people did understand that when someone is behaving like that, they need some support...

SAM: Maybe. [There was another pause. He smiled suddenly.]

SAM: You know, I’m still not doing that letter thing, don’t you!

SARAH: It’s your call.

This is an edited extract taken from chapter one, ‘Sam: containing and working with a male survivor’s rage’, of Helping Male Survivors of Sexual Violation to Recover: An integrative approach – stories from therapy, published in April 2018 by Jessica Kingsley Publishers. It is reproduced with the kind permission of the publishers.

Sarah Van Gogh has worked as a counsellor in private practice for many years and is on the training staff at the Re.Vision Centre for Integrative Transpersonal Counselling and Psychotherapy. She also worked for seven years as a counsellor and trainer for Survivors UK, a London charity that provides support to men who have experienced sexual violation. Sarah studied English at Cambridge University, worked in the fields of theatre, community health and adult education, and has written about the vital connection between the expressive arts and therapy for a number of journals.