Mary Stathopoulos, a Research Officer at ACSSA, interviews Dr Gary Foster from Living Well

Living Well is dedicated to the provision of a supportive, accessible, respectful, service to men who have experienced child sexual abuse or sexual assault.

Mary Stathopoulos, a Research Officer at ACSSA, interviewed Dr Gary Foster, the manager of Living Well, about his insights regarding barriers to disclosure for men, the difficulties faced by individual workers in the field, and the application of feminist principles in providing support for male victim/survivors of sexual assault.

In your practice, what are some of the issues you have identified in providing services to male victim/survivors of sexual abuse?

Can I first thank ACSSA for the opportunity to think through some practice questions in relation to working with men who have experienced childhood sexual abuse or sexual assault. In answering, I am conscious that there is only room here to provide quite generalised responses, also, that work with men who have experienced sexual abuse has many similarities and resonances with work with women who have experienced sexual abuse.

It is clear from our developing service and research evidence that men who have experienced sexual abuse, like women, benefit from being able to access relevant, practical information and support that addresses the impact of sexual abuse and assists them to get on with their lives. Just like women, the men we see report struggling with unwelcome memories, with feeling overwhelmed, with unhelpful thoughts, with feelings of guilt and shame, with feeling isolated or somehow different, with feeling unsure about what to say or do or even believing that things can improve. Our understanding is that men benefit from service provision that understands and connects with their personal life experience and that a major shaping factor in their lives, alongside that of sexual abuse, is gender.

Whilst there is considerable diversity amongst men, adult males face some common social pressures about how they should behave, feel and think as "a man". In our society, "being a man" is not simply a question of being an adult male, it requires a continuous performance of masculinity, where actions or omissions are evaluated according to fit with established masculine identities. The act of a man naming an experience of sexual abuse and seeking help requires a man to confront expectations that as a man he should appear strong and powerful, self-reliant, always in control, rational, logical, always ready for sex and especially, not a victim.

Although enabling in some areas of men's lives, masculine scripts can produce double trouble for men who experience sexual abuse, in that not only the sexual abuse should not have happened or "be allowed" to happen in the first place, but if something did happen he "should" supposedly, "as a man", be able to cope and deal with it (within the restrictive gender code, asking for help is portrayed as a sign of weakness).

Another influence on men's disclosure and help seeking that is very much connected with gender, are questions relating to sexuality. Many men report concerns that if they tell someone about being sexually abused that they will be questioned about their sexual identity and treated differently, that people will wonder whether they are "straight" or "gay", "heterosexual", "bisexual" or "homosexual". Dealing with this issue is considerably more complex than saying that sexual abuse is not about sexual identity.

The reality is that questions of sex and sexuality are very much present in men's lives, (whether men have been sexually assaulted or not). Homophobia has a disciplining function, in that how men talk, act, express care and intimacy, whether they seek help or not is influenced by concern that they will be identified or suspected as being "gay". Societal problematising and devaluing of same sex relations continues to act as a major barrier to men seeking assistance for childhood sexual abuse (recognising that 80% of sexual abuse of male is committed by males).

A further significant barrier to men seeking support and accessing services is the suggestion that a man who experiences abuse is likely to go on to perpetrate abuse. Concern that as a "victim" a man will become a "perpetrator" of abuse is disturbing to men. It stops men from speaking about abuse out of fear of how they will subsequently be perceived or treated. Men can worry that in being sexually abused they have been "infected" or "contaminated" in ways that they just don't know about yet. This can have flow on effects in the men's lives where they isolate themselves, avoid relationships or contact with children and don't discuss experiences of abuse. Unfortunately the "automatic" route from "victim" to "perpetrator" is often uncritically reproduced in the media, in written reports and articles.

And finally, a challenge men, partners, family and friends report is a lack of quality information, services and support designed specifically to assist men who have experienced sexual abuse or sexual assault. This has an unfortunate flow on effect, whereby the man's struggles can become understood by him as a sign of personal failure, increasing his sense of isolation. When problems become seen as a result of personal failure or weakness, this can support the idea that there must be something wrong, damaged or bad about me, making the man less likely to seek help.

The above list of barriers to men's disclosure of sexual abuse and help seeking is in no way comprehensive. Often the sense of shame, guilt and personal failure is overwhelming in and of itself. It is important that barriers to disclosure are addressed at a policy and broader societal level if men are to feel better able to publicly name sexual abuse and access assistance.

What are some of the difficulties faced by service providers/individual workers who do the work of supporting male victim/survivors of sexual abuse?

The challenge we face as service providers/individual workers is that in much of Australia there has not been a concentrated focus on developing responses to connect with, engage and support men who have been sexually victimised or their partners, family and friends (not that there are particular difficulties when working with men). It is an ongoing challenge to find ways to engage and offer assistance to a client base who are reluctant to discuss or be identified as someone subjected to sexual assault.

Our experience at Living Well is that the service needs to be proactive in enhancing public awareness and creating a friendly welcoming service with multiple opportunities for support and assistance. It is worth investing in marketing services specifically to men who have experienced sexual abuse; creating flyers, postcards, booklets that speak to men and address the difficulties they are confronted by. In addition, the service might look at ensuring they offer flexible appointment and reduced waiting times for consultations. Out-of-hours and evenings appointments are particularly relevant for work with men. There is often a short window period when a man will seek assistance. Making time for a phone conversation or an initial meeting is valuable – some men may never ring back

In working with men it is important that practitioners have access to appropriate, information, support, training and supervision. Just as men can become isolated, a practitioner can become isolated or feel extra pressure as the identified specialist men's worker. In working with men who have experienced sexual abuse it is useful for practitioners to connect, share knowledge, understanding, resources and experience with other practitioners doing similar work.

Just as it is important that practitioners access regular clinical and operational supervision (recognising they are separate things) with someone who understands how sexual abuse and gender intersect and can shape people's lives. The possibility of burn out or vicarious trauma is something that those working with people who experience sexual abuse or trauma should always be aware of. It is important that we all take steps to prioritise our mental health and well-being.

One of the challenges that practitioners have mentioned in working with men in enhancing his sense of self and relationship capacities is that some men will only turn up for one or two sessions and exit. This highlights the importance of taking time to engage and understand the man's experience and what he is looking for. Men, like all people, are more likely to access practical tools and support when they have engaged and connected with the person or service.

Practitioners should remain cognizant and aware that a significant number of men subjected to abuse will experience suicidal ideation, with around half attempting suicide at some point.

Whilst, in some places there appears apprehension and mystification of what it means to work with men subjected to sexual abuse, when proper systems and support is in place, working with men should be no more challenging or trauma inducing than working with women.

Do men respond positively to sexual assault counselling that is based on feminist principles? What other service paradigm/s might be useful?

Indicators are that men appreciate and value talking therapies, including those based on feminist principles, along with access to relevant printed resources and group support.

We know that experiences of sexual abuse highlight the importance of being sensitive to power relations, to connecting with a person's lived experience and understanding the influence of gender in shaping people's opportunities and relationships.

Some useful guiding principles and practice wisdom for working with men that are clearly informed by feminist principles, understanding, teaching, activism and therapy:

• Identity is socially constructed (personal is political)
• Power is diffuse, not fixed. It is important to pay attention to power relations as they are enacted within the therapeutic relationship.
• It is valuable to make visible the social and relational aspects of problems and lives. To review and critically consider the relevance and appropriateness of expert diagnostic prescriptions and identity categories, not just accept them.
• Move from established "general knowledge" to exploring and make visible the particularities of the person's lived experience, their context (recognizing diversity and that sex, gender, race, age, sexuality, ability etc all interact and shape life understanding and opportunities).
• Focus on both hearing the impact of traumatic experience in the person's life, at the same time to listen out for what it is that they give value to (to notice and support stands taken against oppression and abuse).
• Work with and through understandings that gender can be both constraining and enabling of life opportunities.

Personal and interpersonal safety is a priority when working with experiences of sexual abuse. It should not be presumed and can take time to develop. Safety may not be something the man has experienced in his family or home context or might be something that he has achieved for himself by "not talking", by closing down and isolating himself or becoming loud and aggressive so that people will leave him alone.

Group work with men is recommended for the same reasons it is of value for working with women. It has the capacity to break down isolation, to allow men to connect with and support men who have had a similar experience. For men, one of the major challenges is to actually make it through the door. What can make it difficult is not just the overwhelming burden of shame, guilt and secrecy, but also the great fear that they will be  judged by other men (not women). Meeting and talking with other men who have experienced sexual abuse, taking positive actions that support the well being of others, actively contributes to feelings of connection and integration that is the identified third phase of trauma work (this is not to say that a man needs to attend a group in order to live a fulfilling life after an experience of sexual abuse).

I am aware that strength-based, solution-focused and generative approaches are promoted as of particular relevance for work with men. These approaches clearly have value. Care is needed however to ensure that in their application there is not a bias towards noticing, strengths and resilience and moving towards an outcome in a way that does not fit with the man's own experience of the sexual abuse and his current picture of himself. In developing a gender sensitive therapeutic service for men who have been subjected to sexual abuse a challenge is to find ways to both acknowledge the profound horror, pain and difficulties produced by sexual assault, whilst simultaneously noticing the person's struggles, ways of managing, holding on to hope, engaging with and commitment to living a full life.