the therapist's perspective, therapy with male survivors has four distinct
phases. This four-phase model of therapy is helpful both as an analogous description
of the recovery process for male survivors and as an analytical tool to assist
in case management and treatment planning.
The four phases are:
1 - Breaking
2 - The Victim Stage
3 - The Survivor Phase
4 - The Thriver Stage
In following chapters, interventions are organized in relation to this four-phase
model and they are presented according to the therapeutic phase in which they
are most appropriately used.)
Individual clients will spend
more or less time in any given phase of healing and some phases will overlap with
one another. Some clients will stay in one phase for a long time, reaching a plateau
in their growth; it may be advisable to take a planned break from therapy during
these times. However, in general, each phase is associated with distinct issues
and demands different skills from the therapist.
At all times,
the therapeutic process for male survivors needs to be relevant to individual
needs. Identifying a client's phase of healing can help a therapist to skillfully
and strategically focus the therapy to meet this client's unique requirements.
beginning abuse-focused therapy, clients need information about the therapeutic
process. Knowing ahead of time that recovery tends to be long-term rather than
short-term and that the healing journey is not a linear one helps clients to make
decisions about their investment in treatment. (The client engagement process
is discussed in Chapter 9.) Each client will have to decide how to allocate his
resources (e.g., time, money, etc.) to support his recovery. Relatively accurate
and candid predictions about the therapeutic process, including the length of
the journey, will help clients make these decisions.
clients a cognitive map with which to understand the healing process can be a
supportive intervention. Although the concept of a four-phase model of healing
is somewhat abstract, being able to identify which phase he is currently in helps
a client know where he is headed and what kind of process he can anticipate en
route. Whether or not clients want such a map, it is essential that each therapist
uses one to guide his interventions. The different phases of the four-phase model
are described below:
Phase 1-Breaking Silence
to himself that he was sexually abused as a child is the first step a survivor
must take to heal from this experience. Reaching out to others for support and
validation of this experience, as well as breaking the silence that has surrounded
the secret of the abuse, is an important step.
indifferent ways to the realization that they were abused. For some men, their
memories surface during therapy for issues that are not abuse-related, when they
begin to realize that their patterns of behavior are the result of childhood sexual
trauma. Other men have never forgotten being abused, but have discounted the impact
of these events on their lives or have never labelled them as abuse. Yet others
have a sudden realization while watching a TV show about sexual abuse, or while
reading a book that refers to sexual abuse, that they have themselves been victimized.
therapists are reluctant to pursue questions about abuse if their client has no
memory of having been abused. "False Memory Syndrome," in which therapists
are thought to create their clients' memories of abuse by planting hypnotic suggestions,
is currently a topic of much debate in therapeutic circles. I believe that concerns
about creating false memories are secondary to giving a client feedback that his
symptoms suggest a history of childhood trauma, which may include sexual abuse.
Until such time as this possibility can be clearly eliminated, it bears examination.
2-The Victim Stage
The main focus of this phase of therapy is to validate
the client's abuse history, to build a safe therapeutic process with the client,
and to provide educational information about the effects of sexual abuse on its
victims. Unless a client has intense flashbacks or other affectively demanding
concerns, much of the work in this phase will be cognitively focused.
often need support in acknowledging their victimization. Even if they can recall
the sexually intrusive events that have happened to them, many men don't call
them "abusive." Educating clients about power differences, coercion,
misrepresenting adult reality, the use of threats and lies to gain compliance,
and so on can assist male victims to fully claim their experience.
the extent that the client's memories permit, he will be asked to develop
a "sexual abuse autobiography" during this phase of therapy. Remembering
how he was groomed for the abuse, who offended against him, how often the abuse
occurred, what explicitly happened, what his reactions were at the time, whether
or not he told anyone and what, if anything, he liked about the experience are
areas to investigate at this stage. Talking openly about the abuse and continuing
to challenge any denial of the experience are primary tasks for this therapeutic
The therapist needs to teach stress management and self-care
skills during this phase, so that as the therapeutic focus becomes more affective,
clients have functional ways of attending to their emotions. Ensuring that clients
have active support systems in place or focusing on building these supports are
therapeutic tasks in the Victim Phase.
In this phase, clients
will generally feel some emotional relief at realizing that the problems they
face in their lives are not the result of being crazy, but the outcome of being
sexually abused as a child. As they gain information about dissociative processes
and other coping strategies, they begin to feel more normal and hopeful about
The transition between the Victim and Survivor Phases of therapy
is marked by the client's ability to place full responsibility for the abuse on
the offender. When the client recognizes that he was a victim in an abusive relationship
and that the abuse was a reflection not of his worth as a person, but of his offender's
unresolved problems, he moves into the next phase of therapy.
3-The Survivor Phase
The Survivor Phase of therapy describes the often
arduous work of repairing clients' emotional, cognitive, and behaviorial dysfunctions.
This is a push/pull stage of therapy. The client's maladaptive life patterns are
slowly replaced by functional sequences as the client takes the risk of developing
new coping strategies. Walking a fine line between containment and expression,
as well as finding a workable balance of both, is the key to success during this
phase of therapy.
Often, clients become discouraged in this
phase. Because they are reclaiming their previously blocked affective processes,
they are more aware of feelings of fear, pain, rage, or sadness. They feel unstable
as they discard old methods of coping and substitute new ones that are still relatively
untested and awkward to use. They feel as if therapy has made them worse rather
than better. Many cases of premature termination occur in this phase as clients
lose their faith in ever being able to make significant changes.
the Survivor Phase, new skills need to be practised outside of therapy sessions.
Throughout this therapeutic stage sessions may involve both spontaneous and planned
abreactive processes. (Working with abreactions will be discussed in Chapter 6.)
At times, clients may need to take a planned break from therapy and integrate
their learning before continuing the process.
between the Survivor Phase and the Thriver Phase is marked by the client's readiness
to take back his own power; this will frequently be manifested by the client's
readiness to confront his offender, either in reality or, more often, symbolically.
This is not a reactive stand taken in defiance against the offender; instead,
it represents an integrated change in which the client no longer feels that the
offender has power over his life.
Phase 4-The Thriver Phase
the client reaches the Thriver Phase, he begins to feel hopeful once again. From
an empowered perspective of having changed previously dysfunctional coping patterns
he can articulate the ways in which he was affected by having been abused. He
realizes that the outcome of successful therapy is not "living happily ever
after," but having the skills and resources that he needs to address the
difficulties that occur in his life.
Thrivers feel responsible
for their lives and they believe that they have many options to choose from in
addressing their life problems, both past and present. The abuse is no longer
seen as a central issue in the client's self-identification; his image of himself
has shifted into the present and he trusts his adult self.
the Thriver Phase, client and therapist must begin the process of termination.
Termination needs to be managed so that the client can leave the therapeutic process
at his own pace. In addition, clients should be given plenty of permission to
return to therapy should they experience a resurgence of symptoms or should new
abuse memories surface.
The therapist must be very careful not to compromise therapist/client boundaries by permitting double relationships
to develop. Clients need their therapists to remain available to them for potential
future consultation; any double relationship, such as when a therapist becomes
a friend, lover, landlord, or business partner to a client, jeopardizes the safety
of the therapeutic relationship. Risk of such double relationships might arise
when the therapist is himself a survivor with needs for social support from relatively
"recovered" fellow survivors or when a recovering client is seen as
a professional ally who can assist in furthering desperately needed services for
- Crowder, Adrienne, Opening the Door: A Treatment Model for Therapy
with Male Survivors of Sexual Abuse, Brunner/Mazel Publishers: New York, 1995.
Reflection Exercise #2
The preceding section contained information
about a four-phase model of stages of therapy. Write three case study examples
regarding how you might use the content of this section in your practice.
What are the four phases of therapy with male survivors of sexual abuse?
Record the letter of the correct answer the .