Treating Men with Histories of Child Sexual Abuse: In-Depth Interviews with Mental Health Practitioners

Background/Purpose: Rates for the sexual abuse for boys in the general population range between 3% - 29% (Fergusson & Mullen, 1999). Researchers have found that 5% to 10% of men in the general population experienced severe sexual abuse during childhood. CSA has the potential to negatively affect numerous dimensions of a survivor's life during adulthood (e.g., mental health, relationships, work history; Maltz, 1991). Studies have found that CSA increases the risk of depression, anxiety, substance abuse, divorce, suicide, and others (Holmes & Slap, 1998; Putnam, 2003). Recent research indicates that the negative effects of CSA on physical and mental health can extend into late life (Draper et al., 2008; Talbot et al., 2009).

Despite these problems, male survivors often guard their secret and don't seek help for decades after the abuse (O'Leary et al., 2009). Furthermore, most of the research to date has focused on female survivors of CSA. Men who were sexually abused as children (MSAC) remain a marginalized, stigmatized and understudied population often in need of clinical services. The aims of this exploratory study were to: 1. increase understanding of the long-term negative effects of CSA for men and 2. identify treatment barriers and issues unique to this population.

Methods: This study consisted of three in-depth case studies with mental health professionals who treat MSAC. The therapists work in three distinct practice settings in a Midwestern state: a public agency, a private agency, and a specialized treatment center for MSAC. Semi-structured interviews were conducted at the therapists' offices and later transcribed. A brief follow-up phone interview was conducted to clarify parts of the initial interview. Using content analysis, the researcher then coded the interviews using an a priori list and grouped the codes according to themes. Member checking was used to ensure accuracy of statements and themes generated from the interviews.

Results: Seven key themes emerged from the interviews: 1. the presenting treatment issue is seldom CSA, 2. social stigma remains the chief barrier to treatment, 3. many MSAC wait years (even decades) to disclose their abuse history, 4. common effects of CSA across the lifespan include anger, anxiety, depression, addictions, and relationship problems, 5. traditional male gender norms often influence coping patterns in unhelpful ways, 6. gender-specific techniques can enhance treatment of MSAC, and 7. despite increased awareness, much more needs to be done to meet the unmet mental health needs of MSAC. Although there was general agreement on all seven themes, there was some variance in the extent to which the therapists use gender-specific techniques with MSAC clients.

Conclusions and Implications: Clinical directors and administrators need to adopt agency practices that encourage MSAC to get treatment. Therapists can assist clients in deconstructing male gender norms that can impair recovery and healing. Social work education and professional training need to incorporate material on meeting the needs of this population. Future studies should assess MSAC treatment needs and barriers by interviewing male survivors directly.