“a Very Steep Climb”: Therapists' Perspectives on Barriers to Disclosure of Childhood Sexual Abuse Experiences for Men

Background and Purpose:  Over the last thirty years, research has found troubling prevalence rates of childhood sexual abuse (CSA) for boys/men, detrimental impacts on mental health, and patterns of delayed or nondisclosure.  The empirical research base on barriers to men’s disclosure of CSA is small.  No known studies have examined the insights of therapists who specialize in treating male survivors on disclosure barriers.  This study aims to fill the gap by exploring mental health specialists’ perspectives on barriers to disclosure of CSA for men, to improve clinical practice and training and facilitate help seeking.

Methods:  Semi-structured interviews were conducted with nine licensed mental health practitioners who are leaders in treating men with CSA histories. Participants averaged 23.2 years of clinical experience, and held advanced degrees in social work, psychology, marriage/family therapy, and education.  The purposive sample was identified through professional and survivor websites, books on CSA for men, and snowball sampling. Interviews explored topics including resource availability, disclosure patterns, and treatment for male survivors of CSA; this analysis focused on data related to disclosure barriers.  Interviews were transcribed and qualitative conventional content analysis was employed, comprised of several inductive phases using immersion, memoing, and in vivo coding.  Independent and consensus-based coding was employed by authors to enhance validity; Hill and colleagues’ (2005) method was used to assess reliability.

Findings:  Analyses identified nine types of barriers, organized into three categories: intrapersonal experience (difficult feelings, lack of language/self-engagement), social milieu (internalized social stigma, negative responses, social loss/judgment, and masculine identity dissonance), and healthcare environment (structural barriers, relational challenges with therapists, and unhelpful therapeutic strategies).

Barriers within the intrapersonal category, including shame and limited insight, concurred with existing research.  Distinct from previous research, findings revealed that some barriers straddle the interpersonal and social/cultural domains, including relational problems, cultural stigma, and masculinity-related issues, creating an amalgamated category.  All participants described obstacles within the healthcare environment, revealing that multiple structural barriers interact to constitute a coherent, new category of disclosure barriers for men.  Participants reported that services and providers are ill-equipped to handle male survivors with aggression issues, space to discuss CSA for men (and outreach/marketing) are lacking, and therapeutic labels (e.g., victim/survivor) paradoxically enhance access to services and hinder men’s disclosure.  Overall, healthcare institutions and providers are meaningful sources of disclosure barriers.

Conclusion and Implications:  Factors that shape men’s silence are interwoven in complex ways, creating formidable and compounding barriers to disclosure of CSA. Intrapersonal barriers represent persistent challenges for men that should be the focus of clinical intervention.  More public awareness of CSA and helpful responses to disclosure are needed.  Improved systemic healthcare approaches should include access to low-cost, long-term, male-centered, trauma-informed therapy services, and improved provider training to mitigate therapist bias, increase trust, and promote safety in clinical relationships.  Future studies with clinicians and clients should explore the usefulness of therapeutic labels, and CSA disclosure barriers in the context of polyvictimization and race/culture-based oppression.