Updated: Sep 12
This month's article was published by Therapy Today, the British Association for Counselling and Psychotherapy flagship publication. Below, you'll find the scans and the text.
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Men, victimhood and recovery from sexual abuse.
Jeremy Sachs discusses a transactional analysis approach to overcoming men’s resistance to sexual abuse recovery
Every day, men are victims of sexual abuse or rape, abused by people who hold power over them. But this experience is directly at odds with the message they grow up with that ‘being a victim is impossible for men’. So what happens when the potentially catastrophic experience of sexual abuse happens?
For years I have worked with men who have experienced rape and sexual abuse – as children, in adolescence and in adulthood – at HIV health services, charities and in private practice. I have run recovery groups in London and Glasgow for men, teenage boys and trans and non-binary people who have survived abuse. In my private practice, I see people of all genders who are survivors.
When sitting with these clients I hear about the damaging societal ideas about men and sexual abuse – men should be able to defend themselves; men can’t be sexually abused; men always want sex and must have enjoyed it; men can’t be abused by a woman. I hear how these myths impact the lives of male survivors. One client, Adrian,* told me: ‘It was three days after (the rape) and I finally get the courage to go to the hospital, because of the pain. Then, the nurse turns around and says, “You don’t have any bruises, that’s unusual, are you sure you were forced?”’
Adrian’s experience is shocking but it’s not unusual – many of my clients report being on the receiving end ofthese false social misconceptions from the people meant to look after them, both loved ones and in wider society. Men are already reluctant seekers of help – men see their GP 32% less than women
and only 8% of men with common mental disorder (CMD) are likely to access NHS Increasing Access to Psychological Therapies (IAPT) services. These barriers become even more significant for men who suffer the catastrophic trauma of sexual abuse or rape – one of the many reasons that more men die by suicide than women, with the greatest number being men in their early 45-50.3.
If society refuses to acknowledge male survivors, how do we expect men in that society to acknowledge their own pain? We know one in six men are sexually abused,4 although this is widely considered to be a conservative figure. An internal survey conducted of service users at SurvivorsUK, a men’s rape and sexual abuse charity, tell us men take on average 26 years to disclose an abuse to anyone, this is if they disclose it at all. Even less data exists about marginalised groups such as transgender or disabled men.
Society and stigma can rob men of permission to be victims of sexual abuse and thus, rob them of the first step to healing.
If men can’t access victimhood, what does society and their own sense of masculinity, allow them to be? I find it useful to think of transactional analysis, specifically, Karpman’s drama triangle6 to help answer that question.
The drama triangle was first created to illustrate the way in which complex interactions occur between people who are enmeshed in conflict or relationships with an imbalance of power. People can be drawn into different roles, feeding off energy that the conflict creates and getting trapped in a particular way of being with certain people.
The three roles in the drama triangle, also known as dynamic positions, are victim, rescuer and persecutor. They are set in an inverse triangle – rescuer and persecutor on top, and victim at the bottom point. It is important to remember that a person is not put into their role within the triangle by another person. Rather, they are actively, but subconsciously, putting themselves there because of how they relate to another person. People can move around the triangle, inhabiting different dynamic positions depending on the relationship they have with the people around them.
In therapy, the counsellor and the client can recognise these patterns and dynamic positions in relation to different people and within the therapeutic alliance. It is a normal and important part of understanding ourselves and our beliefs about the world. Unfairly, the result of damaging myths about masculinity is to demonise what should be considered necessary and normal processing. Sadness is met with ‘man up’, pain is met with ‘get over it’. This means some male survivors fear being labelled or feeling like the ‘victim’, but in fighting to distance themselves from victim, they can find themselves instead in persecutor and rescuer mode.
It is important to note here that persecutor is a dynamic position that comes with complexity and nuance. A particularly damaging myth is that male survivors of sexual abuse will go on to sexually abuse others and it is not one I wish to perpetuate. I am not suggesting an experience of sexual abuse predetermines any behaviour in a person, especially abusive or violent behaviour.
When thinking about my male survivor clients who embody the rescuer dynamic position, I often adapt this definition to rescuer/protector. These rescuer/protector survivors often fuss and worry about everyone around them. This may manifest as protectiveness over family, or as a black and white idea of the world that can become uncomfortable. Some extreme examples are when protectiveness extends to a survivor’s community, identity or gender. Behaviour can become ‘us versus them’. Although the behaviour of the rescuer is aggressive, it serves to keep them in the rescuer position by creating persecutors, rather than making them persecutors. A ‘hero’ is still a hero, even when going to war against a villain.
I remember in one therapy session a client learned my surname (Sachs) and instantly became irate. He was shouting antisemitic sentiments about how, in his eyes, Jews had marginalised and threatened his community in London. Something complicated had happened but I didn’t know what. At first, I felt like I was under attack. The man I had worked and built a relationship with for two months had suddenly filled the therapy room with all the damaging and hurtful stereotypes he could think of about my heritage. My mind was racing – am I in danger? Is this the end of our therapy? What could he throw at me? Who else is in the building? Why is this man in so much pain so suddenly? After a beat, I realised, he wasn’t verbally attacking me. My surname activated something, but once he started his aggression, it wasn’t directed at me. In fact, he wasn’t even looking me while shouting, but rather into the foreground. His words too, while abhorrent, kept coming back to protecting his community, how in his mind, people in his community would ask for his help and advice – he was the community’s protector. He was rescuing his community.
This is an extreme example. More likely though, people inhabiting this position find themselves in caring roles, either informally for family members or in a voluntary or professional capacity. It’s not uncommon to find people with a difficult past working in animal charities or in nurseries. Eve Wallman, a psychotherapeutic counsellor who worked at Battersea Dogs Home for years before becoming a therapist says: ‘My hunch is that animals don’t lie, there are no ulterior motives. Sure, they can be unpredictable, but it’s an unpredictability a person can tune into and learn to read. Animals have no false self. If someone has been mistreated in their past by other humans, caring for animals can be more comfortable.’
While working in these types of caring roles is emotionally exhausting, it often allows a survivor to focus on caring for another object’s trauma, rather than their own. In addition, early studies have found proximity to animals in animal assisted therapy help lower blood pressure improving cardiopulmonary pressures, normalise trauma responses and decease the need for medication.7
These men can find the therapeutic process challenging. In my male survivor groups, men would often say that they have come not to heal or explore their own feelings, but because they want to help other men. They want to nurture those who have faced similar experiences. Often these men are among the ones who are most likely to report nightmares or flashbacks. This could be interpreted as an inability to consciously sit with past pain and the traumatic symptoms are experienced in the subconscious. In one-to-one therapy, I’ll often have conversations with men who are loyally protective of their mothers, even if that mother did significant harm or facilitated abuse in some way. The rescuer/protector position becomes immoveable towards a primary care giver, and to suggest otherwise invites rupture.
‘In some ways it feels worse than the abuse itself,’ says one client, Jo.* ‘You spend years coming to terms with the fact that the abuse wasn’t your fault. You want to believe that your mum was innocent, that she did her best or even that she was a victim too. Culturally speaking, the mother can do no wrong, you know? Then you finally figure out you must come to terms with the anger that she let me down, didn’t do her job properly. You can feel so angry and huge loss all at the same time. It feels unnatural, to be so angry at your mum. It took me almost as long to come to terms with that as it did with the actual abuse.’
Society is full of narratives about persecutory men, many of them glorifying this side of masculinity.
Take your pick of films – a lead male is wronged, he is robbed of his car/dog/girlfriend (or whatever interchangeable and often misogynistically framed object of care) and his only possible recourse is to beat up an entire city with his bare hands until he, and we the audience, can feel a cathartic release through vigilantly justice. To sit with his loss and victimhood is too much, society doesn’t want that of him. He must turn the psychological pain into violence to protect his own vulnerable emotions. This fictional version of masculinity comes very close to the rescuer/protector, but it’s less about ‘let me nurture others so I don’t dwell on my pain or get hurt again’ and is more about saying ‘I will dominate everything, so I don’t dwell on my pain or get hurt again’, and it gets expressed through an expression of strength.
In reality, this perpetrating form of masculinity looks very different. If we want real examples of the persecutor position, all we need to do is look at prisons throughout the UK. Men who have been abused can be seen as violent or have used violence as the only way of either shifting internal pain or claiming agency in the world and end up in the justice system. (Female survivors are more likely to get a diagnosis of the stigmatised and misunderstood borderline personality disorder and end up enmeshed in health services).
In the therapy room, men who exist in the persecutor position often have encountered a lot of relational trauma. In fact, some men’s traumas can be so prolific, it’s not until a long time into the therapeutic relationship that sexual abuse is uncovered. Rather than the tip of an iceberg, sexual abuse is buried at the bottom. This persecuting position may not come out in therapy as overt confrontation at the therapist themselves, but rather at what the therapist is doing. Interventions never land, the client tells you they are bored or they ‘nearly forgot they had therapy’. As the therapist, this might result in feeling deskilled, you might notice you’re bringing in more psychoeducation to prove how knowledgeable you are, and then you can even be at risk of being moved into victim mode – all you want is to do your job and they aren’t letting you.
Men in this position often find themselves not just experiencing relational trauma, but also in conflict with statutory organisations, such as healthcare, the criminal justice system or local councils. This conflict inevitably takes its toll and can be a continuous losing battle.
‘I just hurt people in my life,’ says Jack,* ‘and if they said to me, “look, we love you but you, we know what you’ve been through but you can’t behave like this”, I would ignore them or shout at them or tell them how stupid they were being. Someone made a complaint about me at work for being pushy and angry. This was mad to me because I always enjoyed work, I liked helping or advising people. I didn’t see it as pushy and angry. I almost lost my job, not because they were going to fire me, but because I thought, “F–you! I’m going to leave, then you’ll see how stupid you’re all being”.’
The uniqueness of the victim position allows a person to position themselves where they want support. Unlike other dynamic positions, they seek to relate to other people in a way that elicits help. Often those around someone in victim position are unable to help in a way that relationally connects – dynamic positions are ways of being in the world that can feel immovable. Someone in this dynamic positions can be caught in a cycle of behaviour that constantly reinforces victimhood: ‘every time I go to the shops, it rains’ or ‘why do I always date terrible people, they always find me!’ The difference between this position and the other two, however, it that the premise that victimisation took place is agreed – and this can be hard for some male survivors.
People are rarely locked into one dynamic position, they flux and change depending on who or what the person is in relation with. Relating to anyone as a victim, however, can be simply too psychically dangerous for some survivors – and therein lies the challenge for us in the therapy industry.
The work that is required to support male survivors should start before the client even steps into the therapy room. We need to acknowledge the societal ideas about masculinity and how it prevents men from seeking help. We also need to examine ourselves and our own beliefs that could uphold damaging ideas about men. Sexual abuse is just one barrier that men face to accessing help. I often say in therapy groups and presentations, sexual abuse rarely happens in a vacuum – often men are faced with other challenges such as different forms of abuse, poverty or structural oppression. We must do what we can to be accessible in a meaningful way, communicating to men who face barriers that we are inclusive in a more than tokenistic way. In our personal lives, we need to be aware of when harmful myths about masculinity affect our decisions or behaviour and challenge those around us who knowingly or unknowingly perpetuate these myths.
No all victimhood looks the same. Once men are in therapy, we need to be aware that not all male clients will behave ‘like a victim’. They may occupy the rescuer or persecutor position and resist the therapeutic process. Bion describes one such experience as ‘attacks on linking.’7 This is where a therapist may try to link the pain a client is feeling in the present to objects in their past, often a parent or caregiver. But rather than accepting this link, the client attacks the therapist and thus avoids the pain of making psychic links. This can present in multiple ways – the therapy can feel stuck, like it’s going nowhere, or the client can feel foggy or bored. They may be late for sessions or withhold payment. The pain of surviving sexual trauma can be acted out in every transaction between the client and the therapist, requiring us to work hard to tune in to what is going on.
Different modalities will use different techniques to create space for the client to examine their positions, relationships and feelings. Cognitive behavourial therapists may want to focus the therapy on cognitive restructuring. Together they may deconstruct some of the cognitive distortions that keep clients stuck in dynamic positions and rebuild a world view in a more balanced way that allows for men to need support and help. A person-centred therapist may work to accept and understand the clients’ feelings to help them connect or reconnect with a sense of inner value, taking the power out of external dynamic positions and unhelpful relationships. This self-actualisation leads to healing trauma. Whatever modality, therapy needs to create enough space so that the client can simultaneously step away from ego states and the relationships that maintain them, as well as unlearn some of the damage societal ideas of masculinity have caused.
All dynamic positions are a prison, but they can become a familiar, even comforting one. The goal is not for men to move from a familiar dynamic position into a more challenging one, but to move away from the drama triangle altogether. How therapists support this will depend on modality, the therapeutic setting and the how the therapist builds relational trust with the client.
From a place of trust the therapist can interrogate dynamic positions and investigate the evidence that maintains them. This can be a delicate process – challenging a world view held by someone deeply entrenched in an dynamic position can serve to compound a set of unhelpful beliefs. But, over time, the therapist works to build a trusting and non-judgmental relationship, allowing the client to move around the drama triangle. The goal here is to allow the male client to sit with their own sense of victimhood and not be held hostage by societal beliefs. And, through accepting that they were a victim, allow themselves to seek the support they need in the therapy room and beyond.
*Client names and identifiable details have been changed
 Wang Y, Hunt K, Nazareth I, et al Do men consult less than women? An analysis of routinely collected UK general practice data BMJ Open 2013;3:e003320. doi: 10.1136/bmjopen-2013-003320
2 Office for National Statistics, (2022). Socio-demographic differences in use of Improving Access to Psychological Therapies services, England: April 2017 to March 2018
3 MIND, (2019). Get it off you chest: 10 years on report. www.mind.org.uk/media/6771/get-it-off-your-chest_a4_final.pdf
4 Mankind, (2021). Sexual Consent Poll February. comresglobal.com/polls/mankind-sexual-consent-poll-february-2021/
5 Karpman, S. (2019). Script Drama Analysis II. International Journal of Transactional Analysis Research & Practice
6 Brooks, H.L., Rushton, K., Lovell, K. et al. The power of support from companion animals for people living with mental health problems: a systematic review and narrative synthesis of the evidence. BMC Psychiatry 18, 31 (2018).
7 Bion, W. R. (1959). Attacks on linking. The International Journal of Psychoanalysis,
About the author
Jeremy Sachs is an integrated, intersectionality-informed therapist who works with individuals and couples. He specialises in working with sexual trauma recovery, the LGBTQ+ community and long-term health conditions. He runs sexual abuse recovery groups in Glasgow and is the presenter of The Trauma Talks podcast. @JeremySachs_