There are several important principles of treatment that anyone seeking good professional help in dealing with the effects of unwanted or abusive sexual experiences in childhood should know about.
We cannot list them all or spell them out in great detail. But we can introduce some crucial ones, to help with interviewing potential therapists and reflecting on one’s experiences in treatment.
Reflecting on these principles can be particularly helpful at the beginning of therapy, while establishing trust, as well as later on when challenging things come up in the process.
Not all professional therapists are competent to provide treatment to men who have had unwanted or abusive sexual experiences in childhood, or with particular problems related to such experiences. Competence requires, but is not guaranteed by (1) extensive experience and training in work with people suffering from negative effects of such experience, or (2) ongoing supervision with a more senior and qualified therapist. (See Finding and Evaluating Therapists for resources on interviewing therapists to gather information about their likely level of competence.)
A core experience of unwanted or abusive sexual experiences in childhood is disempowerment: one’s needs, choices and wishes (including not to be used) are ignored and trampled upon. Because such experiences involve betrayal of trust by a more powerful person, it is essential that the therapy not repeat this pattern by disempowering the client.
Thus good treatment is not something that a professional requires the client to accept and ‘comply’ with, as what’s been called the ‘medical model’ of therapy tends to assume. Therapists with this approach or attitude are much less likely to be helpful, and could cause harm.
Rather, the client must be educated about the treatment process and informed of options. Basically, he should be involved as a partner in setting treatment goals and decisions about how to go about achieving them. (There are exceptions, of course, in cases where clients are at immediate risk to harm themselves or others and unable to make safe choices on their own; however, even then, the client should be given as many options and choices as possible.)
Two other principles related to the therapist working to empower the client are worth noting here
- Neutrality. This means that the therapist does not take sides in clients’ inner conflicts (e.g., Should I leave or should stay? Do I trust her or not?), but helps clients identify and work through their mixed feelings and come to their own decisions and solutions. Often people expect therapists to give them advice or tell them what to do (which is consistent with the ‘medical model’ of therapy). But when therapists do so, it can take power away from clients, and prevent new learning and growth. Furthermore, if the client reacts negatively to being ‘told what to do’ – not an unusual response for someone who’s been dominated and manipulated by others in their life – this approach can even increase their attachment to unhealthy choices and behaviors.
- Disinterestedness. This means that the therapist does not use the client to meet his or her needs. This principle not only covers more extreme examples, like sexual exploitation of the client, but more subtle things like the therapist using the client to gratify needs to be admired, respected, etc. This also refers to the therapist not using the client to promote a personal agenda, for example, about how abuse survivors ‘should’ relate to family members or the perpetrator. Of course, as Judith Herman points out, this is ‘an ideal to be striven for, never perfectly attained’ – since therapists are, after all, human beings with their own needs and motives for doing therapy, with personal biases and limitations, etc.
Disconnection is another core component of experience of unwanted or abusive sexual experiences in childhood. Thus a therapist must be capable of connecting with her or his client, that is, capable of being present as a fellow human being with genuine relatedness and empathy.
However, anyone in therapy, especially people who’ve been deeply hurt and betrayed in their lives, are sometimes unable to accurately perceive the therapist, and may ‘project’ onto the therapist their own difficulties connecting (or those of a person who used or abused them sexually, or an unprotecting parent).
Also, connection does not mean ‘closeness’ or ‘intimacy’ in the traditional sense of non-therapy relationships. Boundaries between the therapist and client are absolutely essential. Therapists who share too much of their own experience, become over-involved or engaged in ‘rescue missions’ are not helping their clients; they’re violating the principle of disinterestedness by trying to use the client and the relationship to meet their own needs. This can do tremendous damage to the therapy relationship, disempower the client, prevent healing, and even retraumatize the client.
The Therapeutic Frame
Because the therapy relationship can be an intense experience at times, and involves addressing vulnerable areas of one’s life, it is absolutely necessary that the relationship is bounded by a ‘frame.’ This can be understood as the collection of ‘ground rules’ that create consistency and stability in several dimensions of the relationship. In this way, the frame ensures that the therapy relationship can be safe and healing.
Elements of the therapeutic frame include the length of sessions, starting and ending on time, cancellation and payment procedures, confidentiality and its limits, etc.
The frame helps ensure that the relationship will be a healing one, in which expectations can be established and clarified, boundaries can be maintained, and intense emotions, memories and other experiences can be contained and managed.
Much more could be said about principles of therapy or counseling. The point here has been to spell out a few really important ones. Please know it is your right to ask potential therapists to describe the principles that guide their work with people who have had experiences and problems like yours.