Considerations in the psychoanalytic treatment of men who were sexually abused as children

In this article, I examine the literature on sexually abused men and illustrate with clinical examples from my individual and group psychoanalytic practice the themes that emerge in working with them. Sexual abuse situations with boys are considered in three groups: those involving penetration, those involving inappropriate tactile contact, and those involving noncontact seduction and excitation. The boundary violation inherent in all of these situations is crucial in the treatment of the man who has been abused, as is the familial context of the abuse. Because of societal expectations about male sexuality, men may have trouble considering early sexual experience abusive, particularly if the abuser was the same gender as the man's eventual object choice. Straight or gay men who were abused by men may have questions about their sexual orientation. Acquiescence to abuse may bring up similar concerns. Sexually abused men may have difficulty differentiating among sex, love, nurturance, affection, and abuse. This creates considerable difficulty in their adult relationships, sexual and otherwise. For the analyst treating men who were sexually abused, there may be feelings of being overwhelmed by the seductive energy in the analytic relationship and also wishes to reel back and deny the horror of the material being discussed.