Working with young men who have experienced sexual assault
An article by Noel MacDonald, reproduced here from the DVIRC Newsletter, Spring Edition 2000, regarding "some of the ideas that I have found useful in understanding and working with young men who have experienced sexual assault."
- Dilemmas of working with young men
- Ways to engage young male survivors
- Ongoing work and intervention
- Working with shame, self blame and guilt
- Balancing exploration with building self skills
- Pacing skills
- Re-contextualising 'creative adjustments' and symptoms
- Conclusion and References
I would like to begin by thanking DVIRC for inviting me to write this article about the work that I have been doing with young men who have been sexually assaulted; as well as George Habib for contributing to many of these ideas, which developed out of much time and effort in putting together a workshop on 'Understanding and Working with Young Men who have Experienced Sexual Assault'. The workshop was part of a recent forum organised by the Centres Against Sexual Assault (now BlueKnot) called Working with Men: Dilemmas and Directions.
In this article I will share some of the ideas that I have found useful in understanding and working with young men who have experienced sexual assault. These ideas have emerged from a synthesis of my own developing thoughts, and those of numerous co workers, writers and contributors in the field of sexual assault, masculinity studies, feminist discourse, narrative therapy and other contemporary psychotherapies, particularly Gestalt therapy, which I mainly practice. In particular, it has been the young men I have worked with who have been most helpful in teaching me how to work with them. These ideas about working with young men are of course still in process, and open to new ideas and feedback. Also, I imagine that many of the ideas shared in this article pertain not just to young male survivors, but also to victim/survivors of sexual assault in general.
When working with young men, I consider it important to hold a perspective that is holistic. This includes keeping in mind both the internal (emotional, cognitive, physical, developmental, spiritual) and external (systemic, socio-political and cultural) issues and forces that impact on young men. Here I will particularly touch on the socio-political and developmental dimensions that impact on young men's experiences.
One lens that I have found useful in this work is to consider how dominant constructions of masculinity and heterosexuality impact on men and, in particular, on young men who have been sexually assaulted. Besides the impact of sexual assault, what William Pollack (1999), calls "the boy's code'" (a set of injunctions that expects them to act strong, autonomous, tough, and unfeeling) is already shaping the emotional ground of many young men's lives in a profound way. According to Pollack, boys become "so thoroughly hardened (by this gender straight jacket) that they literally anaesthetise themselves against the pain they must cope with" (1999: 46). Many boys also become shame phobic and do everything they can to live up to the boys' code and to avoid 'losing face' in front of their peers. The cost of this is that many young men feel ashamed to acknowledge any experience that violates this code. Furthermore, they often miss out on the sense of belonging and connection that comes with disclosing their genuine experience and receiving support.
Taking this ground of gender conditioning into consideration, it is not hard to imagine how this internalised boys' code magnifies the shame for a young man who is grappling with the effects of sexual assault. Patrick O'Leary, in his excellent Liberation from Self Blame, states that:
Dominant notions of manhood go a considerable way in explaining the extent of sexual abuse in our culture ... (and) also can affect the ways in which men respond to the experience of sexual assault (O'Leary, 1998: 27).
Numerous other writers have also spoken about the impact of dominant constructions of masculinity on mens experience and of its impact in relation to sexual assault (Lew, 1993; O'Leary 1998; Pollack, 1999). I have also noticed how these dominant notions of masculinity and heterosexuality, which traditionally expect men to be heterosexual, independent, emotionally invulnerable, in control and powerful, have a profound impact on how young men experience and make Meaning out of their sexual abuse. it is these meanings and their effects that I would particularly like to talk about.
These dominant notions of masculinity can commonly lead to the following effects and issues for young men who have been sexually assaulted:
- A profound sense of inadequacy, shame and isolation where young men may believe that they cannot live up to the expectations of traditional masculinity and heterosexuality. This can create beliefs about being a 'failure:' e.g. "A real man should be able to stop the abuse ... should not be affected by the abuse." Such traditional expectations can disable young men from being able to acknowledge and seek support about their sense of shame, guilt, powerlessness, fear, vulnerability, betrayal, anger and other effects associated with being abused.
- Sexual identity confusion and inadequacy as a result of the following assumptions and beliefs: "If I was abused by a homosexual I must be homosexual," "This must have happened to me because I'm gay," "Because my body became aroused I must be gay," or "Will I become gay because of this?" (Lew, 1993).
- Because of these gender expectations, young men are not supported to acknowledge and talk about the effects of sexual assault. Out of a need to feel safe and survive, the public self becomes split off from the private self. As a strategy of coping, many young men minimise and deny the impact of the abuse in their lives and, on the surface, attempt to act 'normal' order to fit in and belong.
- Due to the common effects of sexual assault (loss of trust, betrayal, shame, fear, powerlessness, loneliness, anger, vulnerability, PTSD symptoms, dissociation, aggression, loss of self worth) many young men have trouble developing the relationship skills and trust which enable them to form meaningful friendships and hence to experience a genuine sense of belonging that is based on more authentic forms of self expression. A number of relationship dilemmas and/or difficulties can arise from the inability to work through the experience and effects of sexual assault. These may include:
- reliving victim/victimiser experiences
- identification with traits of the aggressor
- self blame in relationships with others
- meeting emotional needs through sexualised behaviour
- avoidance of intimacy and vulnerability
- a need to control others
- a sense of inadequacy in building trust and friendship, and in receiving and giving love
- over identifying with traditional masculine traits (self reliant, strong, able to cope, appearing confident); ~ externalising the feelings associated with the abuse through promiscuity,
- aggression, violence or risk taking behaviour; withdrawing and isolating oneself;
- internalising the feelings associated with the abuse through self blame, self-harm, lack of self care, suicidal ideation; and
- drug and alcohol abuse.
Because of the above effects, many young men face difficulties in disclosing their experience of sexual assault. Those who do decide to disclose must risk a great deal. Adding to this, many young men and young people in general are at a developmental stage at which their main task is attempting to form an identity of their own, become clear about their sexuality, and experience a sense of belonging with their peers (Geldard and Geldard, 1999). It seems to me that disclosing and facing issues arising from sexual assault can be profoundly threatening to young men who are attempting to achieve these developmental tasks.
Given what has been said so far, it is not surprising that many young men are terrified of counselling. In coming to counselling, or disclosing to another friend or worker, young male survivors must often risk being disbelieved, shamed, overwhelmed by feelings, judged, misunderstood, and having many of their worst fears confirmed e.g. 'I must be gay because my body enjoyed it', 'It was my fault' or 'I will become an abuser'. They must also choose to begin the often painful and uncertain journey of acknowledging to themselves and another person the impact of what happened. This task is coupled with the fears of disclosure and its impact on their sense of self, family, reputation and relationships. In fact I believe that for many young male survivors the very idea of acting in the world to obtain emotional support is profoundly unfamiliar and shameful. Manner states about survivors of sexual assault in general:
The survivor has generally had to operate in a retroflective mode, doing everything for (him/her self, because support (nurturance, help, validation) was either unavailable or dangerous, in that it made him/her vulnerable to further abuse or invalidation” (1995: 20).
Of course, the impact of dominant message about masculinity is not the only factor that contributes to young men avoiding support. The experience of secrecy can also be influenced by the messages internalised from the abuser, one's developmental capacity to know oneself, the intensity of the trauma, the degree of threat and violence used by the abuser, and post abuse denial or lack of support from significant others (Kepner, 1995; Briere, 1996).
For young male survivors, the decision to come to counselling involves doing the opposite of what their survival needs and dominant constructions of masculinity encourage them to do. So how do we support young men to do something that violates these gender injunctions, and asks them to be vulnerable, trusting, open, and to reveal their worst ideas about themselves? This is a major challenge of the work I do!
Support is the fundamental interpersonal base on which the rest of development is built (Kepner, 1995). Keeping this in mind, I have found that the first steps in engaging young male survivors of sexual assault is to actively build safety and support. As already mentioned, for many young men, their first issues about coming to counselling are whether they will be believed, further shamed, controlled or misunderstood. I have also noticed how young male survivors have the assumption that they must talk about the abuse straight away. This assumption seems to create more anxiety for the young man. Hence, as early as possible, hopefully on the phone, I will remind them that it is important that they feel in control of what they want to talk about, where they want to meet me (I do outreach counselling) and for how long.
Once I have met them in person, I also believe that it is helpful right from the start to ask young men about what it is like to come to counselling? What is it like being here right now with me? what were they expecting? Did they come of their own volition? Have they been to counselling before? These questions may give the young men permission to express background issues, concerns and fears. it is usually helpful to let them know what counselling involves, and to reassure them that they can go at their own pace, talk about what they want to and not answer any of my questions if they choose not to. Once I have covered these issues, I then think I am in a better position to clarify what is important to them and what they are hoping to get out of counselling. I also notice that most young male survivors feel safer if they are asked if they want to talk about the effects of sexual abuse, rather than the abuse itself. I think this distinction can be a useful concept for young men.
Apart from the other necessary work of establishing boundaries, discussing confidentiality, and getting some demographic information, I also find it counter shaming to be actively responsive, concerned and supportive (not neutral), and to share my appreciation of the young man's courage in seeking counselling. One of the ways to do this is to openly acknowledge a young man's strength in taking a stand against the pressure to tough it out on his own. Some other questions I might ask are:
- What messages about being a man have made it hard for you to break the silence or come to counselling?'
- What beliefs might others have about sexual assault that can make it hard to talk about?'
- Have you disclosed these experiences with others? How did they respond?'
- What message are you giving to others in breaking the silence of the abuse?'
- What messages do men often get about how they should cope with emotional pain?'
- What did it take to make the decision to come to counselling and talk about this?'
These questions can further support young male survivors in locating their experience within the wider context of patriarchy and to begin to question the effect of the boys' code and other myths about sexual assault on their lives. I would like to acknowledge Patrick O'Leary's ideas (1998) for contributing to many of these questions. I have commonly noticed how relieved young male survivors look when I ask these questions and affirm the strength and courage it took for them to seek support, and to risk being real.
It is also worth considering how these dominant messages of masculinity not only impact on the young men we work with, but also on health professionals. I believe that if practitioners do not question their own notions of masculinity (and femininity), they run the risk of colluding with or overlooking the ways that young male survivors' behaviour is shaped by the boys' code. Understanding and working with these gender constructions gives us scope to begin to stand outside their influence and to explore how they impact on young men and ourselves.
Other ways I have found useful in establishing support, safety and a relationship with the young men are to:
- share my own experience of the young man in a supportive way;
- encourage choice over the content of the session;
- help regulate the pace of the session;
- use age appropriate language;
- normalise and validate their story and experience;
- name and affirm their trust, and caution or mistrust of me (and counselling) as it arises.
Building support, safety, and a healthy therapeutic alliance is not something one develops to move on from. I believe it is an ongoing process that requires constant attention to what is going on between the young man and the counsellor, and to how the young man and myself are experiencing the counselling process as it unfolds.
It is this essential process, and of working with the 'in between' (e.g. transference and other relationship issues) that can allow the young man to co create skills with me to meet their needs for safety, trust, boundaries and regulation of their self-expression. These new skills, which are often underdeveloped for young male survivors, can help them to avoid becoming overwhelmed and re traumatised during counselling, and can then be transferred to other parts of their lives (Kepner, 1995; Briere, 1996). Asking questions like, 'how is the counselling going so far?', 'how would you know when you feel safe to talk about ... or trust me with this part of your story?, 'what do you need to have in place before you are ready to talk about this?' 'how would you know (in your body) when you have said too much?' are some useful ways, I have found, of doing this.
Lastly, I also consider it helpful to build support by sharing my own impressions and experience of the young man when it feels appropriate. This may include choosing to share my concern for him going too fast into memories, the impact of his survival strategies or communication styles on me, or my appreciation of his courage in exploring feelings and expressing sadness. Some of these ideas are informed by a core component of Gestalt therapy theory, called the 'dialogic approach' (see Hycner and Jacobs, 1995).
To me, understanding young male survivors' lived experience and meaning means doing my best not to let theories and models about sexual assault get in the way of listening to and understanding the unique experience and context of each young man I meet. I actively attempt to understand the unique meanings, context and experiences of the young man from his perspective, and I do my best to avoid making premature interpretations and assumptions about his experience. This style of work is influenced by the principles of phenomenology and Gestalt therapy, which are the primary method of exploration that I use as a counsellor (Spinelli, 1989).
The young men I work with often have many complex and contradictory feelings towards the abuser, including love. They may or may not be ready to name what happened as abusive. I believe that if I jump in too early with my own assumptions about what happened (e.g. 'It wasn't your fault', or 'What happened to you was abuse'), I may miss out on understanding the young man's personal meanings and beliefs. I also run the risk of closing off any opportunity to help explore and deconstruct their own ambivalence, mixed feelings, shame, guilt and feelings of self blame. This does not mean that I don't challenge young men's minimisations and denial of obvious acts of violation. It simply means attempting to bracket my own views and opinions until I have really given space for the young man to express his. I come from a position where I am not the expert on the young man's experience. Therefore, when I do offer ideas, opinions and impressions about the young man, I offer them tentatively, with permission to do so, and with plenty of room for the young man to disagree.
Working phenomenologically (attempting to understand their unique meanings and experience) also involves paying attention not just to the content of the young man's story, but also to how they tell their story (process). I believe that it is important to track the young men I am working with by noticing their verbal language, congruence, body language, breathing and facial expressions while talking. This can give me important information and cues about what might be going on for the young man. The information can then be used both to deepen awareness, and to help me attend to issues of pacing, over-stimulation and dissociation (splitting off awareness from one's body or feelings) during the counselling session.
A whole book could be written about the different effects of sexual abuse on young men. However, I do want to make some brief comments about shame, self blame and guilt, all of which are common. Firstly, I believe that it is important to understand the nature and function of shame as an effect of sexual abuse. From a Gestalt perspective, the survival function of shame is to help us move away, close down and protect ourselves from an environment that is perceived as dangerous or critical (Lee, 1996). Originally, in an abusive context (and in some current contexts), this effect and function may have been useful. However, it may now keep a young man permanently disconnected from aspects of himself and from the environment. Unfortunately, because shame can make us feel unworthy of contact, many young male victim/ survivors find it difficult to receive support and to break the self reinforcing cycle of shame.
In my opinion, one useful way of working with shame is for the counsellor to name and actively respond to shame when they see or sense it arising in the session. Shame can manifest in obvious ways such as blushing, withdrawing or avoiding eye contact. It can also manifest in more disguised ways through changing topics, tensing up, getting angry, blaming others. It may be a trigger to dissociation (Yontef, 1993). By tentatively naming shame when it may be appearing, the young man can then have the important opportunity to learn that shame itself will not be shamed, fixed, judged or avoided by the counsellor (Kepner, 1995). I have noticed how relieved some young men become when they can acknowledge their embarrassment and shame about their abuse, or ways they have coped with the abuse. From my experience this can help reduce a young man's fears of exposure and enable him to deepen his awareness and ability to tolerate shame and be vulnerable. I have also found it helpful to normalise shame and its function, to reflect how painful it can be to feel, and when the time is right to help the young man link it back to the abusive, neglectful or cultural contexts in which it developed. This may begin to help the young man separate what he learnt about getting support in his past, from what is available and possible in his current context.
Self blame and guilt can be one of the most challenging and complex aspects of working with young male survivors of sexual assault. In working with young men's sense of self-blame and guilt, I find it helpful to explore its unique meanings. Once the self blame and guilt are out in the open (the young man must feel safe to do this), I can then begin to ask questions that gently explore their function, effects and development. For example: 'What does your self blame do for you?', 'How does self blame strengthen or weaken you?', 'How did you come to see it was your fault?', 'How do you think the abuser contributed to making it feel like you are responsible?' and 'What messages about being a man might contribute to you blaming yourself?'
The function of self blame is incredibly complex and often contains historic adaptive functions for the young man. For instance, by blaming themselves young men may create an illusion of control that helps them to avoid the more painful feelings of grief, anger, powerlessness and despair about the abuse. It may also stop them from needing to seek support. Furthermore, depending on the unique context of the young man's life, some young men may have wanted the affection of the abuser, and have been willing to tolerate the abuse in order to gain this affection. This adds further layers of complexity and confusion for the young man in working through the self blame.
Because young men are expected to be strong and invulnerable, they often do not take into account the unequal power dynamics between themselves and the abuser. I have noticed how many young men feel ashamed and guilty for not being able to stop or protect themselves from the abuse. Because of these issues, I believe it is important to challenge young men about the power imbalances between themselves and the abuser, and to ask how their self-blame is connected to expectations about masculinity. I am indebted to Patrick O'Leary (1998) for his ideas about 'unmasking the politics of power It is also useful to bring to young men's attention the many tactics and tricks perpetrators use to make the victim feel responsible for the abuse.
Some of these ideas have already been briefly mentioned. Typically, many survivors of sexual assault particularly where other forms of abuse were involved have had little opportunity and support to learn the skills of tolerating and managing their experience in healthy, integrity building ways (Kepner, 1995). I have noticed how many young men rely on dissociation, numbing, drug and alcohol abuse and other tension reducing activities such as aggression, avoidance and self harm to cope with their feelings. I find it useful to assume that these young men am doing the best they can given their level of development, insight and the internal and external resources that they have at the time. Although sometimes harmful to self and others, I also assume that within some of these survival functions are the genuine need for self coherence, expression, integrity, connection, strength, safety and equilibrium.
Given this point, one of the most important parts of working with young male survivors of sexual assault is to inquire into and honour the underlying need of their current survival strategies. Once this has happened, I am then in a better position to gently challenge their strategies and to support them in creating new, more adaptive skills to meet their needs and to manage their experience and contact with the world. This is particularly important in cases where I think young men disown their responsibility for hurting others or themselves. Without these skills, young men who want to explore their memories may run the risk of being retraumatised. They have no more internal or external resources to face their unprocessed feelings and experiences than they did when the original abuse occurred. Kepner also states that:
We cannot expect the survivor to change ways of being that have worked so well for her (him) in desperate conditions unless We have first helped her (him) to develop new resources in the present and a sufficient sense of support (1995: 64).
A particularly important part of working with young male survivors is to encourage their awareness of how to pace the speed and level of intensity of their exploration in the session. This can help them to learn to tolerate and ride waves of feeling, without resorting to old modes of adaptation such as denial, self harm, dissociation, avoidance or acting out behaviours. Young male survivors have often had little experience of learning to do this. Collaborating with them to develop pacing skills helps them to know and identify their body signs when they have explored enough and may need to slow down, relax or divert their attention, to more soothing discussions. It also empowers them to make choices about how to manage their level of stimulation during and after the session so that counselling doesn't become a place that can replicate the intensity and flooding of feelings inherent in the original abuse (Kepner, 1995).
For example, one young man with whom I have recently been working did not notice his rising agitation while talking about his past. All of a sudden he became aware of 'rageful' feelings that he did not know how to handle. In hindsight, I can see how I got too interested in his story and forgot to notice his non verbal cues, and to encourage him to slow down and notice what was happening in his body while speaking. This could have helped him to ride the wave of his anger by grounding himself. Eventually this young man did learn to do this and now, according to him, he has an easier time coping with his intense anger. He can also notice his growing body signals (knots in his stomach) that remind him of what he needs to do to take care of himself. It has been through experiences like this, and seeing the consequences of young men uncovering historic memories too fast, that I have learnt the importance of pacing skills.
Other self skills that may help young men to manage and tolerate their feelings and interpersonal situations might include the following:
- Grounding and 'affect tolerance skills'. having the skill to manage intense feelings or dissociation by making contact with the chair, feeling one's feet on the floor, bum on the seat and breathing slowly and deeply while looking around the room (Kepner, 1995; Linehan, 1993).
- Boundary skills: these can be developed by helping young men to actively choose what they want to talk about, where they want to sit, when they have had enough, when to change topics, and acquire the ability to notice one's personal space boundaries and say 'no' to people.
- Self support and self soothing skills: these involve supporting young men to learn how to take care of themselves to eat when hungry, sleep when tired, relax or talk to someone when stressed, and do things for themselves that they enjoy doing such as take a walk, read a book, listen to music.
- Mindfulness skills: encourage young male survivors to learn to stay with their feelings without judging or wanting to change them (Linehan, 1993). This may first involve externalising and challenging their judgements, and reminding them that feelings come in waves when they don't try to interrupt them (Kepner, 1995).
Generally, young male survivors of sexual abuse had little power or capacity to act on behalf of their own needs and to manage their interpersonal boundaries during the abuse. Furthermore, the abusive context often becomes internalised and experienced as being about oneself, rather than about the context. For example, this process can be a result of messages internalised by the abuser ('it was your fault') minimisations and denial of the reality of the abuse by caretakers ('what happened to you wasn't important'); childhood conclusions made about the abuse ('I must be bad because this happened to me') and feelings related to the abuse becoming seen to be about oneself (feeling dirty from the abuse becomes 'I am dirty] (Kepner, 1995). Effects that are essentially a result of an abusive context can thus end up being perceived to be solely about oneself. Young men are often left with a set of experiences and symptoms that are severed from the original context, and because of this they become more vulnerable to confusion, self blame, guilt and shame. This is further exacerbated by the effect of the boys' code and mainstream values of individualism that encourage young men to perceive themselves independently from their surroundings.
Given these factors, it can be very helpful when working with young male survivors to help put their current negative perceptions, symptoms and behaviours back into an interpersonal context (often the abusive context) in which they make sense. According to Kepner (1995), the idea is to take experiences or thoughts that are seen by the young men as being about themselves, and reframe them into a context that includes cultural and historical events. For example, one's current belief about feeling unworthy of support may be a result of growing up in a chronically neglectful environment; or one's experience of fear and free floating anxiety may be about having been frightened and terrified by the abuser
So far I have met no young men who have been able to see the effects of their sexual assault as normal reactions to an abnormal and abusive event. If they did, they would not need counselling! Usually, it is the other way around. They perceive their current behaviours and symptoms as abnormal experiences with no connection to previously abusive or neglectful contexts.
When doing this re contextualisation work it is very important to consider how ready the young man is to do this work, and to offer hypotheses tentatively to him. I consider it is important to ask the young man whether the guesses I offer him, fit 'experientially'. It is like asking the young man to try on a coat to see if it fits. I find the following steps helpful in doing this kind of recontextualising work:
- Explore descriptions of 'creative adjustments" or survival strategies: current patterns, symptoms, self and other perceptions, and coping strategies e.g. drug and alcohol abuse, controlling behaviour, violence, dissociation, self reliance, withdrawal, perfectionism, self harm, work-a holism.
- Look for and validate the 'genuine' purpose and function of the 'creative adjustment' within the current environment e.g. is there a need for safety, familiarity, predictability, comfort, power, equilibrium, survival, security, integrity, self cohesion that gets met in their current coping behaviour, patterns and perceptions? I assume that most young men's current symptoms and problems are a result of once highly adaptive responses to abusive and neglectful environments.
- Tentatively link the purpose of current coping strategies to its original context (recontextualisation experiments, Kepner, 1995). For example, dissociation, numbing and withdrawing were once adaptive responses to being abused.
- Explore how the 'creative adjustment' is a resource and hindrance now. What are its costs and advantages? How does it affect others? In what contexts is it strengthening and weakening you? How does it get in the way of you growing/healing?
- Invite experiments to explore new ways of being in relating to others and in perceiving oneself and the world that allows new choices and possibilities, This can involve helping the young man learn new self skills and the ability to separate the present conditions of his environment from his past.
Note: A creative adjustment is a Gestalt therapy term that refers to how we creatively resolve the dilemmas life presents to us to the best of our ability (Perls, Hefferline and Goodman, 1951). In relation to young men a creative adjustment is 'a solution used by a young man that helps them adapt to their abusive environment and its effects in a way that best maintains their self cohesion, integrity and equilibrium, given their current resources and level of development'.
In this article I have portrayed the way I work with and understand young male survivors of sexual assault. I hope that I have conveyed how complex and challenging this work is, and yet how incredibly rewarding it is to see young male survivors grow and develop healthier ways to live with the knowledge and effects of their abuse. It feels important for me to say that it is much easier to write about this work than it is to actually practice it. This is the part where I often find myself swimming, forgetting what to do, and only remembering afterwards what might have been helpful.
Briere, J. (1996, 2nd ed.), Therapy for Adults Molested as Children: Beyond Survival, Springer Publishing Company, N.Y.
Geldard, K and Geldard, D. (1999), Counselling Adolescents, Sage Publications Inc., London
Hycner, H. and Jacobs, L. (1995), The Healing Relationship in Gestalt Therapy: A Dialogic-Self Psychology Approach, Gestalt Journal Press, Highland, N.Y.
Kepner, J. (1995), Healing Tasks: Psychotherapy with Adult Survivors of Childhood Abuse, Gestalt Institute of Cleveland, Jossey Bass Publishers, San Francisco
Lee, R.G. (1996), 'Shame and the Gestalt Model', in Lee, R.G and Wheeler, G (Eds), The Voice of Shame: Silence and Connection in Psychotherapy, Gestalt Institute of Cleveland, Jossey Bass Publishers, San Francisco
Lew, M. (1993), Victims No Longer: Men Recovering from Incest and Other Sexual Child Abuse, Cedar Publications, Great Britain
Linehan, M. L. (1993), Skills Training Manual for Treating Borderline Personality Disorder (Diagnosis & Treatment of Mental Disorders S.), The Guilford Press, N.Y.
O'Leary, P. (1998), Liberation from Self Blame: Working with Men who have Experienced Childhood Sexual Abuse, Dulwich Centre Publications, Adelaide
Perls, F.S., Hefferline, R., and Goodman, P. (1951), Gestalt Therapy, Julian Press, N.Y.
Pollack, W. (1999), Real Boys: Rescuing Our Sons from the Myths of Boyhood, Scribe Publications, Melbourne
Spinelli, E. (1989): The Interpreted World: An Introduction to Phenomenological Psychology, Sage, London
Yontef, G. M. (1993), Awareness, Dialogue and Process: Essays on Gestalt Therapy, Gestalt Journal Press, Highland, N.Y.