Structure

1	Housekeeping, announcements, & check in	15 min
2	Module content Mid-group review Emotionally-engaged living	45 min
3	Break	15 min
4	Module content Emotionally-engaged living cont. Exercise options, and empathy & compassion	45 min
5	Wrap up: Check out	15 min

 

Resources & materials

• Labels for name tags.
• Notepads & pens.
• Whiteboard markers.
• Refreshments.
• Handouts.

Housekeeping & announcements

Remind the group of the weekly arrival procedures: name tags, welcome to refreshments, cell phones off, etc.

Check in

Module content 1: Mid-group review

This module looks at how the group can review their experience of the group thus far, in order to make sure participants are on the road to fulfilling their hopes and aspirations.

Mid-group review

Re-introduce and invite participants to consider the list of group 'Hopes and aspirations' and established group norms that they created in Week 1. Place them on the wall or have them available as a handout. Facilitators to make a summary statement, present a brief overview of the content covered so far, and content planned for the upcoming weeks. Place the review in context, acknowledging that it is always useful to pause and take stock, to check we are heading in the right direction, and covering the ground in a way that participants find useful and supportive.

• How are we travelling in relation to the identified 'Hopes and aspirations'?
• Are there any additional topics you would like to consider or address?

In pausing and reviewing, it is useful to note how we consider and explore different aspects of life, and that our understanding and priorities can change. Sometimes we don’t know what we don't know, and it is only as we gather new information, or learn about different options or ways of doing things, that we understand what is useful or possible in the present and future.

It can be useful to invite the men to reflect on the discussions in previous sessions/weeks, and to note and maybe voice what they have learned. It can also be useful for facilitators to acknowledge that, in the past weeks, participants may have been 'careful' not to name all the impacts sexual abuse has had on their lives, and that this speaks to the importance of prioritising safety and building trust in developing relationships. In naming this, we are not looking for increased disclosure, but to offer 'support' to those men who have exercised 'self care' in not naming all the impacts of sexual abuse, and hence not naming hopes and aspirations that they may have in addressing these into the future. By naming what cannot be named, or what it might not be safe or prudent to name, we support men who are struggling with 'negative self judgement' or 'self criticism', or who are down on themselves for not talking about some impacts and behaviours at this time. This is an opportunity to re-iterate the importance of care of the self.

Module content 2: Emotionally-engaged living

This module begins a discussion on emotionally-engaged living, in particular how gender relates to male experiences with emotion.

Reflecting on emotions

There are a number of routes into supporting men who have been sexually abused, to develop emotional competency and to live more emotionally-engaged lives. Whilst a discussions of 'anger' can be a typical starting place when talking with men about emotions, the mid-group review provides an opportunity for a more expansive discussion, and to check in with participants about their interest in further developing their understanding, connection, and relationship with emotions. For some men, emotions may have been viewed with suspicion, as something that can overwhelm their mental faculties and resources, or as something to be curtailed and contained (like anger). For some men, emotional engagement has not been a priority in their life, they have lived life disconnected and distanced from emotions, focusing on doing, achieving, getting on. And there will be some men who are seeking out a better understanding of emotions, who recognise the value of enhancing their emotional awareness and vocabulary and living a more emotionally engaged life. Facilitators might invite participants to consider:

• In what ways has the experience of sexual abuse impacted (or not) on your emotional well-being and sense of self? Are some emotions easier to express, access, and manage than others? What are these?
• What are some possible effects of being in a relationship with someone who is not confident in managing and expressing emotions?

Facilitators may ask an evaluative question, such as:

• If a degree of individual emotional awareness and literacy is a prerequisite for a successful relationship, and intimate partner relationships in particular, how would you rate your readiness on a scale of 1 to 10 (1 being not ready at all, 10 being I've got this covered).

Developing emotional literacy and an emotionally-engaged life

Development of a working level of emotional literacy, whereby someone is emotionally aware and has tools to handle a wide range of emotions, is useful for everyone. Developing a working level of emotional literacy is particularly important for men who have been sexually abused, in that they are likely to confront a range of sometimes confusing and intense emotions. In preparing to talk with participants, it is useful to note:

• An emotion is our physiological response to a stimuli, event, or thought. Essentially, it is invisible.
• What we label emotions influences how we respond to them.
• Some emotions are not easily identified.
• Emotions are not discrete, sometimes you can feel a range of emotions at the same time.
• Sometimes you can feel a range of 'competing' emotions at the same time: for example if you are about to do a bungee jump you might be feeling both intense fear and incredible excitement (to the extent that you might feel completely overwhelmed and start to think you are going to die).
• Going in search of what he is 'really feeling', or identifying the 'core feeling', can limit rather than expand options.
• Emotions are not facts!
• There are no right or wrong emotions. No feelings are negative, just difficult.
• People’s responses to emotions are different and can change. What is difficult for one man may be ok for another, and what is difficult in one context may not be in another.
• 'Good', 'ok', or 'bad' are not emotional states, they are judgements or evaluations of feeling states.

Emotional awareness

We all have the capacity to experience emotions, and feeling emotions is part of living a fully engaged life. Males and females are born with an equal capacity to experience and express a wide range of emotions. However, in our culture, men and women are typically taught and learn to recognise, understand, relate to, express, and seek to manage emotions differently. These gendered ways of relating and responding to emotions can produce particular challenges for men who have experienced childhood sexual abuse.

Men and emotions

“In Western culture, men are taught to be the tough ones: They’re not to cry, they’re supposed to have the answers, be the providers, and above all it’s not okay to show emotion…” (Participant 274, Easton, Saltzman & Willis, 2013).

One of the fundamental components of our society's idea of masculinity lies in men's ability to be strong, in control, and emotionally contained. This concept of men and emotions is often grounded in the development of boys from an early age, and strongly cemented by adulthood. These dominant ideas about masculinity can have significant impacts on the way in which men express and experience emotions, including in relation to childhood sexual abuse.

Gender expectations shape both men and women's lives. The differences between genders and emotions starts early on in development, some of which include:

• Expression of emotions is often associated with being seen as weak, cowardly or overemotional.
• The suppression of emotion is strongly associated with masculinity.
• Both men and women face limits on their expression of emotions, but in different ways.
• Learning what are considered acceptable emotions for men and women to have and express begins in early childhood, and is shaped throughout adolescence and into adult life.
• Women generally acknowledge, and express more directly, certain feelings, such as fear or sadness, but are taught to dampen or avoid others, such as anger (Briere & Scott, 2006).
• Men are taught to be in control, to limit and hide emotions, particularly emotions related to vulnerability. And they learn to externalise or to act on the environment as a means to manage and reduce emotional pain or distress (Briere & Scott, 2006).
• The limitations imposed on emotional expression and understanding often leaves men with an inner turmoil that they feel they are unable to relate to, describe, or express.
• Boys learn to repress certain emotions, in order to avoid the stigma of appearing weak and 'feminine'.
• The expectation that men should be in control of their emotions means that, when intense emotions do appear, this can add to men’s feelings of distress, uncertainty, disempowerment, being out of control, and failure as a man.
• Men's efforts to live up to the stoic men's code can result in men suppressing, denying, avoiding, ignoring, or numbing from emotions (resulting in negative mental health outcomes). It can produce a pressure cooker effect, where the more men try to control and keep a lid on emotions, the more they feel out of control.
• The gender expectations around emotions shape men's understanding of self. If men are struggling with emotions, this can lead them to judging themselves, and seeing themselves as a failure and 'less of a man' for not being able to contain and manage emotions.

Emotions

The topic of men and emotions would typically have been touched on in the 'Being a and man' session/discussion. The intent here is to further explore men's relationship with emotions and emotional expression (if required), starting with a review of the cultural suggestions and expectations men are aware of in growing up as boys and men. This can lead into a discussion of how these has influenced the men's lives and finally how these expectations have shaped the men's sense of self. Talking about emotions with a group of men can be unfamiliar territory and requires a degree of care, it can also be rewarding.

The below initial discussion starter questions relate to the expectation and challenges men in general confront in developing emotional literacy, prior to moving on to consider the particular difficulties and constraints that men who have been sexually abused are faced with. The focus on men and emotions in general, helps to 'normalise' men’s struggles and difficulties and is a gentle starting place.

Facilitate individual, pair, small group, or large group reflection on:

• What did you learn about emotions and expressing emotions when you were growing up?
  
• In our culture, are some emotions considered 'feminine' or 'not manly' and some emotions considered 'masculine' – what are they?
  
• Are there ways that boys and men in particular are meant to emotionally react or not react when they are feeling hurt?
  

Invite participants to take a moment to reflect on and share:

• How have these different expectations influenced you in how you understand and handle emotions?
• When did you first learn to hold it in and not show your feelings?
• When did you first learn not to cry? How old were you? How has this impacted on your emotional expression?

Additional questions relating to how these expectations about men and feelings have influenced men's sense of self:

• How have these expectations about how boys and men are meant to experience and handle emotions influenced you in relation to how you understand and think about yourself?
• Have they invited self judgement and self criticism into your life?

Common beliefs regarding men and emotions:

• Men don't show any emotion.
• Male feelings are different from female feelings.
• Feelings are weak and unhealthy.
• Emotional expression is not ok, it's juvenile.
• Boys/men don't cry.
• Women know about, and have free access to, their feelings and men don't.
• Boys and men don't show fear.
• Men get angry and get even.
• Logic is masculine and feelings are feminine.
• Feelings get in the way of thinking. Expressing your feelings means you're out of control.

In listing these common ideas about men and emotions, it is useful to acknowledge each man will negotiate these expectations in his own way and to his unique context. We cannot assume how an individual man will relate to these cultural expectations. What men do commonly appreciate, however, is the opportunity to explore these expectations that usually operate in an unspoken and unexamined manner, and can further silence and contribute to a sense of personal failure.

The facilitator's role is to support the discussion (including introducing information from the start of this section), in a way that highlights some of the unrealistic and unhelpful gender expectations that men who have been abused can face.

A fifteen minute break is held following this module.

Module content 3: Emotionally-engaged living cont.

After the break, an exploration into emotionally-engaged living continues, including expressed and non expressed emotions, and the impact emotion has on men and their bodies.

Facilitators are to introduce content, and to choose exercises to support group members discussion, understanding, and enhanced knowledge and skill, with reference to their emotional awareness, comfort, and literacy.

Presentation

Process model of expression and non-expression of emotions

The below five-step model is a framework that men who have been sexually abused have identified as useful for helping them to understand emotional experiences and responses.

Kennedy-Moore & Watson (1999), 'Process model of emotional expression and non-expression'

Step 1.	Pre-reflective reaction	A potentially emotion-provoking stimulus activates a primary effective state and an accompanying physiological arousal in a person (largely preconscious)
Step 2.	Awareness of affective response	He typically becomes consciously aware of this experience, however training men have received to repress negative or vulnerable emotions may stop him from acknowledging these emotions
Step 3.	Labelling and interpretation of response	If the man becomes conscious of an emotional response he will typically attempt to label it – 'I feel angry'.
Step 4.	Evaluation of response as acceptable	Once labelled emotions are evaluated in terms of beliefs and values to determine if they are acceptable to their understanding of self
Step 5.	Perceived social context for expression	Even if acceptable, an evaluation is then made of the social context to determine how expression of these emotions will be received and the potential impact on self-prior to any expression.

 

This process model highlights how individual knowledge and experience, gender expectations, and sense of self, culture, and context shape men's recognition and response to emotions. It is useful in that it provides a guide to some of the terrain and steps to navigate in developing an emotionally-engaged life. Men seem to like it because, like an instruction or car mechanics manual, it breaks down and identifies different elements and details how what is quite a complex process, which can occur in a nano-second without conscious thought, fits together and operates.

Although feelings start as a physiological response to a stimulus, event, or thought, work on developing emotional vocabulary is a useful starting place when seeking to increase men’s awareness, understanding, and range of responses available.

Expanding men’s emotional vocabulary

Introduce the 'Feelings word list' handout as a useful reference tool to assist in expanding men's emotional literacy. The more tools we have in our toolbox, the more options we have in finding the right tool or word to express what we are feeling. Invite group participants to go through the 'Field of feelings' list, and have them consider the different emotions and different responses to them. This can be done as an individual or large group exercise, worked through by the facilitators (consider group members literacy before asking to read the list and do as an individual exercise). Consider:

• Are you familiar with all these feelings?
• Are you more familiar with some feelings than others?
• Are there some feelings that are easier to express than others?

Part of the impetus in taking time to map out the challenges that face men who have been sexually abused seeking to better identify, understand, and respond to emotions, is to 'highlight the complexity' of what he has had to deal with and is having to deal with. At times men can feel overwhelmed, and think that the difficulties he faces in recognising and responding to emotions are because of his personal inadequacy and failure, rather than the sum of his experiences, and the context in which lives. This can add to a sense of damage and diminished life. Developing the tools that help him identify, navigate through, and keep him on track when strong emotions and difficulties arise are therefore important.

Dealing with strong emotions – One of which is anger

Men who have been sexually abused or sexually assaulted identify having to deal with strong emotions, such as anger, sadness, fear/anxiety, and shame. These are emotions that men worry will completely overwhelm their resources to cope and lead to them feeling and 'being out of control'. Of these emotions, anger is the one that is typically associated with 'being a man' (anger has been described as an 'active emotion' and men are meant to be 'active, doers' that make things happen). Many men will be familiar with anger, able to identify it more easily than other emotions, and provide accounts of how they have dealt with, managed, expressed, or not expressed anger at different times and in different contexts. There is a challenge in working with men to build emotional literacy in ways that acknowledges the subject of anger, without foregrounding it as 'the' central aspect of emotional work with men.

Men’s relationships with anger are complex. Many men will be familiar with anger, having grown up seeing anger expressed in violent and aggressive ways. Anger is different from 'aggression', which can be one of the ways of expressing anger. Anger, the emotion in itself, is not bad or good. Anger can be evoked when someone is acting against our values, when we witness an injustice or someone is being harmed, or when we think about our self being harmed. Whilst some men who have been abused will have developed a habit of expressing anger in aggressive forms, sometimes to protect themselves when they feel threatened, some men will shy away from anger and any form of aggressive expression. When anger appears, there can be other emotions around, which, because of the presence and men's familiarity with anger, do not become acknowledged or recognised. In talking with men about anger (including when introducing models, such as the 'Emotional funnel' or 'iceberg') the emphasis is on increasing emotional literacy, expanding awareness, and the ability to identify a range of emotions that may be present. See useful quote:

“I am so glad for these professionals I have now, because they have really challenged me to learn not everything’s called ‘anger’, some things are called ‘frustration’, some things are called ‘annoying’…I mean you’re not always mad. So for me being a man, I didn’t know that, I was, like pissed off. There was rage and there was anger. Then there were other feeling you didn’t talk about like intimacy, love, that mushy stuff.” Teram et al (2006)

Distress tolerance and emotional regulation

It is useful to have, in your well-being toolbox, a range of ways of dealing with emotions that allows you select the preferred option for this particular emotional response and particular current context. This includes developing knowledge and skills that support distress tolerance, and those that support emotional regulation.

Men and their bodies

In seeking to develop awareness and skills for both distress tolerance and emotional regulation, men are invited to increase their awareness of and connection with their bodies. As the process model of men’s responses to emotions outlined above identifies, an emotion is our physiological response to a stimuli, event or thought, hence developing awareness and better managing emotions involves paying attention to our body and its responses. Paying attention and listening to their bodies is something some men may not have spent a lot of time doing, especially when you consider that in growing up male and in 'being a man', men’s relationships with their bodies are often presented as one of controlling and conquering the body. According to this script, men are meant to be rational, logical, they are meant to be in charge of their bodies, 'mind over matter', 'no pain, no gain'. Many men, particularly older men, will be becoming aware of the cost of not paying attention their bodies and not taking care of their bodies, in terms of health costs, injuries, and pain. However, talking about men’s bodies, and inviting men to develop greater awareness of bodily responses, can still be an uncomfortable conversation for some men – particularly in a group context with other men.

As a mean to increase men's awareness and attention to their bodies, it is useful to invite the men to introduce mindfulness practices as part of daily routine. Establishing healthy routines and mindfulness practice (like the Body Scan) are particularly useful, in that when someone is feeling overwhelmed by emotions and thoughts, it is not the time to be introducing something new. Some men can relate to and prefer to call this quiet time. Routines, such as yoga, thai chi, and pilates are useful in building men's awareness and connection with their bodies (and in the case of yoga, in managing the effects of trauma).

Physical signs of different emotions

Depending on group participants' emotional literacy, comfort, and familiarity with distress tolerance and emotional regulation techniques, it can be useful individually, in dyads, or in the larger group, to map out and discuss:

• What are the physical signs of feeling anxious?
• What are the physical signs of feeling angry?
• What are the physical signs of feeling sad?
• What are the physical signs of feeling shame?

To support this discussion facilitators can introduce images of the body atlas, where scientists have mapped how a range of emotions appear and are expressed in different parts of the body. In presenting these images it is useful to note that every person is different and may experience and feel emotions in different places. The key is for individuals to develop and maintain awareness of their body’s reactions and signs of different emotions.

Thoughts and feelings

A working understanding of emotions inevitably involves an awareness of how thoughts and feeling can interact, accentuate, or diminish sense of distress. It can be useful to map out the different thoughts related to the different feelings, using the above emotions of anxiety, anger, sadness, and shame.

Many of the participants will demonstrate some confusion between thoughts and feelings. This confusion is quite common – a reference can be made to popular culture to accentuate this (e.g., 'I feel like I am losing you'). The following guide can be helpful for facilitators and participants alike to delineate between emotions and thoughts:

“When I think that _______, it makes me feel _____.”

or the corollary statement:

“When I feel _______, I tend to think that ______.”

Module content 4: Exercise options and empathy & compassion

Further Options

To further explore feelings, and develop an awareness of how individual group members personally relate to different feelings, it can be useful to introduce and work through the following categories. This is not about identifying feelings as right or wrong, or good or bad. It is about participants developing an awareness of how they 'personally' respond to particular feelings. As indicated in the previous module, the ways in which someone identifies and categorises feelings influences how they respond to them (It is section four of the process model of emotional expression or non-expression). Using the following categories, invite the participants to categorise different feelings:

• Which feelings, feel comfortable (C) to express?
• Which feelings, feel uncomfortable or difficult (D) to express?
• Which feelings, are particularly confusing or create uncertaintly (U)?
• Which feelings make you feel in a vulnerable state (V)?

From an awareness perspective, it can be useful for participants to consider how these categorisations impact on how they respond to the different emotions. From a distress tolerance and mindfulness perspective, the habit of categorising emotions in negative ways can in itself lead to difficulties accepting emotions and making room for them, to the extent men can set up struggles with emotions and or seek to deny or avoid particular emotions. An awareness of personal responses to different emotions can also be useful in that when they do appear, men can adapt and choose their response in a way that acknowledges their known habit of 'reacting' to particular emotions in particular ways, and to respond in a way that is appropriate for this identified emotion, for them and for this context.

Option: Ego states – Our three operating systems

Some men find the 'Ego state' framework useful when seeking to enhanced and better understand self, their different emotional responses, and operating systems. Reference the handouts 'What are ego states' and 'How ego states are fixed in time' to describe our three operating systems. We define ego states as our collection or repertoire of behaviours, thoughts, and feelings that we operate unconsciously from.

Triggers, flashbacks, & emotional hijacking

For men who have been sexually abused there is the added difficulty of being confronted and emotionally overwhelmed by triggers, difficult memories, flashbacks that can lead to emotional hijacking. Developing a clear awareness of what is emotionally triggering is useful both for settling one self when events do occur (I know this trigger and why I am feeling strong emotions), and in working to purposefully approach and desensitize to a trigger. A difficulty is that some triggers can occur at a subconscious level: a smell, taste, particular dynamic, person or personality style or context. What is most useful In these situations is that a person has the awareness and strategies to identify what is going on, and to settle themselves emotionally in order to get back on track as soon as possible. More detail reviewing and processing of the emotionally triggering and hijacking event, including the possible stimulus and responses to it, can occur at a later date. Whilst naming and discussing in a group context the added difficulty of triggers and emotional hijacking that men sexually abused in childhood can face, processing and addressing individual triggers is better undertaken one on one with a trauma informed counsellor or therapist.

Facilitators to review and refer to 'Flashbacks' handout, 'Grounding exercises' handout, and the 'Emotional hijacking' handout.

Empathy and compassion for self and others

As a precursor for the upcoming discussion on relationships, facilitators are to introduce and support the exploration of two important emotions: empathy and compassion. It is useful to talk through and consider empathy and compassion for self and for others.

Empathy: the feeling that you understand and share another person's experiences and emotions. The ability to share someone else's feelings.
Compassion: sympathetic consciousness of others' distress together with a desire to alleviate it.

Here are some example questions for discussion of empathy and compassion:

• What is empathy? What does it mean to you?
• What does it feel like to have empathy?
• How is empathy important for relationships?
• What would it be like to be in a group without empathy?
• What is the difference between empathy and compassion?
• What is compassion? What does it mean to you?
• What does it feel like to have compassion?
• How might self compassion contribute to your life?
• In what ways do you cultivate and support empathy and compassion for self and for others?

Photo-language, such as 'Picture this' can be used to stimulate discussions on empathy. Invite participants to choose a picture that has a person in it, and talk to the group from that person’s perspective. Put yourself in their shoes. What are they thinking, feeling? If you have trouble starting, pretend that you are that person...

Note: Some professionals differentiate between feeling empathy and social empathy: identifying social empathy as where someone understands that it is important to consider another person’s feeling and perspective, but to do that at a cognitive understanding level, not a 'feeling level'.

Wrap up: Check out

Review: Processes/content covered/reflections

Mindfulness, relaxation, or grounding exercise

Depending on the needs of the group, the following options for grounding may be beneficial prior to closing the group:

• Standing mindful awareness activity.
• Thoughts, Sensations, Emotions (Living Well app).
• Diaphragmatic breathing.

Provision of handout or resources

Group feedback/evaluation

Introduce upcoming session content

Developing healthy relationships: Trust, intimacy, sex

Closing circle exercise: comments/reflections/self care

 

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