Foundations: Session #6 Developing healthy relationships: Trust, intimacy, sex

Structure

1	Housekeeping, announcements & check in	15 min
2	Module content Developing healthy relationships	45 min
3	Break	15 min
4	Module content Trust	45 min
5	Wrap up: Check out	15 min

Resources & materials

Name tags.
Notepads & pens.
Whiteboard markers.
Refreshments.
Handouts.

Housekeeping & announcements

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

Check in

Module content 1: Relationships

“My wife Sharon is my rock. She gets frustrated because I can’t sit down and talk to her about it. I want her to know that I wouldn’t be here without her today. Even though I can’t talk directly to her about what happened, her love and understanding has kept me alive. It’s for her and my son Ben that I keep going.” (p. 53, The Royal Commission Final Report, Vol. 3: Impacts)

Developing positive and healthy relationships

This session focuses on relationships. Relationships are important to men. Men value relationships; they offer a sense of connection, belonging, and partnership, as well as an opportunity to express and experience love, care, and support. For men who have been sexually abused in childhood, relationships are a place where difficulties related to sexual abuse can appear, and where difficulties can be worked through and resolved.

In this session, we explore some of the challenges that men who have been sexually abused in childhood can face, as well as some of the knowledge, understanding, and skills that can help to build healthy relationships. Children learn about initiating and sustaining relationships, safety, boundaries, love, care and trusting connections, who they are, and how they are different and similar to others through being in and 'doing' relationships. Children typically learn about how to be in relationships within the family unit, and later practice and develop these skills within their peer groups. In a safe supportive environment, children learn to go to their caregivers when need nurturing, or if they are hurt, hungry, tired, or sick, and ideally, they learn that they will be supported, cared for, and nurtured. The occurrence of child sexual abuse can impact on relational learning about self and others, and produce extra challenges in navigating and negotiating relationships (particularly when the abuse is committed by a caregiver or someone close). In acknowledging the influence of these formative years, it is important to note that learning about self, and ways of relating and being in relationships, is a life long process. People develop and move in and out of relationships. Relationships grow and evolve throughout the lifespan. Men are encouraged to build relationships at their own pace, and in their own time.

Note: Whilst it is important to ensure that all group processes meets the identified needs and interests of group members, it is especially pertinent when facilitating this session. Facilitators will be required to adapt the session processes and content according to the makeup and relationship circumstances of participants (single, partnered, parent, grandparent, difficulties or not with boundaries, trust, communication, intimacy, sex).

Relationship discussions

Possible introductory warm up exercise for relationship discussion. Let the pictures do the talking. In this activity, participants are invited to explore and examine the pictures provided (Photo language cards, 'Picture this').

Can you choose a picture that represents a relationship or a feature of a relationship for you?
How does it speak to you?
Tell me a story about you and this picture.
Are there any other people who are in the story who should be in the picture?

Facilitate a discussion about relationships. It is useful, as part of an introductory discussion, to map out what makes for a positive healthy relationship, and what are the attributes, or ways of operating, that are signs of negative, unhealthy relationships (the negative discussion can include signs of an 'abusive' relationship). Facilitators to record participants' responses, and to support discussion in introducing and documenting 'known' elements of positive/healthy relationships. This discussion can be expanded to include a discussion of how training in 'being a man', and an experience of child sexual abuse, impacts on close relationships, as a means to counter overwhelming 'totalising accounts' of personal failure or damage - 'I'm just bad', 'I'm just no good at relationships'. Participants are invited to name and share with each other what they personally find easy/rewarding and difficult/hard work in relationships.

General

What makes for a positive, healthy relationship for you?
What knowledge and skills contribute to a positive, healthy relationship for you?
What are the signs of negative, unhealthy relationship?
- Note: difference between unhealthy and abusive behaviour.

Personal

What do you personally find easy in some relationships?
What do you personally find difficult/tricky in relationships?
How have your experiences of sexual abuse/assault influenced your thinking about, and ways of approaching, relationships?
Are there any unhelpful patterns or dynamics that you have noticed in relationships?

Masculinity influences

How has expectations of what it means to 'be a man’ influenced how you engage and behave in close relationships?

Common responses to what makes for a positive, healthy relationship

Respect.
Good communication, listening, talking.
Commitment, working things out together, forgiveness.
Trust, honesty.
Similar interests.
Valuing differences.
Clear expectations, clear boundaries.
Knowing who you are and what you want. Taking responsibility for what is yours.
Friendship, being supportive, showing you care.
Empathy, Understanding.
Being emotionally present and close.
Shared sex drive, good sex.
Clarity around the relationship roles and rules.

Often when men think of relationships, participants are focusing on intimate partner relationships. However men engage in a range of relationships every day, involving differing degrees of trust and personal intimacy. Men engage in relationships with friends (some close, some acquaintances), with family members (parents, siblings, grandparents, children, grandchildren, nieces and nephews), with work colleagues (employer/employee, contractor), with members of different communities (such as sport, religious or community service groups, schools and education) as well as with neighbours, in-laws, people you meet in the local park, shopkeepers and transport services, childcare providers, friends of friends, etc. Some relationships are contractual or exchange based relationships, and some develop and revolve around shared interests or experiences. It is relationships with close friends and partners, which involve greater degrees of trust and intimacy, that can be the most rewarding and pleasurable, and also be the most challenging to navigate and work out.

Core areas

Group discussion about relationships and the challenges in developing, maintaining and growing in relationships are often extensive. This may be the participants' first opportunity to discuss and reflect upon their relationships in a supportive group context as men, let alone as men who have been sexually abused in childhood. Facilitators have a role in supporting individual and group reflection and learning in relation to 'Core areas' of trust, boundaries, communication, relational dynamics ('The trauma and drama triangle'). Consultation with group participants to determine what are the core areas of interest and concern for them is essential in working out where to focus group energy, as each group will be different, and not all 'core areas' are relevant for all men. In addition to the below exercises and foundational material, men have appreciated being provided with copies of 'Renovate your relationship' or similar positive relationship resources written specifically for men.

Trust

Given that child sexual abuse typically involves a breach of trust, it is not surprising that men who have been sexually abused can be left struggling with trust. Many men who have been sexually abused report difficulties in trusting others, adopting an attitude that it is safer not to trust anyone, or that no one or no organisation/institution is trustworthy. This can be played out in partnering and parenting relationships (not wanting to let your children out of your sight). An experience of sexual abuse can even result in men who have been sexually abused not feeling able to trust themselves, believing that the choices they made at the time resulted in the sexual abuse, and hence they cannot trust their own judgement. Some men can become overly trusting, which can lead to further experiences of their trust being disrespected, and add to a sense of mistrust in their own judgement.

Trust is the cornerstone of developing long term supportive relationships. By definition, trust is a firm belief in the reliability and truthfulness of someone or something. In order to explore participants' relationships with trust, draw four concentric circles on the board, and distribute the 'Circles of trust' handout. Identify the middle circle as 'Me', the next circle as 'Trustworthy', the circle after that as 'Potential', and the last circle as 'Don’t trust'. Ask participants to consider in which circle they would place the people in their life:

Partner.
Children.
Close relatives, parents, siblings.
Friends.
Acquaintances or work colleagues.
Strangers.

Here are some example questions to generate discussion:

What is trust? What does it mean to you?
How do you develop trust?
How do you know that the people are trustworthy?
Can you ever trust someone 100%?
Is there an expectation that some people 'should' be trustworthy?
How has your past abuse experience impacted on your relationship with trust?
How can an experience of sexual abuse impact on trust in ourselves and our own judgement?

Boundaries

Discussion about personal and interpersonal boundaries often accompany discussions relating to trust. In order to negotiate and participate in relationships, it is important to be able to identify personal boundaries/limits, to be able to articulate these to others, and to have them respected. People who have experienced child sexual abuse have had their personal boundaries disrespected and violated, therefore, it is not surprising that they value the opportunity to explore and develop skills in articulating and maintaining interpersonal boundaries.

A useful starting point for a discussion about boundaries is to restate some of the core characteristics of child sexual abuse:

It is an inter-personal boundary violation.
Abuse breaches all sense of trust between the child and others.
The boundary violation of the child is major and often repeated.
It may involve many areas of child’s life - emotional, physical, sexual and/or spiritual.

As a consequence, the child learns many things about needs:

He may learn to play down his own needs and perceptions.
He may then learn it is more important to focus on other people's needs.
To maintain emotional safety, he may learn to tolerate other people's behaviour, even when it is inappropriate.

For all of these reasons, negotiating and managing boundaries can be a particular challenge for men sexually abused in childhood. Men who have experienced abuse/boundary violations can respond by adopting:

Boundaries that are very rigid – creating walls between self and others, isolating himself and not letting other close.
Boundaries that are too permeable – leaving the individual with an unclear sense of separation between him and others, of who he is, what is or isn’t his responsibility or need.

Have the participants reflect on boundaries and boundary setting with others. There is merit in delineating how boundaries are different depending on the type of relationship:

With one's partner.
With one's children.
With close relatives, siblings, parents
With friends.
With acquaintances or colleagues.
With strangers.

Communication

Communication is a key relationship skill. Relationships and their growth, or not, are influenced by the quality and clarity of communication between individuals. All relationships confront difficulties at different times. Whereas poor communication can add to confusion and contribute to relationship difficulties, clear communication, including careful listening skills, can help in working through and resolving difficulties, and in contributing to building stronger relationships. Facilitators can support participants in exploring and enhancing generic relationship communication skills (see handouts, 'Renovate your relationship' booklet), and in developing an awareness of their own particular style of communicating and relating. Additional information and support can be provided in relation to communication and managing conflict (Noting the difference between conflict and ‘abuse’, and the importance of naming and linking those engaged in intimate partner violence to appropriate specialised services).

Relational dynamics

Two models/frameworks that some men have identified as useful in helping them to better understand the experience of childhood sexual abuse, and the subsequent impact on relationships, are 'The trauma and drama triangles'. Men have described that, although not ideal nor applicable to all relationship difficulties, these frameworks/models provide an account of how an experience of childhood sexual abuse can increase sensitivity to particular relational dynamics, and importantly, how an awareness of 'The trauma triangle’ and ‘The drama triangle’ can assist them in making sense of their experience in some relational dynamics, and reducing the likelihood of them repeating or participating in unhelpful relational patterns.

'The trauma triangle' and 'The drama triangle' are presented as potentially helpful frameworks for understanding relational dynamics, which they may recognise in their lives and the lives of those close to them. The different dynamics and identity categories are presented as ways of operating and relating that it is useful to be aware of, not for participants to locate themselves and those around them within.

Option - Introduce and present 'The trauma triangle'

Reference the handout 'The trauma triangle' in the Participant workbook.

Option - Introduce and present 'The drama triangle'

Reference the handout 'The drama triangle' in the Participant workbook.

Resource for facilitators in relation to the drama and trauma triangles can be found in Facilitator resources.

Option - Introduce and present 'Attachment styles & the OK corral'

Information on Attachment, and how this can impact on sense of self and relationships, can be useful in developing participant’s awareness and understanding. Whether this is best presented within group or individual context is dependent on individual/group knowledge, experience and current circumstances (see Facilitator Resources for 'Presentation: Attachment styles' and the 'OK corral', and p. 36 in the Participant workbook for information on attachment styles).

Note: Some relationship content may be dealt with post break, prior to exploring the subject of intimacy in intimate partner relationships.

A fifteen minute break is held following this module.

Module content 2: Trust

Refresher activity: Square breathing

Utilising the basic steps of conscious breathing, have participants visualise drawing a square, with each side of the square represented by inhalation, brief hold, exhalation, and then brief hold.

Note: Some of the material detailed prior to the break may be presented and explored post break and prior to questions of intimacy.

Intimacy

What is intimacy?

Intimacy is a sense of closeness or togetherness shared with another person that can take some time and work to establish in a relationship. For men who have experienced child sexual abuse or sexual assault, like many men, becoming comfortable with intimacy can be a challenge.

Intimacy is a close personal connection between two people that usually develops over time. Typically, children learn about and develop intimate relationships through interacting with parents and close family members. As we grow older, opportunities arise to develop more intimate relationships outside of the home, getting to know people, establishing commitment and trust, building connections through work, play, sexual contact, parenting, etc. The journey towards creating intimate relationships is therefore potentially never-ending, and everyone’s experience in growing up and learning about intimacy is going to be different.

Men, sexual abuse, and intimacy

It is understandable that intimacy and close relationships can be a struggle for men who have been sexually abused, given that often the person perpetrating the abuse worked to configure and maintain the abuse as a part of an 'intimate', close relationship. Whilst some men who have been abused can sometimes feel ok at doing surface level relationships, closer more intimate relationships that involve mutual sharing of thoughts, feelings, and vulnerability can understandably be more personally challenging.

Traditional gender roles have done little to prepare and support men to develop close intimate relationships. If a man's primary role is configured as one of breadwinner, going out to work in order to provide food and shelter, there is little emphasis on intimacy. Similarly, a masculinity defined by a man’s ability to stand on his own two feet, be self-reliant, independent, and not show weakness or vulnerability, does not encourage men to develop close, intimate relationships. Add to this, difficulties created by the habit of men viewing and using intimacy in an instrumental way, as something you do in order to obtain sex. Although sex is often an important part of a close, intimate relationship, and can increase feelings of intimacy, sex and intimacy are not one and the same. There can be intimacy without sex and sex without intimacy.

It is therefore useful to explore the understandings and expectations men have around intimacy. It is useful to consider:

What does intimacy mean to you?
What do you know about intimacy?
What were you taught about intimacy when you were growing up?
How do can you achieve intimacy with your current partner, or how have you achieved intimacy in the past?
What builds closeness and greater intimacy in your relationship?
What is the difference between intimacy and sex?
What makes intimacy difficult for you?
How do you like to express and receive love in your relationship?
How does your partner like to express and receive love?

Becoming clear about and developing intimacy

In seeking to develop more intimate caring relationships, it can be useful to explicitly differentiate sexual intimacy from other forms of intimacy. The following list identifies a number of opportunities for enhancing intimacy in relationships:

Emotional intimacy – You are able to share a wide range of both positive and negative feelings without fear of judgement or rejection.
Physical intimacy – The delight in being sensual, playful, and sensitive in sexual intimacy that is joyful and fulfilling for both partners.
Intellectual intimacy – Sharing ideas, talking about issues, or even hotly debating opinions, while still respecting each other’s beliefs and views.
Spiritual intimacy – Discussing how spirituality works in our lives, in such a way that we respect each other's particular spiritual needs and beliefs.
Conflict intimacy – The ability to work through our differences in a fair way, and reach solutions that are broadly and mutually satisfactory, recognising that perfect solutions are not part of human life.
Work intimacy – You are able to agree on ways to share the common loads of tasks in maintaining your home, incomes, and pursuing other mutually agreed goals.
Parenting intimacy – If you have children, you have developed shared ways of being supportive to each other, while enabling your children to grow and become separate individuals.
Crisis intimacy – You are able to stand together in times of crisis, both external and internal to your relationship, and offer support and understanding.
Aesthetic intimacy – Being delighted in beauty, music, art, nature and a whole range of aesthetic experiences, and each of us is prepared to support the other’s enjoyment of different aesthetic pleasures.
Play intimacy – Having fun together, through recreation, relaxation, or humour.

The intention of the above list is to help highlight the multiple possibilities and opportunities for intimacy in relationships.

Practical tips for building and maintaining intimacy

Some practical tips to help men understand and enhance intimacy and love in a relationship are offered by in the book Five Love Languages Men's Edition: The Secret to Love That Lasts (Chapman, 2004). This book encourages men to talk with their partners, and to learn about and attend to both their own and their partner's preferred ways of developing closeness and expressing care. In doing so, it demystifies love and intimacy, presenting information in a practical useful way.

One of the activities that may be useful when working with men could be:

If you were asked, could you identify your preferred 'love language' and that of your partner from the following list?

Words of affirmation: Compliments, words of appreciation, positive feedback about specific things your partner has done.
Quality time: Togetherness – Giving undivided attention, more than just physical proximity. Quality conversation – talking about your day, keeping each other up-to-date, expressing your feelings, being available to listen with care.
Receiving gifts: Putting time and thought into creating/buying gifts. The gift of your 'self' – simply being there at crucial times.
Acts of service: Doing practical tasks for your partner e.g. household chores. Particularly doing these without being asked.
Physical touch: Loving touch is crucial to healthy emotional development for babies and children. Affection is also important for adults, in addition to sexual touch.

Possessing the knowledge of your own and your partner's preferred ways of relating is important. Just as important is letting people know and acting on these preferences in ways and at times when it will build intimacy (Chapman, 2004).

Intimacy and sex

Considerable care is needed in approaching and addressing the topic of sex in a group of men who have been sexually abused. For all the talk of sex and the suggestion that we live in a very sexualised culture, discussions of sex are often very limited or performance based for men. Not surprisingly, men who have experienced child sexual abuse identify sex as an area of confusion and difficulty in intimate partner relationships, and something that is not easy to talk about. In our society, sex has a history of being a taboo subject, a subject associated with shame, a subject not to be talked about in 'polite society', and a subject that can evoke strong feelings. For men who have been sexually abused, talking about the subject of sex can be even trickier in that even minimal discussion, and details about sex, can be triggering and distressing, particularly if it involves information about the physical acts involved. It is important, therefore, for facilitators to take care and take responsibility, to ensure that any discussions are supportive, useful, and constructive for all participants.

Facilitation of a discussion, and provision of some basic information detailing common difficulties, and clarifying any confusion relating to sexuality and sexual identity can be useful. It can help allay fears and 'normalise' some responses and difficulties men have experienced. Men's experience and relationship with sex is not uniform. For some men, sex is a place where they are able to be intimate, to relax, let go, and be vulnerable, in a safe way. For some men sex is a place where they feel most 'a man'. These experience can change over time, where some men felt good about sex in their earlier years, interested, and able to 'perform' any time, anywhere, this is no longer the case, as they become older, engage in committed relationships, or become parents. Facilitation in the style of 'sex ed' teacher can help both to share factual knowledge that some participants may value, and to set the tone of addressing these issues without embarrassment or timidity.

Research with couples where the male partner had experienced sexual abuse has identified:

Increased confusion during sexual and emotional intimacy.
Difficulties when the man 'checked out' and emotionally disengaged.
Feeling distress, shame, or guilt about a sexual response.
Increased emotional engagement and communication are correlated with improvements in the sexual relationship (Jacob-Anderson & McCarthy-Veach, 2005).
Engaging in sexually compulsive behaviour (masturbation, porn).
Aversion to sex or specific sexual activities.
Difficulty trusting sexual partners.
Experiencing panic attacks, disassociation, or flashbacks during sexual activity (Hall, 2008).
Questioning of sexual identity.

As outlined above, whilst an opportunity to reflect upon and discuss sex and intimacy can be very much appreciated by men who have been sexually abused, it needs to be facilitated with care. It requires facilitators to be informed and comfortable with these topics, and to take an influential role, to ensure the experience is safe and useful for all group members (some participants may wish to explore the topic more in individual counselling, or in a specific group addressing sexuality).

With caution, a focused presentation/discussion of common sexual difficulties and confusion related to questions of sexual identities are typically welcomed (see facilitator's handout 'Sex stuff').

Wrap up: Check out

Review: Processes/content covered/reflections

Mindfulness, relaxation, or grounding exercise

Depending on the group, the following options for grounding may be beneficial prior to closing the group.

Time2Breathe (Living Well app).
Guided Leaves on a Stream exercise
Guided diaphragmatic breathing.

Provision of handout or resources

Group feedback/evaluation

Introduce upcoming session content

The focus of the next session is on justice/injustice, and what participants identify that they need to do or sort out for them to get on. It is about acknowledging and working through expectations re justice, revenge and forgiveness, with a focus on foregrounding what is meaningful and important for each man.