International Journal of Coercion, Abuse, and Manipulation Volume 3 2022 52
Alone and Not Alone:
Implications for Clinicians Working with Male Survivors of Childhood
Sexual Abuse
James M. Smith
School of Counseling, Walden University
Adrian S. Warren
School of Counseling, Walden University
Brooks Bastian-Hanks
School of Counseling, Walden University
Abstract1: The prevalence of childhood sexual abuse (CSA) makes it highly likely that mental health professionals
will provide therapy services to survivors, including adult, cisgender men, who face unique barriers in disclosing
the sexual abuse they suffered. This article is written to help clinicians understand these unique barriers and what
mental health professionals can do to support disclosure. Using interpretive phenomenological analysis (IPA),
we studied the lived experiences of three adult, cisgender men who survived CSA but waited until adulthood
to disclose to a mental health professional the abuse they suffered. Some of the themes that emerged from their
disclosures were their similar sense of feeling isolated as a result of the experience yet connected with others who
have had similar experiences guilt feelings about and sense of responsibility for how disclosure affected their loved
ones and family members and the disempowerment associated with having family members and clinicians act
on their disclosure in ways the survivors did not want. Implications for clinicians include a focus on the relational
nature of the therapy and the importance of respecting the client’s autonomy, among others.
Keywords: Child sexual abuse, CSA, male, adult, interpretive phenomenological analysis, IPA
1 Author note: We have no known conflicts of interest to disclose. Correspondence concerning this article should be
directed in writing to James M. Smith, james.smith@mail.waldenu.edu, or 936 Sardonyx Drive, Jefferson City, MO 65109 or
by phone at (573) 469–5086.
In recent years, public awareness of childhood sexual
abuse (CSA) has increased largely as the result of public
scandals such as the Penn State youth program and
the revelations of widespread sexual abuse involving
priests within the Catholic Church (Hattery &Smith,
2018). The #metoomen movement also has encouraged
many male victims to come forward and talk about
their child sexual abuse experiences (Hawkins et al.,
2019). As victims of CSA continue to come forward,
the need for trauma-informed counselors increases.
Without well-informed clinical practice, clinicians
to whom survivors of CSA disclose the abuse they
suffered may inadvertently discourage CSA disclosure,
or worse, inadvertently retraumatize survivors who are
seeking help. Our research sought to provide a basis for
understanding the lived experiences of adult, cisgender
male survivors of CSA who waited until adulthood to
disclose their experiences of abuse to a mental health
professional. To effectively treat survivors of CSA,
counselors must first understand how CSA is defined,
the prevalence of child sexual abuse, and how to best
create a supportive environment within which victims
are willing to disclose their past abuse.
doi.org/10.54208/1000/0003/005

ISSN: 2710-4028 DOI: https://doi.org/10.54208/0003 53
Definition of CSA
CSA has no consistent definition, which has implications
for both research and clinical practice. This lack of
operational definitions increases the difficulty in
researching CSA as a topic. The lack of research with a
consistent definition also leads to difficulty providing
informed care to survivors of CSA.
The varied definitions of CSA reflect many notable
inconsistencies. One such inconsistency is the type
of sexual behavior considered to be sexual abuse.
Some definitions restrict sexual abuse to only genital
penetration, while other definitions include sexual
behaviors such as viewing pornography when no sexual
physical contact occurred (Martin &Silverstone,
2013). The variations among legal definitions of CSA
and age limits that fit the definition from state to state
hinder the reporting of CSA and, in turn, the potential
usability of what is reported. So to use that information
effectively, it’s important to understand the researcher’s
operational definition. For instance, some sexual
contact between two persons may meet the legal
definition of CSA, but the person who was sexually
abused may not conceptualize the sexual contact as
abuse (Vaillancourt Morel et al., 2016).
To further illustrate this point, there is also significant
gender bias when certain experiences are defined as
sexually abusive based on the genders of both the
perpetrators and survivors (Geddes et al., 2013 Giglio
et al., 2011). As examples, a sexual act between an adult
female with a minor male is less likely to be reported
as sexual abuse because people may not conceptualize
this experience as sexual abuse (Geddes et al., 2013
Giglio et al., 2011). As a result, the lack of consistent
definitions of CSA confounds the ability to accurately
ascertain the prevalence of CSA.
Prevalence
An accurate depiction of the prevalence of CSA is
challenging for many reasons. How one defines CSA,
the underreporting of CSA (especially for males),
the variance in legal definitions of CSA across state
jurisdictions, and self-identification of an experience
as CSA are just a few of the challenges to enabling one
to gain a clear understanding of the prevalence of CSA
(Townsend &Rheingold, 2013 Vaillancourt-Morel et
al., 2016). As examples of variations in how the date
is presented, The National Sexual Violence Resource
Center (2016) estimated that one in four girls and one
in six boys will experience some form of sexual abuse
before adulthood. But in an updated review of their
2013 white paper, Townsend, et al., (2016) estimated
the prevalence of CSA to be approximately one in 10
children without the delineation of gender. Although
the statistical estimation of the prevalence of CSA
varies, one may easily assert that any occurrence of
CSA is significant and needs to be addressed and
further researched to better inform mental health
professionals in their efforts to facilitate the disclosure
and healing process.
Disclosure
In 1983, Summit provided one of the earliest
documented theorizations about the process of
disclosure of the childhood sexual abuse. Since that
time, multiple researchers have worked to gain a better
understanding of and quantify that process (Anderson,
2016 Bradley &Wood, 1996 Sorenson &Snow,
1991). Previous understandings of the disclosure
process reflected Sorensen and Snow’s (1991) view that
disclosure was a sequential process. However, Bradley
and Wood (1996) identified the process as more
accurately described by various types of disclosures.
This description of disclosure as a spectrum of types
rather than a sequential process has become the
prevailing paradigm for understanding disclosure of
CSA.
The more recent work of Anderson (2016) has added
more types of disclosure, such as “testing the waters”
and unintentional disclosure (p. 386). “Testing the
waters” addresses the process in which a person may
disclose various elements of the abuse to multiple
individuals to measure the reactions of others to
the disclosure, whereas unintentional disclosure
is the process in which a person describes various
objective behaviors without the awareness that these
objective behaviors meet the criteria for sexual abuse
(Anderson, p. 386). Anderson (2016) further proposed
more of a spectrum model of conceptualization to the
act of disclosure that ranges from active disclosure to
tentative disclosure, and the timing of disclosure from
nondelayed disclosure to delayed disclosure.