small groups for sexual assault/rape victims

Psychotherapy Volume 25/Spring 1988/Number 1

PROVIDING TREATMENT AND SUPPORT FOR PARTNERS OF SEXUAL-ASSAULT SURVIVORS

LAWRENCE J. COHEN University of Wisconsin—Madison

An open-ended support group for husbands and boyfriends of sexual- assault survivors was an effective intervention and provided normative information to the men about their reactions in this situation. This article describes the rationale for the group and outlines its practical operation.

The treatment of survivors of sexual assault has focused on crisis intervention (McCombie & Arons, 1980) and supportive psychotherapy groups (Cryer & Beutler, 1980; Herman & Shatzow, 1983). Very little attention has been paid to the husbands and boyfriends of women who have experienced rape and incest. When these men are mentioned in the literature, it is usually in the context of their tendency to make matters worse by imposing on the women their stereotypical attitudes and their anger (e.g., Williams & Holmes, 1981). In one of the few articles addressing coun- seling of partners of victims, Silverman & McCom- bie (1980) stress interventions aimed at making the man less destructive and more therapeutic.

Outside of the treatment literature, Beneke (1982) gives a well-rounded picture of partners of rape victims. In his book of interviews with all types of men about the topic of rape, he devotes a chapter to husbands, lovers, and friends. The themes that emerge in this chapter include guilt, confusion, feelings of inadequacy, helplessness, uselessness, panic, violation, and anger with the

The author gratefully acknowledges the assistance of Caroline Delano, who at the time of this research was director of the New Orleans Rape Crisis Program.

Reprints may be ordered from Lawrence Cohen, Department of Psychiatry, Clinical Sciences Center, 600 N. Highland Ave., Madison, WI 53792.

rapist and with the victim. Many of the relationships ended, but most of the men were left with increased awareness and insight into the social ramifications of rape and the meaning that rape can have for victims and potential victims.

The men's group described below was started as an attempt to address the issues and needs of partners of sexual-assault survivors in a meaningful way. The group was not seen as either an adjunct of the women's group or as completely separate. Rather, a broader social context of recovery was conceptualized, which included significant rela- tionships.

In spite of the small sample size and the ex- ploratory nature of the data presented below, the New Orleans partners' support group provides an important beginning point for the study of partners of sexual-assault victims and demonstrates the effectiveness of a group intervention with this population.

The Group

The partners' support group was started as an outgrowth of the women's support group of the New Orleans Rape Crisis Program, which is one of the oldest such groups in the country. Most of the men in the group were husbands or boyfriends of women in the women's group; others were referred by leaders of other women's groups or by individual therapists who had heard of the program. The current report covers the first five months of the group's meetings, during which time the author was the facilitator of the group.

The flyer advertising the group provides a brief description of the rationale for the group:

Rape and incest can be severe sources of stress on a relationship, and it often takes active work by both partners to meet this challenge. The group provides resources for men to deal with their own thoughts and feelings about the assault, as well as a place to learn how to be more helpful and supportive with their partners.

94

Partners of Sexual-Assault Survivors

It can be seen that the idea of helping men to be more therapeutic is not ignored, but is placed in a larger context of emphasis on the relationship.

The group met once a week for two hours. Two to six men attended each session; about five were "regulars" and about fifteen men came once or twice over the course of the first five months. The group was deliberately left open-ended so that men would not feel intimidated by the need to make a major commitment, and because many men only wanted or needed one or two sessions. There were no screening procedures and no one was excluded from the group. The men who at- tended were quite diverse in education, occupation, and history of prior therapy. They ranged in age from 21 to 50. Most of the men were married, and most of their partners had experienced pro- longed incestual abuse from their fathers or step- fathers. The other men were boyfriends or husbands of women who were sexually assaulted as adults. Some partners had survived both incest and rape as an adult.

The themes that recurred throughout the group's first five months were consistent with Beneke's (1982) findings. Frustration, concern, helplessness, and anger were all present, but so were empathy and insight.

Group Process "That's amazing, that's exactly what my wife

does!" This sentence was a kind of refrain in the group; the instant bond of shared experience led to a high degree of group cohesiveness and mutual support. The members were very happy to discover that they were not alone; many had never discussed these issues before.

For example, when one man mentioned with great embarrassment that his wife slept with a night light, most of the other men admitted that their partners used night lights too. Besides dis- covering that their partners were not as peculiar as they had thought, the men also gained insight into why night lights are so common for survivors of sexual assault. Besides night lights, many of the men found they had in common many issues relevant to their relationships with their partners. For example, several felt that they had to "walk on eggs" around their partners, while others never knew when they would be faced with an outburst of anger or depression. Many noted that seemingly innocuous statements, such as "I don't care what we have for dinner," would trigger rage or panic in their partners.

Men whose wives were more advanced in the recovery process had instant authority in the group; their advice was sought and followed. In addition, as openness, disclosure, and letting down one's defenses became norms of the group, men who were best able to do these things became natural leaders of the group.

In terms of professional leadership, the dynamics of the group changed considerably over the course of the first month. At first, all questions were directed to the leader, with little interaction among members. There was an emphasis on factual in- formation as opposed to emotional or interpersonal issues. As the men began to know each other and trust each other, both the dynamics and the content of the interactions shifted rapidly. The members began to rely on each other rather than on the facilitator; interaction between members became the core of the group. In addition, the men asked the leader fewer questions about the "professional viewpoint," and more questions of each other about their own experiences. The members became quite skilled at providing insightful interpretations, gentle confrontations, and helpful feedback. Because of their shared experience, their comments to each other had a tremendous impact.

After enough trust developed, some of the men allowed themselves to express their anger with their wives. Contrary to the initial fears of the group leader, this expression did not escalate into name-calling and recriminations, but actually re- sulted in increased empathy and closeness. The men were generally angry and resentful because they felt they bore the brunt of their partners' anger, which should have been directed at the perpetrator. The anger was also a manifestation of their helpless frustration in not being able to help, and their feelings that their own needs were being ignored because of their partners' special needs.

Many men expressed rage at perpetrators, but when one member, an ex-convict, stated matter- of-factly that he would kill his father-in-law if he saw him, the rest of the group was quite disturbed and tried to convince him that this would harm rather than help his wife. To some extent the other men felt their masculinity threatened in this sit- uation, which underlined their difficulty in be- coming more "sensitive" and emotionally sup- portive. This episode forced many men of the group to carefully scrutinize their own attitudes about violence. In general, many of the men ap- peared to be struggling both in and out of the

95

Lawrence J. Cohen

group with breaking out of stereotypes, especially as they came to see the relationship between pre- dominant cultural attitudes and the prevalence of incest and rape.

As described in research on group therapy with victims (Roth et al., 1988), the men in this group were supportive of each other in the difficult task of continuing to face the difficult realities rather than slip back into a more comfortable denial. The similarity of the members' experiences allowed for a reduction in the sense of isolation, and an increase in feelings of hope. Sharing occurred at all levels, from emotional empathy to practical coping techniques. The sexual abuse and the affects associated with it became less terrifying and over- whelming over time.

Education The men's group was designed to provide ed-

ucation as well as support, but not all information was equally useful to the group. In general, material from the clinical and research literature or the leader's own clinical experience was beneficial only if it was presented in the context of specific issues raised by group members.

A few specific ideas seemed to be especially influential in helping the members think about their situations and gain insight into them. First, men were able to see their partners as less path- ological when they learned that the responses to sexual assault that they described were within the normal range of response to a severe trauma. Sec- ond, the idea that incest victims never had a chance to grow up properly, and therefore tend to revert to a childlike state under stress (Blake-White & Kline, 1985), helped men understand why their partners often seemed irrational, nonassertive, and unpredictable. The fact that incest is a betrayal and an overwhelming confusion of sex, intimacy, and control allowed men to feel less threatened by their partners' need for control and for constant "proof" of reliability and trustworthiness.

Since most of the members' partners were in group therapy and some were in individual therapy as well, they were interested in learning more about the process of therapy, and especially about why it seemed to take so long. "Why can't she just forget it and put it behind her?" This question was asked repeatedly in the group. Horowitz's (1976) model of traumatic memories pressing toward integration and refusing to be completely repressed was compelling to the group members. Many group members were willing to give up

their demands to "just forget it" when they realized that some events are so overwhelming that regular coping strategies do not help (Cohen & Roth, 1987), and that some incest victims go on searching for decades for some meaning to make sense of their trauma (Silver et al., 1983).

Self-Education In addition to education by the leader of the

group, the members educated each other (and the leader). As a group the men developed tentative answers to some of their questions about sexual assault.

Many of the men wondered why their partners were still so attached to their families, in spite of the abuse. Over time they helped each other see that their partners were still trying to find the love and care that they never had as a child. They also began to understand that childhood trauma and especially betrayal makes it very difficult to become fully adult and independent.

Some of the group members had read or heard that victims tend to repeat their victimization, often by marrying men who will further victimize them or their children. This "fact" led the men to wonder if they themselves were latent abusers. This possibility was very disturbing to the men, until they realized that their partners were working to break out of the pattern, becoming survivors rather than victims. The men began to feel proud of their role as helper, rather than afraid of their role as potential abuser.

In quite a few cases the men reported that at the time of their marriage their partners were in a denial phase in which they did not recall the abuse. The men realized that each wife had chosen a husband who would support this denial by being emotionally distant, not asking too many probing questions, and not expecting her to be emotionally available or assertive. The men had to ask them- selves how they were adjusting to the changes their partners were making as they progressed in their recovery. Could they allow themselves to become more emotionally open or to accept their partners' newfound assertiveness? As one man put it, "She's getting more assertive and I'm getting blown out of the water; I see it's good for her but it's more than I bargained for." Or another member: "When she recovers she is going to be very strong. I hope I measure up."

As the group members developed insight into the role of society's attitudes concerning sexual assault, they began to question their own ster-

96

Partners of Sexual-Assault Survivors

eotypes. They were excited but apprehensive about the prospect of being different from their own fathers in the areas of expressing emotion, closeness to their children, supportiveness of their wives' assertiveness, and empathy. They addressed these issues both in practical matters such as washing dishes and in abstract areas such as equality of decisionmaking and sharing of emotional respon- sibilities.

Several of the men raised fundamental questions about the benefits and the dangers of therapy, for example, retrieval of painful memories and pro- longed focusing on the traumatic events. Some men longed for a return to the days before therapy when the material was completely repressed, when "everything was fine." A more common view was that there were problems before the events were remembered, but there was no guarantee things would be better after the acute upheaval precipitated by therapy. One man noted that his wife's sisters, who never dealt with the abuse, were abused by their husbands and that one committed suicide. Finally, another member stated, "Looking back there were a lot of problems back then that I did not recognize, and now it seems clear that they were all related to the childhood events. Even though therapy is painful, it would be a step back- ward to shove everything under the rug again."

Almost all of the members of the group felt that they had made mistakes in their relationships. Through the group, "mistakes" were transformed into opportunities for learning and growth. For example, several men felt that they pushed their partners too hard to talk about the trauma, while others realized that they avoided the topic because of their own fears. One husband thought his big mistake was taking over the housework and other responsibilities out of an attempt to help; instead, it made his wife feel even more useless and in- competent. Many of the partners recognized that their "problem-solving" approach was not helpful, but they still had a difficult time focusing on emo- tions and intimacy. Almost all of the men felt that they reacted poorly to their partners' irrational anger, either by getting angry in turn or by in- ternalizing the hostility and feeling depressed. They learned from each other how to respond more effectively.

Case Illustrations Frank

Frank's wife and her sisters were all abused by their father. One committed suicide, one is withdrawn and continues to

be abused by her husband, and Frank's wife has had multiple psychiatric and psychosomatic hospitalizations. As a couple they have severe sexual problems. During the group Frank stated that he was angry and resentful; however, he wished to understand and was eager to find an "excuse" for her behavior. He was no longer sure of his own feelings for her and therefore felt guilty and confused. He felt that he got more than he bargained for, since everything seemed "normal" when they married. "How can I regain my trust in her? How much should I take care of her, ignoring my own needs? Who is there for me when I need support and help?"

Jeffrey

Jeffrey's wife's biological father left the family when she was an infant, and her stepfather sexually abused her for many years. He is puzzled by her unpredictability: "I never know who is going to be there when I get home from work." Their relationship is marked by constant arguments and fights. He hits the wall or the sofa; she bottles it all up. He often feels that he cannot do anything right; if he reaches out he's being too demanding and if he backs away he's being too distant. He does not know how to act with her stepfather, whom they see socially. He does not let his in-laws babysit, which is awkward, because he cannot disclose the reason until his wife is ready for the confrontation. He attributed to the group's influence the fact that he stopped hitting the sofa, stopped screaming, and started communicating more, especially on the way home from the group sessions.

Dan

On his first visit to the group, Dan said that his wife did not have very severe problems compared with the other cases he had heard. However, as he became more open and commu- nicative, she revealed more to him about the trauma and her current symptoms. In fact, she had quite severe symptoms, including dissociative states, hallucinations of herself as a child, and superficial slashing of her hands and arms. Dan wondered about his ability to adjust to her changes, especially to her need for more emotional closeness and communication now that she was no longer denying the incest. Since his wife was just beginning to deal with the incest, the stories of the other men in the group about long-term problems tended to scare him. Gradually he realized it was unrealistic to expect an instant resolution. Dan benefited greatly from feedback from the group about his tendency to distance himself from his emotions. When the group listened to a tape of incest victims discussing their experiences and their recovery, Dan reported that he felt empathy for the first time in his life.

Comments by Partners of Group Members In a separate research project, women in the

survivors' support group were given a questionnaire which included questions about the men's group. There were not enough subjects to statistically assess the impact of the men's group on the wom- en's functioning, but the women's comments about the group were informative. As can be seen, almost all of the women felt that the men's group was beneficial both to the men and to the relationship.

97

Lawrence J. Cohen

We've learned to communicate better and have learned a lot about each other. I don't feel like I'm going through this alone anymore.

He claims all the men do is complain about their bitchy wives.

He now understands the different moods and sexual hangups that may arise.

In the beginning, he was skeptical. It has helped our relationship some in that he can understand some of the problems now between us. He realizes now that when I'm upset and lashing out at him, it's not really him I'm mad at. The group has helped make him more caring and aware. It also has made him sympathetic toward other men in the group when they are having problems, especially ones where the marriage is falling apart.

He is not alone; he can share with others who are experiencing the same thing. He is more aware of potential problems and he verbalizes more. The group has been a catalyst for us to discuss potential problems which other couples have dealt with.

Summary Preliminary clinical experience suggests that an

open-ended, professionally facilitated support group for partners is a viable and valuable tech- nique. Many members of the group gained insight and understanding into their situations, became more empathic and open, learned new coping strategies, explored new ways of behaving and interacting, and began to feel less depressed, anx- ious, and alone. Both the men and some of their partners reported improvements in their relation- ships, especially in the areas of communication, empathy, and control of anger. There was no evidence regarding the direct effect of the group on the women's recovery, but it seems plausible to infer that positive changes in relationships would

have a positive impact on recovery. As such groups become more commonplace, further research will be needed to assess their impact on members and their sexually victimized partners. Another im- portant area of consideration is how to reach part- ners who do not seek out the group, but could possibly benefit from it.

References BENEKE, T. (1982). Men on Rape. New York: St. Martin's

Press. BLAKE-WHITE, J. & KLINE, C M . (1985). Treating the dis-

sociative process in adult victims of childhood incest. Social Casework, 66, 394-402.

COHEN, L. J. & ROTH, S. (1987). The psychological aftermath of rape: Long-term effects and individual differences in recovery. Journal of Social and Clinical Psychology, 5, 525-534.

CRYER, L. C. & BEUTLER, L. (1980). Group therapy: An alternative treatment approach for rape victims. Journal of Sex and Marital Therapy, 6, 40-46.

HERMAN, J. & SHATZOW, E. (1984). Time-limited group therapy for women with a history of incest. International Journal of Group Psychotherapy, 34, 605-616.

HOROWITZ, M. J. (1976). Stress Response Syndromes. New York: Jason Aronson.

MCCOMBIE, S. L. & ARONS, J. H. (1980). Counseling rape victims. In S. L. McCombie (Ed.), The Rape Crisis Inter- vention Handbook (pp. 145-171). New York: Plenum.

ROTH, S., DYE, E. & LEBOWITZ, L. (1988). Group therapy for sexual-assault victims. Psychotherapy, 25, 82-93.

SILVER, R. L., BOON, C. & STONES, M. H. (1983). Searching for meaning in misfortune: Making sense of incest. Journal of Social Issues, 39, 81-102.

SILVERMAN, D. & MCCOMBIE, S. L. (1980). Counseling the mates and families of rape victims. In S. L. McCombie (Ed.), The Rape Crisis Intervention Handbook (pp. 173- 181). New York: Plenum.

Williams, J. E. & HOLMES, K. A. (1981). The Second Assault. Westport, Conn.: Greenwood Press.

98