Episode 269: Male Survivors of Sexual Abuse: Shame, Masculinity, Disclosure & Healing in Therapy with Doriel Jacov
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Understanding and Treating Male Survivors of Childhood Sexual Abuse by Doriel Jacov, JD, LCSW
Introduction: Doriel Jacov on Working with Male Survivors of Sexual Abuse (00:00)
Puder:
Doriel Jacov, welcome to the podcast. I am excited for this topic. This is going to be really good. We're going to be talking about male survivors of sexual abuse. It's not a topic that I've covered yet. You have an interesting story. You're in private practice in New York. You're working around 25, 30 hours a week. You've been seeing male survivors. You also lead a male survivor group. And before becoming a therapist, a social worker masters [licensed clinical social worker (LCSW)], you were actually practicing corporate law for three years, which I find very interesting. So you kind of made a switch.
Jacov:
Yes.
Puder:
But maybe we can get into that later. Like the why of the switch. I think we'll be curious to hear that as well. But maybe we could just open up with a topic because I feel like it's good to sometimes get into the meat of what we're going to be talking about. So how would you like to introduce this topic?
Jacov:
Yes. So you know, working with male survivors of sexual abuse is a really, it's a passion of mine and a deep interest of mine. And, just some general ideas around, some facts, statistics: around one in six males have experienced childhood sexual abuse before the age of 18, which is 16%, a lot more than what many others might expect. Disclosure is significantly lower than for females, for example. And masculinity is deeply intertwined with the experience of the abuse and the aftermath of the abuse. And I think that's been something that I've been just really curious about understanding, unpacking, and exploring.
Why It’s Harder for Males to Disclose Abuse (01:55)
Puder:
Why do you think it's harder for males to disclose?
Jacov:
So I think when it comes to males disclosing, the first component to think about is just a general reality when it comes to sexual abuse, which is shame. All sexual abuse survivors essentially experience a profound sense of shame around, “If this happened to me, what does that say about me? If I wasn't protected, was I worth being protected?” And so those ideas get internalized. And I think when the expectations and norms around masculinity get kind of imprinted on that experience, those norms being, a boy, a man has to be invulnerable, has to be strong, has to be independent, has to have agency. And so when a boy is abused, they feel like they have failed as a man. And that adds a whole other layer of shame.
Jacov:
And then the question becomes so what is the barrier to disclosure? I think it's twofold. The first is a boy or an adult male is afraid of what disclosing or acknowledging will mean about them. You know, “I am a failed man. I am worthless.” But they're also afraid of the flips, the interpersonal side of that, of, “You will think I'm a failed man. You will think I'm worthless. You will humiliate me, or you will invalidate my experience.” So I really see it as kind of an internal and an interpersonal barrier when it comes to disclosure.
Puder:
Yes. The shame is part of the trauma. The shame is thick. It gets internalized. It is kind of like the shadow that follows them. Do you think, what are the situations that lead to them actually disclosing?
When and Why Male Survivors Finally Disclose (04:09)
Jacov:
So what I generally find is that because the barriers are so high to disclosure, a lot of the time disclosure comes in the aftermath of some sort of crisis, some sort of emotional upheaval, that leads someone to have to try to understand what is happening that might have led to this crisis that this person is experiencing. It could be a relationship that is completely unraveling. It could be that work relationships are really tense. It could be that self-worth is at, you know, feeling at an all time low. And a lot of the time they might just not know why that is or what's happening. And so they come into therapy or they, maybe there is some trusted person that, somehow they're able to get to a point of being able to disclose and understand what happened. But it's usually in the aftermath of something really painful, a real struggle.
Puder:
Yes. So talk about how there's aspects of power imbalance, coercion, manipulation. How do those play into this?
Power Imbalance, Coercion, Manipulation & Grooming (05:33)
Jacov:
Yes, so I think, one, you can call it a myth. One myth is that there has to be some really big age difference for it to qualify as abuse. And I don't really see it that way. Traditionally, it was seen that it could only be with an adult and a child. That has expanded over time, you know, in terms of what qualifies as abuse. But the way that I really see it, is some coercion, manipulation and imbalance in power. That power imbalance can even be an experiential difference. So someone who has way more experience in engaging in sexual activities versus someone who has little-to-none. But overall, the coercion and manipulation, those two components on the most extreme level can obviously be violent and forceful. And on the more subtle level they can be what's often described as grooming, kind of providing a lot of warmth, a lot of affection, a lot of positive feedback.
Jacov:
And kind of creating an environment where the perpetrator is creating “our little secret” and the person who's being abused, the boy who's being abused, in a way, feels special, feels special in a way that maybe they don't feel at all elsewhere. And in those cases, it can be really, it can be especially confusing as a boy, as an adult, to make sense of what happened. “If I enjoyed aspects of it, could it have really been abuse?” So in the more subtle ways, it can be profoundly confusing.
Puder:
And then talk about the myth that male survivors will go on to perpetuate abuse.
The Myth That Male Survivors Become Abusers (07:54)
Jacov:
Yes, yes. That is one that unfortunately is somewhat common. You know, the reality is that a pretty decent chunk of people who go on to perpetrate were abused in the past. I think the issue is that it gets conflated with whether or not the majority of people who were abused go on to perpetrate, which is not true. It's a very, very, very small percentage. I think it's anywhere from 1 to 4% based on the studies conducted. So I think it also ties into some of, you know, we talked earlier about the barriers to disclosure. A lot of male survivors may have also internalized the idea or the kind of social expectation that if they were abused, other people will perceive them as a possible abuser. And so I think deconstructing that, I've seen it in practice, has been really useful to kind of undo the fear that can sometimes come along with having experienced sexual abuse, which is that, “Does this mean that I'm an abuser?”
Puder:
Yes. I agree that the rates are really low. Somewhere around 3-4% go on to perpetuate abuse against other people. Now, they could have sort of other types of sequela that are around, you know, for example, I've seen people with OCD who have also had a history of sexual abuse. Some of the OCD thoughts could be around potentially fearing harming other children. Stuff like that. So the themes of their other types of mental health issues could be around child abuse, you know, nightmares, stuff like that. Anything you want to mention about that?
Jacov:
I've absolutely seen that. Fears around being an abuser are so common, and they can manifest as something that looks like or even is OCD. And that can lead to fears around being around children. You know you, somebody who has been abused, especially someone who has OCD, something that often happens is they have these flashing images in their minds that feel terrifying. You know, “This might happen. I need to do something to avoid that,” you know, the compulsion. And so when it comes to interacting with children, you might be in the presence of a child, a niece, a nephew, something like that, and then suddenly some flashing image of maybe a shirt off or something like that. And then there's this panic. And then you may find yourself avoiding children altogether. So it can definitely happen. And I also see obsessive thoughts around sexuality. “Does this mean I'm gay? Does this mean I'm straight? What does it mean about my sexuality?” And it can really become an obsession.
Puder:
Yes. Let's talk a little bit more about the general identity fracture in the aftermath of abuse. Talk about that a little bit.
Identity Fracture and the Impact on Masculinity (11:23)
Jacov:
Yes. So I think that ties a lot into the conversation around masculinity in the sense that as a boy is developing their identity, they inherently absorb societal representations of themself. And, in a lot of cases, that's men, adult men in the world. And when those adult men, often in media, in culture, in the more immediate environment, will express themselves in ways that kind of orient around strength, and in vulnerability, emotional neutrality, stoicism, all of those kinds of values of traditional masculinity. And so, when a boy is developing their identity and they experience the trauma of sexual abuse there's this, what I kind of like to call it, this identity fracture where they feel like they cannot take on masculinity or they can't form an identity around it that feels coherent. And so they can be left with this, “Who am I? Who am I in the world?”
Puder:
Yes. Okay. I also think highly empathic kids sometimes are the ones that get targeted so that it's like the empathy and the absorbing of others' affects. Right? And then if there is a father hole as well, right? That preemptively kind of leads to the targeting. Like, there's a father hunger in some kids, right? I noticed this when I coach sports, and there's some kids that just really want your approval and they really want kind of your connection. Right? Have you seen that at all? Have you seen the preemptive, because this is kind of a preemptive strike against this identity, this desire to conform to someone's ideals potentially, right?
Jacov:
Yes. I think it's not uncommon for a boy who is abused to kind of want some form of deep connection with an adult figure that may not be available in their present life. And what that can create is a hyper- attunement to other adults in terms of what they feel, what they want. And so that hyper-attunement can lead, you know, that's kind of a way to gain connection. If I can read someone else's feelings with their desires, I can be connected to them. And so, yes, I do think that those highly sensitive children, especially ones who have kind of a wound of some kind, a parental wound, kind of a deep desire for connection that they don't have, are more susceptible. And oftentimes, perpetrators are able to clock that. They're able to recognize that in the way a child might be relating to them in the approval that they might be seeking from, say, an adult figure or an older child role model of some kind.
Grooming Parents and the Social Network (15:09)
Puder:
Yes. And I think this is where grooming becomes, it's like the grooming itself. It's not only the grooming of the child, it's the grooming of the parent or parents. It's trying to convince the parents to give access to the kid in a way that's kind of unusual. Anything you want to say on that?
Jacov:
Yes. You know, the majority of abuse happens within the social network of the boy or the child in general. It's kind of well known that the vast majority of abuse happens within the social network. And so that could be family, immediate family. It could be family friends. It could be spiritual leaders. And yes, there's absolutely, oftentimes there can be a grooming process of the parents to find ways to have one-on-one access to a child. Because without that, how else would a perpetrator gain that kind of access? It becomes a lot more challenging for the perpetrator to act on it.
Puder:
Another grooming thing is to show pornography, show erotic content sometimes. You know, it's “accidentally” showing these things. Right? I feel like this goes into that kind of thing like, here you have this kid, maybe there's a wound, maybe there's a hunger for connection, now they're kind of being groomed into, this is the type of way that you're going to get a connection. Right? And so it's these things that, as parents, we need to also be very aware of, be very, how do you protect your kids against this, right? I think this is a question a lot of people are going to be asking themselves as they listen to this again. Any thoughts on that specifically?
Protecting Children: Pornography, Secrets, and Threats (17:12)
Jacov:
Yes. I think there's two things that are coming to my mind. First, around the showing of pornography, that you mentioned. You know, I think especially when a child, when a boy is in their early teens/preteen years where they're developing, you know, they're starting to go through puberty that can be a kind of a way in, if you can call it that, for the perpetrator in terms of, “Here, let me show you pornography. Let me teach you kind of how to engage with yourself sexually.” And the child is, in that case, not realizing that they're being groomed. They almost think that they've been given an opportunity to be able to explore their sexuality with someone who is perhaps more experienced.
Jacov:
But on the point about protecting children, it's such a hard, it's truly such a difficult reality to have to face because you don't want parents to be highly skeptical of any other person spending time with a child. I work with children as well, and parents may have shared concerns around this with me. And my general suggestion is to approach it with the child, especially in terms of teaching them what is an okay touch, what is not an okay touch. Making it clear that children know that certain types of touching from other people is not okay, and that you want them to feel safe and comfortable to come to you if that ever happens with anyone. So, creating an environment with a child that really centers around awareness of what is okay, what's not okay, and that there's safety in disclosure, safety in sharing when this might happen.
Jacov:
And besides that, I think intuition, you know, parental intuition is such a powerful aspect of being a parent. So just knowing that this is possible, listening to your intuition around the adults that are around your children, being mindful about when and how your children have alone time with adults, or even with older children. You know, if there's a 16-year-old who wants to hang out with your 8-year-old, it's fair to be reflective around that. What is the nature of this relationship? To actually take the time to think about, to reflect, and to ask your child, “What is this? What is this relationship like to you? What do you guys do?” You can be curious.
Puder:
Yes. I think another thing is how do you protect kids against fear messages? I guess there's two categories in my mind. There's one, like keeping secrets. “We're going to start to keep a secret.” Right? As a way of grooming. And then also it's like, “Hey, if you were to tell someone, someone is going to get hurt.” Right? And so it's like, “I am more powerful than your parents. I am more scary than your parents.” And these kinds of messages that get inputted. Right?
Jacov:
Yes. Yes. There, again, I certainly come back to the intuition piece, but that's not always going to hit a hundred percent of the time. And so when I think about, when I go back to how can we approach it with the child themselves, and part of the conversation can be, “Even if someone says, ‘I'm going to do something bad, I'm going to do something bad to Mom and Dad, if you don't do this,’ come and tell us.” Right? “It's not going to happen. That's not going to happen. We will protect you.”
Puder:
Yes. I tell my kids, “I am bigger and scarier than any of those people. And if anyone makes those threats, they are small and puny, and they themselves are cowards.” And so, trying to pre-program my kids. Right? Also, language is very important to teach kids. Like what different body parts are. What the words for different things are. I've heard that that's helpful.
Jacov:
Yes.
Puder:
And then, I think being aware of who you are trusting, who you are giving access to your kids. Okay. Let's keep going with this picture of helping the survivor. And so, male survivor identity, the crisis of identity that happens after the sexual trauma, the sexual abuse. Anything else you want to say on that? Maybe the feeling of powerlessness or the feeling of the internalization of worthlessness, that kind of thing?
Powerlessness, Worthlessness & Self-Blame in Survivors (22:20)
Jacov:
Sure. I think there's obviously what we mentioned before about, “If my agency didn't matter, I must be worthless. If no one protected me, maybe I wasn't worth protecting.” I think one that comes up so much is, “If I didn't stop it, maybe it's my fault.” And that happens with boys and girls. And the idea that, “It was my fault,” can serve to protect the perpetrator, especially if the perpetrator is within the family's social network. It can serve to protect a child from understanding the realities of what happened. So, yes, overall, I think all of this contributes to a real confusion around identity and if you feel as though you're worthless, it can be hard to develop a sense of self that feels solid and grounded.
Puder:
I also think it’s almost joked about in our culture. I've seen some Saturday NIght Live skits about the teacher that abuses the male child and the male child that's kind of like going along with it. Right? You know what I'm talking about? This kind of trope of, “Well, is it really abuse if you're male because you're enjoying it?” Right? “Are you really being abused?” And I think the question often becomes, “Well, if you were aroused, if you, if you were pleasured, is that really abuse?” What would you say about that?
Jacov:
Yes. So I think it's fairly known culturally and societally that when a female is abused, it's not uncommon to experience physiological arousal. And the reality is that it's the exact same thing when male abuse happens. It's extremely common for a male to experience physiological arousal, to have an erection, to feel excited. And that very much contributes to this sense of, “Was it really abuse?” And, I think in men there's an, there's a kind of a societal, I don't know, idea that if a man experiences arousal, they are experiencing consent, they are experiencing agency. And so that's kind of where I think this trope, what it's representing is this idea that a man can't be abused because they are strong. They can say no, because they are men, and men can say no. And if they experienced arousal, there's no way that they were abused because arousal and a man is, you know, it's their choice. It's an active agency. If they're not into it, they wouldn't be. So I do think there is a lot of cultural confusion around what arousal means for a male.
Puder:
And I think that's very important to put out there, because I think a lot of people listening to this might be confused on why they were aroused or, “What did that mean for me if I was aroused or there were parts of it that were pleasurable.” Right? It could still be abuse, because remember what we said before, and I think it's great that you brought up those points before, of power. The power imbalance. Right? The manipulation, the coercion, often threats that are in it, as well. Right? The grooming, the knowledge of the perpetrator of what they were doing, what their intention was. Right?
Arousal, Body Betrayal & Sexual Identity Confusion (26:24)
Jacov:
Yes. And I think if somebody who experienced pleasure and arousal were to, for example, acknowledge that what happened is abuse, what they're left feeling is, “My body deeply betrayed me.” And that can be a terrifying thought. So there is a way in which saying, “It wasn't abuse, because I was aroused,” it's adaptive, there's a protective nature to it. Protecting yourself from having to come to terms with this feeling that, “My body betrayed me in a deep and profound way.”
Puder:
Yes. And then, if they were aroused, let's say it was a male adult abusing a male child, if they were aroused, what does that say about their sexual identity?
Jacov:
Nothing. I like to put it simply. It means nothing. A heterosexual boy, a homosexual boy, a bisexual boy, whatever it might be, the fact that they experienced arousal says nothing about their sexual orientation. A boy, as he develops and enters puberty, experiences arousal in many different ways. And so, you also bring up the question around sexual confusion. You know, either as a teenager, as an adult, whatever it might be. And I find that adult males who have been abused are sitting with this question of, let's say it's a male on male abuse. This, “Am I gay?” Or, “Am I gay because of the abuse?” And what I say is, “It doesn't matter.” I don't say it in necessarily those terms, but there's absolutely no evidence that experiencing sexual abuse has any impact on sexual orientation. And two, even if it did, so what. I think that can kind of alleviate some of the need for certainty around what this abuse means. And that need for certainty can be really overwhelming and relentless.
Puder:
I think sometimes I've seen people that have been abused in certain ways, will search for a reenactment of sorts of that abuse that I think is different than sexual orientation or normal sexual things, because it's like, almost like a trauma reenactment. I don't know. Have you seen what I'm talking about? Are you seeing this type of behavior?
Jacov:
Yes. When you ask that question, are you thinking, is it in terms of reenacting the abuse with other men, even though this person, would maybe through therapy ultimately recognize that they are entirely heterosexual? Is that kind of what you're saying?
Puder:
Yes. Like almost like a rape reenactment. Right? Or like a reenactment which is not maybe what they would desire in a connected relationship. Right? But then, there's also this kind of impulsive reenactment desire that sometimes fleets into their mind, which I think can sometimes be more of an enactment of the trauma, which alleviates after the trauma is processed, or the trauma is worked through, the attachment aspects of the trauma is worked through. Maybe the deeper attachment issues as well, because of the father hunger and the sort of the need for…it's like some of that can be deeper and longer work as well. Because it's a longer path to find that identity, I think, if that is there or that quest is there. Right? I don’t know if I'm making sense or not making sense right now.
Jacov:
No, that totally makes sense. I definitely have seen, and continue to see what you're describing in terms of the kind of rape reenactment. And I guess it can show up in multiple ways. You know, somebody can find themselves entering into relationships, for example, with older men, even though there's nothing about any of that that they would otherwise enjoy. And it takes time to really recognize that, oftentimes through treatment, through therapy. Once somebody begins to really unpack what it is that happened to them, and especially to begin to experience compassion and warmth towards their younger self, that begins to unburden someone from this almost sense of compulsion to reenact. And that can be both from being with someone or multiple people of a specific gender that you otherwise would not be attracted to. But it can also be in terms of certain types of sexual expression. Somebody who's a survivor might go into sexual encounters and want to reenact the dynamics of the abuse. And sometimes that can happen. Oftentimes it happens in consenting adult relationships. But also, it can be the case that once somebody begins to explore and unpack what happened to them, the need for that type of reenacting connection weakens, it can become a lot more of a choice.
Grief, Self-Compassion & Metabolizing Trauma (33:10)
Puder:
Yes. Yes. It's similar, I think, to women who have a very narcissistic father. They sometimes end up with very narcissistic men. They grew up with a very narcissistic, maybe some physically abusive domestic violence that they witnessed. They inevitably find themselves unconsciously with men that are more physically violent, abusive, narcissistic, until they get to therapy, when they make the unconscious conscious. Right? And they work through those aspects. I think in a similar way, different types of abuse can manifest in adulthood until it's fully metabolized. And I love how you put, “The compassion for yourself.” In reflective function research, I've been thinking about that a lot with trauma-specific reflective function (T-RF) in a trauma narrative. Where, how do you know if the trauma narrative is catabolized, right? If it's dissociated, if they're dissociating in the trauma narrative, it's not catabolized [see episode 268].
Puder:
A dissociation could sound like they're jumping from different, they're jumping around the narrative. The narrative isn't cohesive and thoughtful. It's like the affects of the narrative may not make sense completely. Maybe they're dissociated in the narrative. Maybe there's just pure rage. Maybe they're idealizing the other person still in the midst of the narrative, right? This is not a metabolized trauma narrative. Whereas, the catabolized trauma narrative, they have the self-compassion. It's obvious that they've worked through the stages of grief. They've worked through the anger. They've worked through the numbness. They've worked through these different things. And they end with some degree of self-compassion. So I love how you put that out there.
Jacov:
Yes. You couldn't have said it better. As I was hearing you speak, I was just thinking, “Grief, grief, grief.” Metabolizing trauma. I think grief is such an essential component of an emotion. If somebody is only talking about their abuse and just talking without emotion, there's a real dissociation present. And I often am sitting in a place feeling that there's something missing in working through this. Once grief appears, I see a real integration and an ability to come to terms with what happened and to have a relationship to it, and to give that child inside of you what it's never been able to receive.
Puder:
Yes. I think this could be confusing to the audience, so maybe I'll just say it again in a different way, is if it's not a processed memory, if the grief hasn't taken place, if you don't have in the midst of the memory, self-compassion, then you have dissociated out affects, emotions. Maybe dissociated, we've talked about in this podcast, disavowed anger, disavowed disgust, disavowed yearnings for connectedness [see episodes 222, 255, and 264]. And so, inevitably you could end up in all sorts of different situations where when it's unconscious, where you could have more of the OCD things that we've talked about, where you have these kinds of obsessive intrusive thoughts that are disturbing. You have the flashbacks, you have nightmares all the ways that PTSD presents. You could have all sorts of attachment issues in future relationships from being asexual to hypersexual.
Puder:
And then you could also have these enactments. Right? It presents in many different ways, but the underlying thing that needs to take place is the grief and the bringing the disavowed into the avowed, which can only happen when the shame is decreased enough in the therapy relationship. Shame will be at the door, right? They will feel shameful in telling you. They will project that you feel critical towards them. And I think, you preemptively, you wrote a lot about this stuff before we talked. I asked you to write something up for me. Talk a little bit more about what shows up between you and the client in the midst of them talking about this, in the midst of them working through this.
Jacov:
Yes. So in the midst of, well, first of all, when it comes to talking about this in the first place, I find that it takes some time, especially with men. They don't often come into treatment saying, “I was abused,” and just being ready to get into it. Oftentimes, there are signs. There's numbness, there's withdrawal, there's attachment issues, whatever it might be. But the kind of transference, countertransference dynamics still are present because, as you described, there's relational dynamics that might be operating unconsciously. And so, from a transference perspective, there's lots of different ways that the abuse can manifest. Some of these include, well, first I'll just say that kind of what I like to think about it is in terms of the victim, perpetrator, bystander, rescuer. Those are kind of the four key underlying drivers of, I think, the way that transference kind of shows up and countertransference shows up in the therapeutic relationship. And I see that part of the healing process involves working through these dynamics.
Puder:
Say that again.
Jacov:
So, victim/perpetrator.
Puder:
Perpetrator, okay. Abuser. So those are….
Jacov:
Those are the flip sides of each other. And then bystander/rescuer. Also the flip sides of each other.
Puder:
Like the disengaged bystander, or the, the bystander that's the uninvolved nonresponsive bystander? You're watching, but you don't care, right? So the bystander, and then what's the fourth one?
Jacov:
Rescuer.
Puder:
And the rescuer, okay. So initially, they may see you as the rescuer, then the victim, right? It may progress to you being the perpetrator: “Why won't you give me access to you on the weekends? Why won't you respond to my calls at night?” You could also be the bystander then, right? Where you're just kind of non-engaged. Right?
Jacov:
Yes.
Puder:
So you could see how the frame of treatment kind of elicits the transference over time, or, they push against the transference or sorry, they push against the frame that creates the transference. Okay. Go into those four different things and how they flip between themself and the provider.
How Trauma Dynamics Play Out in the Therapeutic Relationship (40:43)
Jacov:
Yes. So a patient could be meeting with you as a therapist, and having this constant perception that you're judging them, that everything you say, everything that the patient is saying, you are internally responding with feeling like, “What is this person talking about? Like, this is pointless. Like, why, why?” Just having negative thoughts about the patient. And so the patient is feeling as though you hate them essentially, and they are a victim of your hatred. It can also show up as a patient kind of having this suspicion that the therapist is attracted to them, that the therapist wants them in some sort of manipulative way, that the therapist is only in it for the money. There's this kind of manipulative grooming kind of expected interpersonal relationship withdrawal if the therapist withdraws that the patient may be feeling. They may be feeling both the kind of bystander effect, but also kind of a victim of neglect, which can also tie into, again, the parental dynamics that might have existed for this child in their childhood.
Jacov:
And so that's one way that the patient might be experiencing themselves as a victim to the perpetrator, but then it can flip where the patient can be either experiencing themselves as a perpetrator, either consciously or unconsciously. And, the therapist may be experiencing themselves as a victim. And so this kind of happens when the patient is oftentimes lashing out on the therapist, preemptively devaluing them, making them feel worthless, like they can't help you. Or another example could be, you know, a highly eroticized relationship to the therapist from the patient where, you know, they're flirting with a therapist. They are giving them frequent compliments about their appearance and things like that, making sexual comments. And so in this, you know, in a case like that the therapist is feeling intruded upon and, you know, violated in a way or that, that there's a potential for being violated.
Jacov:
So those are some examples of the way you might see the kind of victim-perpetrator dynamic. And then there's this kind of rescuer/bystander, the kind of uninvolved, non-responsive bystander is a lot of times manifested in withdrawal by the therapist. So that could be a therapist could withdraw for lots of different reasons. They could withdraw, because let's say the patient perceives a therapist as constantly being judgmental, everything the therapist says the patient has this sense that there's a judgment embedded. And so the therapist is, in a way, walking on eggshells. And so maybe they kind of consciously or unconsciously make the decision to back off, to not say as much, to not engage emotionally in a real relational way with the patient. And so the therapist now becomes this….
Puder:
Yes. Yes. In the midst, especially of any attacks, like, “You're attracted to me. You're only here for the money. You hate me.” You know? So the therapist can start to be more careful. And in that carefulness, it can feel like a withdrawal of sorts. Right?
Jacov:
Yes. Absolutely.
Puder:
Is that what you were thinking?
Jacov:
Exactly what I was thinking. Yes. Okay. That's exactly what I was thinking. I mean, it can come from attacks or intrusions. You know, you gave the example of, “Why won't you answer my calls at night? Why can't I have more access to you?”
Puder:
I noticed something about what I said evoked some emotion in you, though. I'm wondering if there's a memory in particular of a client scenario that came to your mind, or something.
Clinical Example: Projective Identification & Therapeutic Helplessness (45:11)
Jacov:
Yes. I would say, there is a client situation that came to mind that it ultimately ended in a termination that felt premature. And so maybe, that was some of the emotion that was elicited. I had a patient who came into treatment and was talking about their abuse in a very casual way: “It happened with my uncle but I enjoyed it, so it doesn't matter.” And the end of our first session involved a question of, “Do you think you can help me at all?” And I think, oftentimes I will respond with some sense of hopefulness. And I did that. And then the next session that this patient came in and said, “I thought about what you said.”
Jacov:
“I don't really think you can help me. I know about myself already. I don't see what talking can do.” And there was this constant back and forth around, “Can you help me? Or are you useless to me?” And this hyper-attunement to the way that I might be responding to what he was saying. And if he sensed some sort of distance, there would be kind of a lashing out. And there was a real inclination for me to withdraw. It started with me trying to rescue. Me trying to over-interpret, to try to offer more and offer more and prove my worth. And it kind of ended with, not the treatment ended with this, but what resulted in terms of my emotional experience was just feeling helplessness and wanting to kind of pull back. “Well, if I can't help you, then I'll just sit here.”
Puder:
And that could be a projective identification. He's projecting onto you the helplessness that he felt. Right? And you eventually identify with it, and you feel helpless that the helplessness is like him putting you as the perpetrator. Right? “You're judging me.” Or, “You don't really think you can help me.” Sorry, let me say that again. The helplessness that he's feeling is more when he's saying things to you like, “You can't help me. You don't really have anything to offer me. I've tried everything I've already done. I already have all this self-knowledge.” Right? Which is a little bit of a devaluation of you and your position as a therapist. It's a devaluation of you as a person. He's feeling helpless. In the description of the abuse with the uncle, helplessness is not part of that narrative. Right? He's numb, he's disconnected. So the helplessness is a part that is unconscious. It's dissociated away. The helplessness is projected, therefore, into you, into this situation unfolding between you guys in a way that's not catabolized, it's not integrated into the memory itself. Right? Of his own helplessness.
Jacov:
Yes. And the thing with projective identification is that as the therapist absorbs the projection and enacts it in their own way, it ends up confirming the belief that the patient already had about themselves and about the way that others will relate to them. So, in the way that I may have withdrawn, that becomes confirmation that, “No one cares about me. No one can help me. No one will help me.” And it becomes this repetitive kind of cycle that most likely plays out in other relationships as well. You know, as we know, the dynamics that come up in relationships outside of therapy inevitably enter the room.
Puder:
Yes. Yes. Like, “You don't really care about me.” So they'll be in other relationships, and they'll be saying things like, “You don't really care about me. You don't really love me.” And then the other person will get really off and they'll take that anger as proof that they don't really care. Like, “See, if you cared, you wouldn't be so angry at me. You're lashing out now, just proving to me how upset…." Well, the anger is really part of the attachment dance. Right? So the anger is like, “I care about you so much, so of course I'm getting angry when you say things that are offensive to me.” Right? So in the attachment dance, it's like numbness is actually a protection in and of itself as well. Right?
Puder:
We sometimes distance ourselves emotionally from those we love so that we don't lash out. So it could be like that, and like, “Oh, you're distancing yourself because you don't love me.” It's like, “No, I'm distancing because I don't know any other way to protect the relationship.” And so, but you're right. I love how you brought that together and it proves their point. It proves their narrative. So what I'm saying with the EFT (emotionally focused therapy) model of attachment is there could be a completely different truth to what's actually unfolding, but they're not looking for that [see episodes 43 and 194]. They're looking to prove a narrative that maybe is the trauma narrative in and of itself. Right? In the midst of the trauma this was the message that was communicated. And so now they're just finding that message everywhere in their life communicated again and again.
Jacov:
Yes. Yes. And I like to think a lot about it in terms of parts. It's almost like this person can almost be possessed by a part of themselves that feels that no one cares about them, and then they are relating in that way with the world, but then maybe, at other times they are possessed by this part of themselves that is constantly needing reassurance and going out and seeking it. So we can move in and out of these kinds of ego states, interpersonally. Right?
Puder:
Yes. Yes. And you could see how a lot…. Because on the podcast we talk a lot about personality. We talk a lot about idealization, devaluation. We talk a lot about splitting, and things like this [see episodes 115, 215, 265, 267, and 268]. This stuff can unfold as a response to the trauma. Right? And so, the idealizing of the therapist could be in a way seeing you as the rescuer. Right? Which is adaptive actually early on to come close to someone, to idealize them. To some degree, it's going to allow the patient to engage. But what you're talking about, with this patient, will go to a more of a devaluation position early on, which makes it harder to engage the treatment that is actually going to help them. Often, from clients like this, I've heard multiple times, “Oh yeah, I've seen a therapist one or two times.” That's it. And it's because they haven't been able to get through the devaluation. The therapist hasn't been able to, maybe. Well, it's just hard to work with clients that devalue you quickly. Right?
Jacov:
Yes. And, if a patient is not able to attach to the therapist, it makes it really challenging for the therapist to have an impact, an emotional resonance, an emotional impact on the kind of internal models that exist with the patient. If somebody is numbed out, detached, withdrawn, it's like anything the therapist says just kind of bounces off. And it's hard to internalize anything new.
Puder:
Yes. Yes. Well spoken. I mean, we know that therapeutic alliance is obviously very important for outcomes [see episodes 28, 32, 36, 41, 55, 62, 69, 70, 77, and 149]. But the other thought that I have, that comes to my mind, is I've had patients who, they're a couple years into treatment and they're still acting in a way that's slightly devaluing, slightly detached, but they really value the therapy. They show up, they pay, so it's like they're valuing it, but they're also devaluing in some ways. They're trying to create a little bit of distance to protect themself. And I don't necessarily feel intimidated by that need for distance. People need a sense sometimes of not, you know, like this is more of a schizoid personality type that has this fear of being consumed. And so they need to create some level of distance between them and another person in order to sort of not feel this consumption, that this person is gaining too much power over me. Or they're fearing that, like this therapist is going to overwhelm them in some way.
Jacov:
Yes. And the hope is that this can actually be spoken about in treatment. Right? That can come from a disclosure or just some general exploration around, “How do you feel about me?” Just really trying to understand. Asking questions that will help the patient be able to explore how they relate to you. But I often find that disclosure can be extremely helpful in situations like that. You know, like, “I find myself feeling…”
Jacov:
“As you're talking right now, I find myself feeling a little defensive.” Or it doesn't necessarily need to be an accusation, but kind of leading with, “What I'm feeling in this moment. I'm finding myself feeling a bit devalued as you're speaking. I don't know if you're intending to do that or what's happening for you in this moment? Or if anything about what I'm saying resonates for you?” And I think that can be so generative in terms of shining a light on what's happening in the room and how that shows up.
Puder:
I tend to personally say things like, “It would make sense to me if part of you did want to, or it was hard to trust me. it would make sense to me like that, especially this early in treatment, that you felt like you were not completely sure if I was going to be helpful for you. It would make sense to me if knowing what I know, a little bit about your history, that there was a part that wanted to push away or make less of the work that we're doing.” So I see it as, because they're adaptive defenses it's like they're, it's like shame. One of the questions I always ask myself is, “How do I reduce shame so that the person continues to tell their story?” It's really hard to grieve the loss and feel sadness if they're stuck in that, the thickness of the shame, which I think you're really in to, from the writing that I read and everything. I think you're really big on that too, is, “Okay, how do I help this client reduce their shame?”
Handling Shame in Therapy (56:00)
Jacov:
Absolutely. Absolutely. I think I completely agree with you, especially early on in treatment, we're still establishing trust. Appreciating the protective mechanisms that a patient is using to survive in the world and has used to survive in the world, I think is essential. It's kind of like if someone has a shield, you don't want to just try to swipe it away because then the person is going to start to feel, “Okay, we have to fight now.” But if you ask questions, “Hey, can you tell me about the shield? Oh, wow! It’s this. It's that. I like the colors. Can you tell me about it?” It completely changes the willingness to be able to put that shield down and engage.
Puder:
Yes. I think I want to ask you a little bit more about the…you said earlier, a patient can have some sexualization, because of the history of the sexualization. Some of that can show up in their transference towards you. What is your way of dealing with that as someone who works with this population?
Erotic & Eroticized Transference with Male Survivors (57:12)
Jacov:
Yes, so that really ties into the conversation we were just having about shame. Right? Because if a patient is disclosing some sort of sexualized or erotic feelings towards the therapist, we want to try to minimize shame as much as we can. And I can say why, but a way that I will generally respond is, first and foremost, “Thank you so much for sharing that with me. I know it was probably really difficult.” So that's the first piece, to kind of express appreciation, to acknowledge how hard it was to share, and then to normalize it. “You know, it's not uncommon for this to come up in treatment. This is a place that is really intimate and close, and it makes sense that these types of feelings could show up here.”
Jacov:
And then lastly, is for the boundary to be, you know, to be clear, especially for someone who has experienced sexual abuse. They, on a deep, deep level, will likely feel reassured by a boundary being set, even if consciously it might be upsetting, disappointing, frustrating, difficult. But, in therapy, as you might know, there are inherent boundaries, and any sort of sexual contact is one of those boundaries. So I kind of like to think about it in kind of that threefold way of appreciation, validation, normalization, and then the boundary.
Jacov:
And this is obviously in the case of somebody who is disclosing in a way that is not enacting the abuse overtly. You know, if somebody is making aggressive sexual comments or engaging in a more explicit, overt way, you would want to handle it a little bit differently. But if someone is coming to you and saying, “This is really hard to say, but I'm starting to think I might be in love with you,” or something like that, that's how I would approach it.
Puder:
Okay. So you differentiate the two. Talk about the two. And do they have names for the two different types of transferences? What's the one that's more of the enactment?
Jacov:
The erotic transference? Is that what you're talking about?
Puder:
Can you talk to me about erotic versus eroticized transference? It seems like you're differentiating between erotic versus eroticized in the two different ways that patients may bring it up. Can you share a little bit more about that?
Jacov:
Sure. Yes. So erotic transference usually presents as something that is a bit more reflective, that the patient is able to kind of look at these feelings from a bit of a mentalized stance, where they can reflect on these feelings. They can talk about these feelings, “I am noticing myself feeling like I'm falling in love with you,” or something like that. So that's the erotic transference. And what I was just describing is how you might respond to that. Eroticized transference is essentially feeling completely engulfed by those feelings and enacting those completely. So, actually asking a therapist on a date, or starting to ask the therapist, “Are you single?” and really engaging in a sexualized way. That's when the transference becomes less reflective, less of a capacity to mentalize what's happening and more acting it out [see episodes 206 and 268].
Puder:
Yes. And I think that the way that you describe the first type, the erotic transference, as like, ”There's something I've been thinking. I'm really ashamed about telling you this. You know, I've been seeing you for a couple years now, and I feel like in the last couple months, I fear I may be falling in love with you, and I don't know what to do with this.” And so that's kind of more of that erotic. The eroticized, there's almost like a predatory part of this. Like, “I'm going to seduce you.” And it's a way of almost warding off vulnerability, intimacy within the relationship. Right? The countertransference, how would you say you deal with that professionally?
Jacov:
Yes. Before I jump into that, there's something that you just mentioned that I just wanted to kind of pick up on a little. The “what is happening beneath the surface” of somebody engaging in eroticized transference. The unconscious experience is often, “My sexuality, my body is the only thing that is valuable so I need to express it in the relationship as a way to avoid humiliation and shame and rejection.” So there can be deep, deep fear and pain underneath eroticized transference. So I just wanted to mention that. And so your question about countertransference….
Puder:
Wait, wait. Let's pause there. Because I think that's good.
Jacov:
Sure. Yeah.
Puder:
The objectification that a person may feel with that type of transference is really profound. Like they were objectified intensely, which led to the need for them feeling like they need to, once again, objectify themself to get anything good from the therapist. Right? And so there's an enactment that's forming and and I would say it's something that can be, I don't know, it's not talked about that much in therapy training. I think it can be very overwhelming if these are things that you are encountering as a therapist. You could seek supervision. You know, and that might be a good place to start, is to talk to some providers who have some experience in navigating these types of issues.
Jacov:
Absolutely. Absolutely.
Puder:
The countertransference it can elicit when this type of stuff comes up, it can elicit a lot of different countertransferences. Talk about some of the countertransference that it can elicit. And then how do you navigate those?
Countertransference Challenges for Therapists (01:03:33)
Jacov:
Yes. So some of what can come up for the therapist, when it comes to erotic or eroticized transference, can involve feeling violated, intruded upon, or that there's a possibility that might happen. The therapist might respond to that with, as we were talking about earlier, withdrawal. Maybe even in a more exaggerated form because they might feel like their safety is at risk or this topic is so taboo or there are such severe ethical consequences when it comes to erotic feelings in a treatment relationship. And one of them, that is very little talked about, is reciprocal desire. Especially in an eroticized transference, there can be a real seduction that happens and no one is immune to that, not even the therapist. And there can be ways that the therapist feels kind of special, almost reenacting kind of a grooming sort of dynamic. And the therapist might find themselves fantasizing, having sexual fantasies, even having dreams, erotic dreams, about a patient. So there's so much that can come up for the therapist countertransferential. And I supervise as well, and supervisees are so afraid of talking about this because it can feel so taboo. And I really think it's so important to be able to talk about these dynamics, to understand what's happening beneath the surface and how to approach it.
Puder:
Right. Right. Yes, it can be something where supervision is probably a hundred percent recommended. And a consultation, I think there's some people that have almost built their whole practice on supervising for these types of things, like Glen Gabbard often does consultations for these kinds of high conflict things. And I think it could be really good. This is why communities, like psychodynamic cohorts, stuff like that, like the ones I lead, can be so helpful. Because it's like, we can talk about it, normalize the human experience, and put it to words. This is not something that you report to a patient, if you have sexual arousal, reciprocal erotic feelings. You don't want to potentially put the patient back into some sort of situation reminiscent of their childhood. This is where therapists can get themselves into trouble. You don't want to break the frame. You want to have a frame, a way that you interact with them. You don't want to change the way that you interact with them based off of this [see episodes 234, 239, 254, and 266].
Jacov:
Yes. Trust is the most important element of a therapeutic relationship, and especially so when it comes to sexual abuse survivors. And as soon as any disclosure of erotic feelings becomes a part of the disclosure, on behalf of the therapist, trust will feel extremely fragile and likely broken. “I can't trust you to engage with me in a way that ensures that I'm safe that you won't do what has been done to me already before.” And that even includes, you know, the person who is presenting in a highly eroticized way where they might be asking you out. Again, they unconsciously want you to say, they need you to say, “No.”
Puder:
Right. It's like just because an enactment is occurring of trauma doesn't mean that you partake in the enactment. Right? And doesn't mean that they want you to partake in the enactment. Actually, you partaking in the enactment becomes further trauma. And I've seen patients who have had therapists that their boundaries have been diffuse, or they've succumbed to some erotic solicitations. And it always hurts the patient. It always becomes another trauma and it makes it really difficult for the patient to trust future providers, as well. And so it's interesting, like it's a taboo for therapists, probably for good reason, right? But the taboo, maybe you can, in supervision, look at what's underneath it.
Puder:
Because it can feel really good to be idealized as well. It can feel really good to be, if other areas of your life are less idealizing of you, that can feel really good. Right? So to have someone who's very, very positive towards you, very sort of interested, curious, highly energetic towards you can feel very good if you're a little bit more narcissistic. I mean, you don't have to be narcissistic to enjoy some degree of idealization, but someone who is narcissistic almost needs that idealization. Right? They interact with people and only want idealization. You know, there are some therapists that maybe have that personality style. Most of us are more depressive. Most of us are more not exactly that type of personality, but those types of personalities can be maybe more vulnerable to that level of idealization as well.
Jacov:
Yes. Idealization almost always feels good to some degree. I think once the therapist takes on what is being projected onto them, that's when it can become risky. And I think just being able to reflect on, “Hey, I'm being idealized right now,” that immediately can create some sort of relationship to that experience that allows you to choose how to relate with the patient and to not take that on.
Puder:
Right. If you're conscious of it, if you're conscious of what's going on, if you see that this is a pattern, and this is a pattern that sometimes the trauma itself is eliciting. Right? It's like they are, or maybe they had in their childhood older figures that sexualized them. You are an older figure, they are in the midst of that enactment with you moving you from rescuer to perpetrator. Right? And it's like we need to say, we are not exactly the rescuer, that's kind of an idealizing of our position. We're kind of more of a guide in the hero's journey [see episodes 107, 110, 149, and 231].
Puder:
We're empowering them, equipping them to keep going on their journey. Right?
Jacov:
Yes. Absolutely. And the idealization often will leave the patient having that reinforced idea that they actually are helpless and that they can't help themselves. And as you were describing, as a guide, so much of the work is helping shore up the patient's internal resources. And by not succumbing to that idealized ideal, idealized dynamic, that's part of supporting that process.
Puder:
Yes. So the other situation that I think sometimes unfolds is more the first type of sexual transfer that you brought up. It's like they're receiving something positive from you. It's over a long period of time. They've received your attunement, your kindness, your warmth. This could be very foreign to them. And this could be something that they really do love. They really do love aspects of what's going on in that. Right? And maybe they've mostly dated people where that's not the case. Right? And so maybe it's like you're something good, the good that has happened. Right? My hope for patients is that they go out and find the parts of it that were good. And find it in new relationships, especially the patients that maybe they've been attracted to more abusive relationships. They had some sort of early childhood abusive situation, and then they had a progression of abusive types of relationships. You know, they've been drawn to the wrong people. If something good has happened, I hope that they can find that good out in the wild, so to speak. And I'm enthusiastic when they do find partners that are very different from partners they've dated before.
Jacov:
Yes.
Puder:
I don’t know if you have any thoughts on that.
Jacov:
I do. I actually feel quite happy when a patient is able to disclose that type of erotic, for example, love. If we want to call it that. And the way that I see it is a lot of the time, especially in grooming, someone who was abused experienced warmth, affection, some twisted version of attunement, which coincided with manipulation and abuse and victimization, sexual victimization. And so it only makes sense that if a therapist is able to offer those, that warmth, that attunement, that connection, that it becomes associated or can become associated with sex, sexuality, victimization. And so when that love kind of presents itself in the therapeutic relationship, it's an opportunity for us to disentangle those two things from each other to disentangle warmth and love and care and attunement from sexuality or sexual victimization. Obviously, you know, in relationships, those two things are interconnected, but the therapeutic relationship is one that is inherently boundaried. And by not merging those two in the therapeutic relationship, it allows for someone to go out and seek warmth and to seek care and attunement that is not, that doesn't feel like it has to come with manipulation.
Puder:
Or it doesn't have to have a transactional, dehumanizing, objectifying aspect to it. Right? And if there are, I think that that sort of transactional objectification may have been what they've experienced largely in a lot of different dynamics. And we get really excited when they find relationships that are kind and generous and warm and all the things that lead to thriving and great families. So that's good.
Jacov:
Yes. Yes.
Puder:
That's good. I'm curious about your journey. How did you go from a corporate lawyer to making this pivot to work with this population?
Jacov’s Journey: From Corporate Lawyer to Trauma Therapist (01:15:20)
Jacov:
Yes. So I studied finance in college and I worked in finance for a bit and then went to law school, became a lawyer. And so much of that had to do with, I think, some ideas of what it means to be a man, that I've internalized; and then also whatever familial expectations and things like that. Desire for security, financial security, and so on. So, I entered the field of law. I was a corporate attorney for around three years and, during my time as an attorney, I went into psychoanalysis four times a week, on the couch, lying down. And it was an arduous, long, but also beautiful process. And you know, I really see it as kind of a playground sandbox to just go in and explore everything.
Jacov:
And I landed on this really deep curiosity around human experience and a desire to be a helper. And so I made the pivot. I left all of that, which obviously was not easy at all. It's a big identity shift. And then I just really saw how I could be meeting with men in therapy and then, after a while, suddenly there's this big disclosure that we hadn't talked about the whole time, and it puts so much of the treatment into context and this deep recognition of how masculinity and shame are such organizing factors that inhibit disclosure and healing. And I just, I really felt pulled into being able to create an environment where disclosure can happen, where safety can be experienced, and trust and healing. And here I am.
Puder:
Awesome. Well, the world is a better place with you as a therapist. I'm sure that we need good contract or a good corporate lawyers, as well, but I think you definitely feel like a therapist. You don't feel like a lawyer. You don't give off lawyer vibes.
Jacov:
I never felt like one.
Puder:
You're like, “I'm really a therapist.”
Jacov:
I know, I'm like trained as a lawyer, but I'm really a therapist.
Puder:
I think a lot of people find the podcast, and I've had a lot of people email me and they're like, “I was a lawyer, or I was in this field, and all of a sudden I'm listening to your podcast nonstop, and then I realize I want to be a therapist.” I'm like, “Yeah, you should probably be a therapist.” They're like, “What's the best path?” I'm like, “You know, probably the fastest.” You know? Yeah. It's good. Yeah.
Jacov:
Yeah.
Puder:
How's your group, your men's group going?
Jacov:
Oh, it's great. Yes, we didn't talk about that. I think group work is an amazing avenue for healing. You know, we talked about the isolation, the invulnerability that men have to carry around this. They often don't have anyone to talk about it with. And to have a space where they can just be honest and learn a new version of being a man can just be so powerful. The group has been going on for, I mean, this particular iteration has been going on for a year and a half, and it's just a highlight of my work. It's such a special space that I think so many men can benefit from, so many male survivors can benefit from the group itself. The group I'm talking about is for male survivors of sexual abuse.
Puder:
So if you're in New York and you're hearing this, Doriell Jacov. Am I saying that right?
Jacov:
Jacob. Jacob.
Puder:
Yes. I don't want to say it like a Russian, “Ja-kov.” Jacob, yeah. You're in New York. And you know, I imagine people may reach out to you and you maybe get too full, but maybe you could point them towards other good therapists in the community that you know. Well, I think we'll wrap it up. Any final thoughts that you didn't get to say, but you really wanted to say before we wrap this up?
Jacov:
We covered so much. We really covered a lot of ground. I think. Nothing, nothing particular comes to mind.
Final Thoughts & Resources (01:20:18)
Puder:
Oh, I'll say on the website, I'm going to put the article you wrote. It has a bunch of links to articles. It has a nice reference section. So if anyone's reading this and they're like, “I really want to dive into this deeper,” you have some different books that you recommend, and some different articles. And you know, if you're starting to see clients like this, I would recommend you dive into it and spend some time, because I don't know how much of this training we get in our training before you graduate. You don't necessarily get as deep a dive as you can post-graduation.
Jacov:
Yes.
Puder:
Yes. Take care. All right. Thank you so much for coming on, and we'll leave it there for today.
Jacov:
All right. My pleasure. It's great speaking with you.