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Section 1
Guided Imagery as a Technique in Treating Male Self-Isolation

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First I would like to address cross-gender issues. Granted it is beneficial in many cases if a boy has been abused by a female that the therapist is male. However with the specific cases I have dealt with regarding sexual abuse of boys, there has been an extenuating circumstance or circumstances that made the referral appropriate.

In several of the cases, I was involved with the boy via a school setting, and we had a prior working relationship. In all cases, the client was offered the option of seeking help from a male therapist. If that request was made, the termination and transfer process was initiated immediately.

In this section, we will examine isolation, as well as the "Power Figure" and guided visualization exercises.

♦ #1 Enforced Societal Conceptions
In today's culture, it is generally believed that sexual abuse occurs significantly more with men and women rather than men and men. This arises from the conception that men, and in this case even young boys, can defend themselves more readily than girls. Also, as commonly thought, most people believe the term "sexual predators" literally, in the idea that the abuser is looking for sexual gratification. In fact, in the case of sexual abuse, the gender of the victim is most of the time inconsequential, as you probably are aware.

According to a study conducted at the Children's Hospital Medical Center of Cincinnati, 11.2 boys per 1,000 children were abused compared to 12.8 girls per 1,000 children. As you can see, there is only a slight difference between the number of cases of boy sexual abuse and girl sexual abuse.

One such client of mine, Andrew, age 13, had a similar preconception about sexual abuse. Andrew had been abused by his uncle at the age of 7. Andrew immediately told his single father about the abuse, but his father was unwilling to acknowledge it. For four years, Andrew felt isolated and was told to keep the secret "in the family". Andrew told me, "My dad made me believe that only gay guys do that to boys and that my uncle was not gay. He said that only girls get abused." I told Andrew that what his uncle did to him was a means of making Andrew feel weak and powerless.

♦ Technique: Power Figure
To help Andrew with his feelings of isolation and disempowerment, I found the "Power Figure" exercise beneficial. I asked Andrew to think of people such as movie characters, real life heroes, or even family members that he deems are powerful. I then asked him to write down why he thought these people were powerful. To help Andrew, I gave a simple definition of power, here's the definition of power I gave Andrew, "Power refers to the ability to influence or control things or people. A person can have influence with another because of his role or position or because of his relationship with another."

Here's the definition of control I gave Andrew, "Control refers to the ability to govern, regulate, or manage something or someone. It also refers to exercising power over or dominating another person." I also emphasized to Andrew that power in the sense that it is used in therapy refers to power over oneself and not over another person.

Surprisingly, Andrew chose the historical figure of Gandhi, who he had studied in class, and who he says had power over the British. I asked Andrew how Gandhi achieved this power and he said, "By standing up to the bad guys and driving them out. But he never hurt anybody." Andrew emulated the figure of Gandhi because he had used a nonviolent means of controlling his surroundings.

Unfortunately, many clients do not have the healthy view of power that Andrew had. Sometimes, this exercise reveals boys beliefs that power equals sex and anger. As you know, these types of responses give an important clue regarding which clients will need extra help in developing a sense of empowerment. We will discuss this more completely in the next section.

♦ #2 Client Self-Isolation
We discussed external isolation through other people in the case of Andrew. Now let's discuss the way young male clients isolate themselves. Often this results from a male client's confusion and guilt over what had occurred. Anxiety and anger often accompany isolation. Without interaction with other people about the abuse, the negative emotions will fester.

I find that group therapy is most beneficial for boy clients that have isolated themselves for several years. It helps them realize that there are other males of his age that are experiencing the same problems and overwhelming emotions and facilitates their recovery. One such extreme case involved Ryan, age 17, who was abused at the age of 5. For over 11 years, Ryan refused to tell anyone about the abuse, thinking he could repress what had happened.

However, as he went through adolescence, Ryan found that he was much more irritable and anxious than his friends. While they became increasingly interested in girls, Ryan found that any kind of sexual thoughts led to extreme anger and fear.

♦ Technique: Guided Imagery
As you know, extreme anxiety and anger and feelings of isolation can be detrimental to an individual in a group therapy session. To quell these feelings, I found the "Guided Imagery" technique helpful. I asked the boys to go find a small spot on the floor or against the wall and either lie down or sit against something, whichever made them most comfortable. I then asked them to choose a scene in nature that best incited feelings of security and comfort. Next, I utilized a guided-imagery exercise as follows:

I want you to sit back in a comfortable position and close your eyes if you can. Take a deep breath and let it out slowly. Take another deep breath and let it out even more slowly. Pay attention to your arms. Shake them a little bit and then let them rest at your side. Notice your legs. Are they in the most comfortable position? Get as comfortable as you can. See if there is any part of your body that is hurting or feels tight. Taking deep breaths may help that part relax. Feel comfortable and peaceful.

Now I want you to imagine you are walking down a long path, surrounded by trees. It is cool and very quiet. You hear only the wind in the trees and some birds chirping. Smell the fresh air as you walk, taking deep breaths as you go. Your body feels strong and peaceful. The path takes you to a large green meadow. The sun is shining, the sky is blue, and the meadow is filled with lush green grass.

As you walk across the meadow, you see a clear blue pond ahead of you. Sit down next to the pond and look into the water. Reflected in the water you see a rainbow. As you look at each color, your body feels more and more relaxed. Your mind becomes calmer and more peaceful with each color. First you are seeing red, now orange, yellow, green, blue, purple, violet.

Take another deep breath and let it out slowly. Bring your imagination back to this room. You're with your friends, and you feel relaxed and calm. When you are ready, go ahead and open your eyes.

Some clients fidget and are restless during this exercise. I ask these restless clients to verbalize what they are feeling and explore the sensation for feelings of anxiety or fear. Older boys downplay the importance of relaxation or guided imagery, but they usually welcome guidance in learning a new skill.

In this section, we discussed the various forms of isolation that male survivors of sexual abuse experience: isolation by others and isolation of themselves.

In the next section, we will examine the idea of empowerment as the foundation for healing and how to build it: through building a sense of responsibility and accountability; through developing his understanding of his power and its limitations; and through equipping the client with knowledge and empowering skills.

Peer-Reviewed Journal Article References:
Arbuthnott, K. D., Arbuthnott, D. W., & Rossiter, L. (2001). Guided imagery and memory: Implications for psychotherapists. Journal of Counseling Psychology, 48(2), 123–132.

Chu, J. Y.-C. (2014). Supporting boys' healthy resistance to masculine norms. Psychology of Men & Masculinity, 15(3), 253–255.

Fosco, G. M., Lippold, M., & Feinberg, M. E. (2014). Interparental boundary problems, parent–adolescent hostility, and adolescent–parent hostility: A family process model for adolescent aggression problems. Couple and Family Psychology: Research and Practice, 3(3), 141–155.

Herndon, P., Myers, B., Mitchell, K., Kehn, A., & Henry, S. (2014). False memories for highly aversive early childhood events: Effects of guided imagery and group influence. Psychology of Consciousness: Theory, Research, and Practice, 1(1), 20–31.

Kapetanovic, S., Skoog, T., Bohlin, M., & Gerdner, A. (2019). Aspects of the parent–adolescent relationship and associations with adolescent risk behaviors over time. Journal of Family Psychology, 33(1), 1–11.

Reigeluth, C. S., & Addis, M. E. (2016). Adolescent boys’ experiences with policing of masculinity: Forms, functions, and consequences. Psychology of Men & Masculinity, 17(1), 74–83.

Sell, C., Möller, H., & Taubner, S. (2018). Effectiveness of integrative imagery- and trance-based psychodynamic therapies: Guided imagery psychotherapy and hypnopsychotherapy. Journal of Psychotherapy Integration, 28(1), 90–113.

Seto, M. C., & Lalumière, M. L. (2010). What is so special about male adolescent sexual offending? A review and test of explanations through meta-analysis. Psychological Bulletin, 136(4), 526–575.

Shevlin, M., Murphy, S., Elklit, A., Murphy, J., & Hyland, P. (2018). Typologies of child sexual abuse: An analysis of multiple abuse acts among a large sample of Danish treatment-seeking survivors of childhood sexual abuse. Psychological Trauma: Theory, Research, Practice, and Policy, 10(3), 263–269.

QUESTION 1
What is an explanation for the idea that in today's culture, it is generally believed sexual abuse occurs significantly more with females rather than males?
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