Psychiatry & Psychotherapy Podcast - Male Survivors of Sexual Abuse: Shame, Masculinity, Disclosure & Healing in Therapy with Doriel Jacov

Episode Date: June 5, 2026

Doriel Jacov joins Dr. Puder to explore the often-overlooked struggles of male survivors of sexual abuse. With one in six males experiencing childhood sexual abuse before age 18, Jacov unpacks the profound impact of shame, masculinity norms, disclosure barriers, and identity fractures that make healing uniquely challenging for men. The conversation covers grooming, power imbalances, coercion, the myth that survivors become abusers, arousal and body betrayal, sexual identity confusion, trauma reenactment, and the complex transference dynamics that arise in therapy, including erotic transference and projective identification. By listening to this episode, you can earn 1.25 Psychiatry CME Credits. Link to blog Link to YouTube video

Doriel Jacob. Welcome to the podcasts. 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, you were actually practicing corporate law for three years, which I find very interesting. So you kind of made a switch.

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 the 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? Yeah, 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, you know, just some general ideas around, some just fact statistics, you know, 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 do you think it's harder for males to disclose? 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, you know, 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 imprinted on that experience, those norms being, you know, 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. 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. Yeah, the shame is, the shame is part of the trauma, the shame is thick, it gets internalized, it kind of like is the shadow that follows them. Yeah, do you think, what are the situations that lead to them actually

disclosing? So what I generally find is that because the barriers are so high to disclosure, a lot of the time, a 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 is completely unraveling. It could be work relationships are really tense. could be self-worth is that, 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, you know, 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. Yeah. So talk about how, there's aspects of power imbalance, coercion, manipulation. How do those play into this? Yeah, so I think, you know, 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 you know coercion manipulation and imbalance in power that power imbalance can even be an experiential difference so someone who has way more experience in you know 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, you know, what's often described as grooming, kind of, you know, providing a lot of warmth, a lot of affection, a lot of positive feedback and kind of creating an environment where the perpetrator is kind of creating our little secret.

And the person who's being abused, the boy who's being abused in a way feel special, feel 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 to, to, you know, if I enjoyed aspects of it, could it have really been abuse? So in the more subtle ways, it can be profoundly confusing. And then talk about the myth that male survivors will go on to perpetuate abuse. Yes, yes. That is one that, unfortunately, is somewhat common.

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 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, you know, does this mean that I'm an abuser? Yeah, I agree that the rates are really low, somewhere on three, four percent go on to perpetuate abuse against other people. Now, they could have sort of other types of sequela that are around, you know, like, for example, I've seen people with OCD who have had also a history of sexual abuse. Some of the OCD thoughts could be around potentially fearing, harming other people. child, 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? I've absolutely seen that. You know, fears around being an abuser are so common

and they can manifest as something that looks like or even is, you know, OCD, and that can lead to fears around being around children. You know, somebody who has been abused, especially if, you know, with 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.

to interacting with children, you know, 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, you know, obsessive thoughts around sexuality. You know, does this mean I'm gay? Does this mean I'm strong? like what does it mean about my sexuality and it can really become an obsession yeah let's let's talk a little bit more about the just the general identity fracture in the aftermath of abuse talk about that a little bit yes so i think that ties a lot into the the conversation around masculinity in the sense that

you know as a as a boy is developing their identity they inherently absorb kind of societal representations of themselves. And, you know, in a lot of cases, that's men, adult men in the world. And those adult men often in media and culture, in the more immediate environment, will express themselves in ways that kind of orient around strength, invulnerability, emotional neutrality, stoicism, all of those kind 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, there's, you know, 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?

Okay, yeah. I also think highly empathic kids sometimes are the ones that get targeted. So, you know, it's like the empathy and the absorbing of others' affects, right? is, and then the kind of the, if there is like 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, because I coach sports,

and there's some kids that just like, they really want your approval. And, you know, they really want kind of your connection, right? Have you seen that at all? seen kind of like the preemptive, because this is kind of a preemptive strike against this identity, this desire to conform to someone's ideals, potentially, right? Mm-hmm. Yes.

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, you know, in their present life. And what that can create is a hyperattunement to other adults, you know, in terms of what they feel, what they want. And so in that hyperattunement can lead, you know, that's kind of a way to, you know, that's kind of a way to 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, an older child role model of some kind. Yeah, and I think this is where, like, 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? Yeah. 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, you know, can be a grooming process to find ways 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, you know, act on it. Another grooming thing is to show pornography, show erotic content, sometimes oops, you know, it's accidentally showing these things, right? I feel like this goes into that kind of thing of like, here you have this kid, maybe there's a wound, maybe there's a hunger for connection.

Now they're kind of like being kind of groomed into like 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 sort of like, like, how do you protect your kids against this, right? Is that a good question a lot of people are going to be asking themselves as they listen to this again. Yeah, any thoughts on that specifically? Yeah, I think there's two things that kind of are coming to my mind.

First, around the kind of showing pornography that you mentioned, you know, I think especially when a child, when, when, um, a boy is in their early teens, uh, preteen years where they're devout, you know, they're, they're starting to go through puberty. That can be, uh, a, um, kind of, um, a way in, if, if you can call it that for the perpetrator in terms of, you know, 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 is not realizing that, you know, they're being groomed. They almost think that they are, they've been given an opportunity to be able to explore their sexuality with someone who is perhaps more experienced. But on the point about protecting children, it's such a hard, it's, it's truly

such a difficult reality to have to face because, you know, you don't want parents to be highly skeptical of any other person spending time with a child. I think, you know, 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 a 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, you know, 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,

or safety in sharing when this might happen. And besides that, I think intuition, 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, you know, what is this relationship like to you? What do you guys do? You can be curious. Yeah.

I think another thing is, like, how do you protect kids against fear messages? Like, if, you know, or I guess there's two categories in my mind. There's one is 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 kind of messages that get inputted, right?

Yeah, yeah. you know, again, I certainly come back to the intuition piece, but that's not always going to, you know, it's not always going to hit 100% of the time. And so when I think about, you know, 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. Yeah. It's not going to happen. That's not going to happen. We will protect you. Yeah. I tell my kids, I am bigger and scarier than any of those people. Yes. And if anyone makes those threats, they are small and puny and they themselves are cowards, you know? Yes. Yes. 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. Yes. And then just, yeah, I think being aware of who are you trusting, who are you, you know, giving access to your kids to, you know. Yeah, okay, but let's keep going with this kind of picture of helping the survivor.

as well, right? And so male survivor identity, the crisis of identity that happens after the sexual trauma, the sexual abuse, anything else we want to say on that? The feel, maybe the feeling of powerlessness or the feeling of the internalization of worthlessness, that kind of thing? Sure. I, you know, I think there's obviously, you know, know 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 as if I didn't stop it maybe it's my fault and that that happens with with boys and girls and the idea that it was my fault can serve to protect 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, yeah, overall, I think all of this contributes to a real confusion around identity. And, you know, if you feel as though you're worthless, it can be hard to develop a sense of self that feels solid and ground it. I also, I think there's, it's almost like joked about in our culture. Like I've seen some Saturday night skits about like the teacher that abuses the male child and the male child that's like, like kind of like going along with it, right?

You know, the, you know what I'm talking about this kind of trope of like, 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 like, well, if you were. aroused if you if you were pleasured is that really abuse what would you say about that yes so i think it's fairly known culturally and and societally that when a female is abused it's it's not uncommon to experience physiological arousal and the reality is that it's the exact same thing with males when 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 the sense of, was it really abuse? And, you know, I think in men,

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, you know, 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 it's an active agency they they

they're not into it they wouldn't be so I do think there is a lot of kind of cultural confusion around what arousal means for a male yeah and I think that's I think that's very important to put out there because I think a lot of people that might be listening to this, might be, like, confused on why they were aroused or why they, you know, what did that mean for me if I was aroused or I wasn't, you know, there were parts of it that were in, like, there was pleasure, right? It's like, 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 like power, the power imbalance, right? The manipulation, the coercion, the, uh,

often threats that are in it as well, right? The grooming, it's like the knowledge of the perpetrator of what they were doing, what their intention was, right? Yeah, 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, you know, it was an abuse, saying it was an 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, you know,

my body betrayed me. deep and profound way. Yeah. And then if they were aroused, let's say that it was a male adult abusing, a male child, right? If they were aroused, what does that say about their sexual identity?

Nothing. I like to put it simply, you know, 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 they're developing puberty,

as they're in puberty, especially experiences arousal in so many different ways. And so, you know, you also bring up the question around sexual confusion you know, either as a teenager, as an adult, whatever it might be. And, you know, 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, you know, am I gay? Or am I gay because of the abuse?

And what I say is, it doesn't matter. You know, I don't say in necessarily those terms, but one, there's absolutely no evidence that experiencing sexual abuse has any impact on sexual orientation. And two, even if it did, so what? And I think that can kind of alleviate some of the need for certainty around what. what this abuse means. And that need for certainty can be really overwhelming and relentless. 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 almost like a trauma reenactment. I don't know. Have you seen, you know what I'm talking about? are you seeing this type of behavior, future behavior. Yes. When you ask that question, are you thinking of, is it in terms of like, reenacting the abuse with other men, even though this person, you know, would maybe through therapy, ultimately

recognize that they are, you know, entirely heterosexual. Is that kind of what you're saying? Yeah. like almost like a like a rape reenactment right or like a reenactment which is not not maybe what they would desire in like a connected you know relationship right but then there's also this kind of like impulsive reenactment desire that sometimes fleets into their mind which which I think can sometimes be more of an like an enactment of the trauma right which 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 there's there's deeper attachment issues as well with the because of the father hunger and the sort of the need for um you know it's like some of that can be deeper and longer work as well because it's like you know the the identity uh is is is it kind of like is a longer path to find that identity, I think, if that is there, or that quest is there, right? I don't know if that's making sense or not making sense right now. No, that totally makes sense. I definitely have seen and, you know, 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 be going and 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, you know, through treatment, through therapy, to, you know, 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 or, yeah, 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. You know, somebody who is a survivor might go into

sexual encounters and want to reenact the dynamics of the abuse. And sometimes that can happen in, oftentimes it happens in consenting adult relationships. But also, it, it, 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. Yeah. Yeah, it's similar. I think women, let's say they 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, you know, until they get to therapy when they make the unconscious, right? And they work through those aspects. I think in a similar way different types of abuse can manifest in adulthood until it's like fully catabolized. And I love how you put the compassion. for yourself, right? In reflective function, research, I've been thinking about that a lot with trauma-specific, reflective,

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. If dissociation could sound like they're jumping from different, they're jumping around the narrative, the narrative isn't a,

cohesive, thoughtful narrative. It's like the affects of the narrative maybe don't 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 catabolized trauma narrative, whereas the catabolized trauma narrative, they have the self-compassion. It's obvious that they've worked through.

the stages of grief, you know, with like they've worked through the anger, they've worked through the numbness, they've worked through, you know, these different things. And they end with some degree of self-compassion. So I love how you put that out there. Yeah, but you couldn't have said it better. I, as I was hearing you speak, I was just thinking grief, grief, grief, grief. I, you know, metabolizing trauma, I think grief is such an essential component. of it, an emotion. If somebody is only talking about their abuse and just talking without emotion,

there's a real dissociation kind of 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.

Yeah, yeah. I think so just to, because 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, you know, we've talked about in this podcast, disavowed anger, disavowed disgust, disavowed yearnings for connectedness. And so inevitably, you could end up in all sorts of different situations when it's unconscious, where you could have more of the OCD thing,

that we've talked about where you have this kind of obsessive intrusive thoughts that are disturbing. You have the flashbacks, you have nightmares, all the way that PTSD presents. You could have all sorts of attachment issues in future relationships from being asexual to hypersexual. And then you could also have these enactments, right? It's all these, 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 once the shame will be at the door right they will feel shameful in telling you they will feel they will project that you feel critical towards them

yeah and i think you know you preemptively you wrote a lot of about this stuff before we talked, I asked you to write something up for me. Talk a little bit more about what shows up in between you and the client in the midst of them talking about this, in the midst of them working through this. Yeah. 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, you know, saying I was abused and just being ready to get into it. Oftentimes, there are signs. There's, you know, numbness, there's withdrawal, there's attachment, um, issues,

whatever it might be. But the kind of transference countertransference dynamics still are present because, as you kind of describe, there's relational dynamics that might kind of be operating unconsciously. And so the, from a, from a, from a transference perspective, there's lots of different ways that the abuse can manifest. Some, some of these include, you know, well, first I'll just say that kind of what I like to think about it is in terms of the, you know, 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 and... Say that again? Yeah. So victim? Victim. Perpetrator. perpetrator. Okay.

Those are, right, those are the flip sides of each other, and then bystander, rescuer. Also the flip sides of each other. Like the disengaged bystander,

or the bystander that's the non-observant, observant, observant, bystander. Yes. You're watching, but you don't care, right?

Mm-hmm. So, okay, so the bystandard. And then what's the fourth one? Rescuer. And the rescuer. Okay.

So, initially they may see you as the rescuer them the victim right it may progress to you being the perpetrator how why won't you

give me access to you on the weekends uh why won't you respond to my calls at night it could you could also be the bystander then right where you're just kind of non engaged right uh huh so you could

see how the frame of treatment kind of elicits the transference over time or, you know, they push against the transference or the, no, sorry, they push against the frame that creates the transference. But yeah, okay, go into those four different things and how they flip between them, themselves and the provider. Yeah. 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, you know, feeling, like, what is this person talking about?

Like, this is pointless. Like, why are 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 type of kind of expected

interpersonal relationship. If the therapist withdraws, 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, you know, in their childhood. And so the, so kind of 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 there's a potential for being violated. 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, you know, 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, it kind of, you know, 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 not becomes this. Yeah. Yeah. in the midst especially of like any attacks like 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 yes yeah yes absolutely and um is that what you were thinking Or you think it's exactly what I was thinking. Yeah, that's exactly what I was thinking. Yeah, I mean, it can, it can come from attacks or intrusions. You know, you gave the example of why, why won't you answer my calls at night? Why can't, you know, why can I have more access to you? Um, exactly. Yeah. I noticed, um, I noticed something of something about what I said evoked some emotion in you, though. I'm wondering if, like, there's a memory in particular of like a client scenario that came to your mind or, or something. Yeah, I would say, you know, 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. You know, I had a patient who came into treatment and was talking about their abuse in a very casual way

you know like I I you know it happened with my uncle but I enjoyed it so it doesn't matter and the the end of our first session involved the question of do you think you can help me at all and I think

oftentimes I will respond with you know some sense of hopefulness and I did that and then the next session that, you know, this patient came in and said, you know, I thought about what you said, 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, you know, constant back and forth around can you help me or are you useless to me. And this hyperattunement 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 overinterpret 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 it kind of what resulted in terms of my emotional experience was just feeling helplessness and wanting to kind of pull back. You know, well, if I can't help you, then I'll just sit here. And that could be a projective identification. He's projecting into you the helplessness that he felt, right?

And you would eventually identify with it and you feel helpless. the helplessness that he's feeling is is more when he's saying things to you like you can't help me you can't you know you don't really have anything to offer me i've tried everything i've already done i already have like all this self-knowledge right which which uh is a little bit of a devaluation of you in your position as a therapist it's a devaluation of you as a person he's feeling helpless in in the description of his uh the abuse with the uncle helplessness is not part of that narrative right he's numb he's disconnected so the helplessness is um it's it's like a part that is unconscious it's dissociated away the helplessness is is is projected therefore into you into the

into the into the 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. Yeah, and the thing with projective identification is that as the therapist kind of 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, you know, 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, you know, 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. Yep. Yeah. Like, you don't really care about me. So there'll be in other relationships. 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 pissed off. And they'll take that anger as like 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 like offensive to me. Right. So in the attachment dance, you know, it's like numbness is actually a protection in and of itself as well, right? 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's like, yeah, it proves their point. It proves their narrative. So what I'm saying with the EFT model of attachment is there could be a completely different truth to what's actually unfolding. But they're not looking for that. 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 yeah and I like to think a lot you know I really like to think about it in terms of parts

you know 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 kind of ego states interpersonally.

Right. Yep. Yep. And you could see how like a lot, you know, because in a podcast we talk a lot about personality, we talk a lot about like idealization, devaluation. We talk a lot about splitting and things like this. 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 we're talking about with this patient is to go to a, more of a devaluative 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 quickly, right? Yeah. And, you know, if a patient is not able to kind of 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 kind of numbed out, detached, withdrawn, it's like anything the therapist says just kind of bounces off. and it's hard to internalize anything new. Yeah, yeah. Well, well-spoken. I mean, we know, you know, that therapeutic alliance is obviously very important for outcomes. But the other thought that I have that comes from 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, they, you know, so it's like they're, they're valuing it, but they're also devaluing in some ways. They're trying to create a little bit of distance to protect themselves. And I don't necessarily feel intimidated by that need for distance. People need a sense sometimes of not, you know, like this more of a schizoid personality type has this fear of being consumed, you know, and so like they need to create some level of distance between them and another person in order to sort of not feel this consumption, you know, that this person is gaining too much

power over me, you know, or they're fearing that like this therapist is like going to like overwhelm them in some way. Yeah, and the hope is that this can actually be spoken about in treatment. You know, that can come from a disclosure or just some general exploration around, you know, how do you feel about me? You know, 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, you know, 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 kind of 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, you know, what's happening in the room and how that shows up as far. I tend to personally say things like it would make sense to me. if, you know, part of you did want to, or it was hard to trust me. You know, it would make sense to me that, like, 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, you know, knowing what I know a little bit about your history, that it was part of you that wanted to push away or make less of the work that we're doing. You know, so I said, I see it as like because they're adaptive defenses.

You know, it's like there, it's like shame. It's like one of the questions I always ask myself is how do I reduce shame so that the person continue 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 the writing that I read and everything. I think you're really big on that too. It's like, okay, how do I help this client reduce their shame? Absolutely. Absolutely. I think I completely agree with you, especially early on in treatment. You know, 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, you know, 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? Like, oh, wow, that's a, 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. Yeah.

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 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? Yeah, 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, if 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 to 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. You know, this is a place that is really intimate and close. And it makes sense that feelings of, you know, these types of feelings could show up here. And then lastly, is the kind of boundary. To be, you know, to be clear, especially for someone who has experienced sexual abuse, they, on a deep, deep level, they will likely feel reassured by a boundary being set. Even if consciously, it might be upsetting, disappointing, frustrating, difficult.

But, you know, in therapy, as you know, 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. 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, you know, I have. this is really hard to say, but I'm starting to, I think I might be in love with you, or something like that. That's kind of how I would approach it. Okay, so you differentiate the two. Talk about the two, and do they have names for the two different types of transferences. 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? Sure. Yeah. 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, you know, a mentalized

stance where they can reflect on these feelings, they can talk about these feelings, you know, I am noticing myself feeling like I'm falling in love with you or something like that. So that's kind of 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, you know, actually asking a therapist on a date or, you know, starting to ask the therapist, are you single and really engaging in a, in a, in a, in a, 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. Yeah. And I think that the way that you describe,

the first type, right, the erotic transference as like they come, you know, there's something I've been thinking. I'm really shameful 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, like I fear I may be falling in love with you and like, I don't know what to do with this. And so that's kind of more of that erotic. Like the eroticized, there's almost like a predatory part of this of like, I'm gonna seduce you.

And it's a way of almost like ward off vulnerability, intimacy, and you know, within the relationship, right? The countertransference, how would you say you deal with that professionally. Yeah. Before I jump into that, there's something that you just mentioned that I just wanted to kind of pick up on a little. What is happening beneath the surface of somebody engaging in eroticized transference?

The unconscious experience is often my sexuality, my body, is my body, is. is the only thing that is valuable. And 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...

Wait, wait, let's pause there because I think that's good. Yeah, sure. Yeah. 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 themselves to get anything good from the therapist, right? Yes. And so there's an enactment that's forming. and I would say it's something that can be,

I don't know, it's not like talked about that much in therapy training. I think, so it can be very overwhelming. If these are things that you are encountering as a therapist, you could seek supervision. Yes. And that might be a good place to start, is like talk to some providers,

who have some experience in navigating these types of issues. Absolutely. Absolutely. Yeah, so countertransference, it can elicit when this type of stuff comes up, it can elicit a lot of different countertransferences. Talk about some of the countertransters that it can elicit, and then how do you navigate those? Yeah, so some of what can come up for the therapist, when it comes to erotic or eroticized transference can involve feeling violated and

truded upon or that there's a possibility that that might happen. The therapist might respond to that with, you know, as we were talking about earlier, you know, withdrawal, maybe even in a more exaggerated form because they might feel like their safety is at risk or this topic, you know, is so taboo or, you know, there are such severe ethical consequences when it comes to, you know, erotic feelings in a treatment relationship. And one of them that is very little talked about is reciprocal desire. You know, especially in an eroticized transference, there can be a real seductive. that happens.

And no one is immune to that, not even the therapist. And there can be ways that the therapist feels so 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 counter-transferentially. And I think, you know, I supervise as well. And it's so, you know, supervisors 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. Right, right, yeah. It can, it can, it could be something where supervision is probably 100% recommended. And a consultation, you know, I think there's some people that have almost built their whole practice on, like, supervising for these types of things. Glenn Gabbard often does like these sort of like consultations for. these kind of high conflict things. But I think it could be really good.

This is why like communities, like psychodynamic cohorts, stuff like that, like the ones I lead can be so awful because it's like we can talk about it, normalize like the human experience and put it to words. You know, this is not something that you report to a patient. If you have sexual arousal, reciprocal erotic feelings, like 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. Yeah, 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 an highly eroticized way where they, you know, they might be asking you out, again, they unconsciously want you to say, they need you to say no. Right. It's like, just because an enactment is occurring of trauma doesn't mean that you partake in the enactment, right? And it 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 have been, that their boundaries have been diffuse or they haven't,

you know, they've succumbed to some erotic, you know, solicitations. And it always hurts the patient. It always becomes another trauma. And it becomes, it makes it really difficult for the patient to trust future providers as well. And so, yeah, it's interesting. like it's a taboo for therapists probably for good reason right like it but the taboo maybe can um

you know in supervision and like looking what's underneath it you know because it can feel really good to be idealized as well you can feel really good to be um you know the uh you know if 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, you know, 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. And, you know, there are some therapists that maybe have that personality style.

Most of us are more depressive. Most of us are more like on the, not exactly that type of personality. But those types of personalities can be maybe more vulnerable to that level of idealization as well. Yeah, 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, to not take that on. 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 um had in their childhood older figures that sexualize them you are an older figure

you know, they are in the midst of that enactment with you, moving you from rescuer to perpetrator. Right. And it's like we need to stay, you know, we are not exactly the rescuer. That's kind of an idealizing of us position. We are kind of more of a guide in the hero's journey. We're empowering them, equipping them to keep going on their journey, right? Yeah, 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're describing, you know, as a guide, so much of the work is helping shore up the patient's internal resources. and by not, you know, succumbing to that idealized, idealizer dynamic, you know, that's part of supporting that process. Right. Yeah. So, you know, when, when the other situation that I think sometimes unfolds is that with the more, the first type of sexual transfer and stuff you brought up, it's like they can, they,

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 it's like 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. And so maybe it's like you're something, the good that has happened,

Right. My hope for patients is that they go out and find that, the parts of it that were good, and find it in new relationships, right? Especially the patients that maybe they've been attracted to more abusive relationships. They had some sort of like 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 than partners they've dated before. Well, I don't know if you have any thoughts on that.

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, you know, 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, you know, that warmth, that attunization. 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 bounderied, 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. It doesn't have to have a transactional, dehumanizing, objectifying aspect to it. And if they're, yeah, I think that that sort of transactional objectification may have been what they've experienced largely in a lot of different dynamics. And, you know, yeah, we get really excited.

when they find relationships that are kind and generous and warm and, you know, all the things that lead to thriving and great families and great, you know. Yeah, so that's good. Yeah. That's good. What do you, I'm curious about your journey. Like, how did you go from a corporate lawyer, right,

to making this pivot, to work with this population? Yeah, so I studied finance in college, and I worked in finance for a bit, and then went to law school, I 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, you know, whatever familial expectations and things like that, desire for security, financial security, and so on. So, you know, 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 analysis, psychoanalysis, four times a week.

And on the couch, lined it on the end. It was an arduous, long, but also a beautiful process. and, you know, I really see it as kind of a playground, a sandbox, to just go in and explore everything. 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, I really saw how I could be meeting with, 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, you know, organizing factors that inhibit disclosure and healing. And I just, I really felt pulled into being able to create an environment where, you know, disclosure can happen, where safety can be experienced and trust and healing. And here I am. Awesome. Well, the world is a better place with you as a therapist. I'm sure we need good contract or good corporate lawyers as well, but I think you're, you definitely like feel like a therapist. You don't feel like a lawyer, you know?

Yeah. You don't give off lawyer fives. I never felt like one. You were like, I'm really a therapist. I know I'm, like, trained as a lawyer, but I'm really a therapist. No, I think a lot of people find the podcast actually from, 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, like, 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 fast, like, what's the best path? I'm like, you know, probably the fastest. Yeah, that's good. Yeah, yeah. How's your group, your men's group going? Oh, it's great. Yeah, we didn't talk about that.

I think group work is an amazing, 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 that I'm talking about is for male survivors of sexually. So if you're in New York and you're hearing this, Doreal, Chakoff, am I saying that right? Jacob. Jacob. I want to say like Russian, Jokhov.

Jacob, yeah, you're in New York, and 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. Absolutely. That you know. And yeah, well, I think we'll wrap it up. Any, like, final thoughts that you didn't get to say,

but you really wanted to say before we kind of wrap this up? We covered so much. We really covered a lot of ground. I think nothing particular comes to mind. Oh, I'll say. On the website, I'm going to put the article you wrote. Okay. 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, some different articles. And 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, you know, in actual like, you know, before you graduated, you don't like necessarily get as deep a dive as you can post-graduation. So. Yeah. Yeah. Stay curious. All right. Thank you so much for coming on and we'll leave it there for today. All right. My pleasure. It's great speaking.