There Is No Gender Neutral

When I wrote my book (and my master’s thesis), one of the common responses from men to my question, “How has recovery changed your idea of being a man?” was that they saw themselves less as men and more as humans. In other words, they believed that the rules for being a man defined less of their behavior and their lives, in general. They believed that they were humans first and foremost, and the expectations of how they were supposed to act as men were less important, reflecting the idea to thine own self be true.

Overall, this is a positive outlook. However, as I wrote in the final section of my book, the danger of subscribing to this belief, with all good intentions, leads us inevitably to a default if we are not paying attention: a world that is defined by the dominant group. Without breaking into a treatise on oppression and marginalization, we cannot ignore the reality that some people receive benefits and advantages in this society simply because they belong to a certain category. And others get just the opposite — deficits and disadvantages — because they belong to another category or, said another way, do not belong to the dominant group.

In terms of gender, the default group is men: manliness, masculinity and patriarchy. Maleness is the norm, the expectation, and even the subconscious’ default for many men and women. We — both men and women — have to be aware of this, or it infiltrates all of our relationships in very insidious ways. Once we are aware of it, we can transcend it.

Ultimately the question for men that I pose is this: Are your behaviors and the beliefs that you maintain reflective of the man you want to be in recovery? Are they what the people in your life truly want to experience from you? Whatever a man’s answer, it should be very clear to him that he will experience the consequences — good and bad — no matter what. On a spiritual and moral plane, we don’t ever get away with treating others as inferior, second-class or any of the other disparaging things that human beings do to one another.

I’m Not Half the (Wo)Man I Used to Be

Men and women are essentially raised to be half human beings: Women are given one part of the dichotomy and men the other. That dichotomy shows up in various degrees of intensity and, of course, because we are all individuals it looks different for each of us (1).  The breakdown could look a little like this(2):

Most of us come into recovery operating within one side of the dichotomy, according to our gender. That does not necessarily reflect who we are but rather how we have learned to express ourselves and survive in society. Our goal in recovery is to then learn how to eschew the false dichotomy and simply allow who we are to surface irrespective of whether those qualities are considered masculine or feminine. As I explain in my next book (which is focused on men creating healthy relationships in recovery), if you are a man, there is nothing you can do and no way of being in which you cannot be a man. The same idea applies to women. But we hear from a very early age that “boys don’t do this” and “girls don’t do that.”

Case in point: I was visiting my sister not too long ago. I wear a necklace made of different-colored, small, rounded stones. When my two-year-old nephew saw it, he said as intelligibly as he could: “Why are you wearing that?” “What?” I said. “That necklace. Boys don’t wear necklaces,” he said in all innocence and seriousness. I laughed and yet I thought to myself, “Holy shit! Seriously? That young?”

As we adhere to the recovery exhortation, to thine own self be true, we begin to move again toward our wholeness as individuals. We round out the rough edges of our character and discover our true selves. While this true self is likely an ideal that we are always moving toward, the more we engage in our recovery and our personal growth, the more likely we are to move toward authentically expressing who we are. Some of it is learning to love parts of ourselves that we were taught or told were not OK. Some of it is coming to embrace parts of ourselves that we rejected. Some of it is expanding what we see as possible ways of being that we never considered or had rejected without ever exploring, often because boys (or girls) aren’t supposed to act that way.

One of many personal examples: As a young boy, I was always sensitive. I learned very early, growing up in a violent alcoholic home, that it was not OK to be a sensitive boy. I learned to hate that part of myself because I thought it was not manly. I have come to realize that it is a part of who I am, and I do not care if others think it is manly or not. In fact, it is a great quality about me when I am able to express it in a healthy way.

Chances are, you and your clients will have your own examples of how this has happened. What is important is to help them be able to verbalize those experiences. And so, it is important that you have done your own work. As a famous piece of recovery literature says: “You cannot transmit something you do not have.” Equally important, however, is that you look at it through the lens of gender to help the unseen become seen.

Whole and Complete

Many of the great spiritual teachers share some core ideas. One of those ideas is that we are born whole and complete, and the process of growing up and living creates a disconnection from our true essence. The process of “waking up,” then, is a process of returning to who we once were and regaining what we once had. As Anthony DeMello (and many of the great Eastern mystics) said, awareness and an enlightened life is a process of subtraction, not addition. We remove that which has accumulated over years and years that blocks our true self, as if we are chiseling rock away to reveal a wondrous statue.

Recovery is one of the greatest pathways for accessing wholeness because, as in Twelve-Step recovery, there is a clearly delineated structure or design for living. As your exploration of the steps deepens, so too does your movement toward wholeness. I am far from an expert on wholeness, but it does seem that recovery leads us toward being complete human beings. My own experience as a man in recovery has shown me that it is quite a bumpy road and who I think I am is constantly changing. That being said, I am moving toward wholeness — or, as some would assert, moving toward realizing the wholeness that already is my life, and in doing so, I become the man I was always meant to be.
Dan Griffin is the author of A Man’s Way through the Twelve Steps and Co-Author of Helping Men Recover.

1. Boys are under the assumption that they should be able to protect themselves. If someone takes advantage of them, they feel it is their own fault, that they should have been stronger.
2. Boys feel they won’t be believed, especially if a woman perpetrated the abuse.
3. Boys worry that if the perpetrator was male then he must be gay, or if he tells, people will think he was gay. To make it clear, we are not saying that gay men abuse boys.
4. Our current social belief is that victims are female and perpetrators are male, therefore males are not seen as abuse victims.

What Happens to These Boys?

1. There is an increase in addiction problems, emotional problems, and relational problems.
2. Reenactment of childhood victimization is the major cause of violence in our society.

Our society’s denial of the reality of child abuse and our collective need not to know should not be underestimated. The abuse of children is an ugly reality.

Since this project with Prevent Child Abuse began three years ago, we have been asked the question, “Why focus on men when more women are abused?” (By the age of 18, one in four women and one in six men will be abused.)

The answer is simple but not so obvious to the general public. The cost to our society is great when we don’t provide treatment for men who were abused as children.

Imagine having a secret burdened with shame, fear, and rage tucked away deep inside of you. Now try facing everyday problems, relationships, work, parenting, and finances in a healthy way. Anyone abused as a child carries scars inside that never quite heal, especially if that person has not been able to talk to about it. When survivors feel “emotionally triggered”, they often act out in rage or use drugs and alcohol to numb pain, while also falling prey to eating disorders, suicide, and other negative behaviors that affect us all as a society.

A high percentage of untreated abused men go on to abuse others — as the saying goes, “Hurt people hurt people.” But if we start the healing process at the core, we can prevent other girls and boys from being abused.

As part of our project, we started the “It Happens to Boys” men’s group for men who have been abused. We started with four men and now have 17. Many of the men in our program are in 12-step recovery groups, and we are finding that many men are not receiving the help they need for their abuse issues in recovery facilities. They mention that they participate in one trauma workshop and that they dealt with their abuse in their fourth step work and now they are done, only to be triggered by something later and to relapse. However, the men who actively work on their abuse issues, have a place to talk and feel safe, bond with other men, and help each other, are doing quite well in their recovery.

Survivors of sexual abuse have an increased risk of using alcohol and drugs as a coping mechanism. Survivors are 13 times more likely to use alcohol, and 26 times more likely to use drugs. But why? The New Britain Sexual Assault Crisis Service’s Counselor Advocate Training Manual states that “the abuse of alcohol and other drugs is a way some survivors choose to cope with their assault. The abused substance can temporarily help the survivor forget the assault and dull feelings of pain, fear, self-blame, and other emotions.” (1)

Clear recognition of the profound effects of early abusive experiences and the complex issues these survivors experience underscores the need for a sophisticated understanding of the treatment process for childhood abuse survivors. Too many of these survivors do not seek treatment because of the shame they experience or because they have locked their memories away. When these memories are locked away, the emotions in these memories can be triggered by anything in the environment and thus making the survivor act out or in, depending on their style.

If a person experiences a trauma and was unable to process it, the emotions tend to remain in the emotional part of the brain, the amygdala. The amygdala is specialized for reacting to stimuli and triggering a physiological response, a process that would be described as the emotion of fear. If the information and emotion does not transfer to the hippocampus, where it is rehearsed and remembered, it stays in the amygdala. The survivor’s emotions can then become triggered, rendering the survivor in an emotional state of fear, re-creating the emotions of the traumatic event.

For example; If you were abused by a male and he wore a certain brand of aftershave, you could be walking around a store not thinking about your abuse, but you smell that aftershave and feel that triggered emotion, and now you are raging at a salesperson because they did not give you the right change.

According to John Lee, author of The Anger Solution, “When we get triggered we tend to regress to an earlier stage of life and we rage”.

Emotional Responses

Both men and women can experience anger, shame, anxiety, numbness, fear, confusion, sadness, self-blame, helplessness, hopelessness, and suicidal feelings. However, the New Britain Sexual Assault Crisis Service’s Counselor Advocate Training Manual states that “Men may show more hostility and aggression rather than tearfulness and fear”. As a reaction to their feelings, male survivors may turn to alcohol or drugs, as well as other self-destructive behaviors. They may lash out at others around them. (2)

Many women and men who have been subjected to severe physical or sexual abuse during childhood suffer from long-term disturbances of the psyche. They may be invaded by nightmares and flashbacks — much like survivors of war with PTSD or, conversely, may freeze into benumbed calm in situations of extreme stress.

Eating Disorders

“Among both adolescent girls and boys, a history of sexual or physical abuse appears to increase the risk of disordered eating behaviors, such as self-induced vomiting or use of laxatives to avoid gaining weight. Among those at increased risk for disordered eating were respondents who had experienced sexual or physical abuse and those who gave low ratings to family communication, parental caring, and parental expectations.” (3)

What Can We Do?

1. Talk to your children, students, and family members. Teach boys and girls about healthy sexual boundaries and their right to set them about their own bodies. Encourage dialogue with safe adults. Reenactment of childhood victimization is the major cause of violence in our society.
2. Prevent Child Abuse: Riverside County is campaigning to educate the public to help the future men in our communities. Look for similar campaigns in your own community.

The men in our group are vigilant about their behavior; they never want to repeat what happened to them with their own children. They are helping themselves and reaching out to other men and boys to help in the education and healing process. They are working tirelessly, speaking wherever they are needed.

1. Elizabeth Stannard Gromish “Why Survivors turn to Alcohol and Drugs”
2. Elizabeth Stannard Gromish “Men can have emotional problems after an assault.”
3. Dr. Dianne Neumark-Sztainer, et al, University of Minneapolis, International Journal of Eating Disorders 2000;28:249-258.

Most addiction treatment programs make it a practice to separate men and women as much as possible. In residential programs this (obviously) is done to prevent fraternization and loss of focus on one’s own process.  But do men and women also react to the same material in different ways?

Treatment Improvement Protocol (TIP) No. 51 from the Center for Substance Abuse Treatment notes there are differences in treatment of males and females: “Although the relationship with the counselor is important to both men and women, each gender defines this connection differently. When women and men were asked what was important about the quality of their therapeutic relationships and their recovery from substance abuse, most women answered, trust and warmth, and most men answered, a utilitarian problem-solving approach” (CSAT TIP No. 51, p. 12).

But what about spirituality? Do men and women approach their spiritual explorations in treatment the same way? One thing many people, addicted or not, find hard to grasp is a sense of the mystery and the intelligence of a spiritual force in their own life. Seeing it in nature helps to personalize it.

Could it be that women approach a fresh or renewed concept of a Higher Power with the same values they wants in their counselor relationship: warmth and trust? If men value solving problems more than emotional intimacy in their counselor relationships, might that also be the way most men approach spiritual exploration?

A particular story, the one about the parasite, does seem to resonate more with men than women. It’s from a new series in development on spirituality. The series takes situations in nature and offers the listener the chance to make comparisons that may relate to the spiritual dimension.

In his book, Parasite Rex: Inside the Bizarre World of Nature’s Most Dangerous Creatures, Carl Zimmer writes of the Lancet Fluke. The Lancet Fluke is a tiny parasite that lives in the digestive system of sheep. It does not harm the sheep in any way. Sometimes the Fluke finds itself on the ground of the pasture, having been passed through the sheep’s digestive system. Now how can the Fluke get back home? It turns out that snails love to feast on sheep excrement. In doing so, it ingests the Lancet Fluke, but the snail is allergic to it; can’t tolerate the Fluke and the snail throws it up. Now, ants happen to love snail “throw up” and the ant ingests the Fluke. What happens next, according to Dr. Zimmer, science cannot explain. The ants that ingest the Lancet Fluke are overcome with an overwhelming compulsion to climb. They must climb. The Fluke is so tiny that it has no head or tail. It is inside of the ant and it makes the ant climb. In the pasture, the closest thing to climb up is usually a blade of grass. So the ant climbs right to the tip of the blade of grass. The sheep comes along and chomps that grass and the ant. And the Lancet Fluke has made its way back home.

We have discovered that men find the story compelling. Women, however, would rather move on to something else. Some comments we have heard are, “If a Higher Power can have a Lancet Fluke make an ant climb up a blade of grass by means of which science cannot understand, I suppose that same Force could help me figure some things out.” “I’m stuck in the snail vomit and I know I’m going to get home, but it sure feels yucky right now.”

At The Gooden Center in Pasadena, California, men have been receiving addiction treatment since 1962. Its sister program, Casa de Las Amigas, across the street and in operation about the same length of time, treats only women. After decades of comparing notes, the counselors concur that women’s issues are more often focused on relationships. Food addiction is also prominent. Men, on the other hand, tend to be more focused on work.  For them, sex addiction is often an ancillary diagnosis. While these are generalizations and are not substantiated with control group trials, there appear to be many instances when treatment for men and for women should differ. TIP No. 51 seems to concur.

We hand it to CSAT for tackling gender-specific treatment differences in TIP 51. And we look forward to the next TIP for how men respond differently. In the meantime, we will continue to use stories of the mysterious and awesome from the natural world in helping clients explore their spiritual life. Men may approach God as a problem to be solved. But in trying to do so, many brush up against a Force both startling and familiar, and even Something they can learn to trust.

Reference List

Center for Substance Abuse Treatment, Substance Abuse Treatment: Addressing the Specific Needs of Women, TIP 51, Rockville, MD, 2009.

Zimmer, Carl, Parasite Rex, Touchstone, New York, 2000

Even more startling is the fact that more than 90 percent of these women wonʹt receive the care they need.
Some have no money. Others have no health insurance coverage. And still others, often older women, have an instilled sense of pride and embarrassment that makes it difficult to ask for help.

For experts, this underlies the importance of gender‐specific treatment for women. The latest research is confirming that same‐sex treatment in a safe and trusted environment is the most effective means of providing help to addicted women.

Consider the story of ʺMarie,ʺ a 39‐year‐old business owner, mother and recovering addict who, from age 19 to 23, thought nothing of tossing back 16 cocktails, and a handful of amphetamines, to reach the perfect numbness. She drank with the intention of blacking out. And, if that wasnʹt going to kill her, her drunk‐driving habit might have, especially after her second DUI crash.

Even today, the memory of how her life spiraled out of control prompts tears from Marie, which is not her real name. She stresses her doubts about survival had she not been sent to New Directions for Women, a single‐sex Costa Mesa, CA‐based recovery program in its third decade, that draws patients from around the country.

New Directions offered the clinical tools for recovery she so desperately needed, Marie explained. But she came away with much more.

Marie spent eight months at the New Directions residential treatment center where she felt safe among her peers as she recovered her sobriety, her family relationships, her self‐esteem and her will to live a clean life.

ʺMy eyes were opened,ʺ she said. ʺI came out of a cloud.ʺ

After completing treatment at New Directions, Marie made a list of her goals and objectives. She noted how her goals might be taken for granted by those who have never faced gripping addictions.

ʺI wrote down that I wanted to have a relationship with a loving man, finish my college degree and someday have children,ʺ she admitted. ʺToday, I have them all.ʺ

Could she have admitted such dreams in a coed treatment environment?

ʺSometimes, around the male presence we edit ourselves,ʺ she continues. At New Directions, ʺjust being all women, it was a more homey setting to let your feelings out. It was a little bit like a sorority, where we were comfortable with each other to share our experiences and find strength and hope in each other.ʺ

Specialized addiction treatment for women dates to the 1869 founding of the Martha Washington Home in Chicago; Binghamton, New Yorkʹs Temple Home, in 1876, and Bostonʹs New England Home for Intemperate Women, whose doors opened in 1879, according to research.

Still, much of modern programming has been developed with one goal in mind, explained Susan Foster, Vice President of Policy Research at the National Center on Addiction and Substance Abuse at Columbia University in Manhattan.

ʺMost treatment in this country is modeled after the male heroin addict,ʺ said Foster. ʺAnd very few people understand how women get blindsided by the effects of drugs and alcohol.ʺ

Foster, with CASA executive director Joseph Califano, released the 2006 book, ʺWomen Under the Influence,ʺ funded by the Bristol‐Myers Squibb Foundation and published by The Johns Hopkins University Press.

It details the myriad differences between women and men and how factors from chemical makeup and metabolism to emotional response and reliance on relationships play into how treatment plans must be tailored for womenʹs unique needs.

ʺIt all comes back to educating the public about how addiction is a health condition,ʺ Foster stressed. ʺA lot of people still think it is a bad choice, or something to put in the moral turpitude box.ʺ

Research shows that as many as 70 percent of women who abuse drugs have had histories of physical and sexual abuse. They also use drugs to boost self‐esteem and confidence. Because of a range of physiological differences, and even the ratio of fat and water in their bodies, one drink for a woman has the same impact as two drinks for a man, research shows.

Rebecca Flood took over New Directions in 2004, a treatment facility located close to beautiful Newport Beach and the Back Bay environmental area. Before she came on board, the place had already turned around the lives of over 2,500 women. But with a truly ʺnew direction,ʺ industry experts agree Flood has revitalized the facility, taking advantage of its primary strength: it has treated only women addicts since its founding.

ʺWomen, as we well know, are more relationship‐based than men,ʺ said Flood, who herself has been clean and sober for 33 years. ʺIf we donʹt address those relationships in a very significant way, they have higher rates of relapse as a result.ʺ

A&E’s top‐rated program “Intervention” filmed its show at the non‐profit treatment center on May 24 as a specifically targeted patient began her treatment. New Directions is providing a 90‐day program for the woman and is also the site of a monthly Intervention Workshop hosted by A&E Interventionist Ken Seeley.

Besides the clinical approach, New Directions offers a holistic component that can range from rock‐climbing and hiking to equine and art therapy and even drum circles.

Jackie Cummings has been working with addicts for 31 years since she cleaned up from her own heroin addiction in 1976. Today, as the manager of recovery services at the 10,000‐member International Longshore and Warehouse Union of Southern California, she said she regularly sends addicted employees to treatment centers so they can regain their lives and jobs.

New Directions she said, is the only all‐women program available to her for the nearly 20 percent to 25 percent of that membership who are women, and may eventually need to seek out assistance.
Kim Miller is the Manager of Womens Addictions Treatment Services at West Virginiaʹs Prestera Center, which for more than 40 years has provided substance abuse treatment as well as behavioral healthcare for thousands of area residents.

Like New Directions, Presteraʹs Renaissance program offers specialized addictions treatment services for women who want a chance at a new life. They have 31 beds for adult women and children and treat about 100 other women on an out‐patient basis.

ʺProviding gender‐specific services is the most important thing we can do,ʺ Miller stressed, especially for women who have experienced trauma and/or sexual abuse.

ʺThey will not discuss this in the presence of men. And in mixed‐gender programs there is no provision for child care. So, a mother is thinking, ʺWhere do my kids go while I go to group?ʺ

Programs for men are more confrontational, she said, ʺbecause men are wired differently.ʺ

Another womenʹs program in Asbury Park, NJ is Epiphany House, started by Sister Janet Christenson, a member of the Sisters of Mercy religious order, in 1989.

The similarly gender‐specific program is focused on addicts who are homeless, or at risk of homelessness, and through the years has helped hundreds upon hundreds of families.

In a published interview, Christenson said she started the program with a $35 monthly stipend from her order until a $100,000 state grant allowed her to open Epiphany House in Long Branch. There, she applied what sheʹd learned from her own recovery to help others.

Among their success stories, is this one from ʺToni,ʺ which is featured on the centerʹs Web site: ʺEpiphany House is sort of like the Marines. Itʹs the hardest job youʹll ever love. It was hard and painful and it was safe and healing. Today my children are safe. I have a home and my home is clean. Iʹm working and I have the respect of my co‐workers. I buy food without food stamps. It doesnʹt get any better than this!ʺ

ʺYes,ʺ agreed Marie, the New Directions alum, now a mother of two children: ʺMy life now is more than I could ever have imagined. I got it because I wanted it. Before, it was a dream. A fantasy. And a wish.ʺ

But after learning what New Directions had to offer? Well, she said, itʹs hard to describe.

ʺMy parents are proud to have their daughter back,ʺ Marie said. ʺI have reconfirmed where I came from, and where I am today. I guess itʹs like this: once you lose something, like yourself, you appreciate that much more being able to get it back.ʺ

Over the years, I’ve known well-meaning gay and lesbian colleagues and students who were unaware of the specific issues that gays and lesbians face. They’ve said they didn’t realize there were stages to coming out, or that there were differences between gay and straight couples, or the typical reactions of  family members, as well as what to do with mixed orientation marriages.

To be uninformed is a form of prejudice by omission. Having a healing, affirmative stance in the therapy room does help relieve some of the distorted thinking that most clients bring in, but having an affirmative stance without being informed about the specific issues that lesbians and gays experience limits your clinical effectiveness.

Gay Affirmative Therapy (GAT) takes the position that there is nothing inherently wrong with being gay or lesbian. What’s wrong is what is done to gay men and lesbians by a homophobic, homo-ignorant society and heterosexist therapy. Living in a shame-based culture creates a variety of behavioral and psychological disorders. GAT focuses on repairing the harm done to these clients, helping them move from shame to pride. GAT does not, in itself, constitute a specific system of psychotherapy but rather is meant to provide a framework that informs psychotherapeutic work with lesbian and gay clients.

What Gay Affirmative Therapy Is Not

In general, GAT explores the trauma, shame, alienation, isolation and neglect that occur to lesbians and gays as children and how this manifests as adults. While important, this has the potential of going too far and eclipsing other issues that your clients face. GAT is not intended to de-emphasize emotional disorders and not examine any pathology. GAT is not supposed to explain all the problems facing gays and lesbians. It is supposed to be an essential inclusion.

Historically, gay-negative therapists jumped to conclusions and applied homophobic and heterosexist trauma models and theories, when in fact gay clients exhibit other individual problems.  For example, a gay male who might appear promiscuous and in stage five of the coming out process could actually be a suffering from bipolar disorder or sexual addiction. The closeted lesbian complaining of low libido may not be repressed, but have suffered sexual abuse in her childhood.

But don’t be afraid to diagnose and pathologize gay-specific problems if need be, just because homosexuality itself has been over-diagnosed and pathologized.

Does this seem confusing? Then you’re on the right track! As therapists, our responsibility is to be armed with all the up-to-date information. Knowing all the ways problems can arise, you can then assess with clients—and with their help—what applies and what doesn’t.

Trauma

All gays and lesbians are touched in some way by trauma. How they are affected and how it manifests depends on the individual, his or her personality, and the family of origin. When working with gays and lesbians, it is important to assess and treat them through the lens of the effects of the trauma of homophobia and heterosexism.

My working definition of trauma is an event or episode, acute or chronic, that causes overstimulation without an outlet or release for that overstimulation. This leaves individuals feeling helpless and overwhelmed. According to this definition, any seemingly harmless event or situation can be subjectively traumatic when it leaves an individual feeling unable to cope, or fearing some ongoing threat.

Growing up gay or lesbian is incrementally traumatic. Slights happen over a period of many years, and children learn to internalize them, all the while struggling to cope with being alone and in secrecy. For those for whom heterosexuality is the “alternative lifestyle,” trying to develop an identity while role playing (or, as one of my clients calls it, “doing straight drag”) is chronically painful. And, it sets the stage for awkward identity development and difficult future functioning.

The trauma lesbian and gay children experience growing up is pervasive. However, this trauma goes even deeper, and it often falls under the radar of therapists and even gays and lesbians themselves. The trauma I’m referring to is a sexual trauma.

The assault on gays’ and lesbians’ sexuality is profound and becomes worse as they enter adolescence and adulthood. The trauma not only affects their psychological identity but also negatively influences their psychosexual formation and identity. The psychological consequences of homophobia and heterosexism parallel those of sexual abuse.

The fact is that most children—gay and straight—learn they have to hide and modify sexual parts of themselves that are discouraged. This hiding modifies, vandalizes, and compromises their identities. The sexual oppression and terrorism experienced by those who grow up gay and lesbian—particularly during the adolescent years when sexuality and intimacy development is at a crucial stage—is profound.

For years, psychological researchers and clinicians believed that those with a homosexual orientation were unable to form close attachments, maintain relationships, and have healthy self-esteem. In other words, it was thought that these negative characteristics were innate to homosexuality. The truth is that they are the result of what is done to gays and lesbians. The effects of covert cultural sexual abuse persist into adulthood and are just as pernicious as those of sexual abuse.

The following will demonstrate how the trauma is sexualized, how it manifests, how to identify it for your clients, and how to help them heal from it.

Defining Covert Cultural Sexual Abuse

Covert cultural sexual abuse (CCSA) is the foundation for many (if not most) problems for gays and lesbians. And most therapists working with gays and lesbians miss this phenomenon. It’s not enough to simply say that gays and lesbians were permanently scarred by the homophobia and heterosexism they experienced growing up. Homophobia and heterosexism are inherent to covert cultural sexual abuse and have devastating, complicated psychological and psychosexual consequences, causing guilt and shame to run as deep as in those who have been sexually abused.

I define covert cultural sexual abuse as chronic verbal, emotional, psychological, and sometimes sexual assaults against an individual’s gender expression, sexual feelings, and behaviors. Conceptually, it is similar to sexual harassment in that it interferes with a person’s ability to function socially, psychologically, romantically, affectionately, and sexually. Its effects persist into adulthood and wreak havoc in people’s lives—as does sexual harassment.

My working definition of sexual abuse (both covert and overt) is whenever one person dominates and exploits another using sexual feelings and behavior to hurt, misuse, degrade, humiliate, or control another. The abuse comes from a person who violates a position of trust, power, and protection of the child. In other words, sex is simply a tool with which to exert power, dominance, and influence—just as in rape and sexual harassment.

Overt sexual abuse involves direct touching, fondling, and intercourse with another person against that person’s will. Covert sexual abuse is subtle and indirect. It includes inappropriate behaviors such as sexual hugs, sexual stares, or inappropriate sexual comments, as well as verbal assaults and denigration, such as punishing a child for not being the “right type” of male or female and homophobic name-calling.

Covert cultural sexual abuse involves bullying through humiliation, offensive language, sexual jokes (of antigay nature), and obscenities. These attacks can be directed at the gay or lesbian person directly or indirectly. In other words, what I define as covert cultural sexual abuse is the expression of heterosexism, a belief in mainstream society that demands that all people be—or pretend to be—heterosexual. Heterosexism uses homophobia to exploit the sexual feelings and behaviors of those who are not heterosexual. In other words, heterosexism perpetrates and violates the trust that gay and lesbian children have in those in who are in positions of trust, power, and protection of them.

To be clear, I am not saying that gays and lesbians are sexually abused. Nor am I diminishing the profound negative effects of overt sexual abuse. What I am trying to help clinicians understand is that many of the deep-seated problems gays and lesbians have come from covert cultural sexual abuse.

Children (and adults) are bombarded by messages—from the church, from politicians, from their schools, from their peers and their family—that being gay is morally wrong, sinful, and forbidden; they internalize these message on some level. The shame and guilt become profound and part of their identity.

Restrictive Socialization Messages

All kids get some social limitations from their families, schools, and communities. Many of these messages are important; they teach children how to behave appropriately in order to be accepted. But the problem with restrictive messages like “don’t think,” “don’t act,” “don’t feel,” and “don’t touch” is that they limit children and cause their core selves to remain underground. If, for example, an innately playful child is taught to curtail her playfulness, she is being forced to deny that part of herself.

And so the false self begins. Gay and lesbian children learn to split off important parts of their core identities. This causes them to lose their sense of self early on. We therapists can help clients resurrect their “buried treasures,” as I call these lost parts of the self, to discover their authentic identity.

Disowning Aspects of the Self

Cutting off romantic and sexual urges becomes habitual for lesbians and gays. The individual’s sense of identity becomes fugitive, and she tends to misinterpret who she really is—not only in relation to sexuality but also in relation to her social sense of self in terms of how to act, feel, think, and experience body sensations. Straight children may disown parts of themselves that shape their identity, but gay children suppress much more of their identities.

When gay and lesbian children cut off and disown parts of themselves, they go underground. They still, however, repeatedly seek conscious expression, if only in excessive denial. But such an attempt at camouflage—being the exact opposite of what the individual hopes to hide—is often laughably recognizable.

Pretending That Nothing’s Wrong

Early on in life, almost everyone learns to present his best face to his peers and classmates—and, conversely, to minimize or deny anything that might subject him to judgments and ridicule. Many gay and lesbian children and teenagers hope that someone will see through their pretending to be straight. They long for someone to say, “I can see something is wrong; let me help you.” Unfortunately, this rarely, if ever, happens.  The “something” that is wrong is not their homosexuality but that they are pretending to be someone whom they are not.

Becoming a Master of Pretense

Just because a client comes out and seeks to integrate his sexual and romantic orientation doesn’t mean he’s vowed to embrace integrity in every other aspect of life. Becoming a master of pretense and living out of integrity is the consequence of suppressing homosexuality. Displaying a false self as a heterosexual to others—and oneself—becomes a way of life. This may explain why many gay men and lesbians don’t stop pretending and hiding even after they come out. Pretending has become a way of life, manifesting in other ways that need to be addressed. They often do not even realize they are continuing with this defense in relationships.

Therapeutic Tools For Psychosocial Information Gathering and Treatment Planning

As a clinician it is important to know the right questions to ask and terminology to use to obtain the best possible assessment and decide what direction to head in for treatment. As a straight clinician you need to watch for the negative transference of your clients, who, as you ask these questions, may feel you are coming from a pathological stance about homosexuality.

I would suggest that as you do the initial intake, you tell your clients that the questions you ask are those you ask in most every session about growing up in a minority status. Assure lesbian and gay clients that you do not believe in the pathogenic models of homosexuality. Reassure them that you want to obtain the best information to help them and that knowing about their gay and lesbian childhoods—even if they did not know they were gay or lesbian as children—is important to helping them understand the type of adult they have become.

You can tell clients that you do not want to create a victim mentality by asking these questions but that you do need to understand their experiences in order to be able to know who and what is accountable for their not having permission to explore their homosexuality. Explain that this is an important part of understanding their adult functioning as gay men and lesbians.

Following are some suggestions of what to ask your clients:

• When do you recall knowing that something about you was different from other children of the same gender—even if you did not call it gay or lesbian?
• When did you discover your gayness or lesbianism?
• Did you feel different from your peers—particularly those of the same gender?
• Did others—adults or peers—notice you were different and shame or bully you for it? If so, how?
• Were you consciously making decisions to hide or pretend to be like everyone else?
• Even if you don’t recall overt forms of abuse for being gay or lesbian as a child, what about the covert abuse, which includes the absence of permission to explore your homosexuality or the lack of role models? How do you feel about that?
• Do you think that not being acknowledged by yourself or others as a gay or lesbian child affects your adult life today in terms of self-esteem and relationships?
• Why do you think you did not tell anyone when you were young?

As a psychotherapist, your goal is to teach gay men and lesbians that they’re not responsible for any of the abuse they received as children and teenagers. Accountability rests on the guilty shoulders of those who did the abuse. Having strong and healthy therapeutic attachments helps gay men and lesbians recover the birthright of their sexuality and heal the effects of covert cultural sexual abuse.

Recently I asked some female residents I work with why they chose an all-female recovery program. They shared several reasons:

1. The single gender community provides the ability to focus better without men around;
2. The ability to feel safer to share certain issues (e.g., molestation, rape, sexual addiction) in a group because male residents are not present;
3. And lastly, the hope that the program would be more sensitive in understanding relationship issues.

I also polled a few local therapists asking what issues are unique to women as they enter therapy. Like my private practice clients, the therapists said women often come in with a presenting complaint of a relationship not working, for instance. Then with further exploration depression and/or anxiety is identified. I would add that I have also noticed many of the female clients I have worked with struggle with numerous health issues such as heart problems, seizure disorder, diabetes, migraines, and digestive difficulties.

So we have women who desire safety-in-connection with other women in order to share about their relational-experiences that are related to other relationships while concurrently experiencing emotional problems and health challenges.

Layered issues or all inter-related?

In 1991 I wrote my graduate paper on Anger & Self-Esteem in Chemically Dependent Women. I was curious about how these pieces fit together. The paper began with a broad literature review that showed the difference in socialization patterns between men and women particularly in the expression of anger. Moreover, it revealed a strong relationship between women who struggled with anxiety and depression and the various manifestations of health problems that often accompany these diagnoses. Alcohol and drugs were used (and still are) to numb/self-medicate both their emotional and physical pain.  My point in sharing this is that I discovered a “collection of papers” at the time, now a book titled Women’s Growth in Connection, regarding women’s development. This gave me a framework for understanding why and how “relationship” is vital to women in how we grow and move in the world.

A Relational Perspective

How might a women’s developmental theory be described? Self-in-relation. Per Surrey (1991) the relational line of development for women is that relationship and identity develop in synchrony. According to Miller (1991), in traditional developmental psychology (Mahler, Erickson, & Levinson) the emphasis is on separation with the goal being the formation of a separate identity. I envision a staircase, distinct steps, with a platform at the top.  Whereas, the “…hyphenated expression ‘self-in-relation’ implies an evolutionary process of development through relationship” (Surrey, 1991). In this model other aspects of self like creativity, autonomy, and assertion would develop within this primary context of relationship. Here, I envision a Ferris wheel, a multi-faceted structure made up of many connecting points. It holds, moves, and is continuous.

Women’s Treatment

As a clinician, being mindful of the “in-relation to” piece has been helpful.  I explore meanings of connections, identify the unspoken rule between two individuals, and review the relationship between the holding on to and the having physical ailments; or, the contrary of the letting go of and the receiving of. The age of women entering treatment for drug and alcohol abuse, and eating disorders, seems to be older now which brings up gender specific issues that can be explored in a larger context of progressive self development: PMS, hormonal changes and menopause, and empty nest syndrome to name of few. I believe all of us – the Doctor, Psychiatrist, Interventionist, MHT, Sponsor, Therapist, even the Marketer (lol, I was one) are the spaces-in-between for that woman on her journey to self-discovery.

Body-Oriented Coaching

The integration is evident to me. All relational experiences, all that makes up the self: mind, emotion, spirit – are all anchored in the body. The body is a great tool and a valuable resource. In my work with women (Experiential, Psychodrama) and from doing my own work (EMDR, Somatic experiencing, and Dance Movement Therapy) I have come to value the wisdom of the body. My body led me out of my head and into self-expression by means of movement. There is a synchrony, a rhythm that is present. It is part of each woman’s story, or should I say song, that can’t necessarily be shared with words. Focusing on the body and coaching women as they move away from alcohol and drugs is powerful. The coaching relationship provides a reciprocal context for the client to be empowered. It is a place where she can be creative, practice, and explore the possible. Some tools I use: Stay curious. Notice. Stay connected to my intuition. Talk less but ask more questions. As I apply these actions to myself, I teach her these skills. It is how I remain authentic and a gentle way to invite her into a new relationship with her body.

Reference:
Jordan, Kaplan, Miller, Stiver, Surrey (1991). Women’s Growth in Connection: Writings from the Stone Center. New York London: The Guildford Press.