Betrayed As Boys (Book Review)

Author:  Gartner, Richard B.
Publisher:  New York: Guilford Press, 1999
Reviewed By:  Steven Knoblauch, Winter 2002, pp. 44-46

Betrayed As Boys by Richard Gartner, is at once an important and disturbing book that should be read, not just by psychoanalysts, but any therapist working in the mental health disciplines today. It has been written for the therapist encountering patients with histories of sexual abuse, whether trained in psychoanalysis or not. I intentionally have not qualified those patients as male or female because, though the book is ostensibly about the treatment of male patients, many of the discussions could be useful to the treatment of females and additionally, the careful comparisons that Gartner offers between treating males and females are rare to find and very helpful. And what is more important, Gartner does not fall into the trap of the binary by drawing irreversible conclusions regarding similarities or differences between males and females. Rather, he offers a comprehensive review of clinical and empirical data that have been developed over years by many researchers and clinicians which suggest many factors that influence the differences between males and females as patients as well as how they are perceived as therapists. His conclusions regarding these differences generally offer the reader a range of considerations one might take into account in coming to clinical decisions while treating patients who have been “betrayed,” a term which Gartner favors over the more common general usage of the term, abused, though he means to signify the same experience that that term connotes in general.

One of the first and subsequently most pervasive themes that Gartner picks up in his discussion is the “denial of sexual betrayal.” As a telling example he offers a tale of being invited to an international conference to present a paper about the treatment of men who have been sexually abused. The sequence of events whereby, first, his paper which had been accepted for presentation, is left off of the program and later, when arriving at the conference he is placed on a panel at the last minute where the moderator proceeds to leave him little time to present, provides a striking example of the kind of, often unconscious yet embarrassing, denial and avoidance of the issue of sexual abuse which is often accomplished with more subtlety than in the example, but nevertheless, is still too common in the mental health professions. Throughout the book, Gartner refers to examples whereby patients he has seen in consultation and often subsequent treatment are met with varying degrees of avoidance and denial of their betrayal in responses from therapists they have either consulted and/or been in treatment with. His point is not to attack the mental health profession so much as to sound a wake up call and offer a large amount of information that can help a mental health professional to confront her own feelings and experiences regarding betrayal and confront the tendencies to avoid and/or deny, first, the occurrence of, and secondly, the severe sequelae resulting from sexual betrayal. While such a reaction is understandable and probably part of a sense of compassion for such human suffering, particularly, as it is experienced by a child, nevertheless, Gartner is clearly calling for those of us treating patients to work hard or harder in some cases, at being attentive to the signs of sexual betrayal as they emerge in the treatment process, and to develop a repertoire of understanding and skills for responding therapeutically to such clinical challenges.

For me, the most compelling chapters in the book were chapters nine and ten in which the author addresses the vicissitudes of therapeutic relationship with sexually abused men. Again, though writing for an audience larger than just the psychoanalytic community, in these chapters Gartner leads with his interpersonal psychoanalytic lens, which he explains earlier in the book, he will be bringing to bear upon many of the issues for its significant usefulness in helping the clinician to understand the relational dimensions of therapeutic treatment. Here, Gartner gets help from Sue Shapiro, another analyst with expert experience and understanding in this area, who co-authors chapter ten dealing with gender and the therapeutic relationship. There, as in the previous chapter, both authors explicate and give ample clinical illustration to the panoply of countertransference experiences which can contribute to and complicate treatment impasses and enactments. The clinical illustrations are particularly useful as they offer examples of how these gifted clinicians have been able to use countertransference experience in the form of fantasy, feelings, and or intellectual formulations to effectively catalyze awareness in both analyst and patient of such impasses and enactments. Furthermore, in the examples given, the reader is able to see how such use of countertransference experience can help the therapeutic dyad to move through difficult moments and sequences with an awareness that can expand a sense of self-agency and responsiveness from another. Sense of self-agency and the ability to sense a safe and supportive responsiveness from the other become central catalytic foci in so many of the clinical examples offered. And yet, at the same time, the authors frankly discuss and illustrate how difficult it is to achieve such mutative moments and give many examples of how even the best technical responses (at least from an outsider’s perspective) only fuel a powerful transferential pattern of repeating roles and patterns of abuser and abused. And, furthermore, for those who have not learned about this tricky aspect of such treatments (Gartner aptly credits Davies and Frawley (1994) for helping to bring this aspect of treatment into focus for the psychoanalytic community), Gartner’s descriptions are significantly valuable.

Clearly, offering an understanding of the uniqueness of the male patient who has been betrayed is a key objective of the book. Chapters five and six are in many ways the most disturbing and difficult to get through because they provide such detailed and clinically compelling descriptions of the kinds of familial and interpersonal contexts in which sexual betrayal occurs. And most disturbing are Gartner’s descriptions of how these contexts can influence a boy’s responses to sexual abuse. I have to admit that even with the experience I have had in treating patients who report childhood sexual betrayal (or maybe because of it), I found myself in sometimes conscious, and sometimes, unconscious avoidance of reading these chapters as I prepared to write this review. Nevertheless, the range of patients that Gartner’s experience allows him to draw from in painting the scenarios within which sexual betrayal can emerge, are formidable and of invaluable use to any clinician wishing to increase her understanding and grasp of such sequelae, short of the actual experience of conducting such a treatment and hearing these kinds of narratives first hand. Again, Gartner is careful to provide the reader with ample detail from the range of specific cases he has treated and at the same time, point out that while generalizations might be deduced from these illustrations, the uniqueness of the array of contextual factors that shape each particular case are quite idiosyncratic to each treatment, and future patients presenting might offer similar but also quite different narratives.

Chapters five and six are preceded by three chapters within which Gartner offers a range of empirically and clinically based observations for “how boys are likely to encode premature sexual situations with women as well as with men, and how these processes interact with internalized ideas about masculinity and homosexuality” (Gartner, 1999, p. 8). These opening descriptions lay the groundwork for the following sections of the book to which I have alluded earlier. They also hang in the background of the subsequent chapters as the ground against which the kinds of confusion and ambivalence that characterizes the internal world of so many men betrayed sexually, ultimately brings them to treatment. In particular, issues of masculinity and homosexuality are often sources of confusion for many males because of the tension between normative narratives, social expectations and personal experience. Gartner gives numerous examples of how such confusion and ambivalence lead to a spiral of toxic self-doubt and self-denigration when colored by early childhood sexual betrayal. Further, he shows how such confusion and ambivalence pervades the internal worlds of patients in treatment, another collection of insightful gems for the clinician desiring to better understand this process, and particularly how this kind of affective patterning might emerge within the relational matrix of treatment.

Additionally, in chapter eight these themes are revisited with particular emphasis on how they contribute to the very knotty issues in treatment of boundary violations and dissociation. Building on the contributions of such analysts as Bromberg (1998), Gabbard (1989), and Price (1994), Gartner offers the clinician/reader a complex but clear and useful understanding of the etiologies and twisting paths of boundary violations and dissociative experience as these serve both protective and destructive purposes, first in the psychic survival of the victim of betrayal, and later in the unfolding process of treatment in which both therapist and patient struggle with the confusion and ambivalent feelings that such patterns suggest about internal experience and meanings for emotional growth or constrictedness.

In effect, this review only skims the surface of what is to be harvested for any reader desiring to know more about these issues and how to harness such knowledge and skill in the treatment process. As such, I am suggesting, here, that one of the best antidotes to begin to offset the kinds of feelings of denial and avoidance which are discussed in the beginning of the book, is to buy the book and read it carefully and slowly, allowing oneself to be moved to the powerful emotional responses that taking on such treatment challenges inevitably entails, in both private reflection and the terrifying enactments of dyadic interaction, avoidance of which only can mute the voices that need to heard if treatment is to be helpful.

With this book, Gartner establishes himself as one of the loudest, most needed and informed voices within our psychoanalytic community helping us all to learn more about, and develop the personal sensitivity and professional knowledge and skill, to be helpful to male patients betrayed as boys who are more and more approaching our consulting rooms with the hope of getting competent professional help. I thank Dr. Gartner for this, clearly, painstaking and monumental contribution.

References

Bromberg, P. M. (1998), Standing in the spaces: Essays on clinical process, trauma and dissociation. Gabbard, G. O. (Ed.), (1989), Sexual exploitation in professional relationships. Washington, DC: American Psychiatric Press.
Davies, J. M. and Frawley, M. G. (1994), Treating the adult survivor of childhood sexual abuse: A psychoanalytic perspective. New York: Basic Books.
Price, M. (1994), Incest: Transference and countertransference implications. Journal of the American Academy of Psychoanalysis. 22, 211-229.

Reviewer Note

Steven H. Knoblauch is faculty and supervising analyst at the Institute for the Psychoanalytic Study of Subjectivity, the Institute for Contemporary Psychotherapy and the Psychoanlytic Psychotherapy Study Center in New York and author of The Musical Edge of Therapeutic Dialogue, published by Analytic Press.

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