Because it is essential that these men feel safe, the therapists have chosen not to permit perpetrators into the group. In addition, each member signs a group contract which requires at least ten weeks participation, explains the rules of confidentiality, and states that although the group members can support one another there will be no dating or sexual contacts between them. The contract also includes a commitment from group members to put feelings into works, and to actively work on the issues that have brought them to therapy. There are basically three stages through which a group progresses: an early, a middle and a late phase. In the early phase, establishing safety and trust are the two most crucial tasks for the co-therapists. This can include education about healthy and abusive families, and the initial sharing by the group members of their history. The second phase, the longest in duration, usually includes more of a therapeutic re-enactment of the dynamics of the family of origin. The co-therapists' tasks here include providing containment and interpretation. The third phase of the group is where group members, after experiencing the modeling and holding environment they need from the therapists, begin to feel more empowered to work with each other, with less overt intervention by the clinicians.
The group is composed of five to six men: gay, bi-sexual and straight. We find that the meeting of this population from all areas of sexual orientation is the most restorative in each and every one's sense of their commonalties as men. This permits respectful exploration of the issues regarding sexual behaviors and sexual preference. Because these men were abused by a male or a female or both, the presence of a male and female co-therapist invites the rich and varied opportunities for transference. In any given situation, group members may experience the therapists or other group members as someone from the past: perpetrator, idealized rescuer, loving attachment figure, non-involved parent, sexual object, or sibling. The group provides a context like a family where the members can work through the disappointment, rage and grief about what has happened to them. It also provides an environment to mourn the losses of the past and to "reality test" the experiences of the present.
Sexual abuse is traumatic. It has been said that survivors of long term sexual abuse do not have either personality disorders or psychosis; they have chronic trauma disorder. These particularities present a dual consideration of a PTSD and borderline profile. Men with a history of long term abuse present a challenge in the group process both because of their fragile ego structures and their propensity to defensively lash out. Because they have been both abused and rewarded inconsistently, they can set double standards between what they expect of themselves and others. They may reenact doublebinds with one another characteristic of a pathological family. Splitting and projections, primitive idealizations and devaluations, omnipotence and diminishment, are all adaptive defenses to long term traumatic survival, and will often be acted out in group. This replicates the borderline process with members attempting to divide the group or collude with one another, making passive aggressive comments, or withdrawing.