kritisk etnografi – Swedish Journal of Anthropology

VOL. 3, NO. 2
URN:NBN:SE:UU:DIVA-432445

Developing Gender and Culture Sensitive

Conversations with Sexually Abused Men by
Blending Ethnography and Psychotherapy
Charlotte C. Petersson | Senior Lecturer in Social Work, Malmö University

ABSTRACT Child sexual abuse can have long-term impact on the survivors’ emotional, physical,
and psychological wellbeing. Male survivors of sexual abuse are less likely to disclose and report
their experience compared to females because of aspects related to male gender socialisation.
Feelings of shame, guilt or confusion about sexual or masculine identity silence sexually abused
men. They report difficulties in both seeking and receiving formal support services tailored to
their specific needs. This article presents collaborative work performed by an anthropologist
and a psychotherapist during therapy of adult men with a history of sexual abuse. By using
certain tools of ethnography in narrative therapy, we developed culture- and gender-sensitive
conversations with sexually abused male clients from diverse backgrounds. A case study is
provided to demonstrate how we worked with the various stages and practices of ethnography
and narrative therapy, focusing on how sexually abused men were invited to unpack the discourses
of masculinity that influenced their ways of understanding themselves and their traumatic past.
The article offers an example of how anthropological knowledge and methods can be applied in
contexts of clinical social work and demonstrates the way that postmodernist and constructive
therapies combined with the tools of ethnography can generate constructive conversations about
gender for sexually abused men.
Key words: child sexual abuse, masculinities, psychotherapy, narrative therapy, ethnography,
applied anthropology

Introduction
Anthropology and psychotherapy have a long historical and, sometimes, controversial
relationship. Readers may be familiar with Malinowski’s (1927) examination of the
psychoanalytical model based on data from the Trobriand Islands, which caused him to
argue that the Oedipal complex was not universal. The critical stance of anthropology is still
challenging to the field of psychotherapy, which adheres to medical science. Anthropologists
have critiqued psychotherapy’s exclusive focus on the inner world of bounded individuals
because it excludes social and cultural aspects of illness (Kleinman 1988; Martin 2019).
When reviewing the clinical and research literature on the psychological consequences
of sexual assault, we can see how the body is depicted as a biological fact, reacting to a
certain stimulus in the environment. In general, therapy with individuals who have
experienced physical or sexual violence focuses on identifying and treating the effects of
such experiences rather than addressing how individuals respond to violence (Wade 1997).
Cultural constructions of gender affect the way men understand, process, articulate and

Contact: Charlotte Petersson charlotte.c.petersson@mau.se

© 2020 Swedish Society for Anthropology and Geography
22 CHARLOTTE PETERSSON | DEVELOPING GENDER AND CULTURE SENSITIVE CONVERSATIONS WITH SEXUALLY ABUSED MEN BY
BLENDING ETHNOGRAPHY AND PSYCHOTHERAPY

respond to experience of sexual abuse (Kia-Keating et al. 2005). Studies within the field of
psychotherapy have identified a need to adopt a gender and culture sensitive approach in
practice. Understanding how boys and men from diverse backgrounds experience masculinity
and supporting them in reflecting on the multiple and shifting masculine norms that shape
and constrain them have been addressed as particularly important in order to engage men in
psychological treatment more effectively (Pederson and Vogel 2007). Cultural competency
has become a popular term within psychotherapy but deconstructing concepts like gender
and culture in the therapeutic encounter is still uncommon (Davies 2019).
Anthropologists have stressed the importance of crossing disciplinary boundaries
in order to carry out applied anthropology and expand the field and its knowledge base
(Hastrup 2017; Podjed et al. 2016). As an anthropologist, I have spent the last 15 years of my
professional life working with sexual health and violence by combining the fields of medical
anthropology and social work. I have moved between conducting anthropological research
within academia and realising social work in the community by supporting abused women,
children and men in shelters and consulting rooms. However, it was not until 2019 that
my knowledge and skills as an anthropologist were purposefully applied in a clinical setting
when I had the opportunity to conduct collaborative work with a group of psychotherapists.
I first met the psychotherapists at a conference where I presented the findings of my research
concerning sexual violence against males (Petersson and Plantin 2019). My presentation
outlined how notions of masculinity may facilitate or impede the process of recovery for
male survivors of sexual abuse and invited psychotherapists to discuss the ways in which
they can address masculinity as part of their services to help boys and men recognise that
such ideas can interface with their experience of sexual abuse. Narrative therapy (White
and Epston 1990), which critically examines wider social discourses and encourages clients
to reauthor their life stories, was mentioned at the conference as an alternative therapeutic
approach for male survivors of sexual abuse (O’Leary 1998). The psychotherapists contacted
me a few months after the conference and asked if I could provide them with consultative
support in their process of developing gender and culture sensitive practices in their work
with sexually abused boys and men from diverse backgrounds.
This article draws on my experience as an anthropologist and the collaborative work I
performed with a psychotherapist during therapy of adult men with a history of sexual abuse
in childhood or adolescence. The purpose of our collaboration was to cultivate practices that
support sexually abused men in reframing their life stories by embracing and reinforcing
the use of certain aspects of ethnography within narrative therapy. The article provides a
window on the process by which the two disciplines join, blending the methodological tools
of ethnography and psychotherapy in order to develop a more culture- and gender-sensitive
therapeutic approach to sexually abused males. It offers an example of how anthropological
knowledge, perspectives and methods can be applied in contexts of clinical social work.

Male Child Sexual Abuse and Masculinity

Research on child sexual abuse (CSA) has grown significantly during the last decades,
including in particular the victimisation of females. Male CSA has received less attention
and is less common, but awareness is growing. CSA is known to have adverse, long-lasting
health outcomes for both genders (Cutajar et al. 2010; Easton et al. 2011). Research that
 KRITISK ETNOGRAFI – SWEDISH JOURNAL OF ANTHROPOLOGY 23

studies the long-term impact of CSA on males shows increased risk for adverse mental
health outcomes, including anxiety, depression, post-traumatic stress disorder (PTSD),
hostility, loneliness, isolation, and alcohol and substance abuse (Alaggia and Millington
2008; Boroughs et al. 2015; Easton and Kong 2017). Sexually abused males also report
struggling with sexual dysfunction, sexual risk behaviours (Mattera et al. 2018) and troubled
thoughts about fatherhood (Price-Robertson 2012). In Sweden, studies seeking to establish
prevalence rates and health outcomes show that male CSA is widespread and significantly
affects the men’s wellbeing (NCK 2014; Swahnberg et al. 2012).
Much research on male CSA has emphasised the impact of dominant masculine
constructions (e.g., Alaggia and Millington 2008; Easton and Kong 2017; O’Leary 1998).
Male sexual abuse stands in contrast to conventional masculine attributes such as being
dominant, physically strong, able to defend oneself, emotionally in control, sexually
assertive and heterosexual. Such norms can make sexually abused boys/men feel that they
did something to trigger the assault or did not do enough to ward it off. They often report
confusion regarding their sexual identity and worry about being labelled as homosexual (if
the perpetrator was a man) or weak (if the perpetrator was a woman) (Corbett 2016). In
some cases, the experience of CSA undermines the men’s own sense of power and control,
which may result in accentuated masculine attributions, including the display of aggression,
violence, hyperactivity, hypersexuality and overcontrolling behaviour (Lisak 1994). Strong
feelings of shame and self-blame hinder men from disclosing their history of CSA. Males
are much less likely to report their experience of sexual abuse and seek psychotherapeutic
help than female victims (O’Leary and Barber 2008.). Those men who turn to professional
support services face a number of obstacles. Many rape crisis centres refuse services to
sexually abused men and some offer counselling that is insensitive to the assaulted men’s
specific needs (Corbett 2016).
Masculinities are not fixed but involve practices that can be remade (Connell 1995). In
Sweden, a context that has been strongly anchored in unique gender equality policies aimed
at producing equal conditions for men and women both at work and in family life, men
relate to transforming masculinities (Plantin 2015). The term “emergent masculinities” has
been applied within the field of medical anthropology to capture new forms of embodied
masculinities that emerge in relation to processes of social change (Inhorn and Wentzell
2011: 802). Men act out masculinities differently and respond differently to major events
in their personal lives, including bodily changes such as aging, illness, traumatic experiences
and medical treatment. Research shows how men with experience of CSA can move away
from an identity formed by the trauma (Andersen 2008; O’Leary 1998). To understand,
accept and recover from the abuse, men may renegotiate their masculine identity by
adopting multiple and alternative forms of masculinities (Kia-Keating et al. 2005; Petersson
and Plantin 2019). Research suggests that this group of men can be supported by therapy
that helps them to deconstruct the gender system that affects their ways of understanding
sexual abuse. In fact, research on the overrepresentation of male survivors of CSA in mental
health populations found that those men who were able to reinterpret and reframe their
experience of abuse were also associated with more positive health outcomes (O’Leary
and Gould 2010).
24 CHARLOTTE PETERSSON | DEVELOPING GENDER AND CULTURE SENSITIVE CONVERSATIONS WITH SEXUALLY ABUSED MEN BY
BLENDING ETHNOGRAPHY AND PSYCHOTHERAPY

Integrating Gender and Culture in Psychotherapy

As noted in the introduction, anthropologists have a long interest in the intersection of
culture and psychology. Well-known anthropological literature draws on a combination of
ethnography and psychotherapy (Crapanzano 1980) and psychoanalytical perspectives have
been applied to analyse ethnographic data (Schwartz et al. 1992). Psychotherapists have in
general been more reserved when it comes to adopting anthropological knowledge. Notions
of power, gender and cultural difference did not enter psychotherapy until the end of the
1980s. At that time, anthropologists like Kleinman (1988: 131) argued that a therapeutic
explanatory system must provide a “symbolic bridge” between people’s experiences and the
socio-cultural context. Since then, mental distress has gradually been associated with gender
and cultural expectations, including the social position and power of the individual. Feminist
therapy has critiqued stereotypical gender ideas and sexist assumptions within traditional
forms of therapy and demonstrated how gender biases are reproduced in therapeutic
relationships (Seem and Clark 2006). To engage men more effectively in psychological
treatment, addressing their experiences of masculinity and how this may be related to
their presented problems has become increasingly important within psychotherapy (Addis
and Mahalik 2003; Berger et al. 2013). Nowadays, cultural competency, which includes
masculinity, is an important skill in psychotherapy and clinical competencies have been
developed for psychotherapists working with men (Liu 2005). The American Psychological
Association (APA) established practice guidelines to enhance gender- and culture-sensitive
psychological practice with boys and men from diverse backgrounds (APA 2018). According
to the guidelines, these practices are applicable to any psychotherapeutic approach
across various professions, such as nursing, social work, counselling, school counselling
and psychiatry.
Within medical anthropology, the cultural competency model has been questioned
because it assumes that culture resides inside of practitioners and clients (Kleinman and
Benson 2006). Culture, in the mind of psychotherapists, refers to the identity of individuals
or to a certain ethnicity (Martin 2019). Thus, culture and gender may easily be represented
in stereotypic terms and clients are assumed to have culturally-rooted responses and reactions
that may clash with those of others. Often psychotherapy frames cultural competency as
the counsellors’ capacity to negotiate the cultural differences that exist between counsellor
and client (Martin 2019). Models that place emphasis on concepts such as “structural
vulnerability” (Quesada et al. 2011) and “structural competency” (Hansen et al. 2018)
have been employed in clinical settings to overcome problems of the cultural approach,
reduce inequalities and enhance health outcomes. Kleinman and Benson (2006), however,
suggest that clinicians should be trained in ethnography rather than cultural competency.
Ethnography is useful for investigating the relationship between individuals and sociocultural
contexts because it places emphasis on what people do, their engagement with others and
their lived experience of illness. From an ethnographic perspective, culture is a process that
cannot be separated from political, economic, religious, psychological and physiological
circumstances. Cultural processes may differ not only between members of different social
groups but also between individuals within the same social group. Variables such as age,
gender, class, ethnicity, religion, disability and sexuality affect experience. Ethnographic
techniques can help psychotherapists to understand illness and distress the way that their
clients understand, feel and respond to it (Kleinman and Benson 2006).
 KRITISK ETNOGRAFI – SWEDISH JOURNAL OF ANTHROPOLOGY 25

Ethnography and Narrative Therapy

While the work of an ethnographer and a psychotherapist are different in many aspects,
certain similarities exist. Anthropology and psychotherapy (in particular psychoanalysis)
are both involved in studying lives over time while trying to remain as close as possible to
people’s experiences. By relying on participant observation, listening and interpretation,
both try to understand the significance of meaning. The similarities between ethnography
and psychotherapy open opportunities for anthropologists and psychotherapists to learn
from each other. In the collaborative work upon which this article is based, I supported the
psychotherapists in adopting certain ethnographic techniques that narrative therapy draws
upon. Before identifying these techniques, a brief summary of narrative therapy is needed.
Narrative therapy, with its origin in family therapy, was developed by social workers
Michael White and David Epston (White and Epston 1990). This approach is influenced
by anthropologists like Bateson (1972), Geertz (1973), Turner (1969), Bruner (1986) and
Myerhoff (1986). Rooted in postmodern philosophy and social constructionism, narrative
therapy takes specifically into account Foucault’s (1973) ideas concerning discourse and
power and is based on the idea that dominant discourses in a given context shape individual
constructions of identity and truth claims. Traditional therapies, situated within positivism
or liberal humanism, depict problems such as depression, anxiety or abuse, as individual
pathologies associated with specific biological or characterological circumstances. In contrast,
White and Epson (1990) argue that people live storied lives and that stories constitute us.
The counsellor should therefore pay attention to the stories that people create to make
sense of their world (White 2007). Narratives both describe and shape people’s lives and
reflect the meanings that they make of their lived experience. The way that clients tell their
narratives is connected to their identity. Narrative therapists are particularly interested in
the way that discourses surrounding gender, culture, ethnicity, class and sexuality shape and
influence people’s understanding of themselves and their lives. When a dominant narrative
does not sufficiently represent lived experience, the individual may suffer from problematic
behaviour or distress (Brown and Augusta-Scott 2007; White 2007). Narrative therapists
consider problems as separate from the individual, and the role of the therapist is to assess the
problem rather than the person’s biology or disorder – a process that is called externalisation.
The therapist must distinguish between the effects of what the clients find to be problematic
and their preferred ways of being and acting in their world (White and Epston 1990).
To develop gender- and culture-sensitive conversations with sexually abused men in our
collaboration, we focused on three aspects of ethnography. The first concerns ethnographic
enquiry. The way that narrative therapists ask questions of their clients is similar to
ethnography. White and Epston (1990) were influenced by Geertz, who emphasised the
importance of approaching culture from the native’s point of view. Like ethnographers,
narrative therapists take the stance of a curious interviewer. We adopted person-centered
interviews, which combine both informant and respondent techniques of interviewing (Levy
and Hollan 2000). By moving back and forth between questions that focus on the client’s
understanding of the external context, and questions that require intimate and personal
responses, the interactions, conflicts, coherence and transformations between the private
and the sociocultural context can be unpacked. In narrative therapy, a sexually abused
male client may present internalised descriptions of himself as personal problems, but in
therapeutic conversations these personal problems can be related to dominant constructions
26 CHARLOTTE PETERSSON | DEVELOPING GENDER AND CULTURE SENSITIVE CONVERSATIONS WITH SEXUALLY ABUSED MEN BY
BLENDING ETHNOGRAPHY AND PSYCHOTHERAPY

of masculinity (O’Leary 1998). Meanings that are made of male sexual abuse are influenced
by cultural understandings of gender and power. By externalising hegemonic discourses on
masculinity and discussing the way they may shape, influence, constrain and disempower
men’s lives, the client reaches an understanding of how these discourses work and becomes
able to question them.
The job of a narrative therapist is to help the client reach new and more useful
understandings of his place in social contexts and relationships. This leads us to the second
area of emphasis that our collaborative work developed upon, namely the role of collectives
for social change or change in relationships. According to narrative therapy, identities
are formed in relationships with others. Such relationship thinking is well established in
anthropology and Bateson’s work on cybernetics is developed from this tradition. During
narrative therapy, the client is invited to reflect on or step into alternative ways of thinking
or being and develop preferred stories of the self (White 2007). An outsider witness may
be invited to the therapy sessions, whose participation, feedback and personal responses to
the conversations in the therapy room will expand and enrich the client’s story by giving
it multiple meanings (White 2007). This outsider witness can be another therapist or
professional, people with inside knowledge, family members or friends of the client. This
technique is inspired by the work of Myerhoff (1986), who saw similar ceremonies arranged
in an isolated Jewish community in Venice, California, in order to deal with experiences
of invisibility and marginality. In narrative therapy, this technique helps clients to present
themselves in preferred ways and to regain strength, agency, power and voice.
The third aspect of ethnography in our collaborative work concerned positionality in
the therapeutic alliance. In traditional models of psychotherapy, such as psychoanalysis, the
therapist tends to take the role of an expert. Psychoanalytical tools involve close observation
of the relationship that develops between the psychoanalyst and the client, resulting in
a power imbalance between them. In classical ethnography, little attention was paid to
the researcher’s position vis-à-vis the people s/he studied, but in the 1990s the field of
autoethnography began to develop (Reed-Danahay 1997; Tedlock 1991). Autoethnography
problematises ethnographic knowledge by discussing dichotomies such as insider/outsider,
familiar/unfamiliar and objective observer/subjective participant; it represents a reflexive and
collaborative approach in which both ethnographer and interlocutor are seen as embodied
subjects whose relationship needs to be explored.
Our collaborative work was informed by these insights. Whereas some therapists have
tried to resolve issues of power imbalance by adopting a neutral and not-knowing position
and letting the client be the expert in the therapeutic encounter (see Brown and Augusta-
Scott 2007), adopting a neutral stance with clients who are dealing with experiences of
sexual abuse may have serious consequences. We chose instead to acknowledge and be clear
about our position and work from the premise that therapist and client are both embodied
subjects with knowledge, agency, and power (ibid.). The clients were aware of the expertise
of both the therapist and the anthropologist regarding sexual abuse. As professionals, we
were going to help clients to deconstruct and re-author oppressive stories, including the
relations of power that constitute them (White and Epston 1990).
In Sweden, the adoption of narrative therapy in practice is limited and mainly situated
with family therapy. Yet extensive research supports the use of narrative therapy, which
has been employed with good results on clients who suffer from depression (Vromans
 KRITISK ETNOGRAFI – SWEDISH JOURNAL OF ANTHROPOLOGY 27

and Schweitzer 2011), eating disorders (Weber et al. 2006), schizophrenia (White 1987)
and who have experienced physical or sexual violence (Brown and Augusta-Scott 2007;
Lee 2017; O’Leary 1998). A growing interest in narrative therapy is found among
psychotherapists who work in marginalised and indigenous communities where people have
been traumatised by war, genocide and violence (e.g., Denborough et al. 2008; Kangaslampi
et al. 2015; Mitchell 2006). However, using the narrative approach in acute situations and
when the client’s safety is threatened has been questioned. According to Miller (2012), the
narrative approach to therapy should be introduced first when the immediate crisis has
passed. White and Epston (1990) argue that experiences such as violence and abuse should
never be externalised in narrative therapy. It is the attitudes and beliefs that underpin the
violence that should be externalised, including the strategies that maintain the abuse, such
as the secrecy and isolation.

The Anthropological Assignment and Clinical Setting

The collaborative work presented here occurred during four months of clinical participation
in 2019. The professionals at the clinic were all female psychologists or social workers with
additional training in cognitive, psychodynamic and family therapies. The clinic, which is
a small private psychotherapy practice, specialises in treating emotional and psychological
trauma, including experiences of violence and sexual assault. It provides individual, couples
and group therapy and arranges self-help recovery groups. The clients are of different ages
and have various social and cultural backgrounds. Sexually abused male clients typically
arrive for treatment of difficulties such as anxiety, hyperactivity, hypersexuality, hostility,
identity crisis, sexual dysfunctions, PTSD and self-harming behaviour. The male clients’ first
visit to the clinic generally takes place several years after the sexual abuse was experienced.
The majority of male clients are of Swedish origin, but clients with culturally diverse
backgrounds have increased slightly over the years, which was one reason why the clinicians
sought an anthropologist to support them.
By cultivating narrative practices and placing emphasis on ethnography, the
psychotherapists at the clinic wanted to develop a gender- and culture-sensitive approach to
counselling. Inspired by family therapy training techniques, which include working in a team
that observes the therapy sessions by being present in the therapy room or via a telephone or
video link, my role was to assist, observe and supervise the psychotherapist during our work.
By discussing with me each counselling session after it had finished, the psychotherapist
would receive methodological support and feedback. Because of the traumatic and sensitive
character of the clients’ experiences, we decided that I should be present in the therapy room
rather than via a screen. The psychotherapist had the main responsibility for the conversations
held during therapy. I was expected to assist the therapist in ethnographic enquiry, clients’
engagement with others, and shared reflections on positionality. In fact, developing self-
awareness of the knowledge, biases, norms and values that we would bring with us into the
therapy room as two female middle-aged professionals started before the therapy sessions.
We shared the stance that adverse mental health outcomes of sexually abused men may
be linked to specific masculine perceptions and attitudes. Further, we did not prescribe a
specific male role for the clients to adopt. Men “do gender” by combining various forms of
masculinity, both conventional norms and new cultural influences that, for example, place
emphasis on emotional expressiveness, caring, love, reciprocity and gender equality.
28 CHARLOTTE PETERSSON | DEVELOPING GENDER AND CULTURE SENSITIVE CONVERSATIONS WITH SEXUALLY ABUSED MEN BY
BLENDING ETHNOGRAPHY AND PSYCHOTHERAPY

The psychotherapist identified clients for whom the adoption of a narrative approach would
be suitable. The clients were informed about the purpose of our collaborative work and then
asked if they wanted to participate. Client anonymity and confidentiality were promised.
The clients who approved were asked how they felt about sharing their sensitive and painful
experiences with two female professionals. All stated that they preferred working with female
therapists as they felt more comfortable in talking about issues of sexual abuse with women.
In the following pages, I present a case study to demonstrate how we worked with
the various stages and practices of narrative therapy and ethnography, focusing on how the
psychotherapist and I invited sexually abused men to unpack the discourses of masculinity
that influenced their ways of understanding themselves and their traumatic past. The case
illustrates our work with a specific client, who is called Omed here. Omed is an 18-year-
old man from Afghanistan, who migrated to Sweden in 2014 as an undocumented and
unaccompanied minor. As an orphan, Omed had spent many years of his childhood at a
military base in Afghanistan where he had been exposed to significant forms of trauma,
including both physical and sexual violence. Omed had attended therapy previously at
other clinics. Language barriers made therapy difficult initially but Omed’s wellbeing had
improved during his first years in Sweden. When Omed started high school, he began to
experience increasing difficulties with social anxiety, isolation and substance abuse. At the
time of the narrative therapy, Omed, fluent in Swedish, explained that he was looking for an
alternative therapeutic approach. He attended seven narrative therapy sessions, which varied
in length between 60-75 minutes.
The following description highlights some of the events of Omed’s life while others
have been removed or changed to preserve his anonymity. As a result, some material is lost.
Details about Omed’s experience of sexual violence have been excluded as the publication
of intimate and sensitive information may have consequences that are difficult to foresee.
Omed read the case illustration before publication to ensure that he could not be identified
and gave permission to publish the case study.

Case Study
During the first session, the therapist and I encouraged Omed to tell us about his cultural
background and life circumstances. Omed disclosed that he had been kidnapped as a
young boy and was raped and sold to a warlord. For several years he had to dress up in
women’s clothing and dance in front of groups of men who abused him sexually afterwards,
a phenomenon that is called bacha bazi in Afghanistan. After being hospitalised for
severe physical injuries, he managed to flee from Afghanistan in 2013. Together with a
few other boys, he made his way to Sweden by selling sex. In Sweden, he suffered from
PTSD, insomnia, anxiety and had difficulties with establishing bonds of trust and close
attachments. Despite this, he was doing well in school and had made new friends, mainly
other Afghan boys. Omed revealed that he had not disclosed his experience of CSA to any
of his friends because of feelings of shame. He told us that he was extremely worried that his
close friends or people at school would find out about his history of CSA and prostitution,
and label him as gay. Omed explained that it was important for him to have Afghan friends
in Sweden, mentioning aspects such as language, food, traditions and a sense of belonging to
a community. Despite this, Omed recounted that he could not be himself among his Afghan
 KRITISK ETNOGRAFI – SWEDISH JOURNAL OF ANTHROPOLOGY 29

friends in a cultural sense. He described that he found most of them to be tough, insensitive,
sexist and shallow – attributes that he felt that he had to adopt in order to gain respect. By
contrast, Omed described himself as a highly sensitive and emotional person.
The psychotherapist started Omed’s second session by asking him what he regarded
to be the core of his problem today and how he would define or label that problem.
Omed said that “weakness” was his problem. He explained that if he could be tougher
and not so emotional and sensitive, he would have less problems. Using an externalising
conversation, the therapist asked Omed how this notion of being weak was influencing
his everyday life. Omed disclosed that he was always feeling weak, anxious, fearful and
unmanly. Omed was concerned that perhaps the experience of CSA had made him gay
because he had continued having sex with men even after he had managed to flee from the
military base. I asked Omed about how notions of being weak affected his relationship with
family and friends in Sweden. Omed revealed that he had tried to be tougher, extroverted
and more powerful and charismatic, like his friends, but this felt wrong. While being tough
and strong made him behave in a socially approved manner, he found it difficult to identify
with such attributes. Instead, his problems with anxiety increased and he began to avoid
social interaction. This deprived him of interpersonal attachments and disconnected him
from his cultural background. Even if he had many friends, he explained that he felt lonely,
isolated and unwell.
During the following therapy session, we started to link Omed’s ideas of being weak
to past contexts. I asked curious and person-centred questions, such as how it could be that
Omed viewed himself as weak and from where he thought that such notions came. Omed
disclosed how he, in the absence of women in Afghan war camps, had been forced to do
female duties, both domestic chores and sexual activities. Our curious questions made it easy
for him to explain gender roles in Afghanistan from his point of view. He said that being a
young boy meant that gender roles, sometimes and by certain men, could be stretched. As a
child without the protection of parents or other relatives, he was transformed into a woman.
Omed said he lived in constant fear in Afghanistan. Like other boys in the same situation, he
used drugs to cope with the abuse and the fear. Omed told us that his feelings of being weak
had actually increased in Sweden. He explained that while male aggression and violence
were normalised in Afghanistan, professionals at the migration agency, health units and
social services in Sweden were shocked by his life story and tended to pity him. Professionals
treated him like a damaged and fragile person. Omed said, “It makes me feel small, like a
child, as if I never grew up”. Omed told us that he would like to be a father someday and
have a family of his own. At the same time, he worried about being too weak and sensitive.
Perhaps he would not be able to protect and support his children in a good way.
I asked Omed if he could think of any situation where he had not felt weak in Sweden.
Omed mentioned his recent work as an intern at a school. With pride, he explained how
he had prevented fights from breaking out when groups of boys had ended up in disputes
with one another. The children respected him for his calm and diplomatic skills. Perhaps he
would be a good teacher someday. As Omed continued telling us narratives about situations
where he did not feel weak, hidden accounts of courage and resistance came to surface. He
realised that his feelings of weakness were not a consequence of deficiency within himself.
He began to separate himself from what he found to be problematic. This allowed him to
take a position against the effects of CSA.
30 CHARLOTTE PETERSSON | DEVELOPING GENDER AND CULTURE SENSITIVE CONVERSATIONS WITH SEXUALLY ABUSED MEN BY
BLENDING ETHNOGRAPHY AND PSYCHOTHERAPY

During our fourth and fifth sessions, the conversations thickened, and we began to
unmask the many expectations that men are up against in various contexts. Omed revealed
that he, in Sweden, often felt pressured to have updated knowledge about technology, cars,
sex and sports, which were topics that he did not have any real interests in. In fact, Omed
felt sickened by what he described as an exaggerated interest in sex among his friends. He
said that such conversations made him feel disconnected from what he believes in and finds
important, such as respect, security, interdependence and empathy. The psychotherapist
and I introduced discussions on different forms of manhood and the idea that masculinities
are socially and historically constructed. I gave several examples of this, including how
notions of fatherhood have changed in Sweden over time. Omed could easily relate to the
cultural differences of fatherhood in Sweden and Afghanistan and told us his perspectives
on differences and similarities. He could reflect that he had certain ideas of gender based
on experience from past contexts and that he had encountered a different gender order and
gender practices in Sweden. Omed gradually realised that he had practiced certain forms of
masculinity and that these norms and practices were incongruent with his lived experience
of sexual abuse. Male sexual abuse contradicts many of the expectations about men’s ways of
being and acting. Victimisation resulted in feelings such as shame, self-blame, powerlessness
and weakness. Omed understood that he had experienced extremely insecure conditions
during his childhood in Afghanistan with serious threats and challenges to his life. His lived
experience made him develop a certain sensitivity and empathy.
In light of these new realisations, Omed began to reinterpret the idea of himself as a
weak person. He understood that he could take up other practices than those of his friends
and still be a man. During our last two sessions, he started to redefine his notion of being
weak as a strength. Our discussions made him realise that there were other ways of living
life, and that male gender could include new cultural influences that, for example, placed
emphasis on emotional expressiveness, caring, love and reciprocity. In this way, Omed was
able to start reauthoring the dominant story of weakness. Together we identified individuals
who supported his preferred ways of being, and social situations where he did not feel
that he had to pretend to be someone else. Outsider witnesses enabled Omed to receive
social recognition, which made him gain confidence and agency. He could renegotiate his
masculine identity.

The Contribution of Ethnography

The experience of CSA leaves survivors forever changed, and the journey from such trauma
to rebuilding one’s life is complex. The case study shows how Omed’s internalised and
problematic stories were deconstructed and reconstructed in the process of narrative therapy.
I now scrutinise more closely the role that ethnography played in this process, and reflect
on how ethnography can contribute to the development of a therapeutic approach that is
sensitive to gender and culture in conversations with sexually abused males.
Initially, the collaborative work was challenged by the medical gaze (Foucault 1973)
of the psychotherapist, who was focused on providing the clients with a diagnosis and
the correct treatment. When people’s identities are labelled by diagnoses or when they are
described as victims associated with certain attributes such as being weak, powerless, helpless
and vulnerable, they may experience marginalisation. Omed’s previous encounters with
professionals in Sweden had resulted in increased feelings of being weak and damaged. More
generally, I noticed that the clients told the therapist a few fairly “thin” or undetailed stories
 KRITISK ETNOGRAFI – SWEDISH JOURNAL OF ANTHROPOLOGY 31

about their life experiences. The meanings that people create from such thin narratives are
often incomplete and do not include reflections on how they would like to live their life
(Combs and Freedman 2012). The contribution of ethnography in the narrative therapy
process was, then, to elicit thick descriptions (Geertz 1973) from the clients, i.e., detailed,
rich and meaningful life stories. We invited Omed to tell us narratives that were not only a
part of his problematic story line but included other life events as well and their significance.
These thicker life stories offered different meanings and possibilities than the story of being
weak and abused. Omed told us about situations where he did not feel weak and revealed
stories of courage and resistance. Simply engaging clients in rich storytelling does not solve
what they find to be problematic, but encouraging the development of alternative stories may
help clients find other perspectives and ways of responding to what they find problematic
(Combs and Freedman 2012). During our conversations with Omed, he embraced life
stories that were of importance to him and that could not be associated with what he found
to be the problem. He told us about his work with children at the school where he was a
trainee, resulting in reflections about perhaps becoming a teacher someday. Inspired by the
work of Bateson (1979), White (2007) argued that the meaning we attach to an experience
is often made with reference to other experiences. It is in the light of contrasting experiences
that meaning is created. Thus, a story about a problem is often told in contrast to something
that is preferred or desired, like Omed’s ambivalent feelings about fatherhood.
The psychotherapist found it difficult to contextualise the problems that the clients
expressed and include the social, cultural and political aspects of illness. She admitted that
the cultural competency model made her think that clients with a certain ethnic background
need to be approached and treated accordingly. By using an ethnographic approach and
considering culture from the client’s point of view, Omed became the one who told us
about how he experienced gender, culture and ethnicity in various settings. We used curious
and person-centred interview questions that focused on a combination of the client’s
understanding of the external context and his own experiences or responses (Levy and Hollan
2000). By this, we were able to expose various gender discourses and power differentials that
supported the problem addressed by Omed. The process of externalising problems, such as
anger, hopelessness or weakness, separated the person from the problem. Helping clients to
locate such problems in discourses reduces their self-blaming attitudes and makes it easier
for them to make changes in their lives. It is easier for clients to respond to a problem that is
located outside of him/herself rather than changing their biology/disorder and/or adjusting
to a life with mental health difficulties. During our conversations in the therapy room,
Omed was able to locate the responsibility for the abuse, including the consequences or
effects he was suffering from, with the abusers in Afghanistan. Omed understood that CSA
does not happen because the child is weak. It is a crime committed by adults whose actions
take place within a context of children’s powerlessness and vulnerability. Omed realised that
his understanding of CSA and his ways of responding to those experiences could be located
in contexts of shifting masculine constructions.
The ethnographic shift in the therapy room generated the development of local,
personal and contextualised knowledge. We worked from the stance that all the members of
the therapeutic encounter were embodied and positioned subjects who actively engaged in
deconstructing and co-authoring the clients’ stories and identities. As two female professionals
who supported sexually abused male clients to deconstruct and re-author oppressive stories,
we could not adopt a neutral or passive stance. Inspired by the autoethnographic approach,
32 CHARLOTTE PETERSSON | DEVELOPING GENDER AND CULTURE SENSITIVE CONVERSATIONS WITH SEXUALLY ABUSED MEN BY
BLENDING ETHNOGRAPHY AND PSYCHOTHERAPY

we used personal reflections as a strategy to understand and analyse our positionality in

the therapy room. By focusing on the clients’ engagement with others, including the
processes and patterns that constitute social contexts, we could, as embodied subjects, help
the clients to see that their stories contained both knowledge and power. The stories were
both socially constraining and involved social agency (Brown and Agusta-Scott 2007). As
outsider witnesses who listened, retold and acknowledged the preferred stories and identities
of the clients, we helped to give the stories multiple meanings and new perspectives. The
psychotherapist and I noted a significant shift in the power dynamics that took place both
in and outside of the therapy room, as a result of which our clients gradually improved
their position during therapy. They were able to make choices in their life to overcome
feelings of marginalisation and isolation. In this sense, narrative therapy fosters agency and
makes it possible for the clients to oppose patterns of marginality and injustice (Combs and
Freedman 2012). In a conversation with Omed more than six months after the narrative
therapy had finished, he told me that our curious questions and our openness and interest in
his past experiences made him look at himself and his life in a different light. He felt that he
was not approached as a patient with severe mental health issues. He said that he felt that he
could express himself freely without experiencing discrimination or shame, which basically
had been the core of his problems.

Conclusion
Research has shown that men who have experienced CSA are less likely to be well-served in
therapeutic and clinical encounters. Yet professional responses can be of crucial importance
for those who need to renegotiate and reformulate their identities, including male sufferers
from CSA. The focus of this article has been to reflect on how ethnography can facilitate to
the adoption and practice of narrative therapy. My intention is not to suggest that narrative
therapy is the only suitable and effective therapeutic approach for sexually abused males.
Men with a history of CSA have unique needs. Clinical practitioners must take into account
the limitations of this approach, including its shortcomings as a treatment for acute and
complex symptoms and PTSD.
By describing how aspects of ethnography contributed to a specific therapeutic
collaboration, I hope to generate insights that others might find useful for further
elaboration. Recognising gender and culture as central principles in organising individuals’
social lives, and situating individual experience of illness and distress in the larger socio-
political-cultural context in which it takes place, was an approach that psychotherapists,
their clients, and I found productive. Postmodernist and constructive therapies combined
with the tools of ethnography can generate good conversations about gender for men who
have experienced isolation and marginalisation and want to overcome feelings such as
shame, guilt and self-hate.

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