I came to be a therapist quite late in life after a successful but ultimately unrewarding career in business. I always felt that there should be something more to life than making money, and it struck me repeatedly how mental health difficulties disrupted the lives of so many of my staff. Within my department, which consisted of over 200 people, I promoted a strong ethos of being a supportive employer and we provided time off for and access to counselling to anyone who needed it. It fell under the remit of ‘flexible working’ so that colleagues wouldn’t need to know why someone didn’t come in on a Thursday morning until 11.00 am. But being the manager, I knew how many people accessed this kind of support, and it eventually occurred to me that, rather than retiring to a lifestyle of golf and DIY, this was maybe something that I could invest the later years of my life into. So I took early retirement and retrained as a therapist.

I assumed from my background that I would work at the supposedly ‘higher’ end of things, maybe business coaching, helping people to set and achieve goals, that sort of thing. But I did my placement at a local Mind office where we provided short-term (6 sessions) counselling for people referred via their GP. Suddenly I was working with lots of people with depression, relational difficulties, and low self-esteem. I was surprised at how much I enjoyed the work, but I found it frustrating to have such little time with them. For my next placement, my aim was to be able to work longer term and coincidentally it ended up being for a sexual abuse counselling service. I’d never given much thought to the topic before, and had very simplistic attitudes—I really had no idea at all about the dynamics of abuse, how in grooming the victim takes on the responsibility that should be the perpetrator’s, and how insidious the impacts of abuse are. I was also completely unaware at just how prevalent abuse is. That alone shocked me to my core, and made me feel that I’d been living in an alternative universe all my life.

I feel quite ashamed when I realise how ignorant I was. The first year was a steep learning curve but I was surprised at how rewarding I found the work. The counselling manager felt that it would be a good idea to send all the male clients my way, and in particular those who could most closely relate to my business background. It really struck me how different they were to many of my previous clients. Most of them were externally very successful: driven, high-achieving workaholics. They didn’t fit my existing schema of ‘mental health’ at all, and caused me to reassess a lot of my preconceptions. I realised that I had unconsciously assumed that most people seeking counselling, especially after sexual abuse, would be female; unemployed; depressed; and lacking in life skills. I felt deeply ashamed of such prejudice. All but one of the men I worked with over the first five years was employed, and probably over two thirds of them at a management level. They were people that I would have considered to be colleagues.

And it hit me like a missile that I had been assuming that abuse survivors would be ‘other’—different to me—in the same way that we think that the perpetrators are ‘other’. We assume that they are monsters and don’t see that they are just normal people with normal jobs living in normal neighbourhoods. And we stigmatise the survivors by assuming that their abuse will be written on their foreheads. I came to realise, albeit slowly, how much energy survivors invest in covering the abuse they have suffered, because they feel so ashamed. It began to stir in me a deep, deep passion to see these people free of the shame that didn’t belong to them, and as I worked more closely with them I increasingly came to feel deeply in awe of the resilience of these men who had survived such atrocities with such little support. I began to feel a little ashamed of my sheltered life and of how much I had moaned about really quite minor inconveniences. Rather than looking down on these survivors, as I might have done when in my previous career, I began to look up to them.

Over the five years I worked for that counselling service, I was struck by the commonalities between many of the survivors I worked with. All expressed some level of chronic disempowerment in their lives, a logical consequence of the powerlessness of trauma. But males in our culture are not expected to demonstrate weakness and vulnerability; they’re not supposed to struggle. Being male is conflated with winning and conquering and being a hero. And I saw this conflict in many of my male clients, who exhibited a distinct split between their work lives and their personal lives. Most of them were determined, driven go-getters. They had subsumed their sense of powerlessness and lack of control by instead taking control and assuming positions of power within their work lives. They were highly respected and successful, with none of their colleagues even beginning to suspect that they had suffered sexual abuse historically or that they struggled as much as they did in their personal lives.

And then in the counselling room, they would literally break down before my very eyes: the most agonising, gut-wrenching sobbing that I’ve ever seen. It was like someone would just throw a switch and they would go from being in control, in charge and dominant, to terrified little boys. It always struck me what a pressure it was for them to have to maintain such an appearance of togetherness in their professional lives, even—for many—their home lives. Whilst some had a string of relational disasters, many of them were married with children, and none of the ones who came to me over that period of time had told their partners about their abuse. It was as if they felt they had to protect everyone around them and took all the responsibility on their own shoulders.

It was so difficult to get these men to open up emotionally. They were all or nothing—together, competent, brave, or sobbing and distraught. It was hard to work in the middle, and for them to be able to identify and verbalise what they were feeling. So their emotions were either suppressed or just burst out of them. Even after crying, many of them wouldn’t be able to put into words what they had been so upset about. The language of emotions was foreign to most of them.

I was also struck by how difficult they found it to mentalise, to really step back from their experience and think about it. In the workplace, this was by no means an impediment to their success: they had a way of operating, they followed the rules of business, and they didn’t need to understand things from other people’s point of view. Some ran into difficulties as a result in their man-management, but mostly business operates—at least in my experience—according to fairly rigid protocols and rules, and you don’t always need a high degree of emotional intelligence to be successful. This was perhaps why so many of the men I worked with found such safety in their work—it was predictable, it didn’t demand too much of them emotionally, and within the business world it’s perfectly acceptable to be cold-blooded and to rely on rationality and logic.

But when I tried to get these men to mentalise about their own experiences of abuse, they really struggled. In some ways they had a very immature psychological outlook: if they felt it was their fault, it was their fault: no point discussing it. If they felt they had been cowards because they hadn’t fought back or run away, they were cowards. There was a real sense of it being black-and-white, and the grayscales were for wimps. It took a long time to break through this with many of my clients, and to help them to be able to see the abuse from the perspective of the frightened 4-year-old boy, or the entrapped 12-year-old. Many seemed to think that the answer lay in them proving themselves as fathers, husbands, breadwinners, managers—that their outward success in terms of salary, car, house and golf handicap would wipe away their sense of intrinsic shame. There was a real terror in terms of coming to terms with their vulnerability and the fact that they were abused and that that abuse was wrong. They preferred to see that they were wrong for having allowed themselves to be abused. It took a lot of work to get them to view it any differently.

The challenge for me personally in working with these men was in not colluding with them. Unconsciously, they invited me to blame them. I found myself more easily triggered into feeling irritated with them, a sort of evoked ‘fight’ response in me. I found myself drawn into wanting to relate to them as a business mentor rather than as a therapist, to tell them to get a grip and set goals and put emotions to one side. Time and again, I realised that I was drawn into this approach. It took a long time for me to realise that I, too, was scared of what might happen if they let their guard down. I realised that I too was expecting them to be strong and to hold it together. Our cultural models have such a strong impact on us, even unconsciously.

The first male DID client I worked with was the CEO of a very successful tech start-up that had grown up out of ‘Silicon Fen’. At work, he was brilliant. At home, he was a mess and it was his impending divorce that drove him into therapy. He thought he could get ‘fixed’ in six sessions—in fact, he was a little surprised that we would need so many. He was as shocked as I was that the third session was ‘hijacked’ by another part of his personality. I had worked with female DID clients previously, and with one in particular it had been extremely slow work, building up trust before any of the parts manifested. But with this male client, we were straight in there. It was as if he couldn’t wait any longer. The narrative—disjointed, mostly unintelligible—of atrocious abuse poured out of him session after session; try as I might, nothing worked to slow him down or keep him in a window of tolerance. His abuse had been particularly severe, and also, in some ways, particularly bizarre—he had been hung over a motorway bridge and warned that if he ever told anyone, they would drop him. He was taken to ‘parties’ at stately homes and abused by both men and women, and forced to abuse other children. If it hadn’t all exploded out of him in the dissociated, fragmented way it did, it would have been unbelievable. And then, in the blink of an eye, the businessman was back in front of me again, with no memory whatsoever for what had just passed.

I worked long-term with this particular client, and all along he held it together at work. His business went from strength to strength. It never failed to impress me that dissociation is such a gift, in that it enables the person to carry on with daily life, even while the trauma is causing such distress internally. I trod very carefully in my work with him, to ensure that he was able to remain functioning at work—it was his ‘island of ability’, his source of resilience. Never in a million years would he have been willing to access mental health services through the NHS, or be seen as a ‘mental health patient’; his business reputation depended on his dissociation. And he really confirmed to me that we need to tailor our services to our clients. I smile when I look back now and think about how I assumed that I would be a business coach, maybe helping the occasional CEO through a divorce or some inter-personal conflict within their organisation. The reality is that people with even the most extreme backgrounds of abuse will walk through our doors, and we have to be open to the possibility that even the CEO of a technology start-up might have DID, and that it’s the dissociation that is facilitating their business brilliance. Above all, this work has taught me never to make assumptions about people and not to put them in boxes. We are all unique.