Betrayed as Boys: Psychodynamic Treatment of Sexually Abused Men, by Richard B. Gartner,  The Guilford Press, 1999,  356 ps.

As the title suggests, Richard B. Gartner emphasizes the concept of betrayal in this new volume on the treatment of men who were sexually abused as boys. More encompassing than other terms such as sexual abuse and incest, the term betrayal captures the depth of interpersonal violation and exploitation of trust, of intimacy and of an inherent power imbalance. As an interpersonal psychoanalyst with a background in family systems theory, Gartner addresses the concept of sexual betrayal through an interpersonal and relational viewpoint. Indeed, the separate chapters in this volume which range from definitions of terms, symptomatology, cultural influences, and gender identity to the therapeutic relationship and group dynamics, are all presented within an interpersonal framework. While the therapeutic relationship is central in work with these patients, it is not, in my opinion, exclusive, and some readers will undoubtedly find this volume lacking in the depth intrinsic to an analysis of the patient's intrapsychic conflicts which are so intensified by the interpersonal violation inherent in sexual betrayal. Despite this limitation, Gartner presents the reader with a satisfying and much needed addition to the as yet small collection of books that specifically address the treatment of men sexually abused as children.

The sections on gender identity, struggles about masculinity, and our culture's encoding sexual abuse as sexual initiation are particularly sensitive and thought provoking. His exploration of societal assumptions that women rarely abuse and that boys invite it, or at the least, experience it as a sexual initiation is one telling explanation of men's reluctance to actually seek therapeutic help for histories of abuse. With all of this in mind, he summarizes the current theories on gender identity, making clear his own view that gender identity is a social construction. This is all extremely worthwhile reading, especially because the vast majority of literature ad