Therapeutic Alliance and In-Session Therapy Needs of Male Adult Sexual Assault Survivors: Perspectives of Survivors and Therapists.

Male sexual victimization is more commonly examined in the context of child sexual abuse than adult sexual assault (ASA; 18+), with therapeutic research largely centering on female survivors, who constitute the main focus of scholarly attention. Consequently, this study explored how the therapeutic alliance is built and what in-session therapy needs emerge for male ASA survivors, as shaped by masculinity and adulthood. Data were collected from 39 in-depth interviews with Jewish Israeli participants, comprising two distinct groups: 19 male ASA survivors and 20 sexual trauma therapists. The data were analyzed separately through reflexive thematic analysis, and only at the final stage were the two groups examined together. Three key findings were identified: (1) facilitators of therapeutic alliance with male ASA survivors include awareness of how age and masculinity shape their experiences, psychoeducation for bonding, and present-focused listening; (2) barriers to therapeutic alliance include an overemphasis on the traumatic event itself, with a therapeutic focus that prioritizes trauma details at the expense of attending to the survivor's broader identity, current needs, and lived experiences; and (3) in-session therapy needs include psychoeducation, present-focused therapy, and changing the therapeutic setting (e.g., stepping out of the therapy room or going for walks). Accordingly, we conclude that the therapeutic alliance and in-session therapy needs of male ASA survivors are shaped by the dual lenses of age and masculinity, highlighting the necessity of adapting therapeutic approaches to address these factors.