Men’s experiences of help- seeking for female- perpetrated intimate partner violence: A qualitative exploration

The subject of female- perpetrated intimate partner violence (IPV) against men has been one of controversy, with well- rehearsed arguments surrounding both the nature and ex-istence of female- perpetrated abuse against men. The aims of this study were to explore men's help- seeking experiences and/or their perceptions of utilising support services/ support networks following IPV victimisation. Consequently, this study explored the help- seeking experiences of 26, largely British, men who self- identified as having experienced female- perpetrated IPV. As the focus was on subjective experiences, a qualitative design was employed. Participation was invited from men who had sought help for their IPV victimisation from a range of sources and those who had not sought help at all. Semi- structured interviews explored the men's experiences of seeking help, and barriers to seeking help, following IPV. The data were analysed using reflexive thematic analysis. Some of the participants who took part in this study had received formal support for


| INTRODUC TI ON
The World Health Organization (WHO; 2021) define intimate partner violence (IPV) as behaviour inflicted by a partner or ex-partner that causes harm to the victim including physical abuse, psychological abuse, sexual coercion and controlling behaviour. IPV is a major social and health problem, associated with severe physical and mental health difficulties (World Health Organization, 2013).
Whilst the majority of victims, including fatalities, are female and the majority of perpetrators are male, the WHO (2012) acknowledges that men are also victims of IPV and sexual violence, both within same-sex and heterosexual relationships. A growing body of research on men's experiences of female-perpetrated IPV (e.g. Bates, 2019;Hine et al., 2020;Huntley et al., 2019;Wallace et al., 2019b) suggests that there are some important differences in men's experiences of IPV, particularly with regard to help-seeking.
Socially and culturally constructed masculine norms endorse being stoic, self-reliant, emotionally inexpressive and in control (Nam et al., 2010;Sullivan et al., 2015), values that are typically perceived by men as being inconsistent with help-seeking (Brown et al., 2019;Gillon, 2008;Hines & Douglas, 2010). However, the nature, source and manner in which help is offered may influence men's openness to seeking help (Huntley et al., 2019;Pollard, 2016), with some evidence suggesting that men react more positively to psychotherapy given its emphasis on promoting autonomy and selfreliance (Berger et al., 2013). Nonetheless, there remains a need to further develop male-friendly approaches to mental health services which facilitate the expression of emotional distress and challenge gender stereotypes (Brown et al., 2019;Emslie et al., 2007), in order to effectively meet the needs of men and overcome barriers to helpseeking (Huntley et al., 2020;Liddon et al., 2019).

| Male help-seeking behaviour and IPV victimisation
Research conducted in the United States and Europe that focused directly and indirectly on men's experiences of help-seeking following female-perpetrated IPV has identified several internal and external barriers to help-seeking. These include men's feelings of shame, embarrassment and their lack of awareness and mistrust of support services (Bates, 2019;Douglas & Hines, 2011;Drijber et al., 2013;Huntley et al., 2019;Machado et al., 2020;Machado et al., 2016;McCarrick et al., 2016;Tsui et al., 2010).

K E Y W O R D S
abused men, counselling, domestic violence, female perpetrators, male victimisation

Implications for practice
• Practitioners should validate men's experiences of intimate partner violence (IPV) and assist them to recognise their relationship as abusive, which can potentially empower men to leave an abusive relationship.
• Practitioners should be mindful to maintain a non-judgemental approach in their work with male victims. This is of particular value when men are self-critical of their perceived failure to meet internal and social masculine expectations as a consequence of their IPV experiences.
• Group-based support services for male victims may provide men with a 'safe' place to share their experiences and navigate some of the challenges presented by masculine norms and expectations.

Implication for policy
• Services should be aware of the importance of early and effective intervention as negative help-seeking experiences can have lasting and significant implications for men's mental health, potentially even exacerbating post-traumatic stress disorder experienced as a result of IPV. Huntley et al. (2019), in a systematic review and qualitative evidence synthesis of studies on help-seeking experiences for male victims of domestic violence, identified fear of disclosure as a central barrier to formal help-seeking. The authors found experiences that were specific to men included fear of challenges to perceptions of their masculinity, at both a personal and a societal level, and fear of being accused of being a perpetrator.
Following a synthesis of systematic review evidence on helpseeking by male victims of domestic violence and abuse, Huntley et al. (2020) outlined recommendations to effectively support male victims, including the need to enhance awareness and visibility of IPV services for men in order to aid access. The authors also recommended the need to facilitate confidentiality and privacy, as well as providing an individual approach and continuity of care to the service user. Whilst these findings provide useful recommendations for the development of policy and practice, the authors call for further research that enhances understanding of the specific experiences and needs of male victims, including barriers to support utilisation and the development of needs-led service provisions (Huntley et al., 2020).
Recent UK-based research by Bates (2019) exploring men's experiences of IPV, including barriers to leaving their relationship and perceptions of societal beliefs about male victims, identified that the men's physical and psychological well-being was negatively influenced by the abuse they experienced. This online qualitative survey study demonstrated that the men perceived society as disbelieving of male victimisation, which negatively impacted their willingness to seek help and leave the relationship.
Negative help-seeking experiences have been shown to have lasting and significant implications on male (and female) victims' mental health (Fauci & Goodman, 2020;Tsui et al., 2010). US research by Douglas and Hines (2011) demonstrated that the association between sustaining IPV and post-traumatic stress disorder (PTSD) was stronger where there were greater levels of hostility towards male victims when voicing their experiences.

| The current study
There is new interest in research on men's help-seeking experiences as a result of female-perpetrated IPV (Huntley et al., 2019).
As support services for male victims evolve (Huntley et al., 2020), with growing recognition of gender-specific experiences and barriers to accessing support (Bates & Douglas, 2020;Hogan et al., 2012;Wallace et al., 2019a), there remains a need to further develop a nuanced understanding of male victims' experiences with (Huntley et al., 2020;Morgan et al., 2014) and perceptions of support services in order to better assist male IPV victims (Barrett et al., 2020;Bates, 2020;Powney & Graham-Kevan, 2019;Tsui et al., 2010). Furthermore, Hine et al. (2020) outline the need for research that investigates men's experiences of informal and indirect help-seeking from friends and family.
Greater awareness of help-seeking behaviour may enhance practitioners' awareness and understanding of how support services can effectively assist male victims and their support networks, facilitating victims' escape and recovery of an abusive relationship (Hine et al., 2020;Holloway et al., 2018;Roddy & Gabriel, 2019;Williamson et al., 2015). The aims of this study were to explore men's help-seeking experiences and/or their perceptions of utilising formal support services including counselling and more informal support networks (e.g. family and friends) following female-perpetrated IPV.
Both men who had sought help from a range of sources of support and men who had not sought any help for their victimisation were recruited, in order to explore participants' perceptions of support services.

| Research design
A broadly experiential qualitative research stance was adopted in order to facilitate understanding of how participants perceived, experienced and made sense of their help-seeking experiences (Braun & Clarke, 2013).

| Participants and recruitment
Participation in this study was invited from men over the age of 18 who self-identified as a victim of female-perpetrated IPV; thus, purposive sampling was used. For the purpose of this study, the definition of IPV and controlling and coercive behaviour used was from the UK Government Home Office: Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners regardless of gender or sexuality.
This can encompass, but is not limited to, the follow- In line with the recommendations of Braun and Clarke (2021), this sample size provided rich data, which were experientially diverse and thus met the analytic requirements of reflexive thematic analysis.
The time period since leaving the relationship and taking part in the interview ranged from five months to 18 years (mean length: 3 years 8 months). Twelve participants were in a relationship at the time of taking part in the interview, four of these were in an abusive relationship (see Table 1 below for further details of the sample).

| Data collection
Data were collected using semi-structured interviews conducted by the first author. Participants were given a choice of three interview modes: face-to-face, Skype video call or telephone. Sturges and Hanrahan (2004) identified that participants value the autonomy of choosing the type of interview they would like to participate in. Furthermore, this flexibility and choice may have enhanced participants' feelings of safety and control. This was particularly important given that some of the men were still in an abusive relationship at the time of conducting the interview (Ellsberg & Heise, 2002). Thirteen participants chose face-to-face interviews, 10 telephone interviews and three Skype interviews. The length of the interviews ranged from 39 min to 2 and a quarter hours (mean length: 1 hr, 25 min).
An interview guide was developed based on a review of existing research (e.g. Douglas & Hines, 2011;Tsui et al., 2010).
Ethical approval for this study was granted by the authors' Faculty Research Ethics Committee. This study adhered to the British Psychological Society (2014) Code of Human Research Ethics. Prior to participation, each participant was given a participant information sheet and was asked to sign a consent form. To maintain anonymity, each participant was invited to choose their own pseudonym at the start of the interview (Braun & Clarke, 2013).

| Data analysis
Inductive reflexive thematic analysis was used to analyse the data following the six-phase process outlined by Braun and Clarke (2006).
As this research aimed to explore the men's subjective experiences of help-seeking following female-perpetrated IPV, a contextualist perspective was adopted, which views subjective experiences as contextually located (Braun & Clarke, 2013). Therefore, this study explored how the research participants made sense of their experiences in their particular social, cultural and historical contexts (Forrester, 2010).
The analytic process began with immersion in the data, noticing interesting aspects about the data relevant to the research question.
The first author led the coding process, which involved systematically generating codes, in order to identify all aspects of the data that were relevant to the research question. Initial themes were then generated by clustering similar codes. These themes were then reviewed against the coded data and the entire data set, and defined and named to capture the essence of the 'story' and substance of each theme. All three authors contributed to the process of theme development in order to facilitate a rich nuanced reading of the data.
The conceptualisation and operationalisation of themes in this study (mostly) departs somewhat from Braun and Clarke's construct of themes as conceptually founded patterns of shared meaning . This is because we sought to explicitly identify barriers to help-seeking and negative and positive experiences of help-seeking in advance of analysis and the men's experiences were thematically organised under these topic headings during the analysis. The final-unanticipated-theme is in line with Braun and Clarke's conceptualisation of themes.
Quality practices in reflexive TA centre on the researcher's depth of engagement with the data and reflexive practice, rather than TA B L E 1 Characteristics of the sample (N = 26)  (2) GCSEs (1) Ordinary National (1) A Level (3) NVQ (3) City and Guilds (2) Level 4 Certificate (1) Undergraduate Degree (7) Postgraduate qualification (5) Prefer not to answer (1) Employment status Unemployed (6) Full-time employment (15) Full-time student (1) Part-time student (1) Retired (3) Self-identified social class Working class (12) New affluent worker (1) Middle class (11) Prefer not to answer (1) Not sure (1) Number of children range (mean) 2-6 (4) Current contact with children Full contact with children (10) Limited contact with one or more children (7) Lost contact with one or more children (9) Relation status at the time of interview Single (14) In a relationship (7) Engaged (1) Married (4) Length of abusive relationship range (mean) 6 weeks-31 years (12 years, 5 months)

Number of abusive relationships
One (20) Two (6) Had counselling for IPV victimisation Yes (11) No (15) measures of inter-coder agreement (Braun & Clarke, 2020). The first author maintained a research journal throughout the research process to reflect on his assumptions around the topic and experiences of conducting the interviews and analysing the data. Meetings with the second and third authors-particularly during the data analysis phase of the research-provided further opportunities for reflection on the assumptions he brought to his analysis of the data and how these might be shaping and delimiting his data engagement and interpretation.

| RE SULTS
The analysis is reported under four headings: Barriers to seeking help; Negative help-seeking experiences; Positive help-seeking experiences: labelling the relationship as abusive; and There is a need for change-"I'm keen to spread the word". Each theme is illustrated with relevant data extracts. The data have been edited to remove superfluous material.

| Barriers to seeking help
This topic heading captures the psychological barriers that prevented the men from seeking help, including a desire to maintain masculine stoicism, a fear of not being believed and a lack of faith that support services could help them. The men's accounts reflected rules around masculine expectations that were restrictive and difficult to follow. Therefore, many of the men did not seek help in an attempt to avoid feelings of shame: It's a shame like that I expect from society or be- to be put in that situation (Frank).
The men's accounts suggest that limited knowledge of the aims of counselling was a barrier to accessing this form of support. Many of the men reported that their friends and family did not recognise and validate their experiences, which undermined their own ability to recognise their relationship as abusive: 'The people I did tell sort of laughed and said "That's women for you"' (John). In some instances, the men reported that family members trivialised their abuse, even considering their injuries to be humorous:

| Positive help-seeking experiences: Labelling the relationship as abusive
Being believed was of significant value to the men: 'Having one other person who believes you is significant, is important, and is a source of great strength' (James). The men frequently described counselling as helpful because the therapist was non-judgemental: 'She offered no judgement at all, which is one of the things that makes it very easy to talk to a counsellor' (Aaron). This appeared to be of particular value given that many of the men were self-critical of their perceived failure to meet internal and social masculine expectations as a consequence of their IPV experiences. Frequently, the men described counselling as beneficial because it was confidential and the counsellor was a stranger, which facilitated their willingness to talk about their experiences: 'It's easy to talk to someone who doesn't know you, I'm okay with that' (Tim).
Some men reported that having counselling whilst in the relationship helped them to recognise their relationship as abusive, which was influential in their decision to leave: Going through this, you know now I see the pattern, now I see it is a pattern, and it's not just a series of isolated events that I'm instigating, and I was only getting that from the opportunity to talk about it and put it all into perspective (Aaron).
Occasionally, the participants reported that the police were instrumental in helping them to recognise their relationship as abusive: 'They said "She's been abusing you", and then I suddenly realised' (John). In addition to labelling the relationship as abusive, some men reported that the police were helpful because they encouraged the men to seek help: 'They said to me "You need to do something, you need to get help". And er…they gave Belonging to a support group for male victims provided the men with a 'safe' place to share their experiences and navigate some of the challenges presented by rigid gender roles: There was a lot of crying went on, a lot of revelations and a lot of crying. And in our recovery programme we all cried together. And I think that's good because men rarely cry, do they? ((laughs)) (John).
John's account demonstrates his questioning of traditional masculine norms through his willingness to share his vulnerability within the group. At the same time, his laughter at this point in the interview may signal some ongoing discomfort with acknowledging and sharing his vulnerability with another man (the male interviewer).

| There is a need for change-'I'm keen to spread the word'
This final theme captures the men's perceptions of changes that need to be made in the wider social context in order to enhance recognition and understanding of female-perpetrated IPV and improve service provision for male victims. These changes typically centred on the need to enhance awareness of male victimisation, and tailor support services to meet the unique needs of men.
The men's willingness to take part in this research was frequently underpinned by a desire to bring about change. The men perceived research as an important first step towards enhancing awareness of male victimisation: 'I'm thankful I can take part in something that will, you know, one day help everyone' (Steven).
In particular, the men's accounts focused on a need to enhance awareness and understanding of female-perpetrated IPV in heterosexual relationships within frontline services: There's no training for the police in being able to spot this kind of thing. There's no training in the NHS, doctors aren't trained on being able to spot male victims of violence (James).
Frequently, the men highlighted the importance of education in reducing stigma surrounding male victimisation: 'I think if men were educated about what they were in they would start to realise that it isn't actually a reflection on their masculinity' (Oliver).
For some of the men, taking part in this research was a significant step towards recognising their resilience. For example, Jay described feeling more comfortable in sharing his vulnerability:

| D ISCUSS I ON
Participants' accounts evidenced a reluctance to disclose their experiences of abuse on account of dominant social constructions of victimisation as a female experience (Wallace et al., 2019a(Wallace et al., , 2019b. Fear of shame and emasculation limited participants' help-seeking behaviour (Bates, 2019;Huntley et al., 2019;Walker et al., 2020). The men's difficulties in identifying and seeking help for their victimisation appeared to centre on their investment in notions of hegemonic masculinity and a fear of being perceived as less masculine (Gillon, 2008;Hine et al., 2020;Zverina et al., 2011). Limited help-seeking was a barrier to leaving their abusive relationship (Bates, 2019;Hines & Douglas, 2010).
These findings support evidence that men often feel pressure to maintain socially appropriate masculine standards of behaviour (Seager, 2019).
Reflecting findings of research with gay male and heterosexual female victims (e.g. Oliffe et al., 2014;Kaukinen et al., 2013), many participants did not use professional sources of support. Frequently, the men believed support services could not or would not help them because they were male victims (Oliffe et al., 2014;Machado et al., 2020;McCarrick et al., 2016), and feared that their victimisation would not be believed or taken seriously (Bates, 2019;Drijber et al., 2013). This fear was partly related to the physical size difference between themselves and their female partners and how this would be perceived by others (Corbally, 2015;Walker et al., 2020).
Some participants reported a lack of recognition and understanding of male victimisation within support services (Hine et al., 2020;. These accounts indicate that violence perpetrated by women against their male partners may be trivialised (Seelau & Seelau, 2005) or even considered to be humorous (Pagelow & Pagelow, 1984).
The men's accounts suggest that not knowing about the aims of counselling was a barrier to accessing and engaging with this form of support (Brown et al., 2019;Millar, 2003). These accounts highlight the importance of increasing understanding of support services amongst male victims in an attempt to reduce stigma and misunderstanding (Huntley et al., 2020). Evidence from research with women suggests that enhanced knowledge of support services is associated with greater support utilisation (Kaukinen et al., 2013). Negative help-seeking experiences had a detrimental impact on the men's willingness to seek further help (Brown et al., 2019). For some men, this resulted in additional feelings of isolation and psychological distress (Drijber et al., 2013). The trauma they experienced from their relationship was exacerbated by a lack of support, resulting in PTSD for some men (Douglas & Hines, 2011).
For some participants, the process of psychologically experiencing within therapy was unhelpful, and there was a preference for practical facts over emotion-focused interventions (Holloway et al., 2018). This finding supports evidence that some men are disempowered by sources of support that require them to 'fit in' to existing services that are not sensitive to the social norms of traditional masculinity and how these shape male experience (Brown et al., 2019;Pollard, 2016). Often, the men reported that they preferred to speak to family and friends about their victimisation, rather than utilise formal sources of support (Barrett et al., 2020;Bates, 2020;Machado et al., 2017).
The availability of social support has been related to posttraumatic growth following trauma (Prati & Pietrantoni, 2009) and may facilitate access to formal support (Machado et al., 2017). The men's ability to recognise their relationship as abusive was related to friends, family and professionals recognising and validating their experiences (Bostock et al., 2009;Burrell & Westmarland, 2019;Roddy, 2013). Many of the participants stressed the value of being believed when talking about their experiences (Walker et al., 2020).
In line with evidence that helpful sources of support may be influential in men's decision to leave an abusive relationship (Wallace et al., 2019b), validation of the men's experiences empowered some of the men to leave their relationship (Pajak et al., 2014).
Supporting the assertion of Hine et al. (2020)  was also a significant step towards the men recognising their personal resilience and strength (Flanagan et al., 2015) and feeling more comfortable in sharing their vulnerability (Joseph, 2015).
There is increasing research interest in men's help-seeking experiences as a result of female-perpetrated IPV, including perceptions and experiences of accessing formal support (e.g. Burrell & Westmarland, 2019;Machado, et al., 2020); informal support (e.g. Barrett et al., 2020;Walker et al., 2020); and men's experiences of coping without help and support (e.g. Bates, 2020). The current study confirms existing findings that for those men who accessed help and support, validation of their experiences of IPV was important in assisting them to recognise their relationship as abusive.
Feelings of shame and a perceived lack of feasible support prevented men from accessing help.

| Clinical implications and conclusions
These findings highlight the need for practitioners to be aware of male victimisation and the unique difficulties experienced by male victims (Barber, 2008;Hogan et al., 2012). Practitioners may benefit from listening to or reading survivors' stories, such as those presented in this paper, to enhance their knowledge and understanding of barriers and facilitating factors to help-seeking (Bates, 2020;Morgan et al., 2014) and contribute to the development of competent therapeutic practice (Roddy & Gabriel, 2019).
Practitioners and support services should be sensitive to the impact of assumptions and values surrounding masculinity and masculine appropriate behaviour, which may negatively impact help-seeking Seager, 2019) and the use of therapy (Hogan et al., 2012). Practitioners should be mindful of the potential difficulty in integrating hegemonic masculinity, defined by Connell (1995) as a normative, desirable way of being a man, underpinned by positions of power and authority (Connell & Messerschmidt, 2005), with the paradoxical experience of being a victim (Hogan et al., 2012).
The men who had positive experiences of therapy valued a counsellor who was non-judgemental and had some understanding of IPV and its effects (Roddy, 2013;Roddy & Gabriel, 2019). A nonjudgemental therapeutic approach was of particular value given that many of the men were self-critical of their perceived failure to meet internal and social masculine expectations. Practitioners should be aware of the importance of facilitating unconditional positive selfregard in the men's recovery from the trauma of being in an abusive relationship (Flanagan et al., 2015). Some participants described counselling as beneficial because it was confidential and with a stranger. These findings further support evidence that men's fears of appearing weak for accessing therapy were reduced following assurances of confidentiality and anonymity (Huntley et al., 2020;Millar, 2003;Tsui et al., 2010).
Supporting the findings of Hine et al. (2020), some men outlined the need to tailor IPV services to accommodate the unique needs of male victims. Treatment models for male victims need to consider the role of masculinity and gender identity (Liddon et al., 2019;. Connell (2000) argued that hegemonic masculinity is a fluid concept and that commitment to the norms and expectations of masculinity can be superseded by distancing from and rejecting social practices, such as stoicism and emotional control (Brown et al., 2019). The men who received help from services that work with male victims of IPV reported that sharing their experiences in a support group with other men who had been through a similar experience provided a 'safe' place to challenge gender norms and reduce feelings of shame and embarrassment surrounding masculinity and victimisation (Carmo et al., 2011;Randle & Graham, 2011).

| Limitations of the research and suggestions for future research
The men who took part in this research self-identified as victims of female-perpetrated IPV. Given that some of the men were reluctant to identify as 'victims' and even objected to the interviewer's use of that term (Drijber et al., 2013;Tsui et al., 2010), consideration should be given to the language used in the recruitment materials and the phrasing of questions in future research. Researchers should be mindful of participants seeking to avoid a victim identity (Donovan & Hester, 2010) for fear of being perceived as less masculine (Bates, 2019).
Further research exploring the desirability and efficacy of support for male victims is required (Bates & Douglas, 2020) to enhance understanding of the experiences of male victims of IPV. This in turn can inform the development of support services and therapeutic practice that centres the needs and experiences of male victims. At the same time, there is also a wider need to challenge traditional masculine norms that inhibit recognition of male victimisation and prevent men from seeking help (Huntley et al., 2019).

ACK N OWLED G EM ENTS
The authors would like to thank the participants who gave their time and spoke so openly about their experiences.