Men and Therapy: Because "According to science, bad things can happen to men too."
Not being a man, I feel a little presumptuous writing on this topic. However, somewhere between 70-80% of practicing therapists are female— so I might just be the right person for the job, or at least the statistically likely one. In my work with many male clients, I’ve come to respect that men have some specific and unique challenges when seeking therapy.
It’s surprisingly hard to find information on the actual ratio of male clients to female clients. In my practice roughly a third of my clients are male. Of course, there are intervening variables; such as that I do not advertise myself as a specialist in men’s issues; and that I live in liberal Austin, Texas. But my colleagues and I have commisserated about seeing a rise in men seeking therapy, which makes me wonder if things aren’t shifting.
Male-ness can be thought of as a culture, with its own set of norms and values. While in the last decade the concept of “toxic masculinity” has underscored what can be destructive about traditional male-ness, identifying strongly with one’s masculinity can also impart guidance to living a life that is healthy and nurturant. Perhaps recognizing and drawing on what is admirable about traditional male values can be a source of collaboration for therapists and clients.
Why do fewer men come to therapy, at least for now? Traditional male values of stoicism and self-reliance may be one reason. Another explanation may be that action-oriented men are uncomfortable with the traditional therapeutic emphasis on verbal exploration and insight (Deering & Gannon, 2005.) Perhaps the counseling community can adjust itself around some of these critiques by offering therapy that is more accessible to men.
For example, communication style can and should be tailored to support a client. Many male clients may do well with a more informal style that includes the use of humor and therapeutic metaphors relating to everyday life (“such as in the areas of work, sports, or technology” as Beel et al. offers—cue up the baseball and car metaphors!) and willingness by the therapist to discuss non-therapy related areas of mutual interest. (Beel, Jeffries, Brownlow, Winterbotham, Du Preez, 2017.)
Therapists should pace therapeutic work to the client, with lots of time spent building the relationship before embarking into deeper waters that might evoke feelings of vulnerability and shame. As Wexler writes, “If you are a clinician you know that men are very sensitive to shame and feelings of incompetence. As a result, we have to do whatever we can to de-shame the therapeutic experience. Otherwise, men will not show up.” (Wexler, 2014, p. 79 as quoted in Beel et al. 2017)
Format and focus is also important. Men may gain confidence if therapy is clear about its goals and process, as opposed to what Beel et al. describe as “more ambiguous, feeling- and insight- oriented strategies.” An explicit orientation to therapy roles, expectations, and options can be particularly helpful at the beginning of treatment for any client new to therapy, including men. Authors identify cognitive-behavioral therapy as a particularly good fit for many men due to its strong emphasis on skills and immediate applicability to everyday situations. “Positive psychology”, a branch of practice that focuses on emphasizing existing client strengths, is also indicated for male clients as it skirts stigma and engages the client to utilize existing successes and skills. See below for a bonus list of what one research team identifies as traditional male strengths.
“It’s not that I’m trying to be difficult. I just don’t get this stuff,” as one male client said to me recently. I nodded sympathetically (core therapy skill). I love working with my male clients and there are a lot of men in my life that I love and want to be well. If they were struggling, I would want them to get therapy, and for it to be therapy that made sense to them.
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“Remember the ladies” as Abigail Adams famously urged John. Never fear, as a lifelong feminist (and yes I love that word) I’m eager to explore specifically women’s issues in therapy and mental health in my next post.
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Bonus!
I particularly enjoyed this list of positive aspects of traditional masculinity I came across in Kiselica and Englar-Carlson’s article. I think it helps to make the above musings more tangible ie, what are these “traditional male values” of which I speak?
Positive aspects of a traditional masculinity:
Male relational style
Male ways of caring
Generative fatherhood
Male self-reliance
The worker/provider tradition of men
Male courage, daring, and risk-taking
The group orientation of boys and men
The humanitarian service of fraternal organizations
Men’s use of humor
Male heroism and sacrifice
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References
Beel, N., Jeffries, C., Brownlow, C., Winterbotham, S., & Du Preez, J. (2017). Recommendations for male-friendly individual counseling with men: A Qualitative systematic literature review for the period 1995–2016. Psychology of Men and Masculinity. Advance online publication, no page numbers available.
Deering, C. & Gannon E. (2005). Gender and psychotherapy with traditional men. American Journal of Psychotherapy, 59(4), 351-360.
Kiselica, M., Englar-Carlson, M. (2010). Identifying, affirming, and building upon male strengths: The positive psychology/positive masculinity model of psychotherapy with boys and men. Psychotherapy: Theory, Research, Practice, Training, 47(3), 276-287.
Rocheleau, M. (2017.) Chart: The percentage of women and men in each profession. Boston Globe. Retrieved from https://www.bostonglobe.com/metro/2017/03/06/chart-the-percentage-women-and-men-each-profession/GBX22YsWl0XaeHghwXfE4H/story.html
Screen grab and subtitle to this post taken from ManTherapy.org, a delightfully tongue-in-cheek website advocating men's mental health because "according to science, bad things can happen to men too."
Random side note: I overheard a really cute conversation today where an elderly non-native English speaking fellow was musing/debating with himself, "Is it 'cheek in tongue'? Or 'tongue in cheek?'"