Be a Man!
Male Identity, Social Changes in
Contemporary America, and the Impact on
Mental Health:
Suggestions for Working with Men in Therapy
WSPA October 2014
Brennan Gilbert PsyD
Robinder Bedi PhD
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Reflection Exercise on man you know (are)
Reflection exercise on why men don’t come to or stay in counseling. Now substitute another identity. What happens?
Social changes 101(Brennan)
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Economic
Cultural
Social
Academic
Generation (focus group)
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Hegemonic masculinity
Privilege and the identity of no-identity
The masculine double bind
Male gender role conflict/stress (O’eil et al., 1986; Eisler, 1995)
Male identity 101(Brennan)
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Presenting Problems in counseling(?)
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Small group/table discussions
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Data on what helps/hinders
Canadian Journal of counseling study
Men do go; men drop out
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Therapeutic Relationship development
Identity development/reflection
Men in therapy (rob) (30)
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Priming and impact (Cosenzo, Franchina, Eisler, Krebs, 2004)
GRC: Success, Power, and Competition; Restricted emotionality; Restricted Affectionate Behavior Between Men; Conflict between work and family relationships.
Some research to suggest a role of testosterone in Male Gender Role (but also some recent research to suggest testosterone a consequence of competition, not
cause).
What do they think???? Male client they had good/bad experience with.
Suggestions: (Both) (30)
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Learning, conditioning, modeling,
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Talking about others is ok (building theory of mind)
Role as strength. Balance and look for exceptions (there are always exceptions).
Role-play, scenario, practice
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Alliance based language, goal direction, teamwork with therapist, overcoming (resiliency language).
Risk assessment and management
Discussion.
Reflection Exercises
• Reflection Exercise on man you know (or are)
• Reflection exercise on why men don’t come to or
stay in counseling. Now substitute another
identity. What happens?
• Steve Hayes on Compassion: “The messages we
carry”
– Broken finger
Introductions
• Introductions
• Some common perspectives:
– “World doesn’t appreciate men anymore”
– “Gender differences are universal”
– “Men are just reacting to women empowerment
(aka hate feminists)”
– “This is just about white men”
– “Its just biological”
Using Kegan’s (1982) Model
• From “The Evolving Self”
• “Identity” is a shifting target over time, with a locus that changes
– i.e. the centrality of one’s socially referenced identity changes over
time (Valiant study has supported this)
– Pick one of your identities:
• If we were doing some science, what % of you would that explain?
• Where did you learn what that means? (parents, friends, tv, music,
interactions with others?)
• What are times/places that this seems like it explains a lot about you? Times
when/places when it doesn’t seem to explain so much? Perhaps that other
identities or senses of yourself seem more “central”?
• Me- at times, maleness seems so central, other times whiteness, then
youngness, others, age, others education, others being from Michigan, etc.
etc.
• We know "men" is an aggregate category, and not every man fits
the stereotype, perfectly, all the time
– Therefore, in what situations, or contexts, and what variables
contribute?
A Little on Identity
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What is an identity and why do we have them?
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I think of identity scripts, schema, or self-activation from a few perspectives:
– Are they different than schemas? Self? True self?
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Belonging and relationships
Anxiety management (coping) and meaning
Goal directed behavior
More?
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Developmental Constructivism (Kegan , 1982)
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Given that these schemas are learned, they are context bound and inter-related
with environmental feedback
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For some men, therapy is a welcome nourishment, reprieve, and opportunity. For
others, it is seem as more of the problem. (The double bind)
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Given that a compassionate understanding of the identity socialization is part of
‘cultural competence,’ what do we know about male identity and how to work
competently with this population?
– The degree to which any schema or self-state is our ‘subjective’ reality, it determines our
behavioral options (especially under conditions of distress).
This Presentation
Four main points:
1.
Identity, and masculinity in particular, is a conferred social status. Given that the
context is changing, what this identity “achieves” is changing. This has costs and
gains for individuals.
- Sexism, homophobia, and racism are less tolerated than ever before.
- The aforementioned point has much to do with the men we see as clients,
their children and spouses, and the work we do with all of them!
2.
The historically privileged status of men has obscured the impact of
identity socialization and continues to limit us.
- This can be usefully understood from a developmental identity
model (i.e. Kegan, 1982)
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For many men (and perhaps all of us in the right situation), threats to masculinity
are a threat to self. As competent providers we need to understand, and respect,
the perceptions of the person while encouraging growth.
4. ***A huge caution: Are we talking about men in ways we don’t talk
about other identities? Are we shaming them (us/me/you?) for things they have
been taught/acculturated into?
Here’s What Breaks My Heart
• Kipnis (1991):
– Boys held less, held outwards more, not matched in
linguistic pace, more likely to get scolded,
punishment, medicated, end up in jail….
– And the fathers…..
– And their fathers……
– And…….
• Men also fear the judgment of other men and
expect them to hold unrealistic masculine
standards for them (while saying they wouldn’t!)
What is “Traditional Masculinity”?
• Male Gender Role:
– “We use the term ‘male role’ to refer to the social norms that
prescribe and proscribe what men should feel and do. It is a
sensitizing concept that summarizes the general social expectations
men face, and these norms can be operatically assessed by examining
attitudes towards the array of prescriptions and proscriptions men
encounter because of their sex.” (Thompson & Pleck, 1986, p. 531)
• David & Brannon (1976) traditional American masculinity:
– “No sissy stuff”
• Distance self from femininity, homophobia, avoid emotions
– “Be a big wheel”
• Strive for achievement and success, focus on competition
– “Be a sturdy oak”
• Avoid vulnerability, stay composed and in control, be tough
– “Give em hell”
• Act aggressively to become dominant
Hegemonic Masculinity
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Traditional Definitions of Masculinity as access to power:
– “This traditional definition of masculinity is hegemonic in that its central organizing principle is
placing men above women and some men (e.g., White, able-bodied, educated, heterosexual,
middle and upper class) above other men (e.g., men of color, [disabled, gay, bisexual, lowincome). This definition of masculinity relies on misogyny and homophobia as its primary
means to enforce rigid and limited gender norms for men…
– “…This hegemonic traditional definition of masculinity results in the oppression of women,
marginalization of some men, and limitations for all men.” (Harris &Edwards, 2010, p. 45)
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From Focus Groups (Harris & Edwards, 2010):
– “performing hegemonic masculinity became a strategy to recapture a sense of manhood that
had been lost as a result of the emasculating aspects of racism, classism, and homophobia
they experienced.” (p. 51)
– “external pressures and expectations to perform hegemonic masculinity, which were
learned and internalized during periods of pre-college gender socialization and reinforced in
college, ultimately prevented them from being the men they truly aspired to be. Instead,
our participants were looking for someone to give them per- mission to stop being the
men they felt they had to be and needed permission to be the men they aspired to
be.” (p. 56)
Gender Role Conflict
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A measure of how much distress the stereotypical gender role causes
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O’neil (2008) reviewed 232 research articles on Gender Role Conflict
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Worth noting: Testosterone does play a role:
– “A psychological state in which socialized gender roles have negative consequences on the
person or others.” (O’Neil, Good, & Holmes, 1995, p. 166–167)
– Is When “rigid, sexist, or restrictive gender roles result in personal restriction, devaluation or
violation of others or self.” (O’Neil et al., 1995, p. 167)”
– Broadly, strong relationships (in the expected directions) to:
– Depression, anxiety, stress, self-esteem, shame, suicidality, and etoh problems across
demographics.
– Also related to interpersonal functioning, marital success and satisfaction, friendships and
propensity to stereotype others.
– Violence towards women and help-seeking
– Several studies that clients are higher than non-clients in GRC
– “Studies have found that racial identity, ethnicity, and acculturation moderate and mediate
GRC.” (P. 418)
– Men higher in basal T less physiologically responsive to gender threatening feedback (Caswell,
Bosson, Vandelo, & Sellers, 2014)
– What does this mean?
Health Disparities
(Harvard Men’s Health Watch, 2010)
• Men more have a shorter life span
• More likely to die of preventable, injury, selfinflected, and risk related causes
• Less likely to do healthy things (you name it)
Its not just due to stigma…
• It’s also an acculturation issue:
– Are men taught to seek help? By their dads? Is it
modeled and encouraged?
– Help-seeking behavior is an end product of multistep intellectual process.
– Is healthy behavior for men encouraged?
Ask for help?
What?
No way!
I do!
To who?
Help is
available?
Work and Education Stats
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The nature of the American workforce and economic opportunities are changing:
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For example, agriculture employees to total workforce (Bureau of Labor Statistics, 2008 as cited in Klienfeld,
2009b)
• 1948: 14.5%
• 2005: 1.6%
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Education is increasingly important to make a living wage:
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Higher educated men(Sun et al., 2003)
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Men with high school education: 26% decrease in real income since 1973 (Sun, Fogg, & Harrington, 2003)
Jobs requiring higher education continue to have highest forecasted growth (Bureau of Labor Statistics)
Earn more
Less likely to be unemployed
Pay more taxes
Vote more
Marry more
And, Males as a whole, aren’t doing well in school:
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Scholastic differences in (Klienfeld, 2009):
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Percentage of college population
Entrance exam scores (nuanced though)
Grades
Time spent on school and college prep activities
Quality of thinking very different (Kleinfeld, 2009b)
**Something to remember: Men have never done great in
school (as a whole!) Higher droop out rates restrict range.
Add in race and SES and the picture gets more dire.
Understanding the “Gender Gap” In Education
• Girls are more likely than boys to:
– Take college-preparatory courses
– More likely to enroll in college immediately after high-school
– More likely to earn a bachelor's degree (Kleinfeld, 2009)
• Mead (2006):
– "The real story is not bad news about boys doing worse, it's good news
about girls doing better…. In fact, with a few exceptions, American
boys are scoring higher and achieving more than they ever have
before.” (p. 3)
– True, but “better than they have before” still may not be enough
• Kimmel (2006):
– “It is not the school experience that “feminizes” boys, but rather the
ideology of traditional masculinity that keeps boys from wanting to
succeed.” (Kimmel, 2006, p. 70)
– My issues with this quote: “wanting”?
Some new data:
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Relationships across the life-span
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Male friendships with women changing
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Changing values about work and fatherhood
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Changing norms for emotional expression
– ““…within-gender variation on our other demographic variables was more striking than
across-gender variation.” (Gillespie, Lever, Frederick, Royce, 2014, p.21)
– Less difference between genders in terms of valuing cross-gender friendships (Felmlee, Sweet,
Sinclair, 2012)
– Doubled number of stay at home dads in last decade (Kramer, Kelly, & McCulloch,2013)
– 89% considered paternity leave important; 60% very or extremely important (Harrington, Van
Duesen, Fraone, Eddy, Haas, 2014)
– Changes in “compulsory heterosexism” for masculinity as gay civil rights progresses
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“Queer Masculinities of Straight Men” (Heasley, 2004)
– President, Speaker of the House
– Brazilian soccer team
– Rise of the “metrosexual”
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Generation Changes
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Shifting philosophical/neurological models
– Internet has opened up forms of self-expression and discovery
– Changing media coverage (e.g. NPR series, marketing, magazine articles)
– Recognizing strengths (Kiselica & Englar-Carlson, 2010)
– Gender Binary? That is, like, soooooo 2002
– Changing understandings of what “self” is and how we make meaning (e.g. Bromberg, 1998;
Hoffman, 2001)
My Model
• Social, cultural, economic changes increasing baseline stress.
– Compounded by developmental injuries
– Including existential identity stress
• Lacking access to alternative narratives, perspective taking, and problem
solving
• Resort to over-learned, automatic, culturally determined responses
– Limbic system activation
– Stereotype threat
• We need compassionate responses to men (just like everyone) and the
challenges they face:
– “…fears associated with loss of privilege— especially among young
Caucasian/White men—may give cause for celebration among some profeminist scholars; yet building a gender-neutral future on a foundation of fear
and anxiety among men is not ideal.” (Pompper, 2010, p. 694)
“Masculine Challenges”
• A man walks into a bar….
– How is he likely to carry himself? Why?
• As a status, masculinity is hard to get, easily lost, and needs to be
conferred social (vs. more often biologically for women)
– Precarious masculinity and performative identity (Vandeloo & Bosson, 2013)
– Kimmel (2006): definition has changed; having something to prove hasn’t
• We don’t make boys kill lions; but somehow, still need to prove manliness?
• Irony- risks we take and risks we don’t!
• “Masculine Challenges”
– Gender role conflict can be activated by instructions, and impacts
performance, physiology, and behavioral repertories (Cosenzo, Franchina,
Eisler, Krebs, 2004; Lash, Eisler, & Schulman, 1990).
• How may being in therapy, the questions asked, and the relationship with
the therapist activate masculine gender scripts?
– Seeking help; admitting emotionality; experiencing distress; feeling
subordinate; new situation; stigma….
Men in Counseling/Psychotherapy
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Men do sometimes go to counseling/psychotherapy, but often drop out; those
who stay often benefit.
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Women are more likely to seek counselling/psychotherapy (estimated gender
breakdown is 7:3; Vessey & Howard, 1993), but men do attend (estimated one in
seven men; Collier, 1982).
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When men do attend , they are more likely to drop out (Pederson & Vogel, 2007)
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Drop out rate is as high as 50% to 75% for domestic violence programs, even when
participation is not mandated (Gondolf & Foster, 1991; Daly & Pelowski, 2000),
– Most commonly stated reasons for unilateral/premature termination include: dissatisfaction
with therapy, discomfort with therapist, therapy had detrimental effects (Hunsley et al., 1999).
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It appears that men may equally benefit (e.g., Zlotnick et al., 1996) or benefit even
more than women (e.g., Cottone et al., 2002).
We Know Relatively Little About How
to Help Men in
Counseling/Psychotherapy
• Men are neglected in counseling/psychotherapy research:
• From 2000 to 2011, the ratio of research in the Canadian Journal of
Counselling and Psychotherapy (CJCP) examining female issues or
employing an exclusively female sample vs male issues/male samples was
12:1 (Hoover et al., 2012).
– From 2000 to 2013, the average sample size in female-only studies was about
N = 24 (SD = 5) vs. only about N = 7 (SD = 8) for male-only studies (Bedi et al.,
submitted).
– Across all research studies, the average sample size was 48 for males (SD =
17.6) and 78 for females (SD = 20), which was statistically significant (t = 2.86,
df = 121, p = .005) with about a moderate effect size (d = 0.37). (Bedi et al.,
submitted)
• Most research studies on the therapeutic alliance have samples of about
75% or more women (Bedi & Richards, 2011).
Evidence-Based Practice???
• Well-established guidelines exist for ethical and effective practice
with women (American Psychological Association, 2007; Canadian
Psychological Association, 2007)
– Not for men/boys
• Know relatively little about the characteristics, processes, and
outcomes of men in counseling/psychotherapy, compared to
women.
• Very little systematic or theory-driven empirical guidance on how to
adapt services to accommodate the culture of masculinity
• The little research we have seems to indicate men tend to prefer a
different set of therapeutic processes (Pollack, 2001; Striver, 1986).
Gender Competence
• Ability to achieve positive outcomes with either
female or male clients.
• Some mental health professionals were better at
working with either men or women (Owen,
Wong, & Rodolfa, 2009).
• Practitioners who are accustomed to working in
androgynous environments may fail to fully grasp
the foreign nature of counseling/psychotherapy
to men who hold “traditional” North American
masculine gender role beliefs.
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Many characteristics considered desirable in a client are traditionally feminine
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clear expression and verbalization of emotions,
ability to discuss personal pain,
the willingness to be vulnerable,
turning to others for help resolving problems.
Traditional gender role teaches men to avoid acting “like a woman” (David &
Brannon, 1976).
– View counseling or psychotherapy as feminizing and believe that seeing a mental health
professional would threaten their masculinity (Englar Carlson & Shepard, 2005).
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Conventional masculine gender norms also emphasize separation and
independence at the cost of attachment and connection, yet counseling and
psychotherapy call for a bond between the professional and the client
(Osherson & Krugman, 1990).
• “We feel the time has come to turn our focus
to how we, as a profession, can better serve
men in our society. Too often, we have heard
from colleagues, students, supervisees, and
supervisors, that they experience a sense of
frustration, helplessness, and ineffectiveness
when working with male clients” (Westwood &
Black, 2012, p. 290).
Study 1: Bedi & Richards (2012)
• Investigated what 37 adult male clients believed
helped form a good “working relationship”
(therapeutic alliance) with their MHPs, using
multivariate concept-mapping analyses of sort data
(and using participants’ language in naming
categories).
• The nine category titles selected for the 74 identified
elements were: Bringing out the Issues, Non-Verbal
Psychotherapist Actions, Emotional Support, Formal
Respect, Practical Help, Office Environment,
Information, Client Responsibility, and Choice of
Professional.
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The three most important categories under the control of the MHP were: Bringing out the Issues, Formal
Respect, and Practical Help.
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“Bringing out the Issues”
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The most highly rated variables in this category were:
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Largest category,
Statistically significantly more helpful than all other categories except Client Responsibility and Formal Respect,
Understood the most uniformly across the men in this study.
Remained the most helpful even when the data was disaggregated by MHP gender.
“the psychotherapist listened to my truthful negative personal reactions to him/her,”
“the psychotherapist made encouraging comments,”
“the psychotherapist asked questions.”
Other examples:
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Asking about other parts of client’s life
Reflecting feelings, paraphrasing content
Validation, normalization, compliments
Asking about goals, asking questions
Challenging the client
Self-disclosure that de-emphasized expertness
Let client decide what to talk about
• Formal Respect
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being greeted by name
recognizing client
not turning client away despite reasonable cause
letting client choose where to sit
taking clients’ office atmosphere preference into
account.
• Practical Help (teaching skills, referrals,
resources, giving homework).
Study II: Richards & Bedi (in press)
• An abbreviated form of the
questionnaire-based CIT, focusing on hindering
factors only, was utilized to capture critical
incidents that were retrospectively
self-reported by 76 clients to be harmful to the
alliance.
• 56 unique CIs extracted and sorted into 7
researcher-named categories:
Not the Right Fit/Approach
Client Unsure of What to Expect in
Session
Counselor/Psychotherapist Pressuring
the Client
Client Uncertain or Untrusting
Client Not Putting in Enough Effort
Time/Timing Problems
Counselor/Psychotherapist Acting on
Assumptions About the Client
• Not the Right Fit/Approach: highest highest participation rate
(32.9%).
• 2nd: Client unsure of what to expect
• 3rd: Pressuring the client
• Not the Right Fit/Approach. centers on a discrepancy between
what the client expects and what the clinician provides.
– The approach, style, direction, or diagnosis of the clinician did not
match the client’s understanding of what was helpful, important,
or appropriate.
– The practitioner’s actions appeared incongruent with the client’s
desirable previous personal experiences or current issues or
priorities for session.
• Client Unsure of What to Expect in Session.
– Experiences listed describe times when the client felt confused,
surprised, taken advantage of, or wronged after encountering some
highly unexpected behavior of the clinician.
• E.g., an unexpected visible display of emotion or conversely showing an
all-business personality, making unforeseen demands on client, not
providing enough information to the client about plans for treatment, or
providing inaccurate communication about plans for treatment.
• Counselor/Psychotherapist Pressuring the Client.
– Incidents when the client feels the clinician (or another person) is
pushing an agenda on the client.
• E.g., Pre-treatment decisions (which clinician to see);
• E.g., Issues during treatment (who should be involved, what type of
treatment approach should be utilized).
Example of a Man in Counseling
https://www.youtube.com/watch?v=OBUJX8fahTg
• What aspects of the conventional male gender
role did you see manifest?
• Anything that resembles your experience with a
“masculine” man?
• Your success stories and stories of difficulty?
• Your examples of what usually works and doesn’t
work?
Recommendations for Developing a
Therapeutic Alliance With a Male
Client
1. Help bring out the issues in a manner more
fitting to many men: asking about goals, validating
the client’s experience, making positive comments,
asking questions, providing suggestions,
normalizing the client’s experience, referring to
details from past sessions, encouraging the client,
asking about parts of the client’s life unrelated to
the presenting concern, letting the client decide
what to talk about, and listening to the client’s
truthful negative reactions about the MHP.
• 2. Demonstrations of formal respect:
greeting the client pleasantly at the start of the session, recognizing
the client in the waiting room, remembering the client’s name, not
turning the client away despite reasonable cause (e.g., funding has not
come in yet), and taking the client’s preferences for the office (e.g.,
chair position, which chair to sit in, air conditioning) into account.
• 3. Quickly offering the man practical help (e.g., teaching him skills,
readings, resources, referrals)
• 4. Role induction: Solicit expectations, educate them about the
process, and walk them through things first (take out the uncertainty
and ambiguity as much as possible).
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5. Vocabulary of men (action words, movement metaphors, de-stigmatizing)
Canadian Veteran’s Transition Program (Amos, 2013; Todd, 2009; Westwood &
Black, 2012)
– Not “post-traumatic stress disorder” (implies weakness etc.), but “stress
injury.”
– Teaching skills of “active listening” as life skills required or successfully
navigating the world of work, school, relationships, business, sports, etc.
• Bestow an advantage on the person (make more informed
choices/decisions)
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“Dropping the baggage”
“Getting hard work done”
“getting past barriers or blocks”
“moving forward in life“
becoming more “honorable” (> than “sensitive”)
trusting one’s “gut,” (> following one’s “intuition”,
providing “back-up” (rather than “support”),
“repairing” (> “healing;”)
“transition”
As a counter to the normative male alexithymia prevalent in North America (Pollack
& Levant, 1998), using such terms provides traditionally masculine men an
accessible route to labeling their strong emotions and physical reactions.
Recommendations
• Do one’s own work
• Asking men what they think (feel?) about asking for help and perhaps how
that will impact the work
• Reframing “defensiveness” and “unwillingness to engage”
• Working from the “inside out”
– Challenging gender role behavior ain’t gonna go well. And isn’t multiculturally
competent!
– Work with to understand motivations/perceptions from within schema and
broaden perspective on options, choices, values, anticipated outcomes, etc.
– Understand utility of identity scripts and question the presumption of conflict
(i.e. know and not choosing or don’t know?)
– Develop “psychological mindedness” by examining implicit theories,
meanings, interpretations, and bridging to learning and reinforcement
• i.e. you’ve learned that being weak is shameful vs. why is being weak shameful?
• i.e. I wonder if this touches on how men are taught not to be weak? Or that having
emotions is weak? Have you seen other guys react to that?
Recommendations 2
• Men have perspectives on these issues! Need permission from
others (especially those who have power) to have their own voice!
• Utilize Kegan and other developmental/identity approachesmeaning making changes over time and can be developed!
• If not directly in work, then recognizing how the situations of work,
life, and therapy can trigger masculine normed behavior.
• Advocate for compassionate approach and confront man shaming
and over generalizing stereotypes.
References
American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57, 1060-1073. doi: 10.1037/0003066X.57.12.1060
Anderson, E. (2009). Inclusive masculinity: The changing nature of masculinities. New York, NY: Routledge.
Bedi, R. P., & Richards, M. (2011). What a man wants: The male perspective on therapeutic alliance formation. Psychotherapy, 48, 381-390. doi: 10.1037/a00224424.
Bedi, R. P., Young, C., Davari, J., Springer, K., & Kane, D. (submitted). Gendered Research in the Canadian Journal of Counselling and Psychotherapy. Manuscript under review.
Bromberg, P. (1998). Standing in the spaces: Essays on clinical process, trauma, and dissociation. Hillsdale, NJ: The Analytic Press. Hillsdale, NJ.
Bureau of Labor Statistics. (2008–2009). Occupational outlook handbook, 2008–09 edition. Retrieved December 8, 2008 from http://www.blas.gov/oco/oco2003.htm.
Canadian Psychological Association, The CPA Section on Women and Psychology (SWAP). (2007). Guidelines for ethical psychological practice with women. Retrieved from
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Caswell, T. A., Bosson, J. K. Vandelo J. A., & Sellers, J. G. (2014). Testosterone and men’s stress responses to gender threat. Psychology of Men & Masculinity, 15, 4-11. DOI: 10.1037/a0031394
Collier, H. V. (1982). Counseling women: A guide for therapists. New York, NY: Macmillan.
Cosenzo, K. A., Franchina, J. J., Eisler, R. M., Krebs, D. (2004). Effects of masculine gender-relevant task instructions on men’s cardiovascular reactivity and mental arithmetic performance.
Psychology of Men & Masculinity, 5, 103-111. DOI: 10.1037/1524-9220.5.2.103
Cottone, J G., Drucker, P., & Javier, R. A. (202). Gender differences in psychotherapy dyads: Changes in psychological symptoms and responsiveness to treatment during 3 months of therapy.
Psychotherapy, 39, 297-308.
Daly, J. E., & Pelowski, S. (200). Predictors of droput among men who batter. Violence Victimology, 15, 137-160.
David, D. S. & Brannon, R. (1976). The Forty-nine percent majority: The male sex role. Random House: New York
Eisler, R. M. (1995). The relationship between masculine gender role stress and men’s health risk: The validation of a construct. In R. F. Levant & W. S. Pollack (Eds.), A new psychology of men (pp.
207–228). New York: Basic Books.
Eisler, R. M., & Skidmore, J. R. (1987). Masculine gender role stress: Scale development and component factors in the appraisal of stressful situations. Behavior Modification, 11, 123–136.
Englar Carlson, M., & Shepard, D. (2005). Engaging men in couples counseling: Strategies for overcoming ambivalence and inexpressiveness. The Family Journal, 13, 383-391.
Felmlee, D., Sweet, E., Sinclair, H. C. (2012). Gender rules: same- and cross-gender friendships norms. Sex Roles, Online. DOI 10.1007/s11199-011-0109-z
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Enhancing Multicultural Competence
Questions to ask yourself as enhance multicultural competence (from O’Neil, 2008):
“(a) Do my stereotypic beliefs about men affect my therapeutic judgment with men
who differ from me in terms of race, class, age, sexual orientation, nationality, or
ethnicity?
(b) Do men who deviate from traditional male stereotypes affect my judgment about
their health or psychopathology?
(c) Are my expectations, assessment processes, and therapeutic approaches different
when treating men from different races, classes, sexual orientations, and ethnicities?
(d) Is it important to assess male clients’ racial, cultural, or sexual identity in the
context of their presenting problem?
(e) Is it important to assess male clients’ experience of racism, sexism, classism,
ethnocentrism, heterosexism, or any other form of oppression?” (p.418)