Breaking Through: Recommended
Best Practices
for Working with Men
Study of Experienced Practitioners
• APA members with oversampling of
practitioners with expertise in working with
boys and men
• Qualitative analysis
• Identified 10 themes
1. Stereotypes, Biases, and
Discomfort With Male Clients
-
Practitioner biases against males and discomfort in the therapeutic
relationship when working with male clients.
Generalized negative set of anticipations or stereotypes about males
-
“My client told me of an incident in which a female therapist said to a male
client that males are aggressive and abusive ‘by nature’ and should be
expected to behave in that manner.”
“A man related that when he called a rape intervention program to talk
about his personal experience of sexual abuse, the counselor told him the
program did not work with offenders.”
One participant said, “I hate that ‘Men Are From Mars' crap. I am sensitive, I
am afraid, I deeply care about the less fortunate, sexism, racism,
heterosexism.”
“The therapist needs to be emotionally comfortable with masculinity”; and
“Therapists who have looked seriously at their own gender biases” as
reflecting best practices.
2. Awareness and Knowledge of
Gender Socialization
• Therapist awareness and knowledge of gender
socialization and male development.
– (1) work with men from a gendered framework
• develop self-awareness as a gendered person of how one’s
own gender contributes to the experiences of treatment for
the male client
– (2) “think complexly about masculinity [by] looking at
problems in a systemic manner.”
• Understand the processes of gender role socialization in
society
• Recognize the individual man exists in a social context of the
economy, politics, family, community, inter-generationally,
with peers, work
2. Awareness and Knowledge of
Gender Socialization (cont.)
• Therapist lack of awareness and knowledge of masculine
gender socialization and male development
– Participants noted the harmful effects of lacking gender selfawareness and training in working with male clients without
knowledge of gender issues, male development, and
socialization.
– “therapists who unknowingly collude in gender stereotypes or
have unresolved issues with men.” For example, one participant
stated:
• Quote: My clients often relate how female and male therapists they
have seen previously put them on the defensive by “strongly
suggesting” or directly stating that boys “don't want to talk” and men
are selfish, putting their jobs/careers and interests before their
families. They feel that these therapists have never understood that in
our society, boys and men are trained to “suck it up and go it alone.”
3. Gender Issues in Assessment
• Incorporating gender issues into assessment
– examining the impact of masculine socialization, roles,
and identities on client issues for assessment
• competent services should “include male socialization in America
as an important context for framing their assessment and
diagnoses.”
• “considering how some ‘acting out’ behavior may be better
understood within the framework of gender role socialization,”
and expressing that best practices should include “understanding
how male depression presents itself.”
• Substance use
– Participants also identified assessing how genderconforming and nonconforming patterns may contribute
to presenting symptomatology
• Benefits and costs of conformity and non-conformity
3. Gender Issues in Assessment (Cont.)
• Biased assessment and diagnosis
– Underdiagnosing gender-atypical and overdiagnosing
gender-typical presenting concerns
• For example, “One patient told me that a previous therapist
actually said to him that ‘men don't get eating disorders.‘
• Another patient told me that a previous therapist asserted
that the patient must be gay since only gay men get eating
disorders.”
– The other side to respondents' concerns about
diagnosis related to excessive diagnosis of malestereotyped concerns (e.g., ADHD).
4. Masculine Gender Roles and
Socialization in Treatment
• Addressing masculine gender roles and socialization in
therapy.
– Importance of addressing gender roles and socialization as
part of treatment itself.
• help men recognize “how it interfaces with difficulties in
relationships and the typical therapy process.”
• importance of “helping male clients overcome aspects of
masculinity that he would prefer to reject (e.g., overfocus on
success/work).”
• encouraging practitioners to “be aware of the pressure of being the
breadwinner,” asking questions about “whether they had achieved
enough in life,” and noting the negative effects of “a male client’s
inability to get work.”
• One participant noted how it was “particularly helpful and
therapeutic for the client to be able to see the positive and
problematic components of how he was thinking about and using
his own masculinity in different areas of his life.”
4. Masculine Gender Roles and
Socialization in Treatment
• Several mentioned the importance of “helping young male clients find
healthy male role models,” with one describing a “female therapist
who helped an adult male client connect with a mentor who could
teach him how to be a ‘man’ in the business world.”
• Others noted that “male therapists can serve as role models for boys
and adolescent males regarding a number of behaviors (expression of
emotions, anger management).”
• This theme dovetailed with comments about the importance of
helping males construct adaptive gender roles that are individually
constructed.
• Participants noted that “therapists should not prescribe any particular type of
gender role behavior, be it traditional or nontraditional. Instead, therapists should
help boys and men find a gender role identity that works for them.”
– Examining benefits and costs exercise
4. Masculine Gender Roles and
Socialization in Treatment (Cont.)
• Not appropriately addressing masculine gender
socialization
– Other respondents were concerned about practitioners
reinforcing detrimental masculine gender roles and behaviors.
• “reinforcing male stereotypes that do not give men permission to
understand and express their emotions and develop identity based
on self rather than status/achievement.”
• Other participants indicated problems coming from “assuming ‘boys
will be boys’ and allowing more drug/alcohol or other damaging
behavior”
• Challenging a boy to “man up” because they are “just being too
sensitive.”
– A number of participants were concerned about practitioners'
failure to assess or validate strengths of traditional masculine
gender roles and behaviors.
• “It is crucial to balance worth by pointing out that traditional men's
action/silence tendencies have advantages in some situations, just
as talking does in others.”
5. Emotions in Therapy
•
•
Addressing emotions in therapy.
Participants emphasized the importance of addressing the impact of gender
socialization on males' emotional expression. They suggested that practitioners work
with clients to help them understand the effects of social prohibitions against men
showing emotions—other than anger—and needing to be strong and in control of
their feelings.
– The client expressed surprise that the (male) therapist would feel that way and [was] even more
surprised he would convey the feelings since he had always been told to “be strong.” This led to
a brief educational moment in the group regarding societal messages to men and boys.
- Another issue within this theme was the importance of addressing emotions
gradually with some men. One respondent said it was important “not to pressure the
client to express and get in touch with feelings till able to do so in a supportive trusting
relationship.”
- Recognizing and addressing core emotional issues underneath anger was
also part of this theme, including “acknowledging the components of anger—shame,
fear, guilt, etc. —and to have these underlying feelings validated.”
5. Emotions in Therapy (Cont.)
• Getting it “just right”
– Participants believed it created problems in psychotherapy when
practitioners held negative beliefs about men's emotional
capacities.
• “There is a bias in the belief that because men do not readily speak of
their emotions, that they are devoid of deep and real affective
experiences.”
– Another harmful practice identified was going too far in the other
direction by addressing emotions excessively or prematurely.
• One respondent observed colleagues who “move too quickly into
questions of feelings without time for the man to gain a sense of
connection, which often comes through discussion of topics or issues
which do not contain immediate affective content.”
• Respondents also found it problematic when practitioners neglected to
assist male clients with developing emotional skills.
– Skills training is a useful way to work with emotions
6. Male-Friendly Adjustments to
Practice
• changing the way treatment is presented to males, the way that
therapeutic language gets used, and how it is conducted
– others suggested that it creates an unwelcoming message to boys and
men in treatment by “not decorating offices/waiting areas for males
(sports memorabilia, newspapers, magazines etc.).”
– using male-congruent communication styles such as metaphors, humor,
being more informal, and using more self-disclosure. One respondent
said, “I like to use metaphors that have a personal meaning to who I am
working with: engines running without oil, a coach versus a referee.”
- Being active in treatment was also encouraged.
- “young boys often don't work that well just ‘sitting and talking'” and the
importance of “incorporating play modalities, movement, and young
male interests into therapy.”
- Other participants identified it as problematic to rely exclusively on
medicating boys and men. For example, a “parent of an elementary
school aged boy was told that medication was the only treatment to
use for ADHD and that behavior therapy does not work with boys
who have ADHD.”
7. Abuse and Trauma Issues
• Participants underlined the importance of practitioners' developing
awareness of the prevalence and consequences of males' experiences of
abuse and implementing sensitive treatment.
– The importance of routine assessment for abuse was emphasized by
participants,
– asking about abuse should be done as “a matter of course during the intake
process
• if my clients are survivors of abuse or neglect, stating that I am asking them about issues
that often bring guys in for counseling or psychotherapy.”
• There was a suggestion from some participants that the lack of assessment
of abuse in males was part of a systemic set of biases. One participant
reported that
– I have consulted in therapy clinics where the clinicians refused to ask male
clients if they have had a history of trauma (particularly coerced sexual contact),
because they believed that it “didn't really happen to men” or they “didn't want
to make them feel wimpy.”
• Addressing the effect of the abuse on the male's sense of masculinity.
•
Respondents highlighted the effect of “feeling ‘feminized' by the experience of
being sexually victimized.”
8. Positively Addressing Sexuality and
Sexual Behavior
- One of the issues discussed in this theme was the importance of
directly discussing sexuality in treatment.
- “I bring up issues related to masturbation, sexual attraction, sexual
impulses early in therapy so that clients feel that the framework of
therapy allow[s] them to openly discuss these issues.”
- Respondents also identified the importance of not pathologizing
male sexuality.
- One described a male client reporting being reassured by learning that
“men ‘like to look' and are more responsive to visual stimulation, and
that ‘looking' is not equivalent to acting/behaving.”
- Others discussed the importance of examining expectations of male
sexuality in connection to larger socialization experiences.
- For example, “The therapist is able to help this man understand that
male socialization makes men believe that they are in charge of sex
and should always be in control.”
9. The Intersection of Other
Sociocultural Identities
• Addressing and supporting diverse men.
• One's identity and experiences as a man take place in the context of
other sociocultural identities connected to sexual orientation, race,
and ethnicity.
– Within this theme, participants also noted the importance of “listening
and understanding how this culture, and whatever subcultures the boy or
man in front of you [espouses], has defined masculinity, and how much
these assumptions have been stamped into the fabric of his being.”
• Disentangle sexual orientation from stereotypical gender roles
– “techniques that do not equate diversity in sexual orientation (e.g., gay,
bisexual, men who have sex with men) with ‘femininity.’”
• Stereotyping men of color.
– Participants reported concerns about how practitioners' stereotypes
regarding men of color caused significant distress for male clients.
• One reported, concerning an African American client, “He had been in therapy with
a White therapist at least eight to 10 sessions. He thought they had developed
rapport by this time and was asked, ‘Are you on drugs or a drug dealer?’
• “[A] Hispanic older male shared [an] experience wherein he felt the therapist
‘looked down on me' when the client noted he did not have a job. The therapist
‘rolled his eyes and looked disgusted.'”
10. Intimate Relationships
• Addressing men’s family and interpersonal relationships.
– Practitioners “affirm men's feelings and attempts to connect with
their family and friends,”
• “affirm men’s feelings and attempts to connect with their family and friends,”
“encouraging their affiliative needs and strategies for connection.”
– Addressing men's family of origin experiences particularly
relationship with father
• “discussing his father hunger, and he has done family of origin work by
returning to visit his father and relating to him as a man rather than a boy.”
• Pathologizing men in couples and family therapy work.
– Within this theme, participants also discussed the importance of
supporting all clients' perspectives in couples and family therapy.
• “Male clients would tell me about marital sessions where they felt they
were the identified patient and the source of trouble in the marriage,”
• “Couples therapy where the therapist overly aligned with the female
partner, taking too critical a stance towards the male, who was seen as
being the ‘problem' when in fact it was more systemic”