On Working with Men

I have a fabulous clinical supervisor who has been working as a therapist for almost 30 years. She has tons of experience with all sorts of people--adolescents, families, kids, women--but she's expressed surprise to hear how many men I see. My caseload has pretty steadily consisted of at least 25% men, and many couples.

Chances are that's because of limited resources. I can't think of a single Spanish-speaking male therapist who will work for free, so it's us or nothing. But that's given me a good opportunity.

An article called Need Therapy? A Good Man is Hard to Find was published in the New York Times on Saturday. It spells out what it calls the "feminization" of mental health care. The numbers of male counselors, social workers, and psychologists are dwindling rapidly. The article suggests that for that reason, many men who need counseling simply don't get the care they need, either because they don't want to see a woman or because a woman might not be able to understand and help as well as a man could.

Of course an important question is, Why aren't there more male counselors? Is the "talking cure" anti-masculine? After all, psychology was fathered by Freud. The article suggests the answer is the lower pay and prestige of fields like counseling and social work. (Psychiatry is still predominantly male-dominated.) So a "feminine" job is devalued, making only females attracted to it. Great. But, that speaks volumes to the importance of Pay and Prestige in Guy World.

In an article called "Why Men Fear Therapy," David Wexler, Ph.D. adds that the way therapy currently functions is a barrier for many men. "Too often therapists--both male and female--try to massage men into being more like women in the ways they express themselves and experience their emotions," he says.

"Think of what we typically ask a man to do in therapy sessions: recognize that something is wrong with him, admit that he needs help, openly discuss and express his emotions, get vulnerable, and depend on someone else for guidance and support--all extremely challenging tasks in Guy World. ...Many of us haven't figured out a way to do all these things and still really feel like men."

...And, I would add, many are simply not interested in doing them. Our goals are different. It is my job to adapt to my clients' realities.

I think many of us (us...women? feminists? therapists?) tend to dismiss or even belittle Guy World. Whatever that means exactly. I would like to better understand what it means, and these articles remind me how important it is to do so.

Call it socialization, but many men don't want to call it that. Consider how much they like talking about the animal kingdom. Steven Stosny, Ph.D. wrote an article called "Lions Without a Cause," entirely about male lions and how they can help us understand male humans. In a pride of lions, the females tend to congregate together and interact more than the males. The males hang out on the outskirts, guarding and protecting the group. They are defined by their proximity to the females and their ability to protect. He goes on to say that being a protector--or feeling like one--is the absolute most crucial priority for a man.

And the worst possible blow, he says, is humiliation. Shame-o-phobia, Dr. Wexler calls it. Underneath depression or anger or dysfunctional behavior often lies a feeling of failure, especially as a protector. Hence, a blow to the ego becomes a crisis of identity. Hence the importance of Pay and Prestige.

They both use these ideas to present tons of helpful tips for working with men, among them:

• Normalizing their experience ("I know this probably isn't much fun for you"),
• Educating ("Did you know men experience more physiological stress when they talk about feelings than women do?"),
• Assuming they have the best of intentions ("You're a good man, you're just doing some unhelpful things"),
• Using power language ("I want to help you be in charge, not the stuff outside of you"),
• Framing your goals as his own ("Compassion/listening is a great way to protect/provide for your family"),
• Seeing their aggression/withdrawal/substance abuse/etc. as their way of expressing pain,
• And good old-fashioned praise.

I have to say in my work, the men have been almost as diverse as the women. There have been some who fit the prototype of the machista Hispanic man (though most of those wouldn't be caught dead in the office of female, white, young hot-shot therapist. Self-selection, yes). But I've also seen a sweet, shy man with social phobia; a gay man struggling to be accepted at church; an adolescent who came to me crying after he committed a sex crime; a young man struggling with low sex drive; and a ton of other things. They have almost always been very respectful, cried with abandon, and happily accepted suggestions. We (women, feminists, therapists) might forget that they need just as much validation as anyone else. We talk about radical acceptance--we also need radical validation.

I don't think I gave men enough credit before, back when I only worked with women. It's been helpful to hear their side of the story. Frequently, I find them particularly fun to work with. We spend a lot less time talking in circles; they're often ready to get stuff done. They appreciate frankness and want me to be transparent, which I like to do. Many anticipate antagonism, so a little understanding softens them quickly. We tend to smile less but use more humor. Most really do have the best of intentions.

The best thing I can do for them is to work from within their world.