Therapy with Men: Silent and In Need
by Miklos Hargitay, PsyD
One of my early clinical training experiences was working at a rape crisis center. While such places are often geared towards helping the disproportionate number of female survivors of sexual violence, it is important to recognize that male survivors also seek services and are often “othered” or neglected in spaces of professional mental health care. Over time, my supervisor and I noticed that our male clients often struggled to maintain appointments. After doing some detective work, we discovered that while the center was designed to be welcoming to our female-identified clients, male-identified clients did not feel that they belonged. As we made some cosmetic adjustments, such as including images of men in clinic brochures, some men began to feel more comfortable coming in, knowing that therapy could be their space as well. '
Men and boys in therapy
According to the American Psychological Association 2018 guidelines on working with men and boys in therapy, men who are socialized into exhibiting traits such as dominance, aggression, or the inhibition of emotional expression are at greater risk for poor mental health outcomes. Such traits are linked to decreased likelihood of seeking therapy services and medical care, as well as heightened risks for suicide, at risk behaviors, and more. Traditional masculinity can also intersect with other crucial factors, such as minority stress, racial/ethnic discrimination, ageism, and other forms of identity oppression can further exacerbate emotional distress and discourage men from being vulnerable about their personal experiences.
The effects of patriarchy on men’s mental health
A man who was taught from an early age to “toughen/man up”, “get over it”, or “keep it inside” when he feels upset is not going to be able to do that forever and will likely engage in self-destructive behaviors as a way to cope. Other problematic messages men are frequently exposed to can also promote toxic masculinity and diminishes honest emotional expression (“real men don’t cry”), racialized ideas about what it means to be a “strong black man”, or beliefs that expressing emotions is incongruent with being a capable provider or caregiver. In the words of advocate and public speaker Jackson Katz, men are often wearing a “tough guise” that may feel protective, but can come at a cost. Dr. Levant, a past president of the American Psychological Association and a key proponent for the 2018 guidelines for men and boys in therapy, comments ironically, “Though men benefit from patriarchy, they are also impinged upon by patriarchy”.
Another impact that traditional masculinity can have on men is the tendency to avoid emotional discomfort through a “problem solving” reflex. As a couples therapist, I have met with heterosexual couples where husbands may attempt to “problem solve” away their wife’s distress and pain. When I make the observation that some problems cannot simply be “fixed”, they can appear confused. For some men, viewing their marriage as a broken down car or a dilapidated house is a more palatable way to avoid sitting with emotional discomfort. In a world where men are rewarded for strength or action and diminished for “weakness”or passivity - it would make sense that men might default to “fixing” rather than emotions.
Men and DIY problem-solving
Finally, when I work with men around addressing a particular need, whether it is addressing anxiety, depression, trauma, or sexual dysfunction, a common response is that they wanted to “work on the problem” themselves and that it is only after they have realized they need more help do they find someone. While this may not be a problem in of itself in every situation, delays in accessing support can prolong pain and distress. A man struggling with panic attacks or PTSD-related triggers who tries to “white knuckle” through the experience is needlessly suffering.
But what if men just do not have emotions? Funnily enough, male clients have proposed that to me. I have trouble believing it. I have led therapy groups of men who have expressed deep vulnerabilities and pain after saying 2-3 weeks before that they “do not think therapy helps.” I have met with men who have only cried a handful of times in their life, including in session with me. One of my first experiences working with men in a correctional facility involved an inmate weeping after being given permission by myself and the correctional officer nearby. Whatever might be getting in the way of more men meeting with a therapist, it is not because men are not in need of support. They very much are.
For men, women who have important men in their life, and mental/medical health professionals, the following can be helpful to consider:
Men are rarely “not thinking or feeling anything”. All people are neurobiologically wired to experience emotion, and emotions are both essential and informative to make sense of one’s lived experience, regardless of gender identity. More likely than not, traditional male socialization has discouraged open, verbal expression of personal thoughts and feelings.
Since masculinity is subject to sociocultural forces that construct gender scripts and expectations, exploring new constructions or expressions of healthy masculinity is possible. Breaking rigid binaries and scripts that affect men from all backgrounds can yield more flexible definitions of what it means to be a man. For example, “positive masculinity” can offer many beneficial attributes, including caring for others, autonomy/independence, courage, and valuing close relationships.
Pappas, S. (2018, January). APA issues first-ever guidelines for practice with men and boys. Monitor on Psychology, 50(1). http://www.apa.org/monitor/2019/01/ce-corner
About the Therapist: Dr. Miklos Hargitay is a clinical psychologist and has worked with many men in therapy, in both individual and group capacities. He identifies as he/him/his and spends his time defining masculinity in terms that are healthy and constructive for him.