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|Case Studies Mar/Apr - Page 11|
The first clinical task is not to assume the necessity of getting around male-gender stereotypes before "real" therapy can begin, but to track whether and how these patterns may manifest in this particular man, this particular couple. The therapist should be alert to how some individual couples may themselves use these stereotypes in ways that obscure who their partners really are. Instead, the author bears down hard on the old dichotomy of "Women are from Venus; men are from Mars." In my experience, this kind of polarization and focus on one aspect of identity—presumably male or female gender-linked traits—blocks many other important avenues toward change.
Useful avenues may take many forms, as they're woven into a complex tapestry of identity: family-of-origin history, including how men and women want to be different from their role models; exploration of historical times that provide many different models of masculinity; the developmental arc of family life, and how the freedom to construct gender roles widens and narrows over time; men's relationship to "how men should be," including who defines that for them and where they're located on the continuum from conforming to resisting. In couples therapy, context is all.
Both the stereotyped gender platform and the metaphor of therapy-as-boot-camp don't do justice to the genuine clinical acumen and sensitivity evident in this case study. Steven Stosny's way of working with clients' values about how they want to love is compelling. Too often, couples therapists work primarily on dissolving painful interactions, rather than connecting people to their deeply held yearnings to love well and be well loved in return. In moments of hurt, which become chronic realities in embattled or disillusioned couples, people can, literally, lose sight of what they care for in their partner.
Stosny provides concrete tools and interesting strategies to try with different men and their partners that emphasize behavior, working with private but insistent beliefs that partners maintain about each other, and the reality of the basic principle of change: practice, practice, practice. These strategies can be added to the repertoire of therapists sensitive to the undeniable ways that social factors foster or constrain intimacy. However, the nuanced and specific way he works with this couple and their particular hopes and struggles around intimacy seems qualitatively different from the unyielding theoretical and relational framework from which the clinical strategy is presumably drawn.
The point of the tongue-in-cheek opening to the case study was that hard-to-engage men, most of whom are chronically resentful or angry, traditionally are less eager to enter therapy than women, drop out more frequently, and sabotage the process more regularly. However, I'm delighted to learn that Michele Bograd has a better track record in attracting such men and retaining them for the duration of her treatment, and that the men she retains have maintained their improvements at one-year follow-ups.