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Women Treating Men - Page 2

Early Days

My first male client at the clinic where I was hired right out of graduate school offered me an unforgettable glimpse into what can go wrong between a male client and a female therapist. George, a young man who was going through a difficult divorce and estrangement from his young kids, arrived for our appointment looking alternately frightened and hostile. Since I was the new therapist on the block, I'd been assigned the worst treatment room: a tiny closet of a space with no windows and a door that didn't stay shut unless it was locked. I welcomed George in, locked the door, and sat down in the chair between him and the door.

The first words out of his mouth were, "What's the calendar with the picture of the kids stuffed into a Christmas stocking doing on your wall? Did you put it there?" Instead of agreeing with this newly separated father of two that the calendar was an insensitive selection under the circumstances—perhaps even offering to take it down if it bothered him—I defensively explained that I hadn't been involved in decorating the room.

Things went further downhill when, before we'd established any real rapport, I decided to ask him, "From your intake form, it seems you're having a hard time right now in your marriage. Can you talk a little about it?" With his terse, mumbled response, he indicated that he wished to say very little about it indeed. Finally, I tried to put a more casual, friendlier spin on the session by saying, "Well, if we're going to work together, it would be good to get to know each other a little." To which he replied, "Why would I want to get to know you?" I was relieved when, after what seemed like an eternity, our session ended. George left without paying for the hour and never came back.

My early experience with George and other male clients soon taught me that working with men was going to present challenges different from those of working with women. Given most men's discomfort with the format of "talk therapy," I had to be prepared to create an atmosphere of comfort and safety that put them at ease early in treatment. Unlike with my female clients, there was no mutuality of experience to draw upon to smooth the process of forging the therapeutic bond. With my male clients, I became keenly aware that often I was seen by them as a woman first and a therapist second.

Emotional expression and intimate connection are part and parcel of what it means to be female. As a woman, I didn't feel unfeminine when I cried or leaned on others for help. But for male clients, trained to maintain a stiff upper lip and appear self-sufficient, the traditional model of therapy runs counter to much of what they've been taught about being a man. Through trial and error (along with some excellent advice from clinicians skilled in working with men), I slowly learned concrete ways to make therapy a less foreign and threatening experience for men. More important, I learned to see therapy through a man's eyes rather than through a woman's.

My women clients were more likely to ask for help because they wanted it (not because someone else suggested they needed it) and were more comfortable openly requesting assistance. Men more often came into therapy under pressure from someone else, frequently an unhappy spouse. If they came on their own because they wanted assistance with some circumscribed issue, they didn't seem to like feeling they were on the receiving end of a "helping relationship." I learned to listen closely to the language they brought into the first session and, using that language, to start working with them right away to create an action plan that emphasized collaboration and coaching. The focus was on what they concretely wanted out of therapy, what their goals were, and how the two of us could work together best to achieve those goals. To make sure that the early focus of treatment was positive, I learned to appreciate the value of asking the miracle question in the first session: "If you woke up tomorrow and everything was just the way you wanted it to be, what would be different? How would you be different?"

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