Growing up in the '50s and '60s, I came of age in a world in which men ran the show, had the higher-paying jobs, and women were seen as second-class citizens. Like many women in my generation, I joined women's groups that questioned basic gender norms and envisioned a society that wasn't dominated by sexism and male privilege. At the same time, I was aware of how men were themselves being shortchanged by restrictive sex-role norms. I was struck by the higher rates of suicide and substance abuse among men, the prevalence of violence, and their shorter life expectancies. Among the men who were my friends and whom I dated, I saw how their need to appear tough, independent, and emotionally in control got in the way of their intimate relationships.
When I started my clinical training, I wondered about the impact of men's discomfort with emotional expression (and women's ignorance of this discomfort) on how male clients experienced therapy with female therapists. Unfortunately, there were no psychology-of-men classes in my doctoral program and no training on men's issues in therapy in my internship, so I found myself pretty much on my own in learning how to work with men.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.
Things went 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.
From many years of attention to men's language, attitudes, and needs, I've developed a specific approach to working with male clients. With a man, I introduce therapy as an educational experience, offering verbal and written descriptions of "what to expect in therapy." I use a variety of cognitive-behavioral techniques, including giving weekly homework assignments and using videotherapy and bibliotherapy. I find that structured assignments and role-playing exercises help men see the therapy process more as an educational experience and less as a pathologically-oriented excavation of their psyches.
I often rely on a sense of humor, down-to-earth language, and judicious self-disclosure to level the playing field between myself and my male clients. For example, I had a depressed male client a few years back who thought medication was "only for weak people." After trying every way I could think of to help him move out of this stance, I ended up sharing with him some of my own experiences with suffering, after which he looked relieved and said, "I don't feel so alone anymore. Maybe I'm not such a loser." He went on to take medication and improved dramatically.
A basic problem for women who treat men is that, no matter how empathic we may be, we haven't had the same socialization they've had. Occasionally male clients will confront me directly about my "ignorance" of what it means to be male—"You can't possibly understand what it's like to be a man. How can you possibly help me?" Over the years, I've learned not to be defensive when a man confronts me in this way. Instead, I'll say something like, "You're absolutely right. I haven't had your experience, but I'm interested in what you've gone through. Tell me more."
While I've emphasized the challenges women experience in treating men, many men request female therapists. When asked why, they've said they feel safer with women because they expect them to be supportive and see them as the better "relationship managers," more experienced in giving feedback and advice about handling subtle relationship tangles. Many men are afraid of being vulnerable and open in front of a man, especially the imagined alpha-male figure of the therapist to whom they're turning for help.
For female clinicians, one of the side benefits of working with men is that it can help us understand the other men in our own lives. Both genders win when we learn more about men. My compassion for men in my personal life has grown as I've learned more about what the world is like for my male clients—how hard it can be having to live up to the sometimes punishing male standards of competence, strength, stoicism, independence, and sexual prowess. If we can move beyond the tendency to see gender issues as a zero-sum game (i.e., the more attention you give to men, the less attention women get), the more we all will win. That's my kind of game.This blog is excerpted from “Women Treating Men." Want to read more articles like this? Subscribe to Psychotherapy Networker Today!