Men in Therapy
Can they leave their gender at the door?
Posted Jan 04, 2020
Suppose you are a therapist or counselor, and a person appears at your door looking for help. Does the person’s gender matter? Does the person’s self-identification in gendered terms matter? Does it matter how the individuals in the person’s social world construe the person or treat the person in gendered terms?
The American Psychological Association, or APA, thinks that gender in all its incarnations is important, and has issued Guidelines for psychological practice with boys and men (APA, 2018). Boys and men receive attention after earlier guidelines have addressed practice with "lesbian, gay, and bisexual clients" (2002), "girls and women" (2007), and "transgender and gender-nonconforming people" (2015; see full references in the 2018 document).
The document represents the work of five authors and 32 scholar consultants, an effort spanning 13 years from the first meeting to the publication of the guidelines. Surely, this work needs to be taken seriously. It will inform and guide a generation of therapists and counselors, and it will affect countless clients, for better or for worse.
The overall tenor of the guidelines is that gender matters a great deal, and that practitioners should care and know what is to be known. They should, above all, be sensitive to clients’ self-construals, to individual and social biases, both explicit and implicit, and to various power dynamics that pervade society like dark energy pervades the universe. It is almost too much to ask.
I tried, with little success, to simulate in my mind what it might be like for a practitioner seeking to assimilate the language, the claims, and the assumptions conveyed in this document. I urge interested parties to read the document and form their own opinion. After all, what I have here is only my own opinion. To give some structure to my thoughts, I ask the following questions:
1. Is there an alternative frame than what is presented in the guidelines?
Yes, there is. Gender, in all its objective, subjective, or socially construed variations, could be ignored. Treatment could be gender-blind.
The treatment of anxiety or depression could be as gender-blind as is the treatment of an infected toenail. Classic theories of personality, abnormal psychology, or clinical treatment are focused on causes, symptoms, and psychological processes, such as mechanisms of learning and memory or perception and inference. Indeed, some of these theories are usefully informed by animal models.
The guidelines provide some information about statistical differences between male and female populations (thereby incidentally reifying the existence of these categories), but such differences do not necessarily reveal anything about deep gender differences or any differential responsiveness of men—compared with women—to particular interventions. Indeed, the role of the guidelines should be to focus on differential responsiveness to treatment options on the view that success rates should be maximized. Alas, the guidelines rarely go beyond asserting that practitioners “are sensitive” to various aspects of gender.
The guidelines would be more persuasive and useful if they articulated a particular view of gender, made it clear how gender moderates treatment success, and then pointed to those treatment options that yield incremental success beyond what one might expect from a null model, that is, a model concerned with problems and solutions independent of gender.
2. What are the roles of science and ideology?
As noted above, the science reported in the guidelines exhausts itself pretty much in a few statistics showing that boys and men have poorer prospects of physical and mental health than girls and women. Little evidence is offered to illuminate why this is so. Instead, the guidelines obliquely and repeatedly point to an ideology of masculinity as the putative root cause of the troubles.
Indeed, contemporary American society provides images of what "a real man" looks like and how he acts. Independence, self-reliance, and a Stoic tolerance for pain and misfortune appear to be central here. Support for this view can be found in the literature on gender stereotyping, but the guidelines do not go into much depth. Instead, they claim that there are many masculinities, and that, for some reason, American society has chosen the one that hurts the most.
Masculinity, as conventionally understood by most American men, is now a sickness. Imagine what this means for a man battling depression. He presents himself for treatment, having thereby already overcome the stereotypic norm that strong men don’t do that, only to be told that the construal of his masculinity, which is arguably a major part of his identity, has a toxic effect on his emotional life.
"Doc," the man might say, "I came to see you because I am depressed, not because I feel bad about being a man." The therapist, having read the guidelines, might now double down and claim that he, the depressed man, is the beneficiary of unearned (read: "immoral") male power and that he is unaware of it.
So there is more for the depressed man to feel bad about. He has learned that belongs to a favored social caste, does not deserve it, has not been aware of it, and is now in therapy in spite of it. The therapist, being sensitive, acknowledges the man’s disappointment, and perhaps his anger, and wishes to respond. Alas, the guidelines leave him or her or them to his or her or their own devices.
3. Who are these boys and men anyway?
The authors of the guidelines very much court the thinking of various postmodern schools, critical theories, and post-deconstructionisms. These schools of thought, as a rule, have little respect or use for science. They are rather concerned with language games.
Someone who likes to think like Jacques Derrida (1997) will assert that “everything is text,” and this necessarily includes masculinity and suicidal thoughts. Having no Archimedean point on which to build a useful theory, postmodernism fails to satisfy simple demands of rationality (and perhaps proudly so). For the depressed man, though, this is not a game. His therapist, who looks at gender through a postmodern lens, will see it disintegrate in front of his or her or their very eyes.
The guidelines dissolve gender in the acid bath of intersectionality. "You may think you are a man," the therapist might say to the client, "but look, you are white man, and you are an old, white man, and you are a heterosexual, old, white man, and you are a heterosexual, old, white man who thinks it’s all right to be a heterosexual, old, white man," and so on and so forth. The notion of intersectionality is political rather than scientific, as it prefers ("privileges," as it were) certain intersections while ignoring others without much help from data (in some cases, I agree, there are relevant data). The final irony of intersectionality is that unless it is scientifically tamed, it dissolves all social and biological categories, so that at the end of the day we are back to the individual, and back to the null model of clinical psychology and treatment.
As to the epigraph, there are, in my opinion, certain general and deep truths about the human condition, among which I count Rollo May's observation. Getting too focused on intersectional identity concerns carries a risk of descending into narcissism.
As to photo of the distraught man, that was added by the editors of Psychology Today. I had no say in it. I'd rather not have it, actually.
American Psychological Association. Boys and Men Guidelines Group (2018). APA Guidelines for Psychological Practice with Boys and Men. American Psychological Association. Retrieved from https://www.apa.org/about/policy/boys-men-practice-guidelines.pdf
Derrida, J. (1997). Of grammatology, Trans. by Spivak, G. C. Baltimore: John Hopkins University Press.