Men: Practice Interventions
Abstract and Keywords
A consistent theme for the majority of men in the United States remains the code of manhood. Men are expected by society to be stoic in the face of danger and to play out, in all aspects of life, the idea of the rugged individual going it alone, even in the face of a quickly changing world. Whereas social-work theorists and practitioners talk about male aggression, sexuality, intimacy, depression, anxiety, addiction, ageing, and work-related concerns, most men are less likely to view these as problems. If they do enter into counseling or treatment, they are less likely to remain for any length of time. Faced with these issues, practitioners are challenged to find ways of engaging men and forming successful collaboration and meaningful outcomes.
Manliness and the Unlikelihood of Seeking Help
The traditional code of masculinity is a primary reason why most men do not seek help or fail to remain in counseling. Brooks (1998) describes men’s view of the therapist’s office as not a “place of understanding and compassion, [but] a place to experience hostile rejection, shame, and alienation” (p. xii). Good, Dell, and Mintz (1989) found that men’s conception of what it means to be a “man” was strongly correlated with their reluctance to engage in clinical services. The more stoic and self-reliant they are, the less likely men are to seek counseling. Addis and Mahalik (2003) found that the majority of men involved in some form of clinical treatment had been mandated or coerced into attending counseling sessions.
Men’s attitudes and the process of most clinical practices converge to discourage men from reaching out for assistance. For the most part, traditional models of clinical social-work practice require the client to take a passive position in relationship to the worker. That is, the clinical practitioner takes the position of expert and expects the “clients” to talk openly and intimately about their life, including their past, and to share their “feelings.” Not participating in this way is interpreted as being “resistant” or “not ready” for treatment. The traditional models of practice requiring self-revealing talk and openness have been viewed by Heesacker and Prichard (1992) as a “feminine” style of relating that does not recognize that men rarely participate in this type of conversation with others, including their spouses. Given that “traditional” male values require men to adhere to the code that “real men” deny vulnerability; are occupied with work, status, control, and achievement; and are required to be forceful and aggressive and to reject femininity, it is without question that typical forms of counseling would not fit these expectations (Brooks, 1998; Doyle, 1995).
Obviously, there are degrees of adherence to these codes of masculinity. With most men, there is some level of tension between the code of interpersonal control and dominance and the requirements of entering into a traditional counseling situation. To be seen as not competent or to be seen as vulnerable is a precarious position for most men. Entering into a client role and “needing help” is not a comfortable position. Many men either refuse to consider counseling or, once involved, attempt to maintain some form of control and competency. If this control is challenged in any way, the help is interpreted as demeaning and a threat. The man himself is supposed to be the problem solver and the one who fixes what is broken. These few examples of the complexity of the issue facing practitioners when attempting to work with men are daunting and uncomfortable for both the man and the practitioner. Brooks (1998) considers this description similar to that of other recognized diversity issues needing attention in practice. He states that “to some extent, psychotherapy with traditional men is always a form of cross-cultural counseling” (Brooks, 1998, p. 65). The focus then shifts to how to alter the traditional structure and process of counseling to better match the life experiences of men.
Allan and Gordon (1990) note that it is important for practitioners to be “gender-sensitive and aware of their own biases if they are to work with men successfully” (p. 132). This sounds strange when we consider the issues of women and race as prominent issues that have been the focus of diversity in practice. Men are not considered a “diversity” issue given that they are not oppressed within society, as are other groups. Yet, men have a very unique set of standards they must learn, meet, and maintain to be a man in American society. This unique set of standards or codes is usually viewed and described from the perspective of those who take the brunt, at times, of men’s insensitivity, stoicism, anger, control, and unavailability. The result is viewing men in negative ways without realizing that these actions have a cost for the man as well as others. Men must maintain this code or feel ashamed, either in their own eyes or in the eyes of others, both men and women.
Gender identity is socially constructed. Masculinity and femininity are socially created definitions that are continually being invented through language within a culture. Our ideas of what is masculine and feminine emerge from how a culture continually creates meaning about people and activities. Thus, what it means to be a man or woman is not found in nature, but is socially created (Gergen, 1999). Men’s socially constructed identity is supported and imposed by a society that still demands that men be men in particular ways. Men who are very different are often seen as “wimps” and weaklings. Many older men, if asked, will remember that on the back of comic books many years ago, there was an advertisement that centered around a weakling getting pushed around on the beach, with his girl taken away by the stronger man. Then, with the help of the Charles Atlas muscle-building program, he returns to knock the guy out and get the girl back. The girl looks very proud to be with him, too. Men do not just walk away from this socially constructed identity. Most men do not realize that it is socially constructed and supported. It just feels “right” and the way men “should” be in this world.
Male-Oriented Approaches to Practice
Various authors and practitioners have described models of practice with men. Brooks (1998) suggests an approach that encourages gender awareness and involvement with other men in groups. It is a traditional approach that looks into assumed gender-specific “psychic pain” caused by the repression of fear and rage according to the code. Levant (1990) focused on practice with men, based on men learning new social skills. Allan and Gordon (1990) focused on psychoeducational techniques that taught men about the problems created in their lives by living according to the male code.
The primary focus of most traditional interventions is on addressing the consequences of the “male code” or gender-role analysis on men’s relationships and their own sense of worth and value (Englar-Carlson, 2006; Methm & Pasick, 1990). They follow the feminist, gender-focused interventions proposed for women, where the social construction of femininity is often challenged as a central part of treatment. In his practice with men, O’Neil (2006) uses the basic assumption that “men usually need to understand how their family of origin, their gender role socialization, and any gender role traumas have affected their growth and problem solving” (p. 260). For men, the impact of the code of masculinity on a man’s position in terms of relationships, as husband, father, and friend, in terms of age-related changes from youth to elderly, and in terms of occupational success in life is a potential target of intervention. This approach applies to a wide range of diverse groups of men. Although unique and compelling differences exist as a result of diversity and marginalization of many men who are not a part of the White heterosexual dominant group, the idea of dissecting the code has been viewed as an essential part of intervention. Men who are members of marginalized and oppressed groups require dissecting oppression and the trauma experienced as a result.
Variation in Masculinities
Diversity exists for men in many forms: socioeconomics, race, ability, religion, age, geography, education, and sexual preference. Most male-focused research has been with middle-class White males. There is clearly a different experience between a White coal miner in Appalachia and a Black taxi driver in Queens, New York. Although all are affected by a code of masculinity, the manner in which this code has been conveyed and demonstrated varies, as do issues of oppression and racism (Levant, Majors, & Kelly, 1998). Little is understood about how diverse groups manage the expectations of “masculinity” in their specific culture (Liu, 2002). It is important that practitioners recognize the potential variations in the code of masculinity and how this is expressed by a particular client within specific diverse contexts.
Franklin (1999) described the experience of African American men in terms of invisibility. He described the African American man as encountering racism that undermines his very sense of self and worth as a person and as a man. Each particular man is acted upon by the general society as if invisible as a viable being. Rasheed and Rasheed (1999) stated that what is needed is “a wider set of lenses for practice strategies that use schema that encompass the realities of African American men. These new lenses also need to be able to search for the strengths and positive attributes of Black men” (p. 6). They call for a dialogical or collaborative relationship during intervention. They suggest a collegial relationship where the client becomes a “partner with the practitioner in exploring different and more empowering ways of being and ways of being masculine” (p. 56). The focus of intervention is the development of a new personal narrative that recognizes not only the personal but also the sociopolitical context of oppression and racism and its impact on the individual African American male’s own personal story. The intention is to rewrite this personal narrative outside the dominant narrative that contains the degrading and demeaning attitudes of racism. Hence, practitioners must be conversant in critical constructivist theory (Sexton & Griffin, 1997; Witkin, 1995) and narrative theory (White & Epston, 1990).
Latino men represent a wide range of cultures sharing a common language. Latino men are identified with the word “machismo,” which comes from “macho,” the Spanish word for man, and connotes an exaggerated presentation of power and strength associated with being a man in our society, as well as domination and providing for the family. Pleck, Sonenstein, and Ku (1993) and Torres, Solberg, and Carlstrom (2002), however, found that there is diversity within Latino men in their expression of masculinity; generalized assigning of machismo attitudes to Latino men is not appropriate. Lum (2007) does not mention the idea of machismo in the third edition of Culturally Competent Practice with Latino families. Liu (2002) found that “Asian” (representing various groups) expressed the traditional code of masculinity. For both Latino and Asian men, the issue is the degree of inclusion in society and the impact of oppression that must be recognized and addressed by the practitioner.
Duran and Duran (1995) relate the failure of Western-based therapies applied to First Nations peoples. They suggest that First Nations peoples identify with the land or region in which they live. The authors assert that these individuals have a “profound sense of intergenerational grief about the historical past [and] that these feelings of unexpressed rage, grief, and distrust are . . . expressed in symptoms” (p. 1). For these reasons, as well as because of oppression and discrimination, traditional therapies often do not work. For example, alcohol “is sometimes personified by Indians as a spirit entity with its own consciousness, and the patient may converse with the spirit to avoid or escape its influence . . . this conversational effort [discouraged as an hallucination by traditional therapists] is therapeutic for Indians” (p. 2). These significant issues must be understood by practitioners if any effort is to be successful with men from First Nations peoples.
Gay men are another group who live in the shadow of heterosexual masculinity, although most adhere to the same ideas as heterosexual men, except for sexual preference (Haldeman, 2005, 2006). Although the stereotype of the gay male is one of flamboyant femininity, most often gay men are socialized as are heterosexual males, with the same code of masculinity. For gay men, this can be a particularly difficult challenge as they are growing up and with intimate same-sex relationships.
The unique experiences of growing up gay in a heterosexual and homophobic world where men are required to hide their identity become a focus of interventions. Importantly, as with other diverse groups, personal experiences of oppression and trauma must be appreciated and addressed in the intervention. The manner in which most oppressed groups are invisible to the dominant groups becomes an issue in itself. Haldeman (2006) describes the media “mainstreaming gays” as an issue for some, in that it “threatens our uniqueness, jeopardizes the individuality that we so cherish, and invites dangerous backlash” (p. 307). Some issues, like coming out, are unique to younger gay teens and older gay men who can feel rejection by younger men. Heterophobia is an issue facing some gay men. As a result of early and continuous trauma and invisibility from the heterosexual community, gay men often become fearful of being with or around heterosexual men, and this must be addressed (Haldeman, 2006).
Challenging the Male Deficit Approaches
The basic premise of traditional male-oriented approaches described briefly, even with the approaches addressing diverse groups of men, is traditional in that men are seen as damaged and misguided by their socialization into the code of masculinity. The intervention becomes a process of confronting men with their deficits, the mythology of the negative masculinity code, to help them change their behavior. The alternative to this deficit-based model is the positive psychology/positive masculinity model (Blundo, 2010; Kiselica & Englar-Carlson, 2010; Kiselica, Englar-Carlson, Horne, & Fisher, 2008). This model accdentuates the positive aspects of the characteristics associated with masculinity. These are “male relational styles; male ways of caring; generative fatherhood; male self-reliance; the worker-provider tradition of men; male courage, daring and risk taking; the group orientation of boys and men; fraternal humanitarian service; male forms of humor; and male heroism” (Kiselica & Englar-Carlson, 2010, p. 277). These are social constructs and are not exclusively male characteristics or styles of relating. They are considered strengths in the following way. As an example, intimacy is generated by the use of humor and horsing around with each other. Male caring comes in the form of “protecting” loved ones and friends and being the worker and provider. The research and outcomes of practice with men from this perspective demonstrate a shift from the negative to a sense of worth and a shift in their attention to “the parts of themselves that are good, creative, successful, kind, and capable” (Kiselica & Englar-Carlson, 2010, p. 279). Utilizing this approach helps in joining with men and building a strong alliance by affirming male strengths, which can then be used to build alternatives to nonproductive and problematic behaviors.
Lee, Sebold, and Uken (2003) have demonstrated an alternative strengths-based and solution-focused approach that engages unresponsive and defensive male clients. Working with men in domestic violence situations, they focus on men becoming responsible for the solution rather than responsible for the problem. Rather than focusing on individual pathology or the code of masculinity, treatment focuses on what the client can do differently. Lee et al. state that “by not focusing on participants’ responsibility for problems and deficits, we are able to direct all therapeutic energy toward supporting participants’ responsibility for building solutions” (p. 13). If men in general avoid being seen as incompetent and vulnerable, confrontation and focusing on what they are doing wrong or badly are not conducive to retaining the men’s participation in treatment. Giving men the responsible position of finding a solution to domestic violence relies on their capacity to solve problems and is one of the values of the code (Blundo, 2010). It is a matter of working with the man’s code as a potential strength rather than working against the code and attempting to change it. The research results have demonstrated very low recidivism rates and high levels of completion of the program (Lee et al., 2003).
The code of masculinity must be understood, as does every manner of diversity in social-work practice. Practitioners must appreciate that the code of masculinity prevents many men from seeking assistance and from remaining in a setting that is a threat to their masculine esteem. Finding ways to acknowledge these values both as strengths and as a means of engaging them through practices that engage the man’s personal version of the code of masculinity, as suggested in the work cited above (Lee et al., 2003), such as solution-focused practice, narrative, and constructivist practices, is important to initiating and sustaining interventions.
The code of masculinity is the centerpiece of treatment in many traditional models of practice with men. It is assumed that the code of masculinity is one of the causes of the problem and must therefore be addressed for the treatment to succeed. An alternative approach uses men’s strengths and possibilities by actually engaging men’s masculinity code, which designates men as action-oriented problem solvers. The alternative perspective expressed in such practices as strengths-based, solution-focused, narrative, and constructivist perspectives provides such an alternative approach. The oppression experienced by men of diverse and marginalized populations is also recognized as a significant element of working with these particular men, who share similar masculinity codes and who must be understood and engaged by social workers.
Men are the least likely to seek assistance and are more likely to address emotional stress through behaviors that are often detrimental to relationships in the home and at work. Social workers must make a concerted effort to reach out and provide opportunities for men to become comfortable with healthier ways of resolving life issues. It is important to note that the word “healthier” does not refer to a nonmasculine way of relating but a manner of using the many forms of masculinity to generate more successful and fulfilling ways of relating to others and themselves. Also, more practice research on masculinity at all age levels can be an important step at better understanding the life and struggles of nearly half of the human population.
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