It is widely acknowledged that men are less likely than women to seek help for mental health issues. At the same time, men’s issues can be misunderstood or overlooked by counselors, the majority of whom are women, say Matt Englar-Carlson, Marcheta Evans and Thelma Duffey, the authors of A Counselor’s Guide to Working with Men, published this past spring by the American Counseling Association.
“Counselors might not think there is much to know in terms of counseling competency when working with men. By default, counselors might adopt a universalistic perspective that ignores male culture and minimizes the experiences and stresses of growing up male. … Like other dimensions of identity, masculinity wholly influences the well-being of men and therefore must be considered and assessed if counselors wish to create effective therapeutic outcomes,” they write in the preface of their book.
Seventy percent of counselors are female, according to statistics from the U.S. Department of Labor, and roughly 75 percent of American Counseling Association members are female.
With this in mind, there are gender-specific themes that counselors should keep in mind – and be sensitive to – when working with men, say Englar-Carlson, Evans and Duffey.
Q+A: A Counselor’s Guide to Working with Men
Responses from co-author Matt Englar-Carlson
Men are statistically less likely to seek help for mental health issues. From your perspective, what can counselors do to help this?
The data here is very clear. Referrals for mental health services are about the same for men and women, and across the Diagnostic and Statistical Manual of Mental Disorders, the incidence of disorders are believed to be equivalent for men and women. Yet, regardless of demographic factors, men are less likely to seek help for mental/physical health concerns. So there is something about how men are living their lives and also how the mental health profession operates that maintains this discrepancy.
There is not enough space here to address the question fully, but counselors can recognize that seeking counseling often is stigmatizing for men and violates masculine norms about how many men should live their lives. Seeking help means relying on others, admitting the need for help, recognizing the influence of emotional problems — and if men are invested in a model of masculinity that values being strong, self-reliant and maintaining emotional control, then counseling is a tough sell, as the popular perception of counseling directly conflicts with this.
To address this, counselors can initially address men’s self-stigmatizing beliefs, normalize concerns and encourage expectancy in a positive outcome, reframe masculine-associated negative beliefs, validate the courage to seek help and the ability to overcome obstacles and, most importantly, meet men where they are. And that can mean getting out of the office and into the community to the places where men congregate. Go to gyms and athletic clubs, fraternal organizations (Rotary, Kiwanis, etc.), churches, business organizations and other places where men go and see if there is a way to talk about men’s health.
Often it is better to modify the message to reduce resistance. For example, I often talk about “men’s health” rather than just “mental health,” as I know that mental health is more stigmatizing. Other research indicates using terms like “coach” rather than “counselor” can be helpful. All of this is really about being strategic in knowing the audience you are trying to target. So you can see that counselors might find themselves borrowing tactics from public health to reduce barriers to help-seeking and working to create social norms where men come to recognize their concerns as normal.
The key here is that counselors cannot do this if they do not understand the men they are trying to help. Counselors need to be masculine-sensitive in their work so that that are able to actually help men when they do come.
What advice would you give to counselors to prevent gender bias when working with men and to keep away from stereotypes — men are “macho,” unemotional, etc.?
The first answer here is that counselors need to do their own work to address their own barriers to working with men. Men and women alike need to examine their own stereotypes about men and their own past experiences so that they are not limited in how they understand the full range of men’s lives.
It is important to know that many men are invested in presenting an image and seeing themselves in a manner that matches the dominant masculine norm. Yet research on masculinity indicates that most men are of middling masculinity. It doesn’t matter how it is measured — most men score close to the middle of the scale. Research also tells us that most men think they’re not as masculine as other men they know, and most men don’t think they’re as masculine as they ought to be. So in other words, the average man thinks he ought to be more masculine. He’s likely to believe that he’s the least masculine guy in the group.
From that perspective, it’s no surprise that men make the effort to prove their masculinity again and again — and that it doesn’t take much prodding, even when it involves doing something stupid. As counselors, we have to use this information wisely, and see and experience the full range of the men that we see. We can easily reinforce masculine norms if that is all we expect, or we can be wise and patient enough to understand that there is a duality to how many men present. They will show you the toughness in order to protect their own tenderness, and they may present as stoic and unemotional in order to protect deeply painful and hurtful feelings. I think counselors need to acknowledge the toughness in order to experience the tenderness and understand why the toughness exists.
One of the key concepts here is being aware of the role of shame in men’s lives (see the article on men and shame by David Shepard and Fredric Rabinowitz in the Journal of Counseling & Development special issue on men and counseling). If counselors are sensitive to men, shame and emotions, then they will quickly learn that what you see on the outside is not always what is going on on the inside for many men.
Who is your target audience for A Counselor’s Guide to Working with Men?
Our audience is rather broad, knowing that everyone has some contact with boys, adolescent males, men and fathers in their personal and professional lives. The ideas in the book are tailored for clinical work with men, but we think the insights gained about male socialization and men’s health behavior could assist the reader with any of the men in their life. Most people know so little about the socialization and psychology of men, and it is rarely discussed in professional circles or among men themselves. We believe that a little knowledge can go a long way, and we hope the book helps the reader develop more sensitivity to men’s lives.
We also are aware that men may not always follow traditional help-seeking pathways, so this book was aimed to help professionals meet men where they are. If that means in a primary care setting, a school, private practice, community mental health facility … any setting is fine, as any interaction is an opportunity to promote health and wellness.
What do you hope counselors take away from the book?
That is a good question, as we considered that idea on many levels. On a basic level, our hope is that counselors learn about the wide range of men and masculinities and how male development can contribute to the difficulties many men experience around living healthy lives. This awareness can shift not only how counselors conceptualize the needs of men, but also how counseling is presented and practiced.
We also believe that ideas in this book will challenge readers to do some self-reflection about their own experiences, beliefs, biases and judgments about men. That process of reflection is critical in being a caring and compassionate counselor who works with men.
At a more technical level, there are many interventions and skills presented that can help counselors create better helping relationships with men and deepen the clinical experience. And I think that is something that our book really highlights — that men crave and can co-create deeper relationships. We put that idea front and center since it is critical to shaping how counselors work with men. You can see that we view working with men through the lens of developing relational cultural competency. Thus, our book looks at knowledge, beliefs and skills.
What would you want all counselor practitioners — school counselors, addictions counselors, mental health counselors, etc. — to know about the book’s subject matter?
First of all, we see this as practical book with clear ideas and case examples that illustrate concepts in action. Further, the book has multiple reflective questions embedded in each chapter that are designed to create a dialogue with the reader. We take an inclusive approach to understanding men and recognizing the wide range of identities associated with how men organize their lives.
We also present the book from a social justice perspective, recognizing the conflicts and barriers — intrapersonal, interpersonal, societal — that contribute to many men’s difficulties in being healthy. We present that perspective with the realization that health needs of men are vast and that the health disparities encountered by many men, but particularly men of color, need our immediate attention. It is easy to observe that men do not seek counseling as much as women, but the real question is, what are counselors doing to tailor their work to bring men to address why men might be hesitant?
Considering that the majority of counselors are women, do you think men’s issues and gender-specific needs are often overlooked or unrecognized in counseling sessions?
That is somewhat complicated to explore. I think that everyone recognizes sex and gender in a counseling session, but not everyone realizes that gender is salient to many men who are in counseling. I think that is true for almost any counselor. So in that sense, it might get ignored, or it plays out in sessions without any specific attention.
It is true that the most common counseling dyad is female to female, so in many cases, it might just be that counselors are not seeing as many men. But as I mentioned above, that also is a pretty significant issue that we ought be to addressing. Some counselor educators do not think the field should look at men’s issues. Due to many factors, it is also true that few counselors receive any formal training about working specifically with men.
One of the ways that male power and privilege works is that it clouds others — men and women alike — from seeing the pain and suffering of men. It leads many to assume that men do not need, want or will not accept assistance. It also deludes people — again, men and women alike — into not examining the role of gender for men. When gender is addressed in counselor training, it is often referring to women’s issues — take a look at chapters on gender in most multicultural counseling textbooks. So I do see a gap between what many men experience in their lives associated with their mental health needs and the counseling profession’s ability to comprehend and meet those needs effectively.
A Counselor’s Guide to Working with Men is available from the American Counseling Association bookstore at counseling.org/publications/bookstore or by calling 800-422-2648 x 222
About the authors
Matt Englar-Carlson is a professor of counseling and co-director of the Center for Boys and Men at California State University, Fullerton.
Marcheta Evans is dean of the School of Professional Studies and the Worden School of Social Service at Our Lady of the Lake University in San Antonio, Texas. She served as ACA president for 2010-2011.
Thelma Duffey is ACA president-elect. She is a professor and chair of the Department of Counseling at the University of Texas at San Antonio.
Related reading: See “Men Welcome Here,” Counseling Today‘s cover story from August 2010: ct.counseling.org/2010/08/men-welcome-here/
Bethany Bray is a staff writer for Counseling Today. Contact her at email@example.com