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6 Ways to Improve Mental Health Treatment for Men

By Dan Griffin, MA, Senior Fellow at The Meadows

In our culture—and in many cultures throughout the world—maleness is often assumed to be the default. For example, four men who play music together are in “a band.” Four women who play music together are in “an all-female band.” When we are presented with a generic descriptor for any person “doctor,” “professor,” “lawyer,” “athlete,” “CEO,” we tend to assume that person is male unless otherwise noted.

This is often pointed out as evidence that our society tends to lend special privileges to maleness by unthinkingly designing systems and programs that favor their needs and preferences. And, often, this is true.

However, the notion that “men are generic and women are special” doesn’t always work to men’s advantage. It leads us to assume that men are brought up in our society without having pressures, biases, and expectations placed on them based on their gender identification. As a result, we tend to spend little time focusing on how gender issues affect their mental health, their addictions, their anger and violence issues, or their development of other unhealthy coping mechanisms.

This also means that mental health professionals don’t often consider whether or not their treatment approaches address issues that are uniquely connected to the internalization of negative messages about masculinity. Addressing messages about masculinity is not typically seen as being critical to the man’s therapeutic engagement and movement toward healthy relationships. (As you might have guessed, I disagree.)

The myth that has developed as a result of this oversight is that men have a hard time engaging in treatment. The truth is that we, as professionals, have a hard time truly engaging men in treatment—meeting them where they are, speaking to them in their language, and listening to the things they don’t, and cannot, say – because our services and methodologies were not designed with the specific needs of men in mind.

In other words, contrary to what so many of us have been taught: It’s us, not them. Men are not failing services as much as we are failing them.

How much can really be done to improve the ways in which we therapeutically engage with men’s? Here are just some of the improvements to consider…

  1. Address the ways that men’s socialization prevents them from connecting.
    The behaviors that are required of men in therapy and in recovery are contrary to what I refer to as “The Man Rules.” The Man Rules, the messages we learn as boys about how to be men, say don’t ask for help, don’t show feelings, don’t be vulnerable, don’t be weak, and whatever you do, don’t cry! And then we put men in therapeutic settings and ask – and even expect – them to do the opposite!

    Most of the conversations we have with men in a treatment setting should be placed within the context of the tension between these two conflicting constructs; and yet, professionals get very little, if any, education or training on this and other critical concepts related to men’s mental health and relational competence.

    When we build our therapeutic relationships with men on a foundational awareness of gender issues, we give them a language for talking about the dissonance they feel between what is expected of them in recovery and what is expected of them as “real men.” It’s important to emphasize that the difficulty and discomfort they are experiencing isn’t a problem with them. They are only trying to reconcile the fact that that they have spent their whole lives trying to live up to certain standards of masculinity, and are now being asked to live up to an entirely different set of expectations. We just rarely acknowledge that.

    The Man Rules are not bad, per se. Nor are they inherently negative. There are some wonderful aspects of being a man and of our culture’s ideas of masculinity. That is incredibly important for clinicians and the men themselves to understand. Men are not the problem – how men have been raised is the problem. Understanding this critical distinction is essential to helping men mitigate the unhealthy shame (as opposed to healthy shame) they have about their behavior and who they think they are. This awareness also helps clinicians who may unintentionally and unconsciously shame and blame men. When you talk to a man about his trauma, addiction, and mental health issues in the context of The Man Rules, you help to take away the shame. Men constantly struggle to navigate the cognitive dissonance between the Man Rules and the process of therapeutic change and recovery. It is when men are not conscious of the significant and profound effect The Man Rules have on every aspect of their lives that suffering and putative therapeutic failure or disengagement occurs.

    There are some men in the recovery community with five, ten, fifteen or more years of recovery who still struggle to be close to another person, struggle to share what is really going on with them emotionally, struggle with violence and abusiveness, and/or are paralyzed by codependent behaviors. The unconscious adherence to the Man Rules are at the heart of so much of this suffering. That is why I advocate a concept I call Conscious Masculinity. It’s the idea that a man can choose to live authentically and show up in his life and in his relationships as the kind of man he wants to be, rather than the kind of man The Man Rules have told him he has to be.

  2. Create a culture of safety.
    No matter how a man acts when he first comes into your treatment program—apathetic, belligerent, sarcastic, or overly enthusiastic—you should think in terms of creating a safe environment for him. Men are unlikely to tell you that they are concerned about their emotional safety, but it is something that will be on their minds— if not consciously, then subconsciously. The lens through which you view his behavior will influence the way that you respond to him, which will, in turn, help him to behave differently. The entire culture of your treatment program or practice may begin to change as everyone; including staff in the organization begins to feel safer.

    That is why it is to also important to approach men’s treatment from a trauma-informed perspective. Men learn as boys that following the Man Rules makes them safe, regardless of the fact that it’s likely a false sense of safety. Turning to The Rules for safety then becomes an unconscious response for many men long into their adult lives.

  3. Speaking of trauma…
    Men are socialized not to see their experiences as trauma, and treatment providers also tend not to see their experiences as trauma. This is because at the heart of so much trauma-informed care lurks the idea of the male as perpetrator—and we don’t care about the trauma or healing of perpetrators.

    When the serious effects of trauma go untreated, men in recovery – even long-term recovery – find that they are struggling with relapse, isolating themselves from others and their 12-step communities, abusing loved ones, destroying their marriages and acting out in ways that are damaging to themselves and others. If a man works his addiction treatment program and recovery plan rigorously but does not address the emotional, physical and psychological fallout of untreated trauma, he will remain stuck in the pain, confusion, depression, anger, and hopelessness of addictive and unhealthy behaviors.

    Mental-health practitioners now understand that one of the distinguishing factors with trauma is not the event itself as much as an individual’s response to the event. It is very important to help men understand that, if they have had a traumatic experience and still suffer from it, it does not mean that they are weak, sick or at fault.

    So, knowing that abuse, trauma, and violence against boys and men are so strongly linked with addiction and poor mental health – and knowing, if left untreated, that the aftermath of these experiences can cause undeniable psychological, emotional, relational, physical and spiritual destruction, and knowing that men experience, express the symptoms of, and heal from trauma differently than women – doesn’t it seem not only logical but necessary to create treatment programs that are trauma-informed and gender-responsive?

  4. Focus on relational competence 
    The majority of the Man Rules are not about connection. In fact, they are about disconnection – from self and from others. Men who are affected by childhood trauma have even more trouble forming and maintaining intimate relationships. This is partly due to the fact that The Man Rules they are taught as boys do not provide a context in which they can learn to value connection, intimacy, and reciprocal relationships. Interpersonal skills like cooperation, seeing another’s perspective, expressing vulnerability, sharing feelings, and empathy do not tend to be part of what boys and men are encouraged to value and practice in their daily lives. As Brené Brown has beautifully pointed out, men can never be seen—or even experience themselves—as weak at any time. That mandate lives deeply inside so many men. That makes creating and staying in truly healthy relationships quite a challenge.

    Despite the fact that most therapy is about being able to create healthy relationships, we rarely acknowledge the inherent challenges of relational engagement for men; nor do we provide nearly enough awareness, skill building, and support for men to truly practice being in relationships. I would even go so far as to say that even when we manage to get men into safe places in therapy and treatment, and model healthy relational engagement for them, we fail to truly prepare them for navigating the challenges of being in relationships day-to-day outside of the therapeutic milieu.

  5. Break into small groups. 
    Something I learned from my professional partner of many years, Rick Dauer: If you want men to open up, put them in small groups. I mean small groups, breaking the men out into sets of threes. The effect is transformative. Men who normally would fly under the radar or simply present as though they are less emotionally engaged will show up in a completely different way. The number three is important – two is too easily turned into a conversation and four can split into pairs or even easily leave one person out. But three? There is just something magical about that number.

  6. Address Sex and Sexuality. 
    Let’s not just talk about sex but talk about sexuality – the whole thing. A large percentage of men’s relapses are directly related to sex. Men commonly struggle with not feeling comfortable engaging in sex while sober, fear of sex, discomfort with themselves sexually, pain from sexual trauma, issues with body image. And, let’s not fail to mention men’s often problematic and unhealthy use of pornography while they are in treatment. As a practitioner, it’s important that you maintain an awareness of the impact that sex and love addiction have on men and all of their relationships. The Man Rules are deeply connected to sex serving as men’s primary – if not sole – vehicle for connection and intimacy. How can we NOT spend extensive time helping men create a healthy sense of their sex and sexuality?

If these six elements become incorporated in men’s treatment plans, you will see marked differences—if not a complete transformation—in how men respond to their treatment experience and how effective clinicians feel working with men.

More Best Practices for Treating Men

I feel very confident that if you incorporate the six principles above into your practice or treatment, you will notice a marked improvement in male patients’ progress. However, in order to really help men make the kinds of breakthrough that ensure their long-term success in recovery, and have a positive ripple effect on those in their families, workplaces, and communities, you need even more in-depth knowledge that you can apply to your interactions with male clients.

In my three-day workshop “A Man’s Way Workshop for Professionals,” I’ll offer even more insights and practical guidance for working with men and helping them navigate the challenges of letting go of The Man Rules and reconstructing their identities and their lives around a healthy and conscious sense of masculinity. The workshop will be held at the Rio Retreat Center at The Meadows in Wickenburg, Arizona. For more information or to register, call 866-986-3225 or reach out online. I would love to see you there. Check out my website: www.dangriffin.com for more resources as well.

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