As a psychologist working with people, I might also be referred to as a counsellor, psychotherapist, therapist, mental health professional or 'shrink'. We need a diverse raft of skills to work with all kinds of people from all kinds of backgrounds. One of the often overlooked niche areas in counselling is working with men as a particular client group. Working with men as a particular client group draws upon certain skills and understanding and the effects of gender are often overlooked by therapists.
In my experience the subtle differences between working with men and women need to be respected in order to adeqately hold the space with the client. The greatest importance in counselling and psychotherapy is being able to 'work with' the client as an individual. They need to know you are really there in the room with them. When you have established this connecting with the client you can then do the emotional or psychological work that you need to do in order to liberate the person from their self-imposed limitations (even if they experienced trauma due to random events or at the hands of others the person is still holding on to the aftereffect in some way, often because they don't have an alternative).
What follows is a seminar that I have taught at various counselling agencies, training other counsellors to be better at working with men and boys. We know this client group is traditionally harder to engage and less 'flowing' with communication than girls and women tend to be. There is an avoidance of being passive and intimate - and in a sense therapy involves being receptive and also quite 'close' emotionally to another human being, being vulnerable and 'spilling your guts' so to speak. There is also an underlying homophobia that many men still have which prevents them from being close to other men, even though they yearn for this deep down, in the sense that close friendships are a life enriching joy and without our close friends (as often precluded by homophobic male awkwardness) life would be lonely and dull.
The following is in seminar format: that is an outline mode document where the facilitator has some knowledge of the points and expounds upon them ad libitum. The topic is about men and how they experience depression and other issues in life. A discussion of the following points with other people should be helpful. The benefit it could serve for you reading this document now is that you can rapidly get through a lot of material in a sketch form, and hopefully finish with a heightened awareness of the plight of the male, and also an understanding of how to make things better for men and boys. Whether you work with men and boys as a client group or you are a man or a boy yourself or you have relationships and friendships with men, such as by being a mother, wife, sister, daughter or friend, this knowledge should help. Remember that men have been the dominant power in the world and thus their (our) needs as men have been overlooked. Now the oppressor has become the oppressed....the tables have turned my friend.
MEN AND DEPRESSION: Solutions through integrated masculinity
By Ben Bruce, Psychologist
How do you feel about the topic?
- Is depression different for men as it is for women?
o The only difference is gender and socialized gender differences that can:
§ Lead to or immunize against depression
§ Exacerbate or reduce depression
- The Rocks of Life:
o Overview of depression and popular treatments:
§ A low flat mood that someone can't get out of, usually lasting more than 3 or 4 weeks. Feeling tired, burdened, unable to experience joy and pleasure in things that used to be fun. Feeling isolated and thinking negatively about one's self, the world, others. A sense of being stuck in the past and stuck in a rut, with low energy - 'like a grey dirty window pane'.
§ Treatments: medication - SSRIs and SNRIs: how they work; exercise; nutrition; self help strategies (meditation, yoga, tai chi, sport, reading self help books); counseling and psychotherapy - Cognitive Behavioural Therapy; support from friends and family; spirituality and purposeful living; meaningful work; as a growth opportunity from 'free space' that depression can provide.
- Overview of Emotion Regulation.
o Core hurts underlying grandiose or surface emotions/ conditions.
o Depression correlating with - Anxiety; - Anger and aggression.
o Impact on the family and vicious cycle of relationship issues making depression worse.
o EQ - Emotional Quotient: perhaps more important than IQ.
o Affect theory:
§ Stimulus -> affect -> feeling -> emotion (+cognitive appraisal) -> response
o ABC of rational emotive therapy: Activating event; Beliefs; Consequence (emotional
- Men as a specific client group: How do gender issues impact men who have depression, regarding coping and treatment?
o Overview of gender differences: roles and values.
o NB difference between masculine and feminine is not the same as male and female.
o Gender polarity: the table of differences.
o Hegemonic (traditional) masculinity.
§ Steven Biddulph: The three issues men struggle with most:
- Social isolation
- Emotional timidity
- Fierce competition
- Three kinds of men
o Men's men: raw masculinity; failure to identify with women and lack of guidance from wise men.
o Women's men: over-identification with women; lack of wise men.
o Men who are their own men: through inner growth, spontaneous self initiation or fortunate enough to have grown up with wise men. Reuniting and reconciling both feminine and masculine traits internally => balance externally.
§ Emotionally and mentally independent
§ Finding their life purpose
§ Assert themselves with issues that have meaning for them
§ Comfortably and readily express themselves
- Children and family
§ They can live with women and without women. They have the empowerment of choice.
§ The deeper masculine is discovered internally and the feminine is discovered internally in relationship to the feminine. This femininity enriches the masculine to achieve a man of balance. We can not be polarized any longer.
§ Men's business is consciously relating to conscious men to do inner work to achieve the above.
- Pathways to manhood.
- Being tied up in a 'polarised gender'
o Group exercise - string and statement cards
o Role play: Select a volunteer from the audience to play 'the man'. Other audience members (6 or so) stand around the man in a circle and have several cards each upon which are statements that they in turn read out to the whole group. The statements are limiting and pressuring statements for the man reflecting polarised gender or rigid hegemonic masculinity. Ask the man to listen to the statements as they're read out. For example: 'You've got to be tough; 'You must make big bucks'; 'You've got to be in control'; 'Don't be a sissy'; 'Harden up'; 'Don't show any emotion' etc.
Someone starts by holding a ball of string or twine. When they read out one statement they unravel and pass the ball around the man and then give it to someone else, returning to their original place holding on to the end of the string. Each participant reads out one statement in turn, holding onto the bit of string that was given to them in the chain and then passing it around the man in the middle. When this is done, we see a man wrapped up in string being pulled in multiple directions. Ask the following questions:
o What was it like for the 'man in the middle'?
o What was it like for the others?
o What was it like for the audience watching?
Cut all the strings one by one and ask the man how he feels after this. Remember to debrief; ask the man to shake it off and remind him that it was a role play.
- Relationships: Types of men who get involved -
o Emotionally distanced jocks and partyboys
o Dopey husbands
o Hen-pecked husbands
o Withdrawn and distant, closed-off, emotionally unavailable men
o Intimidating and violent husbands
o Authentic men as loving, open, honest, assertive equalists
- How do women respond to emotionally liberated, initiated men?
o Mothers can resist the death of the boy and the birth of the man.
§ In ancient times women would support each other through this as the boy went away with the wise men to come back a man.
o Partners can resist as they lose the emotional co-dependence of boy-girl dating interactions.
§ Independent men can be frightening to women.
§ Inner warrior and inner lover.
§ The woman partner may have not had adequate fathering either; so switching to relating to the male partner in a man-woman sense can be intimidating as she is losing the boy-girl attraction that first made him attractive to her. Boy-girl interrelating is codependence.
§ Men need their woman partners to tell them that they trust them and respect them. This satisfies the man's need.
o A good woman will not settle for her man's bullshit.
§ He can't trick her for very long with empty promises and superficial accomplishments. She wants your depth as well as your success. Emotionally and sexually, she wants to feel your deepest gifts and full heart-presence. This is exactly what the man needs to give to the world if he wants to feel complete at death.
- David Deida ('Finding God Through Sex' - Tantra)
- Transactional analysis: parent, adult, child. How do we inter-relate?
- Other obstacles:
o Society and marketing the consumption machine
§ Adolescents are easily manipulated, more fearful, and buy what you tell them to buy.
§ Immaturity means we will look for external replacements (products) to internal deficiencies.
§ Governments can control adolescent populations.
- Feminists and liberated women?
o Most women actually (without necessarily knowing it) want a strong male partner, who:
§ Take the initiative, at least sometimes
§ Make some decisions
§ Talk and argue with them when disagreements occur, as opposed to withdrawing or sulking.
§ The worst words in the world "Sorry Dear"!!!
o Resolving relationships
§ Men need to be assertive
- The 'soft male' is able to say 'I can feel your pain, and I consider your life as important as mine, and I will take care of you'. But he could not say what he wanted, and stick by it. Resolve of that kind is a different matter. - Steve Biddulph (Manhood).
- The pendulum swinging both ways before resting in the middle.
- Depression vs. healthy sadness
o Allowing himself to feel sadness in its extremeness
o Resolving adolescence => manhood
§ Getting tired of boys in men's bodies
o Healing of wounds
o Initiation into manhood
§ Evoking the 'wildman' within and challenging limits; learning skills
§ Liminality and rites of passage
§ Druken disorderly hooning as a replacement for what is missing
§ Quality time with fathers and father figures
o Creating a resilience shield
o Catching up with women's progress by doing 'inner work'.
o Embodying feminine and masculine archetypes: balanced psyche
o Spirituality in men and women:
§ Men retreat to the cave
§ Women retreat to the community and family
- Therefore men opening up is fundamentally difficult.
- Women have learned to embody masculine traits since WWII. Men are still learning to embody feminine traits.
- Men opening up and participating more.
o Men seeking help with depression because of ultimatums from partners.
o Finding a common level in therapy and then steering a course in wards and then outwards.
o The father and son case: lack of quality time, oedipal complex, lack of bonding, disrespect and resentment.
§ The cajoled husband:
- Internet 'cheating'
- Emotional suppression and withdrawal
- Using CBT as an entrance: appealing to logic and task oriented activity leading to deeper work - 'hole in the soul hypnosis' etc.
- Shame Avoidance Theory:
o The 4 quadrants of shame avoidance:
§ Attacking and Withdrawing from Self and Others.
o How are men ashamed about their needs and therefore feeling guilty in seeking support.
- What immunizes people against depression?
§ Getting your physical and psychological needs met: trust, security, safety, power, esteem.
§ Realistic and flexible Optimism and Enthusiasm
§ Early sense of mastery (versus learned helplessness)
§ Good role models to show and teach the above
§ Care givers who were loving, consistent, reliable and fair.
§ Meaningful, absorbing activity: permission to explore and do what we love and what suits us
§ Work-life balance: not using work to avoid, escape or fulfill gaps from neglected areas of life
§ Good healthy relationships and close friends
§ Being able to satisfy one's partner
§ Good health
§ Good self awareness and emotion regulation, tolerating shame; loving and being kind to the self, self soothing.
§ Ability to ask for help when you need it.
§ ...anything else?
- Reframing Masculinity:
o What do we do with all this information?
o The Gender polarity table => Resilience table.
o Which aspects of both genders fit into the resilience table?
- Coping, recovery and growth through:
§ Awareness: 'Man, know thyself'!!
§ Acknowledgement (emotional and rational and gender)
§ Acquired attachment and learning to self sooth
§ Separating 'Normal emotions' from beliefs and information 'About the self'.
- EG. Sadness, loneliness, fear, frustration, tiredness ARE ALL NORMAL EMOTIONS THAT COME AND GO.
- To make sadness mean 'helpless', and loneliness mean 'unloveable', and afraid to mean 'weak and pathetic', is an irrational mistake in our reasoning.
§ Reaching out and getting help IS OKAY!! We were born into a group of people and we are very reliant on others, in family, friendships, relationships, work places, communities.
§ Reassure this as a healthy, strength-based behavior; it is not a weakness. Pretending we are fine when we need change/ help is the real weakness.
- This is like a car without a fuel gauge or an oil light!!!
- Letting the 'emotional guidance system' work, and taking note of it as a 'quality assurance device' about the state of the internal and external world is an information tool.
- Resilience, inner strength, outer strength, coping and growth as Recovered Masculinity.
§ Recovery from depression as an opportunity for growth.
o Where have we travelled today?
o How do we understand the relationship between gender and depression, coping and growth?
o Resolving gender polarity whilst understanding and celebrating that men and women are different.
o Being responsible for our own health.
o A combined/ interactive recovery plan for depression.
§ 'you can't make an omelet without cracking a few eggs' !!