A Five Stage Model for Counselling Men

Introduction

The needs of men are often neglected in today’s society. Given that women make up the majority of counselling clients – research that’s conducted tends to focus more on what is helpful for them than men, simply because they make up a larger share of the research participants. It’s important to understand how to be effective when working with men dealing with mental health issues or suicide.

We know that men have smaller social circles than women (McPherson, Smith-Lovin & Brashears, 2006) and they seek help less often (Courtenay, 2011; p. 13). Finding male therapists is also difficult (Carey, 2011), which can complicate things for men experiencing current or historical intimate partner or sexual violence.

Below is a model for counselling men from the second chapter of “Counselling Fathers from a Strength-Based Perspective” in Counselling Fathers (Oren, et. al., 2010; p.30.) Although this model was originally designed for working with fathers I believe it is equally applicable to working with men who are not fathers.

The five stages are:

1. Rapport and Therapeutic Alliance
2. Assessment
3. Identification of strengths
4. Interventions
5. Resiliency and Termination

Each of these will be reviewed below.

Rapport and Therapeutic Alliance

The first element of any therapy or counselling is establishing a strong therapeutic relationship. The SOLER elements of active listening (Egan, 2007) can be useful, although with a change noted below. There are also some things that can be used to establish rapport when counselling men or boys (Kiselica, 2003), including:

• Displaying magazines relevant to men’s issues (sports, hunting/fishing, men’s health and fitness)
• Flexible scheduling for appointments (shorter or longer to allow time for building rapport without getting tiring)
• Using humour and self-disclosure
• Sitting side-by-side rather than across from each other
• Setting goals and working collaboratively
• Using client-centered language

Kiselica also notes that traditional models of engaging with clients (especially young boys) may be ineffective, and that a more instrumental, active or group-based process may be useful.

Assessment for Counselling Men

A strength-based assessment (Graybeal, 2001) acknowledges the overlooked assets that men bring into the counselling relationship, rather than focusing on problems or challenges. This continues into the next stage (identification of strengths). In addition to identifying strengths, the concept of gender role conflict should be explored.

Gender role conflict (O’Neil, 2008) is defined as “a psychological state in which socialized gender roles have negative consequences for the person or others” and involves six elements (O’Neil, 1981) that have commonly be forced upon men:

1. Restrictive emotionality – The inability of men to express their emotions (often because of society or familial prohibition)
2. Health care problems – Men are less likely to seek help for their physical or mental health problems
3. Obsession with achievement and success
4. Restrictive sexual and affectionate behavior – Related to restrictive emotionality, men are sometimes prohibited from being affectionate with other men
5. Socialized control, power, and competition issues – Men are socialized to pursue control, power and achievement at any cost, while men who choose a different path (for instance, by parenting) are considered weak or un-masculine
6. Homophobia – Men who fear being called gay may be less likely to pursue heterosexual friends

By developing a deep understanding of the conflicts your client is experiencing you will be better able to identify strengths and plan appropriate interventions in the next stages.

Identification of Strengths

Identifying strengths is paramount to a positive therapeutic environment when counselling men, especially for men who have been rejected by therapists in the past. Some positive male qualities include (Oren, et. al., 2010; p.59):

• Altruism
• Courage
• Generativity (Slater, 2003) – the concept of leaving your mark
• Perseverance
• Protection of others
• Responsibility
• Service

These and other values (self-sufficiency, achievement, efficiency, loyalty, and pride) can help build often-fragile male self esteem and provide a framework for intervening.

Interventions for Counselling Men

Now that you’ve performed a comprehensive assessment and you have an understanding of your client’s values, strengths, and what gender role conflict they may be experiencing you are ready to begin planning effective interventions while counselling.

Exploring times in the client’s past when they were able to cope with the problems they’re experiencing now and allowing them to narrate the stories in their life. (Smith, 2006)

Employment is often an area where men succeed, even as they are challenged in their personal life. Using work as a metaphor, men can apply the attitudes of being assertive, prioritizing, building relationships, and so on. Applying these lessons and potentially hidden skills to their personal life can help men improve their ability to deal with problems at home.

Mahalik (1999) used the concept of gender role strain – the idea that men are not living up to their gender or masculinity requirements – to help assessing and working through cognitive distortions. He suggested some strategies for changing cognitive distortions:

1. Explore how men experience cognitive distortions as adaptive or positive instead of negative; for example, a man who values hard work in their career over everything else may experience positive career and financial benefits at the expense of their relationships with their family
2. Examine the connection between gender role and these cognitive distortions
3. Practice experiments to confirm or deny the accuracy of these distortions
4. Provide more accurate beliefs to replace the distorted ones

Throughout the counselling process it’s important to recognize the impact that gender roles has on someone’s behaviour. Gently challenging these and other beliefs (like those around social support or emotional expression) and encouraging new ways of men expressing themselves are ways of working through the intervention stage. (Oren, et. al., 2010; p.145)

Resiliency and Termination

The final stage in counselling men is resiliency and termination. This starts with identification of male-positive resources or institutions such as programs to promote healthy marriages or healthy children (Oren, et. al., 2010; p.38) and finding other more informal supports in the client’s life such as friends, family, coworkers and professionals like doctors, coaches and clergy.

Finally, modelling elements of good termination in general counselling can help the client terminate other relationships (such as with partners) in their personal life more effectively. These elements include (Hardy & Woodhouse, 2008):

• Highlighting the positives of ending sessions
• Providing an open discussion
• Ensuring both client and therapist are prepared for the end of therapy

References

Courtenay, W.H. (2011) Dying To Be Men: Psychosocial, Environmental and Biobehavioral Directions in Promoting the Health of Men and Boys. Routledge: New York, NY.

Egan, G. (2007) The Skilled Helper: A Problem Management Approach to Helping. 8th ed. Thomson Brooks/Cole: Belmont, CA.

Kiselica, M. S. (2003). Transforming psychotherapy in order to succeed with adolescent boys: Male-friendly practices. Journal of Clinical Psychology, 59(11), 1225–1236.

McPherson, M., Smith-Lovin, L., Brashears, M.E. (2006) Social Isolation in America: Changes in Core Discussion Networks Over Two Decades. American Sociological Review. 71(3).

O’Neil, J. M. (1981). Patterns of gender role confl ict and strain: Sexism and fear of femininity in men’s lives. Personnel and Guidance Journal, 60 , 203–210.

O’Neil, J. M. (2008). Summarizing 25 years of research on men’s gender role confl ict using the gender role conflict scale: New research paradigms and clinical implications. The Counseling Psychologist, 36 (3), 358–445.

Slater, C.L. Journal of Adult Development (2003) 10: 53. doi:10.1023/A:1020790820868

Smith, E. J. (2006). The strength-based counseling model: A paradigm shift in psychology. Counseling Psychologist, 34(1), 13-79.

Oren, C.Z., Englar-Carson, M., Stevens, M.A. & Oren, D.C. (2010) Counselling Fathers. Routledge: New York, NY.