What does psychotherapy with men look like?
For the past 10 years, I have specialized in therapeutic work with males. While there are many similarities between psychotherapy with women and men, the way men experience, understand, and express the things that bother them can often be very different from women.
Men and Emotion
A common saying in our society is that “men are bad with emotions,” or that “men don’t know how to express their emotions.” But this is not entirely true. Male children are equally as capable of emotional expression as female children. However, due to strong cultural messages about masculinity, many boys have been trained to suppress their emotional responses. The “suppression” of emotion is different than the “containment” of emotional responses. Contained emotional response is adaptive because it allows for the healthy discharge of normal emotional reactions to life events. Emotional suppression, on the other hand does not allow for the discharge of emotion, which leads to a sort of emotional constipation. The result of emotional constipation is relationship difficulties, physical symptoms (stomach problems, high blood pressure, etc.), substance abuse, chronic numbing, and in some cases- the intermittent explosive discharge of emotion, usually in the form of anger.
It is no secret that society places certain harmful expectations on male and female behavior. Very early in life boys receive powerful messages about how they should conduct and express themselves. “Be a man” “don’t be a crybaby, wimp, whiner, girl, etc.” Every boy has heard such statements over and over, and the powerful conclusion to be drawn is that to be upset, hurt, frightened, or wounded by anything is somehow antithetical with being a man. In many cases if a boy is foolhardy enough to actually express fear or hurt, he risks being subjected to even more hurt usually via ridicule. Accordingly, boys quickly learn that emotions are dangerous. They learn that if they do experience emotional distress, they had better “deal with it” on their own and quickly.
Masked Depression in Men
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) is the essential and agreed upon system for classifying and diagnosing mental illness in our country. This text indicates that Major Depressive Episodes occur in women at roughly twice the rate as they do in men. However, this statistic does not tell the whole story.
What is being increasingly acknowledged is that the apparent disparity in depression between women and men is really the result of a failure to identify depression in men. One of the reasons for this failure is that many men experience and express emotional pain in a very different way from women. While it is true that many men do in fact experience the more well-known symptoms of depression (i.e., sadness, tearfulness, hopelessness, lack of energy, powerlessness, decreased interest in sex, etc.) a tremendous amount of men manifest depression through the only emotion our society “allows” men to have: anger.
Symptoms and signs of masked depression in men include: irritability, anger, and/or hostility. Behaviorally specific indicators include: dominance, domestic violence, assault, drinking/substance abuse/DUI, emotional unavailability/stonewalling, excessive use of pornography and masturbation, promiscuity.