The study of men and masculinity as an important multicultural competency consideration

Review: Recommendations for male-friendly counselling with adolescent males: A qualitative systematic literature review

BACKGROUND

There are growing calls to tailor counselling practices for adolescent males, a population reluctant to engage in psychological treatment despite concerning rates of mental illness. The objective of this systematic review (PROSPERO: CRD4202125547) was to collate and synthesise recommendations for individual counselling with adolescent males (12-18 years).

METHOD

The databases Psychology and Behavioural Science Collection, PsycArticles, PsycINFO, Academic Search Complete, EBSCO eBook Collection, Wiley Science Collection, Taylor and Francis Collection and ProQuest One Academic were searched for articles published between 1995 and November 2021. The quality of evidence was assessed using the JBI critical appraisal checklists, and thematic analysis was employed to synthesise findings across the literature.

RESULTS

A total of 1625 texts were identified, of which 16 met the inclusion criteria. Generated themes included (a) therapist knowledge of masculinity, gender socialisation, and male-relational styles; (b) necessity of therapists to address masculinity in the therapeutic space; and (c) customising engagement and treatment practices to appeal to adolescent males.

CONCLUSIONS

The themes highlighted the unique developmental, and sociocultural considerations practitioners should be aware of when working with young men. Through a multicultural counselling competency framework, masculinity and adolescent male identity are expressions of diverse sociocultural identities that psychological assessment and intervention should ideally be tailored to suit. The findings of the review suggest that empirical research focusing on the experiences of adolescent males receiving psychological treatment is sparse. Further research is needed to inform the development of practicable, gender-sensitive adaptions to counselling practice for young men.

Counseling With Male Clients: The Case for Relational Resilience Approach

Although there is no lack of research on masculinity and help-seeking behavior, men continue to seek counseling less often than women. It is crucial we find effective therapeutic approaches to connect and meet men where they are, acknowledging the positive aspects of their masculinity while addressing their needs in the counseling setting. In this conceptual research article, we propose a new approach for counselors to utilize with men seeking counseling, the Relational Resilience Approach, which applies tenets of Relational-Cultural Theory, Positive Psychology, and Shame Resilience Theory.

Protocol for a randomized controlled trial of the Men in Mind training for mental health practitioners to enhance their clinical competencies for working with male clients

Background

Although the proportion of men seeking professional mental health care has risen over the past two decades, on average, men continue to attend fewer sessions of psychotherapy and are more likely to drop out of treatment prematurely compared to women. Men account for three-quarters of suicide deaths; furthermore, over half of the males who die by suicide have engaged with mental health care in the 12 months prior to their death. These findings highlight a need to equip mental health practitioners with skills to improve male clients’ engagement and mental health outcomes. This article reports the protocol for a randomized controlled trial of Men in Mind, a self-paced online training program purpose-built to advance the clinical competencies of practitioners who provide psychotherapy to male clients.

Methods

A randomized controlled trial with two parallel groups will be conducted. Participating practitioners will be randomly allocated, on a 1:1 basis, to the intervention group (Men in Mind training) or a waitlist control group. The primary outcome, efficacy of the training, will be evaluated by pre- to post-training (T1 to T2) changes in scores on the Engaging Men in Therapy Scale (EMITS) in the intervention group, relative to the control group.

Discussion

This trial will provide evidence of the efficacy of Men in Mind training, as an interim step towards adjusting content and delivery of the intervention to maximize the potential for sustaining and scaling.

Trial registration: The trial was registered prospectively with the Australian New Zealand Clinical Trials Registry on 3rd December 2021 (ACTRN12621001669886).

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-022-00875-9.

Interpersonal Processes in Homogeneous Group Therapy with Orthodox Jewish Men in Israel: Case Example and Clinical Application

This article addresses some of the group psychotherapy process issues involved in treating an ethno-religiously homogeneous population of Orthodox Jewish men using a case-study approach. The single-gender group, which consisted of two coleaders from the same community, occurred in a mental health clinic in Jerusalem, Israel. Eight community members attended the weekly 1.5-hour psychodynamic group meetings for a period of 5 years. Examples from those encounters illustrate three important concerns when working with a homogeneous religious group: (a) contagion and amplification of resistance to discussing taboo subjects based on religious principles; (b) indirect communication and the use of first-person plural pronouns and cliches; and (c) the shame and loneliness associated with nonconformity to religious and cultural expectations. Suggestions for clinical practice are provided based on the case study and existing literature about homogeneous groups in group psychotherapy and the treatment of Orthodox Jews.

Once bitten, twice shy: Dissatisfaction with previous therapy and its implication for future help-seeking among men

OBJECTIVE

Men can be reluctant to disclose distress and many men have ambivalence toward seeking help for depression, leading to poor uptake of and engagement in psychotherapy. The present study sought to explore whether a previously dissatisfying therapy experience leads to greater doubts about the effectiveness of treatment, in turn impacting on a man's willingness to disclose their distress in future.

METHOD

An online survey of 133 Canadian men was conducted to investigate their current depressive symptoms, previous experience of, and belief in, the effectiveness of psychotherapy and likelihood of disclosing distress to their physician. A regression model with mediation was employed to analyze the relationship between these responses.

RESULTS

The regression model highlighted a significant negative association between satisfaction with previous therapy and doubt about the effectiveness of therapy (t = -7.299, 99% confidence interval [-.537, -.254], p < .001). There was also a significant indirect effect, such that doubt about the effectiveness of therapy mediated the association between previous satisfaction and willingness to disclose distress to a physician (t = 3.748, 99% confidence interval [.123, .690], p < .001).

CONCLUSIONS

Providing treatment for depression that men find engaging and satisfying may improve their confidence that psychotherapy can help, make them more likely to reach out for assistance in the future and in turn, benefit their long-term mental health outcomes.

Engaging Men in Psychological Treatment: A Scoping Review

Tailoring psychological treatments to men's specific needs has been a topic of concern for decades given evidence that many men are reticent to seek professional health care. However, existing literature providing clinical recommendations for engaging men in psychological treatments is diffuse. The aim of this scoping review was to provide a comprehensive summary of recommendations for how to engage men in psychological treatment. Four electronic databases (MEDLINE, PubMed, CINAHL, PsycINFO) were searched for articles published between 2000 and 2017. Titles and abstracts were reviewed; data extracted and synthesized thematically. Of 3,627 citations identified, 46 met the inclusion criteria. Thirty articles (65%) were reviews or commentaries; 23 (50%) provided broad recommendations for working with all men. Findings indicate providing male-appropriate psychological treatment requires clinicians to consider the impact of masculine socialization on their client and themselves, and how gender norms may impact clinical engagement and outcomes. Existing literature also emphasized specific process micro-skills (e.g., self-disclosure, normalizing), language adaption (e.g., male-oriented metaphors) and treatment styles most engaging for men (e.g., collaborative, transparent, action-oriented, goal-focused). Presented are clinical recommendations for how to engage men in psychological treatments including paying attention to tapping the strengths of multiple masculinities coexisting within and across men. Our review suggests more empirically informed tailored interventions are needed, along with formal program evaluations to advance the evidence base.

Assessing the role of masculinity in the transmission of HIV: a systematic review to inform HIV risk reduction counseling interventions for men who have sex with men

HIV affects over 1.2 million people in the United States; a substantial number are men who have sex with men (MSM). Despite an abundance of literature evaluating numerous social/structural and individual risk factors associated with HIV for this population, relatively little is known regarding the individual-level role of masculinity in community-level HIV transmission risk. To address this gap, the current analysis systematically reviewed the masculinity and HIV literature for MSM. The findings of 31 sources were included. Seven themes were identified: (1) number of partners, (2) attitudes toward condoms, (3) drug use, (4) sexual positioning, (5) condom decision-making, (6) attitudes toward testing, and (7) treatment compliance. These factors, representing the enactment of masculine norms, potentiate the spread of HIV. The current article aligns these factors into a masculinity model of community HIV transmission. Opportunities for counseling interventions include identifying how masculinity informs a client's cognitions, emotions, and behaviors as well as adapting gender-transformative interventions to help create new conceptualizations of masculinity for MSM clients. This approach could reduce community-level HIV incidence.

Dwelling in suffering: barriers to men's healing from childhood maltreatment

Based on findings from a hermeneutic phenomenological study, this article provides a description and interpretation of barriers to healing that men encountered in the aftermath of childhood maltreatment. An analysis of interview data collected from 52 adult male survivors healing from childhood maltreatment identified a theme, Dwelling in Suffering, as representing the full range of barriers that impeded their healing. Subthemes of Dwelling in Suffering Personally, Relationally, and Social-Environmentally are discussed. This research highlights a complex understanding of the challenges men experience in healing from childhood maltreatment and the need for practice interventions and future research to ameliorate men's suffering.

Understanding adverse childhood experiences (ACE) and their relationship to adult stress among male survivors of childhood sexual abuse

Men who were sexually abused during childhood represent a highly stigmatized, marginalized, and under-researched population at risk for a variety of problems across the lifespan. The purpose of the current study was to (a) describe characteristics of child sexual abuse (CSA) and adverse child experiences (ACE), and (b) examine the relationships among CSA characteristics, ACE, and stressors in adulthood. Using a cross-sectional design, the researcher collected data on 487 adult men through an anonymous, online survey. Bivariate analyses revealed that five CSA characteristics--age at first abuse (r = -.164), number of abusers (r = .231), use of physical force, penetration, and physical injury--were related to the number of ACE. Three CSA characteristics (use of physical force, penetration, and physical injury) and the number of ACE (r = .162) were positively related to the number of stressors in adulthood. Preliminary recommendations for prevention, intervention, and future research are provided.

Life Without Work

Unemployment is a stark reality in today’s economic climate, and many Americans report a fear of loss or decrease in social status as a result of unexpected unemployment. Despite vocational psychology’s emphasis on work as a domain of life, very little exploration on how social class shifts impact workers has been conducted. One way to rectify the current gaps in the literature is to consider the integration of multiple theories that address different aspects of social class identity and the role of work in people’s lives. Intersectional approaches, the Social Class Worldview Model, and the Psychology Working perspectives are discussed in this article as applicable to life without work, particularly in relation to unemployment among underserved populations. Multidisciplinary literature is highlighted and integrated to inform the current understanding of these problems. Implications for psychologists and career counselors conducting research, practice, and public policy are discussed.

An exploratory model of substance use among Asian American women: the role of depression, coping, peer use and Asian values

This study explored the relationship among Asian values, depressive symptoms, perceived peer substance use, coping strategies, and substance use among 167 Asian American college women. More than 66% of the women in our sample scored higher than the clinical cutoff score on the Center of Epidemiological Depression Scale. Three path analyses examining illicit drugs, alcohol use, and binge drinking indicated that perceived peer use was the most robust predictor of substance use. Depressive symptoms were positively associated with illicit drug use and alcohol consumption but were not related to binge drinking. Asian values and coping strategies were not predictive of substance use. Additional analysis revealed that avoidant coping was a strong predictor of depressive symptoms.

Men at risk: considering masculinity during hospital-based social work intervention

The needs of hospitalized male patients are often unrecognized and unmet. Men occupy greater than half of all inpatient hospital beds and incur a broad array of illnesses and injuries at higher rates than women--yet often receive health care that pays surprisingly little attention to the concept of patient masculinity, or to masculinity's influence on the male patient's perspectives, behaviors, goals, interests, needs, and challenges. Little emphasis is placed on considering hospitalized male patients as men , understanding their need for patient-centered care within this context, and intervening in ways that regularly allow strengths to be adequately recognized and utilized. In this article, we explore how hospital social workers can reconsider masculinity as a vibrant and formative component of male patients' lives and actively view its characteristics as comprising more than just potential challenges to medical treatment--but also as untapped sources of resilience and strength.

A community psychology of men and masculinity: historical and conceptual review

This paper introduces the special section by presenting a historical and conceptual review of theory and research on the psychology of men and masculinity and then introducing the section's papers. Men have power because of their gender, but differ in access to power based on other individual characteristics such as social class, income, education, ethnicity, sexual orientation, or physical strength. Men typically have been studied as generic rather than gendered beings in psychology. In contrast, a gendered analysis of men highlights the ways in which men's experience, masculinity, and behavior contribute to health and social problems and to resources commonly addressed by community psychologists. Our gendered analysis suggests ways of working with men in group, organizational, and community settings to create positive individual and social change. Crucial to this analysis is the paradox that enacting masculinity both privileges and damages men. A second paradox stems from men having power as a group over women while individual men feel powerless or victimized by women as a group. The papers in this volume illustrate key themes of our historical and conceptual review through studies of adolescent and adult men as fathers, patients, partner abusers, support group participants and community members, and through examination of the impact of their gendered identities and behavior on health, well being, and justice.

Negotiating dominant masculinity ideology: strategies used by gay, bisexual and questioning male adolescents

In the context of a U.S. dominant masculinity ideology, which devalues men who are not heterosexually identified, many gay, bisexual and questioning (GBQ) adolescent males must develop their own affirming and health-promoting sense of masculinity. In order to promote the well-being of GBQ young men, exploration of their reactions and responses to dominant images of masculinity is needed. We qualitatively analyzed interviews with 39 GBQ African American, Latino, and European American male adolescents (15-23 years old). Participants reported a range of responses to traditional masculinity ideologies, most of which centered on balancing presentations of masculine and feminine characteristics. Negotiation strategies served a variety of functions, including avoiding anti-gay violence, living up to expected images of masculinity, and creating unique images of personhood free of gender role expectations. These data suggest a complex picture of GBQ male adolescents' management of masculinity expectations and serve as a basis for culturally and developmentally specific HIV prevention programs.

Integrating Practice Guidelines Into Professional Training

The authors present the findings of a special task group (STG) organized to explore effective training strategies for the practice guidelines focused on diverse populations. They provide a brief literature review and summarize survey data from academic training directors regarding current use of practice guidelines. The authors then describe the Integrative Training Model (ITM), developed by the STG, as a framework for students and professionals to incorporate the complex array of information contained in each set of guidelines. Unique challenges associated with incorporating the ITM are described, as well as pedagogical considerations for both students and current professionals. The authors believe the ITM may help students and professionals increase their diversity competence by developing a more holistic understanding of the various dimensions and social group experiences that affect their clients and themselves.

Summarizing 25 Years of Research on Men's Gender Role Conflict Using the Gender Role Conflict Scale

This article reviews 232 empirical studies that used the Gender Role Conflict Scale (GRCS) over the past 25 years (1982-2007). The article introduces the gender role conflict (GRC) construct using past definitions and theoretical models. The research findings for diverse men are summarized and studies related to men's intrapersonal, interpersonal, and therapeutic lives are analyzed. The empirical support, criticism, and challenges to the gender role conflict research program are reviewed. A contextual research paradigm with seven domains is presented and 18 research questions and two research models are discussed to foster more moderation and mediation studies on men's GRC. A new diagnostic schema to assess men's GRC in therapy and during psychoeducational interventions is discussed. The research review concludes that GRC is significantly related to men's psychological and interpersonal problems and therefore an important construct for psychologists and other helping professionals.