Engaging Men in Couples Therapy

David Shepard, Michele Harway

• Publisher: Routledge
• Year: 2012
• ISBN:
  9781135163952
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy Counselling
• Index: Psychology

This book will help practitioners overcome one of the leading challenges in couples therapy: working effectively with the male partner. Men have unique needs and psychological issues that many clinicians may not recognize or know how to address. This volume presents chapters by the leading practitioners associated with current therapeutic models, including Emotionally Focused Couple Therapy, Imago Relationship Therapy, Integrated Behavioral Couple Therapy, and more. Using in-depth case examples, they demonstrate how their approaches can be adapted to be "male-sensitive" and respond to the ambivalence so many men experience about couples work. Special topics are also addressed, including infidelity, cultural diversity, working with veterans, and fathering issues. This book will enrich therapists' work with couples, making treatment a welcoming experience for both partners and the treatment process more gratifying for the therapist.

CHAPTER

1

Introduction

Setting the Stage

DAVID S. SHEPARD AND MICHÈLE HARWAY

The need for effective couples therapy has never been stronger. As Gurman has observed, “Divorce and marital problems are among the most stressful conditions people face. Partners in troubled relationships are more likely to suffer from anxiety, depression and suicidality, and substance abuse: from both acute and chronic medical problems” (2008, p. 3). Long and Young (2007) note the following sobering facts about the state of marriage: (a) one-half of all marriages end in divorce; (b) marital distress contributes to nearly 50% of admissions to mental hospitals; (c) couples issues can cause or worsen severe psychological and behavioral problems for children. Although similar statistics are not available for the impact of relationship distress on nonmarital couples, it is likely that the same kinds of negative outcomes can be obtained for them as well.

On the one hand, couples therapy has become the treatment of choice for distressed couples (Sperry, Carlson, & Peluso, 2006). At the same time, the success rate of couples therapy is alarmingly low, at least according to John Gottman, perhaps the preeminent researcher in the field. He reviewed the efficacy research and concluded that only 35% of couples report gains during treatment, and just 11% to 18% of couples are able to maintain their progress after ending therapy (Gottman, 1999). The premise of this book is that a crucial and overlooked reason for treatment failures may be the couples therapist’s inability to respond to the needs and psychological issues particular to the male partner. Thus, it is important to note that this is not a volume about therapy with a special population, but one designed to help the reader succeed in the endeavor of working with couples. Simply put, it is about doing couples therapy well.

For couples therapy to succeed, three conditions must be met: both partners must feel equally comfortable in the therapeutic setting; both partners need to feel understood; and both partners must be convinced the therapy is “balanced,” that is, the counselor is not aligned with the views and interests of a particular partner. When the process is not balanced, therapy is likely to end prematurely (Mack, 1989). These essential core conditions can be met, and specific, theory-based interventions can be effective, only when they are applied from a male-sensitive perspective, that is, when the psychology of men and masculinity is taken into account. Issues related to engaging women in therapy have been addressed long ago (Fitzgerald & Nutt, 1986; Gilligan, Rogers, & Tolman, 1991; McGoldrick, Anderson, & Walsh, 1991; Rawlings & Carter, 1977; Worrell & Remer, 1997). Most couples therapists are knowledgeable about how to engage their female clients, and the therapy process itself essentially capitalizes on skills that women more than men have been socialized to develop. As a result, engaging women in therapy will not be the primary focus of this book. Our goal for this book is to provide a research-informed practitioner’s guide to conducting male-sensitive couples therapy, whether in private practice, community mental health, or university settings. This approach will benefit both the male clients who present because of relationship distress and also their female partners who will benefit from the work that will ensue.

WHY MALE-SENSITIVE COUPLES THERAPY IS ESSENTIAL

A number of factors contribute to the challenge couples therapists face in making the process male sensitive.

Men’s socialization experiences can make couples therapy an unfriendly environment. Over 20 years of research on the psychology of men has explored men’s reluctance to utilize mental health services (Addis & Mahalik, 2003). It has become well documented that male gender role socialization emphasizes self-reliance; restrictive emotionality, specifically the vulnerable affects; and denial or suppression of dependency needs (Good & Robertson, 2010). Many men are reluctant to engage in a process that presumes the failure of self-reliance, that values accessing and expressing tender feelings, and that facilitates contact with yearnings for dependence on another human being, whether the therapist or partner.

This tension between the values of psychotherapy and the male role have been thought to explain men’s underutilization of mental health services in general; imagine, then, what it may feel like for a man to participate in couples therapy. Not only are core identity-related values being challenged by the therapeutic situation, but his female partner is likely to be far more at ease with the process, not to mention, able to display a capacity to engage in the language of feelings that surpasses his own, leaving him feeling incompetent and “one down.” Women’s socialization trains them in the language of psychotherapy, but the language of therapy is often a different language than the one men have learned to speak throughout their lives (Shay, 1996). Couples therapy can thus be a place where a man’s self-esteem is challenged, and if counselors fail to maintain sensitivity to this vulnerability, the therapy—and, concomitantly, the relationship itself—may be at risk.

Men often feel underappreciated for their contribution to the relationship.Generally, women initiate couples treatment, voicing the complaint that their male partner does not understand their feelings. At the same time, note Shay and Maltas, “men feel misunderstood and unappreciated for their contributions to the relationship and criticized for demonstrating the kinds of traits that lead to their succeeding professionally and being good providers” (1998, p. 98). Character strengths like emotional calmness in a crisis, persistence when faced with challenges, and problemsolving skills can be sources of pride for many men, and yet may be of little help in deepening their intimate relationship with their partner. The active listening, “relationship talk,” and disclosure of vulnerable emotions that the female partner defines as intimacy-enhancing may not be part of the male partner’s relational repertoire. Couples therapy that does not affirm a man’s strengths while focusing on his perceived weaknesses can leave a male client feeling at once devalued by both therapist and partner, and incompetent in satisfying his partner’s intimacy requests.

The newest intervention models in the couples therapy field emphasize the skills many females already have and many men do not. In previous decades, behavioral marital therapy was the most popular and evidence-supported intervention model, and its problem-solving approach may have been well suited to the action-oriented styles of male clients. However, there has been a virtual revolution over the last 20 years in both research and practice (Kottler & Shepard, 2007). Models such as emotionally focused couples therapy (Greenman, Faller, & Johnson, this volume; Johnson, 2004), integrated behavioral couples therapy (Baucom, this volume; Jacobson & Christensen, 1996), and Imago Relationship Therapy (Hendrix, 1988; Luquet, 2005, this volume) have received empirical support, and are being widely adopted by therapists. All of these models emphasize expression of vulnerable feelings and increased levels of empathic connection—client tasks that can run counter to the gender role socialization experiences of many men. Given the research support they have demonstrated, the practitioner-developers of these models are presumably doing something right in making counseling male friendly. One purpose of this volume, then, is to present chapters by practitioners associated with the development of these models who can answer the question directly and through illustrative case studies: How are they adapting their conceptualizations and interventions to the needs, backgrounds, and styles of the male partner?

Both of us are couples therapists as well as teachers, and we see the results of couples therapists’ lack of knowledge in male-sensitive couples counseling in our own clinical practice. A significant portion of our clients report a previously negative experience in couples therapy, usually manifesting in a complaint by the male partner that “the therapist took my wife’s side.” When we explore the man’s frustration in the introductory session, we often learn that what really happened is not that the previous therapist openly agreed with the wife and contradicted the husband, but instead, fell into one of the following traps: (a) Without realizing it, the counselor sent signals that the female partner’s expressions of emotion were much appreciated; the male partner, who may be less openly feeling, received fewer approving nonverbal gestures and empathic responses. (b) The female client complained that her partner seemed distant and disconnected, and therapy became focused on getting the man to be more openly expressive and empathic; the man received the message that he was the “problem” in the relationship. (c) The male partner’s tendency to problem solve was labeled as dysfunctional, whereas the female partner’s desires for increased communication were supported. (d) A female couples counselor may have failed to appreciate a male client’s unexpressed fears that a woman-to-woman coalition was forming against him.

Couples therapists need help in understanding the psychology of men and masculinity as it relates to the practice or couples therapy; the goal of this book is to provide that assistance. To that effect, we invited authors who are deeply immersed in the development of male-sensitive clinical treatments to share how they conceptualize and intervene with couples from this gender-aware perspective. Some of these authors have a particular expertise in the area of men and masculinity research and clinical practice, some are associated with the development of well-known couples therapy models, and some are specialists in working with specific populations (e.g., men of color and veterans) or specific issues (e.g., infidelity, issues of fathering, sexual dysfunctions).

The reader will notice a particular theme that runs through many of the chapters in the book and plays a central role in why many men struggle in couples therapy; that theme is the role of shame in men’s lives. The issue of shame manifests in both the male member’s vulnerability to experience shame in sessions and in the presenting problem that brought the couple into therapy. It is critical, then, that the couples therapist knows how to use interventions and choose words that avoid inadvertently shaming the male partner.

Clearly a better understanding of the dynamics of shame in the lives of men and how these dynamics developed is necessary for effective clinical practice. Shame has been described as a public sense of inadequacy (Osherson & Krugman, 1990) and a feeling of deep worthlessness and helplessness, “a piercing awareness of ourselves as fundamentally deficient in some vital way as a human being” (Kaufman, 1985, p. 8). Boys learn to feel that sense of deficiency when they fail to conform to the rules of masculinity, resulting in repeated acts of embarrassment and humiliation from their male peers. Hartley (1959) observed this phenomenon of boys being shamed over 50 years ago. Pollack’s more recent research (1998) with boys suggests that shame is still a powerful mechanism enforcing the Boy Code (don’t cry, don’t show neediness, dominate others, and demonstrate bravado and aggression). Krugman, a specialist in the relationship between male development and psychological trauma, wrote, “Boy culture is competitive, insensitive, and often cruel. Being chosen last, or not at all, is a vivid memory for many men. Being picked on, afraid to fight, or forced to fight generates a welter of intense feelings, with shame at the core” (1995, p. 93).

Feelings of shame lead a boy to negative self-talk where he exaggerates how he operates in the world and where he might tell himself that “I am unacceptable, weak, a loser, inferior, …” This self-negating voice leads to increased self-consciousness and perhaps even to rage, which may serve as a protection to keep at bay others who might shame him again. As a result of early experience around shame, boys may also learn to mask (and in some cases, deny) their emotions, particularly their vulnerable ones, and instead adopt a false self of toughness and independence. Some may isolate themselves to avoid further shaming experiences. Some turn the feelings outward, becoming bullies. Any or all of these defensive maneuvers designed to prevent feelings of shame may later become part of adult men’s inner life, understandably leaving them vigilant to protecting themselves from being shamed by their partners as well as by their therapist. It is for this reason that clinicians who treat men (whether individually or in couples therapy) must be particularly sensitive to not revictimizing male clients, especially when the presenting issue is already a profoundly humiliating one. In many of our subsequent chapters, authors focus on the shame that men present with (whether it be their lack of skills in the couple arena, or a personal problem such as one related to sexual functioning or infidelity) and demonstrate how the therapist can deconstruct the male partners’ shame-bound experiences that keep them from fully knowing their feelings and keep both partners from knowing the joys of relationships.

CONTENTS OF THE BOOK

In conceptualizing this volume, we decided early in our process that counseling gay men in relationships, while bringing forth many of the same issues we are addressing here, warranted its own book and we concluded that providing a single chapter on this specific population would be doing a disservice to the many varied types of relationships present in the gay community and the complexity of gay relationships in their own right. Thus, the reader will notice that our focus is exclusively on heterosexual couples.

The book that we have developed includes three distinct sections. Part I, “Foundations of Male-Sensitive Couples Therapy,” sets the stage for the chapters that follow. Its goal is to identify and discuss the critical issues regarding engaging men in couples therapy and making this modality a place where men feel as comfortable and free to be vulnerable as their female partners. In this initial chapter, we have identified the need for this book, and set forth its goals. In Chapter 2, we consider the five most critical challenges that men present in couples therapy, and which, if left unattended, may undermine the work of well-meaning clinicians. Although the chapter is framed around the pitfalls of conducting therapy that is uninformed by knowledge of male psychology, we essentially are laying out our clinical recommendations for effective, male-sensitive couples therapy, based on our years of experience striving to bring gender sensitivity to our clinical work.

In Chapter 3, Fredric E. Rabinowitz reviews the most current scholarship on effective counseling with men, emphasizing a developmental perspective that helps explain why men have difficulties with their intimate relationships as well as with the tasks of participating in couples work. Rabinowitz then incorporates this perspective into a “primer” on conducting therapy with men.

Part II, “Theoretical Models,” presents the work of well-known clinicians representing a number of theoretical orientations to couples therapy. In each chapter, case material is presented and the authors have focused on how their approach might provide male-sensitive therapy. In C...

Table of contents

• Cover Page
• Half Title Page
• The Routledge Series on Counseling and Psychotherapy with Boys and Men
• Title Page
• Copyright Page
• Dedication
• Contents
• Series Editor's Foreword
• Acknowledgments
• About the Editors
• About the Contributors
• 1 Introduction Setting the Stage
• Section I Foundations of Male-Sensitive Couples Therapy
• Section II Theoretical Models
• Section III Special Populations and Issues
• Index