Open post

A Psychologist Among Veterans: Co-Producing The Veterans’ Stabliisation Programme

by Dr Roger Kingerlee

My starting point, on first meeting with a veteran of HM Armed Forces in the clinical setting, is that I already owe them a debt. As a civilian, I am conscious of the fact that all veterans have voluntarily put themselves forward to protect me and my fellow citizens against potential harm. In this sense, every veteran I meet has already done more for me than I ever will for them. This, as a civilian psychologist who also works with veterans, I never forget.

Much of my activity revolves around running our Veterans’ Stabilisation Programme (VSP) in Norfolk with my friend and colleague Luke Woodley, Founder of Walnut Tree Health and Wellbeing CIC. Partly via the Walnut Tree Facebook page, Luke engages local veterans, forming a key bridge into NHS services – including the 16-week VSP.

We wrote the VSP jointly, combining Luke’s own experience of combat-related post-traumatic stress, my knowledge of cognitive behavioural therapy (CBT), and our NHS colleague John King’s expertise in mindfulness meditation. In effect, the VSP offers veterans, the majority of whom are male, a bespoke psychological deconditioning process, allowing them to transition into civilian life more fully and more successfully.

Some of the key psychological matters here are invisible to the naked eye, which may help explain why they have taken so long to identify in the UK and beyond. The hidden combination, for example, of military training overlaid with aspects of post-traumatic stress can have profound – and often to individuals and their families – apparently inexplicable effects on day-to-day life. Faced, at times, with mounting emotional pressure, and feeling that there is no-one who can help, many veterans encounter real difficulties, often compounded by anxiety, low mood, and substance use to self-medicate. Understandably, this can spiral.

To counter this, in the VSP, we explore the psychological mechanics involved and how – directly based on Luke’s lived experience – to dismantle the machine. There is a pattern here: I explain the CBT; Luke translates this into military language and metaphor; then John soothes us all with the healing balm of mindfulness.

Quite rightly, most of our veterans are sceptical to begin with. But with military-grade courage in the form of radical openness, and on a more or less weekly basis within the group, Luke walks out into the historical no-man’s land of exploring male feelings in public. He lays bare how it was for him at his darkest hour – and how he clawed his way back to life. This is full mental self-disclosure, and peer role modelling, of the highest order, in true Forces’ spirit. When one man gives of himself and his experience so completely to others, shame is vanquished by hope. A privilege to witness, and to be part of. Where Luke leads, the group can follow, slowly but surely, towards the light.

Each VSP, too, has its own themes, according to the needs of the group. Some recur. One is sleep, since the traumas of the past often linger in the unconscious only to emerge at night, and may need a nudge that – thanks to advances in psychological science and practice – we can now give. Another is family relationships, which can be strained. Frequently, here, gains are possible via improved communication and understanding between partners and family members.

By the end of each VSP, we do our collective best to ensure that everyone has learned and, critically, applied, useful material to enhance their own stability. Some may need further specialist trauma therapy. Some may be ready to return to work, full- or part-time. Many, perhaps even all, feel ‘normal’ again, knowing that they are not alone. Far from it: they are among friends.

So, while my own civilian’s debt to these individuals can never be fully repaid, when they leave the VSP after 16 weeks I can feel that I have contributed at least something. With all the psychological skill I can muster, I have played a small part in explaining how it can help to begin to let go of aspects of the past, and to begin to seize the present. Or, as Luke puts it: it’s time to stop fighting and start living.

 

About the author

Dr Roger Kingerlee is a Consultant Clinical Psychologist at Norfolk and Suffolk NHS Foundation Trust. Roger and colleagues are presenting their latest research findings at the Male Psychology Conference on 23rd June http://www.malepsychology.org.uk/the-conference-2018/

Read more about the Walnut Tree Health and Wellbeing: https://www.facebook.com/walnuttreehw/

You can vote now for a Male Psychology Section of the BPS.
Details are here http://www.malepsychology.org.uk/male-psychology-network/vote-for-a-male-psychology-section/

 

 

 

 

 

Open post

What are the criticisms of the proposed Male Psychology Section, and are they valid?

by Dr John Barry and Martin Seager

Criticism and alternative views are part of science, and we at the Male Psychology Network have benefited from both. We welcome healthy debate, and have held two public debates at UCL in the past year.

After several years of listening to various opinions about male psychology, today we feel that we have developed the basis for a field that is of real scientific and humanitarian worth. Many people within and outside Psychology see the inclusive value in having a male psychology section of the BPS, so it’s perhaps surprising that there are still some people in the field of psychology who are actively opposed to the idea of promoting understanding of male gender issues. What could be the basis for such opposition?

The main source of opposition is a website by Dr Glen Jankowski, lecturer at Leeds Beckett University and committee member of the BPS Psychology of Women and Equalities Section. He claims to use feminist theory to justify his opposition to the creation of a Male Psychology Section. You can find his 6-page website here https://notomalepsych.wordpress.com/ and make up your own mind about it, but here we will simply point out some of the more glaring flaws packed densely into his brief website.

Page 1: The author claims that a feminist approach to masculinity will help men more than the approach advocated by the Male Psychology Network. Feminism is indeed one possible approach to masculinity but not the only one or the most promising from the viewpoint of men themselves. The feminist approach suggested by Dr Jankowski is predicated on negative views of masculinity rather than a sincere empathy for men experiencing mental health issues.

We believe that the notion that masculinity is somehow toxic and in need of wholesale reconstruction is in itself a toxic belief that does not reflect the scientific evidence or everyday life. The prevalence of these toxic views and the need to test them scientifically means that there is even more need for a Male Psychology Section, not less. We are not convinced that blaming masculinity or patriarchy for the mental health problems of men provides a basis for helping men. For example, the Duluth model of domestic violence is blind to the possibility that men can be victims of violence from women. This obviously is a total failure of science and a failure of compassion towards male victims given that men make up anything from 33-50% of the victims of domestic violence.

The author also claims that men are disproportionately advantaged over women (“the patriarchal dividend”). However he ignores a great deal of evidence of male disadvantage, for example, the fact that 75% of suicides are by men, 85% of rough sleepers are men and boys have been doing poorly in education compared to girls for some 30 years.  We suggest that the existence of differences, disadvantages and inequalities in either direction relating to gender are an argument for a Male Psychology Section, not against it.

Page 3: In an apparent attempt to minimise the significance of the fact that most suicides are by men, the author of the ‘say no’ website presents a graph showing that women think about suicide more than men do. No doubt contemplating suicide is serious in itself, but it is bad science and unempathic – especially for a psychologist – to conflate thinking about suicide with the completion of the act of suicide.

Page 4: The Male Psychology Network takes a balanced view of masculinity in both its positive and negative aspects. We have stated very clearly in publications and lectures that men are capable of committing terrible crimes (e.g. Barry, 2016). We are sincere in wanting to understand why these behaviours exist, and how we can address these problems as psychologists. The ‘say no’ website however seems to be arguing that we are trying to deny female suffering and victimhood. This is simply false and a ‘straw person’ argument, attributing beliefs and opinions to us that we have never expressed. We fully accept that women’s issues and victimhood need addressing too, and we hope that women too can benefit from our research. After all, men, women and children share this planet together.

Page 5: The ‘say no’ website tries to make the argument that our research, presentations and publications ignore minority men e.g. BME and gay men. This is simply incorrect. Our research is inclusive of all categories of men, and we are interested in masculinity as a whole. The available data suggests that suicide rates in black men are higher than in black women and higher in gay men than in gay women, thus although it is important to see suicide from an ethnic and sexuality perspective, we also need to recognise the ever-present gender perspective. Without a more scientific approach, the core gender issues behind suicide and other predominantly male behaviours are in danger of remaining overlooked.

Dr Jankowski’s categorisations of our work tend to obscure examples of minorities e.g. one of our most downloaded studies is one about Black men’s mental health (Roper & Barry, 2016). We have also done research in which ethnic and sexual minority variables are taken into account (e.g. Seager et al, 2014). Moreover, we would strongly argue that by and large our work is relevant to men in general, and minority men can benefit from our work. More recently, our work is increasingly focusing on the (less unpalatably “patriarchal”) working class men who make up the majority of prisoners, soldiers, drug addicts, and school drop-outs. The ‘say no’ website has overlooked this.

Page 6: The final page of the website reveals what might be the underlying reason for opposition to creating a Male Psychology Section: “We fear that the new proposed section will divert resources, effort and good will away from helping not only men but also women.”  This defensive ‘zero sum’ mindset is surely not what we want to see in a healthy scientific environment, and it is not clear to us how it can be reasonably argued that having a Male Psychology Section could be bad for men. As to women, who share their lives with men and boys, it must surely be a good thing if psychological science helps society to understand men better.

Dr Jankowski also claims in his website that there has been a lack of discussion about Male Psychology. However we have always been very open about our research, presentations and debates (which he seems to acknowledge on page 5 of his website), and although he has been invited to discuss or debate with us both privately and in public, to date he has not done so.

We think it is a shame that a new Section of the BPS that is potentially so useful to a huge number of people might be blocked by the misguided views of a few. We hope that this short article has helped to persuade you that a Male Psychology Section would be a positive and practical source of help not only for men and boys, but for the women and girls who share their lives.

 

About the authors                                                      

John Barry is a chartered psychologist and co-founder of the Male Psychology Network.

Martin Seager is a consultant clinical psychologist and co-founder of the Male Psychology Network

 

You can vote now for a Male Psychology Section of the BPS.
Details are here http://www.malepsychology.org.uk/male-psychology-network/vote-for-a-male-psychology-section/

 

References

Barry, J. (2016). Can psychology bridge the gender empathy gap? South West Review, Winter 2016, 31–36.

Roper, T., & Barry, J. A. (2016). Is having a haircut good for your mental health? New Male Studies5 (2), 58-74.

Seager M, Sullivan L, and Barry JA (2014).  Gender-Related Schemas and Suicidality: Validation of the Male and Female Traditional Gender Scripts Questionnaires. New Male Studies, 3, 3, 34-54

Open post

Boxing and mental health

by Dr John Barry

It is often said anecdotally that boxing is a good way to help wayward working class boys to learn to be more disciplined. The British Medical Asscociation (BMA) reject this suggestion as patronizing and say that boxing should be banned (White, 2007), but my guess is that wayward working class boys don’t want the BMA to dictate their life choices, and would consider their interference patronizing.

The life story of a boxer is depicted in popular culture as one of hardship and challenge, punctuated by moments of glory. There are many such depictions, from the fictional (e.g. Rocky) to the biographical (e.g. Raging Bull), but there has been little serious academic effort to understand the psychological life of boxers.

We often hear that boxers risk brain damage (‘punch drunk’ syndrome) (Roberts et al, 1990) and other brain injuries (Bernick & Banks, 2013). But the evidence for brain damage in boxing isn’t a no-brainer, as shown by the systematic review of amateur boxing in the British Medical Journal which concluded that “there is no strong evidence for brain injury” (Loosemore 2007, p.812).

Although there are mental health benefits of exercise in general (Callaghan, 2004) and boxing in particular (Bin et al, 2015), there is a tragedy inherent in arc of a competitive boxing career, as depicted so often in Hollywood. The window of opportunity to excel in sports such as boxing is generally limited to youth and early adulthood. Within this time frame, the quality of life of a sportsman may go from humble beginnings to fame and glory, and back to humble again, in the space of a decade or two. The impact on mental health of such a trajectory is potentially immense, and potentially devastating. And although this arc is fascinating from the point of view of Hollywood, the psychological impact of such a life course has received surprisingly little attention from academia.

This is not to say that the trajectory of a boxer’s career is definitely much worse than that of other sportsmen, though given the raw competitiveness of boxing and the extreme demands and rewards of this sport, it is easy to imagine that the highs and lows might be more extreme too. Knowing the importance of job satisfaction to men (Barry & Daubney, 2017), it is difficult to underestimate the impact of these highs and lows.

There is something about the primal nature of boxing that is fascinating. Boxers seem to epitomize the ‘Fight and Win’ rule (or ‘social script’) of traditional masculinity (Seager et al, 2014). However taking this ‘rule’ to an extreme can be predictive of suicidal thinking. The dangers of pushing the ‘Fight and Win’ rule to the extreme correspond with what we know about the stress-inducing consequences of making ‘rigid demands’ of ourselves (Ellis & Harper, 1961). This makes intuitive sense, as shown in a study where participants suggested that irrational beliefs (e.g. I absolutely have to win) were associated with the suicide of a fictional boxer (Sporrle and Forsterling, 2007).

So, is boxing good for mental health? I would love to see more research on this question. What we do know is that although 75% of suicides in the general population are male, men are less likely than women to seek psychological help (Kung, 2003). Although talking about feelings is almost always beneficial for everyone, we know that men are less inclined than women to want to deal with distress by talking about their feelings (Holloway et al, 2018), and some men prefer to use exercise as a way of dealing with stress (Frydenberg & Lewis, 1993). We also know that male depression can sometimes be expressed through aggressive or even violent behavior (Brownhill et al, 2005).

Putting all of this information together, is it not a huge stretch of the imagination to suggest that men might find mental health benefits in boxing. However these benefits are probably masked by other factors, for example, the people who are the most attracted to boxing may have long-standing issues related to being raised in harsh environments, the fact that there is a risk of brain injury and cognitive impairment, and the fact that those taking a career in boxing may be in for a life of extreme highs and lows. Also, helping boxers with mental health issues is likely to be a complex task because therapists simply demanding that they talk about their feelings is unlikely to be the best way to get them to talk about their feelings.

Should we ban boxing, as the BMA suggest? I don’t think so. Rather, we should properly investigate the potential benefits. Should psychologists do more to support those who go into boxing? Definitely yes. Many boxers may have experienced a harsh early environment, and boxing is one way of keeping feelings and behaviours in check. Psychologists might offer other coping strategies, and be more aware of the stressors typical of the boxer’s life trajectory.

 

About the author

Dr John Barry is a chartered psychologist and co-founder of the Male Psychology Network. http://www.malepsychology.org.uk/male-psychology-network/about-us/

  Vote for a Male Psychology of the BPS between 7th May and 20th June.
Details are here http://www.malepsychology.org.uk/male-psychology-network/vote-for-a-male-psychology-section/

References

Bernick, C., & Banks, S. (2013). What boxing tells us about repetitive head trauma and the brain. Alzheimer’s research & therapy5(3), 23.

Bin, W. A. N. G., Yang-cai, X. U., Zhi-kun, W. U., Hua-ping, X. U., & Dong-ying, W. A. N. G. (2015). Effect of wushu boxing teaching on college students’ physical and mental health. Education of Chinese Medicine1, 009.

Brownhill, S., Wilhelm, K., Barclay, L., & Schmied, V. (2005). ‘Big build’: hidden depression in men. Australian and New Zealand Journal of Psychiatry, 39(10), 921-931.

Callaghan, P. (2004). Exercise: a neglected intervention in mental health care?. Journal of psychiatric and mental health nursing11(4), 476-483.

Albert, E., & Harper Robert, A. (1961). A Guide to Rational Living. Hollywood: Wehman Brothers.

Frydenberg, E., & Lewis, R. (1993). Boys play sport and girls turn to others: Age, gender and ethnicity as determinants of coping. Journal of adolescence16(3), 253.

Loosemore, M., Knowles, C. H., & Whyte, G. P. (2007). Amateur boxing and risk of chronic traumatic brain injury: systematic review of observational studies. Bmj, 335(7624), 809.

Roberts, G. W., Allsop, D., & Bruton, C. (1990). The occult aftermath of boxing. Journal of Neurology, Neurosurgery & Psychiatry53(5), 373-378.

Seager, M., Sullivan, L., & Barry, J. (2014). Gender-related schemas and suicidality: Validation of the male and female traditional gender scripts questionnaires. New Male Studies, 3(3), 34-54.

White, C. (2007). Mixed martial arts and boxing should be banned, says BMA. BMJ: British Medical Journal, 335(7618), 469.

 

 

 

 

 

 

 

 

Open post

A conversation evolving away from toxic masculinity and towards positive masculinity

by Dr John Barry

I got an email a couple of weeks ago asking if I wanted to be on a panel discussing ‘What does it mean to be a man?’ by a new group called Can We Just Ask?

This isn’t an excitingly new question, but it looked like a good opportunity to – given the negative narratives around men and masculinity these days – take the opportunity to add balance to the discussion. The format seemed interesting – no presentations or lectures, just straight to Q&A. Also I knew from the media that the opinions of the other panel members would create a diversity of thought.

The other panel members were writer & performer Jordan Stephens, best known for being half of the hip hop duo Rizzle Kicks, and journalist & author Poorna Bell who suffered the tragic loss of her husband to suicide in May 2015.

So a few days ago (31st May 2018) I went to the very salubrious MindSpace in Shoreditch, Central London. It was a sunny evening in late May and we were given a friendly welcome by Alice and Will of Can We Just Ask.

To cut a long story short, some of the issues discussed included men’s mental health, representations of men in the media, toxic masculinity, and why we need to be more positive about masculinity.

Although it’s clear that we didn’t agree on all points, you can see that over the course of the discussion we were converging towards some agreement on the major brush strokes. Overall I think the discussion was positive and thought provoking, with minimal cross-talking or grandstanding.

Well done to Annie and Will for creating such a good forum for intelligent discussion.

You can watch the video of the whole discussion here [here]

 

About the author

Dr John Barry is a chartered psychologist and co-founder of the Male Psychology Network

 

You can vote now for a Male Psychology Section of the BPS.
Details are here http://www.malepsychology.org.uk/male-psychology-network/vote-for-a-male-psychology-section/

 

 

 

Open post

Gender blindness is not a blindfold of impartiality

by Dr John Barry

First published on the BPS blog spot on 21st April 2017 https://www.bps.org.uk/blogs/dr-john-barry/gender-blindness-not-blindfold-impartiality

 

A: “Well, we’re academics, so we know we’re pretty objective when it comes to research”

B: “We think we are, but what if collectively we can’t see our biases about gender?”

A: “Oh yeah, but we have unconscious bias training for that”

B: “But what if that is part of the bias”

A: [Silence]

B: “What if not recognizing gender differences is a cognitive bias. What if this bias is causing us to do more harm than good?”

A: [Silence]

 

 

You might end up having the same type of conversation if you try to point out, as I did recently, that academia sometimes has a blind spot for problems facing men and boys.

The truth is that psychologists are, by and large, some of the most well-intentioned people you will find. We all want to do the right thing, to help people, and mostly we succeed.

For example, we have created all sorts of techniques and procedures to reduce human suffering, and we agonise over how well these techniques work, how we can improve them, how widely they can be applied.

But what if we are like a shoe maker who creates lots of styles of shoe, but only in one size?

For many customers the shoe will more or less fit, but for others it won’t fit at all.

In research into the gendered needs of men and women in therapy, we have found that, in general terms, women want to talk about their feelings and men just want a quick solution (Russ et al, 2015; Lemkey et al, 2016; Holloway et al, [2018]).

But psychologists mainly offer therapies based around discussing feelings – a single size of shoe, that isn’t always a good fit for men.

We have also found that many therapists are somewhat uneasy about fully accepting that there are gender differences in their clients (Russ et al, 2015; Holloway et al, [2018]), and experience cognitive dissonance when asked to think about the sex differences they routinely observe.

This tendency would be harmless, except that some gender differences are clinically important – for example, men commit suicide more than women do (ONS, 2015) but seek therapy less (Kung, 2003)

If we are disinclined to explore the reasons for this because thinking about gender differences makes us feel uncomfortable, then we have become a helping profession incapable of helping.

How widespread is this problem? ‘Beta bias’ in research – the tendency to ignore or minimise gender differences – emerged in the 1970s (Hare-Mustin & Marecek, 1988), and today ideas such as Hyde’s (2005) ‘gender similarities hypothesis’ prevail.

But what if beta bias – like Type II errors in research – has led to an inadvertent neglect of men and boys? Have we, sincere and well-meaning psychologists, been trying so hard to defeat sexism that we have inadvertently created a different kind?

But… before we start feeling guilty and blaming ourselves, we need to realise that the roots of what Seager et al (2014) call male gender blindness go much deeper than modern psychology.

Indeed the origins are probably in the evolution of our species, rooted in our tendency to see men as the strong protectors of society, and not typically people in need of protection (Seager, Farrell and Barry, 2016), which perhaps explains why there appears to be a difference in how much sympathy we have for men and women experiencing the same types of problem (the gender empathy gap; Barry, 2016).

For example, when we see a drunk man picking a fight in the street, our first thought is not ‘poor man, acting out his childhood trauma,’ instead we think ‘what an idiot – lock him up!’

So it’s not our fault that we are so easily led away from seeing male suffering – we can blame evolution for that. But as psychologists, it is our responsibility and professional duty to make sure that we do what we can to meet the needs of everyone, even if it means having to face up to gender differences.

 

You can vote now for a Male Psychology Section of the BPS.
Details are here http://www.malepsychology.org.uk/male-psychology-network/vote-for-a-male-psychology-section/

 

About the author

Dr John Barry is a chartered psychologist and co-founder of the Male Psychology Network.

 

References

Barry, J. (2016). Can psychology bridge the gender empathy gap? South West Review, 4, 31-36 http://www.malepsychology.org.uk/wp-content/uploads/2016/08/gender-empathy-gap-BPS-SW-Review-Barry-Winter-2016-author-copy.pdf

Hyde, J. S. (2005). The gender similarities hypothesis. American psychologist, 60(6), 581.

Holloway, K., Seager, M., and Barry, J.A. [2018]. Are clinical psychologists and psychotherapists overlooking the gender-related needs of their clients? [Clinical Psychology Forum, July 2018]

Kung, H. C., Pearson, J. L., & Liu, X. (2003). Risk factors for male and female suicide decedents ages 15–64 in the United States. Social psychiatry and psychiatric epidemiology38(8), 419-426 https://link.springer.com/article/10.1007/s00127-003-0656-x

Lemkey, L., Brown, B., & Barry, J. A. (2015). Gender distinctions: Should we be more sensitive to the different therapeutic needs of men and women in clinical hypnosis? Findings from a pilot interview study. Australian Journal of Clinical Hypnotherapy & Hypnosis, 37(2), 10 http://www.malepsychology.org.uk/wp-content/uploads/2016/08/gender-distinctions-in-clinical-hypnosis-Lemkey-Brown-Barry-2016-1.pdf

ONS, Office of National Statistics (2015). Suicide rates in the United Kingdom, 2013 Registrations http://tinyurl.com/mzplbzr

Russ, S., Ellam-Dyson, V., Seager, M., & Barry, J.A. (2015). Coaches’ Views on Differences in Treatment Style for Male and Female Clients. New Male Studies, 4(3) http://www.malepsychology.org.uk/wp-content/uploads/2016/08/coaching-gender-differences-Russ-et-al-2015-author-copy.pdf

Seager, M., Sullivan, L., and Barry, J.A. (2014). The Male Psychology Conference, University College London, June 2014. New Male Studies, 3, 41-68 http://www.malepsychology.org.uk/wp-content/uploads/2016/08/Male-Psychology-Conf-NMS-Seager-et-al-2014.pdf

Seager, M., Farrell, W. & Barry, J.A. (2016). The Male Gender Empathy Gap: Time for psychology to take action. New Male Studies5(2), 6-16 http://www.malepsychology.org.uk/wp-content/uploads/2016/08/article-2-.pdf

Open post

Helping Male Survivors of Sexual Violation to Recover

Men who have experienced sexual violation often have a kind of invisibility in the world. They are not prominent in literature about therapy, in research about sexual violation, or even generally in the public awareness. This has begun to change somewhat, recently, in the aftermath of the revelations about high-profile predatory figures in the media world and the abuse of young males in football and other sports. But, on the whole, the idea of a man or a male child being raped, sexually abused, manipulated or used by another is still a deep taboo for many people.

If we cannot face this taboo, we are collectively failing to look into the reason behind an enormous amount of suffering and even of death.

In an article in Therapy Today, Phil Mitchell, himself a male survivor of sexual violation and a specialist clinician in this field, makes the point that ‘Of the 6,188 suicides registered in the UK in 2015, three quarters were males. It could be argued that, for some males, especially those who have been sexually exploited, death can be seen as preferable to being seen as less of a man’ (Mitchell 2017).

Sadly, even some in the caring professions continue to feel that there is something so grotesquely awful and unthinkable, so incomprehensible – or even downright unbelievable – about a man or boy being sexually hurt or objectified, that they fear they do not have what it takes to be able to work with this issue or do not wish to even attempt it. In a systematic review of research published online in the International Journal of Mental Health Nursing, only 22 per cent of people using statutory mental health services are ever asked by mental health staff about previous experiences of abuse. Of those who were asked, women patients were far more likely to be asked than male patients (Read et al. 2017).

I wrote a book about effective therapy for male survivors of abuse, which was published by Jessica Kingsley in April 2018: ‘Helping Male Survivors of Sexual Violation to Recover. Stories from Therapy.‘ Part of my motivation in writing it was to honour the courage and the determination to heal shown by the many men I have accompanied in their therapeutic work over the last 17 years.

Another reason I wrote the book was to encourage and embolden those in the helping professions who think they might not have the capacity or skill to support this client group. My hope is that the book will help them trust that they certainly can be of use to male survivors of sexual abuse, whenever they offer a combination of warmth and rigorous thinking within the context of a respectful relationship.

The book takes the form of fictionalised case studies of 7 male survivors from a wide range of backgrounds, ages, and tells the story of the therapy for each one. The common theme, in all the stories  – no matter what the age, education, income, sexuality or family background of the individual coming for support  – is that male survivors have a particular burden that they carry, to do with the deeply held belief that a male should be strong and tough.

Even when this belief is not held consciously, and even when it is vigorously rejected on a conscious level, its roots still seem to go deep, both within many individuals and within our collective. So, in a culture where boys and men cannot help but take on board certain fundamental messages about males needing to embody strength, power, and being in control, when they have not been able to embody those qualities, eg. when they have experienced sexual abuse, they are left with almost intolerable grief, anger and, most crucially, shame.

The American psychologist Silvan Tomkins explains why the shame after abuse is so shattering for men:

“Though terror speaks of life and death, and distress makes the world a vale of tears, yet shame strikes deepest into the heart of man. While terror and distress hurt, they are wounds inflicted from the outside which penetrate the smooth surface of the ego; but shame is felt as an inner torment, as sickness of the soul. It does not matter whether the humiliated one has been shamed by derisive laughter or whether he mocks himself. In either event he feels himself naked, defeated, alienated, lacking in dignity or worth” (Tomkins, 1963).

The good news is that the healing balm for the stinging shame Tomkins describes is available to any man whenever he is able to speak, and feel understood and supported about an experience that has left him with shame. Individual therapy, as well as other sources of emotional and psychological support, such as compassionate friends and/or a partner, and being part of an accepting group or team, can all provide opportunities for this vital dissolving of shame. It seems a simple thing.

But there are still too few opportunities for men and boys to feel helped in this way. There are still too many men and boys staring into an abyss of isolation and a feeling that they are alone and fatally flawed for having once been helpless and vulnerable when they were abused.

 

‘Helping Male Survivors of Sexual Violation to Recover: An integrative approach – stories from therapy’  by Sarah Van Gogh is published by Jessica Kingsley. The book is available at a 20% discount from the regular price of £22.99  for readers of the Male Psychology Network blog from www.jkp.com/uk/products using reader offer code ‘SVG’.

 

About the author

Sarah Van Gogh has worked as a counsellor in private practice for many years and is on the training staff at the Re.Vision Centre for Integrative Transpersonal Counselling and Psychotherapy in North London. She also worked for seven years as a counsellor and trainer for Survivors UK, a London charity that provides support to men who have experienced sexual violation. She studied English at Cambridge University, worked in the fields of theatre, community health and adult education, and has written about the vital connection between the expressive arts and therapy for a number of journals. She writes a regular column in the BACP Private Practice Journal.

 

References

Mitchell, P. (2017) ‘Boys can be victims too’. Therapy Today 28(8), 34–7.

Read, J., Harper, D., Tucker, I. and Kennedy, A. (2017) ‘Do adult mental health services identify child abuse and neglect? A systematic review’. International Journal of Mental Health Nursing    27(1), 7–19.

Tomkins, S. (1963) Affect/Imagery/Consciousness: Vol 2. The Negative Affects. New York: Springer.

 

You can vote now for a Male Psychology Section of the BPS.
Details are here http://www.malepsychology.org.uk/male-psychology-network/vote-for-a-male-psychology-section/

 

 

 

 

 

 

Open post

Some mental health issues in boys are linked to the absence of their fathers

The main reasons the boys were referred to me, a psychotherapist, were: (a) a diagnosis of ADHD with a strapline that nurture had been strongly implicated in causation, (b) self-harm where the referrer had sensed a vaguely seen family issue as part of the causation, and (c) predatory sexual behaviour recognised as similarly reactive. I discovered that the absence of the father was implicated throughout each of these types of referral.

The father’s role in so-called conventional families is to support the mother by helping her calibrate her approach to the baby, and throughout infancy and childhood. It is also to be a different parent to the mother, so that the baby/child recognises difference. This recognition is the beginning of learning that carries on through all situations in life. My case notes revealed that the absence of the father had allowed for an overly close relationship between mother and son. Further, nearly all the children I saw could be said to be under-achieving at school because of a disinterest, through failure to recognise, an inability to learn. Experiencing difference in early infancy acts like a blueprint for apprehending new phenomena through life. By definition, new situations bring difference because they are new and different. Similarly, so too does new information like that constantly available at school. An early appreciation of difference is therefore a strength factor for learning in life and the classroom.

I want to spend a few moments outlining the absent father’s role in the three main referral types mentioned above.

 

ADHD

McQuade and Hoza (2015) discuss the psycho-social and emotional problems of children diagnosed with ADHD. They and others (for example, Mikami, 2015) also discuss how such children find relationships with family, friends and peers very difficult because they appear to find self-regulation problematic. Barkley (2015) writes about the lack of regulatory control children have over their own minds, emphasising their difficulties with their executive functioning in the classroom. They cannot calibrate themselves in relation to the tasks they are required to perform.

Calibration and regulation is an essential part of the father’s role. Working individually with the mothers and the boys I was able to help them begin to recognise, and then change, their relationship. Speaking for nearly all such cases, one boy said “I can see now that being in class felt so claustrophobic. It was my only space away from Mum and I filled it up with the feeling of needing to be free of her. I couldn’t concentrate. I couldn’t organise myself. I was disruptive to others.”

 

Self-Harm

The need for escape implied in the previous quotation featured in all three referral types. Self-harm is usually seen by mental health professionals as a cry to release feelings that cannot be expressed verbally or through other means. This is as true of those who cut themselves as it is for those who poison themselves, often through overdoses.

When there is only the mother to confide in, and if and when this relationship is felt to be the cause of the feelings that become unbearable to the young person, then self-harm can provide an escape route for feelings. My work with one young boy ended with him recognising that I had provided a mental space away from his relationship with his mother. He memorably told me – “I realise now that I needed Dad to have been at home giving me a different person, like you have, to feel things with instead of Mum and all her issues.”

 

Predatory Sexual Behaviour

In no way am I reducing the seriousness of predatory behaviour for the perpetrator, and certainly not for the victim, when I say that the mother with issues played a very large part in the actions of the boys I saw. Whilst some fathers are violent and eventually leave (or are required by law to leave) the family home, it is also the case that some mothers push out non-violent partners because they do not fit with the historical script of these mothers.

Many mothers I saw had very serious issues with men. Some had been abused by their own fathers or grandfathers. Having sons presented them with a problem. How were they to live with a male in their house once they had expelled the boy’s father, but then lived with their memories of being abused by their own fathers? Some mothers pulled their sons close to them, saying that they were their pride and joy whilst, in the next breath, saying they were just like (whoever had abused them). The claustrophobia released by self-harm for other boys was, for these boys, only released by behaving in the intrusive way that these mothers had been at the receiving end of with their own fathers. So disturbing was the relationship with their mothers, so non-existent were the opportunities to find another escape route, that these boys repeated the offences already a feature of their families.

So, in brief, the absence of the father can have profound consequences on both mother and son. There are a great many young boys and, without doubt, young girls with absent fathers who would benefit from an approach to their mental health that takes into account his role and the consequences of his absence.

 

About the author

Andrew Briggs is an experienced psychotherapist, and former Trust Head of Child and Adolescent Psychotherapy; Organisational Consultant at NHS Hampshire, Kent, London and Sussex; and lecturer.

Andrew is an engaging speaker, and will be expanding on the above theme on Friday 22nd June at the Male Psychology Conference

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Details are here http://www.malepsychology.org.uk/male-psychology-network/vote-for-a-male-psychology-section/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Open post

Should psychology help all men or just some men?

by Dr John Barry
Originally published on the BPS blog spot as The starving elephant will not be cured by a chiropodist 25th Aug 2017 [here]

There is a wise Hindu parable about how three blind men try to understand what an elephant is. The first one walks over and grasps its tail, and proclaims that an elephant is like a snake. Another grasps his leg suggests that an elephant is like a tree.

You can probably see where this is going: in focusing only on individual parts we often fail to see the full picture.

The elephant in the room in psychology is men’s mental health.

Male suicides around the world average about twice that of female suicides (Värnik, 2012) yet many psychologists don’t seem to notice.

Boys are falling behind in education all over the world (Stoet & Yang, 2016), yet many psychologists don’t seem to notice.

Even when these issues are pointed out to psychologists, many of them demonstrate ‘male gender blindness’ (e.g. Jankowski’s letter in July’s Psychologist) and instead of seeing the problem as a whole, they see the issues in terms of men who also belong to a minority groups by virtue of sexuality or ethnicity.

But if we split up male psychology into small sections, we risk being like the blind men and the elephant, failing to understand the whole picture.

It also begs the question of whether you have to belong to a minority group before psychologists are prepared to help you.

An important common denominator underlying the issues facing apparently disparate demographics of men is the blindness of the field of psychology to issues facing men and boys. If the elephant was being starved, then the solution would not be to call in a chiropodist to treat its skinny feet. The solution is to address the issue holistically and, as psychologists, we can best address male psychology issues by recognizing the totality of the problem, not just the various symptoms.

For the same reason, the Male Psychology Section sees the importance of collaborating with other Sections in order to find positive solutions. For example, educational psychologists might help solve the problem of male underachievement in school, and not only that of working class boys, but of all boys. Additionally, occupational and forensic psychologists might assess how much underachievement in school is related to general underachievement in life, and how much it might be linked to other issues such as homelessness, substance abuse, and criminality.

The roots of the problem are not ‘the patriarchy’, or testosterone, or ‘toxic masculinity’ (we debunked this in a debate at UCL recently). Potentially, the most immediately treatable root of the problem is male gender blindness and the associated gender empathy gap (Barry, 2016).

I say ‘potentially’, because although the concept of male gender blindness is easy to understand, many well-intentioned people find it incredible difficult to see the totality of the problems facing men and boys.

But we would like to invite those who are genuinely interested in men’s mental health to do something positive: join us in healing the problem at its roots.

Because as long as we fail to see problems such as male suicide as being a male gender issue, the problems will continue to fester.

 

About the author

John Barry is a Chartered Psychologist and one of the founders of the Male Psychology Network.

 

You can vote now for a Male Psychology Section of the BPS.
Details are here http://www.malepsychology.org.uk/male-psychology-network/vote-for-a-male-psychology-section/

Open post

Men’s mental healthcare – striving for better reach

Originally published in the BPS Psychologist magazine, June 2018. Accessed online 9th May 2018 [here]
Zac Seidler (University of Sydney) calls on professionals and society more broadly to see beyond ‘boys will be boys’.

Health professionals and society more broadly continue to blame men for their failure to seek help; they reportedly lack emotional communication skills, insight into their psychology, and the foresight to reach out before hitting crisis. This overwhelmingly negative narrative of masculinity, focused on what men can’t do, is epitomised in the assertion that ‘women seek help – men die’ (Angst & Ernst, 1997). The staggering and rising male suicide rate would look to confirm this statement, if it wasn’t for the fact that men are seeking help. The problem is, when they do, clinicians struggle to diagnose, communicate with and treat men’s mental health issues as they often manifest in an atypical way, with externalising symptoms like anger, irritability and substance misuse (Addis & Mahalik, 2003). It’s time we stop passing off such behaviours as ‘boys will be boys’ and learn to address these effectively – as a call for help.

Increasingly, research demonstrates our narrow perspective may be driving this bias. But this is changing, with a slow shift from a rigid construct of ‘traditional masculinity’ (e.g. strength & stocisim), to a more nuanced conception of multiple masculinities, neither all negative nor positive, that result from our complex socialisation (Kiselica & Englar-Carlson, 2010). These masculinities are diverse, intersecting and often contradictory, like the fact that an Indian man in the army who is homosexual has a web of masculinities that must co-exist. With this new wave of masculinity studies, the idea that psychological treatment is ‘the antithesis of masculinity’ is being challenged, leading to questions about what works for men within our existing mental health services, and why. Asking these questions will enable us to adjust from a largely ‘gender blind’ mental health service, to a more tailored ‘gender sensitive’ one (Owen et al., 2009). If we shift our perception of masculinity away from deficit, to one of understanding and using its strengths and diversity to our advantage, we may overcome barriers to men accessing effective psychological treatment (Seidler et al., 2018). The almost 5000 men who lose their lives to suicide each year in the UK must be a catalyst for change.

Researchers and clinicians have been saying for decades that men do not seek help, especially when it comes to psychological concerns like anxiety or depression. What recent research has supported, though, is that men do want to seek help, and will engage in treatment, if they are given the right type of help (Fogarty et al., 2015; Seidler et al., 2017). Indeed, more men are seeking help for mental health concerns than ever before (Harris et al., 2015). However, as these men may already have to overcome self-stigma, discomfort, and negative beliefs surrounding help seeking before initiating treatment, it follows that clinicians should do their utmost to ensure that their efforts do not go wasted through the provision of an inappropriate treatment style (Pederson & Vogel, 2007). The cost of failing to lay a groundwork of trust, respect and rapport with a male client is poor attendance, premature dropout, a negative treatment experience and risk of future avoidance of services altogether (Johnson et al., 2012).

Here is what is needed practically to have real implications on this treatment dilemma:

  1. Clinicians need to be trained to better understand, integrate and adapt their practice when working with men. Clinicians with greater gender-competence (much like multicultural competency) have reliably better outcomes with male clients (Owen et al., 2009). Without consideration of the impact of masculine socialisation on both themselves and the male client in treatment, the status quo of relying on restrictive and often negative assumptions and beliefs about masculinity will remain.
  2. Men may need a stronger emphasis on education and orientation to mental health services to improve insight and understanding into their symptoms, treatment and the potential interplay of their masculinity. An emphasis on active problem solving can be addressed through the inclusion of decision trees, progress reviews and session goals.
  3. Research has shown that the therapeutic alliance is key in engaging men by providing a collaborative, transparent and strength-based framework for treatment that promotes men’s empowerment or autonomy over dependence (Seidler et al., 2017).
  4. Plenty of ‘traditionally masculine’ traits are both amenable to, and useful within a psychological treatment setting. Men’s desire to proactively problem solve, be action-oriented and goal-focused in their attempts to overcome mental health issues translates well into almost all treatment approaches.
  5. Positive and pro-social practices of masculinity (e.g. mateship or family ‘protector’) are gaining traction in the field, and introducing them more readily into practice will only have benefits with male client engagement (Kiselica & Englar-Carlson, 2010).
  6. Language is central when relating with and engaging male clients and therefore more purposeful self-disclosure and use of colloquial, metaphorical or de-stigmatising language may help improve male retention in treatment (Mahalik et al., 2012)

Importantly, the integration of specific male-centred treatment styles and strategies into practice should remain separate from any particular treatment orientation, because the types of treatment preferred and most effective amongst men are diffuse. Rather than focusing on what treatment is offered, attention should be directed to the how of treatment. While these elements are considered ‘micro-skills’ that make up good therapy regardless of the client’s gender, it is becoming increasingly clear that a purposeful amplification of these skills may have greater impact in engaging male clients.

‘Pro-health’ men do not need to abandon their masculine ideals of strength or self-reliance, rather they can redraw more flexible boundaries. These men can symbolically ‘fight’ their mental health issues through the courageous act of seeking help but may withdraw from the process if psychological treatment is not tailored to them. Men across multiple studies have described feeling that their clinicians have preconceived ideas about them as men leading to a consequent failure to build a therapeutic alliance (Seymour-Smith et al., 2002). Instead, collaborative and male-centered modes of working, built on trust, transparency and respect are key for men, leading to better engagement in psychological treatment (Seidler et al., 2017).

The proliferation of mental health awareness campaigns encourage men to seek help to narrow the gender gap. But once they reach out for assistance, it is imperative that the system they are drawn into is capable of effectively treating their needs and concerns in an engaging way. Including the client’s masculine socialisation and its impact on their presenting issues throughout assessment and formulation, seeking and reinforcing positive masculinity in the client and understanding the impact of gender beliefs and attitudes on one’s own practice will only serve to improve men’s psychological treatment. It seems psychological therapy needs to ‘Man Up’, or at least muscle up, to support what is hoped to be an influx of these men in coming years.

 

About the author

Zac Seidler is a Registered Psychologist, MPsych (Clin)/ PhD (Candidate), in the School of Psychology, Faculty of Science, at the University of Sydney.

 

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Open post

Positive Masculinity is what we need to be talking about now

by Matt Englar-Carlson, Ph.D. (pictured above).

As a child of the 70’s, I had a sense that my boyhood was a slightly different world than my father’s had been. And now as the father of a teenager, I know that his boyhood is different than mine.

Learning about masculinity can be a funny thing. It is in the air all around us, but rarely is direct attention or instruction drawn towards it as an actual “thing” to consider and reflect upon. My research with men of all ages has taught me that very few of them have reflected upon what masculinity means to them.  It is something that they know, but don’t really know. As a boy, like countless other boys, I learned about masculinity by observation, social pressure, and through direct action- often at the end of an insult or insinuation, or by observing – or being the one directing – a comment or putdown towards another.

Rules of masculinity are all around us, yet they are context dependent- meaning that my rural, primarily White community reinforced notions of masculinity that were a bit different from the more racially diverse urban settings less than an hour away from my home. Like most boys and men, I understood what not to do as a male in certain contexts. In fact there were more rules about what NOT to do as compared to what to do. I also understood that these notions had a certain amount of plasticity to them – even though I knew that I should not cry, tears often formed in my eyes as I could not really control them. Rarely did I encounter boys or men who were the rigid masculine caricatures that I saw on television, typically boys and men had a bit more complexity to them. In that sense, masculinity for many men was multi-dimensional as both aspirational and inspirational. No one ever talked about this stuff in public around me, but I had already had the sense the rules of masculinity where incomplete and in many cases flat out wrong. My private and intimate conversations with my male friends were my evidence, and yet so many rules and restrictions about men were omnipresent and constantly reinforced.

Learning about the psychology of men in graduate school was a true change point in my life. Scholarship in the field made sense to me, and digging deeper into men’s lives and experiences provided the mirror to better understand myself and the men around me. The psychology of men and masculinities helped me see my male clients as male and that this meant something unique to how they experienced the world and psychotherapy itself.  I was obsessed with reading all of the research I could find from across the globe.

My knowledge based deepened, and I noticed that like much of the existing psychology scholarship, the focus in the psychology of men was on distress, pathology, and dysfunction. Our knowledge base was skewed towards negative traits and functioning of men. I certainly understood the masculinity literature and could filter my life through it, but it seemed to only be part of the story of the men that I knew personally and professionally, and over time I noticed that I had a harder time finding myself in the literature.

I knew that men experienced both the dark aspects of masculinity- rigidity, pain, and distress associated with denying “unmasculine” traits and rewarding anger, violence, and destructive habits- but as men they also experienced or strove towards the healthy aspects as well. These healthy aspects seemed associated with growth-oriented relationships with others as a father, partner, or friend, community building notions of service and provision towards the greater good, and ideas around personal and social responsibility. As a clinician, these were the areas I focused on since they reflected the aspect of men’s lives that my clients cared about the most. My clients often expressed shame and deficiency around the darker side of masculinity, yet they shared more hope and motivation around notions of the men they wanted to be. They were motivated by health, and discouraged by distress. Growth and change conversations were inspired by the ideas of the men they could be – akin to what Davies, Shen-Miller, and Isacco (2010) called possible masculinities.

 In no way is being male a psychological problem, but the expression of some male roles that encourage shame, aggression, dominance, and indifference often brew psychological problems on cultural and individual levels. For me, this is where positive masculinity emerges. It is about contrasting alignment to rigid notions of masculinity, and allowing the space for men to refine and define what being a man means to them. Defining positive masculinity can be difficult, and I hesitate to fully define it in terms of traits because of the variation in socialization and contextual factors, but term like healthy, prosocial, adaptive, and socially responsible are often in the definitional mix.

Positive masculinity is a counterbalance to shame (truly, the core emotion for understanding men), offering growth and encouragement to men by focusing attention on what is possible and healthy in the lives of men. Importantly, positive masculinity can be beacon for men to strive towards: “As a man, what are you moving towards, and how do you want to contribute?” At a time of so much global transformation around gender and social roles, we need professionals who are able to help men navigate this changing world.

About the author

Matt Englar-Carlson, Ph.D., is a Professor of Psychology at California State University at Fullerton, US. His is one of the co-founders of the Positive Psychology / Positive Masculinity approach to men’s mental health. Matt will be giving a keynote speech and leading a panel discussion on ‘perceptions of men’s mental health worldwide’ at the Male Psychology Conference at UCL on 23rd June 2016.

Reference

Davies, J., Shen-Miller, D., & Isacco, A. (2010). The men’s center approach to addressing the health crisis of college men. Professional Psychology: Research and Practice, 41, 347–354.

You can vote now (7th May 20th June) for a Male Psychology Section of the BPS.
Details are here http://www.malepsychology.org.uk/male-psychology-network/vote-for-a-male-psychology-section/

 

 

 

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